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Lee AW, Jacobs W, Tran M, Nguyen B, Hua DN, Ho JN, Van Nguyen T. Sociodemographic characteristics associated with hepatitis C virus infection in Vietnamese Americans: A cross-sectional analysis of community screening data. PLoS One 2022; 17:e0275210. [PMID: 36166444 PMCID: PMC9514619 DOI: 10.1371/journal.pone.0275210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 09/12/2022] [Indexed: 12/09/2022] Open
Abstract
Background Prevalence of hepatitis C virus (HCV) infection among Vietnamese Americans is reportedly high. Understanding the profile of those at greater risk of HCV in this ethnic population is a vital step to addressing this high prevalence. We hypothesize that certain sociodemographic characteristics increase the likelihood of having HCV in Vietnamese Americans. Methods Cross-sectional data from 2,497 Vietnamese Americans in Southern California who participated in a series of community hepatitis screening events organized by the Vietnamese American Cancer Foundation (VACF) were analyzed. Serological tests via immunoassays were used to determine whether the participant had hepatitis C antibodies (anti-HCV) to indicate a HCV infection. Sociodemographic characteristics as well as participants’ reasons for screening were collected from questionnaires, and logistic regression models with odds ratios (ORs) and 95% confidence intervals (CIs) were used to quantify their associations with HCV infection. Results Approximately 5.8% of the study population was infected with HCV. Older adults and male participants had higher odds of being infected with HCV (e.g. OR = 2.90, 95% CI 1.25–6.76 for ages 70+ versus ages <40; OR = 2.57, 95% CI 1.79–3.69 for male versus female participants) as were those with a family history of HCV infection (OR = 2.74, 95% CI 1.57–4.78). In addition, perceived self-risk as a motivation for screening was significantly associated with HCV infection (OR = 1.88, 95% CI 1.26–2.78). Conclusions This study identifies specific subgroups in the Vietnamese American community who would largely benefit from targeted interventions given their higher likelihood of having HCV. These interventions should emphasize improving HCV knowledge and promoting HCV self-risk assessment since awareness of one’s own risk may motivate those likely to be infected to get screened.
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Affiliation(s)
- Alice W. Lee
- Department of Public Health, California State University, Fullerton, Fullerton, CA, United States of America
- * E-mail:
| | - Wura Jacobs
- Department of Kinesiology, California State University, Stanislaus, Turlock, CA, United States of America
| | - Michelle Tran
- Department of Public Health, California State University, Fullerton, Fullerton, CA, United States of America
| | - Becky Nguyen
- Vietnamese American Cancer Foundation, Fountain Valley, CA, United States of America
| | - Dung N. Hua
- Vietnamese American Cancer Foundation, Fountain Valley, CA, United States of America
| | - John N. Ho
- Vietnamese American Cancer Foundation, Fountain Valley, CA, United States of America
| | - Thai Van Nguyen
- Vietnamese American Cancer Foundation, Fountain Valley, CA, United States of America
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Tien A, Sahota A, Yang SJ, Balbuena R, Chang M, Lim C, Fong TL. Prevalence and Characteristics of Chronic Hepatitis C Among Asian Americans Are Distinct From Other Ethnic Groups. J Clin Gastroenterol 2021; 55:884-890. [PMID: 33074947 DOI: 10.1097/mcg.0000000000001447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/12/2020] [Indexed: 01/22/2023]
Abstract
GOAL The goal of this study was to determine the prevalence and characteristics of chronic hepatitis C (CHC) among Asian Americans compared with other ethnicities. BACKGROUND Chronic hepatitis C virus (HCV) affects an estimated 2.7 million in the United States, but there are limited data on HCV among Asian Americans. STUDY A total of 3,369,881 adults over the age of 18 who were patients of the integrated health care system in Southern California and 4903 Asian participants at community hepatitis screenings were included in a cross-sectional study. Variables included HCV serology, HCV genotype, comorbidities, and coinfections. RESULTS The prevalence of CHC was 1.3% in the general population (8271 adults) and 0.6% among Asians. The prevalence of CHC was significantly higher in the 1945-1965 birth cohort with 2.7% (5876) in the general population and 1.0% (313) among Asians (P<0.001). Asians had the highest rates of hepatitis B coinfection (2.9% vs. 0.2%, P<0.001). The distribution of genotypes among Asians differed from the general population with the most common genotype being 1b (27.5%) and a higher presence of genotype 6 (9.5%) (P<0.001). The presence of cirrhosis was 17.6% in Asians. Disaggregated Asian data showed that CHC was highest among Vietnamese and Cambodian and that genotype 6 was predominant among these 2 subgroups. CONCLUSIONS The prevalence of chronic HCV was significantly lower in Asians compared with other ethnicities. However, disaggregated data among Asians showed the highest prevalence rates among adults from Vietnam and Cambodia.
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Affiliation(s)
| | - Amandeep Sahota
- Gastroenterology, Kaiser Permanente Los Angeles Medical Center
| | - Su-Jau Yang
- Department of Research and Evaluation, Southern California Kaiser Permanente, Pasadena, CA
| | - Ronald Balbuena
- Department of Research and Evaluation, Southern California Kaiser Permanente, Pasadena, CA
| | - Mimi Chang
- Asian Pacific Liver Center, St. Vincent Medical Center
| | - Carolina Lim
- Asian Pacific Liver Center, St. Vincent Medical Center
| | - Tse-Ling Fong
- Asian Pacific Liver Center, St. Vincent Medical Center
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine at University of Southern California, Los Angeles
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Rapoud D, Quillet C, Pham Minh K, Vu Hai V, Nguyen Thanh B, Nham Thi Tuyet T, Tran Thi H, Molès JP, Vallo R, Michel L, Feelemyer J, Weiss L, Lemoine M, Vickerman P, Fraser H, Duong Thi H, Khuat Thi Hai O, Des Jarlais D, Nagot N, Laureillard D. Towards HCV elimination among people who inject drugs in Hai Phong, Vietnam: study protocol for an effectiveness-implementation trial evaluating an integrated model of HCV care (DRIVE-C: DRug use & Infections in ViEtnam-hepatitis C). BMJ Open 2020; 10:e039234. [PMID: 33208326 PMCID: PMC7677340 DOI: 10.1136/bmjopen-2020-039234] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION In Vietnam, people who inject drugs (PWID), who are the major population infected by hepatitis C virus (HCV), remain largely undiagnosed and unlinked to HCV prevention and care despite recommended universal hepatitis C treatment. The data on the outcomes of HCV treatment among PWID also remain limited in resource-limited settings. The DRug use & Infections in ViEtnam-hepatitis C (DRIVE-C) study examines the effectiveness of a model of hepatitis C screening and integrated care targeting PWID that largely uses community-based organisations (CBO) in Hai Phong, Vietnam. In a wider perspective, this model may have the potential to eliminate HCV among PWID in this city. METHODS AND ANALYSIS The model of care comprises large community-based mass screening, simplified treatment with direct-acting antivirals (DAAs) and major involvement of CBO for PWID reaching out, linkage to care, treatment adherence and prevention of reinfection. The effectiveness of DAA care strategy among PWID, the potential obstacles to widespread implementation and its impact at population level will be assessed. A cost-effectiveness analysis is planned to further inform policy-makers. The enrolment target is 1050 PWID, recruited from the DRIVE study in Hai Phong. After initiation of pan-genotypic treatment consisting of sofosbuvir and daclatasvir administrated for 12 weeks, with ribavirin added in cases of cirrhosis, participants are followed-up for 48 weeks. The primary outcome is the proportion of patients with sustained virological response at week 48, that will be compared with a theoretical expected rate of 70%. ETHICS AND DISSEMINATION The study was approved by Haiphong University of Medicine and Pharmacy's Ethics Review Board and the Vietnamese Ministry of Health. The sponsor and the investigators are committed to conducting this study in accordance with ethics principles contained in the World Medical Association's Declaration of Helsinki (Ethical Principles for Medical Research Involving Human Subjects). Informed consent is obtained before study enrolment. The data are anonymised and stored in a secure database. The study is ongoing. Results will be presented at international conferences and submitted to international peer-review journals. TRIAL REGISTRATION NUMBER NCT03537196.
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Affiliation(s)
- Delphine Rapoud
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Catherine Quillet
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Khue Pham Minh
- Faculty of Public Health, Haiphong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Vinh Vu Hai
- Department of Infectious and Tropical Diseases, Viet Tiep Hospital, Hai Phong, Vietnam
| | - Binh Nguyen Thanh
- Faculty of Public Health, Haiphong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | | | - Hong Tran Thi
- Faculty of Public Health, Haiphong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Jean-Pierre Molès
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Roselyne Vallo
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Laurent Michel
- CESP Inserm UMRS 1018, Paris Saclay University, Pierre Nicole Center, French Red Cross, Paris, France
| | - Jonathan Feelemyer
- College of Global Public Health, New York University, New York, New York, USA
| | - Laurence Weiss
- Department of Clinical Immunology, Hôtel Dieu Hospital, Paris, France
| | - Maud Lemoine
- Department of Surgery and Cancer, Liver Unit, Imperial College London, London, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Huong Duong Thi
- Faculty of Public Health, Haiphong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | | | - Don Des Jarlais
- College of Global Public Health, New York University, New York, New York, USA
| | - Nicolas Nagot
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Didier Laureillard
- Department of Infectious and Tropical Diseases, Nîmes University Hospital, Nîmes, France
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Vu M, Huynh VN, Berg CJ, Allen CG, Nguyen PH, Tran NA, Srivanjarean Y, Escoffery C. Hepatitis B Testing Among Vietnamese in Metropolitan Atlanta: The Role of Healthcare-Related and Acculturation-Related Factors. J Community Health 2021; 46:767-76. [PMID: 33180219 DOI: 10.1007/s10900-020-00947-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Compared to other racial/ethnic groups, U.S. Vietnamese have higher Hepatitis B infection prevalence, which is a major liver cancer risk factor. Increased testing could reduce this disparity. It is critical to understand subgroups of U.S. Vietnamese least likely to have been tested for Hepatitis B and design appropriate interventions. We examined healthcare- and acculturation-related factors influencing Hepatitis B testing among U.S. Vietnamese. METHODS Survey data of 100 U.S. Vietnamese attending health fairs/programs hosted by community-based organizations (2017-2018) were analyzed. Healthcare-related predictors included insurance and past 2-year checkup. Acculturation-related predictors included Vancouver Acculturation Index, percentage of lifetime in the U.S., and Vietnamese and English fluency. We conducted a multiple logistic regression controlling for age, sex, education, and household income. RESULTS The sample was an average 37.5 years old and 61.6% female. Insurance coverage was reported by 83.0%. Average percentage of lifetime in the U.S. was 56.8%. Seventy percent reported having received Hepatitis B testing. Hepatitis B testing was associated with health insurance (aOR = 2.61, 95% CI = [1.05-6.47], p = .04) but not any acculturation-related predictors CONCLUSION: Improving insurance coverage and options can be a strategy to increase Hepatitis B testing among U.S. Vietnamese. More education regarding Hepatitis B (e.g., via community-based, culturally-appropriate, lay health worker-led programs) is needed to ensure that individuals are aware of their testing status and pursue appropriate healthcare decisions.
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Lee AW, Jacobs W, Chan E, Nguyen B, Hua DN, Ho JN, Yuen P, Van Nguyen T. Insight into hepatitis B prevalence and risk factors among Vietnamese Americans: a cross-sectional analysis of data from a community-based screening program. BMJ Open 2019; 9:e029616. [PMID: 31455706 PMCID: PMC6720462 DOI: 10.1136/bmjopen-2019-029616] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The aims of our study were to describe current hepatitis B prevalence among Vietnamese Americans and to examine predictors of hepatitis B risk in this specific ethnic community. DESIGN Cross-sectional analysis of data from a community-based screening program. SETTING This analysis was based on hepatitis screening community events in Southern California. PARTICIPANTS 2508 Vietnamese Americans in Southern California. OUTCOME MEASURES Serological tests for hepatitis B surface antigen, hepatitis B surface antibody, and total hepatitis B core antibody were used to classify participants as one of four hepatitis B infection statuses: currently infected, previously infected, susceptible, or immune due to a previous hepatitis B vaccination. RESULTS Across 2508 participants, 9.0% were currently infected with hepatitis B and 17.7% were at risk for hepatitis B. Females and those reporting a previous hepatitis B vaccination were at significant decreased risk of hepatitis B (OR=0.48, 95% CI 0.33 to 0.69 and OR=0.53, 95% CI 0.31 to 0.93, respectively) whereas those born outside of the USA and with a family history of the disease showed substantial increased risk (OR=13.36, 95% CI 1.62 to 110.05 and OR=4.68, 95% CI 2.66 to 8.22, respectively). Among those who reported a previous hepatitis B vaccination, less than half (42.9%) possessed the protective antibodies that result from a hepatitis B vaccination. CONCLUSIONS Vietnamese Americans remain disproportionately burdened by hepatitis B. Public health efforts that focus on improving hepatitis B awareness and vaccination knowledge and that are tailored to specific high-risk subgroups, such as immigrants and those with infected family members, could help in addressing the disease's burden in this high-prevalence population.
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Affiliation(s)
- Alice W Lee
- Department of Public Health, California State University, Fullerton, California, USA
| | - Wura Jacobs
- Department of Kinesiology, California State University, Stanislaus, Turlock, California, USA
| | - Elena Chan
- Department of Public Health, California State University, Fullerton, California, USA
| | - Becky Nguyen
- Vietnamese American Cancer Foundation, Fountain Valley, California, USA
| | - Dung N Hua
- Vietnamese American Cancer Foundation, Fountain Valley, California, USA
| | - John N Ho
- Vietnamese American Cancer Foundation, Fountain Valley, California, USA
| | - Priscilla Yuen
- Department of Public Health, California State University, Fullerton, California, USA
| | - Thai Van Nguyen
- Vietnamese American Cancer Foundation, Fountain Valley, California, USA
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6
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Li AA, Kim D, Kim W, Dibba P, Wong K, Cholankeril G, Jacobson IM, Younossi ZM, Ahmed A. Disparities in mortality for chronic liver disease among Asian subpopulations in the United States from 2007 to 2016. J Viral Hepat 2018; 25:1608-1616. [PMID: 30112849 PMCID: PMC6709979 DOI: 10.1111/jvh.12981] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 05/12/2018] [Revised: 07/31/2018] [Accepted: 08/02/2018] [Indexed: 12/15/2022]
Abstract
The Asian American population is characterized by remarkable diversity. Studying Asians as an aggregate group may obscure clinically meaningful heterogeneity. We performed a population-based study using data from the US National Vital Statistics System. We determined the trends in age-standardized mortality rates for chronic liver disease stratified by aetiology among the most populous US-based Asian subgroups (Asian Indians, Chinese, Filipino, Japanese, Korean and Vietnamese) and compared it to non-Hispanic whites. Annual percentage change was calculated to determine temporal mortality patterns using joinpoint analysis. Hepatitis C virus-related mortality rates were higher in non-Hispanic whites compared to individual Asian subgroups, but a sharp decline in mortality rates was noted in 2014 among non-Hispanic whites and all Asian subgroups. Age-standardized hepatitis B virus-related mortality rates were higher in all Asian subgroups as compared to non-Hispanic whites in 2016, with the highest mortality among Vietnamese followed by Chinese. Mortality rates for alcoholic liver disease have been steadily trending upwards in all Asian subgroups, with the highest mortality in Japanese. Overall, age-standardized cirrhosis-related mortality rates were highest in non-Hispanic whites, followed by Japanese, and more distantly by Vietnamese and other subgroups. However, hepatocellular carcinoma-related mortality rates were higher in most Asian subgroups led by Vietnamese, Japanese and Koreans compared to non-Hispanic whites. In this population-based study utilizing a nationally representative database, we demonstrated a marked heterogeneity in the mortality rates of aetiology-specific chronic liver disease among Asian subgroups in the United States.
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Affiliation(s)
- Andrew A. Li
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Donghee Kim
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California
| | - Won Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea
| | - Pratima Dibba
- Division of Gastroenterology, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Katherine Wong
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California
| | - George Cholankeril
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California
| | - Ira M. Jacobson
- Department of Medicine, New York University School of Medicine, New York, New York
| | - Zobair M. Younossi
- Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, Virginia
| | - Aijaz Ahmed
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California
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Abstract
The World Health Organization estimates that 170 million persons are infected with HCV worldwide, but only 22 million are from the Americas and Europe, compared to 94 million from Asia. HCV prevalence in the general US population is 1.6 %, but data for Asian Americans are limited. Our goal was to examine HCV prevalence in Asian Americans in a large ethnically diverse patient cohort seeking primary care at a free clinic in Northern California. A total of 1347 consecutive patients were seen from September 2009 to October 2012 and were studied via individual chart review using case report forms. HCV infection was defined as positive HCV antibody (anti-HCV) or HCV RNA by PCR. 699 out of 1347 patients were screened for HCV. Asian Americans comprised 57.2 % of these patients and 29 (4.1 %) patients tested positive for HCV. Of these 29 HCV-positive patients, 22 (75.9 %) were Asian, yielding a prevalence of 5.5 % for Asians and 2.3 % for non-Asians (P = 0.038). The highest HCV prevalence was seen in Vietnamese patients at 7.9 %, and 6.0 % in Chinese patients. Of the HCV-positive Asians, none had a history of intravenous drug use (IVDU), tattoos, or sexual exposure. On multivariate analysis, significant independent predictors for positive HCV infection were male gender (OR 2.53, P = 0.02) and presence of known risk factors (OR 21.1, P < 0.001). However, older age and Asian ethnicity were found to be significant predictors of HCV infection (OR 1.03, P = 0.05 and 2.31, P = 0.066, respectively). In our study, HCV prevalence in patients seeking routine primary care was 5.5 % in Asian Americans, which was over double the prevalence for non-Asians at 2.3 %. Known risk factors were also notably absent in Asian patients with HCV infection. The high prevalence of HCV in Asian-Americans is likely reflective of the higher prevalence of HCV in their countries of origin in Asia. Asian-Americans immigrants from endemic countries are at higher risk of HCV infection and should be screened for HCV, regardless of their exposure risk profile.
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Affiliation(s)
- Oliver N Lin
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, 750 Welch Road, Suite 210, Palo Alto, CA, 94304, USA
| | - Christine Chang
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, 750 Welch Road, Suite 210, Palo Alto, CA, 94304, USA
| | - Joyce Lee
- Stanford University School of Medicine, Stanford, CA, USA
| | - Ailinh Do
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, 750 Welch Road, Suite 210, Palo Alto, CA, 94304, USA
| | - Marina Martin
- Division of General Medical Discipline, Stanford University Medical Center, Palo Alto, CA, USA.,Pacific Free Clinic, San Jose, CA, USA
| | - Andy Martin
- Pacific Free Clinic, San Jose, CA, USA.,Stanford Center for Clinical Informatics, Palo Alto, CA, USA
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, 750 Welch Road, Suite 210, Palo Alto, CA, 94304, USA.
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8
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Le AK, Zhao C, Hoang JK, Tran SA, Chang CY, Jin M, Nguyen NH, Yasukawa LA, Zhang JQ, Weber SC, Garcia G, Nguyen MH. Ethnic disparities in progression to advanced liver disease and overall survival in patients with chronic hepatitis C: impact of a sustained virological response. Aliment Pharmacol Ther 2017; 46:605-616. [PMID: 28766727 DOI: 10.1111/apt.14241] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 05/08/2017] [Revised: 06/04/2017] [Accepted: 07/08/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chronic hepatitis C (CHC) can lead to cirrhosis and hepatocellular carcinoma (HCC). A sustained virological response (SVR) is associated with improved outcomes, however, its impact on different ethnic groups is unknown. AIM To evaluate ethnic differences in the natural history of CHC and the impact of SVR. METHODS We conducted a cohort study of 8039 consecutive adult CHC patients seen at two medical centres in California between January 1997 and June 2016. Individual chart review confirmed CHC diagnosis. RESULTS Asian and Hispanic but not African American patients had significantly higher cirrhosis and HCC incidence than Caucasians. On multivariate analysis, Hispanic ethnicity was independently associated with increased cirrhosis (adjusted HR 1.37, CI, confidence interval 1.10-1.71, P=.006) and HCC risk (adjusted HR 1.47, CI 1.13-1.92, P=.004) compared to Caucasian. Asian ethnicity had a significant association with cirrhosis (adjusted HR 1.28, CI 1.02-1.61, P=.034) and HCC risk (adjusted HR 1.29, CI 0.94-1.77, P=.025). In patients who achieved SVR, Hispanic ethnicity was no longer independently associated with cirrhosis (adjusted HR 1.76, CI 0.66-4.71, P=.26) or HCC (adjusted HR 1.05, CI 0.27-4.08, P=.94); nor was Asian ethnicity (adjusted HR 0.62, CI 0.21-1.82, P=.38 for cirrhosis; 2.01, CI 0.63-6.36, P=.24 for HCC). Similar findings were observed with overall survival among the ethnicities by SVR status. CONCLUSION Hispanic and Asian ethnicity was independently associated with increased cirrhosis and HCC risk. Achieving an SVR eliminates the ethnic disparity in liver disease progression and overall survival between Hispanic and Asian vs Caucasian CHC patients.
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Affiliation(s)
- A K Le
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - C Zhao
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.,Department of Cirrhosis, Institute of Liver Disease, Shuguang Hospital, Shanghai, China
| | - J K Hoang
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - S A Tran
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.,Stanford University, Palo Alto, CA, USA
| | - C Y Chang
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.,David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - M Jin
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.,Department of Epidemiology and Biostatistics, Zhejiang University, Hangzhou, China
| | - N H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.,Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - L A Yasukawa
- Center for Clinical Informatics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - J Q Zhang
- Chinese Hospital, San Francisco, CA, USA
| | - S C Weber
- Center for Clinical Informatics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - G Garcia
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - M H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
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Strong C, Hur K, Kim F, Pan J, Tran S, Juon HS. Sociodemographic characteristics, knowledge and prevalence of viral hepatitis infection among Vietnamese Americans at community screenings. J Immigr Minor Health 2016; 17:298-301. [PMID: 24715472 DOI: 10.1007/s10903-014-0015-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Few studies have investigated the prevalence of hepatitis B virus (HBV) and C virus (HCV) infection among Vietnamese Americans (VAs). The purpose of this paper is to assess the prevalence of HBV and HCV infection, identify the sociodemographic characteristics of the HBV infected population and the level of HBV knowledge among VAs in the Baltimore-Washington metropolitan areas with data from a health fair in 2011. A total of 617 VAs received serological testing for HBV and HCV, and 329 completed a survey of HBV knowledge assessment. About 9% were infected with HBV and 5% with HCV. Vietnamese Americans younger than 30 years had the highest HBV prevalence (13.1%) followed by those age 41-50 years (12.1%). The prevalence of HCV infection was particularly higher among those older than 70 years old (13.9%). Misunderstanding HBV as a food-borne disease is prevalent among VAs. Efforts to develop public health screening and education programs targeting this population are warranted.
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Affiliation(s)
- Carol Strong
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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10
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Nguyen Truong T, Laureillard D, Lacombe K, Duong Thi H, Pham Thi Hanh P, Truong Thi Xuan L, Chu Thi N, Luong Que A, Vu Hai V, Nagot N, Tuaillon E, Dominguez S, Lemoine M. High Proportion of HIV-HCV Coinfected Patients with Advanced Liver Fibrosis Requiring Hepatitis C Treatment in Haiphong, Northern Vietnam (ANRS 12262). PLoS One 2016; 11:e0153744. [PMID: 27148964 PMCID: PMC4858210 DOI: 10.1371/journal.pone.0153744] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 04/04/2016] [Indexed: 02/06/2023] Open
Abstract
Rationale and Aims Screening and treatment for chronic hepatitis C are very limited in Vietnam and clinical data on HCV-related liver disease in HIV-coinfected people are almost inexistent. This study aimed to assess the severity of liver fibrosis and its risk factors in HIV-HCV coinfected patients in Haiphong, Northern Vietnam. Methods A cross-sectional study was conducted at a HIV outpatient clinic. Consecutive HIV treated adults with positive HCV serology completed a standardised epidemiological questionnaire and had a comprehensive liver assessment including hepatic elastography (Fibroscan®, Echosens). Results From February to March 2014, 104 HIV-HCV coinfected patients receiving antiretroviral therapy (ART) were prospectively enrolled (99 males, median age: 35.8 (32.7–39.6) years, median CD4 count: 504 (361–624) /mm3. Of them, 93 (89.4%) had detectable HCV RNA (median 6.19 (4.95–6.83 Log10 IU/mL). Patients were mainly infected with genotypes 1a/1b (69%) and genotypes 6a/6e (26%). Forty-three patients (41.3%) had fibrosis ≥F2 including 24 patients (23.1%) with extensive fibrosis (F3) and/or cirrhosis (F4). In univariate analysis, excessive alcohol consumption, estimated time duration from HCV infection, nevirapine and lopinavir-based ARV regimen and CD4 nadir were associated factors of extensive fibrosis/cirrhosis. Alcohol abuse was the only independent factor of extensive fibrosis in multivariate analysis. Using Fibroscan® as a gold standard, the high thresholds of AST-to-platelet ratio index (APRI) and fibrosis-4 score (FIB-4) had very good performances for the diagnosis of extensive fibrosis/cirrhosis (Se: 90 and 100%, Sp:84 and 81%, AUROCs = 0.93, 95%CI: 0.86–0.99 and 0.96 (0.92–0.99), respectively). Conclusion In this study, nearly 25% of HIV-HCV coinfected patients successfully treated with ART have extensive fibrosis or cirrhosis, and therefore require urgently HCV treatment.
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Affiliation(s)
- Tam Nguyen Truong
- University of Medicine Pham Ngoc Thach, Ho Chi Minh City, Vietnam
- INSERM U1058 "Pathogenesis and Control of Chronic Infections", Montpellier, France
| | - Didier Laureillard
- INSERM U1058 "Pathogenesis and Control of Chronic Infections", Montpellier, France
- Department of Infectious and Tropical Diseases, Caremeau University Hospital, Nîmes, France
| | - Karine Lacombe
- Department of Infectious and Tropical Diseases, Saint-Antoine Hospital, AP-HP, Paris, France
- Sorbonne Universités, UPMC Université Paris 06, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
| | - Huong Duong Thi
- Department of Public Health, University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Phuc Pham Thi Hanh
- Department of Infectious and Tropical Diseases, Viet Tiep Hospital, Hai Phong, Vietnam
| | | | - Nga Chu Thi
- Department of virology, Viet Tiep hospital, Haiphong, Vietnam
| | - Anh Luong Que
- Department of virology, Viet Tiep hospital, Haiphong, Vietnam
| | - Vinh Vu Hai
- Department of Infectious and Tropical Diseases, Viet Tiep Hospital, Hai Phong, Vietnam
| | - Nicolas Nagot
- INSERM U1058 "Pathogenesis and Control of Chronic Infections", Montpellier, France
- Department of epidemiology, University Hospital, Montpellier, France
| | - Edouard Tuaillon
- INSERM U1058 "Pathogenesis and Control of Chronic Infections", Montpellier, France
- Department of bacteriology and virology, University Hospital, Montpellier, France
| | - Stéphanie Dominguez
- Department of clinical immunology, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Maud Lemoine
- Department of Hepatology, St Mary’s Hospital, Imperial College, London, United Kingdom
- * E-mail:
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Coppola N, Alessio L, Pisaturo M, Macera M, Sagnelli C, Zampino R, Sagnelli E. Hepatitis B virus infection in immigrant populations. World J Hepatol 2015; 7:2955-2961. [PMID: 26730274 PMCID: PMC4691698 DOI: 10.4254/wjh.v7.i30.2955] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 09/16/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatitis B virus (HBV) is the most common cause of hepatitis worldwide, with nearly 350 million people chronically infected and 600000 deaths per year due to acute liver failure occurring during acute hepatitis or, more frequently, in HBV-related liver cirrhosis or hepatocellular carcinoma. Ongoing immigration from countries with a high HBV endemicity to those with a low HBV endemicity warrants particular attention to prevent the spread of HBV infection to the native population. This review article analyzes the epidemiology and virological and clinical characteristics of HBV infection in immigrant populations and in their host countries, and suggests prophylactic measures to prevent the spread of this infection. Among the immigrants from different geographical areas, those from South East Asia and sub-Saharan Africa show the highest prevalences of hepatitis B surface antigen (HBsAg) carriers, in accordance with the high endemicity of the countries of origin. The molecular characteristics of HBV infection in immigrants reflect those of the geographical areas of origin: HBV genotype A and D predominate in immigrants from Eastern Europe, B and C in those from Asia and genotype E in those from Africa. The literature data on the clinical course and treatment of HBsAg-positive immigrants are scanty. The management of HBV infection in immigrant populations is difficult and requires expert personnel and dedicated structures for their assistance. The social services, voluntary operators and cultural mediators are essential to achieve optimized psychological and clinical intervention.
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Abstract
OBJECTIVES The aim of this study was to identify socio-economic and acculturation factors associated with hepatitis C (HCV) screening and infection among US Vietnamese Americans. METHODS Participants were recruited from 7 Vietnamese community-based organizations in Pennsylvania and New Jersey. The analysis ultimately included 309 participants who participated in a HCV education intervention program. RESULTS Overall, 82.5% (255 of 309) intervention participants completed HCV screening over the 6 months prior to the post-intervention assessment. In multivariate-adjusted analysis, participants who lived in Vietnam for 40 years versus 20 years were more likely to receive HCV screening; unemployed individuals were less likely to receive HCV screening than employed people. Among screened participants, 7.5% had HCV infection. CONCLUSIONS These findings will guide future culturally and linguistically appropriate interventions to reduce HCV infection and HCV-related liver cancer.
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Affiliation(s)
- Grace X Ma
- Department of Public Health and Center for Asian Health, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Guo Yolanda Zhang
- Center for Asian Health, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Mary Y Jung
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA
| | - Xiang S Ma
- Center for Asian Health, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Shumenghui Zhai
- Center for Asian Health, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Mei Zhao
- Center for Asian Health, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Xiaoli Ma
- College of Medicine, Drexel University, Philadelphia, PA, USA.
| | - Sunmin Lee
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA
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13
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Pollack HJ, Kwon SC, Wang SH, Wyatt LC, Trinh-Shevrin C. Chronic hepatitis B and liver cancer risks among Asian immigrants in New York City: Results from a large, community-based screening, evaluation, and treatment program. Cancer Epidemiol Biomarkers Prev 2015; 23:2229-39. [PMID: 25368398 DOI: 10.1158/1055-9965.epi-14-0491] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) infection, the predominant cause of hepatocellular carcinoma (HCC) worldwide, disproportionately affects Asian Americans. Limited data exist on the variability and characteristics of infection that determine disease progression risk within U.S. Asian ethnic subgroups. METHODS Retrospective analyses were conducted on a large, community-based HBV screening and treatment program in New York City (NYC). From 2004 to 2008, the program enrolled 7,272 Asian-born individuals. Determinants of HBV seroprevalence were calculated and risk factors for HCC progression were compared across Asian subgroups. RESULTS Among newly tested individuals, 13% were HBV positive. Seroprevalence varied significantly with age, gender, education, birthplace, and family history of infection. Chinese-born individuals, particularly from the Fujian province, had the highest seroprevalence (23.2% and 33.1%, respectively). Clinical and virologic characteristics placed HBV-infected individuals at significant risk for HCC. Significant differences in HCC risk existed among Asian subgroups in bivariate analysis, including age, gender, HBV viral load, and HBeAg status. Differences in HBV genotype and family history of HCC may further HCC risk among subgroups. CONCLUSIONS Asian immigrants in NYC have a high prevalence of HBV infection and are at significant risk of disease progression and HCC. Although heterogeneity in HBV seroprevalence was found by Asian subgroups, HCC risk among infected individuals was primarily explained by age and gender differences. Country and province of birth, age, and gender may further explain seroprevalence differences. IMPACT Findings provide estimates of HBV burden in Asian ethnic subgroups and identify high-risk groups to target for screening and treatment that can prevent HCC.
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Affiliation(s)
- Henry J Pollack
- Department of Pediatrics, New York University School of Medicine, New York, New York.
| | - Simona C Kwon
- Department of Population Health, New York University School of Medicine, New York, New York
| | - Su H Wang
- Saint Barnabas Medical Center, Center for Asian Health, Livingston, New Jersey. Formerly at Charles B. Wang Community Health Center, New York, New York
| | - Laura C Wyatt
- Department of Population Health, New York University School of Medicine, New York, New York
| | - Chau Trinh-Shevrin
- Department of Population Health, New York University School of Medicine, New York, New York
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Abstract
INTRODUCTION Chronic hepatitis B (CHB) affects over 350 million people worldwide and can lead to life-threatening complications, including liver failure and hepatocellular cancer (HCC). Modern antiviral therapies could stem the rising tide of hepatitis B-related HCC, provided that individuals and populations at risk can be reliably identified through hepatitis B screening and appropriately linked to care. Opportunistic disease screening cannot deliver population-level outcomes, given the large number of undiagnosed people, but they may be achievable through well-organized and targeted community-based screening interventions. MATERIAL AND METHODS This review summarizes the experience with community-based CHB screening programs published in the English-language literature over the last 30 years. RESULTS They include experiences from Taiwan, the USA, The Netherlands, New Zealand, and Australia. Despite great variability in program setting and design, successful programs shared common features, including effective community engagement incorporating the target population's cultural values and the ability to provide low-cost or free access to care, including antiviral treatment. CONCLUSION While many questions still remain about the best funding mechanisms to ensure program sustainability and what the most effective strategies are to ensure program reach, linkage to care, and access to treatment, the evidence suggests scope for cautious optimism. A number of successful, large-scale initiatives in the USA, Asia-Pacific, and Europe demonstrated the feasibility of community-based interventions in effectively screening large numbers of people with CHB. By providing an effective mechanism for community outreach, scaling up these interventions could deliver population-level outcomes in liver cancer prevention relevant for many countries with a large burden of disease.
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Affiliation(s)
| | - Jacob George
- Storr Liver Unit, Westmead Millennium Institute and Westmead Hospital, University of Sydney, Westmead, Sydney, NSW Australia
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15
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Nguyen K, Van Nguyen T, Shen D, Xia V, Tran D, Banh K, Ruan V, Hu KQ. Prevalence and Presentation of Hepatitis B and C Virus (HBV and HCV) Infection in Vietnamese Americans via Serial Community Serologic Testing. J Immigr Minor Health 2014; 17:13-20. [DOI: 10.1007/s10903-013-9975-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Zuure FR, Urbanus AT, Langendam MW, Helsper CW, van den Berg CHSB, Davidovich U, Prins M. Outcomes of hepatitis C screening programs targeted at risk groups hidden in the general population: a systematic review. BMC Public Health 2014; 14:66. [PMID: 24450797 PMCID: PMC4016146 DOI: 10.1186/1471-2458-14-66] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 01/10/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Effective screening programs are urgently needed to provide undiagnosed hepatitis C virus (HCV)-infected individuals with therapy. This systematic review of characteristics and outcomes of screening programs for HCV focuses on strategies to identify HCV risk groups hidden in the general population. METHODS We conducted a comprehensive search of MEDLINE and EMBASE databases for articles published between 1991-2010, including studies that screened the general population using either a newly developed (nonintegrated) screening program or one integrated in existing health care facilities. Look-back studies, prevalence studies, and programs targeting high-risk groups in care (e.g., current drug users) were excluded. RESULTS After reviewing 7052 studies, we identified 67 screening programs: 24 nonintegrated; 41 programs integrated in a variety of health care facilities (e.g., general practitioner); and 2 programs with both integrated and nonintegrated strategies. Together, these programs identified approximately 25,700 HCV-infected individuals. In general, higher HCV prevalence was found in programs in countries with intermediate to high HCV prevalence, in psychiatric clinics, and in programs that used a prescreening selection based on HCV risk factors. Only 6 programs used a comparison group for evaluation purposes, and 1 program used theory about effective promotion for screening. Comparison of the programs and their effectiveness was hampered by lack of reported data on program characteristics, clinical follow-up, and type of diagnostic test. CONCLUSIONS A prescreening selection based on risk factors can increase the efficiency of screening in low-prevalence populations, and we need programs with comparison groups to evaluate effectiveness. Also, program characteristics such as type of diagnostic test, screening uptake, and clinical outcomes should be reported systematically.
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Affiliation(s)
- Freke R Zuure
- Public Health Service of Amsterdam, the Netherlands, Infectious Diseases Cluster, P.O. Box 2200, Amsterdam 1000 CE, The Netherlands
| | - Anouk T Urbanus
- Public Health Service of Amsterdam, the Netherlands, Infectious Diseases Cluster, P.O. Box 2200, Amsterdam 1000 CE, The Netherlands
- Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (University of Amsterdam), P.O. Box 22660, Amsterdam 1100 DD, The Netherlands
| | - Miranda W Langendam
- Dutch Cochrane Centre, Academic Medical Center, P.O. Box 22660, Amsterdam 1100 DD, The Netherlands
| | - Charles W Helsper
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
| | - Charlotte HSB van den Berg
- Public Health Service of Amsterdam, the Netherlands, Infectious Diseases Cluster, P.O. Box 2200, Amsterdam 1000 CE, The Netherlands
- Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (University of Amsterdam), P.O. Box 22660, Amsterdam 1100 DD, The Netherlands
| | - Udi Davidovich
- Public Health Service of Amsterdam, the Netherlands, Infectious Diseases Cluster, P.O. Box 2200, Amsterdam 1000 CE, The Netherlands
| | - Maria Prins
- Public Health Service of Amsterdam, the Netherlands, Infectious Diseases Cluster, P.O. Box 2200, Amsterdam 1000 CE, The Netherlands
- Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (University of Amsterdam), P.O. Box 22660, Amsterdam 1100 DD, The Netherlands
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Kin KC, Lin B, Chaung KT, Ha NB, Trinh HN, Garcia RT, Nguyen HA, Nguyen KK, Levitt BS, da Silveira EB, Nguyen MH. Less-established risk factors are common in Asian Americans with hepatitis C virus: a case-controlled study. Dig Dis Sci 2013; 58:3342-7. [PMID: 24081641 DOI: 10.1007/s10620-013-2884-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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: 07/03/2013] [Accepted: 09/10/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS The Centers for Disease Control and Prevention recommend screening for hepatitis C virus (HCV) in patients with injection drug use, blood transfusion before 1992, stigmata of liver disease, or born between 1945 and 1965. The purpose of this study was to examine risk factors for HCV acquisition in Asian Americans. METHODS This was a case-controlled study, with 471 consecutive patients testing positive for anti-HCV between January 2001 and December 2008. Controls included 471 patients with negative HCV matched at a one-to-one ratio for sex, age (±5 years), and ethnicity. RESULTS For Asian patients, the most common risk factors were blood transfusion and acupuncture or exposure to dirty needles (27 and 20 %, respectively). On multiple logistic regression, potential predictors for a positive anti-HCV test in Asians were acupuncture or exposure to dirty needles (OR = 12.9, P < 0.0001), body tattoo (OR = 12.0, P = 0.001), and history of blood transfusion (OR = 5.7, P < 0.0001). DISCUSSION Acupuncture and exposure to dirty needles are independent risk factors of HCV infection. Asians coming from endemic areas should be screened for HCV even when commonly-known risk factors for Western patients are not present.
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Affiliation(s)
- Kevin C Kin
- Pacific Health Foundation, San Jose, CA, USA,
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Martinez AA, Zaldivar Y, Hong CC, Alvarado-Mora MV, Smith R, Ortiz AY, Pinho JRR, Cristina J, Pascale JM. Molecular characterisation of hepatitis B virus in the resident Chinese population in Panama City. Mem Inst Oswaldo Cruz 2013; 108:541-7. [PMID: 23903967 PMCID: PMC3970604 DOI: 10.1590/s0074-02762013000500002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 01/23/2013] [Accepted: 04/26/2013] [Indexed: 02/06/2023] Open
Abstract
Despite the effectiveness of current hepatitis B virus (HBV) vaccines, it is estimated that 350 million individuals suffer from chronic HBV infection and more than 50% of these affected individuals live on the Asian continent. Panama is a country with a great diversity of foreign groups; the Chinese community is a large example of this phenomenon. There is an urgent need to perform studies that evaluate the prevalence and the genetic diversity of HBV in this community. This study aimed to evaluate the prevalence of HBV and its genotypes and mutant variants in the Chinese population residing in Panama. In total, 320 subjects were enrolled in the study. Forty-two subjects (13.1%) were positive for HBsAg and HBV-DNA from 18 subjects revealed the presence of genotypes B2 and C1. Secondary mutations associated with drug resistance at positions rtV207L and rtN239T of the reverse transcriptase gene were identified. Additionally, the mutation pair A1762T/G1764A was found in three samples and the mutation G1896A was detected in an HBeAg-negative subject. In conclusion, to our knowledge, this is the first study to report high HBV prevalence rates in resident ethnic Chinese in Central America and the presence of genotypes B2 and C1 in this region.
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Affiliation(s)
- Alexander Augusto Martinez
- Gorgas Memorial Institute for Health Studies, Panama, Panama
- Department of Biotechnology, Acharya Nagarjuna University, Guntur,
India
- Instituto de Investigaciones Científicas y Servicios de Alta
Tecnología-AIP, Ciudad del Saber, Clayton, Panama
| | | | - Chen Ch Hong
- Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Monica Viviana Alvarado-Mora
- Laboratório de Gastroenterologia e Hepatologia Tropical,
Departamento de Gastroenterologia, Instituto de Medicina Tropical, Faculdade de
Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Rebecca Smith
- Gorgas Memorial Institute for Health Studies, Panama, Panama
| | - Alma Y Ortiz
- Gorgas Memorial Institute for Health Studies, Panama, Panama
| | - João Renato Rebello Pinho
- Laboratório de Gastroenterologia e Hepatologia Tropical,
Departamento de Gastroenterologia, Instituto de Medicina Tropical, Faculdade de
Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Juan Cristina
- Laboratorio de Virología Molecular, Centro de Investigaciones
Nucleares, Facultad de Ciencias, Universidad de la República, Montevideo, Uruguay
| | - Juan Miguel Pascale
- Gorgas Memorial Institute for Health Studies, Panama, Panama
- School of Medicine, University of Panama, Panama, Panama
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Nguyen LH, Nguyen MH. Systematic review: Asian patients with chronic hepatitis C infection. Aliment Pharmacol Ther 2013; 37:921-36. [PMID: 23557103 DOI: 10.1111/apt.12300] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [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: 09/02/2012] [Revised: 10/16/2012] [Accepted: 03/12/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND Chronic hepatitis C (CHC) infection is a risk factor for both the development of end-stage liver disease and hepatocellular carcinoma (HCC). Globally, approximately 170 million people are chronically infected with the hepatitis C virus (HCV), and the majority of these individuals come from the western Pacific and Southeast Asia regions (94.6 million persons combined). CHC is an understudied and underappreciated health problem in many Asian countries and in the US, where Asians represent one of the fastest growing groups of new Americans. AIM To perform a systematic review of the current literature on the epidemiology, diagnosis and screening, clinical characteristics and response to anti-viral therapy of Asians with CHC. METHODS Using a PubMed search of 'hepatitis C' and 'Asia,' 341 original manuscripts published in peer-reviewed journals were identified, and 99 were selected based on their relevance. RESULTS Many Asian CHC patients do not have easily identifiable risk factors and may be underdiagnosed. Rates of HCV infection in Asians on community screening in the US are unexpectedly high, and there is a high prevalence of HCV genotype 6 in Southeast Asia and Southern China. HCV-infected Asians tend to present at older age and may have higher risk of HCC; however, they respond better to anti-viral therapy than non-Asians across all HCV genotypes. CONCLUSIONS Given the high HCV endemicity in Asia, lack of identifiable risk factors and favourable treatment response rates in Asians, we advocate the screening for HCV infection of all Asians who come from areas where HCV prevalence is ≥2%.
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Affiliation(s)
- L H Nguyen
- Stanford University School of Medicine, Stanford, CA, USA
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Kin KC, Lin B, Ha NB, Chaung KT, Trinh HN, Garcia RT, Nguyen KK, Nguyen HA, da Silveira EB, Levitt BS, Nguyen MH. High proportion of hepatitis C virus in community Asian American patients with non-liver-related complaints. J Clin Gastroenterol 2013; 47:367-71. [PMID: 23090039 DOI: 10.1097/MCG.0b013e3182688b3e] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
GOALS AND BACKGROUND Besides United States population born between 1945 and 1965, screening for hepatitis C virus (HCV) is not recommended for the general US population. However, HCV may be more prevalent in certain subgroups and screening may be warranted. The goal of this study was to examine the proportion of HCV in a large sample of community Asian American patients presenting for non-liver-related complaints. STUDY We conducted a cross-sectional study of 1246 patients tested for hepatitis C virus antibodies (anti-HCV) referred to 2 gastroenterology clinics for non-liver-related gastrointestinal reasons between January 2001 and February 2011. We determined HCV status and patient history via electronic medical record review. RESULTS Of the 1246 study patients tested for anti-HCV, the majority were Asian (81.4%) and 29 Asian patients (2.9%) had positive anti-HCV. HCV proportion in the remaining 232 non-Asians (non-Hispanic whites and Hispanics) was 1.7%. Asians with positive anti-HCV were more likely to have had blood transfusions (31.0% vs. 6.6%, P<0.0001) or acupuncture (10.3% vs. 1.5%, P<0.0001). Of the 976 Asian patients with hepatitis B surface antigen testing, 38 (3.9%) also had detectable hepatitis B surface antigen. CONCLUSIONS Among patients seen at community gastroenterology clinics for non-liver-related reasons, HCV proportion was 1.7% for non-Asians and 2.9% for Asians. Screening for HCV should be offered to high-risk patients presenting to gastroenterology clinics with unrelated gastrointestinal complaints.
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Abstract
PURPOSE To determine whether self-reported maximal and daily activity levels are impaired among patients with nonalcoholic fatty liver disease (NAFLD), hepatitis C (HCV) and hepatitis B (HBV). METHODS Clinicodemographic, diagnostic, self-report and standard laboratory data were obtained. Univariate, multivariate and regression analyses were performed comparing group maximal (Maximum Activity Score [MAS]) and daily activity scores (Adjusted Activity Score [AAS]), adjusted for age and gender. RESULTS Two hundred twenty-two patients completed activity-level self-reports (mean age [52.4 ± 10.0 years], BMI [28.3 ± 6.58], 31.2% NAFLD, 48.3% HCV, 20.3% HBV). On multivariate analysis, significantly higher MAS (p < 0.05) and AAS in HBV patients correlated with absence of cirrhosis, younger age, male gender (higher MAS) and lower BMI (higher AAS). Lowest activity levels were found primarily in obese patients (p < 0.009). Compared with population norms, NAFLD and HCV cohorts scored mildly disabled on MAS; the HBV cohort scored low normal. Mild disability on AAS was observed in patients with HBV; moderate disability in those with NAFLD, HCV. CONCLUSIONS All groups had significantly lower activity levels than population norms. Nonobese patients showed significantly less disability than obese patients. Patients with NAFLD and HCV are likely to have lower levels than those with HBV without cirrhosis. This presents an additional risk factor for disability and mortality. IMPLICATIONS FOR REHABILITATION • Hepatitis B (HBV), hepatitis C (HCV), and nonalcoholic fatty liver disease (NAFLD) patients had significantly lower activity levels than expected for their age and gender, as measured by the Human Activity Profile (HAP). • Overweight and normal weight chronic liver disease (CLD) patients showed significantly less disability than obese chronic liver disease patients. • Patients with NAFLD and HCV are likely to participate in low levels of activity that require fewer metabolic equivalents for completion, adding an additional risk factor for disability and mortality. • Targeting low activity level in CLD patients, and decreasing BMI below the obesity threshold, may reduce disability and risk of mortality.
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Dunford L, Carr MJ, Dean J, Waters A, Nguyen LT, Ta Thi TH, Thi LAB, Do HD, Thi TTD, Nguyen HT, Diem Do TT, Luu QP, Connell J, Coughlan S, Nguyen HT, Hall WW, Nguyen Thi LA. Hepatitis C virus in Vietnam: high prevalence of infection in dialysis and multi-transfused patients involving diverse and novel virus variants. PLoS One 2012; 7:e41266. [PMID: 22916104 PMCID: PMC3419252 DOI: 10.1371/journal.pone.0041266] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 06/19/2012] [Indexed: 12/22/2022] Open
Abstract
Hepatitis C virus (HCV) is a genetically diverse pathogen infecting approximately 2–3% of the world's population. Herein, we describe results of a large, multicentre serological and molecular epidemiological study cataloguing the prevalence and genetic diversity of HCV in five regions of Vietnam; Ha Noi, Hai Phong, Da Nang, Khanh Hoa and Can Tho. Individuals (n = 8654) with varying risk factors for infection were analysed for the presence of HCV Ab/Ag and, in a subset of positive specimens, for HCV RNA levels (n = 475) and genotype (n = 282). In lower risk individuals, including voluntary blood donors, military recruits and pregnant women, the prevalence of infection was 0.5% (n = 26/5250). Prevalence rates were significantly higher (p<0.001) in intravenous drug users (IDUs; 55.6%, n = 556/1000), dialysis patients (26.6%, n = 153/575) commercial sex workers (CSWs; 8.7%, n = 87/1000), and recipients of multiple blood transfusions (6.0%, n = 32/529). The prevalence of HCV in dialysis patients varied but remained high in all regions (11–43%) and was associated with the receipt of blood transfusions [OR: 2.08 (1.85–2.34), p = 0.001], time from first transfusion [OR: 1.07 (1.01–1.13), p = 0.023], duration of dialysis [OR: 1.31 (1.19–1.43), p<0.001] and male gender [OR: 1.60 (1.06–2.41), p = 0.026]. Phylogenetic analysis revealed high genetic diversity, particularly amongst dialysis and multi-transfused patients, identifying subtypes 1a (33%), 1b (27%), 2a (0.4%), 3a (0.7%), 3b (1.1%), 6a (18.8%), 6e (6.0%), 6h (4.6%), 6l (6.4%) and 2 clusters of novel genotype 6 variants (2.1%). HCV genotype 1 predominated in Vietnam (60%, n = 169/282) but the proportion of infections attributable to genotype 1 varied between regions and risk groups and, in the Southern part of Vietnam, genotype 6 viruses dominated in dialysis and multi-transfused patients (73.9%). This study confirms a high prevalence of HCV infection in Vietnamese IDUs and, notably, reveals high levels of HCV infection associated with dialysis and blood transfusion.
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Affiliation(s)
- Linda Dunford
- Ireland Vietnam Blood-Borne Virus Initiative (IVVI), Dublin, Ireland and Ha Noi Vietnam
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Michael J. Carr
- Ireland Vietnam Blood-Borne Virus Initiative (IVVI), Dublin, Ireland and Ha Noi Vietnam
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Jonathan Dean
- Ireland Vietnam Blood-Borne Virus Initiative (IVVI), Dublin, Ireland and Ha Noi Vietnam
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Allison Waters
- Ireland Vietnam Blood-Borne Virus Initiative (IVVI), Dublin, Ireland and Ha Noi Vietnam
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Linh Thuy Nguyen
- Ireland Vietnam Blood-Borne Virus Initiative (IVVI), Dublin, Ireland and Ha Noi Vietnam
- Laboratory for Molecular Diagnostics, National Institute of Hygiene and Epidemiology, Ha Noi, Vietnam
| | - Thu Hong Ta Thi
- Ireland Vietnam Blood-Borne Virus Initiative (IVVI), Dublin, Ireland and Ha Noi Vietnam
- Laboratory for Molecular Diagnostics, National Institute of Hygiene and Epidemiology, Ha Noi, Vietnam
| | - Lan Anh Bui Thi
- Ireland Vietnam Blood-Borne Virus Initiative (IVVI), Dublin, Ireland and Ha Noi Vietnam
- Laboratory for Molecular Diagnostics, National Institute of Hygiene and Epidemiology, Ha Noi, Vietnam
| | - Huy Duong Do
- Ireland Vietnam Blood-Borne Virus Initiative (IVVI), Dublin, Ireland and Ha Noi Vietnam
- Laboratory for Molecular Diagnostics, National Institute of Hygiene and Epidemiology, Ha Noi, Vietnam
| | - Thu Thuy Duong Thi
- Ireland Vietnam Blood-Borne Virus Initiative (IVVI), Dublin, Ireland and Ha Noi Vietnam
- Laboratory for Molecular Diagnostics, National Institute of Hygiene and Epidemiology, Ha Noi, Vietnam
| | - Ha Thu Nguyen
- Ireland Vietnam Blood-Borne Virus Initiative (IVVI), Dublin, Ireland and Ha Noi Vietnam
- Laboratory for Molecular Diagnostics, National Institute of Hygiene and Epidemiology, Ha Noi, Vietnam
| | - Trinh Thi Diem Do
- Ireland Vietnam Blood-Borne Virus Initiative (IVVI), Dublin, Ireland and Ha Noi Vietnam
- Laboratory for Molecular Diagnostics, National Institute of Hygiene and Epidemiology, Ha Noi, Vietnam
| | - Quynh Phuong Luu
- Ireland Vietnam Blood-Borne Virus Initiative (IVVI), Dublin, Ireland and Ha Noi Vietnam
- Laboratory for Molecular Diagnostics, National Institute of Hygiene and Epidemiology, Ha Noi, Vietnam
| | - Jeff Connell
- Ireland Vietnam Blood-Borne Virus Initiative (IVVI), Dublin, Ireland and Ha Noi Vietnam
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Suzie Coughlan
- Ireland Vietnam Blood-Borne Virus Initiative (IVVI), Dublin, Ireland and Ha Noi Vietnam
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Hien Tran Nguyen
- Ireland Vietnam Blood-Borne Virus Initiative (IVVI), Dublin, Ireland and Ha Noi Vietnam
- Laboratory for Molecular Diagnostics, National Institute of Hygiene and Epidemiology, Ha Noi, Vietnam
| | - William W. Hall
- Ireland Vietnam Blood-Borne Virus Initiative (IVVI), Dublin, Ireland and Ha Noi Vietnam
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
- * E-mail: (WWH); (LANT)
| | - Lan Anh Nguyen Thi
- Ireland Vietnam Blood-Borne Virus Initiative (IVVI), Dublin, Ireland and Ha Noi Vietnam
- Laboratory for Molecular Diagnostics, National Institute of Hygiene and Epidemiology, Ha Noi, Vietnam
- * E-mail: (WWH); (LANT)
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Sereno L, Mesquita F, Kato M, Jacka D, Nguyen TTV, Nguyen TN. Epidemiology, responses, and way forward: the silent epidemic of viral hepatitis and HIV coinfection in Vietnam. ACTA ACUST UNITED AC 2012; 11:311-20. [PMID: 22828983 DOI: 10.1177/1545109712453939] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Viral hepatitis is a disease of great concern to public health that is now met by a favorable momentum to combat the global epidemic. This article is intended to highlight the importance of viral hepatitis in the Vietnam population as well in the group of people living with HIV/AIDS (PLWHA). We reviewed available data on epidemiology and response on hepatitis B virus (HBV) and hepatitis C virus (HCV) and HIV coinfection in Vietnam. The hepatitis B surface antigen (HBsAg) prevalence in the general population ranged from 5.7% to 24.7%. The anti-HCV prevalence ranged from 0.38% to 4.3% in the general population, while among people who inject drugs (PWIDs) it ranged from 31% to 97.2%. The HBV prevalence among PLWHA is similar to the general population, while HCV/HIV coinfection is concentrated in some groups. Anti-HCV prevalence among HIV-infected PWIDs can be as high as 98.5%. Developing policies for diagnosis and treatment of chronic HBV and HCV infections are critical priorities in order to prevent clinical progression to cirrhosis and liver cancer.
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Affiliation(s)
- Leandro Sereno
- 1World Health Organization Vietnam Country Office, Hanoi, Vietnam
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24
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Thu Thuy PT, Bunchorntavakul C, Tan Dat H, Rajender Reddy K. A randomized trial of 48 versus 24 weeks of combination pegylated interferon and ribavirin therapy in genotype 6 chronic hepatitis C. J Hepatol 2012; 56:1012-1018. [PMID: 22266603 DOI: 10.1016/j.jhep.2011.12.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [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: 08/24/2011] [Revised: 10/28/2011] [Accepted: 12/14/2011] [Indexed: 12/26/2022]
Abstract
BACKGROUND & AIMS Genotype 6 chronic hepatitis C (HCV) is encountered predominantly in Southeast Asia and data on optimal treatment strategy is limited. This study was aimed at assessing the rate and predictors of sustained virological response (SVR) in genotype 6 chronic HCV following 48 and 24 weeks of pegylated interferon and ribavirin therapy. METHODS This investigator-initiated, open-label randomized trial was conducted in Vietnam between 2008 and 2010. One hundred and five treatment-naïve HCV genotype 6 patients were randomized to either 48-week (N=70) or 24-week (N=35) duration of pegylated interferon (PEG-IFN) alfa-2a 180 mcg/week and ribavirin (RBV) 15mg/kg/day; 92 patients completed the study (63 in the 48-week and 29 in the 24-week group, respectively). Primary outcome was sustained virological response (SVR) as intention-to-treat analysis. RESULTS There was no statistical difference in SVR between 48-week and 24-week treated groups (71% vs. 60%, respectively; p=0.24). In the 48-week and 24-week treatment groups, 81% and 80% of cases achieved rapid virological response (RVR) (p=0.86), and 86% and 80% achieved complete early virological response (p=0.45). Among those patients with RVR, SVR was in 86% (48-weeks), and 75% (24-weeks) of cases, whereas following non-RVR, only 8% of cases had an SVR with 48-week treatment duration. CONCLUSIONS Overall, RVR was achieved in the majority of genotype 6 patients and, in those patients, similar and high rates of SVR were noted following 24-week and 48-week therapy. This observation, however, needs validation in a larger study to demonstrate non-inferiority of the shorter duration therapy. In non-RVR patients, even 48-week therapy achieved low SVR rates.
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Affiliation(s)
| | - Chalermrat Bunchorntavakul
- Rajavithi Hospital, Ministry of Public Health, Bangkok, Thailand; Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ho Tan Dat
- Medic Medical Center, Ho Chi Minh City, Viet Nam
| | - K Rajender Reddy
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA.
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