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Dobrowolska K, Pawłowska M, Zarębska-Michaluk D, Rzymski P, Janczewska E, Tudrujek-Zdunek M, Berak H, Mazur W, Klapaczyński J, Lorenc B, Janocha-Litwin J, Parfieniuk-Kowerda A, Dybowska D, Piekarska A, Krygier R, Dobracka B, Jaroszewicz J, Flisiak R. Direct-acting antivirals in women of reproductive age infected with hepatitis C virus. J Viral Hepat 2024; 31:309-319. [PMID: 38483035 DOI: 10.1111/jvh.13936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/16/2024] [Accepted: 03/03/2024] [Indexed: 05/18/2024]
Abstract
Eliminating hepatitis C virus (HCV) infection in the population of women of reproductive age is important not only for the health of women themselves but also for the health of newborns. This study aimed to evaluate the implementation of this goal by analysing the effectiveness of contemporary therapy in a large cohort from everyday clinical practice along with identifying factors reducing therapeutic success. The analysed population consisted of 7861 patients, including 3388 women aged 15-49, treated in 2015-2022 in 26 hepatology centres. Data were collected retrospectively using a nationwide EpiTer-2 database. Females were significantly less often infected with HCV genotype 3 compared to males (11.2% vs. 15.7%) and less frequently showed comorbidities (40.5% vs. 44.2%) and comedications (37.2% vs. 45.2%). Hepatocellular carcinoma, liver transplantation, HIV and HBV coinfections were reported significantly less frequently in women. Regardless of the treatment type, females significantly more often reached sustained virologic response (98.8%) compared to males (96.8%). Regardless of gender, genotype 3 and cirrhosis were independent factors increasing the risk of treatment failure. Women more commonly reported adverse events, but death occurred significantly more frequently in men (0.3% vs. 0.1%), usually related to underlying advanced liver disease. We have demonstrated excellent effectiveness and safety profiles for treating HCV infection in women. This gives hope for the micro-elimination of HCV infections in women, translating into a reduced risk of severe disease in both women and their children.
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Affiliation(s)
| | - Małgorzata Pawłowska
- Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | | | - Piotr Rzymski
- Department of Environmental Medicine, Poznań University of Medical Sciences, Poznań, Poland
| | - Ewa Janczewska
- Department of Basic Medical Sciences, School of Public Health in Bytom, Medical University of Silesia, Katowice, Poland
| | | | - Hanna Berak
- Outpatient Clinic, Hospital for Infectious Diseases in Warsaw, Warsaw, Poland
| | - Włodzimierz Mazur
- Clinical Department of Infectious Diseases in Chorzów, Medical University of Silesia, Katowice, Poland
| | - Jakub Klapaczyński
- Department of Internal Medicine and Hepatology, The National Institute of Medicine of the Ministry of Interior and Administration, Warszawa, Poland
| | - Beata Lorenc
- Pomeranian Center of Infectious Diseases, Medical University, Gdańsk, Poland
| | - Justyna Janocha-Litwin
- Department of Infectious Diseases and Hepatology, Wrocław Medical University, Wrocław, Poland
| | - Anna Parfieniuk-Kowerda
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, Białystok, Poland
| | - Dorota Dybowska
- Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Anna Piekarska
- Department of Infectious Diseases and Hepatology, Medical University of Łódź, Łódź, Poland
| | - Rafał Krygier
- Outpatients Hepatology Department, State University of Applied Sciences, Konin, Poland
| | | | - Jerzy Jaroszewicz
- Department of Infectious Diseases and Hepatology, Medical University of Silesia in Katowice, Bytom, Poland
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, Białystok, Poland
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Carey I, Christiana M, Marie-Ange M, Teresa B, Maria GV, Dusheiko G, Agarwal K. Universal versus targeted screening for HCV infection in pregnancy in a diverse, multi-ethnic population: Universal screening is more comprehensive. J Viral Hepat 2022; 29:1079-1088. [PMID: 36138559 DOI: 10.1111/jvh.13752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/27/2022] [Accepted: 09/07/2022] [Indexed: 12/29/2022]
Abstract
Universal hepatitis C screening in pregnancy is not recommended by NICE due to a lack of effective interventions to prevent mother to child transmission (MTCT) and is only offered to pregnant women at increased risk of infection (intra-venous drug use [IVDU] or with a HCV positive family member). No testing is offered to patients from high endemic areas. However, data regarding true seroprevalence in multi-ethnic inner-city populations in the UK are required. This study aimed to determine test positivity rates of HCV infection in an unselected South East London ethnically diverse population of pregnant women by universal screening during routine antenatal care compared with a "targeted" screening approach. "Targeted" risk-based screening was performed in two eras (2016, n = 1002) and subsequently in 2018, after modifying the HCV risk questionnaire (n = 1122). Universal opt out screening was similarly performed in two eras in 2017 (n = 1012) and again in 2019 (n = 1057). During screening for HBV, HIV and syphilis, anti-HCV was tested, followed by an iterative HCV RNA test in those positive for anti-HCV. All anti-HCV-positive women were referred to the specialist hepatology service, and testing was offered to all family members. All HCV RNA-positive patients were followed during pregnancy and post-delivery period and were offered treatment. All infants of HCV RNA-positive mothers were linked to care with paediatric team. In the 2016 "targeted" screening cohort 212/1002 had a risk of BBV (blood borne viral) infection and (0.6%) were anti-HCV positive and HCV RNA positive. 0.3% patients were newly diagnosed. In the 2017 universal screening cohort, 1012/1038 pregnant women consented to testing. 0.96% were anti-HCV positive and 0.86% women were HCV RNA positive with 0.67% newly diagnosed. After modification of the risk-based questionnaire, a second risk-based targeted cohort were tested in 2018: 342/1122 (31%) were assessed as at risk and were offered an anti-HCV test. 0.71% were anti-HCV positive and 0.27% were HCV RNA positive. In the 2019 cohort tested by universal screening, 1049/1057 women were tested and 0.85% tested positive for anti-HCV, 0.28% women were HCV RNA positive. All newly diagnosed patients were born abroad. All patients had mild liver disease and had normal pregnancies. All patients were treated post-delivery and achieved SVR. All patients were negative for other BBV infections. In conclusion, the anti-HCV test positive rate in this ethnically diverse pregnant cohort ranged between 0.96% and 0.6% (whole cohort) but the rate depended upon the era and screening methodology used. Universal screening detected a higher numbers of anti-HCV positive women during pregnancy, including those not previously aware of their hepatitis C. While there was not significant drop in seroprevalence in pregnant women between 2016 and 2019, we observed that the ratio of HCV RNA positive to anti-HCV positive women has declined over time, from 0.86% in 2016 (100% HCV RNA+) to 0.28% in 2019 (33% HCV RNA+) for whole cohort probably due to increased HCV treatment rates from 2016. These data have important implications for hepatitis C testing in pregnancy and the appropriate methodology to use for maximal accuracy.
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Affiliation(s)
- Ivana Carey
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - Moigboi Christiana
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - McLeod Marie-Ange
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - Bowyer Teresa
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - Guerra Veloz Maria
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - Geoff Dusheiko
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - Kosh Agarwal
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
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Heck JE, Wu CK, Huang X, Chew KW, Tong M, Federman N, Ritz B, Arah OA, Li CY, Yu F, Olsen J, Hansen J, Lee PC. Cohort study of familial viral hepatitis and risks of paediatric cancers. Int J Epidemiol 2021; 51:448-457. [PMID: 34966942 PMCID: PMC9308392 DOI: 10.1093/ije/dyab262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/07/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Although viral hepatitis causes paediatric hepatocellular carcinoma and hepatic and extrahepatic cancers in adults, there are few epidemiologic studies on paediatric-cancer risks from parental viral hepatitis. In a nationwide study in a viral hepatitis endemic region and with confirmation in another population-based sample, we examined associations between parental hepatitis B (HBV) and C (HCV) infections and risks of cancers in offspring. METHODS We included all children born in Taiwan in 2004-2014 (N = 2 079 037) with 2160 cancer cases ascertained from the Cancer Registry. We estimated risks for paediatric cancers using Cox proportional-hazard regressions. We checked these associations in a nationwide case-control study in Denmark (6422 cases, 160 522 controls). RESULTS In Taiwan, paternal HBV was related to child's hepatoblastoma [hazard ratio (HR) = 1.77, 95% confidence interval (CI) = 1.05, 2.97] when identified at any time in the medical record, and when analyses were limited to hepatitis diagnoses occurring before the child's birth, risks increased (HR = 2.08, 95% CI = 1.13-3.80). Paternal HCV was related to child's non-Hodgkin lymphoma (HR = 2.06, 95% CI = 1.13-3.74). Maternal HCV was weakly related to increased risks of all childhood cancers [all types combined; HR = 1.45, 95% CI = 0.95-2.22]. The population-attributable fraction of hepatoblastoma for maternal, paternal and child HBV was 2.6%, 6.8% and 2.8%, respectively. CONCLUSIONS Parental HBV and HCV may be risk factors for hepatic and non-hepatic cancers in children. If associations are causal, then parental screening and treatment with antivirals may prevent some paediatric cancers.
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Affiliation(s)
- Julia E Heck
- Department of Rehabilitation and Health Services, College of Health and Public Service, University of North Texas, Denton, TX, USA,Center for Racial and Ethnic Equity in Health and Society, University of North Texas, Denton, TX, USA,Corresponding author. College of Health and Public Service, University of North Texas, 1155 Union Circle #311340, Denton, TX 76203-5017, USA. E-mail:
| | - Chia-Kai Wu
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Beitou Dist, Taipei, Taiwan
| | - Xiwen Huang
- Center for Racial and Ethnic Equity in Health and Society, University of North Texas, Denton, TX, USA
| | - Kara W Chew
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Myron Tong
- Asian Liver Center, Geffen School of Medicine and Ronald Reagan Medical Center, UCLA, Los Angeles, CA, USA
| | - Noah Federman
- Department of Pediatrics, Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Beate Ritz
- Department of Epidemiology, Fielding School of Public Health, University of California (UCLA), Los Angeles, CA, USA
| | - Onyebuchi A Arah
- Department of Epidemiology, Fielding School of Public Health, University of California (UCLA), Los Angeles, CA, USA,Department of Statistics, UCLA College of Letters and Science, Los Angeles, CA, USA,Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Chung-Yi Li
- Department of Public Health, National Cheng Kung University, Tainan, Taiwan,Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Fei Yu
- Department of Biostatistics, Fielding School of Public Health UCLA, Los Angeles, CA, USA
| | - Jorn Olsen
- Department of Clinical Epidemiology, Aarhus University, Aarhus N, Denmark
| | - Johnni Hansen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Pei-Chen Lee
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Beitou Dist, Taipei, Taiwan,Department of Psychiatry, Taipei City Hospital, Taipei, Taiwan,Inserm U1018, Team ‘Exposome, Heredity, Cancer and Health’, CESP, Villejuif, France
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Wilson RD. Guideline No. 409: Intrauterine Fetal Diagnostic Testing in Women with Chronic Viral Infections. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 42:1555-1562.e1. [PMID: 33308791 DOI: 10.1016/j.jogc.2020.09.007] [Citation(s) in RCA: 1] [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
OBJECTIVE This revised guideline provides updated information for the care of women with chronic viral infections who require intrauterine fetal diagnostic testing. TARGET POPULATION Women with chronic viral infections who are pregnant or planning a pregnancy. OPTIONS Non-invasive screening tests for diagnosis: maternal serum placental analytes with or without nuchal translucency, sonography, maternal serum cell-free placental DNA; and intrauterine fetal diagnostic testing: amniocentesis, chorionic villus sampling, cordocentesis. OUTCOMES The recommendations in this guideline have the potential to decrease or eliminate morbidity and mortality in women with chronic viral infections and their infants, which is associated with significant health and economic outcomes. EVIDENCE Published literature was retrieved through searches of PubMed, guidelines of national societies (Society of Obstetricians and Gynaecologists of Canada, American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine, other international societies), and the Cochrane Library using appropriate controlled vocabulary (amniocentesis, chorionic villus sampling, cordocentesis, procedure pregnancy loss risk, viral vertical transmission, fetal and neonatal infection) and keywords (maternal infection or exposure, hepatitis B, hepatitis C, human immunodeficiency virus). Results were restricted to systematic reviews, randomized controlled trials or controlled clinical trials (if available), and observational case-control studies or case series from 2012 to 2019 published in English or French. Studies from 1966 to 2002 were previously reviewed in the SOGC guideline No. 123: Amniocentesis and Women with Hepatitis B, Hepatitis C, or Human Immunodeficiency Virus, and those from 2002 to 2012 were previously reviewed in the SOGC guideline No. 309: Prenatal Invasive Procedures in Women With Hepatitis B, Hepatitis C, and/or Human Immunodeficiency Virus Infections. Updated literature searches were completed regularly through August 2019 and were incorporated into this guideline. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE The intended users are maternity care providers and women with chronic viral infections. This guideline provides information to educate and counsel these women, and to offer them reproductive options. RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).
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Wilson RD. Directive clinique n o 409 : Tests diagnostiques fœtaux intra-utérins en cas d'infection virale chronique maternelle. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:1563-1570.e1. [PMID: 33308792 DOI: 10.1016/j.jogc.2020.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIF La présente directive clinique révisée met à jour les renseignements sur la prestation de soins aux femmes atteintes d'une infection virale chronique devant se soumettre à un test diagnostique fœtal intra-utérin. POPULATION CIBLE Femmes atteintes d'une infection virale chronique qui sont enceintes ou prévoient le devenir. OPTIONS Tests de dépistage non invasifs à des fins diagnostiques : marqueurs placentaires sériques maternels avec ou sans mesure de la clarté nucale, échographie, ADN fœtal libre circulant dans le sang maternel; et tests diagnostiques fœtaux intra-utérins : amniocentèse, biopsie choriale (choriocentèse), cordocentèse. ISSUES Les recommandations de la présente directive clinique pourraient réduire ou éliminer la morbi-mortalité chez les femmes atteintes d'une infection virale chronique et leurs nourrissons, ce qui est associé à d'importantes conséquences sur les plans de la santé et de l'économie. DONNéES PROBANTES: La littérature publiée a été recueillie au moyen de recherches dans les bases de données PubMed et Cochrane Library ainsi que dans les directives cliniques de sociétés médicales nationales et internationales (Société des obstétriciens et gynécologues du Canada, American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine et d'autres sociétés internationales) en utilisant un vocabulaire (amniocentesis, chorionic villus sampling, cordocentesis, procedure pregnancy loss risk, viral vertical transmission, fetal and neonatal infection) et des mots clés (maternal infection or exposure, hepatitis B, hepatitis C, human immunodeficiency virus) contrôlés et appropriés. Les résultats retenus se limitent aux revues systématiques, aux essais cliniques randomisés ou aux essais cliniques comparatifs (si disponibles) et aux études cas-témoins observationnelles ou études de série de cas publiées entre 2012 et 2019 en anglais ou en français. Les études publiées entre 1966 et 2002 ont déjà été examinées dans la directive clinique de la SOGC no 123, L'amniocentèse chez les femmes infectées par l'hépatite B, l'hépatite C ou le virus de l'immunodéficience humaine; les études publiées entre 2002 et 2012 ont quant à elles été examinées dans la directive clinique de la SOGC no 309, Interventions effractives prénatales chez les femmes qui présentent des infections par le virus de l'hépatite B, le virus de l'hépatite C et/ou le virus de l'immunodéficience humaine. De nouvelles recherches ont été effectuées dans la littérature jusqu'en août 2019, puis ont été intégrées à la présente directive clinique. MéTHODES DE VALIDATION: L'auteur a évalué la qualité des données probantes et la solidité des recommandations au moyen du cadre méthodologique GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Consulter l'annexe A en ligne (le tableau A1 pour les définitions et le tableau A2 pour les interprétations des recommandations fortes et faibles). PUBLIC VISé: Les utilisateurs prévus sont des fournisseurs de soins de maternité et les femmes atteintes d'une infection virale chronique. Cette directive fournit des renseignements pour renseigner et conseiller ces femmes et leur offrir des options de procréation. RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).
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