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Manoharan L, Latham NH, Munari SC, Traeger MW, Menon V, Luhmann N, Baggaley R, Macdonald V, Verster A, Siegfried N, Matthews GV, Stoové M, Hellard ME, Doyle JS. Immediate treatment for recent hepatitis C infection in people with high-risk behaviors: a systematic review and meta-analysis. Hepatol Commun 2023; 7:02009842-202304010-00002. [PMID: 36930865 PMCID: PMC10027039 DOI: 10.1097/hc9.0000000000000082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 12/27/2022] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND AND AIMS Direct-acting antivirals (DAAs) are almost exclusively approved for the treatment of chronic HCV. This poses a significant barrier to the treatment of recently acquired HCV because of the limited access to DAAs. This review seeks to address this issue by synthesizing evidence of the benefits and harms of immediate treatment after the detection of recently acquired HCV in people at higher risk of infection. APPROACH AND RESULTS A systematic review and meta-analysis were conducted reporting on populations with recently acquired HCV at higher risk of infection. Studies were included if they assessed standard duration DAA treatment regimens and reported on the benefits and harms of immediate treatment (within one year of diagnosis). Outcomes included sustained virological response at 12 weeks post-treatment (SVR12), incidence, treatment initiation and adherence, overtreatment, engagement in care, and adverse events. Eight cohort studies, 3 open-label trials, and 1 case series study were included, reporting on 2085 participants with recently acquired HCV infection. No studies included a comparison group. Eight studies assessed DAA treatment in either men who have sex with men or men who have sex with men with HIV, 2 studies assessed treatment in people who inject drugs, and 2 among people living with HIV. Immediate treatment of HCV was associated with a pooled SVR12 of 95.9% (95% CI, 92.6%-99.3%). Three studies reported on hepatitis C incidence, where most participants were treated in the chronic phase of infection. A treatment completion rate of 100% was reported in 2 studies, and only 1 serious adverse event was described. CONCLUSIONS High rates of cure were achieved with the treatment of recently acquired hepatitis C in people at higher risk of infection. Serious adverse events were rare, highlighting individual benefits consistent with the treatment of chronic hepatitis C. The impact of immediate treatment on HCV incidence requires further evaluation.
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Affiliation(s)
| | | | | | - Michael W Traeger
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Niklas Luhmann
- World Health Organization, Global HIV, Geneva, Switzerland
| | | | | | | | | | - Gail V Matthews
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Mark Stoové
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Margaret E Hellard
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Infectious Diseases, the Alfred Hospital and Monash University, Melbourne, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Joseph S Doyle
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Infectious Diseases, the Alfred Hospital and Monash University, Melbourne, Australia
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2
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Essa S, Al-Attiyah R, Siddique I, Al-Nakib W. Modulation of Immune Cell Subsets by Hepatitis C Virus and Antiviral Therapy in Early Virological Response HCV Genotype 4-Infected Patients with Compensated Liver Disease. Med Princ Pract 2021; 30:168-177. [PMID: 32966988 PMCID: PMC8114070 DOI: 10.1159/000511783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/22/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Resolution of chronic hepatitis C virus (HCV) infection requires a complicated interaction between immune cell subsets. The effect of antiviral therapy on immune cell subsets remains to be defined. This study aimed to investigate the absolute count of certain immune cell subsets during therapy with pegylated interferon-α and ribavirin (PegIFN/RBV). MATERIALS AND METHODS Sixty HCV genotype 4-infected patients with compensated liver disease were treated with PegIFN/RBV therapy for 52 weeks. Efficacy was measured by studying the early virological response (EVR) at post-therapy week 12. Absolute counts of mature T cells, T helper cells, T cytotoxic cells, activated T cells, natural killer cells, natural killer/T (NKT) cells, B cells, and T regulatory cells (Treg), and the ratio of T helper to T cytotoxic cells were longitudinally analyzed by flow cytometry throughout the treatment and follow-up course. RESULTS Of the 60 genotype 4-infected subjects, 39 (65%) had EVR and 21 (35%) were non-EVR patients. In the first part of this study, there were significantly lower mean absolute count values of mature T, T cytotoxic, B, and NKT cells. Also, we detected statistically significantly lower mean values for the percentages of T cytotoxic, NKT, Treg, and activated T cells of HCV-infected patients at baseline values when compared with healthy subjects. After the initiation of PegIFN/RBV therapy, frequencies of T helper cells, activated T cells, Treg cells, B cells, and T helper:T cytotoxic ratio were found to be significantly lower in EVR patients than in non-EVR patients (p < 0.05). In contrast, frequencies of T cytotoxic and NKT cells were significantly increased in EVR patients when compared to non-EVR patients (p < 0.05). CONCLUSION These results suggest a pattern of higher levels of T cytotoxic and NKT cells, and lower levels of T helper, activated T, Treg, and B cell populations in patients who respond favorably to PegIFN/RBV therapy.
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Affiliation(s)
- Sahar Essa
- Department of Microbiology, Faculty of Medicine, , Kuwait University, Safat, Kuwait,
| | - Raja'a Al-Attiyah
- Department of Microbiology, Faculty of Medicine, , Kuwait University, Safat, Kuwait
| | - Iqbal Siddique
- Department of Medicine, Faculty of Medicine, Kuwait University, Safat, Kuwait
- Thunayan Al-Ghanim Gastroenterology Center, Al-Amiri Hospital, Safat, Kuwait
| | - Widad Al-Nakib
- Department of Microbiology, Faculty of Medicine, , Kuwait University, Safat, Kuwait
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3
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Kalafateli M, Buzzetti E, Thorburn D, Davidson BR, Tsochatzis E, Gurusamy KS. Pharmacological interventions for acute hepatitis C infection. Cochrane Database Syst Rev 2018; 12:CD011644. [PMID: 30521693 PMCID: PMC6517308 DOI: 10.1002/14651858.cd011644.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) is a single-stranded RNA (ribonucleic acid) virus that has the potential to cause inflammation of the liver. The traditional definition of acute HCV infection is the first six months following infection with the virus. Another commonly used definition of acute HCV infection is the absence of HCV antibody and subsequent seroconversion (presence of HCV antibody in a person who was previously negative for HCV antibody). Approximately 40% to 95% of people with acute HCV infection develop chronic HCV infection, that is, have persistent HCV RNA in their blood. In 2010, an estimated 160 million people worldwide (2% to 3% of the world's population) had chronic HCV infection. The optimal pharmacological treatment of acute HCV remains controversial. Chronic HCV infection can damage the liver. OBJECTIVES To assess the comparative benefits and harms of different pharmacological interventions in the treatment of acute HCV infection through a network meta-analysis and to generate rankings of the available pharmacological treatments according to their safety and efficacy. However, it was not possible to assess whether the potential effect modifiers were similar across different comparisons. Therefore, we did not perform the network meta-analysis and instead we assessed the comparative benefits and harms of different interventions versus each other or versus no intervention using standard Cochrane methodology. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Science Citation Index Expanded, World Health Organization International Clinical Trials Registry Platform, and randomised controlled trials registers to April 2016 to identify randomised clinical trials on pharmacological interventions for acute HCV infection. SELECTION CRITERIA We included only randomised clinical trials (irrespective of language, blinding, or publication status) in participants with acute HCV infection. We excluded trials which included previously liver transplanted participants and those with other coexisting viral diseases. We considered any of the various pharmacological interventions compared with placebo or each other. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We calculated the odds ratio (OR) and rate ratio with 95% confidence intervals (CI) using both fixed-effect and random-effects models based on the available-participant analysis with Review Manager 5. We assessed risk of bias according to Cochrane, controlled risk of random errors with Trial Sequential Analysis, and assessed the quality of the evidence using GRADE. MAIN RESULTS We identified 10 randomised clinical trials with 488 randomised participants that met our inclusion criteria. All the trials were at high risk of bias in one or more domains. Overall, the evidence for all the outcomes was very low quality evidence. Nine trials (467 participants) provided information for one or more outcomes. Three trials (99 participants) compared interferon-alpha versus no intervention. Three trials (90 participants) compared interferon-beta versus no intervention. One trial (21 participants) compared pegylated interferon-alpha versus no intervention, but it did not provide any data for analysis. One trial (41 participants) compared MTH-68/B vaccine versus no intervention. Two trials (237 participants) compared pegylated interferon-alpha versus pegylated interferon-alpha plus ribavirin. None of the trials compared direct-acting antivirals versus placebo or other interventions. The mean or median follow-up period in the trials ranged from six to 36 months.There was no short-term mortality (less than one year) in any group in any trial except for one trial where one participant died in the pegylated interferon-alpha plus ribavirin group (1/95: 1.1%). In the trials that reported follow-up beyond one year, there were no further deaths. The number of serious adverse events was higher with pegylated interferon-alpha plus ribavirin than with pegylated interferon-alpha (rate ratio 2.74, 95% CI 1.40 to 5.33; participants = 237; trials = 2; I2 = 0%). The proportion of people with any adverse events was higher with interferon-alpha and interferon-beta compared with no intervention (OR 203.00, 95% CI 9.01 to 4574.81; participants = 33; trials = 1 and OR 27.88, 95% CI 1.48 to 526.12; participants = 40; trials = 1). None of the trials reported health-related quality of life, liver transplantation, decompensated liver disease, cirrhosis, or hepatocellular carcinoma. The proportion of people with chronic HCV infection as indicated by the lack of sustained virological response was lower in the interferon-alpha group versus no intervention (OR 0.27, 95% CI 0.09 to 0.76; participants = 99; trials = 3; I2 = 0%). The differences between the groups were imprecise or not estimable (because neither group had any events) for all the remaining comparisons.Four of the 10 trials (40%) received financial or other assistance from pharmaceutical companies who would benefit from the findings of the research; the source of funding was not available in five trials (50%), and one trial (10%) was funded by a hospital. AUTHORS' CONCLUSIONS Very low quality evidence suggests that interferon-alpha may decrease the incidence of chronic HCV infection as measured by sustained virological response. However, the clinical impact such as improvement in health-related quality of life, reduction in cirrhosis, decompensated liver disease, and liver transplantation has not been reported. It is also not clear whether this finding is applicable in the current clinical setting dominated by the use of pegylated interferons and direct-acting antivirals, although we found no evidence to support that pegylated interferons or ribavirin or both are effective in people with acute HCV infection. We could find no randomised trials comparing direct-acting antivirals with placebo or other interventions for acute HCV infection. There is significant uncertainty in the benefits and harms of the interventions, and high-quality randomised clinical trials are required.
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Affiliation(s)
- Maria Kalafateli
- Royal Free Hospital and the UCL Institute of Liver and Digestive HealthSheila Sherlock Liver CentreLondonUK
| | - Elena Buzzetti
- Royal Free Hospital and the UCL Institute of Liver and Digestive HealthSheila Sherlock Liver CentreLondonUK
| | - Douglas Thorburn
- Royal Free Hospital and the UCL Institute of Liver and Digestive HealthSheila Sherlock Liver CentreLondonUK
| | - Brian R Davidson
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryPond StreetLondonUKNW3 2QG
| | - Emmanuel Tsochatzis
- Royal Free Hospital and the UCL Institute of Liver and Digestive HealthSheila Sherlock Liver CentreLondonUK
| | - Kurinchi Selvan Gurusamy
- University College LondonDivision of Surgery and Interventional Science9th Floor, Royal Free HospitalRowland Hill StreetLondonUKNW3 2PF
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Misra S, Dieterich DT, Saberi B, Kushner T. Direct-acting antiviral treatment of acute hepatitis C virus infections. Expert Rev Anti Infect Ther 2018; 16:599-610. [PMID: 30067402 DOI: 10.1080/14787210.2018.1505502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Hepatitis C contributes to significant morbidity and mortality worldwide. AHCV is defined as documented infection within 6 months of exposure. Treating acute hepatitis C virus (AHCV) with direct-acting antiviral agents in persons who inject drugs, HIV-positive men who have sex with men, and patients who acquire HCV nosocomially can contribute to the elimination of disease globally, preclude the morbidity and mortality of chronic disease, and prevent further transmission. Areas covered: In this review, we describe the epidemiology of AHCV, its natural history, the considerations involved in the decision of whether to treat AHCV, and the most current DAA therapy guidelines. PubMed was queried using key words and bibliographies were evaluated for relevant articles. Expert commentary: Despite the obvious benefits of AHCV treatment, clinical management is limited by the ability to identify asymptomatic cases and the absence of fully supported guidelines. However, clinical research is advancing and identifying specific regimens, decreasing treatment durations, and creating strategies to target at risk groups and screen for AHCV.
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Affiliation(s)
- Suresh Misra
- a Division of Liver Diseases, Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Douglas T Dieterich
- a Division of Liver Diseases, Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Behnam Saberi
- a Division of Liver Diseases, Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Tatyana Kushner
- a Division of Liver Diseases, Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
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5
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Martinello M, Hajarizadeh B, Grebely J, Dore GJ, Matthews GV. Management of acute HCV infection in the era of direct-acting antiviral therapy. Nat Rev Gastroenterol Hepatol 2018; 15:412-424. [PMID: 29773899 DOI: 10.1038/s41575-018-0026-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The management of acute HCV infection has not been standardized following the availability of direct-acting antiviral agents (DAAs) for chronic HCV infection, and substantial uncertainty exists regarding the optimal treatment regimen and duration. Despite the lack of direct evidence, the 2016 American Association for the Study of Liver Diseases (AASLD)-Infectious Diseases Society of America (IDSA) guidelines supported "the same regimens for acute HCV as recommended for chronic HCV infection … owing to high efficacy and safety", whereas the 2016 European Association for the Study of the Liver (EASL) guidelines recommended sofosbuvir-ledipasvir, sofosbuvir-velpatasvir or sofosbuvir plus daclatasvir for 8 weeks in acute HCV infection, with a longer duration of 12 weeks recommended for those infected with HIV and/or baseline HCV RNA levels >1,000,000 IU/ml. This Review outlines the epidemiology, natural history and diagnosis of acute HCV infection and provides contemporary information on DAAs for acute and recent HCV infection. The Review also discusses the 2016 AASLD-IDSA and EASL recommendations for acute HCV infection management in light of available evidence and highlights key differences in study populations and design that influence interpretation. We focus on populations at high risk of HCV transmission and acquisition, including people who inject drugs and HIV-positive men who have sex with men, and highlight the potential effects of diagnosis and treatment of acute HCV infection in contributing to HCV elimination.
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Affiliation(s)
- Marianne Martinello
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW, Sydney, NSW, Australia.
| | - Behzad Hajarizadeh
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW, Sydney, NSW, Australia
| | - Jason Grebely
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW, Sydney, NSW, Australia
| | - Gregory J Dore
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW, Sydney, NSW, Australia
| | - Gail V Matthews
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW, Sydney, NSW, Australia
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6
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Li C, Hu J. A case report of sofosbuvir and daclatasvirto treat a patient with acute hepatitis C virus genotype 2 monoinfection. Medicine (Baltimore) 2018; 97:e0416. [PMID: 29642211 PMCID: PMC5908610 DOI: 10.1097/md.0000000000010416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/21/2018] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Direct-acting antivirals (DAAs) are the first-line treatment for patients with chronic hepatitis C virus (HCV) infection. However, its effects on patients with acute HCV infection are poorly understood, and the data for treatment of DAAs for genotype 2 acute monoinfection patients with HCV are lacking. PATIENT CONCERNS In this case report, a 26 year-old Chinese female acquired a tattoo and developed fatigue, nausea, and anorexia. Laboratory tests showed abnormal liver function. DIAGNOSES Five months after the patient acquired a tattoo, laboratory tests showed anti-HCV antibody titers were 26.0 s/co, HCV RNA was 5.74×10 IU/mL, and HCV genotype was 2a. The patient was diagnosed with acute hepatitis C (AHC). INTERVENTIONS HCV RNA did not have spontaneous clearance 12 weeks after the infection of the patient. The patient received sofosbuvir (SOF) and daclatasvir (DCV) combination treatment for 12 weeks. OUTCOMES Laboratory tests showed HCV RNA was undetectable at weeks 4, and anti-HCV antibody was in seroconversion at weeks 12 during treatment. The patient achieved a sustained virological response 36 weeks after the end of treatment. LESSONS Patients with acute HCV genotype 2 monoinfection would benefit from antiviral treatment with SOF and DCV.
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Affiliation(s)
- Chen Li
- Liver Failure Treatment and Research Center, 302 Military Hospital, Beijing, P.R. China
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7
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Gaeta GB, Puoti M, Coppola N, Santantonio T, Bruno R, Chirianni A, Galli M. Treatment of acute hepatitis C: recommendations from an expert panel of the Italian Society of Infectious and Tropical Diseases. Infection 2017; 46:183-188. [PMID: 29238918 DOI: 10.1007/s15010-017-1107-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 12/04/2017] [Indexed: 12/24/2022]
Abstract
AIM This paper is aimed at providing practical recommendations for the management of acute hepatitis C (AHC). METHODS This is an expert position paper based on the literature revision. Final recommendations were graded by level of evidence and strength of the recommendations. RESULTS Treatment of AHC with direct-acting antivirals (DAA) is safe and effective; it overcomes the limitations of INF-based treatments. CONCLUSIONS Early treatment with DAA should be offered when available.
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Affiliation(s)
- Giovanni B Gaeta
- Infectious Diseases, Campania University "Luigi Vanvitelli", Naples, Italy.
| | - Massimo Puoti
- Infectious Diseases, Niguarda Hospital, Milan, Italy
| | - Nicola Coppola
- Infectious Diseases, Campania University "Luigi Vanvitelli", Naples, Italy
| | | | | | | | - Massimo Galli
- Infectious Diseases, University of Milan, Milan, Italy
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8
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Tomkins A, Lee V. Intervention to improve management of acute hepatitis C infection in a UK sexual health clinic. Int J STD AIDS 2017; 29:195-197. [DOI: 10.1177/0956462417727193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A case note review was conducted for all newly-diagnosed acute hepatitis C virus (HCV)-infected patients attending our sexual health clinic pre- and post-implementation of an HCV clinic proforma between January 2010 and September 2016. In total, 87 patient notes were included (40 pre-intervention, 47 post-intervention) of whom 81 were HIV-positive. Data were collected regarding documentation of the following: baseline investigations, four-weekly HCV viral load monitoring, risk assessment, partner notification, advice given and Public Health England (PHE) notification. Appropriate baseline investigations, four-weekly monitoring of HCV viral loads, risk assessment and advice documentation all improved in the post-intervention group when compared to pre-intervention. PHE notification and partner notification remained below the national standard post-intervention, with educational measures among relevant staff implemented accordingly. This audit demonstrates improvement across several key areas post clinic proforma implementation.
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Affiliation(s)
- A Tomkins
- The Hathersage Centre, The Northern Contraception, Sexual Health and HIV Service, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - V Lee
- The Hathersage Centre, The Northern Contraception, Sexual Health and HIV Service, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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9
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Kalafateli M, Buzzetti E, Thorburn D, Davidson BR, Tsochatzis E, Gurusamy KS. Pharmacological interventions for acute hepatitis C infection: an attempted network meta-analysis. Cochrane Database Syst Rev 2017; 3:CD011644. [PMID: 28285495 PMCID: PMC6464698 DOI: 10.1002/14651858.cd011644.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) is a single-stranded RNA (ribonucleic acid) virus that has the potential to cause inflammation of the liver. The traditional definition of acute HCV infection is the first six months following infection with the virus. Another commonly used definition of acute HCV infection is the absence of HCV antibody and subsequent seroconversion (presence of HCV antibody in a person who was previously negative for HCV antibody). Approximately 40% to 95% of people with acute HCV infection develop chronic HCV infection, that is, have persistent HCV RNA in their blood. In 2010, an estimated 160 million people worldwide (2% to 3% of the world's population) had chronic HCV infection. The optimal pharmacological treatment of acute HCV remains controversial. Chronic HCV infection can damage the liver. OBJECTIVES To assess the comparative benefits and harms of different pharmacological interventions in the treatment of acute HCV infection through a network meta-analysis and to generate rankings of the available pharmacological treatments according to their safety and efficacy. However, it was not possible to assess whether the potential effect modifiers were similar across different comparisons. Therefore, we did not perform the network meta-analysis, and instead, we assessed the comparative benefits and harms of different interventions versus each other or versus no intervention using standard Cochrane methodology. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Science Citation Index Expanded, World Health Organization International Clinical Trials Registry Platform, and randomised controlled trials registers to April 2016 to identify randomised clinical trials on pharmacological interventions for acute HCV infection. SELECTION CRITERIA We included only randomised clinical trials (irrespective of language, blinding, or publication status) in participants with acute HCV infection. We excluded trials which included previously liver transplanted participants and those with other coexisting viral diseases. We considered any of the various pharmacological interventions compared with placebo or each other. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We calculated the odds ratio (OR) and rate ratio with 95% confidence intervals (CI) using both fixed-effect and random-effects models based on the available-participant analysis with Review Manager 5. We assessed risk of bias according to Cochrane, controlled risk of random errors with Trial Sequential Analysis, and assessed the quality of the evidence using GRADE. MAIN RESULTS We identified 10 randomised clinical trials with 488 randomised participants that met our inclusion criteria. All the trials were at high risk of bias in one or more domains. Overall, the evidence for all the outcomes was very low quality evidence. Nine trials (467 participants) provided information for one or more outcomes. Three trials (99 participants) compared interferon-alpha versus no intervention. Three trials (90 participants) compared interferon-beta versus no intervention. One trial (21 participants) compared pegylated interferon-alpha versus no intervention, but it did not provide any data for analysis. One trial (41 participants) compared MTH-68/B vaccine versus no intervention. Two trials (237 participants) compared pegylated interferon-alpha versus pegylated interferon-alpha plus ribavirin. None of the trials compared direct-acting antivirals versus placebo or other interventions. The mean or median follow-up period in the trials ranged from six to 36 months.There was no short-term mortality (less than one year) in any group in any trial except for one trial where one participant died in the pegylated interferon-alpha plus ribavirin group (1/95: 1.1%). In the trials that reported follow-up beyond one year, there were no further deaths. The number of serious adverse events was higher with pegylated interferon-alpha plus ribavirin than with pegylated interferon-alpha (rate ratio 2.74, 95% CI 1.40 to 5.33; participants = 237; trials = 2; I2 = 0%). The proportion of people with any adverse events was higher with interferon-alpha and interferon-beta compared with no intervention (OR 203.00, 95% CI 9.01 to 4574.81; participants = 33; trials = 1 and OR 27.88, 95% CI 1.48 to 526.12; participants = 40; trials = 1). None of the trials reported health-related quality of life, liver transplantation, decompensated liver disease, cirrhosis, or hepatocellular carcinoma. The proportion of people with chronic HCV infection as indicated by the lack of sustained virological response was lower in the interferon-alpha group versus no intervention (OR 0.27, 95% CI 0.09 to 0.76; participants = 99; trials = 3; I2 = 0%). The differences between the groups were imprecise or not estimable (because neither group had any events) for all the remaining comparisons.Four of the 10 trials (40%) received financial or other assistance from pharmaceutical companies who would benefit from the findings of the research; the source of funding was not available in five trials (50%), and one trial (10%) was funded by a hospital. AUTHORS' CONCLUSIONS Very low quality evidence suggests that interferon-alpha may decrease the incidence of chronic HCV infection as measured by sustained virological response. However, the clinical impact such as improvement in health-related quality of life, reduction in cirrhosis, decompensated liver disease, and liver transplantation has not been reported. It is also not clear whether this finding is applicable in the current clinical setting dominated by the use of pegylated interferons and direct-acting antivirals, although we found no evidence to support that pegylated interferons or ribavirin or both are effective in people with acute HCV infection. We could find no randomised trials comparing direct-acting antivirals with placebo or other interventions for acute HCV infection. There is significant uncertainty in the benefits and harms of the interventions, and high-quality randomised clinical trials are required.
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Affiliation(s)
- Maria Kalafateli
- Royal Free Hospital and the UCL Institute of Liver and Digestive HealthSheila Sherlock Liver CentreLondonUK
| | - Elena Buzzetti
- Royal Free Hospital and the UCL Institute of Liver and Digestive HealthSheila Sherlock Liver CentreLondonUK
| | - Douglas Thorburn
- Royal Free Hospital and the UCL Institute of Liver and Digestive HealthSheila Sherlock Liver CentreLondonUK
| | - Brian R Davidson
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryPond StreetLondonUKNW3 2QG
| | - Emmanuel Tsochatzis
- Royal Free Hospital and the UCL Institute of Liver and Digestive HealthSheila Sherlock Liver CentreLondonUK
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10
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Rockstroh JK, Bhagani S, Hyland RH, Yun C, Dvory-Sobol H, Zheng W, Brainard DM, Ingiliz P, Lutz T, Boesecke C, Nelson M. Ledipasvir-sofosbuvir for 6 weeks to treat acute hepatitis C virus genotype 1 or 4 infection in patients with HIV coinfection: an open-label, single-arm trial. Lancet Gastroenterol Hepatol 2017; 2:347-353. [PMID: 28397698 DOI: 10.1016/s2468-1253(17)30003-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/06/2017] [Accepted: 01/10/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND The latest European Association for the Study of the Liver (EASL) guidelines now recommend that patients with acute hepatitis C virus (HCV) infection should be treated with a combination of sofosbuvir and an NS5A inhibitor for 8 weeks. However, the ideal duration of treatment with interferon-free regimens, particularly in HIV-coinfected individuals, remains unknown. We assessed the efficacy and safety of 6 weeks of ledipasvir-sofosbuvir for acute genotype 1 or 4 HCV in HIV-1-coinfected patients. METHODS This open-label, single-arm trial, done in Germany and the UK, included patients with acute HCV genotype 1 or 4 and HIV-1. At screening, patients were either receiving HIV antiretrovirals and had HIV RNA less than 200 copies per mL, or not receiving antiretrovirals and had a CD4 T-cell count of greater than 500 cells per μL. All patients received ledipasvir-sofosbuvir once daily for 6 weeks. The primary efficacy endpoint was the proportion of patients with sustained virological response 12 weeks after the end of treatment (SVR12). This study is registered with ClinicalTrials.gov, number NCT02457611. FINDINGS Between June 11, 2015, and Jan 8, 2016, we enrolled and treated 26 patients. All (100%) were men, 24 (92%) were white, and 25 (96%) were receiving antiretroviral treatment. 19 (73%) had genotype 1a and seven (27%) had genotype 4 HCV. Overall, 20 (77%; 95% CI 56-91) of 26 patients achieved SVR12: 15 (79%) of 19 with genotype 1a, and five (71%) of seven with genotype 4. Of six patients not achieving SVR12, three relapsed, two achieved sustained virological response 4 weeks after the end of treatment but were lost to follow-up, and one was reinfected. The most common adverse events were fatigue (seven participants [27%]), nasopharyngitis (seven [27%]), and headache (six [23%]). No patient discontinued or interrupted therapy due to adverse events. No HIV rebound occurred during the study. INTERPRETATION The rate of cure with a fixed-dose combination of ledipasvir-sofosbuvir for patients with acute genotype 1 or 4 HCV infection and HIV-1 coinfection is similar to historic rates with interferon-based treatment, but with shorter treatment duration and more favourable safety outcomes. FUNDING Gilead Sciences.
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Affiliation(s)
| | | | | | | | | | - Wei Zheng
- Gilead Sciences, Foster City, CA, USA
| | | | | | - Thomas Lutz
- Infektiologikum, Frankfurt/Main, Frankfurt, Germany
| | | | - Mark Nelson
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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11
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Ranieri R, Starnini G, Carbonara S, Pontali E, Leo G, Romano A, Panese S, Monarca R, Prestileo T, Barbarini G, Babudieri S. Management of HCV infection in the penitentiary setting in the direct-acting antivirals era: practical recommendations from an expert panel. Infection 2016; 45:131-138. [PMID: 28025726 DOI: 10.1007/s15010-016-0973-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 12/06/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND The prevalence of HCV infection is higher among prisoners than in the general population. The introduction of HCV direct-acting antivirals (DAA) holds the potential to improve clinical outcomes also in inmates. However, treatment of hepatitis C in inmates has to face several clinical and logistical issues which are peculiar of prison environment. Recommendations on the management of HCV infection specific for the penitentiary setting in the DAA era remain scant. The Italian Society for Penitentiary Medicine and Healthcare has, therefore, issued these recommendations, to provide clinicians with a guide for the comprehensive management of HCV infection in the restriction setting, taking into account its peculiar characteristics. RESULTS Dedicated diagnostic and treatment procedures should be established in each prison. In particular, the use of DAAs appears crucial to provide patients with an effective therapeutic option, able to overcome the limitations of IFN-based regimens with a short period of treatment. DAA treatment should be initiated as soon as possible in all eligible subjects with the aim to cure the patient, as well as to limit the transmission of HCV infection both inside the penitentiary system and to the free community, once the inmates ends his/her release. Importantly, efforts should be made to open a discussion with regulatory bodies, to define specific regulations aimed to guarantee wide access to effective therapies of all eligible patients, to optimize the management of and the adherence to the HCV treatment, and to ensure the therapeutic continuity after discharge from prison.
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Affiliation(s)
- Roberto Ranieri
- Azienda Ospedaliera Santi Paolo e Carlo Penitentiary Infectious Diseases Unit, University of Milan, Milan, Italy
- SIMSPe-Italian Society for Penitentiary Medicine and Healthcare, v.le San Pietro35/b, 07100, Sassari, Italy
| | - Giulio Starnini
- SIMSPe-Italian Society for Penitentiary Medicine and Healthcare, v.le San Pietro35/b, 07100, Sassari, Italy
- U.O.C. Medicina protetta-Malattie infettive, Viterbo, Italy
| | - Sergio Carbonara
- SIMSPe-Italian Society for Penitentiary Medicine and Healthcare, v.le San Pietro35/b, 07100, Sassari, Italy
- Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | - Emanuele Pontali
- SIMSPe-Italian Society for Penitentiary Medicine and Healthcare, v.le San Pietro35/b, 07100, Sassari, Italy
- Infectious Disease Unit, Ospedale Galliera, Genoa, Italy
| | - Guido Leo
- SIMSPe-Italian Society for Penitentiary Medicine and Healthcare, v.le San Pietro35/b, 07100, Sassari, Italy
- Infectious Disease Unit, Ospedale Amedeo di Savoia, Turin, Italy
| | | | - Sandro Panese
- Ospedale dell'Angelo Malattie infettive e Tropicali, Venice, Italy
| | - Roberto Monarca
- SIMSPe-Italian Society for Penitentiary Medicine and Healthcare, v.le San Pietro35/b, 07100, Sassari, Italy
- Ospedale Belcolle, Viterbo, Italy
| | | | - Giorgio Barbarini
- Malattie Infettive e Tropicali IRCCS San Matteo, Università di Pavia, Pavia, Italy
- Case Circondariali di Pavia, Voghera e Vigevano, Italy
| | - Sergio Babudieri
- SIMSPe-Italian Society for Penitentiary Medicine and Healthcare, v.le San Pietro35/b, 07100, Sassari, Italy.
- Infectious Disease Unit, University of Sassari, Sassari, Italy.
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12
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Butler B, Narayan B, Potts J, Emmanuel J. Symptomatic Acute Hepatitis C Infection Following a Single Episode of Unprotected Sexual Intercourse. Case Rep Infect Dis 2016; 2016:8639098. [PMID: 27957361 PMCID: PMC5121440 DOI: 10.1155/2016/8639098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 10/10/2016] [Accepted: 10/18/2016] [Indexed: 11/21/2022] Open
Abstract
A previously healthy 23-year-old MSM presented with jaundice, systemic upset, and rash 2 months after a single episode of unprotected sexual intercourse. Liver biochemistry was grossly deranged, with markedly elevated transaminases and hyperbilirubinaemia. Serology was positive for genotype 1a hepatitis C virus (HCV) and in the absence of other causes, acute HCV infection was suspected. He was subsequently successfully treated with pegylated interferon and ribavirin for 24 weeks and made a full clinical and biochemical recovery.
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Affiliation(s)
- Benjamin Butler
- Department of Acute Medicine, Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London E1 1BB, UK
| | - Bhaskar Narayan
- Department of Acute Medicine, Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London E1 1BB, UK
| | - Jonathan Potts
- Department of Acute Medicine, Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London E1 1BB, UK
| | - Julian Emmanuel
- Department of Acute Medicine, Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London E1 1BB, UK
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13
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Deterding K, Spinner CD, Schott E, Welzel TM, Gerken G, Klinker H, Spengler U, Wiegand J, Schulze Zur Wiesch J, Pathil A, Cornberg M, Umgelter A, Zöllner C, Zeuzem S, Papkalla A, Weber K, Hardtke S, von der Leyen H, Koch A, von Witzendorff D, Manns MP, Wedemeyer H. Ledipasvir plus sofosbuvir fixed-dose combination for 6 weeks in patients with acute hepatitis C virus genotype 1 monoinfection (HepNet Acute HCV IV): an open-label, single-arm, phase 2 study. THE LANCET. INFECTIOUS DISEASES 2016; 17:215-222. [PMID: 28029529 DOI: 10.1016/s1473-3099(16)30408-x] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/10/2016] [Accepted: 08/11/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Early treatment of acute hepatitis C virus (HCV) infection with interferon alfa is highly effective, but can be associated with frequent side-effects. We investigated the safety and efficacy of an interferon-free regimen for treatment of acute HCV infection. METHODS In this prospective, open-label, multicentre, single-arm pilot study, we enrolled adults (≥18 years) with acute HCV genotype 1 monoinfection from ten centres in Germany. Patients were given ledipasvir (90 mg) plus sofosbuvir (400 mg) as a fixed-dose combination tablet once daily for 6 weeks. The primary efficacy outcome was the proportion of patients with sustained virological response (defined as undetectable HCV RNA 12 weeks after the end of treatment; other primary outcomes were safety and tolerability of ledipasvir plus sofosbuvir. The primary analysis population consisted of all patients who received at least one dose of study drug. Safety was also assessed in all patients who received at least one dose of the study drug. This trial is registered with ClinicalTrials.gov, number NCT02309918. FINDINGS Between Nov 19, 2014, and Nov 10, 2015, we enrolled 20 patients. Median HCV RNA viral load at baseline was 4·04 log10 IU/mL (1·71-7·20); 11 patients were infected with HCV genotype 1a and nine patients with genotype 1b. All patients achieved a sustained virological response 12 weeks after the end of treatment (20 [100%] of 20 patients). Treatment was well tolerated; there were no drug-related serious adverse events. Up to 12 weeks after treatment, 22 possible or probable drug-related adverse events were reported. There was one serious adverse event, which was judged unrelated to the study drug; one patient was admitted to hospital for surgery of a ruptured cruciate ligament. INTERPRETATION Treatment for 6 weeks with ledipasvir plus sofosbuvir was well tolerated and highly effective in patients with acute HCV genotype 1 monoinfection. Short-duration treatment of acute hepatitis C might prevent the spread of HCV in high-risk populations. FUNDING Gilead Sciences, HepNet Study-House/German Liver Foundation, and German Centre for Infection Research (DZIF).
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Affiliation(s)
- Katja Deterding
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; HepNet Study-House, German Liver Foundation, Hannover, Germany
| | - Christoph D Spinner
- Department of Medicine II, University Hospital Klinikum rechts der Isar, Munich, Germany
| | - Eckart Schott
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Tania M Welzel
- Department of Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - Guido Gerken
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Hartwig Klinker
- Department of Internal Medicine II, Division of Infectious Diseases, University of Würzburg Medical Center, Würzburg, Germany
| | - Ulrich Spengler
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Johannes Wiegand
- Department of Gastroenterology and Rheumatology, Section of Hepatology, University of Leipzig, Leipzig, Germany
| | | | - Anita Pathil
- Department of Internal Medicine IV, Gastroenterology and Hepatology, University Clinic of Heidelberg, Heidelberg, Germany
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; HepNet Study-House, German Liver Foundation, Hannover, Germany; German Centre for Infection Research (DZIF), partner site Hannover-Braunschweig, Germany
| | - Andreas Umgelter
- Department of Medicine II, University Hospital Klinikum rechts der Isar, Munich, Germany
| | - Caroline Zöllner
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Zeuzem
- Department of Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | | | - Kristina Weber
- Department of Biostatistics, Hannover Medical School, Hannover, Germany
| | - Svenja Hardtke
- HepNet Study-House, German Liver Foundation, Hannover, Germany; German Centre for Infection Research (DZIF), partner site Hannover-Braunschweig, Germany
| | | | - Armin Koch
- Department of Biostatistics, Hannover Medical School, Hannover, Germany
| | | | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; HepNet Study-House, German Liver Foundation, Hannover, Germany; German Centre for Infection Research (DZIF), partner site Hannover-Braunschweig, Germany.
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; HepNet Study-House, German Liver Foundation, Hannover, Germany; German Centre for Infection Research (DZIF), partner site Hannover-Braunschweig, Germany.
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14
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Dirchwolf M, Marciano S, Mauro E, Ruf AE, Rezzonico L, Anders M, Chiodi D, Petta NG, Borzi S, Tanno F, Ridruejo E, Barreyro F, Shulman C, Plaza P, Carbonetti R, Tadey L, Schroder T, Fainboim H. Clinical epidemiology of acute hepatitis C in South America. J Med Virol 2016; 89:276-283. [PMID: 27253181 DOI: 10.1002/jmv.24588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2016] [Indexed: 12/14/2022]
Abstract
There is scarce data pertaining to acute hepatitis C (aHC) infection in South America. We aimed to describe clinical characteristics and evolution of aHC in a South American cohort. A retrospective survey was conducted at 13 hepatology units. All patients ≥16 years old with aHC diagnosis were included. Demographic, clinical and outcome information were registered in a standardized ad hoc questionnaire. Sixty-four patients were included. The majority were middle-aged (median age: 46 years) and female (65.6%); most of them were symptomatic at diagnosis (79.6%). HCV-1 was the most prevalent genotype (69.2%). Five patients had liver failure: three cases of severe acute hepatitis, one case of fulminant hepatitis and one case of acute-on-chronic liver failure. Nosocomial exposure was the most prevalent risk factor. Evolution was assessed in 46 patients. In the untreated cohort, spontaneous resolution occurred in 45.8% and was associated with higher values of AST/ALT and with the absence of intermittent HCV RNA viremia (P = 0.01, 0.05, and 0.01, respectively). In the treated cohort, sustained virological response was associated with nosocomial transmission and early treatment initiation (P = 0.04 each). The prevalence of nosocomial transmission in this South-American cohort of aHC stresses the importance of following universal precautions to prevent HCV infection. J. Med. Virol. 89:276-283, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Melisa Dirchwolf
- Hepatopatías Infecciosas, Hospital F.J. Muñiz, Buenos Aires, Argentina
| | | | - Ezequiel Mauro
- Liver Unit, Hospital Italiano de Buenos, Buenos Aires, Argentina
| | - Andrés Eduardo Ruf
- Fundación para la Docencia e Investigación de las Enfermedades del Hígado (FUNDIEH), Buenos Aires, Argentina
| | - Lucrecia Rezzonico
- Hepatología, Hospital de la Asociación Médica Dr. Felipe Glasman, Bahía Blanca, Buenos Aires, Argentina
| | - Margarita Anders
- Unidad de Hepatología y Trasplante Hepático, Hospital Alemán, Buenos Aires, Argentina
| | - Daniela Chiodi
- Hospital de Clínicas, Facultad de Medicina, UDELAR, Montevideo, Uruguay
| | - Néstor Gill Petta
- Servicio de Gastroenterología y Hepatología, Hospital Central del Instituto de Previsión Social de Asunción, Paraguay
| | - Silvia Borzi
- Sección Hepatología, HIGA Prof. Dr. Rodolfo Rossi, La Plata Buenos Aires, Argentina
| | - Federico Tanno
- Servicio de Hepatología y Gastroenterología, Hospital Provincial del Centenario de Rosario, Argentina
| | - Ezequiel Ridruejo
- Sección Hepatología, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno "CEMIC", Unidad de Hepatología y Trasplante Hepático, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Fernando Barreyro
- Laboratorio de Microbiología, Facultad de Química y Ciencias Naturales Universidad de Misiones, Posadas, Argentina
| | | | - Pablo Plaza
- Gastroenterología y Hepatología, Salta Capital, Argentina
| | - Rodolfo Carbonetti
- Gastroenterología y Hepatología, Hospital de Clínicas Nicolás Avellaneda, Tucumán, Argentina
| | - Luciana Tadey
- Unidad de Virología, Hospital F.J. Muñiz, Buenos Aires, Argentina
| | - Teresa Schroder
- Hepatopatías Infecciosas, Hospital F.J. Muñiz, Buenos Aires, Argentina
| | - Hugo Fainboim
- Hepatopatías Infecciosas, Hospital F.J. Muñiz, Buenos Aires, Argentina
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15
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Omata M, Kanda T, Wei L, Yu ML, Chuang WL, Ibrahim A, Lesmana CRA, Sollano J, Kumar M, Jindal A, Sharma BC, Hamid SS, Dokmeci AK, Al-Mahtab M, McCaughan GW, Wasim J, Crawford DHG, Kao JH, Yokosuka O, Lau GKK, Sarin SK. APASL consensus statements and recommendations for hepatitis C prevention, epidemiology, and laboratory testing. Hepatol Int 2016; 10:681-701. [PMID: 27229718 PMCID: PMC5003900 DOI: 10.1007/s12072-016-9736-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/20/2016] [Indexed: 02/06/2023]
Abstract
The Asian Pacific Association for the Study of the Liver (APASL) convened an international working party on "APASL consensus statements and recommendations for management of hepatitis C" in March 2015 to revise the "APASL consensus statements and management algorithms for hepatitis C virus infection" (Hepatol Int 6:409-435, 2012). The working party consisted of expert hepatologists from the Asian-Pacific region gathered at the Istanbul Congress Center, Istanbul, Turkey on 13 March 2015. New data were presented, discussed, and debated during the course of drafting a revision. Participants of the consensus meeting assessed the quality of the cited studies. The finalized recommendations for hepatitis C prevention, epidemiology, and laboratory testing are presented in this review.
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Affiliation(s)
- Masao Omata
- Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu-shi, Yamanashi, 400-8506, Japan.
- The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Tatsuo Kanda
- Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Lai Wei
- Peking University People's Hospital, Peking University Hepatology Institute, Beijing, China
| | - Ming-Lung Yu
- Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Wang-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Alaaeldin Ibrahim
- GI/Liver Division, Department of Internal Medicine, University of Benha, Banha, Egypt
| | | | - Jose Sollano
- University Santo Tomas Hospital, Manila, Philippines
| | - Manoj Kumar
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Ankur Jindal
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | | | - Saeed S Hamid
- Department of Medicine, Aga Khan University and Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - A Kadir Dokmeci
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Mamun Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, 1000, Bangladesh
| | - Geofferey W McCaughan
- Royal Prince Alfred Hospital, Centenary Institute, University of Sydney, Sydney, Australia
| | - Jafri Wasim
- Department of Medicine, Aga Khan University and Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Darrell H G Crawford
- University of Queensland, School of Medicine, Woolloongabba, QLD, 4102, Australia
| | - Jia-Horng Kao
- National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
| | - Osamu Yokosuka
- Graduate School of Medicine, Chiba University, Chiba, Japan
| | - George K K Lau
- The Institute of Translational Hepatology, Beijing 302 Hospital, Beijing, China
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
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16
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Hullegie SJ, Claassen MAA, van den Berk GEL, van der Meer JTM, Posthouwer D, Lauw FN, Leyten EMS, Koopmans PP, Richter C, van Eeden A, Bierman WFW, Newsum AM, Arends JE, Rijnders BJA. Boceprevir, peginterferon and ribavirin for acute hepatitis C in HIV infected patients. J Hepatol 2016; 64:807-12. [PMID: 26689767 DOI: 10.1016/j.jhep.2015.12.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/03/2015] [Accepted: 12/04/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND & AIMS Acute hepatitis C virus infections (AHCV) are prevalent among HIV positive men having sex with men and generally treated with pegylated interferon-alpha (PegIFN) and ribavirin (RBV) during 24weeks. The addition of a protease inhibitor could shorten therapy without loss of efficacy. METHODS We performed an open-label, single arm study to investigate the efficacy and safety of a 12-week course of boceprevir, PegIFN and RBV for AHCV genotype 1 infections in 10 Dutch HIV treatment centers. The primary endpoint of the study was achievement of sustained virological response rate at week 12 (SVR12) in patients reaching a rapid viral response at week 4 (RVR4) and SVR12 in the intent to treat (ITT) entire study population was the most relevant secondary endpoint. RESULTS One hundred twenty-seven AHCV patients were screened in 16 months, of which 65 AHCV genotype 1 patients were included. After spontaneous clearance in six patients and withdrawal before treatment initiation in two, 57 started therapy within 26 weeks after infection. RVR4 rate was 72%. SVR12 rate was 100% in the RVR4 group. SVR12 rate in the ITT group was 86% and comparable to the SVR12 rate of 84% in 73 historical controls treated for 24 weeks with PegIFN and RBV in the same study centers. CONCLUSION With the addition of boceprevir to PegIFN and RBV, treatment duration of AHCV genotype 1 can be reduced to 12 weeks without loss of efficacy. Given the high drug costs and limited availability of interferon-free regimens, boceprevir PegIFN and RBV can be a considered a valid treatment option for AHCV. ClinicalTrials.gov, number NCT01912495.
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Affiliation(s)
- Sebastiaan J Hullegie
- Department of Internal Medicine and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands.
| | - Mark A A Claassen
- Department of Internal Medicine and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Guido E L van den Berk
- Department of Internal Medicine and Infectious Diseases, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Jan T M van der Meer
- Department of Internal Medicine and Infectious Diseases, Academisch Medisch Centrum, Amsterdam, The Netherlands
| | - Dirk Posthouwer
- Department of Internal Medicine and Department of Medical Microbiology, Maastricht Universitair Medisch Centrum, Maastricht, The Netherlands
| | - Fanny N Lauw
- Department of Internal Medicine and Infectious Diseases, Slotervaart Ziekenhuis, Amsterdam, The Netherlands
| | - Eliane M S Leyten
- Department of Internal Medicine and Infectious Diseases, Medisch Centrum Haaglanden, Den Haag, The Netherlands
| | - Peter P Koopmans
- Department of Internal Medicine and Infectious Diseases, Radboud Universitair Medisch Centrum, Nijmegen, The Netherlands
| | - Clemens Richter
- Department of Internal Medicine and Infectious Diseases, Rijnstate Ziekenhuis, Arnhem, The Netherlands
| | | | - Wouter F W Bierman
- Department of Internal Medicine, Infectious Diseases Service, University of Groningen, Universitair Medisch Centrum Groningen, Groningen, The Netherlands
| | - Astrid M Newsum
- Department of Internal Medicine and Infectious Diseases, Academisch Medisch Centrum, Amsterdam, The Netherlands; Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Joop E Arends
- Department of Internal Medicine Division of Infectious Diseases, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Bart J A Rijnders
- Department of Internal Medicine and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
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17
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18
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Martinello M, Hellard M, Shaw D, Petoumenos K, Applegate T, Grebely J, Yeung B, Maire L, Iser D, Lloyd A, Thompson A, Sasadeusz J, Haber P, Dore GJ, Matthews GV. Short duration response-guided treatment is effective for most individuals with recent hepatitis C infection: the ATAHC II and DARE-C I studies. Antivir Ther 2016; 21:425-34. [PMID: 26867206 DOI: 10.3851/imp3035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Individuals with recent HCV infection may benefit from shortened duration therapy. These studies evaluated the efficacy and safety of response-guided regimens with pegylated interferon-α2a and ribavirin for people with recent HCV infection. METHODS Participants with recent hepatitis C (duration of infection ≤18 months) enrolled in the ATAHC II (pegylated interferon-α2a ± ribavirin) and DARE-C I (pegylated interferon-α2a, ribavirin and telaprevir) studies were included for analysis. Treatment duration was response-guided (ATAHC II: 8, 16, 24 or 48 weeks; DARE-C I: 8, 12 or 24 weeks) and dependent on time to first undetectable HCV RNA using Roche Taqman HCV RNA testing. The primary efficacy end point was sustained virological response at 12 weeks (SVR12) by intention-to-treat. Logistic regression analyses were used to identify predictors of SVR. RESULTS A total of 82 participants (62% HIV-positive) were enrolled in ATAHC II (treated, n=52) and 14 (79% HIV-positive) in DARE-C I. The predominant modes of HCV acquisition were injecting drug use (ATAHC II 55%, DARE-C I 36%) and sexual intercourse with a partner of the same sex (ATAHC II 39%, DARE-C I 64%). SVR12 was 71% in both ATAHC II (37/52) and DARE-C I (10/14) with 56% in ATAHC II receiving shortened therapy (8 or 16 weeks). SVR was associated with a rapid virological response (odds ratio 10.80; P=0.001). CONCLUSIONS The majority of participants were able to receive short duration response-guided therapy with pegylated interferon-α2a and ribavirin. Response-guided therapy for recent hepatitis C infection could be considered in the absence of available interferon-free therapies. ClinicalTrials.gov registry (ATAHC II: NCT01336010; DARE-C I: NCT01743521).
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Affiliation(s)
- Marianne Martinello
- Viral Hepatitis Clinical Research Program, The Kirby Institute, UNSW Australia, Sydney, NSW, Australia.
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Symptoms of anxiety and depression are frequent in patients with acute hepatitis C and are not associated with disease severity. Eur J Gastroenterol Hepatol 2016; 28:187-92. [PMID: 26575158 DOI: 10.1097/meg.0000000000000517] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Neuropsychiatric symptoms of hepatitis C virus (HCV) infection and during peginterferon α therapy have been investigated in the chronic stage of the infection, but have not been described during the acute phase of the disease so far. We therefore evaluated anxiety and depression in patients with acute hepatitis C by the Hospital Anxiety and Depression Scale (HADS) within a clinical trial. METHODS Data were analysed from the German Hep-Net Acute HCV-III study. Anxiety and depression were characterized by an anxiety (HADS-A) and a depression subscale (HADS-D). More than eight points in each subscale were considered clinically relevant. Data were prospectively collected at baseline, end of treatment and at the end of the study. RESULTS At baseline, a HADS-A above eight points was observed significantly more frequently than a HADS-D above eight points [n=23/103 (22%) vs. n=12/103 (12%); P=0.041].A pathological HADS-A or HADS-D score did not correlate with age, sex, IL28B genotype, the probable mode of infection, HCV genotype or severity of disease as investigated by alanine aminotransferase and bilirubin levels.Antiviral therapy did not influence anxiety as 12/50 (24%) of patients had HADS-A above 8 at the end of therapy. The proportion of patients with HADS-D above eight points increased from 12% at baseline to 24% (n=12/50) at the end of therapy (P=0.06). HADS results were not associated with lost to follow-up or sustained virological response rates. CONCLUSION HADS data in acute HCV infection indicate that anxiety and depression do not correlate with severity of the disease, mode of acquisition, lost to follow-up and sustained virological response rates.
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Brook G, Bhagani S, Kulasegaram R, Torkington A, Mutimer D, Hodges E, Hesketh L, Farnworth S, Sullivan V, Gore C, Devitt E, Sullivan AK. United Kingdom National Guideline on the Management of the viral hepatitides A, B and C 2015. Int J STD AIDS 2016; 27:501-25. [PMID: 26745988 DOI: 10.1177/0956462415624250] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 12/01/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Gary Brook
- London North West Healthcare NHS Trust, London, UK
| | | | | | | | - David Mutimer
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Louise Hesketh
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Simon Farnworth
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | | | - Emma Devitt
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Ann K Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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21
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Doyle JS, Deterding K, Grebely J, Wedemeyer H, Sacks-Davis R, Spelman T, Matthews G, Rice TM, Morris MD, McGovern BH, Kim AY, Bruneau J, Lloyd AR, Page K, Manns MP, Hellard ME, Dore GJ. Response to treatment following recently acquired hepatitis C virus infection in a multicentre collaborative cohort. J Viral Hepat 2015; 22:1020-32. [PMID: 26098993 PMCID: PMC4618180 DOI: 10.1111/jvh.12429] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 05/06/2015] [Indexed: 12/21/2022]
Abstract
Pegylated interferon therapy is highly effective in recently acquired HCV. The optimal timing of treatment, regimen and influence of host factors remains unclear. We aimed to measure sustained virological response (SVR) during recent HCV infection and identify predictors of response. Data were from five prospective cohorts of high-risk individuals in Australia, Canada, Germany and the United States. Individuals with acute or early chronic HCV who commenced pegylated interferon therapy were included. The main outcome was SVR, and predictors were assessed using logistic regression. Among 516 with documented recent HCV infection, 237 were treated (pegylated interferon n = 161; pegylated interferon/ribavirin n = 76) (30% female, median age 35 years, 56% ever injected drugs, median duration of infection 6.2 months). Sixteen per cent (n = 38) were HIV/HCV co-infected. SVR among those with HCV mono-infection was 64% by intention to treat; SVR was 68% among HCV/HIV co-infection. Independent predictors of SVR in HCV mono-infection were duration of HCV infection (the odds of SVR declined by 8% per month of infection, aOR 0.92, 95% CI 0.85-0.99, P = 0.033), IFNL4 genotype (adjusted OR 2.27, 95% CI 1.13-4.56, P = 0.021), baseline HCV RNA <400 000 IU/mL (aOR 2.06, 95% CI 1.03-4.12, P = 0.041) and age ≥40 years (vs <30: aOR 2.92, 95% CI 1.31-6.49, P = 0.009), with no difference by drug regimen, HCV genotype, symptomatic infection or gender. The effect of infection duration on odds of SVR was greater among genotype-1 infection. Interferon-based HCV treatment is highly effective in recent HCV infection. Duration of infection, IFNL4 genotype and baseline HCV RNA levels can predict virological response and may inform clinical decision-making.
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Affiliation(s)
- Joseph S. Doyle
- Centre for Population Health, Burnet Institute, Melbourne, Australia,School of Population Health and Preventive Medicine, Monash University, Melbourne, Australia,Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia
| | - Katja Deterding
- Hannover Medical School, Hannover, Germany,Hep-Net Study House: German Network of Competence on Viral Hepatitis, Germany
| | | | - Heiner Wedemeyer
- Hannover Medical School, Hannover, Germany,Hep-Net Study House: German Network of Competence on Viral Hepatitis, Germany,German Centre for Infection Research (DZIF), Hannover-Braunschweig, Germany
| | - Rachel Sacks-Davis
- Centre for Population Health, Burnet Institute, Melbourne, Australia,School of Population Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tim Spelman
- Centre for Population Health, Burnet Institute, Melbourne, Australia
| | | | - Thomas M. Rice
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA
| | - Meghan D. Morris
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA
| | | | | | | | - Andrew R. Lloyd
- School of Medical Sciences, UNSW Australia, Sydney, Australia
| | - Kimberly Page
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA
| | - Michael P. Manns
- Hannover Medical School, Hannover, Germany,Hep-Net Study House: German Network of Competence on Viral Hepatitis, Germany,German Centre for Infection Research (DZIF), Hannover-Braunschweig, Germany
| | - Margaret E. Hellard
- Centre for Population Health, Burnet Institute, Melbourne, Australia,School of Population Health and Preventive Medicine, Monash University, Melbourne, Australia,Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia
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22
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Liu CH, Sheng WH, Sun HY, Hsieh SM, Lo YC, Liu CJ, Su TH, Yang HC, Liu WC, Chen PJ, Chen DS, Hung CC, Kao JH. Peginterferon plus Ribavirin for HIV-infected Patients with Treatment-Naïve Acute or Chronic HCV Infection in Taiwan: A Prospective Cohort Study. Sci Rep 2015; 5:17410. [PMID: 26616669 PMCID: PMC4663763 DOI: 10.1038/srep17410] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 10/23/2015] [Indexed: 12/23/2022] Open
Abstract
Data are limited on the effectiveness and safety of peginterferon plus ribavirin in HIV-infected Asian patients with acute or chronic HCV infection. HIV-infected Taiwanese patients with acute HCV infection received peginterferon plus weight-based ribavirin for 24 weeks (n = 24), and those with chronic HCV genotype 1 or 6 (HCV-1/6) and HCV genotype 2 or 3 (HCV-2/3) infection received response-guided therapy for 12-72 and 24-48 weeks, respectively (n = 92). The primary endpoint was sustained virologic response (SVR), defined as undetectable HCV RNA 24 weeks off-therapy. The SVR rates were 83% and 72% in patients with acute and chronic HCV infection (p = 0.30), and 68% and 72% in patients with chronic HCV-1/6 and HCV-2/3 infection (p = 0.48), respectively. While no factors predicted SVR in acute HCV and chronic HCV-2/3 infection, age (odds ratio [OR] per 1-year increase: 0.88, 95% confidence interval [CI]: 0.78-0.99, p = 0.04), HCV RNA (OR per 1-log10 increase: 0.18, 95% CI: 0.03-0.98, p = 0.03), IL28B genotype (OR: 5.52, 95% CI: 1.55-12.2, p = 0.02), and RVR (OR: 9.62, 95% CI: 3.89-15.3, p = 0.007) predicted SVR in chronic HCV-1/6 infection. In conclusion, the SVR rates of peginterferon plus ribavirin for 24 weeks and for response-guided 12-72 weeks are satisfactory in HIV-infected Taiwanese patients with acute and chronic HCV infection.
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Affiliation(s)
- Chen-Hua Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Douliou, Taiwan
| | - Wang-Hui Sheng
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Szu-Min Hsieh
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Chun Lo
- Office of Preventive Medicine, Centers for Disease Control, Taipei, Taiwan
| | - Chun-Jen Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tung-Hung Su
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hung-Chih Yang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
- Department of Microbiology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Chun Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pei-Jer Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ding-Shinn Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- China Medical University, Taichung, Taiwan
| | - Jia-Horng Kao
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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Coppola N, Pisaturo M, Sagnelli C, Onorato L, Sagnelli E. Role of genetic polymorphisms in hepatitis C virus chronic infection. World J Clin Cases 2015; 3:807-822. [PMID: 26380828 PMCID: PMC4568530 DOI: 10.12998/wjcc.v3.i9.807] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 12/09/2014] [Accepted: 06/08/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To analyze the host genetics factors influencing the clinical course and the response to antiviral treatment in patients with chronic hepatitis C (CHC).
METHODS: We conducted an electronic search on the PubMed and MEDLINE (2000-2014) databases and Cochrane library (2000-2014). A total of 73 articles were retrieved and their data were extensively evaluated and discussed by the authors and then analyzed in this review article.
RESULTS: Several studies associated polymorphisms in the interleukin 28B gene on chromosome 19 (19q13.13) with a spontaneous viral clearance in acute hepatitis C and with the response to pegylated interferon (Peg-IFN)-based treatment in chronic hepatitis C patients. Other investigations demonstrated that inosine triphosphate pyrophosphatase genetic variants protect hepatitis C virus-genotype-1 CHC patients from ribavirin-induced anemia, and other studies that a polymorphism in the patatin-like phospholipase domain-containing protein 3 was associated with hepatic steatosis in CHC patients. Although not conclusive, some investigations suggested that the vitamin D-associated polymorphisms play an important role in the achievement of sustained virologic response in CHC patients treated with Peg-IFN-based antiviral therapy. Several other polymorphisms have been investigated to ascertain their possible impact on the natural history and on the response to treatment in patients with CHC, but the data are preliminary and warrant confirmation.
CONCLUSION: Several genetic polymorphisms seem to influence the clinical course and the response to antiviral treatment in patients with CHC, suggesting individualized follow up and treatment strategies.
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Martinello M, Matthews GV. Enhancing the detection and management of acute hepatitis C virus infection. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:899-910. [PMID: 26254495 DOI: 10.1016/j.drugpo.2015.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 06/07/2015] [Accepted: 07/07/2015] [Indexed: 12/23/2022]
Abstract
Acute HCV infection refers to the 6-month period following infection acquisition, although this definition is somewhat arbitrary. While spontaneous clearance occurs in approximately 25%, the majority will develop chronic HCV infection with the potential for development of cirrhosis, end stage liver disease and hepatocellular carcinoma. Detection of acute HCV infection has been hampered by its asymptomatic or non-specific presentation, lack of specific diagnostic tests and the inherent difficulties in identifying and following individuals at highest risk of transmitting and acquiring HCV infection, such as people who inject drugs (PWID). However, recognition of those with acute infection may have individual and population level benefits and could represent an ideal opportunity for intervention. Despite demonstration that HCV treatment is feasible and successful in PWID, treatment uptake remains low with multiple barriers to care at an individual and systems level. Given the burden of HCV-related disease among PWID, strategies to enhance HCV assessment, treatment and prevention in this group are urgently needed. As the therapeutic landscape of chronic HCV management is revolutionised by the advent of simple, highly effective directly-acting antiviral (DAA) therapy, similar opportunities may exist in acute infection. This review will discuss issues surrounding improving the detection and management of acute HCV infection, particularly in PWID.
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Affiliation(s)
- Marianne Martinello
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW 2052, Australia.
| | - Gail V Matthews
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW 2052, Australia
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25
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26
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Hullegie SJ, Arends JE, Rijnders BJA, Irving WL, Salmon D, Prins M, Wensing AM, Klenerman P, Leblebicioglu H, Boesecke C, Rockstroh JK, Hoepelman AIM. Current knowledge and future perspectives on acute hepatitis C infection. Clin Microbiol Infect 2015; 21:797.e9-797.e17. [PMID: 25892133 DOI: 10.1016/j.cmi.2015.03.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 03/17/2015] [Accepted: 03/28/2015] [Indexed: 12/13/2022]
Abstract
Acute hepatitis C virus (HCV) infections are frequently seen worldwide in certain risk groups, with an annual incidence rate varying between 0.08% and 66%. Although this incidence is substantial, a delayed diagnosis during chronic infection is most often made in the absence of clinical symptoms in the acute phase of the infection. Currently used methods to diagnose acute HCV infection are IgG antibody seroconversion and repeated HCV RNA measurements, although no definitive diagnostic test is currently available. Progress in the field of adaptive and innate immune responses has aided both advances in the field of HCV vaccine development and a more basic understanding of viral persistence. The rapid changes in the treatment of chronic HCV infection will affect therapeutic regimens for acute HCV infection in the coming years, leading to shorter treatment courses and pegylated interferon-free modalities. This review gives an overview of the current knowledge and uncertainties, together with some future perspectives on acute hepatitis C epidemiology, virology, immunology, and treatment.
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Affiliation(s)
- S J Hullegie
- Department of Infectious Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - J E Arends
- Department of Infectious Diseases, University Medical Centre Utrecht, Utrecht, The Netherlands; The European Study Group of Viral Hepatitis (ESGVH), UK.
| | - B J A Rijnders
- Department of Infectious Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - W L Irving
- The European Study Group of Viral Hepatitis (ESGVH), UK; NIHR Biomedical Research Unit in Gastroenterology and the Liver, University of Nottingham, Nottingham, UK
| | - D Salmon
- The European Study Group of Viral Hepatitis (ESGVH), UK; Université Paris Descartes, Paris, France
| | - M Prins
- Cluster Infectious Diseases, Department of Research, Public Health Service, Amsterdam, The Netherlands; Department of Infectious Diseases, CINIMA, Academic Medical Centre, Amsterdam, The Netherlands
| | - A M Wensing
- Department of Infectious Diseases, University Medical Centre Utrecht, Utrecht, The Netherlands; The European Study Group of Viral Hepatitis (ESGVH), UK
| | - P Klenerman
- NDM and Jenner Institute, University of Oxford, Oxford, UK
| | - H Leblebicioglu
- The European Study Group of Viral Hepatitis (ESGVH), UK; Department of Infectious Diseases, Ondokuz Mayis University, Samsun, Turkey
| | - C Boesecke
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - J K Rockstroh
- The European Study Group of Viral Hepatitis (ESGVH), UK; Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - A I M Hoepelman
- Department of Infectious Diseases, University Medical Centre Utrecht, Utrecht, The Netherlands; The European Study Group of Viral Hepatitis (ESGVH), UK
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27
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Carvalho-Filho RJ, Feldner ACCA, Silva AEB, Ferraz MLG. Management of hepatitis C in patients with chronic kidney disease. World J Gastroenterol 2015; 21:408-422. [PMID: 25593456 PMCID: PMC4292272 DOI: 10.3748/wjg.v21.i2.408] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/07/2014] [Accepted: 12/08/2014] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) infection is highly prevalent among chronic kidney disease (CKD) subjects under hemodialysis and in kidney transplantation (KT) recipients, being an important cause of morbidity and mortality in these patients. The vast majority of HCV chronic infections in the hemodialysis setting are currently attributable to nosocomial transmission. Acute and chronic hepatitis C exhibits distinct clinical and laboratorial features, which can impact on management and treatment decisions. In hemodialysis subjects, acute infections are usually asymptomatic and anicteric; since spontaneous viral clearance is very uncommon in this context, acute infections should be treated as soon as possible. In KT recipients, the occurrence of acute hepatitis C can have a more severe course, with a rapid progression of liver fibrosis. In these patients, it is recommended to use pegylated interferon (PEG-IFN) in combination with ribavirin, with doses adjusted according to estimated glomerular filtration rate. There is no evidence suggesting that chronic hepatitis C exhibits a more aggressive course in CKD subjects under conservative management. In these subjects, indication of treatment with PEG-IFN plus ribavirin relies on the CKD stage, rate of progression of renal dysfunction and the possibility of a preemptive transplant. HCV infection has been associated with both liver disease-related deaths and cardiovascular mortality in hemodialysis patients. Among those individuals, low HCV viral loads and the phenomenon of intermittent HCV viremia are often observed, and sequential HCV RNA monitoring is needed. Despite the poor tolerability and suboptimal efficacy of antiviral therapy in CKD patients, many patients can achieve sustained virological response, which improve patient and graft outcomes. Hepatitis C eradication before KT theoretically improves survival and reduces the occurrence of chronic graft nephropathy, de novo glomerulonephritis and post-transplant diabetes mellitus.
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Santantonio TA, Fasano M, Sagnelli E. Reply: To PMID 24442928. Hepatology 2014; 60:2129. [PMID: 24585448 DOI: 10.1002/hep.27100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 02/24/2014] [Indexed: 12/07/2022]
Affiliation(s)
- Teresa Antonia Santantonio
- Department of Clinical and Experimental Medicine, Infectious Diseases, University of Foggia, Foggia, Italy
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Dai CY, Chuang WL, Yu ML. A 24-week pegylated interferon alpha-2b versus a 12-week pegylated interferon alpha-2b alone or with ribavirin for patients with acute hepatitis C. Hepatology 2014; 60:2128-9. [PMID: 24585417 DOI: 10.1002/hep.27096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 01/31/2014] [Indexed: 12/07/2022]
Affiliation(s)
- Chia-Yen Dai
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical UniversityHospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Fernández Rodriguez CM, Gutierrez Garcia ML. [Impact of antiviral therapy on the natural history of hepatitis C virus]. GASTROENTEROLOGIA Y HEPATOLOGIA 2014; 37:583-92. [PMID: 25066318 DOI: 10.1016/j.gastrohep.2014.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 05/28/2014] [Indexed: 02/08/2023]
Abstract
Chronic hepatitis C virus infection affects around 150 million persons, and 350,000 persons worldwide die of this disease each year. Although the data on its natural history are incomplete, after the acute infection, most patients develop chronic forms of hepatitis C with variable stages of fibrosis. In these patients, continual inflammatory activity can cause significant fibrosis, cirrhosis, decompensation of the liver disease, or hepatocarcinoma. In the next few years, it is expected that hepatitis C virus infection and its complications will significantly increase, as will the incidence of hepatocarcinoma in Spain. This review presents the data on the natural history of hepatitis C virus infection and discusses the potential impact of antiviral therapy on the distinct stages of the disease.
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31
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Sagnelli E, Santantonio T, Coppola N, Fasano M, Pisaturo M, Sagnelli C. Acute hepatitis C: clinical and laboratory diagnosis, course of the disease, treatment. Infection 2014; 42:601-10. [DOI: 10.1007/s15010-014-0608-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 02/24/2014] [Indexed: 02/06/2023]
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