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Yu ML, Tai CM, Mo LR, Kuo HT, Huang CF, Tseng KC, Lo CC, Bair MJ, Wang SJ, Huang JF, Yeh ML, Chen CT, Tsai MC, Huang CW, Lee PL, Yang TH, Huang YH, Chong LW, Chen CL, Yang CC, Hung CH, Yang SS, Cheng PN, Hsieh TY, Hu JT, Wu WC, Cheng CY, Chen GY, Zhou GX, Tsai WL, Kao CN, Lin CL, Wang CC, Lin TY, Lin CL, Su WW, Lee TH, Chang TS, Liu CJ, Dai CY, Chen CY, Kao JH, Lin HC, Chuang WL, Peng CY. An algorithm for simplified hepatitis C virus treatment with non-specialist care based on nation-wide data from Taiwan. Hepatol Int 2024; 18:461-475. [PMID: 38246899 PMCID: PMC11014878 DOI: 10.1007/s12072-023-10609-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/10/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Both European Association for the Study of the Liver (EASL) and American Association for the Study of Liver Diseases and the Infectious Diseases Society of America (AASLD-IDSA) guidelines recommend simplified hepatitis C virus (HCV) treatment with pan-genotypic sofosbuvir/velpatasvir or glecaprevir/pibrentasvir for eligible patients. This observational study used real-world data to assess these regimens' safety in eligible patients and develop an algorithm to identify patients suitable for simplified treatment by non-specialists. METHODS 7,677 HCV-infected patients from Taiwan Hepatitis C Registry (TACR) who received at least one dose of sofosbuvir/velpatasvir or glecaprevir/pibrentasvir, and fulfilled the EASL/AASLD-IDSA criteria for simplified treatment were analyzed. Multivariate analysis was conducted on patient characteristics and safety data. RESULTS Overall, 92.8% (7,128/7,677) of patients achieved sustained virological response and only 1.9% (146/7,677) experienced Grades 2-4 laboratory abnormalities in key liver function parameters (alanine aminotransferase, aspartate aminotransferase, and total bilirubin), with only 18 patients (0.23%) experiencing Grades 3-4 abnormalities. Age > 70 years old, presence of hepatocellular carcinoma, total bilirubin > 1.2 mg/dL, estimated glomerular filtration rate < 60 mL/min/1.73 m2, and Fibrosis-4 > 3.25 were associated with higher risks of Grades 2-4 abnormalities. Patients with any of these had an odds of 4.53 times than that of those without in developing Grades 2-4 abnormalities (p < 0.01). CONCLUSIONS Real-world data from Taiwan confirmed that simplified HCV treatment for eligible patients with pan-genotypic regimens is effective and well tolerated. The TACR algorithm, developed based on this study's results, can further identify patients who can be safely managed by non-specialist care.
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Affiliation(s)
- Ming-Lung Yu
- School of Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-Sen University, No. 70, Lianhai Rd, Gushan District, Kaohsiung City, Taiwan, 804
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Shihcyuan 1st Rd, Sanmin District, Kaohsiung City, Taiwan, 807
- Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, No. 100, Shihcyuan 1st Rd, Sanmin District, Kaohsiung City, Taiwan, 807
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Rd, Niaosong District, Kaohsiung City, Taiwan, 833
| | - Chi-Ming Tai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, I-Shou University, No. 1, Section 1, Xuecheng Rd, Dashu District, Kaohsiung City, Taiwan, 840
- School of Medicine for International Students, College of Medicine, I-Shou University, No. 1, Section 1, Xuecheng Rd, Dashu District, Kaohsiung City, Taiwan, 840
| | - Lein-Ray Mo
- Division of Gastroenterology, Tainan Municipal Hospital (Managed By Show Chwan Medical Care Corporation), No. 670, Chongde Rd, East District, Tainan City, Taiwan, 701
| | - Hsing-Tao Kuo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, No. 901, Zhonghua Rd, Yongkang District, Tainan City, Taiwan, 710
- School of Medicine, College of Medicine, National Sun Yat-Sen University, No. 70, Lianhai Rd, Gushan District, Kaohsiung City, Taiwan, 804
| | - Chung-Feng Huang
- School of Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-Sen University, No. 70, Lianhai Rd, Gushan District, Kaohsiung City, Taiwan, 804
- Ph.D. Program in Translational Medicine, College of Medicine, Kaohsiung Medical University and Academia Sinica, No. 128, Section 2, Academia Rd, Nangang District, Taipei City, Taiwan, 115
| | - Kuo-Chih Tseng
- Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Rd, Dalin Township, Chiayi County, Taiwan, 622
- School of Medicine, Tzuchi University, No. 701, Section 3, Zhongyang Rd, Hualien City, Hualien County, Taiwan, 970
| | - Ching-Chu Lo
- Division of Gastroenterology, Department of Internal Medicine, St. Martin De Porres Hospital, No. 60, Minquan Rd, East District, Chiayi City, Taiwan, 600
| | - Ming-Jong Bair
- Division of Gastroenterology, Department of Internal Medicine, Taitung Mackay Memorial Hospital, No. 1, Lane 303, Zhangsha St, Taitung City, Taitung County, Taiwan, 950
- Mackay Medical College, No. 46, Section 3, Zhongzheng Rd, Sanzhi District, New Taipei City, Taiwan, 252
| | - Szu-Jen Wang
- Division of Gastroenterology, Department of Internal Medicine, Yuan's General Hospital, No. 162, Chenggong 1st Rd, Lingya District, Kaohsiung City, Taiwan, 802
| | - Jee-Fu Huang
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Shihcyuan 1st Rd, Sanmin District, Kaohsiung City, Taiwan, 807
- Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, No. 100, Shihcyuan 1st Rd, Sanmin District, Kaohsiung City, Taiwan, 807
| | - Ming-Lun Yeh
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Shihcyuan 1st Rd, Sanmin District, Kaohsiung City, Taiwan, 807
- Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, No. 100, Shihcyuan 1st Rd, Sanmin District, Kaohsiung City, Taiwan, 807
| | - Chun-Ting Chen
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Rd, Neihu District, Taipei City, Taiwan, 114
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital Penghu Branch, National Defense Medical Center, No. 90, Qianliao, Magong City, Penghu County, Taiwan, 880
| | - Ming-Chang Tsai
- School of Medicine, Chung Shan Medical University, Department of Internal Medicine, Chung Shan Medical University Hospital, No. 110, Section 1, Jianguo N Rd, South District, Taichung City, Taiwan, 402
| | - Chien-Wei Huang
- Division of Gastroenterology, Kaohsiung Armed Forces General Hospital, No. 2, Zhongzheng 1st Rd, Lingya District, Kaohsiung City, Taiwan, 802
| | - Pei-Lun Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, No. 901, Zhonghua Rd, Yongkang District, Tainan City, Taiwan, 710
| | - Tzeng-Hue Yang
- Lotung Poh-Ai Hospital, No. 83, Nanchang St, Luodong Township, Yilan County, Taiwan, 265
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Rd, Beitou District, Taipei City, Taiwan, 112
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming Chiao Tung University, No. 155, Section 2, Linong St, Beitou District, Taipei City, Taiwan, 112
| | - Lee-Won Chong
- Division of Hepatology and Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Shilin District, Taipei City, Taiwan, 111
- School of Medicine, Fu-Jen Catholic University, No. 510, Zhongzheng Rd, Xinzhuang District, New Taipei City, Taiwan, 242
| | - Chien-Lin Chen
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, No. 701, Section 3, Zhongyang Rd, Hualien City, Hualien County, Taiwan, 970
| | - Chi-Chieh Yang
- Department of Gastroenterology, Division of Internal Medicine, Show Chwan Memorial Hospital, No. 542, Section 1, Zhongshan Rd, Changhua City, Changhua County, Taiwan, 500
| | - Chao-Hung Hung
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Rd, Niaosong District, Kaohsiung City, Taiwan, 833
| | - Sheng-Shun Yang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Section 4, Taiwan Boulevard, Xitun District, Taichung City, Taiwan, 407
| | - Pin-Nan Cheng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 1, Dasyue Rd, East District, Tainan City, Taiwan, 701
| | - Tsai-Yuan Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Rd, Neihu District, Taipei City, Taiwan, 114
| | - Jui-Ting Hu
- Liver Center, Cathay General Hospital, No. 280, Section 4, Ren'ai Rd, Da'an District, Taipei City, Taiwan, 106
| | - Wen-Chih Wu
- Wen-Chih Wu Clinic, Fengshan, Kaohsiung, Taiwan, 830
| | - Chien-Yu Cheng
- Division of Infectious Diseases, Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, No. 1492, Zhongshan Rd, Taoyuan District, Taoyuan City, Taiwan, 330
- Institute of Public Health, School of Medicine, National Yang-Ming Chiao Tung University, No. 155, Section 2, Linong St, Beitou District, Taipei City, Taiwan, 112
| | - Guei-Ying Chen
- Penghu Hospital, Ministry of Health and Welfare, No. 10, Zhongzheng Rd, Magong City, Penghu County, Taiwan, 880
| | | | - Wei-Lun Tsai
- Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying District, Kaohsiung City, Taiwan, 813
| | - Chien-Neng Kao
- National Taiwan University Hospital Hsin-Chu Branch, No. 25, Lane 442, Section 1, Jingguo Rd, North District, Hsinchu City, Taiwan, 300
| | - Chih-Lang Lin
- Liver Research Unit, Department of Hepato-Gastroenterology and Community Medicine Research Center, Chang Gung Memorial Hospital at Keelung, College of Medicine, Chang Gung University, No. 222, Maijin Rd, Anle District, Keelung City, Taiwan, 204
| | - Chia-Chi Wang
- Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and School of Medicine, Tzu Chi University, No. 289, Jianguo Rd, Xindian District, New Taipei City, Taiwan, 231
| | - Ta-Ya Lin
- Cishan Hospital, Ministry of Health and Welfare, No. 60, Zhongxue Rd, Qishan District, Kaohsiung City, Taiwan, 842
| | - Chih-Lin Lin
- Department of Gastroenterology, Renai Branch, Taipei City Hospital, No. 10, Section 4, Ren'ai Rd, Da'an District, Taipei City, Taiwan, 106
| | - Wei-Wen Su
- Department of Gastroenterology and Hepatology, Changhua Christian Hospital, No. 176, Zhonghua Rd, Changhua City, Changhua County, Taiwan, 500
| | - Tzong-Hsi Lee
- Division of Gastroenterology and Hepatology, Far Eastern Memorial Hospital, No. 21, Section 2, Nanya S Rd, Banqiao District, New Taipei City, Taiwan, 220
| | - Te-Sheng Chang
- Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan and College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd, Guishan District, Taoyuan City, Taiwan, 333
| | - Chun-Jen Liu
- Hepatitis Research Center and Department of Internal Medicine, National Taiwan University Hospital, No. 1, Section 4, Roosevelt Rd, Da'an District, Taipei City, Taiwan, 106
| | - Chia-Yen Dai
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Shihcyuan 1st Rd, Sanmin District, Kaohsiung City, Taiwan, 807
- Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, No. 100, Shihcyuan 1st Rd, Sanmin District, Kaohsiung City, Taiwan, 807
| | - Chi-Yi Chen
- Division of Gastroenterology and Hepatology, Department of Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, No. 539, Zhongxiao Rd, East District, Chiayi City, Taiwan, 600
| | - Jia-Horng Kao
- Hepatitis Research Center and Department of Internal Medicine, National Taiwan University Hospital, No. 1, Section 4, Roosevelt Rd, Da'an District, Taipei City, Taiwan, 106
| | - Han-Chieh Lin
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Rd, Beitou District, Taipei City, Taiwan, 112
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming Chiao Tung University, No. 155, Section 2, Linong St, Beitou District, Taipei City, Taiwan, 112
| | - Wan-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Shihcyuan 1st Rd, Sanmin District, Kaohsiung City, Taiwan, 807.
- Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, No. 100, Shihcyuan 1st Rd, Sanmin District, Kaohsiung City, Taiwan, 807.
| | - Cheng-Yuan Peng
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, No. 2, Yude Rd, North District, Taichung City, Taiwan, 404.
- School of Medicine, China Medical University, No. 91, Xueshi Rd, North District, Taichung City, Taiwan, 404.
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Kamal A, Metawea M, Omar H, Ghallab M, Kassem A, Naguib H. Hepatitis C Virus-Related One-Year Hepatocellular Carcinoma Recurrence After Directly Acting Antivirals: A Randomized Controlled Trial. J Gastrointest Cancer 2024:10.1007/s12029-024-01035-5. [PMID: 38436921 DOI: 10.1007/s12029-024-01035-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE Available data on hepatocellular carcinoma (HCC) recurrence after direct-acting antivirals (DAAs) treatment for hepatitis C virus (HCV) are conflicting. No randomized trials were done. This study aims to compare the 1-year HCC recurrence rates in patients who received DAAs after tumor ablation versus those who postponed HCV treatment for 1 year. METHODS Included patients were randomized after complete HCC ablation into two groups: a postponed DAAs group for whom DAAs initiation was postponed for 12 months and a DAAs group who were given sofosbuvir/velpatasvir. Patients were followed for 1 year. RESULTS Eighty-four HCV patients with a mean age of 56.35 ± 8.12 years were included; 78.57% of them were males. The number of lesions per patient ranged from 1 to 3 lesions, and the size of the largest lesion ranged from 1.5 to 5 cm. There were no statistically significant differences between both groups regarding baseline characteristics. In the DAAs group (43 patients), 11 patients had HCC recurrence, while 25 patients in the postponed DAAs group (41 patients) had HCC recurrence. Using Kaplan-Meier analysis, the 1-year recurrence-free survival (RFS) was significantly higher in the DAAs group (72.2% vs. 38%, P = 0.001). On multivariate analysis, both higher albumin levels (HR 0.147, 95% CI 0.066-0.329) and receiving DAAs (HR 0.358, 95% CI 0.176-0.730) 1 year after ablation were associated with significantly lower recurrence. CONCLUSION Direct-acting antiviral usage after complete hepatocellular carcinoma ablation significantly decreases the 1-year HCC recurrence rates, but the risk of recurrence is still not eliminated. The study registration number on clinicaltrials.gov : NCT04653818 (initial release on 28/11/2020).
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Affiliation(s)
- Ahmed Kamal
- Hepatology Unit, Internal Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Marwa Metawea
- Hepatology Unit, Internal Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Heba Omar
- Pulmonology Clinical Pharmacy, Alexandria University Hospitals, Alexandria University, Alexandria, Egypt
- Fellow of Microbiology, Alexandria University, Alexandria, Egypt
| | - Mahmoud Ghallab
- Radiodiagnosis and Intervention Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Ahmed Kassem
- Radiology Department, Faculty of Medicine, Port Said University, Port Said, Egypt
| | - Hend Naguib
- Hepatology Unit, Internal Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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3
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Park JE, Nguyen VH, Tsai PC, Toyoda H, Leong J, Guy JE, Yeh ML, Huang CF, Yasuda S, Abe H, Hsu YC, Tseng CH, Liu J, Chen YL, Lin PY, Jun DW, Yoshimaru Y, Ogawa E, Ishigami M, Enomoto M, Tamori A, Uojima H, Wang XZ, Xu Q, Takahashi H, Eguchi Y, Inoue K, Huang DQ, Zhao WJ, Chuang WL, Dai CY, Huang JF, Barnett S, Maeda M, Cheung R, Landis C, Tanaka Y, Roberts LR, Schwartz ME, Kumada T, Yu ML, Nguyen MH. Racial and ethnic disparities in untreated patients with hepatitis C virus-related hepatocellular carcinoma but not in those with sustained virologic response. Aliment Pharmacol Ther 2024; 59:742-751. [PMID: 38173278 DOI: 10.1111/apt.17863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/14/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Racial and ethnic disparities exist for hepatitis C virus (HCV) treatment and hepatocellular carcinoma (HCC) survival. AIM To evaluate the impact of HCV treatment on such disparities. METHODS In a retrospective cohort study, we analysed 6069 patients with HCV-related HCC (54.2% Asian, 30.1% White, 8.5% Black, and 7.3% Hispanic) from centres in the United States and Asia. RESULTS The mean age was 61, 60, 59 and 68, respectively, for White, Black, Hispanic and Asian patients. Black patients were most likely to have Barcelona Clinic Liver Cancer stage D, vascular invasion and distant metastasis (23% vs. 5%-15%, 20% vs. 10%-17% and 10% vs. 5%-7%, respectively; all p < 0.0001). Treatment rate with direct-acting antiviral agents (DAA) was 35.9% for Asian, 34.9% for White, 30.3% for Hispanic (30.3%), and 18.7% for Black patients (p < 0.0001). Among those untreated or without sustained virologic response (SVR), 10-year survival rates were 35.4, 27.5, 19.3 and 14.0, respectively, for Asian, Hispanic, White and Black patients (p < 0.0001). There were no statistically significant differences among those with SVR (p = 0.44). On multivariable analysis adjusted for relevant confounders, there was no statistically significant association between survival and being Hispanic (aHR: 0.68, p = 0.26) or Black (aHR: 1.18, p = 0.60) versus White. There was a significant association between being Asian American and survival (aHR: 0.24, p = 0.001; non-U.S. Asian: aHR: 0.66, p = 0.05), and for SVR (aHR: 0.30, p < 0.0001). CONCLUSION DAA treatment rates were suboptimal. Racial and ethnic disparities resolved with HCV cure. Early diagnosis and improved access to HCV treatment is needed for all patients with HCV infection.
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Affiliation(s)
- Jung Eun Park
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Vy H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Pei-Chien Tsai
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center of Excellence for Metabolic Associated Fatty Liver Disease, School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Hidenori Toyoda
- Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Jennifer Leong
- Henry D. Janowitz Division of Gastroenterology, Mount Sinai Health System, New York, New York, USA
| | - Jennifer E Guy
- Division of Gastroenterology and Hepatology, California Pacific Medical Center, San Francisco, California, USA
| | - Ming-Lun Yeh
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center of Excellence for Metabolic Associated Fatty Liver Disease, School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Chung-Feng Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center of Excellence for Metabolic Associated Fatty Liver Disease, School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Satoshi Yasuda
- Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Hiroshi Abe
- Division of Gastroenterology and Hepatology, Shinmatsudo Central General Hospital, Matsudo, Japan
| | - Yao-Chun Hsu
- Division of Gastroenterology and Hepatology, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Cheng-Hao Tseng
- Division of Gastroenterology and Hepatology, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Joanne Liu
- University of Washington, Seattle, Washington, USA
| | - Yao-Li Chen
- Department of Surgery, Liver Transplantation Center, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ping-Yi Lin
- Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Dae Won Jun
- Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, South Korea
| | - Yoko Yoshimaru
- Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Eiichi Ogawa
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Masatoshi Ishigami
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masaru Enomoto
- Department of Hepatology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
- Department of Transfusion Medicine, Osaka Metropolitan University Hospital, Osaka, Japan
| | - Akihiro Tamori
- Department of Hepatology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Haruki Uojima
- Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Xiao Zhong Wang
- Division of Gastroenterology and Hepatology, Xinjiang Medical University, Xinjiang, China
| | - Qiang Xu
- Division of Gastroenterology and Hepatology, Xinjiang Medical University, Xinjiang, China
| | - Hirokazu Takahashi
- Liver Center, Saga University Hospital, Saga, Japan
- Division of Metabolism and Endocrinology, Saga University Faculty of Medicine, Saga, Japan
| | - Yuichiro Eguchi
- Liver Center, Saga University Hospital, Saga, Japan
- Locomedical General Institute, Locomedical Eguchi Hospital, Saga, Japan
| | - Kaori Inoue
- Liver Center, Saga University Hospital, Saga, Japan
- Division of Metabolism and Endocrinology, Saga University Faculty of Medicine, Saga, Japan
| | - Daniel Q Huang
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wen Jing Zhao
- Department of Hepatology, Hepatobiliary Disease Hospital of Jilin Province, Jilin, China
| | - Wan-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Yen Dai
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center of Excellence for Metabolic Associated Fatty Liver Disease, School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Jee-Fu Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center of Excellence for Metabolic Associated Fatty Liver Disease, School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Scott Barnett
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Mayumi Maeda
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | | | - Yasuhito Tanaka
- Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
- Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Lewis R Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Myron E Schwartz
- Henry D. Janowitz Division of Gastroenterology, Mount Sinai Health System, New York, New York, USA
| | - Takashi Kumada
- Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center of Excellence for Metabolic Associated Fatty Liver Disease, School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
- Department of Epidemiology and Population Health, Stanford University Medical Center, Palo Alto, California, USA
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4
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Kam LY, Yeo YH, Ji F, Henry L, Cheung R, Nguyen MH. Treatment rates and factors associated with direct-acting antiviral therapy for insured patients with hepatitis C-related hepatocellular carcinoma - A real-world nationwide study. Aliment Pharmacol Ther 2024; 59:350-360. [PMID: 37937485 DOI: 10.1111/apt.17794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/03/2023] [Accepted: 10/23/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Since the inception of the interferon-free direct-acting antiviral agents (DAAs) for hepatitis C virus (HCV) infection, guidelines as to who should receive this potentially curative treatment have evolved. Treatment with DAAs is now considered for all patients except for those considered moribund. AIM To determine the DAA treatment rate for patients with HCV-related hepatocellular carcinoma (HCC). METHODS This was a retrospective study from January 2015 to March 2021 of a national sample of privately insured patients with HCV-related HCC using Optum's Clinformatics® Data Mart (CDM) Database - a large, de-identified, adjudicated claims database. RESULTS We identified 3922 patients with HCV-related HCC: 922 (23.5%) received DAA. Compared to untreated patients, DAA-treated patients were younger (65.2 ± 7.5 vs. 66.4 ± 7.5 years, p < 0.001), more frequently saw a gastroenterology/infectious disease (GI/ID) physician (41.2% vs. 34.2%), and had decompensated cirrhosis (56% vs. 53%, p = 0.001). In multivariable analysis, younger age (HR: 0.98, 95% CI: 0.97-0.99, p < 0.001), GI/ID care (HR: 3.06, 95% CI: 2.13-4.51, p < 0.001), and having cirrhosis (compensated: HR: 1.60, 95% CI: 1.18-2.21, p = 0.003; decompensated: HR: 1.45, 95% CI: 1.07-1.98, p = 0.02) were associated with receiving DAA treatment, but not sex, race, or ethnicity. DAA-treated patients had significantly higher 5-year survival than untreated patients (47.2% vs. 35.2%, p < 0.001). Following adjustment for age, sex, race/ethnicity, Charlson Comorbidity Index, and HCC treatment, receiving DAA treatment was associated with lower mortality (aHR: 0.61, 95% CI: 0.53-0.69, p < 0.001). CONCLUSION DAA treatment remains underutilised in insured patients with HCV-related HCC; fewer than one in four patients received treatment. Seeing a specialist and having decompensated cirrhosis were predictors for DAA treatment; additional efforts are needed to increase awareness of HCV treatment.
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Affiliation(s)
- Leslie Y Kam
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Yee Hui Yeo
- Karsh Division of Gastroenterology and Hepatology, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Fanpu Ji
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Linda Henry
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
- Department of Epidemiology and Population Health, Stanford University Medical Center, Palo Alto, California, USA
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5
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Lu MY, Huang CF, Hung CH, Tai C, Mo LR, Kuo HT, Tseng KC, Lo CC, Bair MJ, Wang SJ, Huang JF, Yeh ML, Chen CT, Tsai MC, Huang CW, Lee PL, Yang TH, Huang YH, Chong LW, Chen CL, Yang CC, Yang S, Cheng PN, Hsieh TY, Hu JT, Wu WC, Cheng CY, Chen GY, Zhou GX, Tsai WL, Kao CN, Lin CL, Wang CC, Lin TY, Lin C, Su WW, Lee TH, Chang TS, Liu CJ, Dai CY, Kao JH, Lin HC, Chuang WL, Peng CY, Tsai CW, Chen CY, Yu ML. Artificial intelligence predicts direct-acting antivirals failure among hepatitis C virus patients: A nationwide hepatitis C virus registry program. Clin Mol Hepatol 2024; 30:64-79. [PMID: 38195113 PMCID: PMC10776298 DOI: 10.3350/cmh.2023.0287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/02/2023] [Accepted: 11/20/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND/AIMS Despite the high efficacy of direct-acting antivirals (DAAs), approximately 1-3% of hepatitis C virus (HCV) patients fail to achieve a sustained virological response. We conducted a nationwide study to investigate risk factors associated with DAA treatment failure. Machine-learning algorithms have been applied to discriminate subjects who may fail to respond to DAA therapy. METHODS We analyzed the Taiwan HCV Registry Program database to explore predictors of DAA failure in HCV patients. Fifty-five host and virological features were assessed using multivariate logistic regression, decision tree, random forest, eXtreme Gradient Boosting (XGBoost), and artificial neural network. The primary outcome was undetectable HCV RNA at 12 weeks after the end of treatment. RESULTS The training (n=23,955) and validation (n=10,346) datasets had similar baseline demographics, with an overall DAA failure rate of 1.6% (n=538). Multivariate logistic regression analysis revealed that liver cirrhosis, hepatocellular carcinoma, poor DAA adherence, and higher hemoglobin A1c were significantly associated with virological failure. XGBoost outperformed the other algorithms and logistic regression models, with an area under the receiver operating characteristic curve of 1.000 in the training dataset and 0.803 in the validation dataset. The top five predictors of treatment failure were HCV RNA, body mass index, α-fetoprotein, platelets, and FIB-4 index. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the XGBoost model (cutoff value=0.5) were 99.5%, 69.7%, 99.9%, 97.4%, and 99.5%, respectively, for the entire dataset. CONCLUSION Machine learning algorithms effectively provide risk stratification for DAA failure and additional information on the factors associated with DAA failure.
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Affiliation(s)
- Ming-Ying Lu
- School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Feng Huang
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Ph.D. Program in Translational Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, and Academia Sinica, Taipei, Taiwan
| | - Chao-Hung Hung
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chi‐Ming Tai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Lein-Ray Mo
- Division of Gastroenterology, Tainan Municipal Hospital (Managed By Show Chwan Medical Care Corporation), Tainan, Taiwan
| | - Hsing-Tao Kuo
- School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, Yongkang District, Tainan, Taiwan
| | - Kuo-Chih Tseng
- Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzuchi University, Hualien, Taiwan
| | - Ching-Chu Lo
- Division of Gastroenterology, Department of Internal Medicine, St. Martin De Porres Hospital, Chiayi, Taiwan
| | - Ming-Jong Bair
- Division of Gastroenterology, Department of Internal Medicine, Taitung Mackay Memorial Hospital, Taitung, Taiwan
- Mackay Medical College, New Taipei City, Taiwan
| | - Szu-Jen Wang
- Division of Gastroenterology, Department of Internal Medicine, Yuan’s General Hospital, Kaohsiung, Taiwan
| | - Jee-Fu Huang
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Lun Yeh
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Ting Chen
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital Penghu Branch, National Defense Medical Center, Taipei, Taiwan
| | - Ming-Chang Tsai
- School of Medicine, Chung Shan Medical University, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chien-Wei Huang
- Division of Gastroenterology, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Pei-Lun Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | | | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Lee-Won Chong
- Division of Hepatology and Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Chien-Lin Chen
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Chi-Chieh Yang
- Department of Gastroenterology, Division of Internal Medicine, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Sheng‐Shun Yang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Pin-Nan Cheng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tsai-Yuan Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jui-Ting Hu
- Liver Center, Cathay General Hospital, Taipei, Taiwan
| | - Wen-Chih Wu
- Wen-Chih Wu Clinic, Fengshan, Kaohsiung, Taiwan
| | - Chien-Yu Cheng
- Division of Infectious Diseases, Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Guei-Ying Chen
- Penghu Hospital, Ministry of Health and Welfare, Penghu, Taiwan
| | | | - Wei-Lun Tsai
- Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chien-Neng Kao
- National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Chih-Lang Lin
- Liver Research Unit, Department of Hepato-Gastroenterology and Community Medicine Research Center, Chang Gung Memorial Hospital at Keelung, College of Medicine, Chang Gung University, Keelung, Taiwan
| | - Chia-Chi Wang
- Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and School of Medicine, Tzu Chi University, Taipei, Taiwan
| | - Ta-Ya Lin
- Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan
| | - Chih‐Lin Lin
- Department of Gastroenterology, Renai Branch, Taipei City Hospital, Taipei, Taiwan
| | - Wei-Wen Su
- Department of Gastroenterology and Hepatology, Changhua Christian Hospital, Changhua, Taiwan
| | - Tzong-Hsi Lee
- Division of Gastroenterology and Hepatology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Te-Sheng Chang
- Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Jen Liu
- Hepatitis Research Center and Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Yen Dai
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jia-Horng Kao
- Hepatitis Research Center and Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Han-Chieh Lin
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Wan-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Yuan Peng
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Chun-Wei- Tsai
- Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Chi-Yi Chen
- Division of Gastroenterology and Hepatology, Department of Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
| | - Ming-Lung Yu
- School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - TACR Study Group
- School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Ph.D. Program in Translational Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, and Academia Sinica, Taipei, Taiwan
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Division of Gastroenterology, Tainan Municipal Hospital (Managed By Show Chwan Medical Care Corporation), Tainan, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, Yongkang District, Tainan, Taiwan
- Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzuchi University, Hualien, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, St. Martin De Porres Hospital, Chiayi, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, Taitung Mackay Memorial Hospital, Taitung, Taiwan
- Mackay Medical College, New Taipei City, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, Yuan’s General Hospital, Kaohsiung, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital Penghu Branch, National Defense Medical Center, Taipei, Taiwan
- School of Medicine, Chung Shan Medical University, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- Division of Gastroenterology, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
- Lotung Poh-Ai Hospital, Yilan, Taiwan
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Division of Hepatology and Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
- Department of Gastroenterology, Division of Internal Medicine, Show Chwan Memorial Hospital, Changhua, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Liver Center, Cathay General Hospital, Taipei, Taiwan
- Wen-Chih Wu Clinic, Fengshan, Kaohsiung, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
- Penghu Hospital, Ministry of Health and Welfare, Penghu, Taiwan
- Zhou Guoxiong Clinic, Penghu, Taiwan
- Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- Liver Research Unit, Department of Hepato-Gastroenterology and Community Medicine Research Center, Chang Gung Memorial Hospital at Keelung, College of Medicine, Chang Gung University, Keelung, Taiwan
- Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and School of Medicine, Tzu Chi University, Taipei, Taiwan
- Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan
- Department of Gastroenterology, Renai Branch, Taipei City Hospital, Taipei, Taiwan
- Department of Gastroenterology and Hepatology, Changhua Christian Hospital, Changhua, Taiwan
- Division of Gastroenterology and Hepatology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan and College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Hepatitis Research Center and Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
- Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan
- Division of Gastroenterology and Hepatology, Department of Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
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Lo CC, Lei WY, Huang YC, Hwang JJ, Lo CY, Lin CH, Cheng HS, Liao YT, Liang PC, Chiou MJ, Bair MJ, Dai CY, Yu ML. Micro-elimination of hepatitis C virus infection in the rural and remote areas of Taiwan - A multi-center collaborative care model. J Microbiol Immunol Infect 2023; 56:680-687. [PMID: 36822945 DOI: 10.1016/j.jmii.2023.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/05/2022] [Accepted: 01/20/2023] [Indexed: 02/12/2023]
Abstract
INTRODUCTION Taiwan has several hepatitis C virus (HCV) hyper-endemic areas. We aimed to evaluate the effectiveness and safety of a collaborative HCV care system with an outreach decentralized strategy among the resource-constrained rural/remote areas of Taiwan. METHODS The pilot study was conducted in four high HCV-endemic townships in the rural/remote areas of Taoyuan, Alishan, Zhuoxi and Xiulin. Registered residents who worked or lived in the four areas and were aged 30-75 years were invited to participate in this program. Multidisciplinary HCV care teams provided outreach decentralized services of anti-HCV screening, link-to-diagnosis, and link-to-treatment with direct-acting antiviral agents (DAA). The primary end-point was sustained virological response (SVR). RESULTS Of 8291 registered residents who were invited as the target population, 7807 (94.2%) subjects received anti-HCV screening, with the average anti-HCV prevalence rate of 14.2% (1108/7807) (range among four areas: 11.8%-16.7%). The rate of link-to-diagnosis was 94.4% (1046/1108) of anti-HCV-positive subjects (range: 90.9%-100%) with an average HCV-viremic rate of 55.1% (576/1046) (range: 50.0%-64.3%). The link-to-treat rate was 94.4% (544/576) in HCV-viremic subjects (range from 92.7% to 97.2%). Overall, 523 (96.1%) patients achieved an SVR (range: 94.7%-97.6%). Eventually, the overall effectiveness was 80.7% (range: 74.6%-93.1%). The presence of hepatocellular carcinoma at baseline was the only factor associated with DAA failure. The DAA regimens were well-tolerated. CONCLUSION The outreach decentralized community-based care system with DAA therapy was highly effective and safe in the achievement of HCV micro-elimination in the resource-constrained rural and remote regions, which could help us to tackle the disparity.
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Affiliation(s)
- Ching-Chu Lo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Martin De Porres Hospital, Chung-Jen Junior College of Nursing, Health Sciences and Management, Chiayi, Taiwan
| | - Wei-Yi Lei
- Department of Medicine, Hualien Tzu Chi Hospital, Buddihist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan
| | - Ying-Che Huang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Veterans General Hospital Yuli Branch, Taipei, Taiwan
| | - Jow-Jyh Hwang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Martin De Porres Hospital, Chung-Jen Junior College of Nursing, Health Sciences and Management, Chiayi, Taiwan
| | - Chen-Yu Lo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Martin De Porres Hospital, Chung-Jen Junior College of Nursing, Health Sciences and Management, Chiayi, Taiwan; Eberly College of Science, Department of Biology, Schreyer Honors College, Pennsylvania State University, United States
| | - Chien-Hung Lin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Martin De Porres Hospital, Chung-Jen Junior College of Nursing, Health Sciences and Management, Chiayi, Taiwan
| | - Hsu-Sheng Cheng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Martin De Porres Hospital, Chung-Jen Junior College of Nursing, Health Sciences and Management, Chiayi, Taiwan
| | - Yee-Tam Liao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Martin De Porres Hospital, Chung-Jen Junior College of Nursing, Health Sciences and Management, Chiayi, Taiwan
| | - Po-Cheng Liang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung, Taiwan
| | - Meng-Jau Chiou
- Taoyuan District Public Health Center, Kaohsiung, Taiwan
| | - Ming-Jong Bair
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taitung Mackay Memorial Hospital, Taitung, Taiwan; Department of Medicine, Mackay Medical College, New Taipei, Taiwan.
| | - Chia-Yen Dai
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung, Taiwan; School of Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan.
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung, Taiwan; School of Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan; Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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7
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Huang CI, Liang PC, Wei YJ, Tsai PC, Hsu PY, Hsieh MY, Liu TW, Lin YH, Hsieh MH, Jang TY, Wang CW, Yang JF, Yeh ML, Huang CF, Dai CY, Chuang WL, Huang JF, Yu ML. A people-centered decentralized outreach model toward HCV micro-elimination in hyperendemic areas: COMPACT study in SARS Co-V2 pandemic. J Microbiol Immunol Infect 2023:S1684-1182(23)00090-7. [PMID: 37188573 DOI: 10.1016/j.jmii.2023.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 03/13/2023] [Accepted: 04/25/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES Gaps in linkage-to-care remain the barriers toward hepatitis C virus (HCV) elimination in the directly-acting-antivirals (DAA) era, especially during SARS Co-V2 pandemics. We established an outreach project to target HCV micro-elimination in HCV-hyperendemic villages. METHODS The COMPACT provided "door-by-door" screening by an "outreach HCV-checkpoint team" and an "outreach HCV-care team" for HCV diagnosis, assessment and DAA therapy in Chidong/Chikan villages between 2019 and 2021. Participants from neighboring villages served as Control group. RESULTS A total of 5731 adult residents participated in the project. Anti-HCV prevalence rate was 24.0% (886/3684) in Target Group and 9.5% (194/2047) in Control group (P < 0.001). The HCV-viremic rates among anti-HCV-positive subjects were 42.7% and 41.2%, respectively, in Target and Control groups. After COMPACT engagement, 80.4% (304/378) HCV-viremic subjects in the Target group were successfully linked-to-care, and Control group (70% (56/80), P = 0.039). The rates of link-to-treatment and SVR12 were comparable between Target (100% and 97.4%, respectively) and Control (100% and 96.4%) groups. The community effectiveness was 76.4% in the COMPACT campaign, significantly higher in Target group than in Control group (78.3% versus 67.5%, P = 0.039). The community effectiveness decreased significantly during SARS Co-V2 pandemic in Control group (from 81% to 31.8%, P < 0.001), but not in Target group (80.3% vs. 71.6%, P = 0.104). CONCLUSIONS The outreach door-by-door screen strategy with decentralized onsite treatment programs greatly improved HCV care cascade in HCV-hyperendemic areas, a model for HCV elimination in high-risk marginalized communities in SARS Co-V2 pandemic.
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Affiliation(s)
- Ching-I Huang
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine and Hepatitis Research Center, College of Medicine, and Enter for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Cheng Liang
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Ju Wei
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Pei-Chien Tsai
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Po-Yao Hsu
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Yen Hsieh
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ta-Wei Liu
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yi-Hung Lin
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Meng-Hsuan Hsieh
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tyng-Yuan Jang
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chih-Wen Wang
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jeng-Fu Yang
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ming-Lun Yeh
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; School of Medicine and Hepatitis Research Center, College of Medicine, and Enter for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Feng Huang
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; School of Medicine and Hepatitis Research Center, College of Medicine, and Enter for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Yen Dai
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; School of Medicine and Hepatitis Research Center, College of Medicine, and Enter for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wan-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; School of Medicine and Hepatitis Research Center, College of Medicine, and Enter for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jee-Fu Huang
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; School of Medicine and Hepatitis Research Center, College of Medicine, and Enter for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; School of Medicine and Hepatitis Research Center, College of Medicine, and Enter for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan; Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
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8
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Nguyen VH, Huang DQ, Le MH, Jin M, Lee EY, Henry L, Nerurkar SN, Ogawa E, Thin KN, Teng MLP, Goh KS, Kai JCY, Wong C, Tan DJH, Thuy LTT, Hai H, Enomoto M, Cheung R, Nguyen MH. Global treatment rate and barriers to direct-acting antiviral therapy: A systematic review and meta-analysis of 146 studies and 1 760 352 hepatitis C virus patients. Liver Int 2023; 43:1195-1203. [PMID: 36825358 DOI: 10.1111/liv.15550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 02/15/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Global data on the treatment rate with direct-acting antivirals (DAAs) for chronic hepatitis C (CHC) are sparse. We aimed to evaluate the CHC treatment rate and barriers to treatment in the DAA era. METHODS We searched PubMed, EMBASE and Cochrane from inception to 5 August 2021, for relevant articles. Patients treated with DAAs without interferon (IFN) therapy were categorized as IFN-free DAAs. Patients receiving DAA with IFN or unclear IFN status were categorized as DAA/IFN. RESULTS We identified and analysed data from 146 studies (1 760 352 CHC patients). DAA/IFN treatment rate was 16.0% (95% CI: 9.9-23.3, 49 studies, 886 535 patients). IFN-free DAA treatment rate was 52.3% (95% CI: 46.2-58.4, 123 studies, 1 276 754 patients): 45.4% in North America, 64.2% in South America (1 study), 90.4% in Africa (most data from Egypt), 54.4% in Europe, 60.7% in Australia and 60.5% in Asia, (p < .0001); 49% with hepatitis B co-infection and 32.3% with hepatocellular carcinoma (HCC). Treatment was not a priority in 22.8% of patients in Europe and 16.7% in Australia, compared to only 4.8% in North America and 2.1% in Asia (p < .0001). Poor adherence to clinical follow-up was the cause of no treatment in 74.7% of patients in Australia, 37.0% in North America, 7.9% in Europe and 14.3% in Asia (p < .0001). CONCLUSION Though a marked improvement from IFN/DAA, the treatment rate with IFN-free DAA remains suboptimal (52.3% overall, 32.3% in HCC patients). Non-adherence to clinical follow-up and lack of disease awareness were treatment barriers.
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Affiliation(s)
- Vy H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Q Huang
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Michael H Le
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA.,Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Michelle Jin
- Stanford University School of Medicine, Stanford, California, USA
| | - Eunice Y Lee
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Linda Henry
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Sanjna N Nerurkar
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Eiichi Ogawa
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Khin N Thin
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Margaret L P Teng
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Kang S Goh
- Department of Internal Medicine, National University Health System, Singapore, Singapore
| | - Justin C Y Kai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Connie Wong
- Lane Medical Library, Stanford University School of Medicine, Palo Alto, California, USA
| | - Darren J H Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Le T T Thuy
- Department of Hepatology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hoang Hai
- Department of Hepatology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Masaru Enomoto
- Department of Hepatology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA.,Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, California, USA
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9
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Ito T, Nguyen MH. Perspectives on the Underlying Etiology of HCC and Its Effects on Treatment Outcomes. J Hepatocell Carcinoma 2023; 10:413-428. [PMID: 36926055 PMCID: PMC10013586 DOI: 10.2147/jhc.s347959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/25/2023] [Indexed: 03/11/2023] Open
Abstract
Hepatocellular carcinoma (HCC) continues to be a serious medical problem with poor prognosis worldwide. The distribution of the major etiologies of HCC is changing due to the progress of anti-viral treatments, including hepatitis B virus (HBV) suppression by nucleoside/nucleotide analogues (NAs) and increased sustained virologic response (SVR) rates by direct-acting antivirals (DAAs) for hepatitis C virus (HCV), as well as the rising trend of nonviral liver disease. Although viral hepatitis remains the most common cause of HCC, non-alcoholic liver disease (NAFLD) with metabolic syndrome and alcohol-associated liver disease (ALD) are increasing. Effective and well-tolerated NAs treatment can slow the disease progression of chronic HBV infection to cirrhosis, end-stage liver disease, and reduce HCC risk. Treatment with NAs is also associated with significant improvement in the long-term survival of patients with HBV infection who already have HCC. DAAs have achieved viral elimination in almost all patients with HCV without significant adverse events, even in patients with decompensated liver cirrhosis and HCC. Similarly, DAA therapy can reduce disease progression, liver and non-liver complications, and improve the long-term survival of patients with chronic HCV infection with or without HCC. Meanwhile, NAFLD is a rapidly increasing cause of HCC along with the epidemics of obesity and type 2 diabetes globally. NAFLD-related HCC can occur in patients without cirrhosis and is known to have a lower survival rate than viral hepatitis-related HCC. Since there is currently no specific pharmacotherapy effective for NAFLD, lifestyle modification and prevention of complications are important to improve prognosis. Additionally, ALD is the second fastest-growing cause of HCC-related deaths, especially with an accelerated trend since the COVID-19 pandemic. This review provides an overview of the epidemiologic trends in the etiologies of HCC, and the progress of treatments for each etiology and the impact on outcome in the patients with HCC.
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Affiliation(s)
- Takanori Ito
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, CA, USA.,Department of Epidemiology and Population Health, Stanford University Medical Center, Palo Alto, CA, USA
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10
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Nguyen VH, Kam L, Yeo YH, Huang DQ, Henry L, Cheung R, Nguyen MH. Characteristics and Treatment Rate of Patients With Hepatitis C Virus Infection in the Direct-Acting Antiviral Era and During the COVID-19 Pandemic in the United States. JAMA Netw Open 2022; 5:e2245424. [PMID: 36477481 PMCID: PMC9856330 DOI: 10.1001/jamanetworkopen.2022.45424] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Clinical data on hepatitis C virus (HCV) treatment rates in the United States are sparse. OBJECTIVE To evaluate HCV treatment rates in the era of direct-acting antivirals (DAAs). DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from the deidentified Optum Cliniformatics Data Mart Database (2014-2021) on patients with HCV in the DAA and COVID-19 eras. The database includes patients with private health insurance in the US. MAIN OUTCOMES AND MEASURES The treatment rate and changes over time were assessed with adjusted log-binomial regression, and factors associated with treatment were examined using multivariable logistic regression. RESULTS A total of 133 348 patients with HCV (79 567 [59.7%] men; mean [SD] age, 59.7 [12.3] years; 4448 [3.3%] Asian, 24 662 [18.5%] Black, and 74 750 [56.1%] White individuals) were included; 38 180 (26.8%) had HCV RNA data, and of those, 20 277 (53.1%) had positive HCV RNA. Overall, 13 214 patients with positive HCV RNA tests (65.2%) received DAA treatment; 6456 of 6634 patients treated with DAAs (97.3%) achieved sustained virologic response. After adjusting for age, sex, and race and ethnicity, the treatment rate in 2018 was 0.5 times greater than the rate in 2014 (adjusted prevalence ratio, 1.50; 95% CI, 1.42-1.59) but declined after 2018, decreasing from 64.8% to 61.2%, and especially after 2019, when it decreased to less than 60% (P < .001). The number of patients with viremic HCV identified in between April 2020 and March 2021 also decreased to 496 from 2761 and 3258 in the preceding 2 years. Receiving care from a gastroenterologist or infectious disease specialist with advanced care practitioner (ie, nurse practitioner, physician assistant, or clinical nurse specialist) was independently associated with greater odds of DAA treatment (adjusted odds ratio [aOR], 1.64; 95% CI, 1.07-1.50). Patients with decompensated cirrhosis and/or hepatocellular carcinoma (HCC) were 31% less likely to receive treatment compared with those without (aOR, 0.69; 95% CI, 0.54-0.90). CONCLUSIONS AND RELEVANCE In this cohort study, less than two-thirds of insured patients with viremic HCV received DAA treatment, with declines in both the treatment rate and the number of viremic HCV diagnoses since 2019 and especially during the COVID-19 pandemic. Further efforts are needed to increase HCV diagnosis and treatment, especially for those with cirrhosis and HCC. An urgent call for nationwide actions to improve access to DAA treatment, community outreach programs, and specialists through referral pipelines is needed in the United States to stay on track to meet the World Health Organization goal of reducing the burden of viral hepatitis with the eventual goal to eliminate viral hepatitis.
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Affiliation(s)
- Vy H. Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California
| | - Leslie Kam
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California
| | - Yee Hui Yeo
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California
- Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniel Q. Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Linda Henry
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Mindie H. Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, California
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11
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Lo CC, Huang CF, Cheng PN, Tseng KC, Chen CY, Kuo HT, Huang YH, Tai CM, Peng CY, Bair MJ, Chen CH, Yeh ML, Lin CL, Lin CY, Lee PL, Chong LW, Hung CH, Chang TS, Huang JF, Yang CC, Hu JT, Lin CW, Chen CT, Wang CC, Su WW, Hsieh TY, Lin CL, Tsai WL, Lee TH, Chen GY, Wang SJ, Chang CC, Mo LR, Yang SS, Wu WC, Huang CS, Hsiung CK, Kao CN, Tsai PC, Liu CH, Lee MH, Liu CJ, Dai CY, Chuang WL, Lin HC, Kao JH, Yu ML. Ledipasvir/sofosbuvir for HCV genotype 1, 2, 4-6 infection: Real-world evidence from a nationwide registry in Taiwan. J Formos Med Assoc 2022; 121:1567-1578. [PMID: 35123849 DOI: 10.1016/j.jfma.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 12/08/2021] [Accepted: 01/11/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/PURPOSE The Taiwan Association for the Study of the Liver (TASL) HCV Registry (TACR) is a nationwide registry of chronic hepatitis C patients in Taiwan. This study evaluated antiviral effectiveness of ledipasvir (LDV)/sofosbuvir (SOF) in patients in the TACR. METHODS Patients enrolled in TACR from 2017-2020 treated with LDV/SOF were eligible. The primary outcome was the proportion of patients with sustained virologic response 12 weeks after end of treatment (SVR12). RESULTS 5644 LDV/SOF ± ribavirin-treated patients were included (mean age: 61.4 years; 54.4% female). Dominant viral genotypes were GT1 (50.8%) and GT2 (39.3%). 1529 (27.1%) patients had liver cirrhosis, including 201 (3.6%) with liver decompensation; 686 (12.2%) had chronic kidney disease. SVR12 was achieved in 98.6% of the overall population and in 98.2% and 98.7% of patients with and without cirrhosis, respectively. SVR12 rates in patients with compensated cirrhosis treated with LDV/SOF without RBV were >98%, regardless of prior treatment experience. SVR12 was 98.6%, 98.4%, 100%, 100%, and 98.7% among those with GT1, GT2, GT4, GT5, and GT6 infections, respectively. Although patient numbers were relatively small, SVR12 rates of 100% were reported in patients infected with HCV GT2, GT5, and GT6 with decompensated cirrhosis and 98% in patients with severely compromised renal function. LDV/SOF adherence ≤60% (P < 0.001) was the most important factor associated with treatment failure. Incidence of adverse events was 15.8%, with fatigue being the most common. CONCLUSION LDV/SOF is effective and well tolerated in routine clinical practice in Taiwan. Cure rates were high across patient populations.
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Affiliation(s)
- Ching-Chu Lo
- Division of Gastroenterology, Department of Internal Medicine, St. Martin De Porres Hospital, Chiayi, Taiwan; Chung-Jen Junior College of Nursing, Health Sciences and Management, Chiayi, Taiwan
| | - Chung-Feng Huang
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine and Hepatitis Research Center, College of Medicine, Center for Cancer Research and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pin-Nan Cheng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kuo-Chih Tseng
- Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi; School of Medicine, Tzuchi University, Hualien, Taiwan
| | - Chi-Yi Chen
- Division of Gastroenterology and Hepatology, Department of Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Taiwan
| | - Hsing-Tao Kuo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, Yongkang District, Tainan, 710, Taiwan
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chi-Ming Tai
- Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Cheng-Yuan Peng
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, School of Medicine, China Medical University, Taichung, Taiwan
| | - Ming-Jong Bair
- Division of Gastroenterology, Department of Internal Medicine, Taitung Mackay Memorial Hospital, Taiwan; Mackay Medical College, New Taipei City, Taiwan
| | - Chien-Hung Chen
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan
| | - Ming-Lun Yeh
- School of Medicine and Hepatitis Research Center, College of Medicine, Center for Cancer Research and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Lang Lin
- Department of Gastroenterology and Hepatology, Keelung Chang Gung Memorial Hospital, Taiwan
| | - Chun-Yen Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan; Graduate Institute of Biomedical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pei-Lun Lee
- Chi Mei Medical Center, Liouying Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taiwan
| | - Lee-Won Chong
- Division of Hepatology and Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Chao-Hung Hung
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan; Division of Hepatogastroenterology, Department of Internal Medicine, ChiaYi Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Te Sheng Chang
- Division of Hepatogastroenterology, Department of Internal Medicine, ChiaYi Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jee-Fu Huang
- School of Medicine and Hepatitis Research Center, College of Medicine, Center for Cancer Research and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Chieh Yang
- Department of Gastroenterology, Division of Internal Medicine, Show Chwan Memorial Hospital, Taiwan
| | - Jui-Ting Hu
- Liver Center, Cathay General Hospital, Taiwan
| | - Chih-Wen Lin
- Division of Gastroenterology and Hepatology, E-Da Dachang Hospital, School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chun-Ting Chen
- Division of Gastroenterology, Department of Internal Medicine Tri-Service General Hospital Penghu Branch, National Defense Medical Center, Taipei, Taiwan; Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Chi Wang
- Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and School of Medicine, Tzu Chi University, Taiwan
| | - Wei-Wen Su
- Department of Gastroenterology and Hepatology, Changhua Christian Hospital, Taiwan
| | - Tsai-Yuan Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Lin Lin
- Department of Gastroenterology, Renai Branch, Taipei City Hospital, Taipei, Taiwan
| | - Wei-Lun Tsai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Taiwan
| | - Tzong-Hsi Lee
- Division of Gastroenterology and Hepatology, Far Eastern Memorial Hospital, Taiwan
| | | | - Szu-Jen Wang
- Division of Gastroenterology, Department of Internal Medicine, Yuan's General Hospital, Taiwan
| | - Chun-Chao Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taiwan
| | - Lein-Ray Mo
- Division of Gastroenterology, Tainan Municipal Hospital, Taiwan
| | - Sheng-Shun Yang
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | | | | | - Chien-Neng Kao
- National Taiwan University Hospital Hsin-Chu Branch, Taiwan
| | - Pei-Chien Tsai
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chen-Hua Liu
- Hepatitis Research Center and Department of Internal Medicine, National Taiwan University Hospital, Taiwan
| | - Mei-Hsuan Lee
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taiwan
| | - Chun-Jen Liu
- Hepatitis Research Center and Department of Internal Medicine, National Taiwan University Hospital, Taiwan
| | - Chia-Yen Dai
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine and Hepatitis Research Center, College of Medicine, Center for Cancer Research and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wan-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine and Hepatitis Research Center, College of Medicine, Center for Cancer Research and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Han-Chieh Lin
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taiwan
| | - Jia-Horng Kao
- Hepatitis Research Center and Department of Internal Medicine, National Taiwan University Hospital, Taiwan.
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine and Hepatitis Research Center, College of Medicine, Center for Cancer Research and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
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12
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Parikh ND, Mehta N, Hoteit MA, Yang JD, John BV, Moon AM, Salgia RJ, Pillai A, Kassab I, Saeed N, Thyssen E, Nathani P, McKinney J, Chan W, Durkin C, Connor M, Alsudaney M, Konjeti R, Durand B, Nissen NN, Kim HP, Paknikar R, Rich NE, Schipper MJ, Singal AG. Association between sustained virological response and clinical outcomes in patients with hepatitis C infection and hepatocellular carcinoma. Cancer 2022; 128:3470-3478. [PMID: 35796530 PMCID: PMC9545187 DOI: 10.1002/cncr.34378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/05/2022] [Accepted: 03/09/2022] [Indexed: 11/16/2022]
Abstract
Background Sustained viral response (SVR) improves survival for patients with hepatitis C (HCV) and hepatocellular carcinoma (HCC) after curative treatment; however, the benefit of SVR in those with active HCC with a significant competing risk of mortality is unknown. This study aimed to evaluate the association between SVR and outcomes in patients with active HCC. Methods The authors performed a multicenter, retrospective cohort study including consecutive adults with HCV cirrhosis and treatment‐naive HCC diagnosed between 2014 and 2018. Patients were stratified into two groups: active viremia (n = 431) and SVR before HCC diagnosis (n = 135). All patients underwent nonsurgical therapy as their initial treatment and were followed until liver transplantation, last follow‐up, or death. The primary outcome was incident or worsening hepatic decompensation within 6 months and the secondary outcome was overall survival. All analyses used inverse probability of treatment weights (IPTW) to account for differences between the nonrandomized cohorts. Results Post‐SVR patients had significantly lower odds of hepatic decompensation compared to viremic patients (odds ratio [OR], 0.18; 95% confidence interval [CI], 0.06–0.59). Results were consistent among subgroups of patients with Child Pugh A cirrhosis (OR, 0.22; 95% CI, 0.04–0.77), Barcelona Clinic Liver Cancer stage B/C HCC (OR, 0.20; 95% CI, 0.04–0.65), and those receiving nonablative HCC therapies (OR, 0.21; 95% CI, 0.07–0.67). However, in IPTW multivariable Cox regression, SVR was not associated with improved survival (hazard ratio, 0.79; 95% CI, 0.56–1.12). Conclusions Patients with HCV‐related HCC and SVR are less likely to experience hepatic decompensation than viremic patients, suggesting patients with HCC who are undergoing nonsurgical therapies may benefit from DAA treatment. Hepatitis C virus‐related hepatocellular carcinoma remains prevalent in clinical practice, however, whether treatment of hepatitis C improves outcomes is unknown. The authors have shown an association between hepatitis C sustained virological response and decreased risk of hepatic decompensation in patients with hepatocellular carcinoma, across stages of disease and types of therapy received. See also pages 000–000.
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Affiliation(s)
- Neehar D Parikh
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Neil Mehta
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California, USA
| | - Maarouf A Hoteit
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ju Dong Yang
- Division of Gastroenterology, Cedars Sinai, Los Angeles, California, USA
| | - Binu V John
- Division of Gastroenterology, University of Miami, Miami, Florida, USA.,Section of Hepatology, Miami VA Health System, Miami, Florida, USA
| | - Andrew M Moon
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Reena J Salgia
- Division of Gastroenterology, Henry Ford Health System, Detroit, Michigan, USA
| | - Anjana Pillai
- Division of Gastroenterology, University of Chicago, Chicago, Illinois, USA
| | - Ihab Kassab
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Naba Saeed
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Emil Thyssen
- Division of Digestive and Liver Diseases, University of Texas Southwestern, Dallas, Texas, USA
| | - Piyush Nathani
- Division of Digestive and Liver Diseases, University of Texas Southwestern, Dallas, Texas, USA
| | - Jeffrey McKinney
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California, USA
| | - Wesley Chan
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California, USA
| | - Claire Durkin
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew Connor
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Manaf Alsudaney
- Division of Gastroenterology, Cedars Sinai, Los Angeles, California, USA
| | - Rajesh Konjeti
- Division of Gastroenterology and Hepatology, University of Kentucky, Lexington, Kentucky, USA
| | - Brenda Durand
- Comprehensive Transplant Center, Cedars Sinai, Los Angeles, California, USA
| | - Nicholas N Nissen
- Comprehensive Transplant Center, Cedars Sinai, Los Angeles, California, USA
| | - Hannah P Kim
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Nicole E Rich
- Division of Digestive and Liver Diseases, University of Texas Southwestern, Dallas, Texas, USA
| | - Matthew J Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Amit G Singal
- Division of Digestive and Liver Diseases, University of Texas Southwestern, Dallas, Texas, USA
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13
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Ogawa E, Kawano A, Ooho A, Furusyo N, Satoh T, Takahashi K, Kajiwara E, Dohmen K, Nakamuta M, Azuma K, Koyanagi T, Yamashita N, Yanagita K, Ichiki Y, Kuniyoshi M, Yamashita N, Morita C, Sugimoto R, Kato M, Shimoda S, Nomura H, Hayashi J. Long-term hepatic function of patients with compensated cirrhosis following successful direct-acting antiviral treatment for hepatitis C virus infection. J Gastroenterol Hepatol 2022; 37:371-377. [PMID: 34618379 DOI: 10.1111/jgh.15703] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/24/2021] [Accepted: 10/01/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Direct-acting antivirals (DAAs) have contributed to the improvement of outcomes for all patients with chronic hepatitis C. The aim of this study was to evaluate the long-term hepatic benefits of hepatitis C virus (HCV) cure by DAAs in patients with compensated cirrhosis. METHODS This multicenter cohort study consisted of consecutive patients with compensated cirrhosis who initiated interferon-free DAA treatment before September 2016. The impact of treatment on long-term hepatic function was followed for at least 4 years after the end of treatment, and the progression to decompensation was evaluated. RESULTS The data of 394 patients were available for study. The median age was 70, and 41% had modified albumin-bilirubin (ALBI) grade 2b. During a short-term follow-up 1 year after the end of treatment, FIB-4 index and ALBI score significantly improved. The achievement rates of FIB-4 < 3.25 (40%) and ALBI grade 1 (70%) reached their plateau in the first year; however, there were significant further improvements in platelet count and α-fetoprotein level after the first year. The annual incidence of decompensation was 1.30 (95% confidence interval 0.83-2.02) per 100 person-years. In multivariable analysis, male sex and modified ALBI grade 2b at baseline were associated with decompensation. CONCLUSIONS In a large real-world cohort of patients with compensated cirrhosis treated with a DAA, remarkable improvement in hepatic function was seen after HCV cure, especially during the first year after the end of treatment. Treatment in the early stage of cirrhosis would be of great benefit for preventing liver deterioration to decompensation.
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Affiliation(s)
- Eiichi Ogawa
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Akira Kawano
- Department of Medicine, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Aritsune Ooho
- Department of Hepatology, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Norihiro Furusyo
- General Internal Medicine, Taihaku Avenue Clinic, Fukuoka, Japan
| | - Takeaki Satoh
- Center for Liver Disease, Kokura Medical Center, National Hospital Organization, Kitakyushu, Japan
| | | | | | - Kazufumi Dohmen
- Department of Internal Medicine, Chihaya Hospital, Fukuoka, Japan
| | - Makoto Nakamuta
- Department of Gastroenterology, Kyushu Medical Center, National Hospital Organization, Fukuoka, Japan
| | - Koichi Azuma
- Department of Medicine, Kyushu Central Hospital, Fukuoka, Japan
| | | | | | - Kimihiko Yanagita
- Department of Internal Medicine, Saiseikai Karatsu Hospital, Karatsu, Japan
| | - Yasunori Ichiki
- Department of Internal Medicine, JCHO Kyushu Hospital, Kitakyushu, Japan
| | - Masami Kuniyoshi
- Department of Gastroenterology, Kyushu Rosai Hospital, Kitakyushu, Japan
| | - Naoki Yamashita
- Department of Gastroenterology, Kyushu Medical Center, National Hospital Organization, Fukuoka, Japan
| | - Chie Morita
- Department of Internal Medicine, Kyushu Railway Memorial Hospital, Kitakyushu, Japan
| | - Rie Sugimoto
- Department of Gastroenterology, Kyushu Cancer Center, Fukuoka, Japan
| | - Masaki Kato
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Graduate School of Nutritional Sciences, Nakamura Gakuen University, Fukuoka, Japan
| | - Shinji Shimoda
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hideyuki Nomura
- Department of Internal Medicine, Haradoi Hospital, Fukuoka, Japan
| | - Jun Hayashi
- Kyushu General Internal Medicine Center, Haradoi Hospital, Fukuoka, Japan
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14
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Ogawa E. Editorial: the role for PIVKA-II measurement after HCV elimination by direct-acting anti-virals in terms of prediction of hepatocellular carcinoma. Aliment Pharmacol Ther 2022; 55:122-123. [PMID: 34907552 DOI: 10.1111/apt.16696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Eiichi Ogawa
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
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15
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Ogawa E, Nakamuta M, Furusyo N, Kajiwara E, Dohmen K, Kawano A, Ooho A, Azuma K, Takahashi K, Satoh T, Koyanagi T, Yamashita N, Ichiki Y, Yamashita N, Kuniyoshi M, Yanagita K, Amagase H, Morita C, Sugimoto R, Kato M, Shimoda S, Nomura H, Hayashi J. Long-term assessment of recurrence of hepatocellular carcinoma in patients with chronic hepatitis C after viral cure by direct-acting antivirals. J Gastroenterol Hepatol 2022; 37:190-199. [PMID: 34374128 PMCID: PMC9291903 DOI: 10.1111/jgh.15659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/15/2021] [Accepted: 08/04/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Early hepatocellular carcinoma (HCC) recurrence is common, even after achieving hepatitis C virus (HCV) cure. This study was carried out to assess the long-term trends and predictors of recurrence after HCV cure by direct-acting antivirals (DAAs). METHODS This retrospective, multicenter cohort study enrolled 365 consecutive patients with chronic hepatitis C who required HCC treatment following sustained viral response (SVR) by DAA administration. Patients with HCC recurrence before SVR were excluded. Late HCC recurrence and its predictors beyond the post-treatment early phase (24 weeks after SVR) were evaluated. RESULTS The data of 326 patients were available for the final analysis. The median follow-up duration from SVR determination was 2.7 years. Median age was 74, and 220 (67.5%) were 70 or over. The corresponding 5-year cumulative HCC recurrence rates of previous curative and palliative treatment groups were 45.4% and 65.7%, respectively (log-rank test: P < 0.001). Cox regression multivariable analysis revealed that cirrhosis (hazard ratio [HR] 1.85, P = 0.021), the number of HCC nodules (≥ 2) (HR 1.52, P = 0.031), and previous palliative HCC treatment (HR 1.71, P = 0.012) were independent predictors of late recurrence, in addition to the predictors of early recurrence; AFP > 7 ng/mL at 12 weeks after DAA administration, time from HCC complete response (CR) to DAA initiation (< 1 year), and the number of HCC treatments necessary to achieve CR (≥ 2). CONCLUSIONS The evaluation of fibrosis and characteristics of the previous HCC would allow for better HCC recurrence stratification, which would be helpful for developing long-term surveillance strategies.
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Affiliation(s)
- Eiichi Ogawa
- Department of General Internal MedicineKyushu University HospitalFukuokaJapan
| | - Makoto Nakamuta
- Department of Gastroenterology, Kyushu Medical CenterNational Hospital OrganizationFukuokaJapan
| | | | | | | | - Akira Kawano
- Department of MedicineKitakyushu Municipal Medical CenterKitakyushuJapan
| | - Aritsune Ooho
- Department of HepatologySteel Memorial Yawata HospitalKitakyushuJapan
| | - Koichi Azuma
- Department of MedicineKyushu Central HospitalFukuokaJapan
| | | | - Takeaki Satoh
- Center for Liver Disease, Kokura Medical CenterNational Hospital OrganizationKitakyushuJapan
| | | | | | - Yasunori Ichiki
- Department of Internal MedicineJCHO Kyushu HospitalKitakyushuJapan
| | - Naoki Yamashita
- Department of Gastroenterology, Kyushu Medical CenterNational Hospital OrganizationFukuokaJapan
| | - Masami Kuniyoshi
- Department of GastroenterologyKyushu Rosai HospitalKitakyushuJapan
| | - Kimihiko Yanagita
- Department of Internal MedicineSaiseikai Karatsu HospitalKaratsuJapan
| | | | - Chie Morita
- Department of Internal MedicineKyushu Railway Memorial HospitalKitakyushuJapan
| | - Rie Sugimoto
- Department of GastroenterologyKyushu Cancer CenterFukuokaJapan
| | - Masaki Kato
- Department of Medicine and Bioregulatory Science, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan,Graduate School of Nutritional SciencesNakamura Gakuen UniversityFukuokaJapan
| | - Shinji Shimoda
- Department of Medicine and Biosystemic Science, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | | | - Jun Hayashi
- Kyushu General Internal Medicine CenterHaradoi HospitalFukuokaJapan
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16
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Abstract
BACKGROUND Underdiagnosis of HCV infection may hinder the obtainment of 2030 elimination goal. OBJECTIVE To estimate the pre-DAA HCV diagnosis rate to inform future public health effort. METHODS Data were obtained from three nationwide databases (Truven Health MarketScan Research Database 2007-2014, US Census Bureau 2012-2016 and NHANES 2007-2014). HCV diagnosis was defined with either one inpatient or two outpatient HCV International Classification of Disease 9 codes, providing the number of patients with diagnosed HCV (Truven). US Census Bureau data were used for age- and sex-standardization. We derived the total (diagnosed and undiagnosed) HCV infection using the NHANES database. To determine the rate and number of undiagnosed HCV, we subtracted diagnosed HCV burden (Truven) from the total HCV burden (NHANES). RESULTS Of the 198 073 302 privately insured Americans, 1.49% (2 951 490 persons) had HCV infection. However, only 362 672 (12.29%) persons were diagnosed with HCV, leaving 2 588 818 (87.71%) undiagnosed. About two-third (68.04%) and one-third (33.04%) of diagnosed HCV patients had HCV RNA or genotype tests overall, with even lower rates for the ≥65 age group, respectively. CONCLUSION In the pre-DAA era, only 12% of insured Americans with HCV were diagnosed. While this grim statistic is expected to rise, much more effort is needed to enhance the HCV care cascade.
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17
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Yeh ML, Liang PC, Tsai PC, Wang SC, Leong J, Ogawa E, Jun DW, Tseng CH, Landis C, Tanaka Y, Huang CF, Hayashi J, Hsu YC, Huang JF, Dai CY, Chuang WL, Nguyen MH, Yu ML. Characteristics and Survival Outcomes of Hepatocellular Carcinoma Developed after HCV SVR. Cancers (Basel) 2021; 13:cancers13143455. [PMID: 34298669 PMCID: PMC8306695 DOI: 10.3390/cancers13143455] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary It is important to understand the impact of viremia on the survival of hepatocellular carcinoma (HCC) in hepatitis C patients. This study aimed to investigate the characteristics and survival between hepatitis C patients with and without viremia at HCC diagnosis. We enrolled 1,389 HCC patients, including 301 with HCC developed after hepatitis C eradication (post-SVR HCC) and 1,088 with hepatitis C viremia (viremic HCC). Post-SVR HCC patients had better liver function, earlier tumor stages and higher median survival than viremic HCC patients. But post-SVR HCC was not independently associated with survival on further multivariate analysis. On sub-analysis, viremic HCC patients who subsequently eradicated hepatitis C had higher median survival and was also significantly associated with lower mortality as compared to post-SVR HCC. Therefore, the advantages in clinical and tumor characters determined the better overall survival of post-SVR HCC patients; however, eradication of hepatitis C after HCC also improved survival. Abstract The clinical presentation and survival of hepatocellular carcinoma (HCC) after hepatitis C virus (HCV) eradication as compared to HCC in viremic patients are not well characterized. We aimed to investigate the characteristics and survival between HCV patients with and without viremia at HCC diagnosis.: We retrospectively analyzed overall survival outcomes in 1389 HCV-related HCC patients, including 301 with HCC developed after HCV eradication (post-SVR HCC) and 1088 with HCV viremia at HCC diagnosis (viremic HCC). We also evaluated overall survival in the two groups using propensity score-matching methods.: At HCC diagnosis, post-SVR HCC patients were older, less obese, less likely cirrhotic, with better liver function, lower alfa-fetoprotein levels, earlier BCLC stages, and higher rate of treatment with surgery. Overall, post-SVR HCC patients had higher median survival than viremic patients (153.3 vs. 55.6 months, p < 0.01), but post-SVR HCC was not independently associated with survival on multivariate analysis (adjusted HR: 1.05, 95% CI: 0.76–1.47). However, on sub-analysis, viremic HCC patients who subsequently received anti-viral treatment and achieved SVR had higher median survival than post-SVR HCC patients (p < 0.01). Viremic HCC with subsequent SVR was also significantly associated with lower mortality as compared to post-SVR HCC (adjusted HR: 0.18, 95% CI: 0.11–0.29). In addition, we observed similar findings in our analysis of the propensity score-matched cohorts.: The advantages in clinical and tumor characters at HCC diagnosis determined the better overall survival of post-SVR HCC patients; however, HCV eradication after HCC development was also associated with improved survival.
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Affiliation(s)
- Ming-Lun Yeh
- Department of Internal Medicine and Hepatitis Center, Hepatobiliary Division, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (M.-L.Y.); (P.-C.L.); (P.-C.T.); (C.-F.H.); (J.-F.H.); (C.-Y.D.); (W.-L.C.)
- Lipid Science and Aging Research Center, School of Medicine, and Hepatitis Research Center, College of Medicine, and Center for Cancer Research and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Po-Cheng Liang
- Department of Internal Medicine and Hepatitis Center, Hepatobiliary Division, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (M.-L.Y.); (P.-C.L.); (P.-C.T.); (C.-F.H.); (J.-F.H.); (C.-Y.D.); (W.-L.C.)
| | - Pei-Chien Tsai
- Department of Internal Medicine and Hepatitis Center, Hepatobiliary Division, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (M.-L.Y.); (P.-C.L.); (P.-C.T.); (C.-F.H.); (J.-F.H.); (C.-Y.D.); (W.-L.C.)
| | - Shu-Chi Wang
- Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Jennifer Leong
- Henry D. Janowitz Division of Gastroenterology, Mt. Sinai Health System, New York, NY 10029, USA;
| | - Eiichi Ogawa
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka 812-8582, Japan;
| | - Dae Won Jun
- Department of Gastroenterology, School of Medicine, Hanyang University, Seoul 04763, Korea;
| | - Cheng-Hao Tseng
- Division of Gastroenterology of Hepatology, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan; (C.-H.T.); (Y.-C.H.)
| | - Charles Landis
- Department of Gastroenterology, University of Washington Medical Center, Seattle, WA 98195, USA;
| | - Yasuhito Tanaka
- Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8555, Japan;
| | - Chung-Feng Huang
- Department of Internal Medicine and Hepatitis Center, Hepatobiliary Division, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (M.-L.Y.); (P.-C.L.); (P.-C.T.); (C.-F.H.); (J.-F.H.); (C.-Y.D.); (W.-L.C.)
- Lipid Science and Aging Research Center, School of Medicine, and Hepatitis Research Center, College of Medicine, and Center for Cancer Research and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Jun Hayashi
- Kyushu General Internal Medicine Center, Haradoi Hospital, Fukuoka 812-0063, Japan;
| | - Yao-Chun Hsu
- Division of Gastroenterology of Hepatology, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan; (C.-H.T.); (Y.-C.H.)
| | - Jee-Fu Huang
- Department of Internal Medicine and Hepatitis Center, Hepatobiliary Division, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (M.-L.Y.); (P.-C.L.); (P.-C.T.); (C.-F.H.); (J.-F.H.); (C.-Y.D.); (W.-L.C.)
- Lipid Science and Aging Research Center, School of Medicine, and Hepatitis Research Center, College of Medicine, and Center for Cancer Research and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Chia-Yen Dai
- Department of Internal Medicine and Hepatitis Center, Hepatobiliary Division, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (M.-L.Y.); (P.-C.L.); (P.-C.T.); (C.-F.H.); (J.-F.H.); (C.-Y.D.); (W.-L.C.)
- Lipid Science and Aging Research Center, School of Medicine, and Hepatitis Research Center, College of Medicine, and Center for Cancer Research and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Wan-Long Chuang
- Department of Internal Medicine and Hepatitis Center, Hepatobiliary Division, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (M.-L.Y.); (P.-C.L.); (P.-C.T.); (C.-F.H.); (J.-F.H.); (C.-Y.D.); (W.-L.C.)
- Lipid Science and Aging Research Center, School of Medicine, and Hepatitis Research Center, College of Medicine, and Center for Cancer Research and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Mindie H. Nguyen
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, CA 94304, USA
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, CA 94304, USA
- Correspondence: (M.H.N.); (M.-L.Y.); Tel.: +1-65-0498-6084 (M.H.N.); +88-6-7312-1101 (ext. 7475) (M.-L.Y.); Fax: +1-65-0498-5692 (M.H.N.); +88-67312-3955 (M.-L.Y.)
| | - Ming-Lung Yu
- Department of Internal Medicine and Hepatitis Center, Hepatobiliary Division, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (M.-L.Y.); (P.-C.L.); (P.-C.T.); (C.-F.H.); (J.-F.H.); (C.-Y.D.); (W.-L.C.)
- Lipid Science and Aging Research Center, School of Medicine, and Hepatitis Research Center, College of Medicine, and Center for Cancer Research and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Correspondence: (M.H.N.); (M.-L.Y.); Tel.: +1-65-0498-6084 (M.H.N.); +88-6-7312-1101 (ext. 7475) (M.-L.Y.); Fax: +1-65-0498-5692 (M.H.N.); +88-67312-3955 (M.-L.Y.)
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18
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Ji F, Li T, Nguyen MH. Improved survival and high sustained virologic response with DAA therapy in patients with HCV-related HCC: A call for expanded use. J Gastroenterol Hepatol 2021; 36:1721-1722. [PMID: 33528034 DOI: 10.1111/jgh.15420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 01/21/2021] [Accepted: 01/31/2021] [Indexed: 12/21/2022]
Affiliation(s)
- F Ji
- Department of Infectious Diseases, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,National and Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - T Li
- Department of Infectious Diseases, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - M H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA.,Department of Epidemiology and Population Health, Stanford University, Palo Alto, California, USA
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19
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Chen C, Huang C, Cheng P, Tseng K, Lo C, Kuo H, Huang Y, Tai C, Peng C, Bair M, Chen C, Yeh M, Lin C, Lin C, Lee P, Chong L, Hung C, Huang J, Yang C, Hu J, Lin C, Chen C, Wang C, Su W, Hsieh T, Lin C, Tsai W, Lee T, Chen G, Wang S, Chang C, Mo L, Yang S, Wu W, Huang C, Hsiung C, Kao C, Tsai P, Liu C, Lee M, Liu C, Dai C, Kao J, Chuang W, Lin H, Yu M. Factors associated with treatment failure of direct-acting antivirals for chronic hepatitis C: A real-world nationwide hepatitis C virus registry programme in Taiwan. Liver Int 2021; 41:1265-1277. [PMID: 33655714 PMCID: PMC8252422 DOI: 10.1111/liv.14849] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND/AIMS Direct-acting antivirals (DAAs) are highly effective in treating chronic hepatitis C virus (HCV)-infected patients. The real-world treatment outcome in Taiwanese patients on a nationwide basis is elusive. METHODS The Taiwan HCV Registry (TACR) programme is a nationwide registry platform including 48 study sites, which is organized and supervised by the Taiwan Association for the Study of the Liver. The primary endpoint was sustained virological response (SVR12, undetectable HCV RNA 12 weeks after end-of-treatment). RESULTS A total of 13 951 registered patients with SVR12 data available were analysed (mean age, 63.0 years; female, 55.9%; HCV genotype-1 [GT1], 57.9%; cirrhosis, 38.4%; preexisting hepatocellular carcinoma [HCC], 10.6%; and hepatitis B virus coinfection, 7.7%). The overall SVR12 rate was 98.3%, with 98.7%, 98.0%, 98.4% and 97.4% in treatment-naïve noncirrhotic, treatment-naïve cirrhotic, treatment-experienced noncirrhotic and treatment-experienced cirrhotic patients, respectively. The SVR12 rate was > 95% across all subgroups except treatment-experienced cirrhotic patients who received sofosbuvir/ribavirin (88.7%), treatment-naïve noncirrhotic patients (94.8%) and treatment-experienced cirrhotic (94.8%) patients who received daclatasvir/asunaprevir. The most important factor associated with treatment failure was DAA adherence < 60% ( adjusted odds ratio [aOR]/95% confidence interval [CI]: 117.1/52.4-261.3, P < .001), followed by GT3/GT2 (aOR/CI: 5.78/2.25-14.9, P = .0003 and aOR/CI: 1.55/1.05-2.29, P = .03, compared with GT1), active hepatocellular carcinoma (aOR/CI: 4.29/2.57-7.16, P < .001), the use of sofosbuvir/ribavirin (aOR/CI: 2.51/1.67-3.77, P < .001) and daclatasvir/asunaprevir (aOR/CI: 3.29/1.94-5.58, P < .001), decompensated liver cirrhosis (aOR/CI: 2.50/1.20-5.22, P = .02) and high HCV viral loads (aOR/CI: 2.16/1.57-2.97, P < .001). CONCLUSIONS DAAs are highly effective in treating Taiwanese HCV patients in the real-world setting. Maintaining DAA adherence and selecting highly efficacious regimens are keys to ensure treatment success.
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Affiliation(s)
- Chi‐Yi Chen
- Division of Gastroenterology and HepatologyDepartment of MedicineDitmanson Medical Foundation Chiayi Christian HospitalChiayiTaiwan
| | - Chung‐Feng Huang
- Hepatobiliary DivisionDepartment of Internal Medicine and Hepatitis CenterKaohsiung Medical University HospitalKaohsiung Medical UniversityKaohsiungTaiwan,School of Medicine and Hepatitis Research CenterCollege of Medicine, and Center for Cancer Research and Center for Liquid Biopsy and Cohort ResearchKaohsiung Medical UniversityKaohsiungTaiwan
| | - Pin‐Nan Cheng
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineCollege of MedicineNational Cheng Kung University HospitalNational Cheng Kung UniversityTainanTaiwan
| | - Kuo‐Chih Tseng
- Department of Internal MedicineDalin Tzu Chi HospitalBuddhist Tzu Chi Medical FoundationChiayiTaiwan,School of MedicineTzuchi UniversityHualienTaiwan
| | - Ching‐Chu Lo
- Division of GastroenterologyDepartment of Internal MedicineSt. Martin De Porres HospitalChiayiTaiwan
| | - Hsing‐Tao Kuo
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineChi Mei Medical CenterTainanTaiwan
| | - Yi‐Hsiang Huang
- Division of Gastroenterology and HepatologyDepartment of MedicineTaipei Veterans General Hospital,Institute of Clinical MedicineSchool of MedicineNational Yang‐Ming UniversityTaipeiTaiwan
| | - Chi‐Ming Tai
- Department of Internal MedicineE‐Da HospitalKaohsiungTaiwan,School of MedicineCollege of MedicineI‐Shou UniversityKaohsiungTaiwan
| | - Cheng‐Yuan Peng
- Center for Digestive MedicineDepartment of Internal MedicineSchool of MedicineChina Medical University HospitalChina Medical UniversityTaichungTaiwan
| | - Ming‐Jong Bair
- Division of GastroenterologyDepartment of Internal MedicineTaitung Mackay Memorial HospitalTaitungTaiwan,Mackay Medical CollegeNew Taipei CityTaiwan
| | - Chien‐Hung Chen
- Division of Hepato‐GastroenterologyDepartment of Internal MedicineKaohsiung Chang Gung Memorial HospitalCollege of MedicineChang Gung UniversityTaoyuanTaiwan
| | - Ming‐Lun Yeh
- School of Medicine and Hepatitis Research CenterCollege of Medicine, and Center for Cancer Research and Center for Liquid Biopsy and Cohort ResearchKaohsiung Medical UniversityKaohsiungTaiwan,Department of Internal MedicineKaohsiung Municipal Siaogang HospitalKaohsiung Medical University HospitalKaohsiung Medical UniversityKaohsiungTaiwan
| | - Chih‐Lang Lin
- Department of Gastroenterology and HepatologyKeelung Chang Gung Memorial HospitalKeelungTaiwan
| | - Chun‐Yen Lin
- Department of Gastroenterology and HepatologyChang Gung Memorial HospitalLinkou BranchTaoyuanTaiwan,Graduate Institute of Biomedical ScienceCollege of MedicineChang Gung UniversityTaoyuanTaiwan
| | - Pei‐Lun Lee
- Liouying Division of Gastroenterology and HepatologyDepartment of Internal medicineChi Mei Medical CenterTainanTaiwan
| | - Lee‐Won Chong
- Division of Hepatology and GastroenterologyDepartment of Internal MedicineShin Kong Wu Ho‐Su Memorial HospitalTaipeiTaiwan,School of MedicineFu‐Jen Catholic UniversityNew Taipei CityTaiwan
| | - Chao‐Hung Hung
- Division of Hepato‐GastroenterologyDepartment of Internal MedicineKaohsiung Chang Gung Memorial HospitalCollege of MedicineChang Gung UniversityTaoyuanTaiwan,Division of HepatogastroenterologyDepartment of Internal MedicineChiaYi Chang Gung Memorial HospitalPuziTaiwan
| | - Jee‐Fu Huang
- School of Medicine and Hepatitis Research CenterCollege of Medicine, and Center for Cancer Research and Center for Liquid Biopsy and Cohort ResearchKaohsiung Medical UniversityKaohsiungTaiwan,Department of Internal MedicineKaohsiung Municipal Ta‐Tung HospitalKaohsiung Medical University HospitalKaohsiung Medical UniversityKaohsiungTaiwan
| | - Chi‐Chieh Yang
- Department of GastroenterologyDivision of Internal MedicineShow Chwan Memorial HospitalChanghuaTaiwan
| | - Jui‐Ting Hu
- Liver CenterCathay General HospitalTaipeiTaiwan
| | - Chih‐Wen Lin
- School of MedicineCollege of MedicineI‐Shou UniversityKaohsiungTaiwan,Division of Gastroenterology and HepatologyE‐Da Dachang HospitalKaohsiungTaiwan
| | - Chun‐Ting Chen
- Division of GastroenterologyDepartment of Internal MedicineTri‐Service General Hospital Penghu BranchNational Defense Medical CenterTaipeiTaiwan,Division of GastroenterologyDepartment of Internal MedicineTri‐Service General HospitalNational Defense Medical CenterTaipeiTaiwan
| | - Chia‐Chi Wang
- School of MedicineTaipei Tzu Chi HospitalBuddhist Tzu Chi Medical FoundationTzu Chi UniversityHualienTaiwan
| | - Wei‐Wen Su
- Department of Gastroenterology and HepatologyChanghua Christian HospitalChanghuaTaiwan
| | - Tsai‐Yuan Hsieh
- Division of GastroenterologyDepartment of Internal MedicineTri‐Service General HospitalNational Defense Medical CenterTaipeiTaiwan
| | - Chih‐Lin Lin
- Department of GastroenterologyRenai branchTaipei City HospitalTaipeiTaiwan
| | - Wei‐Lun Tsai
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineKaohsiung Veterans General HospitalKaohsiungTaiwan
| | - Tzong‐Hsi Lee
- Division of Gastroenterology and HepatologyFar Eastern Memorial HospitalNew Taipei CityTaiwan
| | - Guei‐Ying Chen
- Penghu HospitalMinistry of Health and WelfareTaipeiTaiwan
| | - Szu‐Jen Wang
- Division of GastroenterologyDepartment of Internal MedicineYuan’s General HospitalKaohsiungTaiwan
| | - Chun‐Chao Chang
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineTaipei Medical University HospitalTaipeiTaiwan,Division of Gastroenterology and HepatologyDepartment of Internal MedicineSchool of MedicineCollege of MedicineTaipei Medical UniversityTaipeiTaiwan
| | - Lein‐Ray Mo
- Division of GastroenterologyTainan Municipal HospitalTainanTaiwan
| | - Sheng‐Shun Yang
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineTaichung Veterans General HospitalTaichungTaiwan
| | | | | | | | - Chien‐Neng Kao
- National Taiwan University Hospital Hsin‐Chu BranchHsinchuTaiwan
| | - Pei‐Chien Tsai
- Hepatobiliary DivisionDepartment of Internal Medicine and Hepatitis CenterKaohsiung Medical University HospitalKaohsiung Medical UniversityKaohsiungTaiwan
| | - Chen‐Hua Liu
- Hepatitis Research Center and Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Mei‐Hsuan Lee
- Institute of Clinical MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Chun‐Jen Liu
- Hepatitis Research Center and Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Chia‐Yen Dai
- Hepatobiliary DivisionDepartment of Internal Medicine and Hepatitis CenterKaohsiung Medical University HospitalKaohsiung Medical UniversityKaohsiungTaiwan,School of Medicine and Hepatitis Research CenterCollege of Medicine, and Center for Cancer Research and Center for Liquid Biopsy and Cohort ResearchKaohsiung Medical UniversityKaohsiungTaiwan
| | - Jia‐Horng Kao
- Hepatitis Research Center and Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Wan‐Long Chuang
- Hepatobiliary DivisionDepartment of Internal Medicine and Hepatitis CenterKaohsiung Medical University HospitalKaohsiung Medical UniversityKaohsiungTaiwan,School of Medicine and Hepatitis Research CenterCollege of Medicine, and Center for Cancer Research and Center for Liquid Biopsy and Cohort ResearchKaohsiung Medical UniversityKaohsiungTaiwan
| | - Han‐Chieh Lin
- Division of Gastroenterology and HepatologyDepartment of MedicineTaipei Veterans General Hospital,Institute of Clinical MedicineSchool of MedicineNational Yang‐Ming UniversityTaipeiTaiwan
| | - Ming‐Lung Yu
- Hepatobiliary DivisionDepartment of Internal Medicine and Hepatitis CenterKaohsiung Medical University HospitalKaohsiung Medical UniversityKaohsiungTaiwan,School of Medicine and Hepatitis Research CenterCollege of Medicine, and Center for Cancer Research and Center for Liquid Biopsy and Cohort ResearchKaohsiung Medical UniversityKaohsiungTaiwan
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20
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Ji F, Li J, Liu L, Liang J, Wang X, Liu J, Cai D, Huang R, Zhang J, Wang Q, Nan Y, Li J, Ye Q, Zhang M, Xu Q, Guo F, Zhao C, Liu L, He C, Li Y, Wang W, Kam LY, Tran S, Maeda M, Mizuta A, Li Z, Dang S, Ren W, Zhu Q, Cheung R, Niu J, Xie W, Pan H, Ren H, Wu C, Shang J, Wang F, Nguyen MH. High hepatitis C virus cure rates with approved interferon-free direct-acting antivirals among diverse mainland Chinese patients including genotypes 3a and 3b. J Gastroenterol Hepatol 2021; 36:767-774. [PMID: 32840326 DOI: 10.1111/jgh.15192] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/04/2020] [Accepted: 07/19/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Globally, China has the highest chronic hepatitis C (CHC) burden, but its real-world direct-acting antiviral (DAA) data are limited. Our aim is to investigate the real-world outcome of China Food and Drug Administration-approved DAA therapies across mainland China including those with genotype (GT) 3. METHODS The REAL-C is a multinational real-world interferon-free DAA-treated CHC registry of several mainland China and other Asian centers. We evaluated the sustained virological response rate 12 weeks after end of treatment (SVR12), adverse events, and treatment effect on liver function and fibrosis (fibrosis-4 index). RESULTS We analyzed 859 DAA-treated CHC patients (6/1/2017-5/30/2019) from 12 mainland China centers (three municipalities and nine provinces): median age 52, 49.9% male, 33.1% cirrhosis, 95% treatment naïve, and 2.5% HBsAg+ . The most common GT was GT1b (523, 62.2%), followed by GT2a (156, 18.5%), GT3b (74, 8.8%), GT3a (41, 4.9%), and GT6 (37, 4.4%). SVR12 rates were 98.0% overall (95% confidence interval 96.9-98.8%), 98.1% for GT1b, 96.8% GT2a, 100% GT3a, 97.3% GT3b, and 100% GT6. Baseline cirrhosis and male sex but not prior treatment history, renal dysfunction, age, and GTs were associated with SVR12. For both cirrhotic and non-cirrhotic patients, there were significant improvement in liver function tests, alpha fetoprotein, and fibrosis-4 index with SVR12. Serious adverse events were rare (1.1%) with only nine patients discontinuing therapy prematurely and anemia being the most common adverse event (13.1%, mostly with ribavirin). CONCLUSIONS In real-world Chinese patients with diverse GTs, Chinese Food and Drug Administration-approved interferon-free DAAs were well tolerated, provided high cure rates (98.0% overall) including GT3a/3b, and led to improvement of liver function.
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Affiliation(s)
- Fanpu Ji
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jie Li
- Department of Infectious Diseases, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Li Liu
- Department of Hepatology, The Third People's Hospital of Kunming, Kunming, China
| | - Jing Liang
- Department of Gastroenterology and Hepatology, Tianjin Third Central Hospital, Tianjin, China
| | - Xiaozhong Wang
- Hospital of Traditional Chinese Medicine Affiliated to Xinjiang Medical University, Urumqi, China
| | - Junping Liu
- Department of Infectious Diseases, Henan Provincial People's Hospital, Zhengzhou, China
| | - Dachuan Cai
- Department of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Huang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Jiajie Zhang
- Department of Infectious Diseases, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Qi Wang
- Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yuemin Nan
- Department of Hepatology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Junyi Li
- Department of Hepatology, The Third People's Hospital of Kunming, Kunming, China
| | - Qing Ye
- Department of Gastroenterology and Hepatology, Tianjin Third Central Hospital, Tianjin, China
| | - Mingyuan Zhang
- Department of Hepatology, First Hospital of Jilin University, Changchun, China
| | - Qiang Xu
- Hospital of Traditional Chinese Medicine Affiliated to Xinjiang Medical University, Urumqi, China
| | - Feng Guo
- Hospital of Traditional Chinese Medicine Affiliated to Xinjiang Medical University, Urumqi, China
| | - Changqing Zhao
- Department of Cirrhosis, Institute of Liver Disease, Shuguang Hospital, Shanghai University of T. C. M., Shanghai, China
| | - Lingdi Liu
- Department of Hepatology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Caini He
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yu Li
- Department of Infectious Diseases, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Wenjun Wang
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Leslie Y Kam
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Sally Tran
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Mayumi Maeda
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Akiko Mizuta
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Zongfang Li
- Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shuangsuo Dang
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wanhua Ren
- Department of Infectious Diseases, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Qiang Zhu
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.,Division of Gastroenterology and Hepatology, Veteran Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Junqi Niu
- Department of Hepatology, First Hospital of Jilin University, Changchun, China
| | - Wen Xie
- Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hongying Pan
- Department of Infectious Diseases, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Hong Ren
- Department of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chao Wu
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Jia Shang
- Department of Infectious Diseases, Henan Provincial People's Hospital, Zhengzhou, China
| | - Fengmei Wang
- Department of Gastroenterology and Hepatology, Tianjin Third Central Hospital, Tianjin, China
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
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21
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Abstract
Hepatitis C virus represents an important global health issue with 71 million of infected people in the word. Direct-acting antivirals are quite new molecules that hit specific Hepatitis C virus proteins useful for viral replication and assembly. Notably, Direct-acting antivirals bring to high sustained virological response rates showing also a great safety profile. This treatment revolution had an impact on transplantation world, in fact the number of liver transplants due to Hepatitis C virus-related cirrhosis and hepatocellular carcinoma is quickly decreasing. Even if this therapy has achieved excellent results in terms of morbility and mortality rates' reduction, there are some debated issues to consider. In the present review the main clinical challenges in every-day management of Hepatitis C virus patients treated with Direct-acting antivirals and the debated effects of viral clearance (metabolic, cardiovascular, immunologic and neoplastic) are discussed. The detection of barriers that can preclude the delivery of Hepatitis C virus care, is the most complex challenge for the scientific community. To obtain the Hepatitis C virus global eradication by 2030, as the World Health Organization has set, will be complex and laborious and will need a further multilevel effort.
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Affiliation(s)
- Stefano Gitto
- Unit of Internal Medicine and Liver, University Hospital Careggi, Florence, Italy
| | - Carmela Cursaro
- Unit of Internal and Metabolic Medicine, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandra Bartoli
- Unit of Internal and Metabolic Medicine, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Marzia Margotti
- Unit of Internal and Metabolic Medicine, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Pietro Andreone
- Unit of Internal and Metabolic Medicine, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy -
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22
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Tanaka Y, Ogawa E, Huang CF, Toyoda H, Jun DW, Tseng CH, Hsu YC, Enomoto M, Takahashi H, Furusyo N, Yeh ML, Iio E, Yasuda S, Lam CPM, Lee DH, Haga H, Yoon EL, Ahn SB, Wong G, Nakamuta M, Nomura H, Tsai PC, Jung JH, Song DS, Dang H, Maeda M, Henry L, Cheung R, Yuen MF, Ueno Y, Eguchi Y, Tamori A, Yu ML, Hayashi J, Nguyen MH. HCC risk post-SVR with DAAs in East Asians: findings from the REAL-C cohort. Hepatol Int 2020; 14:1023-1033. [PMID: 33277685 DOI: 10.1007/s12072-020-10105-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite HCV cure, patients remain at risk for HCC, but risk factor data for HCC following SVR are limited for Asian patients. METHODS To address this gap, we analyzed 5814 patients (5646 SVR, 168 non-SVR) from the Real-World Evidence from the Asia Liver Consortium for HCV (REAL-C) who did not have HCC or a history of HCC at baseline (pre-DAA treatment) and did not develop HCC within 6 months of baseline. To assess the effect of SVR on HCC incidence, we used 1:4 propensity score matching [(PSM), age, sex, baseline cirrhosis, and baseline AFP] to balance the SVR and non-SVR groups. RESULTS In the PSM cohort (160 non-SVR and 612 SVR), the HCC incidence rate per 100 person years was higher in the non-SVR compared to the SVR group (5.26 vs. 1.94, p < 0.001). Achieving SVR was independently associated with decreased HCC risk (adjusted HR [aHR]: 0.41, p = 0.002). Next, we stratified the SVR cohort of 5646 patients to cirrhotic and noncirrhotic subgroups. Among cirrhotic SVR patients, aged ≥ 60, having an albumin bilirubin grade (ALBI) of 2 or 3 (aHR: 2.5, p < 0.001), and baseline AFP ≥ 10 ng/mL (aHR: 1.6, p = 0.001) were associated with higher HCC risk, while among the non-cirrhotic SVR group, only baseline AFP ≥ 10 ng/mL was significant (aHR: 4.26, p = 0.005). CONCLUSIONS Achieving SVR decreases HCC risk; however, among East Asians, patients with elevated pretreatment AFP remained at risk. Pretreatment AFP, an easily obtained serum marker, may provide both prognostic and surveillance value for HCC in East Asian patients who obtained SVR.
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Affiliation(s)
- Yasuhito Tanaka
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Eiichi Ogawa
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Chung-Feng Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Hepatitis Research Center, College of Medicine and Cohort Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hidenori Toyoda
- Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Dae Won Jun
- Department of Gastroenterology, Hanyang University, Seoul, South Korea
| | - Cheng-Hao Tseng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Yao-Chun Hsu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Masaru Enomoto
- Department of Hepatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hirokazu Takahashi
- Liver Center, Saga University Hospital, Saga, Japan.,Division of Metabolism and Endocrinology, Saga University Faculty of Medicine, Saga, Japan
| | - Norihiro Furusyo
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Ming-Lun Yeh
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Hepatitis Research Center, College of Medicine and Cohort Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Etsuko Iio
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Satoshi Yasuda
- Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Carla Pui-Mei Lam
- Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Dong Hyun Lee
- Department of Gastroenterology, Good Gang-An Hospital, Busan, Korea
| | - Hiroaki Haga
- Department of Gastroenterology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Eileen L Yoon
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Seoul, South Korea
| | - Sang Bong Ahn
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, South Korea
| | - Grace Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Makoto Nakamuta
- Department of Gastroenterology, Kyushu Medical Center, National Hospital Organization, Fukuoka, Japan
| | - Hideyuki Nomura
- Department of Internal Medicine, Haradoi Hospital, Fukuoka, Japan
| | - Pei-Chien Tsai
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Hepatitis Research Center, College of Medicine and Cohort Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jang Han Jung
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Do Seon Song
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hansen Dang
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, 780 Welch Road, Palo Alto, CA, 94304, USA
| | - Mayumi Maeda
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, 780 Welch Road, Palo Alto, CA, 94304, USA
| | - Linda Henry
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, 780 Welch Road, Palo Alto, CA, 94304, USA
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, 780 Welch Road, Palo Alto, CA, 94304, USA.,Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Man-Fung Yuen
- Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong.,State Key Laboratory of Liver Research, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Yoshiyuki Ueno
- Department of Gastroenterology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | | | - Akihiro Tamori
- Department of Hepatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Hepatitis Research Center, College of Medicine and Cohort Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jun Hayashi
- Kyushu General Internal Medicine, Haradoi Hospital, Fukuoka, Japan
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, 780 Welch Road, Palo Alto, CA, 94304, USA.
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23
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Ogawa E, Nomura H, Nakamuta M, Furusyo N, Kajiwara E, Dohmen K, Kawano A, Ooho A, Azuma K, Takahashi K, Satoh T, Koyanagi T, Ichiki Y, Kuniyoshi M, Yanagita K, Amagase H, Morita C, Sugimoto R, Kato M, Shimoda S, Hayashi J. Incidence of Hepatocellular Carcinoma after Treatment with Sofosbuvir-Based or Sofosbuvir-Free Regimens in Patients with Chronic Hepatitis C. Cancers (Basel) 2020; 12:cancers12092602. [PMID: 32933027 PMCID: PMC7563479 DOI: 10.3390/cancers12092602] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/03/2020] [Accepted: 09/09/2020] [Indexed: 01/17/2023] Open
Abstract
Simple Summary The development of hepatocellular carcinoma (HCC) has not been well-controlled, even after the elimination of hepatitis C virus (HCV), especially for those with cirrhosis or of high-age. Fibrosis-related biomarkers have been recognized as useful predictors for the development of HCC; however, there are few analyses of the HCC incidence for the various regimens with direct-acting antivirals (DAA). We found that DAA treatment with sofosbuvir, an oral nucleotide analogue inhibitor of HCV NS5B polymerase, was not associated with the development of de novo HCC within five years by propensity score matched analysis. Moreover, the distribution of the early stage of HCC (the Barcelona Clinic Liver Cancer stage 0/A) was similar for all treatment regimens, irrespective of the use of sofosbuvir. Abstract Advanced fibrosis/cirrhosis and related biomarkers have been recognized as useful predictors of the development of hepatocellular carcinoma (HCC) by patients with chronic hepatitis C (CHC) following hepatitis C virus (HCV) cure by direct-acting antivirals (DAAs). However, it remains unclear if DAAs themselves have an influence on or facilitate the development of HCC. This multicenter cohort study included CHC patients without a history of HCC who achieved HCV elimination by DAAs. Cohorts of 835 patients treated with a sofosbuvir (SOF)-based regimen and 835 treated with a SOF-free regimen were matched 1:1 by propensity scoring with nine variables to evaluate differences in HCC incidence. The median observation period was 3.5 years. Sixty-nine cases of HCC were found during 5483.9 person-years (PY) over the entire follow-up period. The annual incidence was similar for both groups (SOF-based 1.25 and SOF-free 1.27 per 100 PY, respectively: adjusted hazard ratio (HR) 1.26, 95% confidence interval (CI) 0.75–2.12, p = 0.39). However, the annual incidence within the first two years was higher for patients treated with SOF than for those without, but did not reach significance (1.50 and 0.97 per 100 PY incidence rates, respectively: adjusted HR 2.05, 95% CI 0.98–4.25, p = 0.06). In summary, DAA treatment with SOF was not associated with an increase in the development of de novo HCC.
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Affiliation(s)
- Eiichi Ogawa
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka 8128582, Japan;
- Correspondence:
| | - Hideyuki Nomura
- The Center for Liver Disease, Shin-Kokura Hospital, Kitakyushu 8038505, Japan;
- Department of Internal Medicine, Haradoi Hospital, Fukuoka 8138588, Japan
| | - Makoto Nakamuta
- Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka 8108563, Japan;
| | - Norihiro Furusyo
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka 8128582, Japan;
- General Internal Medicine, Taihaku Avenue Clinic, Fukuoka 8120039, Japan
| | | | - Kazufumi Dohmen
- Department of Internal Medicine, Chihaya Hospital, Fukuoka 8138501, Japan;
| | - Akira Kawano
- Department of Medicine, Kitakyushu Municipal Medical Center, Kitakyushu 8028561, Japan;
| | - Aritsune Ooho
- Department of Hepatology, Steel Memorial Yawata Hospital, Kitakyushu 8058508, Japan;
| | - Koichi Azuma
- Department of Medicine, Kyushu Central Hospital, Fukuoka 8158588, Japan;
| | | | - Takeaki Satoh
- Center for Liver Disease, National Hospital Organization Kokura Medical Center, Kitakyushu 8028533, Japan;
| | - Toshimasa Koyanagi
- Department of Medicine, Fukuoka City Hospital, Higashi-ku, Fukuoka 8120046, Japan;
| | - Yasunori Ichiki
- Department of Internal Medicine, JCHO Kyushu Hospital, Kitakyushu 8068501, Japan;
| | - Masami Kuniyoshi
- Department of Gastroenterology, Kyushu Rosai Hospital, Kitakyushu 8000296, Japan;
| | - Kimihiko Yanagita
- Department of Internal Medicine, Saiseikai Karatsu Hospital, Karatsu 8470852, Japan;
| | | | - Chie Morita
- Department of Internal Medicine, Kyushu Railway Memorial Hospital, Kitakyushu 8000031, Japan;
| | - Rie Sugimoto
- Department of Gastroenterology, Kyushu Cancer Center, Fukuoka 8111395, Japan;
| | - Masaki Kato
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 8128582, Japan;
| | - Shinji Shimoda
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 8128582, Japan;
| | - Jun Hayashi
- Kyushu General Internal Medicine Center, Haradoi Hospital, Fukuoka 8138588, Japan;
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Ogawa E, Takayama K, Hiramine S, Hayashi T, Toyoda K. Association between steatohepatitis biomarkers and hepatocellular carcinoma after hepatitis C elimination. Aliment Pharmacol Ther 2020; 52:866-876. [PMID: 32697871 DOI: 10.1111/apt.15976] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/21/2020] [Accepted: 06/27/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND A strong association between chronic hepatitis C (CHC) and hepatic steatosis has been reported. However, the influence of steatohepatitis on hepatocellular carcinoma (HCC) after hepatitis C virus (HCV) elimination remains unclear. AIM To evaluate the development of HCC after HCV cure using a new steatohepatitis-related biomarker. METHODS This cohort study analysed the prospective database of 290 CHC patients without a history of HCC who achieved HCV elimination by direct-acting antivirals. We calculated the FibroScan-aspartate aminotransferase (FAST) score 12 weeks after the end of treatment (pw12). The risk of HCC was analysed using the multivariable Cox proportional hazard model. RESULTS HCV genotype (GT)1 was most prevalent at 72.4%, followed by GT2 (26.6%). Median follow-up period was 4.2 years (IQR 3.1-4.5). The cumulative HCC incidence for a FAST score ≥ 0.35 was significantly higher than that for a FAST score < 0.35 (log-rank test: P < 0.001). The annual HCC incidence rate for a FAST score ≥ 0.35 was significantly higher than that for a FAST score < 0.35, in patients with liver stiffness measurement (LSM) ≥10 kPa (adjusted hazard ratio [HR] 4.41, 95% confidence interval [CI] 1.30-15.0, P = 0.018). After adjusting for variables, including age, albumin, alpha-fetoprotein, the patatin-like phospholipase domain-containing the 3 (PNPLA3) rs738409 genotype, and pw12 fibrosis markers with FIB-4, non-alcoholic fatty liver disease fibrosis score, and LSM, FAST score ≥ 0.35 was associated with the development of HCC (adjusted HR 4.42, 95% CI 1.02-19.9, P = 0.043). CONCLUSIONS Steatohepatitis-related biomarkers with the FAST score are helpful for predicting the development of HCC after HCV elimination.
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Affiliation(s)
- Eiichi Ogawa
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Koji Takayama
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Satoshi Hiramine
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Takeo Hayashi
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Kazuhiro Toyoda
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
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Abstract
The treatment of chronic hepatitis C (CHC) has been revolutionized in an era of all-oral direct-acting antivirals (DAAs) since 2014. Satisfactory treatment efficacy and tolerability can be provided by novel DAAs. Nevertheless, there are still some unmet needs and emerging issues in the treatment of CHC in the DAA era. Certain hard-to-cure populations are prone to have inferior treatment responses, including patients with severe liver decompensation, active hepatocellular carcinoma (HCC), and hepatitis C virus (HCV) genotype 3 (HCV-3) infection and those who experience multiple DAA treatment failures. Hepatitis B virus (HBV) reactivation during and after DAA treatment has raised concern regarding the use of prophylactic antivirals against HBV throughout DAA treatment. However, the standard strategy for the use of prophylactic antivirals is not uniform across regional guidelines. In the post-sustained virological response (SVR) period, HCC still occurs in a substantial proportion of patients. Due to the relatively short follow-up period, the net benefit of the achievement of an SVR by DAAs in the reduction of extrahepatic manifestations has not yet been determined. Attention must also be paid to HCV reinfection, particularly in high-risk populations. The most critical and unmet need for HCV elimination is the large gap in the HCV care cascade at the population level. To accomplish the World Health Organization (WHO)'s goal for HCV elimination by 2030, the expansion of access to HCV care requires a continuous effort to overcome practical and political challenges.
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Affiliation(s)
- Chung-Feng Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Liquid Biopsy and Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Liquid Biopsy and Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
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Yu ML, Chen PJ, Dai CY, Hu TH, Huang CF, Huang YH, Hung CH, Lin CY, Liu CH, Liu CJ, Peng CY, Lin HC, Kao JH, Chuang WL. 2020 Taiwan consensus statement on the management of hepatitis C: Part (II) special populations. J Formos Med Assoc 2020; 119:1135-1157. [PMID: 32354689 DOI: 10.1016/j.jfma.2020.04.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/05/2020] [Indexed: 12/13/2022] Open
Abstract
Hepatitis C virus (HCV) infection is a silent killer that leads to rapid progression of liver cirrhosis and hepatocellular carcinoma (HCC). High prevalence of HCV infection has been reported in Taiwan, especially in high-risk populations including people who inject drugs (PWID) and patients requiring dialysis. Besides, certain populations merit special considerations due to suboptimal outcome, potential drug-drug interaction, or possible side effect. Therefore, in the second part of this 2-part consensus, the Taiwan Association for the Study of the Liver (TASL) proposes the treatment recommendations for the special population in order to serve as guidance to optimizing the outcome in the direct-acting antiviral (DAA) era. Special populations include patients with acute or recent HCV infection, previous DAA failure, chronic kidney disease, decompensated cirrhosis, HCC, liver and other solid organ transplantations, receiving an HCV viremic organ, hepatitis B virus (HBV) and HCV dual infection, HCV and human immunodeficiency virus (HIV) coinfection, active tuberculosis infection, PWID, bleeding disorders and hemoglobinopathies, children and adolescents, and pregnancy. Moreover, future perspectives regarding the management of hepatitis C are also discussed and summarized in this consensus statement.
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Affiliation(s)
- Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine and Hepatitis Research Center, College of Medicine, Center for Cancer Research and Center for Liquid Biopsy, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Pei-Jer Chen
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Yen Dai
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine and Hepatitis Research Center, College of Medicine, Center for Cancer Research and Center for Liquid Biopsy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsung-Hui Hu
- Division of Hepato-Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chung-Feng Huang
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine and Hepatitis Research Center, College of Medicine, Center for Cancer Research and Center for Liquid Biopsy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chao-Hung Hung
- Division of Hepato-Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chun-Yen Lin
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chen-Hua Liu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Jen Liu
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Cheng-Yuan Peng
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Han-Chieh Lin
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jia-Horng Kao
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Wan-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine and Hepatitis Research Center, College of Medicine, Center for Cancer Research and Center for Liquid Biopsy, Kaohsiung Medical University, Kaohsiung, Taiwan
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