1
|
Kennedy CE, Yeh PT, Verster A, Luhmann N, Nguyen VTT, de Mello MB, Baggaley R, Macdonald V. Do Peer Navigators Improve Initiation and Retention in HIV/VH/STI Treatment Programs for People From Key Populations? A Systematic Review of Effectiveness, Values and Preferences, and Cost. J Acquir Immune Defic Syndr 2024; 95:305-312. [PMID: 38416032 PMCID: PMC10896188 DOI: 10.1097/qai.0000000000003364] [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] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 11/15/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND Key populations are disproportionately affected by HIV, viral hepatitis (VH), and sexually transmitted infections (STIs) and face barriers to care. Peer navigation programs are widely used, but evidence supporting their use has not been synthesized. SETTING Peer navigation programs for sex workers, men who have sex with men, people who inject drugs, prisoners, and trans and gender diverse people globally. METHODS To inform World Health Organization guidelines, we conducted a systematic review of effectiveness, values and preferences, and cost studies published between January 2010 and May 2021. We searched CINAHL, PsycINFO, PubMed, and EMBASE; screened abstracts; and extracted data in duplicate. The effectiveness review included randomized controlled trials and comparative observational studies evaluating time to diagnosis or linkage to care, treatment initiation, treatment retention/completion, viral load, cure, or mortality. We assessed risk of bias and summarized findings in GRADE evidence profiles. Values and preferences and cost data were summarized descriptively. RESULTS Four studies evaluated the effectiveness of peer navigators for key populations. All were focused on HIV; none were designed for VH or STIs. These studies showed mixed effects on linkage to care, treatment retention/completion, and viral load; no studies measured treatment initiation, cure, or mortality. Two values and preferences studies with community-based organization staff and health workers suggested peer navigators for key populations were acceptable and valued, although continued challenges remained. No cost studies were identified. CONCLUSIONS Although limited, available studies provide moderate certainty evidence for benefits of HIV/VH/STI peer navigation programs for key populations. Further evaluations are needed.
Collapse
Affiliation(s)
- Caitlin E. Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and
| | - Ping T. Yeh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and
| | - Annette Verster
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Niklas Luhmann
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Van T. T. Nguyen
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Maeve B. de Mello
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Rachel Baggaley
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Virginia Macdonald
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| |
Collapse
|
2
|
Aguilar-Galindo F, Nguyen VTT, Singh R, Domaracka A, Huber BA, Díaz-Tendero S, Rousseau P, Maclot S. Unexpected and delayed fragmentation dynamics of the organometallic ferrocene induced by ion-collision. Phys Chem Chem Phys 2024; 26:7638-7646. [PMID: 38363201 DOI: 10.1039/d3cp05430f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
We have investigated the fragmentation dynamics of the organometallic ferrocene molecule after interaction with multiply charged ions using multicoincidence mass spectrometry and quantum chemistry calculations. We observed unexpected fragmentation dynamics of the two-body breakup channels from ferrocene dications revealing a charge screening effect from the iron atom and delayed fragmentation dynamics. These observations are rationalized through the population of a specific long-lived excited state, where one positive charge is located on each cyclopentadienyl ring.
Collapse
Affiliation(s)
- F Aguilar-Galindo
- Department of Chemistry, Universidad Autónoma de Madrid, 28049, Madrid, Spain
- Institute for Advanced Research in Chemistry (IAdChem), Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - V T T Nguyen
- Normandie Univ., ENSICAEN, UNICAEN, CEA, CNRS, CIMAP, 14000, Caen, France
| | - R Singh
- Normandie Univ., ENSICAEN, UNICAEN, CEA, CNRS, CIMAP, 14000, Caen, France
| | - A Domaracka
- Normandie Univ., ENSICAEN, UNICAEN, CEA, CNRS, CIMAP, 14000, Caen, France
| | - B A Huber
- Normandie Univ., ENSICAEN, UNICAEN, CEA, CNRS, CIMAP, 14000, Caen, France
| | - S Díaz-Tendero
- Department of Chemistry, Universidad Autónoma de Madrid, 28049, Madrid, Spain
- Institute for Advanced Research in Chemistry (IAdChem), Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Condensed Matter Physics Center (IFIMAC), Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - P Rousseau
- Normandie Univ., ENSICAEN, UNICAEN, CEA, CNRS, CIMAP, 14000, Caen, France
| | - S Maclot
- Institut Lumière Matière UMR 5306, Université Claude Bernard Lyon 1, CNRS, Univ Lyon, 69100 Villeurbanne, France.
| |
Collapse
|
3
|
Sabin KM, Burke-Shyne N, Chang J, Daniels C, Nguyen VTT, Verster A. Imperfect progress: treatment options for opioid dependence. Lancet HIV 2021; 8:e60-e61. [PMID: 33539758 DOI: 10.1016/s2352-3018(20)30345-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Keith M Sabin
- Strategic Information Department, UNAIDS, 20 Avenue Appia, 1211 Geneva 27, Switzerland.
| | | | - Judy Chang
- International Network of People who Use Drugs, London, UK
| | | | | | - Annette Verster
- Department of Global HIV, Hepatitis, and STI Programmes, WHO, Geneva, Switzerland
| |
Collapse
|
4
|
Nguyen VTT. Primary cilia structure is prolonged in enteric neurons of Alzheimerʼs Disease model mice. PHARMACOPSYCHIATRY 2020. [DOI: 10.1055/s-0039-3402990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
5
|
Duong MC, Nguyen VTT, Otsu S, McLaws ML. Prevalence of hepatitis B and C virus infections in hemodialysis patients in Vietnam: A systematic review and meta-analysis. JGH Open 2019; 4:29-38. [PMID: 32055694 PMCID: PMC7008166 DOI: 10.1002/jgh3.12199] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 04/27/2019] [Accepted: 05/04/2019] [Indexed: 12/19/2022]
Abstract
Background and Aim Chronic hemodialysis patients are at high risk of contracting hepatitis B (HBV) and C (HCV) virus infections. In Vietnam, the seroprevalence of HBV and HCV infections is approximately 10 and 4%, respectively. Although the chronic hemodialysis population is increasing, relatively little epidemiology is available for HBV and HCV infections in this population. To address this, we reviewed the current literature on the magnitude of these infections in the hemodialysis population in Vietnam. Methods Four databases were used to search for publications containing the prevalence of HBV and/or HCV infections in hemodialysis patients in Vietnam. Grey literature search was utilized to identify local publications. Prevalence and 95% confidence interval were used or calculated, and a meta‐analysis was conducted on HBV and HCV prevalence for comparison. Results Sixteen studies were included in the review. The search identified knowledge gaps in the current literature. Available data show that HBV and HCV infections remain prevalent in the hemodialysis population. HBV prevalence is not different between the north and the south of Vietnam. The pattern of HCV prevalence is different, with recent reports of lower prevalence in the south than in the north, while HCV prevalence varies between hemodialysis units in the same regions. Conclusions A national prevalence survey of hemodialysis patients would improve the reliability and generalizability of the findings. However, the review confirmed that both HBV and HCV were prevalent in hemodialysis patients. The findings support a reinforcement of infection prevention to minimize the risk of HBV and HCV transmission in hemodialysis facilities.
Collapse
Affiliation(s)
- Minh C Duong
- School of Public Health and Community Medicine University of New South Wales Sydney New South Wales Australia
| | | | | | - Mary-Louise McLaws
- School of Public Health and Community Medicine University of New South Wales Sydney New South Wales Australia
| |
Collapse
|
6
|
Abstract
From an EtOAc-soluble fraction of the leaves of Azadirachta indica, one new lactam 28-norlimonoid named nimbandiolactam-21 (1), together with 2 known limonoids (2 and 3) were isolated. Their relative structures were elucidated based on NMR spectroscopic analysis. Nimbandiolactone-23 (2) showed the most potent α-glucosidase inhibitory activity, with an IC50 value of 38.7 μM. Compound 1 represents the first naturally occurring example of a 28-norlimonoid having the lactam moiety. The plausible biosynthetic pathway for the formation of lactam moiety in 1 was proposed.
Collapse
Affiliation(s)
- Nhi Y T Nguyen
- a Faculty of Chemistry , VNUHCM-University of Science , Ho Chi Minh City , Vietnam
| | - Phu H Dang
- a Faculty of Chemistry , VNUHCM-University of Science , Ho Chi Minh City , Vietnam
| | - Van T T Nguyen
- a Faculty of Chemistry , VNUHCM-University of Science , Ho Chi Minh City , Vietnam
| | - Phuc H Dang
- b Theoretical Physics Research Group , Advanced Institute of Materials Science, Ton Duc Thang University , Ho Chi Minh City , Vietnam.,c Faculty of Applied Sciences , Ton Duc Thang University , Ho Chi Minh City , Vietnam
| | - Quan L Tran
- a Faculty of Chemistry , VNUHCM-University of Science , Ho Chi Minh City , Vietnam
| |
Collapse
|
7
|
Draffan AG, Frey B, Fraser BH, Pool B, Gannon C, Tyndall EM, Cianci J, Harding M, Lilly M, Hufton R, Halim R, Jahangiri S, Bond S, Jeynes TP, Nguyen VTT, Wirth V, Luttick A, Tilmanis D, Pryor M, Porter K, Morton CJ, Lin B, Duan J, Bethell RC, Kukolj G, Simoneau B, Tucker SP. Derivatives of imidazotriazine and pyrrolotriazine C-nucleosides as potential new anti-HCV agents. Bioorg Med Chem Lett 2014; 24:4984-8. [PMID: 25288185 DOI: 10.1016/j.bmcl.2014.09.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 07/08/2014] [Revised: 09/08/2014] [Accepted: 09/10/2014] [Indexed: 01/10/2023]
Abstract
Previous investigations identified 2'-C-Me-branched ribo-C-nucleoside adenosine analogues, 1, which contains a pyrrolo[2,1-f][1,2,4]triazin-4-amine heterocyclic base, and 2, which contains an imidazo[2,1-f][1,2,4]triazin-4-amine heterocyclic base as two compounds with promising anti-HCV in vitro activity. This Letter describes the synthesis and evaluation of a series of novel analogues of these compounds substituted at the 2-, 7-, and 8-positions of the heterocyclic bases. A number of active new HCV inhibitors were identified but most compounds also demonstrated unacceptable cytotoxicity. However, the 7-fluoro analogue of 1 displayed good potency with a promising cytotherapeutic margin.
Collapse
Affiliation(s)
- Alistair G Draffan
- Biota Scientific Management Pty. Ltd, 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Barbara Frey
- Biota Scientific Management Pty. Ltd, 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Benjamin H Fraser
- Biota Scientific Management Pty. Ltd, 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Brett Pool
- Biota Scientific Management Pty. Ltd, 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Carlie Gannon
- Biota Scientific Management Pty. Ltd, 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Edward M Tyndall
- Biota Scientific Management Pty. Ltd, 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Julia Cianci
- Biota Scientific Management Pty. Ltd, 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Michael Harding
- Biota Scientific Management Pty. Ltd, 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Michael Lilly
- Biota Scientific Management Pty. Ltd, 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Richard Hufton
- Biota Scientific Management Pty. Ltd, 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Rosliana Halim
- Biota Scientific Management Pty. Ltd, 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Saba Jahangiri
- Biota Scientific Management Pty. Ltd, 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Silas Bond
- Biota Scientific Management Pty. Ltd, 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Tyrone P Jeynes
- Biota Scientific Management Pty. Ltd, 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Van T T Nguyen
- Biota Scientific Management Pty. Ltd, 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Veronika Wirth
- Biota Scientific Management Pty. Ltd, 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Angela Luttick
- Biota Scientific Management Pty. Ltd, 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Danielle Tilmanis
- Biota Scientific Management Pty. Ltd, 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Melinda Pryor
- Biota Scientific Management Pty. Ltd, 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Kate Porter
- Biota Scientific Management Pty. Ltd, 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Craig J Morton
- Biota Scientific Management Pty. Ltd, 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Bo Lin
- Biota Scientific Management Pty. Ltd, 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Jianmin Duan
- Boehringer Ingelheim (Canada) Ltd, Research and Development, 2100 rue Cunard, Laval, Québec H7S 2G5, Canada
| | - Richard C Bethell
- Boehringer Ingelheim (Canada) Ltd, Research and Development, 2100 rue Cunard, Laval, Québec H7S 2G5, Canada
| | - George Kukolj
- Boehringer Ingelheim (Canada) Ltd, Research and Development, 2100 rue Cunard, Laval, Québec H7S 2G5, Canada
| | - Bruno Simoneau
- Boehringer Ingelheim (Canada) Ltd, Research and Development, 2100 rue Cunard, Laval, Québec H7S 2G5, Canada
| | - Simon P Tucker
- Biota Scientific Management Pty. Ltd, 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| |
Collapse
|
8
|
Draffan AG, Frey B, Pool B, Gannon C, Tyndall EM, Lilly M, Francom P, Hufton R, Halim R, Jahangiri S, Bond S, Nguyen VTT, Jeynes TP, Wirth V, Luttick A, Tilmanis D, Thomas JD, Pryor M, Porter K, Morton CJ, Lin B, Duan J, Kukolj G, Simoneau B, McKercher G, Lagacé L, Amad M, Bethell RC, Tucker SP. Discovery and Synthesis of C-Nucleosides as Potential New Anti-HCV Agents. ACS Med Chem Lett 2014; 5:679-84. [PMID: 24944743 DOI: 10.1021/ml500077j] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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: 02/20/2014] [Accepted: 04/10/2014] [Indexed: 02/08/2023] Open
Abstract
Nucleoside analogues have long been recognized as prospects for the discovery of direct acting antivirals (DAAs) to treat hepatitis C virus because they have generally exhibited cross-genotype activity and a high barrier to resistance. C-Nucleosides have the potential for improved metabolism and pharmacokinetic properties over their N-nucleoside counterparts due to the presence of a strong carbon-carbon glycosidic bond and a non-natural heterocyclic base. Three 2'CMe-C-adenosine analogues and two 2'CMe-guanosine analogues were synthesized and evaluated for their anti-HCV efficacy. The nucleotide triphosphates of four of these analogues were found to inhibit the NS5B polymerase, and adenosine analogue 1 was discovered to have excellent pharmacokinetic properties demonstrating the potential of this drug class.
Collapse
Affiliation(s)
- Alistair G. Draffan
- Biota Scientific Management Pty. Ltd., 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Barbara Frey
- Biota Scientific Management Pty. Ltd., 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Brett Pool
- Biota Scientific Management Pty. Ltd., 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Carlie Gannon
- Biota Scientific Management Pty. Ltd., 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Edward M. Tyndall
- Biota Scientific Management Pty. Ltd., 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Michael Lilly
- Biota Scientific Management Pty. Ltd., 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Paula Francom
- Biota Scientific Management Pty. Ltd., 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Richard Hufton
- Biota Scientific Management Pty. Ltd., 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Rosliana Halim
- Biota Scientific Management Pty. Ltd., 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Saba Jahangiri
- Biota Scientific Management Pty. Ltd., 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Silas Bond
- Biota Scientific Management Pty. Ltd., 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Van T. T. Nguyen
- Biota Scientific Management Pty. Ltd., 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Tyrone P. Jeynes
- Biota Scientific Management Pty. Ltd., 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Veronika Wirth
- Biota Scientific Management Pty. Ltd., 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Angela Luttick
- Biota Scientific Management Pty. Ltd., 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Danielle Tilmanis
- Biota Scientific Management Pty. Ltd., 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Jesse D. Thomas
- Biota Scientific Management Pty. Ltd., 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Melinda Pryor
- Biota Scientific Management Pty. Ltd., 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Kate Porter
- Biota Scientific Management Pty. Ltd., 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Craig J. Morton
- Biota Scientific Management Pty. Ltd., 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Bo Lin
- Biota Scientific Management Pty. Ltd., 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| | - Jianmin Duan
- Research
and Development, Boehringer Ingelheim (Canada), Ltd., 2100 rue Cunard, Laval, Québec H7S 2G5, Canada
| | - George Kukolj
- Research
and Development, Boehringer Ingelheim (Canada), Ltd., 2100 rue Cunard, Laval, Québec H7S 2G5, Canada
| | - Bruno Simoneau
- Research
and Development, Boehringer Ingelheim (Canada), Ltd., 2100 rue Cunard, Laval, Québec H7S 2G5, Canada
| | - Ginette McKercher
- Research
and Development, Boehringer Ingelheim (Canada), Ltd., 2100 rue Cunard, Laval, Québec H7S 2G5, Canada
| | - Lisette Lagacé
- Research
and Development, Boehringer Ingelheim (Canada), Ltd., 2100 rue Cunard, Laval, Québec H7S 2G5, Canada
| | - Ma’an Amad
- Research
and Development, Boehringer Ingelheim (Canada), Ltd., 2100 rue Cunard, Laval, Québec H7S 2G5, Canada
| | - Richard C. Bethell
- Research
and Development, Boehringer Ingelheim (Canada), Ltd., 2100 rue Cunard, Laval, Québec H7S 2G5, Canada
| | - Simon P. Tucker
- Biota Scientific Management Pty. Ltd., 10/585 Blackburn Road, Notting Hill, Victoria 3168, Australia
| |
Collapse
|
9
|
Abstract
Hepatitis B virus (HBV) infection remains a major public health problem in Vietnam. Recent studies have found that prevalence of current HBV infection (HBsAg+) ranges from 10% to 20% in the general population and 20% to 40% among injecting drug users and HIV+ patients. However, HBV prevention and control in Vietnam relies heavily on universal infant vaccination program and HBsAg screening for blood donors. Currently, HBV prevention and control is underfunded by the government and receives little support from international agencies. HBV-related liver disease will continue to create a heavy burden for public health in Vietnam in the next several decades unless appropriate interventions are undertaken urgently. Establishment of a national strategy for HBV prevention and control is crucial to develop and implement effective interventions.
Collapse
Affiliation(s)
- Van T T Nguyen
- The University of New South Wales, Sydney, NSW 2052, Australia.
| |
Collapse
|
10
|
Abstract
Worldwide, 350 million people are chronically infected with hepatitis B virus (HBV) who are at greater risk of hepatocellular carcinoma (HCC) compared with uninfected people. The relative risks of HCC among people infected with HBV ranges from 5 to 49 in case-control studies and from 7 to 98 in cohort studies. More than 50% of HCC cases worldwide and 70-80% of HCC cases in highly HBV endemic regions are attributable to HBV. Incidence of HCC (per 100,000 person/year) among people with chronic HBV infection ranges from 400 to 800 in male and from 120 to 180 in female. Factors associated with increased risk of HCC include demographic characteristics (male sex and older age), lifestyles (heavy alcohol consumption and smoking), viral factors (genotype C, D F, high level of HBV DNA, core/precore mutation) and clinical factors (cirrhosis, elevated alpha-fetoprotein (AFP) and alanine aminotransferase (ALT)). HBV-related HCC has extremely poor prognosis with median survival less than 16 months. Survival rates of HBV-related HCC ranged from 36% to 67% after 1 year and from 15% to 26% after 5 year of diagnosis. Older age, liver function impairment, vascular invasion, tumour aggressiveness and elevated AFP are associated with HCC survival. Global burden of HBV-related liver disease is still a major challenge for public health in the 21st century. While decreases in incidence of HBV infection have been observed in birth cohorts following the introduction of universal infant HBV vaccination programme, HBV-related HCC incidence in is projected to increase for at least two decades because of the high prevalence of chronic HBV infection and prolonged latency to HCC development. To reduce HBV-related HCC continued expansion of universal infant HBV vaccination is required along with antiviral therapy targeted to those individuals at highest risk of HCC. Broad public health strategies should include routine testing to identify chronic HBV infection, improved health infrastructures including human resource to provide diagnosis and treatment assessment.
Collapse
Affiliation(s)
- V T T Nguyen
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia.
| | | | | |
Collapse
|
11
|
Abstract
BACKGROUND AND AIM Incidence and mortality of hepatocellular carcinoma (HCC) has increased markedly over the last three decades in Australia. An increasing proportion of HCC cases is related to chronic viral hepatitis including hepatitis B virus (HBV) infection. However, there is very limited data on HBV-related HCC survival. METHODS Data on HBV-related HCC cases was obtained from a community-based linkage study. HCC cases notified to the New South Wales (NSW) Central Cancer Registry (CCR) during the period 1994-2002 were linked to HBV notifications from the NSW Health Department. Age, sex, country of birth, year of diagnosis, tumor stage were extracted from the CCR database. Survival analysis was conducted to determine median survival and identify predictors of survival. RESULTS Over the 9-year study period, 278 HCC cases were linked to chronic HBV infection. The majority of cases were male (83.5%) and overseas-born (93.6%); Asian-born cases accounted for 72.1%. Median survival following HCC diagnosis was 15.0 months. HCC survival was poorer among older age groups (P < 0.0001), and among cases with regional spread (hazard ratio, 3.23; 95% confidence interval, 1.83-5.69; P < 0.0001) and distant metastases (hazard ratio, 3.85; 95% confidence interval, 2.44-6.08; P < 0.0001). Sex, region of birth and study period (1994-1997 vs 1998-2002) were not associated with HCC survival. CONCLUSION The vast majority of HBV-related HCC were overseas-born, however, region of birth was unrelated to HCC survival. The continued extremely poor HCC survival, including lack of improvement in HCC survival in more recent years, suggests low uptake of HCC screening programs. Public health strategies including early diagnosis and appropriate referral for antiviral therapy assessment and increased HCC screening among high-risk populations are required to reduce HCC incidence and improve HCC survival.
Collapse
Affiliation(s)
- Van T T Nguyen
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia.
| | | | | | | |
Collapse
|