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Lopes SS, Pericot-Valverde I, Lum PJ, Taylor LE, Mehta SH, Tsui JI, Feinberg J, Kim AY, Norton BL, Page K, Murray-Krezan C, Anderson J, Karasz A, Arnsten J, Moschella P, Heo M, Litwin AH. Overreporting of adherence to hepatitis C direct-acting antiviral therapy and sustained virologic response among people who inject drugs in the HERO study. BMC Infect Dis 2024; 24:251. [PMID: 38395747 PMCID: PMC10893697 DOI: 10.1186/s12879-024-09124-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Self-reported adherence to direct-acting antivirals (DAAs) to treat hepatitis C virus (HCV) among persons who inject drugs (PWID) is often an overreport of objectively measured adherence. The association of such overreporting with sustained virologic response (SVR) is understudied. This study among PWID aimed to determine a threshold of overreporting adherence that optimally predicts lower SVR rates, and to explore correlates of the optimal overreporting threshold. METHODS This study analyzed per-protocol data of participants with adherence data (N = 493) from the HERO (Hepatitis C Real Options) study. Self-reported and objective adherence to a 12-week DAA regimen were measured using visual analogue scales and electronic blister packs, respectively. The difference (Δ) between self-reported and objectively measured adherence was calculated. We used the Youden index based on receiver operating characteristic (ROC) curve analysis to identify an optimal threshold of overreporting for predicting lower SVR rates. Factors associated with the optimal threshold of overreporting were identified by comparing baseline characteristics between participants at/above versus those below the threshold. RESULTS The self-reported, objective, and Δ adherence averages were 95.1% (SD = 8.9), 75.9% (SD = 16.3), and 19.2% (SD = 15.2), respectively. The ≥ 25% overreporting threshold was determined to be optimal. The SVR rate was lower for ≥ 25% vs. < 25% overreporting (86.7% vs. 95.8%, p <.001). The factors associated with ≥ 25% Δ adherence were unemployment; higher number of days and times/day of injecting drugs; higher proportion of positive urine drug screening for amphetamine, methamphetamine, and oxycodone, and negative urine screening for THC (tetrahydrocannabinol)/cannabis. CONCLUSIONS Self-reported DAA adherence was significantly greater than objectively measured adherence among PWID by 19.2%. Having ≥ 25% overreported adherence was associated with optimal prediction of lower SVR rates. PWID with risk factors for high overreporting may need to be more intensively managed to promote actual adherence.
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Affiliation(s)
- Snehal S Lopes
- Department of Public Health Sciences, Clemson University, 29634, Clemson, SC, USA
| | - Irene Pericot-Valverde
- Department of Psychology, College of Behavioral, Social, and Health Sciences, Clemson University, 29634, Clemson, SC, USA
| | - Paula J Lum
- Department of Medicine, University of California, San Francisco, 1001 Potrero Ave, 94110, San Francisco, CA, USA
| | - Lynn E Taylor
- Department of Pharmacy Practice and Clinical Research, University of Rhode Island, 7 Greenhouse Road, 02881, Kingston, RI, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6546, 21205, Baltimore, MD, USA
| | - Judith I Tsui
- Department of Medicine, University of Washington, 325 9th Ave, 98104, Seattle, WA, USA
| | - Judith Feinberg
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, 930 Chestnut Ridge Road, 26505, Morgantown, WV, USA
- Department of Medicine, Section of Infectious Diseases, West Virginia University School of Medicine, 1 Medical Center Drive, 26506, Morgantown, WV, USA
| | - Arthur Y Kim
- Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit St, 02114, Boston, MA, USA
- Harvard Medical School, 02115, Boston, MA, USA
| | - Brianna L Norton
- Albert Einstein College of Medicine, 10461, Bronx, NY, USA
- Department of Medicine, Montefiore Medical Center, 10467, Bronx, NY, USA
| | - Kimberly Page
- Department of Internal Medicine, Health Sciences Center, University of New Mexico, University of New Mexico, MSC 10, 5550, 87131, Albuquerque, NM, USA
| | - Cristina Murray-Krezan
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, 15213, Pittsburgh, PA, USA
| | - Jessica Anderson
- Department of Internal Medicine, Health Sciences Center, University of New Mexico, University of New Mexico, MSC 10, 5550, 87131, Albuquerque, NM, USA
| | - Alison Karasz
- UMass Chan Medical School, University of Massachusetts Medical School, 55 Lake Ave, North, 01605, Worcester, MA, USA
| | - Julia Arnsten
- Albert Einstein College of Medicine, 10461, Bronx, NY, USA
- Department of Medicine, Montefiore Medical Center, 10467, Bronx, NY, USA
| | - Phillip Moschella
- Department of Emergency Medicine, Prisma Health, Greenville, SC, USA
- School of Health Research, Clemson University, Clemson, SC, USA
- Department of Medicine, University of South Carolina School of Medicine, 876 W Faris Rd, 29605, Greenville, SC, USA
| | - Moonseong Heo
- Department of Public Health Sciences, Clemson University, 29634, Clemson, SC, USA
| | - Alain H Litwin
- School of Health Research, Clemson University, Clemson, SC, USA.
- Department of Medicine, University of South Carolina School of Medicine, 876 W Faris Rd, 29605, Greenville, SC, USA.
- Department of Medicine, Prisma Health, 29605, Greenville, SC, USA.
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2
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Gordon SC, Kaushik A, Chastek B, Anderson A, Yehoshua A. Characteristics associated with receipt of treatment among patients diagnosed with chronic hepatitis C virus. J Viral Hepat 2023; 30:756-764. [PMID: 37377165 DOI: 10.1111/jvh.13860] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/26/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023]
Abstract
Although current guidelines recommend that nearly all patients with chronic hepatitis C virus (HCV) infection receive treatment, a substantial proportion remain untreated. We conducted an administrative claims analysis to provide real-world data on treatment patterns and characteristics of treated versus untreated patients among individuals with HCV in the United States. Adults with an HCV diagnosis from 01 July 2016 through 30 September 2020 and continuous health plan enrolment for 12 months before and ≥1 month after the diagnosis date were identified in the Optum Research Database. Descriptive and multivariable analyses were conducted to evaluate the association between patient characteristics and the rate of treatment. Of 24,374 patients identified with HCV, only 30% initiated treatment during follow-up. Factors associated with increased rate of treatment included younger age versus age 75+ (hazard ratio [HR] 1.50-1.83 depending on age group), commercial versus Medicare insurance (HR 1.32), and diagnosis by a specialist versus a primary care physician (HR 2.56 and 2.62 for gastroenterology and infectious disease or hepatology, respectively) (p < .01 for all). Several baseline comorbidities were associated with decreased rate of treatment, including psychiatric disorders (HR 0.87), drug use disorders (HR 0.85) and cirrhosis (HR 0.42) (p < .01 for all). These findings highlight existing HCV treatment inequities, particularly among older patients and those with psychiatric disorders, substance use disorders or chronic comorbidities. Targeted efforts to increase treatment uptake in these populations could mitigate a considerable future burden of HCV-related morbidity, mortality and healthcare costs.
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Affiliation(s)
- Stuart C Gordon
- Henry Ford Health System and Wayne State University School of Medicine, Detroit, Michigan, USA
| | | | | | - Amy Anderson
- Optum Life Sciences, Eden Prairie, Minnesota, USA
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Dybowska D, Zarębska-Michaluk D, Rzymski P, Berak H, Lorenc B, Sitko M, Dybowski M, Mazur W, Tudrujek-Zdunek M, Janocha-Litwin J, Janczewska E, Klapaczyński J, Parfieniuk-Kowerda A, Piekarska A, Sobala-Szczygieł B, Dobrowolska K, Pawłowska M, Flisiak R. Real-world effectiveness and safety of direct-acting antivirals in hepatitis C virus patients with mental disorders. World J Gastroenterol 2023; 29:4085-4098. [PMID: 37476581 PMCID: PMC10354581 DOI: 10.3748/wjg.v29.i25.4085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/01/2023] [Accepted: 04/28/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND It is estimated that 58 million people worldwide are infected with the hepatitis C virus (HCV). Patients with severe psychiatric disorders could not be treated with previously available interferon-based therapies due to their unfavorable side effect profile. This has changed with the introduction of direct-acting antivirals (DAA), although their real-life tolerance and effectiveness in patients with different psychiatric disorders remain to be demonstrated. AIM To evaluate the effectiveness and safety of DAA in patients with various mental illnesses. METHODS This was a retrospective observational study encompassing 14272 patients treated with DAA for chronic hepatitis C in 22 Polish hepatology centers, including 942 individuals diagnosed with a mental disorder (anxiety disorder, bipolar affective disorder, depression, anxiety-depressive disorder, personality disorder, schizophrenia, sleep disorder, substance abuse disorder, and mental illness without a specific diagnosis). The safety and effectiveness of DAA in this group were compared to those in a group without psychiatric illness (n = 13330). Antiviral therapy was considered successful if serum ribonucleic acid (RNA) of HCV was undetectable 12 wk after its completion [sustained virologic response (SVR)]. Safety data, including the incidence of adverse events (AEs), serious AEs (SAEs), and deaths, and the frequency of treatment modification and discontinuation, were collected during therapy and up to 12 wk after treatment completion. The entire study population was included in the intent-to-treat (ITT) analysis. Per-protocol (PP) analysis concerned patients who underwent HCV RNA evaluation 12 wk after completing treatment. RESULTS Among patients with mental illness, there was a significantly higher percentage of men, treatment-naive patients, obese, human immunodeficiency virus and hepatitis B virus-coinfected, patients with cirrhosis, and those infected with genotype 3 (GT3) while infection with GT1b was more frequent in the population without psychiatric disorders. The cure rate calculated PP was not significantly different in the two groups analyzed, with a SVR of 96.9% and 97.7%, respectively. Although patients with bipolar disorder achieved a significantly lower SVR, the multivariate analysis excluded it as an independent predictor of treatment non-response. Male sex, GT3 infection, cirrhosis, and failure of previous therapy were identified as independent negative predictors. The percentage of patients who completed the planned therapy did not differ between groups with and without mental disorders. In six patients, symptoms of mental illness (depression, schizophrenia) worsened, of which two discontinued treatments for this reason. New episodes of sleep disorders occurred significantly more often in patients with mental disorders. Patients with mental illness were more frequently lost to follow-up (4.2% vs 2.5%). CONCLUSION DAA treatment is safe and effective in HCV-infected patients with mental disorders. No specific psychiatric diagnosis lowered the chance of successful antiviral treatment.
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Affiliation(s)
- Dorota Dybowska
- Department of Infectious Diseases and Hepatology, Faculty of Medicine, Nicolaus Copernicus University, Bydgoszcz 85-030, Poland
| | - Dorota Zarębska-Michaluk
- Department of Infectious Diseases and Allergology, Jan Kochanowski University, Kielce 25-317, Poland
- Department of Infectious Diseases, Provincial Hospital, Kielce 25-317, Poland
| | - Piotr Rzymski
- Department of Environmental Medicine, University of Medical Sciences, Poznań 60-806, Poland
- Integrated Science Association, Universal Scientific Education and Research Network, Poznań 60-806, Poland
| | - Hanna Berak
- Outpatient Clinic, Hospital for Infectious Diseases in Warsaw, Warsaw 01-201, Poland
| | - Beata Lorenc
- Pomeranian Center of Infectious Diseases, Medical University, Gdańsk 80-214, Poland
| | - Marek Sitko
- Department of Infectious and Tropical Diseases, Jagiellonian University, Kraków 31-088, Poland
| | - Michał Dybowski
- Utrecht University School of Economics, Utrecht University, Utrecht 3584 EC, Netherlands
| | - Włodzimierz Mazur
- Clinical Department of Infectious Diseases, Medical University of Silesia, Chorzów 41-500, Poland
| | | | - Justyna Janocha-Litwin
- Department of Infectious Diseases and Hepatology, Medical University of Wrocław, Wrocław 50-367, Poland
| | - Ewa Janczewska
- Department of Basic Medical Sciences, Faculty of Public Health in Bytom, Medical University of Silesia, Katowice 40-007, Poland
| | - Jakub Klapaczyński
- Department of Internal Medicine and Hepatology, Central Clinical Hospital of the Ministry of Internal Affairs and Administration, Warsaw 00-241, Poland
| | - Anna Parfieniuk-Kowerda
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, Białystok 15-089, Poland
| | - Anna Piekarska
- Department of Infectious Diseases and Hepatology, Medical University of Łódź, Łódź 91-347, Poland
| | - Barbara Sobala-Szczygieł
- Department of Infectious Diseases and Hepatology, Medical University of Silesia, Bytom 41-902, Poland
| | | | - Malgorzata Pawłowska
- Department of Infectious Diseases and Hepatology, Faculty of Medicine, Nicolaus Copernicus University, Bydgoszcz 85-030, Poland
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, Białystok 15-089, Poland
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Gutiérrez-Rojas L, de la Gándara Martín JJ, García Buey L, Uriz Otano JI, Mena Á, Roncero C. Patients with severe mental illness and hepatitis C virus infection benefit from new pangenotypic direct-acting antivirals: Results of a literature review. GASTROENTEROLOGIA Y HEPATOLOGIA 2023; 46:382-396. [PMID: 35718017 DOI: 10.1016/j.gastrohep.2022.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/25/2022] [Accepted: 06/07/2022] [Indexed: 05/09/2023]
Abstract
INTRODUCTION Hepatitis C virus (HCV) infection is a global health problem that can results in cirrhosis, hepatocellular carcinoma and even death. HCV infection is 3-20-fold more prevalent among patients with versus without severe mental illness (SMI), such as major depressive disorder, personality disorder, bipolar disorder and schizophrenia. Treatment options for HCV were formerly based on pegylated interferon alpha, which is associated with neuropsychiatric adverse events, and this contributed to the exclusion of patients with SMI from HCV treatment, elimination programmes, and clinical trials. Moreover, the assumption of poor adherence, scant access to healthcare and the stigma and vulnerability of this population emerged as barriers and contributed to the low rates of treatment and efficacy. METHODS This paper reviews the literature published between December 2010 and December 2020 exploring the epidemiology of HCV in patients with SMI, and vice versa, the effect of HCV infection, barriers to the management of illness in these patients, and benefits of new therapeutic options with pangenotypic direct antiviral agents (DAAs). RESULTS The approval of DAAs has changed the paradigm of HCV infection treatment. DAAs have proven to be an equally efficacious and safe option that improves quality of life (QoL) in patients SMI. CONCLUSIONS Knowledge of the consequences of the HCV infection and the benefits of treatment with new pangenotypic DAAs among psychiatrists can increase screening, referral and treatment of HCV infection in patients with SMI.
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Affiliation(s)
| | | | - Luisa García Buey
- Gastroenterology Department, Liver Unit, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Madrid, Spain
| | - Juan I Uriz Otano
- Gastroenterology Department, Liver Unit, Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Álvaro Mena
- Infectious Diseases Unit, Internal Medicine Service, Clinical Virology Group, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complejo Hospitalario Universitario de A Coruña (CHUAC), Universidade da Coruña, Coruña, Spain
| | - Carlos Roncero
- Psychiatry Service, University of Salamanca Health Care Complex and Psychiatric Unit, School of Medicine, Institute of Biomedicine, University of Salamanca, Salamanca, Spain
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5
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Cornberg M, Ahumada A, Aghemo A, Andreoni M, Bhagat A, Butrymowicz I, Carmiel M, Chodick G, Conway B, Song Y, Gasbarrini A, Hüppe D, Plaza FJ, Lampertico P, Alonso MLM, Myles L, Persico M, Ramji A, Sarrazin C, Villa E, Weil C, Otano JIU. Safety and Effectiveness Using 8 Weeks of Glecaprevir/Pibrentasvir in HCV-Infected Treatment-Naïve Patients with Compensated Cirrhosis: The CREST Study. Adv Ther 2022; 39:3146-3158. [PMID: 35543964 PMCID: PMC9239949 DOI: 10.1007/s12325-022-02158-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
Abstract
Introduction In clinical trials with hepatitis C virus-infected treatment-naïve (TN) patients with compensated cirrhosis (CC), glecaprevir/pibrentasvir (G/P), a fixed-dose, once-daily, pangenotypic regimen, has demonstrated sustained virologic response at posttreatment Week 12 (SVR12) > 95%. We evaluated the real-world safety and effectiveness of 8-week G/P therapy in TN patients with CC, including certain subgroups of interest. Methods The CREST study is a real-world, noninterventional, multicenter study retrospectively assessing data from Canada, Germany, Israel, Italy, and Spain. The full analysis set (FAS) designated all patients in the study; the modified analysis set (MAS) excluded patients who discontinued G/P for nonvirologic failure or who had missing SVR12 data. The primary endpoint was SVR12; safety endpoints were also assessed. Results A total of 386 patients were included in the FAS, 375 patients completed the study, and 325 patients were included in the MAS; 51 patients had missing SVR12 data. Overall, in the MAS and FAS, SVR12 was achieved in 99.1% and 84.2% of patients, respectively. In subgroups of interest, the percentage of patients achieving SVR12 in the MAS (and FAS) was: genotype (GT)3: 97.5% (80.6%); FibroScan® ≥ 12.5 kPa: 98.9% (89.3%); platelet count < 100 × 109/l: 100% (88.2%); both platelets < 150 × 109/l and FibroScan® > 20 kPa: 100% (88.9%); aspartate aminotransferase-to-platelet ratio index > 1.09: 98.7% (83.1%); fibrosis-4 index > 3.25: 98.6% (84.0%); albumin < 3 g/dl: 100% (91.7%); people who use drugs: 97.7% (84.3%); psychiatric disorders: 96.6% (84.8%); and human immunodeficiency virus coinfection: 100% (95.0%). Overall, 26.9% (104/386) of patients experienced an adverse event, none of which were classed as serious. Conclusion In this real-world cohort, 8 weeks of G/P therapy was well tolerated in TN patients with CC. SVR12 rates were similar to clinical trials, supporting 8-week treatment in TN patients with CC, including those with signs of advanced liver disease and GT3 infection.
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Affiliation(s)
- Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Adriana Ahumada
- Liver Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alessio Aghemo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Division of Internal Medicine and Hepatology, Humanitas Research Hospital IRCCS, Rozzano, Italy
| | | | | | | | - Michal Carmiel
- Liver Unit, Galilee Medical Center, Nahariya, Israel
- The Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel
| | - Gabriel Chodick
- Maccabitech, Maccabi Healthcare Services, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Brian Conway
- Vancouver Infectious Diseases Center and Simon Fraser University, Vancouver, BC, Canada
| | - Yanna Song
- AbbVie Inc., North Chicago, Illinois, USA
| | - Antonio Gasbarrini
- Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Dietrich Hüppe
- Gastroenterologische Gemeinschaftspraxis Herne, Herne, Germany
| | - Francisco Jorquera Plaza
- Digestive System Service, Complejo Asistencial Universitario de León, IBIOMED and CIBERehd, León, Spain
| | - Pietro Lampertico
- Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Policlinico-Division of Gastroenterology and Hepatology, CRC 'AM and A Migliavacca' Centre for Liver Disease, Milan, Italy
- University of Milan, Milan, Italy
| | | | | | - Marcello Persico
- Dipartimento di Medicina Clinica Medica, Epatologica e Lungodegenza, AOU OO. RR. San Giovanni di Dio Ruggi e D'Aragona, Salerno, Italy
| | - Alnoor Ramji
- University of British Columbia, Vancouver, BC, Canada
| | - Christoph Sarrazin
- Department of Internal Medicine and Livercenter, St. Josefs-Hospital Wiesbaden and Viral Hepatitis Research Group, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| | - Erica Villa
- UC Gastroenterologia, Dipartimento di Specialità Mediche, Azienda Ospedaliera Universitaria di Modena, Modena, Italy
| | - Clara Weil
- Maccabitech, Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Juan Isidro Uriz Otano
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Department of Gastroenterology, Liver Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
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6
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Pericot-Valverde I, Heo M, Niu J, Rennert L, Norton BL, Akiyama MJ, Arnsten J, Litwin AH. Relationship between depressive symptoms and adherence to direct-acting antivirals: Implications for Hepatitis C treatment among people who inject drugs on medications for opioid use disorder. Drug Alcohol Depend 2022; 234:109403. [PMID: 35306390 PMCID: PMC9278790 DOI: 10.1016/j.drugalcdep.2022.109403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/16/2022] [Accepted: 03/08/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Interferon-based regimens exacerbated depressive symptoms, which interfered with treating hepatitis C virus (HCV) among people who inject drugs (PWID). Direct-acting antivirals (DAA) are not associated with worsening depressive symptoms; however, the impact of depressive symptoms on adherence remains little known. We examined the association between depressive symptoms and adherence to DAA among HCV-infected PWID. A secondary aim was to identify the optimal cut-off for major depressive disorder for this population. METHODS Participants were 150 HCV-infected PWID on maintenance treatment enrolled in a randomized clinical trial testing three HCV care models. Severity of depressive symptoms were assessed using the Beck Depression Inventory-II (BDI-II) at baseline and every 4 weeks during treatment. Current major depressive disorder at baseline was diagnosed by the Mini-International Neuropsychiatric Interview. Adherence was measured during treatment (weeks 1-12) using electronic blister packs RESULTS: BDI-II scores ≥ 18 were identified as the optimal threshold for diagnosing major depressive disorder. Participants with BDI scores ≥ 18 at baseline had significantly lower adherence rates at weeks 1-4 of treatment compared to those with BDI scores < 18 (b = -0.23, 95% CI: 0.45-0.01, p = 0.044), but not in any other time intervals (weeks 5-8, b = -0.03, 95% CI: -0.32, 0.26, p = 0.825; weeks 9-12, b = -0.33, 95% CI -0.70, 0.02, p = 0.066). CONCLUSIONS Elevated depressive symptoms were associated with lower adherence to DAA only during the first 4 weeks of HCV treatment. Neither severe depressive symptoms nor major depressive disorder appears to be a barrier to DAA adherence among PWID.
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Affiliation(s)
- Irene Pericot-Valverde
- Prisma Health Addiction Research Center, Greenville, SC, USA; Clemson University School of Health Research, Clemson University, Clemson, SC, USA.
| | - Moonseong Heo
- Prisma Health Addiction Research Center, Greenville, SC, USA,Clemson University School of Health Research, Clemson University, Clemson, SC, USA,Department of Public Health Sciences, Clemson, SC, USA
| | - Jiajing Niu
- School of Mathematical and Statistical Sciences, Clemson University, Clemson, SC, USA
| | - Lior Rennert
- Clemson University School of Health Research, Clemson University, Clemson, SC, USA
| | - Brianna L. Norton
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Matthew J. Akiyama
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Julia Arnsten
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alain H. Litwin
- Prisma Health Addiction Research Center, Greenville, SC, USA,Clemson University School of Health Research, Clemson University, Clemson, SC, USA,University of South Carolina School of Medicine, Department of Medicine, Greenville, SC, USA,Corresponding author: Alain H. Litwin, MD, MS, MPH, Department of Medicine, University of South Carolina School of Medicine, Greenville, SC, USA Department of Internal Medicine, Prisma Health, 605 Grove Road, Suite 205, Greenville, SC 29605, USA. 1-864-455-6658,
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7
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Le E, Chee G, Kwan M, Cheung R. Treating the Hardest to Treat: Reframing the Hospital Admission as an Opportunity to Initiate Hepatitis C Treatment. Dig Dis Sci 2022; 67:1244-1251. [PMID: 33770327 DOI: 10.1007/s10620-021-06941-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/06/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Chronic hepatitis C (CHC) is traditionally treated in the outpatient setting. Despite the excellent tolerability, shortened treatment duration, and high cure rates of newer direct-acting antivirals (DAAs), many vulnerable patients remain untreated due to issues with linkage to care. AIMS This study sought to reframe and establish the hospital admission as a unique opportunity to initiate antiviral treatment for patients with CHC, particularly those with psychosocial or linkage to care issues. METHODS Patients with untreated CHC were identified either on the Psychiatry or Med/Surg wards at the Veterans Affairs Palo Alto Health Care System (VAPAHCS). If found to be appropriate for treatment initiation, patients were started on antivirals during their hospitalization and followed closely while inpatient and after discharge to assess for sustained virologic response (SVR), treatment tolerability, and treatment completion. RESULTS Overall, 36% (23) of potential treatment candidates were initiated on DAA treatment during their hospitalization. Of these patients, 91.3% had documented treatment completion with an intention-to-treat and modified intention-to-treat SVR rate of 91.3% and 100%, respectively. CONCLUSIONS We establish the hospital admission as a valuable opportunity for HCV treatment initiation, yielding excellent treatment outcomes in those who would not otherwise be treated and achieved a modified intention-to-treat response rate of 100%.
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Affiliation(s)
- Elizabeth Le
- Department of Medicine, VA Palo Alto Health Care System, 3801 Miranda Ave (111), Palo Alto, CA, 94304, USA.
| | - Grace Chee
- Pharmacy Service, VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA, 94304, USA
| | - Miki Kwan
- Department of Medicine, VA Palo Alto Health Care System, 3801 Miranda Ave (111), Palo Alto, CA, 94304, USA
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Department of Medicine, VA Palo Alto Health Care System (111), 3801 Miranda Ave, Palo Alto, CA, 94304, USA.,Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford, CA, 94305, USA
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8
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Braude M, Phan T, Con D, Woolley I, Sundram S, Clarke D, Dev A, Sievert W. Hepatitis C virus in people with serious mental illness: An analysis of the care cascade at a tertiary health service with a pilot 'identify and treat' strategy. Intern Med J 2021; 53:700-708. [PMID: 34719839 DOI: 10.1111/imj.15604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/01/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND People with serious mental illness (SMI) are underserved from a hepatitis C Virus (HCV) screening and treatment perspective. AIMS To examine the HCV care cascade in people with SMI and to pilot a supported HCV treatment integration program. METHODS HCV prevalence was retrospectively analysed from 4,492 consecutive individuals admitted to a tertiary hospital mental health service between January 2017 and December 2018. Sub-cohort analysis of screening patterns and predictors of seropositive infection was performed. Referral pathways and community care integration were analysed for HCV positive individuals, and a prospective community-based 'identify and treat' HCV program was assessed. RESULTS Screening for HCV had been performed in 18.6% (835/4,492) of the cohort. Seroprevalence was 4.6% (207/4,492). HCV seropositivity was associated with age > 40-years (OR = 9.30, CI 3.69-23.45, p <0.01), injecting drug use (IDU) (OR = 24.26, CI 8.99-65.43, p <0.01), and previous incarceration (OR = 12.26, 4.51-33.31, p <0.01). In a cohort of treatment-eligible individuals, 43.3% (90/208) had neither been referred to specialist services or general practitioners for HCV management. Amongst those referred to specialist services, 64.7% (57/88) did not attend scheduled follow-up, and 48.3% (15/31) of attendees were lost to follow-up. Through an intensified community access program, 10 people were successfully treated for HCV, though 22 could not be engaged. CONCLUSION People with SMI are underserved by traditional models of HCV healthcare. Intensified community-based support can partially bolster the treatment cascade, though investment in innovative screening and management strategies are required to achieve healthcare parity. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Michael Braude
- Department of Gastroenterology and Hepatology, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Timothy Phan
- Department of Gastroenterology and Hepatology, Monash Health, Melbourne, Australia
| | - Danny Con
- Department of Gastroenterology and Hepatology, Eastern Health, Melbourne, Australia
| | - Ian Woolley
- School of Clinical Sciences, Monash University, Melbourne, Australia.,Department of Infectious Diseases, Monash Health, Melbourne, Australia
| | - Suresh Sundram
- Department of Mental Health, Monash Health, Melbourne, Australia.,Psychological Medicine, Monash University, Melbourne, Australia
| | - David Clarke
- Department of Mental Health, Monash Health, Melbourne, Australia.,Psychological Medicine, Monash University, Melbourne, Australia
| | - Anouk Dev
- Department of Gastroenterology and Hepatology, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia
| | - William Sievert
- Department of Gastroenterology and Hepatology, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia
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9
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Ziff J, Vu T, Dvir D, Riazi F, Toribio W, Oster S, Sigel K, Weiss J. Predictors of hepatitis C treatment outcomes in a harm reduction-focused primary care program in New York City. Harm Reduct J 2021; 18:38. [PMID: 33789691 PMCID: PMC8010955 DOI: 10.1186/s12954-021-00486-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/22/2021] [Indexed: 12/15/2022] Open
Abstract
Background The social determinants of health that influence steps in the entire Hepatitis C Virus (HCV) treatment cascade must be identified to achieve HCV elimination goals. This project aimed to evaluate the association of these factors with HCV treatment completion and return for sustained virologic response (SVR) testing. Methods We used retrospective cohort data from our primary care-based HCV treatment program that provides comprehensive harm reduction care to those who use or formerly used drugs. Among persons who began direct-acting antiviral HCV treatment between December 2014 and March 2018, we identified two outcomes: HCV treatment completion and return for SVR assessment 12 weeks after treatment end. Several predictors were ascertained including sociodemographic information, substance use, psychiatric symptoms and history, housing instability, and HCV treatment regimen. We then evaluated associations between predictors and outcomes using univariate and multivariable statistical methods. Results From a cohort of 329 patients treated in an urban primary care center, multivariable analysis identified housing instability as a single significant predictor for HCV treatment completion (odds ratio [OR]: 0.3; 95% confidence interval [CI]: 0.1–0.9). Among patients completing treatment, 226 (75%) returned for SVR assessment; the sole predictor of this outcome was Medicaid as primary insurance (compared to other insurances; OR 0.3; 0.1–0.7). Conclusions Innovative strategies to help unstably housed persons complete HCV treatment are urgently needed in order to reach HCV elimination targets. Educational and motivational strategies should be developed to promote individuals with Medicaid in particular to return for SVR viral load testing, a critical post-treatment component of the HCV treatment cascade. Trial registration Not applicable.
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Affiliation(s)
- Jacob Ziff
- Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program, Division of General Internal Medicine, Icahn School of Medicine At Mount Sinai, 17 East 102nd Street, 7th floor, New York City, NY, 10029, United States.
| | - Trang Vu
- Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program, Division of General Internal Medicine, Icahn School of Medicine At Mount Sinai, 17 East 102nd Street, 7th floor, New York City, NY, 10029, United States
| | - Danielle Dvir
- Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program, Division of General Internal Medicine, Icahn School of Medicine At Mount Sinai, 17 East 102nd Street, 7th floor, New York City, NY, 10029, United States
| | - Farah Riazi
- Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program, Division of General Internal Medicine, Icahn School of Medicine At Mount Sinai, 17 East 102nd Street, 7th floor, New York City, NY, 10029, United States
| | - Wilma Toribio
- Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program, Division of General Internal Medicine, Icahn School of Medicine At Mount Sinai, 17 East 102nd Street, 7th floor, New York City, NY, 10029, United States
| | - Scott Oster
- Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program, Division of General Internal Medicine, Icahn School of Medicine At Mount Sinai, 17 East 102nd Street, 7th floor, New York City, NY, 10029, United States
| | - Keith Sigel
- Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program, Division of General Internal Medicine, Icahn School of Medicine At Mount Sinai, 17 East 102nd Street, 7th floor, New York City, NY, 10029, United States
| | - Jeffrey Weiss
- Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program, Division of General Internal Medicine, Icahn School of Medicine At Mount Sinai, 17 East 102nd Street, 7th floor, New York City, NY, 10029, United States
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10
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Liu X, Hu P. Efficacy and Safety of Glecaprevir/Pibrentasvir in Patients with Chronic HCV Infection. J Clin Transl Hepatol 2021; 9:125-132. [PMID: 33604263 PMCID: PMC7868694 DOI: 10.14218/jcth.2020.00078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/03/2020] [Accepted: 12/22/2020] [Indexed: 12/11/2022] Open
Abstract
Hepatitis C virus (HCV) infection is a major cause of end-stage liver disease, including decompensated cirrhosis and hepatocellular carcinoma. Over 95% of patients with HCV infection have achieved sustained virologic response at 12 weeks under the treatment of several pan-genotypic regimens approved for patients with HCV infection. The glecaprevir/pibrentasvir (G/P) regimen has some features that distinguish it from others and is the only 8-week regimen approved for treatment-naive patients and patients experienced in regimens containing (peg)interferon, ribavirin, and/or sofosbuvir, without an HCV NS3/4A protease inhibitor or NS5A inhibitor (except those with genotype 3). This review aims to summarize the efficacy and safety of G/P in HCV-infected patients from clinic trials and real-world studies, including those who have historically been considered difficult to cure.
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Affiliation(s)
| | - Peng Hu
- Correspondence to: Peng Hu, Department of Infectious Diseases, Institute for Viral Hepatitis, The Key Laboratory of Molecular Biology for Infectious Diseases, Chinese Ministry of Education, The Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Road, Yuzhong District, Chongqing 400010, China. Tel: +86-23-62887083, Fax: +86-23-63703790, E-mail: ,
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11
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Fuchs M, Monto A, Bräu N, Charafeddine M, Schmidt W, Kozal M, Naggie S, Cheung R, Schnell G, Yu Y, Richards K, Mullally V, Cohen DE, Toro D. Ombitasvir/paritaprevir/ritonavir and dasabuvir±ribavirin for chronic HCV infection in US veterans with psychiatric disorders. J Med Virol 2020; 92:3459-3464. [PMID: 31829433 PMCID: PMC7687116 DOI: 10.1002/jmv.25655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 12/09/2019] [Indexed: 11/05/2022]
Abstract
Hepatitis C virus (HCV) infections are more common among US veterans receiving care through Veterans Affairs (VA) Medical Centers than among the general population. Historically, HCV therapies had lower efficacy rates in VA patients, possibly due to common comorbidities such as psychiatric disorders and substance abuse. The direct-acting antivirals ombitasvir/paritaprevir/ritonavir and dasabuvir (OBV/PTV/r+DSV)±ribavirin (RBV) are approved in the US for HCV genotype 1 (GT1)-infected adults with or without cirrhosis. This study prospectively evaluated the safety and efficacy of OBV/PTV/r+DSV±RBV in VA patients with HCV GT1 infection. TOPAZ-VA was a phase 3b, open-label trial. Adult US veterans with HCV GT1 infection, without cirrhosis or with compensated cirrhosis, were eligible for enrollment. Patients with GT1a infection received OBV/PTV/r +DSV+RBV for 12 weeks or 24 weeks (for those with cirrhosis); GT1b-infected patients without cirrhosis received OBV/PTV/r +DSV for 12 weeks; those with cirrhosis received OBV/PTV/r +DSV with RBV. The primary endpoint was sustained virologic response at posttreatment week 12 (SVR12); safety was also assessed. Ninety-nine patients were enrolled at 10 sites from May through November 2015. The majority were male (96%), white (60%), and with GT1a infection (68%); 49% reported ongoing psychiatric disorders. Overall, 94% (93/99) achieved SVR12; three patients had a virologic failure. The most common AEs were fatigue (28%), headache (20%), and nausea (15%); six patients discontinued treatment due to AEs. In US veterans with HCV GT1 infection, OBV/PTV/r +DSV±RBV yielded a 94% overall SVR12 rate and was well tolerated. The presence of psychiatric disorders and/or injection drug use did not impact efficacy.
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Affiliation(s)
- Michael Fuchs
- Hepatology Section, Hunter Holmes McGuire VA Medical CenterVirginia Commonwealth UniversityRichmondVirginia
| | - Alexander Monto
- Department of GastroenterologySan Francisco VA Medical CenterSan FranciscoCalifornia
| | - Norbert Bräu
- Viral Hepatitis ProgramJames J Peters VA Medical CenterNew York CityNew York
| | | | - Warren Schmidt
- Department of Internal MedicineIowa City VA Healthcare SystemIowa CityIowa
| | - Michael Kozal
- Department of Internal Medicine, VA Connecticut Healthcare System, Yale School of MedicineYale UniversityNew HavenConnecticut
| | - Susanna Naggie
- Department of MedicineDurham VA Medical CenterDurhamNorth Carolina
| | - Ramsey Cheung
- Department of Gastroenterology and HepatologyVA Palo Alto Healthcare SystemPalo AltoCalifornia
| | | | - Yao Yu
- AbbVie IncNorth ChicagoIllinois
| | | | | | | | - Doris Toro
- Gastroenterology SectionVA Caribbean Healthcare SystemSan JuanPuerto Rico
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12
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Margusino-Framiñán L, Bobadilla-Pérez E, Cid-Silva P, Rodríguez-Sotelo A, Yáñez-Rubal JC, Mena-de-Cea Á, Suárez-López F, Prieto-Pérez A, Giménez-Arufe V, Delgado-Blanco M, Sanclaudio-Luhia AI, Martín-Herranz I, Castro-Iglesias Á. Effectiveness and safety of direct-acting antivirals in hepatitis C infected patients with mental disorders: Results in real clinical practice. J Med Virol 2020; 92:3488-3498. [PMID: 32181917 DOI: 10.1002/jmv.25772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/10/2020] [Indexed: 11/08/2022]
Abstract
The aim of this study is to analyze the effectiveness and safety of direct-acting antivirals (DAAs) in psychiatric patients with chronic hepatitis C (CHC). Secondary objectives included adherence and drug-drug interaction (DDIs) evaluations. Prospective observational comparative study carried out during 3 years. Psychiatric patients were included and mental illness classified by a psychiatric team based on clinical records. Main effectiveness and safety variables were sustained virologic response (SVR) at posttreatment week 12 (SVR12) and rate of on-treatment serious drug-related adverse events (AEs), respectively. A total of 242 psychiatric and 900 nonpsychiatric patients were included. SVR12 by intention-to-treat (ITT) analysis of psychiatric vs nonpsychiatric patients was 92.6% (95% confidence interval [CI], 89.1-96.1) vs 96.2% (95% CI, 94.9-97.5) (P = .02). SVR12 by modified-ITT analysis was 97.8% (95% CI, 95.0-99.3) vs 98.4% (95% CI, 97.5-99.3) (P = .74). 92.2% of psychiatric patients with mental disorders secondary to multiple drug use (MDSDU) and 93.0% of psychiatric patients without MDSDU vs 96.2% of nonpsychiatric patients reached SVR12 (P = .05 and P = .20, respectively). The percentage of adherent patients to DAAs did not show differences between cohorts (P = .08). 30.2% of psychiatric patients and 27.6% of nonpsychiatric patients presented clinically relevant DDIs (P = .47). 1.7% vs 0.8% of psychiatric vs nonpsychiatric patients developed serious AEs (P = .39); no serious psychiatric AEs were present. DAAs have shown a slightly lower effectiveness in psychiatric patients with CHC, as a result of loss of follow up, which justifies the need for integrated and multidisciplinary health care teams. DAAs safety, adherence, and DDIs, however, are similar to that of nonpsychiatric patients.
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Affiliation(s)
- Luis Margusino-Framiñán
- Pharmacy Service, Universitary Hospital of A Coruña, A Coruña, Spain
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña, SERGAS, University of A Coruña (UDC), A Coruña, Spain
| | | | - Purificación Cid-Silva
- Pharmacy Service, Universitary Hospital of A Coruña, A Coruña, Spain
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña, SERGAS, University of A Coruña (UDC), A Coruña, Spain
| | | | | | - Álvaro Mena-de-Cea
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña, SERGAS, University of A Coruña (UDC), A Coruña, Spain
- Infectious Diseases Unit, Internal Medicine Service, Universitary Hospital of A Coruña, A Coruña, Spain
| | - Francisco Suárez-López
- Hepatology Unit, Digestive System Service, Universitary Hospital of A Coruña, A Coruña, Spain
| | | | | | - Manuel Delgado-Blanco
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña, SERGAS, University of A Coruña (UDC), A Coruña, Spain
- Hepatology Unit, Digestive System Service, Universitary Hospital of A Coruña, A Coruña, Spain
| | | | | | - Ángeles Castro-Iglesias
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña, SERGAS, University of A Coruña (UDC), A Coruña, Spain
- Infectious Diseases Unit, Internal Medicine Service, Universitary Hospital of A Coruña, A Coruña, Spain
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13
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Fabrazzo M, Zampino R, Vitrone M, Sampogna G, Del Gaudio L, Nunziata D, Agnese S, Santagata A, Durante-Mangoni E, Fiorillo A. Effects of Direct-Acting Antiviral Agents on the Mental Health of Patients with Chronic Hepatitis C: A Prospective Observational Study. Brain Sci 2020; 10:E483. [PMID: 32726940 PMCID: PMC7463817 DOI: 10.3390/brainsci10080483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/04/2020] [Accepted: 07/24/2020] [Indexed: 02/06/2023] Open
Abstract
In chronic hepatitis C (CHC) patients, interferon-based treatments showed toxicity, limited efficacy, and psychiatric manifestations. Direct-acting antiviral (DAA) agents appeared safer, though it remains unclear if they may exacerbate or foster mood symptoms in drug-naïve CHC patients. We evaluated 62 CHC patients' mental status, before and 12 weeks after DAA therapy, by assessment scales and psychometric instruments. We subdivided patients into two groups, CHC patients with (Group A) or without (Group B) a current and/or past psychiatric history. After DAA treatment, Group A patients showed low anxiety and improved depression, no variation in self-report distress, but worse general health perceptions. No significant difference emerged from coping strategies. Depression and anxiety improved in Group B, and no change emerged from total self-reported distress, except for somatization. Moreover, Group B increased problem-focused strategies for suppression of competing activities, and decreased strategies of instrumental social support. Contrarily, Group B reduced significantly emotion-focused strategies, such as acceptance and mental disengagement, and improved vitality, physical and social role functioning. DAA therapy is safe and free of hepatological and psychiatric side effects in CHC patients, regardless of current and/or past psychiatric history. In particular, patients without a psychiatric history also remarkably improved their quality of life.
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Affiliation(s)
- Michele Fabrazzo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (G.S.); (L.D.G.); (D.N.); (S.A.); (A.F.)
| | - Rosa Zampino
- Division of Internal Medicine, Unit of Infectious and Transplant Medicine, University of Campania “L. Vanvitelli”, AORN Ospedali dei Colli, Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Naples, Italy; (R.Z.); (M.V.); (A.S.); (E.D.-M.)
- Internal Medicine, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza Miraglia 1, 80138 Naples, Italy
| | - Martina Vitrone
- Division of Internal Medicine, Unit of Infectious and Transplant Medicine, University of Campania “L. Vanvitelli”, AORN Ospedali dei Colli, Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Naples, Italy; (R.Z.); (M.V.); (A.S.); (E.D.-M.)
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (G.S.); (L.D.G.); (D.N.); (S.A.); (A.F.)
| | - Lucia Del Gaudio
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (G.S.); (L.D.G.); (D.N.); (S.A.); (A.F.)
| | - Daniela Nunziata
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (G.S.); (L.D.G.); (D.N.); (S.A.); (A.F.)
| | - Salvatore Agnese
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (G.S.); (L.D.G.); (D.N.); (S.A.); (A.F.)
| | - Anna Santagata
- Division of Internal Medicine, Unit of Infectious and Transplant Medicine, University of Campania “L. Vanvitelli”, AORN Ospedali dei Colli, Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Naples, Italy; (R.Z.); (M.V.); (A.S.); (E.D.-M.)
| | - Emanuele Durante-Mangoni
- Division of Internal Medicine, Unit of Infectious and Transplant Medicine, University of Campania “L. Vanvitelli”, AORN Ospedali dei Colli, Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Naples, Italy; (R.Z.); (M.V.); (A.S.); (E.D.-M.)
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (G.S.); (L.D.G.); (D.N.); (S.A.); (A.F.)
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14
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Negro F. Natural History of Hepatic and Extrahepatic Hepatitis C Virus Diseases and Impact of Interferon-Free HCV Therapy. Cold Spring Harb Perspect Med 2020; 10:cshperspect.a036921. [PMID: 31636094 DOI: 10.1101/cshperspect.a036921] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The hepatitis C virus (HCV) infects 71.1 million persons and causes 400,000 deaths annually worldwide. HCV mostly infects the liver, causing acute and chronic necroinflammatory damage, which may progress toward cirrhosis and hepatocellular carcinoma. In addition, HCV has been associated with several extrahepatic manifestations. The advent of safe and effective direct-acting antivirals (DAAs) has made the dream of eliminating this public health scourge feasible in the medium term. Prospective studies using DAA-based regimens have shown the benefit of HCV clearance in terms of both liver- and non-liver-related mortality.
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Affiliation(s)
- Francesco Negro
- Divisions of Clinical Pathology and of Gastroenterology and Hepatology, University Hospital, 1211 Genève 4, Switzerland
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15
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de Gennaro N, Diella L, Monno L, Angarano G, Milella M, Saracino A. Efficacy and tolerability of DAAs in HCV-monoinfected and HCV/HIV-coinfected patients with psychiatric disorders. BMC Infect Dis 2020; 20:196. [PMID: 32138757 PMCID: PMC7059311 DOI: 10.1186/s12879-020-4922-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 02/26/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Few data are available regarding the use of direct antiviral agents (DAAs) for chronic hepatitis C in psychiatric patients. The aim of the study is to assess safety and outcome of DAAs in patients with psychiatric comorbidities. METHODS This retrospective, observational, single-centre study enrolled patients treated with psychiatric drugs who initiated DAAs between 2015 and 2018. Patients were classified into two groups: A (on anxiolitycs/antidepressant) and B (on antipsychotics). Week-12 sustained virological response (SVR-12) and adverse events (AEs) were evaluated. RESULTS One hundred forty-four patients were included (A:101; B:43). Patients were 49.3% males, mean age 60 years (SD ± 13.5); 31.9% cirrhotic; 125 (86.8%) HCV-monoinfected and 19 (13.2%) HCV /HIV-coinfected. Twenty patients (13.8%) required a change of psychiatric therapy before initiation of DAA. Overall, SVR-12 was achieved in 88.2% of subjects in intention-to-treat(ITT)-analysis. Lower SVR rates were observed in group B vs A (79% vs 92%, p = 0.045) and in those changing psychiatric drugs vs others (8% vs 30%, p = 0.015). According to per-protocol (PP)-analysis, SVR-12 was achieved in 93/95 (97.9%) in group A versus 34/36 (94.4%) in group B (p = 0.30). At least one AE occurred in 60 patients (41.6%), including 10 severe AEs, leading to 3 discontinuations. AEs were more frequently reported in group A (p = 0.015). CONCLUSIONS The study confirms effectiveness and safety of DAA-based treatment also in this special population, even if a careful evaluation of history and drug-drug interactions is warranted.
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Affiliation(s)
- Nicolò de Gennaro
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Piazza Giulio Cesare n. 11, 70124, Bari, Italy.
| | - Lucia Diella
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Piazza Giulio Cesare n. 11, 70124, Bari, Italy
| | - Laura Monno
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Piazza Giulio Cesare n. 11, 70124, Bari, Italy
| | - Gioacchino Angarano
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Piazza Giulio Cesare n. 11, 70124, Bari, Italy
| | - Michele Milella
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Piazza Giulio Cesare n. 11, 70124, Bari, Italy
| | - Annalisa Saracino
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Piazza Giulio Cesare n. 11, 70124, Bari, Italy
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