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Ingiliz P, Lutz T, Schewe K, Baumgarten A, Krznaric I, Mauss S, Christensen S, Bickel M, Schmidt AJ, Sabranski M, He F, Jain S, Martin NK, Rockstroh JK, Boesecke C. Recently acquired HCV infection in men who have sex with men in Germany in the direct-acting antivirals era and during the COVID-19 pandemic. HIV Med 2024; 25:967-975. [PMID: 38812289 DOI: 10.1111/hiv.13651] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/22/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION Direct-acting antivirals (DAAs) are key to eliminating hepatitis C virus (HCV). In men who have sex with men (MSM) with HIV co-infection, recently acquired HCV infection is common. Sexual practices and reinfection rates may hamper micro-elimination despite high treatment rates. METHODS The cohort included MSM with recently acquired HCV infection from 2014 to 2021. The patients' demographic, clinical, behavioural, and laboratory data and treatment and reinfection outcomes were documented. RESULTS A total of 237 men with recently acquired HCV infection were included: 216 (91%) had HIV. The median age was 46 years (interquartile range [IQR] 39-52), and the median CD4 count was 660/mm3 (IQR 527-835). The annual incidence of recently acquired HCV remained between 0.28% and 0.43% but dropped to 0.02% in 2021 during the COVID pandemic, almost reaching micro-elimination. The reinfection incidence was 15.5 per 100 patient-years (95% confidence interval 12.6-18.8), and reinfection was associated with the use of crystal methamphetamine (p = 0.032) and ketamine (p = 0.042). In total, 31.3% had multiple reinfections, and four reinfections occurred in users of pre-exposure prophylaxis. CONCLUSIONS High treatment and cure rates did not lead to HCV elimination. A change in sexual behaviour, potentially imposed by COVID-19 restrictions, led to micro-elimination in the NoCo cohort. As recently acquired HCV is prevalent in MSM with and without HIV, surveillance is necessary to consolidate elimination goals.
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Affiliation(s)
- Patrick Ingiliz
- ZIBP, Berlin, Germany
- APHP Henri-Mondor University Hospital, INSERM U955, Créteil, France
| | | | | | | | | | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Düsseldorf, Germany
| | - Stefan Christensen
- Centrum für Interdisziplinäre Medizin, Münster, Germany
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Münster, Münster, Germany
| | | | - Axel J Schmidt
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Feng He
- Biostatistics Research Center, University of California San Diego, San Diego, California, USA
| | - Sonia Jain
- Biostatistics Research Center, University of California San Diego, San Diego, California, USA
| | - Nastasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Jürgen K Rockstroh
- Department of Medicine I, University of Bonn, Bonn, Germany
- German Centre for Infection Research (DZIF), Partner-site Cologne-Bonn, Bonn, Germany
| | - Christoph Boesecke
- Department of Medicine I, University of Bonn, Bonn, Germany
- German Centre for Infection Research (DZIF), Partner-site Cologne-Bonn, Bonn, Germany
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2
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Tramonti Fantozzi MP, Ceccarelli L, Petri D, De Vita E, Agostini A, Colombatto P, Stasi C, Rossetti B, Brunetto M, Surace L, Salvati A, Calì A, Tacconi D, Bianco C, Redi D, Fabbiani M, Panza F, Luchi S, Modica S, Moneta S, Iacopini S, Nencioni C, Chigiotti S, Ottaviano G, Zignego AL, Blanc P, Pierotti P, Mariabelli E, Berni R, Silvestri C, Tavoschi L. Hepatitis C epidemiology and treatment outcomes in Italy: Impact of the DAA era and the COVID-19 pandemic. J Viral Hepat 2024. [PMID: 39072924 DOI: 10.1111/jvh.13983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 06/18/2024] [Accepted: 07/16/2024] [Indexed: 07/30/2024]
Abstract
HCV infection poses a global health threat, with significant morbidity and mortality. This study examines HCV trends in a large Italian region from 2015 to 2022, considering demographic changes, evolving clinical profiles, treatment regimens and outcomes, including the impact of the COVID-19 pandemic. This multicentre retrospective study analysed demographics, clinical histories and risk factors in 6882 HCV patients. The study spanned before and after the direct-acting antiviral (DAA) era, and the COVID-19 period, focusing on treatment outcomes (SVR12, non-SVR12 and patients lost to follow-up). Statistical methods included ANOVA, multinomial logistic regression, Kruskal-Wallis test and chi-square analysis, and were conducted adhering to the intention-to-treat (ITT) principle. The cohort, mainly Italian males (average age 58.88), showed Genotype 1 dominance (56.6%) and a high SVR12 rate (97.5%). The pandemic increased follow-up losses, yet SVR12 rates remained stable, influenced by factors like age, gender, cirrhosis and comorbidities. Despite COVID-19 challenges, the region sustained high SVR12 rates in HCV care, emphasising the importance of sustained efforts in HCV care. Continuous screening and targeted interventions in high-risk populations are crucial for achieving WHO elimination targets. The study highlights the resilience of HCV care during the pandemic and provides insights for future public health strategies.
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Affiliation(s)
| | - Luca Ceccarelli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Davide Petri
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Erica De Vita
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Antonello Agostini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | - Cristina Stasi
- CRIA-MASVE Center for Research and Innovation, Careggi University Hospital, Florence, Italy
| | | | - Maurizia Brunetto
- Hepatology Unit, Pisa University Hospital, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lidia Surace
- Hepatology Unit, Pisa University Hospital, Pisa, Italy
| | | | - Alessia Calì
- Hepatology Unit, Pisa University Hospital, Pisa, Italy
| | - Danilo Tacconi
- Division of Infectious Diseases, Arezzo Hospital, Arezzo, Italy
| | - Claudia Bianco
- Division of Infectious Diseases, Arezzo Hospital, Arezzo, Italy
| | - David Redi
- Division of Infectious Diseases, Arezzo Hospital, Arezzo, Italy
| | | | - Francesca Panza
- Infectious and Tropical Diseases Unit, Siena University Hospital, Siena, Italy
| | - Sauro Luchi
- Division of Infectious Diseases and Hepatology, San Luca Hospital, AUSL Toscana Nord Ovest, Lucca, Italy
| | - Sara Modica
- Division of Infectious Diseases and Hepatology, San Luca Hospital, AUSL Toscana Nord Ovest, Lucca, Italy
| | - Sara Moneta
- Division of Infectious Diseases and Hepatology, San Luca Hospital, AUSL Toscana Nord Ovest, Lucca, Italy
| | - Sarah Iacopini
- Division of Infectious Diseases and Hepatology, San Luca Hospital, AUSL Toscana Nord Ovest, Lucca, Italy
| | | | | | | | - Anna Linda Zignego
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Pierluigi Blanc
- Division of Infectious Diseases 1-2, AUSL Toscana Centro, Florence, Italy
| | - Piera Pierotti
- Division of Infectious Diseases 1-2, AUSL Toscana Centro, Florence, Italy
| | - Elisa Mariabelli
- Division of Infectious Diseases 1-2, AUSL Toscana Centro, Florence, Italy
| | - Roberto Berni
- Epidemiology Unit, Tuscany Regional Health Agency, Florence, Italy
| | | | - Lara Tavoschi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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3
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Thomadakis C, Basoulis D, Tsachouridou O, Protopapas K, Paparizos V, Astriti M, Chini M, Chrysos G, Marangos M, Panagopoulos P, Kofteridis D, Sambatakou H, Mastrogianni E, Panatzis N, Pechlivanidou E, Psichοgiou M, Touloumi G. HCV Cascade of Care in HIV/HCV Co-Infected Individuals: Missed Opportunities for Micro-Elimination. Viruses 2024; 16:885. [PMID: 38932178 PMCID: PMC11209384 DOI: 10.3390/v16060885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/17/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
People living with HIV-HCV co-infection comprise a target group for HCV-micro-elimination. We conducted an HCV cascade of care (CoC) for HIV-HCV co-infected individuals living in Greece and investigated factors associated with different HCV-CoC stages. We analyzed data from 1213 participants from the Athens Multicenter AIDS Cohort Study. A seven-stage CoC, overall and by subgroup (people who inject drugs (PWID), men having sex with men (MSM), men having sex with women (MSW), and migrants], was constructed, spanning from HCV diagnosis to sustained virologic response (SVR). Logistic/Cox regression models were employed to identify factors associated with passing through each CoC step. Among 1213 anti-HCV-positive individuals, 9.2% died before direct-acting antiviral (DAA) availability. PWID exhibited higher mortality rates than MSM. Of 1101 survivors, 72.2% remained in care and underwent HCV-RNA testing. Migrants and PWID showed the lowest retention rates. HCV-RNA was available for 79.2% of those in care, with 77.8% diagnosed with chronic HCV. Subsequently, 71% initiated DAAs, with individuals with very low CD4 counts (<100 cells/μL) exhibiting lower odds of DAA initiation. SVR testing was available for 203 individuals, with 85.7% achieving SVR. The SVR rates did not differ across risk groups. In 2023, significant gaps and between-group differences persisted in HCV-CoC among HIV-HCV co-infected individuals in Greece.
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Affiliation(s)
- Christos Thomadakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (C.T.); (N.P.); (E.P.)
| | - Dimitrios Basoulis
- 1st Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (D.B.); (E.M.); (M.P.)
| | - Olga Tsachouridou
- Infectious Diseases Unit, 1st Internal Medicine Department, AHEPA University Hospital, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece;
| | - Konstantinos Protopapas
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, 124 62 Athens, Greece;
| | - Vasilios Paparizos
- AIDS Unit, Clinic of Venereologic & Dermatologic Diseases, Medical School, Syngros Hospital, National and Kapodistrian University of Athens, 161 21 Athens, Greece;
| | - Myrto Astriti
- 1st Department of Internal Medicine and Infectious Diseases Unit, General Hospital of Athens G. Gennimatas, 115 27 Athens, Greece;
| | - Maria Chini
- 3rd Department of Internal Medicine Infectious Diseases Unit, Red Cross General Hospital, 115 26 Athens, Greece;
| | - Georgios Chrysos
- Infectious Diseases Unit, Tzaneion General Hospital of Piraeus, 185 36 Athens, Greece;
| | - Markos Marangos
- Department of Internal Medicine & Infectious Diseases, Patras University General Hospital, 265 04 Patras, Greece;
| | - Periklis Panagopoulos
- Infectious Diseases Unit, 2nd University Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, 681 00 Alexandroupolis, Greece;
| | - Diamantis Kofteridis
- Department of Internal Medicine, University Hospital of Heraklion, 715 00 Heraklion, Greece;
| | - Helen Sambatakou
- HIV Unit, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Hippokration University General Hospital, 115 27 Athens, Greece;
| | - Elpida Mastrogianni
- 1st Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (D.B.); (E.M.); (M.P.)
| | - Nikos Panatzis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (C.T.); (N.P.); (E.P.)
| | - Evmorfia Pechlivanidou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (C.T.); (N.P.); (E.P.)
| | - Mina Psichοgiou
- 1st Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (D.B.); (E.M.); (M.P.)
| | - Giota Touloumi
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (C.T.); (N.P.); (E.P.)
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Zhou S, Qi K, Bersoff-Matcha SJ, Mishra P, Struble K. Sex-related difference analyses of efficacy and safety in clinical trials of direct-acting antivirals to treat chronic HCV genotype 1 and 3 infections. J Viral Hepat 2024; 31:78-87. [PMID: 38111976 DOI: 10.1111/jvh.13901] [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: 09/21/2023] [Accepted: 11/19/2023] [Indexed: 12/20/2023]
Abstract
This study aims to identify clinically meaningful sex differences in efficacy and selected safety adverse events for the treatment of chronic hepatitis C virus infection (HCV) or HIV/HCV co-infection in those receiving combination direct-acting antiviral (DAA) regimens. Our assessment was based on adult trial participants treated at the approved DAA dosage and treatment duration from 40 phase 3 clinical trials submitted to the FDA. Female enrollment ranged from 11% to 54% (overall mean 38%). Females with HCV genotype (GT) 1 or 3 infection had statistically significant higher unadjusted or covariant-adjusted odds of achieving sustained virologic response at post-treatment Week 12 (SVR12) compared with males. Odds ratios favouring females were observed among Whites and those ≥40 years of age with HCV GT1 or 3 infections, and among those ≥50 years of age, non-cirrhotic and those with HCV GT3 infection who were treatment-experienced. These differences were not clinically relevant due to the high SVR12 rate achieved by females and males, overall or in subgroups. No differences were observed in SVR12 rates between HCV GT1 mono-infected and HCV GT1/ HIV-1 co-infected participants. Numerically, more females reported headache, fatigue and nausea compared to males, but the differences were small and predominately Grade 1 or 2 severity. Discontinuation rates for any reason or due to an adverse event were low and similar between the sexes. Our study demonstrated females successfully complete DAA regimens and achieve high SVR12 rates despite numerically higher adverse events for certain commonly reported events.
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Affiliation(s)
- Shuang Zhou
- Center for Drug Evaluation and Research, Division of Antivirals, FDA, Silver Spring, Maryland, USA
| | - Karen Qi
- Center for Drug Evaluation and Research, Office of Biostatistician, FDA, Silver Spring, Maryland, USA
| | | | - Poonam Mishra
- Center for Drug Evaluation and Research, Division of Antivirals, FDA, Silver Spring, Maryland, USA
| | - Kimberly Struble
- Center for Drug Evaluation and Research, Division of Antivirals, FDA, Silver Spring, Maryland, USA
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