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Butaru AE, Gheonea DI, Rogoveanu I, Diculescu M, Boicea AR, Bunescu M, Streba CT, Oancea CN. Micro-Elimination: Updated Pathway to Global Elimination of Hepatitis C in Small Communities and Industrial Settings during the COVID 19 Pandemic. J Clin Med 2021; 10:jcm10214976. [PMID: 34768496 PMCID: PMC8584569 DOI: 10.3390/jcm10214976] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/19/2021] [Accepted: 10/24/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND In response to the goal of the World Health Organisation to eliminate hepatitis C virus infections by 2030, Romania is striving for national elimination. An already successful micro-elimination project was expanded to test-and-treat specific populations and at-risk groups. The aim of this project was to identify the individuals with HCV infection in disadvantaged regions who do not have proper medical care access. MATERIALS AND METHODS Our two-arm interventional cross-sectional study used rapid anti-HCV antibody testing on two population groups from the Romanian southwestern region of Oltenia, approached between September 2020 and May 2021. The first group consisted of predominantly over 40 years old individuals, recruited through five family doctors from two medium-sized towns (community lot-CL). We approached a second group, aged 18-65, through 11 medical offices of five large factories in the same region (industry lot, IL). A 12-items questionnaire was given to each participant, to determine risk factors and record demographic data. Eligible patients initiated antiviral therapy using direct-acting antivirals (DAAs). RESULTS We enrolled 15,383 individuals between all 16 locations. The overall prevalence by antibody testing was 0.77% (119 cases). Of these, 57 subsequently received treatment with DAAs. We identified blood transfusions as a risk factor within the CL. Participants in the IL reported a relatively high risk for the following situations: sharing of personal hygiene belongings with another person, performing previous blood transfusions, dental interventions and previous surgery. CONCLUSIONS In this global context, the use of micro-elimination allows interventions to be faster and more efficient. This is possible by targeting smaller and specific HCV risk groups.
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Affiliation(s)
- Anca Elena Butaru
- Department of Infectious Disease, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Dan Ionuț Gheonea
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (D.I.G.); (I.R.)
| | - Ion Rogoveanu
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (D.I.G.); (I.R.)
| | - Mircea Diculescu
- Department of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Ancuța-Ramona Boicea
- Department of Labor Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.-R.B.); (M.B.)
| | - Marius Bunescu
- Department of Labor Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.-R.B.); (M.B.)
| | - Costin-Teodor Streba
- Research Center of Gastroenterology and Hepatology of Craiova, 200638 Craiova, Romania
- Department of Pulmonology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Correspondence: ; Tel.: +40-722-38-99-06
| | - Carmen Nicoleta Oancea
- Department of Analytical Chemistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
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Abstract
Chronic hepatitis C virus (HCV) infection is a leading cause of liver disease. The World Health Organization has called for the global elimination of HCV by 2030. NPs can significantly expand the availability of community-based providers and bridge gaps in HCV treatment to assist in eradicating this curable virus.
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Effectiveness of implementing a decentralized delivery of hepatitis C virus treatment with direct-acting antivirals: A systematic review with meta-analysis. PLoS One 2020; 15:e0229143. [PMID: 32084187 PMCID: PMC7034833 DOI: 10.1371/journal.pone.0229143] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 01/30/2020] [Indexed: 12/13/2022] Open
Abstract
Direct-acting agents (DAAs) for hepatitis C virus (HCV) treatment are safe and highly effective. Few studies described the sustained virologic response rates of treatment conducted by non-specialists. We performed a systematic review and meta‐analysis to evaluate the effectiveness of decentralized strategies of HCV treatment with DAAs. PubMed, Embase, Scopus and LILACS were searched until March-2019. Studies were screened by two researchers according to the following inclusion criteria: HCV treatment using DAAs on real-life cohort studies or clinical trials conducted by non-specialized health personnel. The primary endpoint was the sustained virologic response rate at week 12 after the end-of-treatment (SVR12), which is binary at the patient level. Data were extracted in duplicate using electronic-forms and quality appraisal was performed with the NIH Quality Assessment Tool. Heterogeneity was assessed by I2 statistics. Random-effects meta-analysis models were used for pooling SVR12 rates. Publication bias was assessed using funnel plots. Among the 130 selected studies, nine papers were included for quantitative synthesis. The quality-appraisal was good for two, fair for three and poor for four studies. The pooled relative risk (RR) of SVR12 was not statistically different between decentralized strategy and treatment by specialists [RR = 1.05; 95% confidence interval (95% CI): 0.98–1.1; I2 = 45% (95% CI: 0–84%), p = 0.145]. SVR12 rate for decentralized HCV treatment was 81% [SVR12 95% CI: 72–89%; I2 = 93% (95% CI: 88–96%)] and 95% [SVR12 95%CI: 92–98%; I2 = 77% (95% CI: 52–89%)] with intention to treat analysis and per-protocol analysis, respectively. SVR12 rates using DAAs managed by non-specialized health personnel were satisfactory and similar to those obtained by specialists. This new delivery strategy can improve access to HCV treatment, especially in resource-limited settings. PROSPERO #: CRD42019122609.
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Aghemo A, Piroth L, Bhagani S. What do clinicians need to watch for with direct-acting antiviral therapy? J Int AIDS Soc 2019; 21 Suppl 2:e25076. [PMID: 29633552 PMCID: PMC5978638 DOI: 10.1002/jia2.25076] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 01/18/2018] [Indexed: 12/15/2022] Open
Abstract
Introduction The introduction of drugs targeting the virus replication cycle has revolutionized treatment of chronic hepatitis C virus. These drugs, called direct‐acting antivirals, have brought about extremely high rates of virological cure and have increased the number of patients who can receive treatment due to the lack of absolute contraindications. A combination of different classes of direct‐acting antivirals is the current standard of care. Although treatment administration and monitoring has been simplified in recent years, it is still relatively complex and mostly in the hands of specialists. Several factors must be assessed before starting treatment to maximize efficacy and minimize side effects of treatment. In this review, we describe the factors that impact on the efficacy and safety of antiviral treatment for hepatitis C and provide clear recommendations for clinicians prescribing direct‐acting antivirals. Methods We reviewed literature to define best practice, based on factors associated with treatment efficacy and safety data to recommend treatment options, baseline and on‐treatment assessments. The review included searches in PubMed, and the abstracts presented at the International Liver Congress TM and The Liver Meeting TM between January 2013 and September 2017. Results Clinical features that must be assessed before starting treatment include virological factors, such as hepatitis C virus genotype, HIV and hepatitis B coinfection and host factors, such as concomitant medications, liver disease stage and renal function. Conclusions Patients who start antiviral treatment for chronic hepatitis C require a thorough clinical evaluation. There is a need for assessing factors that impact on the treatment schedule and duration or affect the pharmacokinetics of direct‐acting antivirals.
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Affiliation(s)
- Alessio Aghemo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Division of Internal Medicine and Hepatology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Lionel Piroth
- Infectious Diseases Department, University Hospital, INSERM, Dijon, France
| | - Sanjay Bhagani
- Department of Infectious Diseases/HIV Medicine, Royal Free London Foundation Trust, Research Department of Infection, UCL, London, UK
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Parigi TL, Torres MCP, Aghemo A. Upcoming direct acting antivirals for hepatitis C patients with a prior treatment failure. Clin Mol Hepatol 2019; 25:360-365. [PMID: 31042864 PMCID: PMC6933124 DOI: 10.3350/cmh.2019.0022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 02/18/2019] [Indexed: 02/06/2023] Open
Abstract
Despite the high efficacy of direct acting antivirals (DAAs) not all patients successfully clear hepatitis C virus infection, in fact, approximately 1-3% fail to reach a sustained virological response 12 weeks after end of treatment. DAA failures are characterized by advanced liver disease, specific genotypes/subtypes and resistance associated substitutions to the DAA class they have been treated with. Current European Association for the Study of the Liver guidelines recommend three therapeutic options for such patients. The first is a 12 week course of sofosbuvir (SOF), velpatasvir (VEL) and voxilaprevir (VOX), which has shown to be effective in 90-99% of patients and was granted A1 level recommendation. The second option, reserved for patients who have predictors of failure consists in 12 weeks regimen with glecaprevir (GLE) and pibrentasvir (PIB), effective in 90-97%. Finally, although not supported by published data, for especially difficult to treat patients there should theoretically be a benefit in prolonged combinations of SOF+GLE/PIB or SOF/VEL/VOX±ribavirin. This review presents the latest evidence from both clinical trials and real-life on such therapeutic strategies.
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Affiliation(s)
- Tommaso Lorenzo Parigi
- Division of Internal Medicine and Hepatology, Humanitas Research Hospital IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | | | - Alessio Aghemo
- Division of Internal Medicine and Hepatology, Humanitas Research Hospital IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
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García-Murria MJ, Expósito-Domínguez N, Duart G, Mingarro I, Martinez-Gil L. A Bimolecular Multicellular Complementation System for the Detection of Syncytium Formation: A New Methodology for the Identification of Nipah Virus Entry Inhibitors. Viruses 2019; 11:E229. [PMID: 30866435 PMCID: PMC6466393 DOI: 10.3390/v11030229] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/01/2019] [Accepted: 03/02/2019] [Indexed: 12/17/2022] Open
Abstract
Fusion of viral and cellular membranes is a key step during the viral life cycle. Enveloped viruses trigger this process by means of specialized viral proteins expressed on their surface, the so-called viral fusion proteins. There are multiple assays to analyze the viral entry including those that focus on the cell-cell fusion induced by some viral proteins. These methods often rely on the identification of multinucleated cells (syncytium) as a result of cell membrane fusions. In this manuscript, we describe a novel methodology for the study of cell-cell fusion. Our approach, named Bimolecular Multicellular Complementation (BiMuC), provides an adjustable platform to qualitatively and quantitatively investigate the formation of a syncytium. Furthermore, we demonstrated that our procedure meets the requirements of a drug discovery approach and performed a proof of concept small molecule high-throughput screening to identify compounds that could block the entry of the emerging Nipah virus.
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Affiliation(s)
- María J García-Murria
- Department of Biochemistry and Molecular Biology, ERI BioTecMed, University of Valencia, 46100 Valencia, Spain.
| | - Neus Expósito-Domínguez
- Department of Biochemistry and Molecular Biology, ERI BioTecMed, University of Valencia, 46100 Valencia, Spain.
| | - Gerard Duart
- Department of Biochemistry and Molecular Biology, ERI BioTecMed, University of Valencia, 46100 Valencia, Spain.
| | - Ismael Mingarro
- Department of Biochemistry and Molecular Biology, ERI BioTecMed, University of Valencia, 46100 Valencia, Spain.
| | - Luis Martinez-Gil
- Department of Biochemistry and Molecular Biology, ERI BioTecMed, University of Valencia, 46100 Valencia, Spain.
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Craviotto V, Lamonaca L, Aghemo A, Lleo A. No clinical impact of HCV RNA determination at the end of treatment in patients receiving directly acting antivirals. Liver Int 2018; 38:2342-2342.. [PMID: 30218615 DOI: 10.1111/liv.13961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- Vincenzo Craviotto
- Department of Biomedical Sciences, Humanitas University and Humanitas Research Hospital, Pieve Emanuele (Milano), Italy
| | - Laura Lamonaca
- Department of Biomedical Sciences, Humanitas University and Humanitas Research Hospital, Pieve Emanuele (Milano), Italy
| | - Alessio Aghemo
- Department of Biomedical Sciences, Humanitas University and Humanitas Research Hospital, Pieve Emanuele (Milano), Italy
| | - Ana Lleo
- Department of Biomedical Sciences, Humanitas University and Humanitas Research Hospital, Pieve Emanuele (Milano), Italy
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Lacombe K, Klein MB. The Rocky Road to viral hepatitis elimination: assuring access to antiviral therapy for ALL coinfected patients from low- to high-income settings. J Int AIDS Soc 2018; 21 Suppl 2:e25073. [PMID: 29633554 PMCID: PMC5978684 DOI: 10.1002/jia2.25073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 12/27/2022] Open
Affiliation(s)
- Karine Lacombe
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France.,AP-HP, Hôpital Saint Antoine, Infectious Diseases Unit, Paris, France
| | - Marina B Klein
- Research Institute of the McGill University Health Centre, Montréal, Québec, Canada.,Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
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