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Bjorgen JC, Dick JK, Cromarty R, Hart GT, Rhein J. NK cell subsets and dysfunction during viral infection: a new avenue for therapeutics? Front Immunol 2023; 14:1267774. [PMID: 37928543 PMCID: PMC10620977 DOI: 10.3389/fimmu.2023.1267774] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/25/2023] [Indexed: 11/07/2023] Open
Abstract
In the setting of viral challenge, natural killer (NK) cells play an important role as an early immune responder against infection. During this response, significant changes in the NK cell population occur, particularly in terms of their frequency, location, and subtype prevalence. In this review, changes in the NK cell repertoire associated with several pathogenic viral infections are summarized, with a particular focus placed on changes that contribute to NK cell dysregulation in these settings. This dysregulation, in turn, can contribute to host pathology either by causing NK cells to be hyperresponsive or hyporesponsive. Hyperresponsive NK cells mediate significant host cell death and contribute to generating a hyperinflammatory environment. Hyporesponsive NK cell populations shift toward exhaustion and often fail to limit viral pathogenesis, possibly enabling viral persistence. Several emerging therapeutic approaches aimed at addressing NK cell dysregulation have arisen in the last three decades in the setting of cancer and may prove to hold promise in treating viral diseases. However, the application of such therapeutics to treat viral infections remains critically underexplored. This review briefly explores several therapeutic approaches, including the administration of TGF-β inhibitors, immune checkpoint inhibitors, adoptive NK cell therapies, CAR NK cells, and NK cell engagers among other therapeutics.
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Affiliation(s)
- Jacob C. Bjorgen
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Jenna K. Dick
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States
- Center for Immunology, University of Minnesota, Minneapolis, MN, United States
| | - Ross Cromarty
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States
| | - Geoffrey T. Hart
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States
- Center for Immunology, University of Minnesota, Minneapolis, MN, United States
| | - Joshua Rhein
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
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2
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Wasitthankasem R, Wanlapakorn N, Pimsing N, Posuwan N, Poovorawan Y. Simplified Test-to-Treat Strategy for Hepatitis C in Thailand: The Phetchabun Model. J Infect Dis 2023; 228:S198-S203. [PMID: 37703343 DOI: 10.1093/infdis/jiac490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
The complexity of the hepatitis C virus (HCV) diagnostic workflow and stringent criteria for universal health coverage are significant barriers to achieving HCV elimination in Thailand. A test-to-treat strategy using a rapid diagnostic test (RDT) for screening at point of care, followed by a qualitative nucleic acid testing, is a promising strategy to facilitate population-wide screening for HCV infection and expedite time to treatment. This strategy was evaluated in Phetchabun province, Thailand, where the HCV burden is relatively high. This simplified HCV test-to-treat strategy showed strong potential to be implemented at a national level. Several obstacles to implementation included the stringent criteria for universal health coverage, which prioritizes patients with advanced disease, the continuous policy revision for HCV treatment and care, the relatively low public awareness of HCV infection, and the lagging of government policy prioritization. All of these contribute to the delayed progress in hepatitis elimination.
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Affiliation(s)
- Rujipat Wasitthankasem
- National Biobank of Thailand, National Science and Technology Development Agency, Pathum Thani, Thailand
| | - Nasamon Wanlapakorn
- Chulabhorn International College of Medicine, Thammasat University, Rangsit Campus, Patum Thani, Thailand
| | - Napaporn Pimsing
- Phetchabun Provincial Public Health Office, Phetchabun, Thailand
| | - Nawarat Posuwan
- Chulabhorn International College of Medicine, Thammasat University, Rangsit Campus, Patum Thani, Thailand
| | - Yong Poovorawan
- Chulabhorn International College of Medicine, Thammasat University, Rangsit Campus, Patum Thani, Thailand
- Fellow of Royal Society of Thailand (FRS[T]), The Royal Society of Thailand, Sanam Sueapa, Dusit, Bangkok, Thailand
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3
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Chu C, Gomes T, Antoniou T, Wong WWL, Janjua N, Guertin JR, Schwartz KL, Feld J, Kwong J, Tadrous M. The impact of expanded access to direct acting antivirals for Hepatitis C virus on patient outcomes in Canada. PLoS One 2023; 18:e0284914. [PMID: 37552677 PMCID: PMC10409286 DOI: 10.1371/journal.pone.0284914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/22/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) has high global prevalence and can lead to liver complications and death. Access to direct-acting antivirals (DAAs) in Canada increased following several policy changes, however the real-world impact of expanded DAA access and increased use of these drugs is unknown. OBJECTIVE We aimed to determine the early change in rates of HCV-related hospitalizations overall and HCV-related hospitalizations with hepatocellular carcinoma (HCC) after expanded DAA access. METHODS We conducted a population-based time series analysis using national administrative health databases in Canada. Rates of HCV-related hospitalizations and HCV-related hospitalizations with HCC were enumerated monthly between April 2006 and March 2020. We used Autoregressive Integrated Moving Average (ARIMA) models with ramp functions in October 2014 and January 2017 to evaluate the impact of policies to expand DAA access on hospitalization outcomes. RESULTS Rates of HCV-related hospitalizations in Canada increased between 2006 and 2014, and gradually declined thereafter. The decrease after October 2014, or the first policy change, was significant (p = 0.0355), but no further change was found after the second policy change in 2017 (p = 0.2567). HCV-related hospitalizations with HCC increased until end of 2013, followed by a plateau, before declining in 2016. No significant shifts were found after the first policy change in 2014 (p = 0.1291) nor the second policy change in 2017 (p = 0.6324). Subgroup analyses revealed that those aged 50-64 and males had observable declines in rates of HCV-related hospitalizations in the year prior to the first policy change. CONCLUSIONS Expanding DAA access was associated with a drop in HCV-related hospitalizations in the overall Canadian population coinciding with the 2014 policy change. In light of the time required for HCV-related complications to manifest, continued ongoing research examining the real-world effectiveness of DAAs is required.
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Affiliation(s)
- Cherry Chu
- Institute for Health System Solutions and Virtual Care, Women’s College Hospital, Toronto, ON, Canada
| | - Tara Gomes
- Unity Health Toronto, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Tony Antoniou
- Unity Health Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - William W. L. Wong
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada
| | - Naveed Janjua
- BC Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jason Robert Guertin
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Quebec City, QC, Canada
- Centre de recherche du CHU de Québec-Université Laval, Quebec City, QC, Canada
- Centre de Recherche en Organogénèse expérimentale de l’Université Laval/LOEX, Quebec City, QC, Canada
| | - Kevin L. Schwartz
- Public Health Ontario, Toronto, ON, Canada
- St. Joseph’s Health Centre, Unity Health Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jordan Feld
- Toronto Centre for Liver Disease, University Health Network, Toronto, ON, Canada
| | - Jeff Kwong
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mina Tadrous
- Institute for Health System Solutions and Virtual Care, Women’s College Hospital, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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Gudi SK, Eltonsy S, Delaney J, Osiowy C, Taylor C, Kaita K, Alessi-Severini S. Annual trends of hepatitis C virus infection in Manitoba between 1998 and 2018: A focus on special populations. CANADIAN LIVER JOURNAL 2023; 6:249-260. [PMID: 37503521 PMCID: PMC10370720 DOI: 10.3138/canlivj-2022-0030] [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: 10/21/2022] [Accepted: 11/02/2022] [Indexed: 07/29/2023]
Abstract
Background Hepatitis C virus (HCV) infection is a major cause of liver-related morbidity and mortality worldwide. Epidemiological data of HCV infection in the Canadian province of Manitoba are limited. Methods A population-based retrospective study was conducted using data from the Manitoba Centre for Health Policy repository. Using the test results provided by the Cadham provincial laboratory, individuals in Manitoba with a diagnosis of HCV infection were identified. Annual prevalence and incidence rates (crude and standardized) were calculated for the overall population and stratified by sex, regional health authority (RHA), residence area, income quintile, and special population groups (children, older adults, and pregnant persons). Results A total of 8,721 HCV cases were diagnosed between 1998 and 2018 in Manitoba. Overall crude HCV incidence and prevalence were estimated as 0.03% and 0.37% during the study period, respectively. No significant change was observed in the standardized HCV incidence rate (per 100,000) during the study period (54.3 in 1998 and 54.8 in 2018). However, the standardized HCV prevalence (per 100,000) increased from 52.5 (95% CI 39.2-68.7) in 1998 to 655.2 (95% CI 605.9-707.3) in 2018. An overall average incidence rate based on sex, RHA, region, income, and special population groups was observed to be higher in males (40.1), Winnipeg RHA (42.7), urban region (42.3), low-income quintiles (78.5), and pregnant persons (94.3), respectively. Conclusion Although incidence rates of HCV infection in Manitoba appeared to have initially declined, rates showed an upward trend by the end of the study period while prevalence increased steadily.
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Affiliation(s)
- Sai Krishna Gudi
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sherif Eltonsy
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joseph Delaney
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Carla Osiowy
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Carole Taylor
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kelly Kaita
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Ambulatory Care for Section of Hepatology, Winnipeg, Manitoba, Canada
- Viral Hepatitis Investigative Unit, Winnipeg, Manitoba, Canada
| | - Silvia Alessi-Severini
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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5
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Maretti-Mira AC, Salomon MP, Hsu AM, Matsuba C, Golden-Mason L. Chronic HCV infection promotes cytotoxicity in antigen-specific CD8 + T cells regardless of virus specificity. FRONTIERS IN VIROLOGY (LAUSANNE, SWITZERLAND) 2023; 3:1198361. [PMID: 37886042 PMCID: PMC10601542 DOI: 10.3389/fviro.2023.1198361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Introduction Despite advancements in hepatitis C virus (HCV) infection treatment, HCV still represents a significant public health burden. Besides progressive hepatic damage, viral persistence has lasting effects on innate and adaptive immune responses. Lack of a complete understanding of the factors driving an effective HCV response contributes to the failure to develop a vaccine for prevention. This study advances the existing knowledge on HCV-specific CD8+ T cells and describes the impact of current or past HCV infection on CD8+ T cells specific for other viruses. Methods We used barcoded-dextramers to identify and sort CD8+ T cells specific for HCV, cytomegalovirus, and influenza, and characterized them using single-cell RNA sequencing technology. Our cohort included chronic (cHCV), spontaneously resolved (rHCV), and subjects undergoing direct-acting antiviral (DAA) therapy. Results We show that HCV-specific CD8+ T cells have cytotoxic features in patients with cHCV, which is progressively reduced with DAA therapy and persists 12 weeks after treatment completion. We also observe a shift in the CD8+ T cell phenotype on DAA treatment, with decreased effector memory and exhausted cell signatures. In rHCV, we also detected a smaller proportion of effector memory cells compared to cHCV. The proportion of CD8+ exhausted T cells in cHCV and rHCV subjects was comparable. Moreover, we also observed that non-HCV virus-specific CD8+ T cells exhibit robust cytotoxic traits during cHCV infection. Discussion Altogether, our findings suggest that cHCV infection promotes cytotoxicity in CD8+ T cells regardless of virus specificity. The immunological changes caused by cHCV infection in CD8+ T cells may contribute to worsening the ongoing hepatic damage caused by HCV infection or exacerbate the immune response to possible co-infections. Our data provide a resource to groups exploring the underlying mechanisms of HCV-specific T cell spontaneous and treatment-induced resolution to inform the development of effective vaccines against HCV infection.
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Affiliation(s)
- Ana C. Maretti-Mira
- USC Research Center for Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Matthew P. Salomon
- USC Research Center for Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Angela M. Hsu
- USC Research Center for Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Chikako Matsuba
- USC Research Center for Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Lucy Golden-Mason
- USC Research Center for Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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6
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Jagirdhar GSK, Pulakurthi YS, Chigurupati HD, Surani S. Gastrointestinal tract and viral pathogens. World J Virol 2023; 12:136-150. [PMID: 37396706 PMCID: PMC10311582 DOI: 10.5501/wjv.v12.i3.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/17/2023] [Accepted: 04/27/2023] [Indexed: 06/21/2023] Open
Abstract
Viral gastroenteritis is the most common viral illness that affects the gastrointestinal (GI) tract, causing inflammation and irritation of the lining of the stomach and intestines. Common signs and symptoms associated with this condition include abdominal pain, diarrhea, and dehydration. The infections commonly involved in viral gastroenteritis are rotavirus, norovirus, and adenovirus, which spread through the fecal-oral and contact routes and cause non-bloody diarrhea. These infections can affect both immunocompetent and immunocompromised individuals. Since the pandemic in 2019, coronavirus gastroenteritis has increased in incidence and prevalence. Morbidity and mortality rates from viral gastroenteritis have declined significantly over the years due to early recognition, treatment with oral rehydration salts, and prompt vaccination. Improved sanitation measures have also played a key role in reducing the transmission of infection. In addition to viral hepatitis causing liver disease, herpes virus, and cytomegalovirus are responsible for ulcerative GI disease. They are associated with bloody diarrhea and commonly occur in im-munocompromised individuals. Hepatitis viruses, Epstein-Barr virus, herpesvirus 8, and human papillomavirus have been involved in benign and malignant diseases. This mini review aims to list different viruses affecting the GI tract. It will cover common symptoms aiding in diagnosis and various important aspects of each viral infection that can aid diagnosis and management. This will help primary care physicians and hospitalists diagnose and treat patients more easily.
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Affiliation(s)
| | | | | | - Salim Surani
- Department of Pulmonary, Critical Care and Sleep Medicine, Texas A&M University, College Station, TX 77843, United States
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7
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Jabin A, Uddin MF, Al Azad S, Rahman A, Tabassum F, Sarker P, Morshed AKMH, Rahman S, Raisa FF, Sakib MR, Olive AH, Islam T, Tahsin R, Ahmed SZ, Biswas P, Habiba MU, Siddiquy M, Jafary M. Target-specificity of different amyrin subunits in impeding HCV influx mechanism inside the human cells considering the quantum tunnel profiles and molecular strings of the CD81 receptor: a combined in silico and in vivo study. In Silico Pharmacol 2023; 11:8. [PMID: 36999133 PMCID: PMC10052254 DOI: 10.1007/s40203-023-00144-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 02/11/2023] [Indexed: 03/31/2023] Open
Abstract
HCV is a hepatotropic RNA virus recognized for its frequent virulence and fatality worldwide. Despite many vaccine development programs underway, researchers are on a quest for natural bioactive compounds due to their multivalent efficiencies against viral infections, considering which the current research aimed to figure out the target-specificity and therapeutic potentiality of α, β, and δ subunits of amyrin, as novel bioactive components against the HCV influx mechanism. Initially, the novelty of amyrin subunits was conducted from 203 pharmacophores, comparing their in-silico pharmacokinetic and pharmacodynamic profiles. Besides, the best active site of CD81 was determined following the quantum tunneling algorithm. The molecular dynamic simulation was conducted (100 ns) following the molecular docking steps to reveal the parameters- RMSD (Å); Cα; RMSF (Å); MolSA (Å2); Rg (nm); PSA (Å); SASA (Å2), and the MM-GBSA dG binding scores. Besides, molecular strings of CD81, along with the co-expressed genes, were classified, as responsible for encoding CD81-mediated protein clusters during HCV infection, resulting in the potentiality of amyrins as targeted prophylactics in HCV infection. Finally, in vivo profiling of the oxidative stress marker, liver-specific enzymes, and antioxidant markers was conducted in the DMN-induced mice model, where β-amyrin scored the most significant values in all aspects.
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Affiliation(s)
- Anika Jabin
- grid.443020.10000 0001 2295 3329Department of Biochemistry and Microbiology, North South University, Dhaka, 1229 Bangladesh
| | - Mohammad Fahim Uddin
- grid.413273.00000 0001 0574 8737College of Material Science and Engineering, Zhejiang Sci-Tech University, Hangzhou, 310018 Zhejiang People’s Republic of China
| | - Salauddin Al Azad
- grid.258151.a0000 0001 0708 1323Key Laboratory of Industrial Biotechnology, Ministry of Education, School of Biotechnology, Jiangnan University, Wuxi, 214122 Jiangsu Province People’s Republic of China
| | - Ashfaque Rahman
- grid.443020.10000 0001 2295 3329Department of Biochemistry and Microbiology, North South University, Dhaka, 1229 Bangladesh
| | - Fawzia Tabassum
- grid.412506.40000 0001 0689 2212Department of Genetic Engineering and Biotechnology, Shahjalal University of Science and Technology, Sylhet, 3114 Bangladesh
| | - Pritthy Sarker
- grid.443020.10000 0001 2295 3329Department of Biochemistry and Microbiology, North South University, Dhaka, 1229 Bangladesh
| | - A K M Helal Morshed
- grid.207374.50000 0001 2189 3846Pathology and Pathophysiology Major, Academy of Medical Science, Zhengzhou University, Zhengzhou City, 450001 Henan Province People’s Republic of China
| | - Samiur Rahman
- grid.443020.10000 0001 2295 3329Department of Biochemistry and Microbiology, North South University, Dhaka, 1229 Bangladesh
| | - Fatima Fairuz Raisa
- grid.52681.380000 0001 0746 8691Department of Electrical and Electronic Engineering, Brac University, Dhaka, 1212 Bangladesh
| | - Musfiqur Rahman Sakib
- grid.449329.10000 0004 4683 9733Department of Pharmacy, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, 8100 Bangladesh
| | - Abeer Hasan Olive
- grid.442996.40000 0004 0451 6987Department of Pharmacy, East West University, Dhaka, 1212 Bangladesh
| | - Tabassum Islam
- grid.442996.40000 0004 0451 6987Department of Computer Science and Engineering, East West University, Dhaka, 1212 Bangladesh
| | - Ramisha Tahsin
- grid.443020.10000 0001 2295 3329Department of Pharmaceutical Sciences, North South University, Dhaka, 1229 Bangladesh
| | - Shahlaa Zernaz Ahmed
- grid.443020.10000 0001 2295 3329Department of Biochemistry and Microbiology, North South University, Dhaka, 1229 Bangladesh
| | - Partha Biswas
- Department of Genetic Engineering and Biotechnology, Jashore University of Science and Technology, Jashore, 7408 Bangladesh
| | - Mst. Umme Habiba
- Data Science Research Unit, RPG Interface Lab, Jashore, 7400 Bangladesh
| | - Mahbuba Siddiquy
- grid.258151.a0000 0001 0708 1323State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, 214122 Jiangsu Province People’s Republic of China
| | - Maryam Jafary
- grid.411705.60000 0001 0166 0922Division of Food Safety and Hygiene, Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, 1416634793 Iran
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8
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Quality Assurance for Hepatitis C Virus Point-of-Care Diagnostics in Sub-Saharan Africa. Diagnostics (Basel) 2023; 13:diagnostics13040684. [PMID: 36832172 PMCID: PMC9955859 DOI: 10.3390/diagnostics13040684] [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: 12/01/2022] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
As part of a multinational study to evaluate the Bioline Hepatitis C virus (HCV) point-of-care (POC) testing in sub-Saharan Africa (SSA), this narrative review summarises regulatory standards and quality indicators for validating and approving HCV clinical diagnostics. In addition, this review also provides a summary of their diagnostic evaluations using the REASSURED criteria as the benchmark and its implications on the WHO HCV elimination goals 2030.
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Papageorgiou L, Papakonstantinou E, Diakou I, Pierouli K, Dragoumani K, Bacopoulou F, Chrousos GP, Eliopoulos E, Vlachakis D. Semantic and Population Analysis of the Genetic Targets Related to COVID-19 and Its Association with Genes and Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1423:59-78. [PMID: 37525033 DOI: 10.1007/978-3-031-31978-5_6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
SARS-CoV-2 is a coronavirus responsible for one of the most serious, modern worldwide pandemics, with lasting and multifaceted effects. By late 2021, SARS-CoV-2 has infected more than 180 million people and has killed more than 3 million. The virus gains entrance to human cells through binding to ACE2 via its surface spike protein and causes a complex disease of the respiratory system, termed COVID-19. Vaccination efforts are being made to hinder the viral spread, and therapeutics are currently under development. Toward this goal, scientific attention is shifting toward variants and SNPs that affect factors of the disease such as susceptibility and severity. This genomic grammar, tightly related to the dark part of our genome, can be explored through the use of modern methods such as natural language processing. We present a semantic analysis of SARS-CoV-2-related publications, which yielded a repertoire of SNPs, genes, and disease ontologies. Population data from the 1000 Genomes Project were subsequently integrated into the pipeline. Data mining approaches of this scale have the potential to elucidate the complex interaction between COVID-19 pathogenesis and host genetic variation; the resulting knowledge can facilitate the management of high-risk groups and aid the efforts toward precision medicine.
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Affiliation(s)
- Louis Papageorgiou
- Laboratory of Genetics, Department of Biotechnology, School of Applied Biology and Biotechnology, Agricultural University of Athens, Athens, Greece
| | - Eleni Papakonstantinou
- Laboratory of Genetics, Department of Biotechnology, School of Applied Biology and Biotechnology, Agricultural University of Athens, Athens, Greece
| | - Io Diakou
- Laboratory of Genetics, Department of Biotechnology, School of Applied Biology and Biotechnology, Agricultural University of Athens, Athens, Greece
| | - Katerina Pierouli
- Laboratory of Genetics, Department of Biotechnology, School of Applied Biology and Biotechnology, Agricultural University of Athens, Athens, Greece
| | - Konstantina Dragoumani
- Laboratory of Genetics, Department of Biotechnology, School of Applied Biology and Biotechnology, Agricultural University of Athens, Athens, Greece
| | - Flora Bacopoulou
- University Research Institute of Maternal and Child Health & Precision Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - George P Chrousos
- University Research Institute of Maternal and Child Health & Precision Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Elias Eliopoulos
- Laboratory of Genetics, Department of Biotechnology, School of Applied Biology and Biotechnology, Agricultural University of Athens, Athens, Greece
| | - Dimitrios Vlachakis
- Laboratory of Genetics, Department of Biotechnology, School of Applied Biology and Biotechnology, Agricultural University of Athens, Athens, Greece.
- University Research Institute of Maternal and Child Health & Precision Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece.
- Division of Endocrinology and Metabolism, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece.
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10
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Shin SH, Park SH. [Viral Hepatitis in Patients with Inflammatory Bowel Disease]. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2022; 80:51-59. [PMID: 36004631 DOI: 10.4166/kjg.2022.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 07/29/2022] [Accepted: 07/30/2022] [Indexed: 06/15/2023]
Abstract
There has been a rise in the incidence of inflammatory bowel disease (IBD) in developing countries, including South Korea. Consequently, the use of immunosuppressive agents such as immunomodulators or biologics has also increased. Due to immunosuppression, patients on these agents are at increased risk of various opportunistic infections during treatment, which may sometimes lead to serious adverse outcomes. Viral hepatitis, especially hepatitis B, is one of the infectious conditions that can be reactivated during immunosuppressive therapy, and adequate strategies for monitoring and prophylaxis are needed to prevent it. South Korea is one of the countries with intermediate endemicity for hepatitis A and B. Thus, taking adequate precautions against viral hepatitis could prevent new infections or reactivation of these conditions in patients with IBD on immunosuppressive therapy. In this review article, we have summarized the latest evidence on viral hepatitis in patients with IBD that would be of assistance in clinical practice.
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Affiliation(s)
- Seung Hwan Shin
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Hyoung Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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11
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Sreekumar BK, Taha TY, Ott M. Taking cues from convalescence to improve vaccines against hepatitis C virus. J Clin Invest 2022; 132:161819. [PMID: 35912856 PMCID: PMC9337820 DOI: 10.1172/jci161819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hepatitis C virus (HCV) infection remains a worldwide public health issue despite direct-acting antivirals. A substantial proportion of infected individuals (15%–45%) spontaneously clear repeated HCV infections with genetically different viruses by generating broadly neutralizing antibodies (bNAbs). However, translating this response into an effective vaccine strategy has been unsuccessful. In this issue of the JCI, Frumento and colleagues report on their study of bNAb evolution longitudinally in convalescent individuals with repeated infections. Using pseudotyped viruses, well-characterized monoclonal antibodies, and complex modeling, the authors show that multiple exposures to antigenically related, antibody-sensitive viral envelope proteins induced potent bNAbs. This work provides valuable insight into the best strategies for developing HCV vaccines in the future that may successfully reproduce the immunity induced during natural exposures.
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Imbeth-Acosta P, Leal-Martínez V, Ramos-Clason E, Pájaro-Galvis N, Martínez-Ávila MC, Almanza-Hurtado A, Rodríguez-Yanez T, Bermudez-Montero J, Vergara-Serpa O, Abuabara-Franco E, Raad-Sarabia M, Villar-González EP, Tatis-Geney SI, Collazos-Torres LA, Rico-Fontalvo J, Daza-Arnedo R, Pérez-Calvo C, Alvarado-Castell H, López Acuña GH. Prevalence of Chronic Infection by Hepatitis C Virus in Asymptomatic Population With Risk Factors in Cartagena, Colombia. Front Med (Lausanne) 2022; 9:814622. [PMID: 35860730 PMCID: PMC9289182 DOI: 10.3389/fmed.2022.814622] [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: 11/15/2021] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Infection by the hepatitis C virus (HCV) is an important cause of chronic liver disease, considered a public health problem worldwide with high morbidity and mortality due to limited access to diagnostic tests in developing countries. Only a small percentage know their infection status and receive timely treatment. It is critical to make diagnostic tests for HCV infection accessible and to provide timely treatment, which not only reduces the spread of infection but also stops the progression of HCV disease without symptoms. Objective To determine the prevalence of chronic infection by HCV in patients with risk factors by using rapid tests in Cartagena, Colombia, and describe their epidemiological characteristics. Methodology A cross-sectional descriptive observational study was carried out on asymptomatic adults with risk factors for HCV infection in the city of Cartagena between December 2017 and November 2019. A rapid immunochromatographic test was performed to detect antibodies, characterizing the population. Results In total, 1,023 patients were identified who met the inclusion criteria, 58.5% women and 41.4% men, obtaining nine positive results, confirming chronic infection with viral load for HCV, finding seven cases of genotype 1b and two genotype 1a. Conclusion In our study, a prevalence of hepatitis C infection of 0.9% was found in asymptomatic individuals with risk factors, which allows us to deduce that the active search for cases in risk groups constitutes a pillar for the identification of the disease, the initiation of antiviral therapy, and decreased morbidity and mortality.
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Affiliation(s)
- Pedro Imbeth-Acosta
- Department of Gastroenterology and Hepatology, Diagnostico y Terapeutica en Gastroenterologia y Hepatologia (DITEG), Cartagena, Colombia
- Department of Internal Medicine, University of Sinu, Cartagena, Colombia
| | | | - Enrique Ramos-Clason
- Department of Public Health and Medical Research, University of Sinu, Cartagena, Colombia
| | | | - María Cristina Martínez-Ávila
- Epidemiologist, Grupo Biotoxam, Universidad de Cartagena, Cartagena, Colombia
- *Correspondence: María Cristina Martínez-Ávila
| | - Amilkar Almanza-Hurtado
- Department of Critical Care Médicine, Gestion Salud Instituto Prestador de Salud (IPS), University of Cartagena, Cartagena, Colombia
| | - Tomás Rodríguez-Yanez
- Department of Critical Care Médicine, Gestion Salud Instituto Prestador de Salud (IPS), University of Cartagena, Cartagena, Colombia
| | | | | | | | - María Raad-Sarabia
- Department of Internal Medicine, University of Sinu, Cartagena, Colombia
| | | | | | | | - Jorge Rico-Fontalvo
- Department of Nephrology, Colombian Association of Nephrology, Medellín, Colombia
| | - Rodrigo Daza-Arnedo
- Department of Nephrology, Colombian Association of Nephrology, Medellín, Colombia
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McKay LGA, Thomas J, Albalawi W, Fattaccioli A, Dieu M, Ruggiero A, McKeating JA, Ball JK, Tarr AW, Renard P, Pollakis G, Paxton WA. The HCV Envelope Glycoprotein Down-Modulates NF-κB Signalling and Associates With Stimulation of the Host Endoplasmic Reticulum Stress Pathway. Front Immunol 2022; 13:831695. [PMID: 35371105 PMCID: PMC8964954 DOI: 10.3389/fimmu.2022.831695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Following acute HCV infection, the virus establishes a chronic disease in the majority of patients whilst few individuals clear the infection spontaneously. The precise mechanisms that determine chronic HCV infection or spontaneous clearance are not completely understood but are proposed to be driven by host and viral genetic factors as well as HCV encoded immunomodulatory proteins. Using the HIV-1 LTR as a tool to measure NF-κB activity, we identified that the HCV E1E2 glycoproteins and more so the E2 protein down-modulates HIV-1 LTR activation in 293T, TZM-bl and the more physiologically relevant Huh7 liver derived cell line. We demonstrate this effect is specifically mediated through inhibiting NF-κB binding to the LTR and show that this effect was conserved for all HCV genotypes tested. Transcriptomic analysis of 293T cells expressing the HCV glycoproteins identified E1E2 mediated stimulation of the endoplasmic reticulum (ER) stress response pathway and upregulation of stress response genes such as ATF3. Through shRNA mediated inhibition of ATF3, one of the components, we observed that E1E2 mediated inhibitory effects on HIV-1 LTR activity was alleviated. Our in vitro studies demonstrate that HCV Env glycoprotein activates host ER Stress Pathways known to inhibit NF-κB activity. This has potential implications for understanding HCV induced immune activation as well as oncogenesis.
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Affiliation(s)
- Lindsay G. A. McKay
- Department of Clinical Infection, Microbiology and Immunology, Institute of Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Jordan Thomas
- Department of Clinical Infection, Microbiology and Immunology, Institute of Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Wejdan Albalawi
- Department of Clinical Infection, Microbiology and Immunology, Institute of Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Antoine Fattaccioli
- Laboratory of Biochemistry and Cell Biology (URBC), Namur Research Institute for Life Sciences (NARILIS), University of Namur (UNamur), Namur, Belgium
| | - Marc Dieu
- MaSUN, Mass Spectrometry Facility, University of Namur (UNamur), Namur, Belgium
| | - Alessandra Ruggiero
- Department of Clinical Infection, Microbiology and Immunology, Institute of Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Jane A. McKeating
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jonathan K. Ball
- Wolfson Centre for Global Virus Research and School of Life Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Alexander W. Tarr
- Wolfson Centre for Global Virus Research and School of Life Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Patricia Renard
- Laboratory of Biochemistry and Cell Biology (URBC), Namur Research Institute for Life Sciences (NARILIS), University of Namur (UNamur), Namur, Belgium,MaSUN, Mass Spectrometry Facility, University of Namur (UNamur), Namur, Belgium
| | - Georgios Pollakis
- Department of Clinical Infection, Microbiology and Immunology, Institute of Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - William A. Paxton
- Department of Clinical Infection, Microbiology and Immunology, Institute of Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom,*Correspondence: William A. Paxton,
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Wasitthankasem R, Posuwan N, Pimsing N, Phaengkha W, Ngamnimit S, Vichaiwattana P, Thongpan I, Tongsima S, Vongpunsawad S, Poovorawan Y. Prescreening with a Rapid Diagnostic Test Followed by a Confirmatory Qualitative Nucleic Acid Test Can Simplify Hepatitis C Diagnosis. Am J Trop Med Hyg 2022; 106:tpmd211016. [PMID: 35226876 PMCID: PMC9128707 DOI: 10.4269/ajtmh.21-1016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/06/2022] [Indexed: 11/07/2022] Open
Abstract
Asymptomatic hepatitis C virus (HCV) infection without treatment is associated with chronic liver diseases including hepatocellular carcinoma. A major obstacle to hepatitis C diagnosis leading to antiviral treatment in some developing countries is the complicated HCV testing required before treatment. To simplify an HCV test-to-treat strategy, which could lead to timely diagnosis and treatment at the point-of-care, we evaluated the performance of four anti-HCV rapid diagnostic tests (RDTs) (Abon, Blue Cross, Healgen, and SD Bioline). They yielded comparable sensitivity (80-83%), specificity (99-100%), and accuracy (90-91.5%). When we field-tested Abon in 4,769 residents of an HCV-endemic province in Thailand, 306 seropositive individuals (6.4%) were identified. In comparison, laboratory test using an automated commercial chemiluminescent microparticle immunoassay (Abbott ARCHITECT) identified slightly more seropositives (327% or 6.9%). Field implementation suggests that Abon was sensitive (88.7%), specific (99.6%), and accurate (98.9%). Furthermore, 82% (250/306) of Abon-positive samples had detectable HCV RNA as determined by nucleic acid test (Roche cobas). The same 250 samples out of 327 reactive in Abbott immunoassay also had detectable HCV RNA (mean RNA level: log 6.28 IU/mL, range: log 3.06- 7.78 IU/mL). The use of RDT followed by qualitative nucleic acid test can cost-effectively identify the majority of HCV seropositive individuals with active infection, which will obviate the need for expensive viral load quantification tests when simplifying HCV diagnosis for the test-to-treat program at the point-of-care.
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Affiliation(s)
- Rujipat Wasitthankasem
- National Biobank of Thailand, National Science and Technology Development Agency, Pathum Thani, Thailand
| | - Nawarat Posuwan
- Chulabhorn International College of Medicine, Thammasat University, Rangsit Campus, Patum Thani, Thailand
| | - Napaporn Pimsing
- Phetchabun Provincial Public Health Office, Phetchabun, Thailand
| | | | | | - Preeyaporn Vichaiwattana
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ilada Thongpan
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sissades Tongsima
- National Biobank of Thailand, National Science and Technology Development Agency, Pathum Thani, Thailand
| | - Sompong Vongpunsawad
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yong Poovorawan
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Butaru AE, Mămuleanu M, Streba CT, Doica IP, Diculescu MM, Gheonea DI, Oancea CN. Resource Management through Artificial Intelligence in Screening Programs-Key for the Successful Elimination of Hepatitis C. Diagnostics (Basel) 2022; 12:diagnostics12020346. [PMID: 35204437 PMCID: PMC8871056 DOI: 10.3390/diagnostics12020346] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/23/2022] [Accepted: 01/26/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The elimination of the Hepatitis C virus (HCV) will only be possible if rapid and efficient actions are taken. Artificial neural networks (ANNs) are computing systems based on the topology of the biological brain, containing connected artificial neurons that can be tasked with solving medical problems. AIM We expanded the previously presented HCV micro-elimination project started in September 2020 that aimed to identify HCV infection through coordinated screening in asymptomatic populations and developed two ANN models able to identify at-risk subjects selected through a targeted questionnaire. MATERIAL AND METHOD Our study included 14,042 screened participants from a southwestern region of Oltenia, Romania. Each participant completed a 12-item questionnaire along with anti-HCV antibody rapid testing. Hepatitis-C-positive subjects were linked to care and ultimately could receive antiviral treatment if they had detectable viremia. We built two ANNs, trained and tested on the dataset derived from the questionnaires and then used to identify patients in a similar, already existing dataset. RESULTS We found 114 HCV-positive patients (81 females), resulting in an overall prevalence of 0.81%. We identified sharing personal hygiene items, receiving blood transfusions, having dental work or surgery and re-using hypodermic needles as significant risk factors. When used on an existing dataset of 15,140 persons (119 HCV cases), the first ANN models correctly identified 97 (81.51%) HCV-positive subjects through 13,401 tests, while the second ANN model identified 81 (68.06%) patients through only 5192 tests. CONCLUSIONS The use of ANNs in selecting screening candidates may improve resource allocation and prioritize cases more prone to severe disease.
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Affiliation(s)
- Anca Elena Butaru
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.E.B.); (I.P.D.)
| | - Mădălin Mămuleanu
- Department of Automatic Control and Electronics, University of Craiova, 200585 Craiova, Romania;
- Oncometrics S.R.L., 200677 Craiova, Romania
| | - Costin Teodor Streba
- Oncometrics S.R.L., 200677 Craiova, Romania
- Department of Pulmonology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, 200638 Craiova, Romania;
- Correspondence: ; Tel.: +40-722-38-99-06
| | - Irina Paula Doica
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.E.B.); (I.P.D.)
| | - Mihai Mircea Diculescu
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Dan Ionuț Gheonea
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, 200638 Craiova, Romania;
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Carmen Nicoleta Oancea
- Department of Analytical Chemistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
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16
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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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17
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Wang GP, Schnell GL, Kort JJ, Sidhu GS, Schuster L, Tripathi RL, Larsen L, Michael LC, Bergquist K, Magee A, Patel CB, Whitlock JA, Tamashiro R, Peter JA, Fried MW, Nelson DR. Linkage of resistance-associated substitutions in GT1 sofosbuvir + NS5A inhibitor failures treated with glecaprevir/pibrentasvir. J Hepatol 2021; 75:820-828. [PMID: 34023351 DOI: 10.1016/j.jhep.2021.04.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/15/2021] [Accepted: 04/27/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND & AIMS Retreatment with glecaprevir/pibrentasvir (G/P) resulted in a rate of sustained virologic response 12 weeks after treatment completion (SVR12) of >90% in HCV genotype 1 (GT1) patients who previously failed a regimen of sofosbuvir plus an NS5A inhibitor (NS5Ai). This study investigated the prevalence and impact of baseline NS3 and NS5A resistance-associated substitutions (RASs) on the efficacy of G/P in prior GT1 sofosbuvir+NS5Ai failures and the persistence of treatment-emergent RASs. METHODS Longitudinal samples from 177 patients enrolled in a phase IIIb, randomized pragmatic clinical trial were analyzed. Patients without cirrhosis were randomized to 12 or 16 weeks of G/P, and patients with compensated cirrhosis were randomized to G/P and ribavirin for 12 weeks or G/P for 16 weeks. Linkage of RAS was identified using Primer-ID next-generation sequencing at a 15% cut-off. RESULTS Of 177 patients, 169 (95.5%) were PI-naïve. All 33 GT1b-infected patients achieved SVR12. In GT1a-infected patients, baseline NS5A RASs were prevalent (74.5%, 105/141) but NS3 RASs were uncommon. Baseline NS3 RASs had no impact on G/P efficacy and patients with baseline NS5A RASs showed a numerically but not statistically significantly lower SVR12 rate compared to those without NS5A RASs (89% vs. 97%). SVR12 was achieved in 34 of 35 (97%) patients without NS5A baseline substitution, and 53 of 57 (93%), 35 of 40 (88%), 5 of 8 (63%) with single, double-linked, and triple-linked NS5A substitutions, respectively. Among 13 patients with virologic failure, 4 acquired treatment-emergent NS3 RASs and 10 acquired NS5A RASs. CONCLUSION Baseline NS5A RASs were highly prevalent. The presence of an increasing number of linked NS5A RASs in GT1a showed a trend in decreasing SVR12 rates, although no specific NS5A RASs or their linkage pattern were associated with lower SVR12 rates. LAY SUMMARY Direct-acting antivirals have revolutionized the treatment of chronic hepatitis C infection, but treatment failure occurs in some patients. Retreatment of patients who previously failed a regimen consisting of sofosbuvir and an NS5A inhibitor with a regimen of glecaprevir and pibrentasvir (G/P) is >90% effective. Herein, we analyzed samples from these patients and showed that retreatment efficacy with G/P is lower in patients with double- or triple-linked NS5A resistance mutations than in patients with single or no NS5A resistance mutations. CLINICAL TRIAL NUMBER NCT03092375.
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Affiliation(s)
- Gary P Wang
- Division of Infectious Diseases and Global Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA; Infectious Disease Section, Medical Service, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA.
| | | | | | - Gurjit S Sidhu
- Division of Infectious Diseases and Global Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Layla Schuster
- Division of Infectious Diseases and Global Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | | | | | - Larry C Michael
- HCV-Target Data Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ken Bergquist
- HCV-Target Data Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ashley Magee
- HCV-Target Data Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chandni B Patel
- Division of Infectious Diseases and Global Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Joan A Whitlock
- Division of Infectious Diseases and Global Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Ryan Tamashiro
- Division of Infectious Diseases and Global Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Joy A Peter
- Hepatology Research, University of Florida, Gainesville, FL, USA
| | - Michael W Fried
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David R Nelson
- Department of Medicine, University of Florida, Gainesville, FL, USA
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18
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Abu-Freha N, Wainstock T, Poupko L, Sheiner E. Maternal Hepatitis B or Hepatitis C Virus Carrier Status is Not a Risk Factor for Long-Term Oncologic Morbidity of the Offspring: A Population-Based Cohort Study. Cancer Invest 2021; 39:690-695. [PMID: 33784229 DOI: 10.1080/07357907.2021.1910704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We investigated whether maternal hepatitis B virus (HBV) or hepatitis C virus (HCV) carrier status increases the risk for long-term oncologic morbidity of their offspring up to the age of 18 years. A population-based cohort study was conducted, including all singleton deliveries between the years 1991 and 2014 at a tertiary medical center. Our study included: HBV carriers (n = 588), HCV carriers (n = 183) and non-carriers (n = 241,570. No significant differences regarding oncologic morbidity were found between offspring of HBV carriers (0.2%), HCV carriers (0%) and non-carriers (0.6%; p = 0.216, respectively). To conclude: maternal HBV or HCV carrier status is not a risk factor for long-term oncologic morbidity of the offspring.
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Affiliation(s)
- Naim Abu-Freha
- The Institute of Gastroenterology and Hepatology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- The Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Liat Poupko
- Medical School for International Health, Ben-Gurion University, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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19
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Myers D, McVaney B, Higginbotham Z. A case of disseminated cryptococcus in an immunocompetent individual necessitating ventriculoperitoneal shunt. Med Mycol Case Rep 2021; 32:53-55. [PMID: 33898212 PMCID: PMC8053781 DOI: 10.1016/j.mmcr.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/15/2021] [Accepted: 03/01/2021] [Indexed: 11/25/2022] Open
Abstract
Cryptococcosis is a rare fungal disease causes primarily by two opportunistic organisms. It is usually seen in the immunocompromised but rarely it can infect immunocompetent individuals. We present a case of disseminated cryptococcus manifesting as cryptococcal meningitis in a young immunocompetent individual that led to substantial nonobstructive hydrocephalus which required VP shunt placement.
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Affiliation(s)
- Daniel Myers
- Northwestern University, Chicago, IL, USA.,West Virginia School of Osteopathic Medicine, Lewisburg, WV, USA
| | - Brooke McVaney
- West Virginia School of Osteopathic Medicine, Lewisburg, WV, USA
| | - Zachary Higginbotham
- West Virginia School of Osteopathic Medicine, Lewisburg, WV, USA.,Marshall School of Medicine Huntington, WV, USA
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20
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Rajabi A, Sharafi H, Alavian SM. Harm reduction program and hepatitis C prevalence in people who inject drugs (PWID) in Iran: an updated systematic review and cumulative meta-analysis. Harm Reduct J 2021; 18:12. [PMID: 33482831 PMCID: PMC7825164 DOI: 10.1186/s12954-020-00441-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/16/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Prevalence of hepatitis C virus (HCV) infection among people who inject drugs (PWID) in Iran is high. Since 2005, the Iranian government has implemented a harm reduction program to control HCV. We aimed to describe the prevalence of HCV antibody (Ab) in Iranian PWID before and after the implementation of harm reduction with cumulative meta-analysis. METHODS Following PRISMA guidelines, we conducted a systematic review and meta-analysis of studies published on the seroprevalence of HCV among PWID. We systematically reviewed the literature to identify eligible studies up to December 2018 in international and national databases. Pooled prevalence and 95% confidence intervals were calculated using Der Simonian and Laird method, taking into account conceptual heterogeneity. Subgroup analyses were performed by harm reduction implementation and studies' characteristics to assess the sources of heterogeneity. We used Cochran-Armitage test for the linear trend of the prevalence of HCV Ab among PWID. RESULTS We reviewed 5966 papers and reports and extracted data from 62 eligible records. The pooled HCV Ab prevalence among PWID in Iran was 46.5% (95% confidence interval [95% CI] 41.1-52.0%). Overall, the Cochran-Armitage test for trend indicated a significant decreasing trend of HCV Ab prevalence (P = 0.04). The cumulative meta-analysis showed a slight decline in the prevalence of HCV Ab between the years 2005 and 2018. CONCLUSIONS The HCV Ab prevalence among PWID in Iran is high, with a considerable geographical variation. The prevalence of HCV Ab among PWID in Iran slightly decreased after 2005 which could be, at least to some extent, related to the implementation of extensive harm reduction programs in the country.
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Affiliation(s)
- Abdolhalim Rajabi
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, Iran
- Environmental Health Research Center, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran
| | | | - Seyed Moayed Alavian
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, Iran.
- Middle East Liver Diseases (MELD) Center, Tehran, Iran.
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21
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Goutzamanis S, Doyle JS, Horyniak D, Higgs P, Hellard M. Peer to peer communication about hepatitis C treatment amongst people who inject drugs: A longitudinal qualitative study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 87:102983. [PMID: 33126166 DOI: 10.1016/j.drugpo.2020.102983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/23/2020] [Accepted: 10/09/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Little is known about how information on direct-acting antiviral treatment for hepatitis C circulates through peer networks of people who inject drugs. In this study we aimed to explore what and how treatment-related information is shared between people undergoing treatment and their peers. METHODS Participants were recruited from two general practice clinics and the community-based hepatitis C Treatment and Prevention Study. Semi-structured interviews were conducted with each participant (N = 20) before, during and following treatment. Interviews explored hepatitis C treatment experiences, key sources of DAA information and the impact of receiving and sharing knowledge. Inductive thematic analysis was conducted. Time sequential matrices were generated to understand thematic change over time. RESULTS Fifty-four interviews were conducted with 20 participants across seven field-sites in Melbourne, Australia. Key themes were: 'peers as a source treatment information', 'do it together' and 'becoming a treatment advocate'. Peers were a crucial trusted source of information. Positive treatment anecdotes were important for building confidence in and motivation to initiate treatment. Many participants adopted a 'treatment advocate' role in their close peer networks, which was described as empowering. Some participants described benefits of undertaking treatment alongside members of their close network. CONCLUSION Findings illustrate the importance of close peers in shaping treatment perceptions and engagement. This will be important in designing health promotion messaging and interventions to increase treatment uptake.
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Affiliation(s)
- Stelliana Goutzamanis
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, SA, 3004; School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne VIC 3004.
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, SA, 3004; Department of Infectious Diseases, The Alfred and Monash University, 85 Commercial Rd, Melbourne, Victoria, SA, 3004
| | - Danielle Horyniak
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, SA, 3004; School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne VIC 3004; Behaviour and Health Risks Program, Burnet Institute, 85 Commercial Rd, Melbourne, Victoria, SA, 3004
| | - Peter Higgs
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, SA, 3004; Department of Public Health, La Trobe University, Plenty Rd & Kingsbury Dr, Bundoora VIC 3086
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, SA, 3004; School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne VIC 3004; Department of Infectious Diseases, The Alfred and Monash University, 85 Commercial Rd, Melbourne, Victoria, SA, 3004
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22
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Siddiqui M, Manansala JS, Abdulrahman HA, Nasrallah GK, Smatti MK, Younes N, Althani AA, Yassine HM. Immune Modulatory Effects of Vitamin D on Viral Infections. Nutrients 2020; 12:E2879. [PMID: 32967126 PMCID: PMC7551809 DOI: 10.3390/nu12092879] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/29/2020] [Accepted: 08/31/2020] [Indexed: 02/07/2023] Open
Abstract
Viral infections have been a cause of mortality for several centuries and continue to endanger the lives of many, specifically of the younger population. Vitamin D has long been recognized as a crucial element to the skeletal system in the human body. Recent evidence has indicated that vitamin D also plays an essential role in the immune response against viral infections and suggested that vitamin D deficiency increases susceptibility to viral infections as well as the risk of recurrent infections. For instance, low serum vitamin D levels were linked to increased occurrence of high burdens viral diseases such as hepatitis, influenza, Covid-19, and AIDS. As immune cells in infected patients are responsive to the ameliorative effects of vitamin D, the beneficial effects of supplementing vitamin D-deficient individuals with an infectious disease may extend beyond the impact on bone and calcium homeostasis. Even though numerous studies have highlighted the effect of vitamin D on the immune cells, vitamin D's antiviral mechanism has not been fully established. This paper reviews the recent mechanisms by which vitamin D regulates the immune system, both innate and adaptive systems, and reflects on the link between serum vitamin D levels and viral infections.
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Affiliation(s)
- Maheen Siddiqui
- College of Health Science-QU Health, Qatar University, Doha 2713, Qatar; (M.S.); (J.S.M.); (G.K.N.); (N.Y.); (A.A.A.)
| | - Judhell S. Manansala
- College of Health Science-QU Health, Qatar University, Doha 2713, Qatar; (M.S.); (J.S.M.); (G.K.N.); (N.Y.); (A.A.A.)
| | - Hana A. Abdulrahman
- Biomedical Research Center, Qatar University, Doha 2713, Qatar; (H.A.A.); (M.K.S.)
| | - Gheyath K. Nasrallah
- College of Health Science-QU Health, Qatar University, Doha 2713, Qatar; (M.S.); (J.S.M.); (G.K.N.); (N.Y.); (A.A.A.)
- Biomedical Research Center, Qatar University, Doha 2713, Qatar; (H.A.A.); (M.K.S.)
| | - Maria K. Smatti
- Biomedical Research Center, Qatar University, Doha 2713, Qatar; (H.A.A.); (M.K.S.)
| | - Nadin Younes
- College of Health Science-QU Health, Qatar University, Doha 2713, Qatar; (M.S.); (J.S.M.); (G.K.N.); (N.Y.); (A.A.A.)
- Biomedical Research Center, Qatar University, Doha 2713, Qatar; (H.A.A.); (M.K.S.)
| | - Asmaa A. Althani
- College of Health Science-QU Health, Qatar University, Doha 2713, Qatar; (M.S.); (J.S.M.); (G.K.N.); (N.Y.); (A.A.A.)
- Biomedical Research Center, Qatar University, Doha 2713, Qatar; (H.A.A.); (M.K.S.)
| | - Hadi M. Yassine
- College of Health Science-QU Health, Qatar University, Doha 2713, Qatar; (M.S.); (J.S.M.); (G.K.N.); (N.Y.); (A.A.A.)
- Biomedical Research Center, Qatar University, Doha 2713, Qatar; (H.A.A.); (M.K.S.)
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23
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Ponvilawan B, Charoenngam N, Rujirachun P, Wattanachayakul P, Tornsatitkul S, Rittiphairoj T, Ungprasert P. Chronic Hepatitis C Virus Infection is Associated with an Increased Risk of Lung Cancer: A Systematic Review and Meta-analysis. Lung 2020; 198:705-714. [DOI: 10.1007/s00408-020-00365-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/27/2020] [Indexed: 12/24/2022]
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24
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Carvalho-Louro DM, Soares EB, Trevizoli JE, Marra TMG, da Cunha ALR, Rodrigues MP, Carvalho-Furtado ACL, Dos Santos BTA, de Assis da Rocha Neves F. Hepatitis C screening, diagnosis, and cascade of care among people aged > 40 years in Brasilia, Brazil. BMC Infect Dis 2020; 20:114. [PMID: 32041537 PMCID: PMC7011476 DOI: 10.1186/s12879-020-4809-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/21/2020] [Indexed: 12/18/2022] Open
Abstract
Background Identifying patients with hepatitis C virus (HCV) infection and enhancing the cascade of care are essential for eliminating HCV infection. This study aimed to estimate the prevalence of positive anti-HCV serology in Brasilia, Brazil, and evaluate the efficiency of the cascade of care for HCV-positive individuals. Methods This cross-sectional study analyzed 57,697 rapid screening tests for hepatitis C in individuals aged > 40 years between June 2018 and June 2019. HCV-positive patients were contacted and scheduled to undergo the HCV RNA viral test, genotyping, and transient elastography. Results The prevalence of positive serology was 0.27%. Among 161 patients with positive anti-HCV serology, 124 (77%) were contacted, 109 (67.7%) were tested for HCV RNA viral load, and 69 (42.8%) had positive results. Genotype 1 (75%) was the most prevalent genotype. Among 65 patients (94.2%) who underwent transient elastography, 30 (46.2%) presented with advanced fibrosis. Additionally, of the 161 patients, 55 (34.1%) were referred for treatment, but only 39 (24.2%) complied, with 36 (22.4%) showing sustained virological response. By the end of the study, 16 patients were still awaiting to receive medication. Conclusions The prevalence of HCV-positive patients was low in Brasilia, and the gaps in the cascade of care for these patients were significantly below the targets of HCV infection elimination. This study opens new avenues for eliminating HCV infection and suggests that partnerships with clinical laboratories to conduct anti-HCV tests are a useful strategy to improve HCV diagnosis. Trial registration Research Ethics Committee of the Faculty of Health Sciences of the University of Brasília - UNB (CAAE number 77818317.2.0000.0030) and by the Ethics Committee of the Health Science Teaching and Research Foundation - FEPECS/SES/DF (CAAE number 77818317.2.3001.5553).
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Affiliation(s)
| | - Eric Bassetti Soares
- Gilead Sciences Farmacêutica do Brasil Ltd. and Liver Center at UFMG, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, 04711-130, Brazil
| | - Jose Eduardo Trevizoli
- Gastroenterology Unit, Instituto Hospital de Base, Brasilia, Federal District, 70322-000, Brazil
| | - Thayna Moreira Gomes Marra
- Postgraduate Program in Health Sciences and Technologies, University of Brasilia, Brasilia, Federal District, 70919-970, Brazil
| | | | - Marcelo Palmeira Rodrigues
- Pneumology Unit, Faculty of Medicine, University of Brasilia, Brasilia, Federal District, 70673-432, Brazil
| | | | - Beatriz Taynara Araujo Dos Santos
- Subsecretaria de Atencao Integral a Saude, Secretaria do Estado de Saude do Distrito Federal, Brasilia, Federal District, 70770-200, Brazil
| | - Francisco de Assis da Rocha Neves
- Molecular Pharmacology Laboratory, Faculty of Health Sciences, University of Brasilia, Brasilia, Federal District, 70919-970, Brazil
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25
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Behzadifar M, Behzadifar M, Bragazzi NL. A systematic review and meta-analysis of the prevalence of hepatitis C virus infection in people who inject drugs in Iran. BMC Public Health 2020; 20:62. [PMID: 31937278 PMCID: PMC6961327 DOI: 10.1186/s12889-020-8175-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 01/08/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is one of the major public health challenges generating a relevant burden. High-risk groups, including people who inject drugs (PWID), are at serious risk for developing HCV. In recent years, several investigations have been conducted in Iran to assess the prevalence e of HCV among PWID. The aim of the present study was to synthesize the literature performing a comprehensive search and meta-analysis. METHODS A comprehensive literature search was carried out from January 2000 to September 2019. Several international databases, namely Scopus, PubMed/MEDLINE, Embase, ISI/Web of Science, PsycINFO, CINAHL, the Cochrane Library and the Directory of Open Access Journals (DOAJ), as well as Iranian databases (Barakathns, SID and MagIran), were consulted. Eligible studies were identified according to the following PECOS (population, exposure, comparison/comparator, outcome and study type) criteria: i) population: Iranian population; ii) exposure: injection drug users; iii) comparison/comparator: type of substance injected and level of substance use, iv) outcome: HCV prevalence; and v) study type: cross-sectional study. After finding potentially related studies, authors extracted relevant data and information based on an ad hoc Excel spreadsheet. Extracted data included the surname of the first author, the study journal, the year of publication, the number of participants examined, the type of diagnostic test performed, the number of positive HCV patients, the number of participants stratified by gender, the reported prevalence, the duration of drug injection practice and the history of using a shared syringe. RESULTS Forty-two studies were included. 15,072 PWID were assessed for determining the prevalence of HCV. The overall prevalence of HCV among PWID in Iran was computed to be 47% (CI 95: 39-56). The prevalence ranged between 7 and 96%. Men and subjects using a common/shared syringe were 1.46 and 3.95 times more likely to be at risk, respectively. CONCLUSION The findings of the present study showed that the prevalence of HCV among PWIDs in Iran is high. The support and implementation of ad hoc health-related policies and programs that reduce this should be put into action.
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Affiliation(s)
- Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Meysam Behzadifar
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nicola Luigi Bragazzi
- School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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26
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Miller LS, Millman AJ, Lom J, Osinubi A, Ahmed F, Dupont S, Rein D, Vellozzi C, Harris AM. Defining the hepatitis C cure cascade in an Urban health system using the electronic health record. J Viral Hepat 2020; 27:13-19. [PMID: 31505088 DOI: 10.1111/jvh.13199] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 06/10/2019] [Accepted: 08/26/2019] [Indexed: 12/28/2022]
Abstract
Hepatitis C virus (HCV) infection is a public health threat. The electronic health record (EHR) can be used to monitor patients along the HCV cure cascade and highlight opportunities for interventions to improve cascade outcomes. We developed an HCV patient registry using data from Grady Health System's (GHS) EHR and performed a cross-sectional analysis of 72 745 GHS patients who received anti-HCV testing from 2004 to 2016. We created a testing cascade: (1) anti-HCV reactive, (2) HCV RNA tested and (3) HCV RNA detectable; and a cure cascade: (1) HCV RNA detectable, (2) engaged in care, (3) treatment prescribed, (4) sustained virologic response (SVR) tested and (5) SVR documented. A total of 9893 (14%) had reactive anti-HCV tests of 72 745 patients tested, 5109 (52%) of these had HCV RNA tested, and 4224 (43%) were HCV RNA detectable. A total of 2738 (65%) of 4224 with detectable RNA were engaged in care, 909 (22%) were prescribed antiviral therapy, and 354 (8%) achieved SVR. Factors associated with HCV treatment included cirrhosis, tobacco use, depression, diabetes, obesity, alcohol use, male gender, black race and Medicare insurance. Uninsured patients were significantly less likely to be prescribed HCV treatment. In conclusion, using EHR data, we identified high anti-HCV prevalence and noted gaps in HCV RNA testing, linkage to care and treatment. The EHR can be used to evaluate the effectiveness of targeted interventions to overcome these gaps.
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Affiliation(s)
| | - Alexander J Millman
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer Lom
- Emory University School of Medicine, Atlanta, GA, USA
| | - Ademola Osinubi
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Farah Ahmed
- NORC at the University of Chicago, Atlanta, GA, USA
| | - Sarah Dupont
- Emory University School of Medicine, Atlanta, GA, USA
| | - David Rein
- NORC at the University of Chicago, Atlanta, GA, USA
| | - Claudia Vellozzi
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Aaron M Harris
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
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27
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Ramdas V, Talwar R, Banerjee M, Joshi AA, Das AK, Walke DS, Borhade P, Dhayagude U, Loriya R, Gote G, Bommakanti A, Sivaram A, Agarwal G, Goswami A, Nigade P, Mehta M, Patil V, Modi D, Kumar H, Mallurwar S, Dash A, Modi F, Kuldharan S, Srivastava P, Singh M, Narasimham L, Gundu J, Sharma S, Kamboj RK, Palle VP. Discovery and Characterization of Potent Pan-Genotypic HCV NS5A Inhibitors Containing Novel Tricyclic Central Core Leading to Clinical Candidate. J Med Chem 2019; 62:10563-10582. [PMID: 31710479 DOI: 10.1021/acs.jmedchem.9b01562] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The identification of a novel class of potent pan-genotypic NS5A inhibitors with good pharmacokinetic profile suitable for potential use in treating HCV infections is disclosed here. The present series of compounds are with less complex tricyclic central core, identified through a systematic SAR study carried out on biphenyl moiety. The SAR outcome has confirmed the requirement of near planar and linear conformation of the molecule to achieve the best pan-genotypic activity. In addition, SAR with substituted imidazoles on improvement of antiviral activity is disclosed. The newly identified compounds 12, 16, 19-21 have shown desirable pharmacokinetic profiles with a favorable uptake of compounds in liver and maintained a significant concentration for up to 8 h in the liver. In addition, compounds 20 and 21 have shown superior pan-genotypic anti-HCV activity compared to ledipasvir and daclatasvir. Additional characterization and preliminary safety assessment resulted in the identification of compound 20 as a potential clinical candidate.
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Affiliation(s)
- Vidya Ramdas
- Novel Drug Discovery & Development , Lupin Ltd. , Lupin Research Park, Survey No. 46 A/47 A, Village Nande, Taluka Mulshi , Pune 412115 , India
| | - Rashmi Talwar
- Novel Drug Discovery & Development , Lupin Ltd. , Lupin Research Park, Survey No. 46 A/47 A, Village Nande, Taluka Mulshi , Pune 412115 , India
| | - Moloy Banerjee
- Novel Drug Discovery & Development , Lupin Ltd. , Lupin Research Park, Survey No. 46 A/47 A, Village Nande, Taluka Mulshi , Pune 412115 , India
| | - Advait Arun Joshi
- Novel Drug Discovery & Development , Lupin Ltd. , Lupin Research Park, Survey No. 46 A/47 A, Village Nande, Taluka Mulshi , Pune 412115 , India
| | - Amit Kumar Das
- Novel Drug Discovery & Development , Lupin Ltd. , Lupin Research Park, Survey No. 46 A/47 A, Village Nande, Taluka Mulshi , Pune 412115 , India
| | - Deepak Sahebrao Walke
- Novel Drug Discovery & Development , Lupin Ltd. , Lupin Research Park, Survey No. 46 A/47 A, Village Nande, Taluka Mulshi , Pune 412115 , India
| | - Prashant Borhade
- Novel Drug Discovery & Development , Lupin Ltd. , Lupin Research Park, Survey No. 46 A/47 A, Village Nande, Taluka Mulshi , Pune 412115 , India
| | - Usha Dhayagude
- Novel Drug Discovery & Development , Lupin Ltd. , Lupin Research Park, Survey No. 46 A/47 A, Village Nande, Taluka Mulshi , Pune 412115 , India
| | - Rajesh Loriya
- Novel Drug Discovery & Development , Lupin Ltd. , Lupin Research Park, Survey No. 46 A/47 A, Village Nande, Taluka Mulshi , Pune 412115 , India
| | - Ganesh Gote
- Novel Drug Discovery & Development , Lupin Ltd. , Lupin Research Park, Survey No. 46 A/47 A, Village Nande, Taluka Mulshi , Pune 412115 , India
| | - Apparao Bommakanti
- Novel Drug Discovery & Development , Lupin Ltd. , Lupin Research Park, Survey No. 46 A/47 A, Village Nande, Taluka Mulshi , Pune 412115 , India
| | - Aruna Sivaram
- Novel Drug Discovery & Development , Lupin Ltd. , Lupin Research Park, Survey No. 46 A/47 A, Village Nande, Taluka Mulshi , Pune 412115 , India
| | - Gautam Agarwal
- Novel Drug Discovery & Development , Lupin Ltd. , Lupin Research Park, Survey No. 46 A/47 A, Village Nande, Taluka Mulshi , Pune 412115 , India
| | - Arnab Goswami
- Novel Drug Discovery & Development , Lupin Ltd. , Lupin Research Park, Survey No. 46 A/47 A, Village Nande, Taluka Mulshi , Pune 412115 , India
| | - Prashant Nigade
- Novel Drug Discovery & Development , Lupin Ltd. , Lupin Research Park, Survey No. 46 A/47 A, Village Nande, Taluka Mulshi , Pune 412115 , India
| | - Maneesh Mehta
- Novel Drug Discovery & Development , Lupin Ltd. , Lupin Research Park, Survey No. 46 A/47 A, Village Nande, Taluka Mulshi , Pune 412115 , India
| | - Vinod Patil
- Novel Drug Discovery & Development , Lupin Ltd. , Lupin Research Park, Survey No. 46 A/47 A, Village Nande, Taluka Mulshi , Pune 412115 , India
| | - Dipak Modi
- Novel Drug Discovery & Development , Lupin Ltd. , Lupin Research Park, Survey No. 46 A/47 A, Village Nande, Taluka Mulshi , Pune 412115 , India
| | - Hemant Kumar
- Novel Drug Discovery & Development , Lupin Ltd. , Lupin Research Park, Survey No. 46 A/47 A, Village Nande, Taluka Mulshi , Pune 412115 , India
| | - Sadanand Mallurwar
- Novel Drug Discovery & Development , Lupin Ltd. , Lupin Research Park, Survey No. 46 A/47 A, Village Nande, Taluka Mulshi , Pune 412115 , India
| | - Amruta Dash
- Novel Drug Discovery & Development , Lupin Ltd. , Lupin Research Park, Survey No. 46 A/47 A, Village Nande, Taluka Mulshi , Pune 412115 , India
| | - Falguni Modi
- Novel Drug Discovery & Development , Lupin Ltd. , Lupin Research Park, Survey No. 46 A/47 A, Village Nande, Taluka Mulshi , Pune 412115 , India
| | - Sandip Kuldharan
- Novel Drug Discovery & Development , Lupin Ltd. , Lupin Research Park, Survey No. 46 A/47 A, Village Nande, Taluka Mulshi , Pune 412115 , India
| | - Pratima Srivastava
- Novel Drug Discovery & Development , Lupin Ltd. , Lupin Research Park, Survey No. 46 A/47 A, Village Nande, Taluka Mulshi , Pune 412115 , India
| | - Minakshi Singh
- Novel Drug Discovery & Development , Lupin Ltd. , Lupin Research Park, Survey No. 46 A/47 A, Village Nande, Taluka Mulshi , Pune 412115 , India
| | - Lakshmi Narasimham
- Novel Drug Discovery & Development , Lupin Ltd. , Lupin Research Park, Survey No. 46 A/47 A, Village Nande, Taluka Mulshi , Pune 412115 , India
| | - Jayasagar Gundu
- Novel Drug Discovery & Development , Lupin Ltd. , Lupin Research Park, Survey No. 46 A/47 A, Village Nande, Taluka Mulshi , Pune 412115 , India
| | - Sharad Sharma
- Novel Drug Discovery & Development , Lupin Ltd. , Lupin Research Park, Survey No. 46 A/47 A, Village Nande, Taluka Mulshi , Pune 412115 , India
| | - Rajender Kumar Kamboj
- Novel Drug Discovery & Development , Lupin Ltd. , Lupin Research Park, Survey No. 46 A/47 A, Village Nande, Taluka Mulshi , Pune 412115 , India
| | - Venkata P Palle
- Novel Drug Discovery & Development , Lupin Ltd. , Lupin Research Park, Survey No. 46 A/47 A, Village Nande, Taluka Mulshi , Pune 412115 , India
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Zhou B, Cai GFF, Lv HKK, Xu SFF, Wang ZTT, Jiang ZGG, Hu CGG, Chen YDD. Factors Correlating to the Development of Hepatitis C Virus Infection among Drug Users-Findings from a Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2345. [PMID: 31269774 PMCID: PMC6651123 DOI: 10.3390/ijerph16132345] [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] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 06/30/2019] [Indexed: 02/07/2023]
Abstract
Hepatitis C remains a significant public health threat. However, the main routes of transmission have changed since the early 1990s. Currently, drug use is the main source of hepatitis C virus (HCV) infection, and some measures have been successively implemented and additional studies have been published. However, the factors correlating with HCV infection failed to clearly define. Our study pooled the odds ratios (ORs) with 95% confidence intervals (CIs) and analyzed sensitivity by searching data in the PubMed, Elsevier, Springer, Wiley, and EBSCO databases. Publication bias was determined by Egger's test. In our meta-analysis, HCV-infected and non-HCV-infected patients from 49 studies were analyzed. The pooled ORs with 95% CIs for study factors were as follows: Injecting drug use 10.11 (8.54, 11.97); sharing needles and syringes 2.24 (1.78, 2.83); duration of drug use >5 years 2.39 (1.54, 3.71); unemployment 1.50 (1.22, 1.85); commercial sexual behavior 1.00 (0.73, 1.38); married or cohabiting with a regular partner 0.88 (0.79, 0.98), and sexual behavior without a condom 1.72 (1.07, 2.78). This study found that drug users with histories of injecting drug use, sharing needles and syringes, drug use duration of >5 years, and unemployment, were at increased risk of HCV infection. Our findings indicate that sterile needles and syringes should be made available to ensure safe injection. In view of that, methadone maintenance treatment can reduce or put an end to risky drug-use behaviors, and should be scaled up further, thereby reducing HCV infection.
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Affiliation(s)
- Biao Zhou
- Department of Scientific Research and Information Management, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Gao Feng Feng Cai
- Department of Scientific Research and Information Management, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Hua Kun Kun Lv
- Department of Scientific Research and Information Management, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
- Department of Immunization planning, Zhejiang provincial key laboratory of infectious disease vaccine and prevention and control. 3399 Binsheng Road, Hangzhou 310051, China
| | - Shuang Fei Fei Xu
- Department of Scientific Research and Information Management, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Zheng Ting Ting Wang
- Department of Scientific Research and Information Management, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Zheng Gang Gang Jiang
- Department of Scientific Research and Information Management, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Chong Gao Gao Hu
- Department of Scientific Research and Information Management, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China.
| | - Yong Di Di Chen
- Department of Scientific Research and Information Management, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China.
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Elad S, Zadik Y, Caton JG, Epstein JB. Oral mucosal changes associated with primary diseases in other body systems. Periodontol 2000 2019; 80:28-48. [DOI: 10.1111/prd.12265] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Sharon Elad
- Department of Oral MedicineEastman Institute for Oral Health Rochester New York USA
- Hospital DentistryStrong Memorial Hospital Rochester New York USA
| | - Yehuda Zadik
- Oral Medicine for Hematologic and Oncologic PatientsDepartment of Oral Medicine, Sedation and Maxillofacial ImagingHebrew University‐Hadassah School of Dental Medicine Jerusalem Israel
- Department of Oral MedicineOral and Maxillofacial InstituteMedical CorpsIsrael Defense Forces Tel Hashomer Israel
| | - Jack G. Caton
- Department of PeriodontologyEastman Institute for Oral Health Rochester New York USA
| | - Joel B. Epstein
- Samuel Oschin Comprehensive Cancer InstituteCedars‐Sinai Medical Center Los Angeles California USA
- Division of Otolaryngology and Head and Neck Surgery City of HopeCity of Hope National Medical Center Duarte California USA
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30
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Ijaz B, Ahmad W, Das T, Shabbiri K, Husnain T, Hassan S. HCV infection causes cirrhosis in human by step-wise regulation of host genes involved in cellular functioning and defense during fibrosis: Identification of bio-markers. Genes Dis 2019; 6:304-317. [PMID: 32042870 PMCID: PMC6997584 DOI: 10.1016/j.gendis.2019.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/25/2019] [Indexed: 12/15/2022] Open
Abstract
Chronic Hepatitis C Viral (HCV) infection is a leading health problem worldwide and resulted in fibrotic scar formation, and finally liver-cirrhosis. Although contemporary therapies can partially reverse this destructive process, the rehabilitation is too slow and unsuitable for all chronic infections. The current study elucidates the mechanism of disease progression from early (F1) to moderate (F2, F3), and to severe fibrosis (F4)/cirrhosis in HCV genotype 3a infected patients to find out new candidates as potential disease progression markers and antiviral therapeutic agents. A total of 550 genes were found differentially regulated in the four fibrosis stages and grouped in 22 classes according to their biological functions. Gene set enrichment (GSEA) and Ingenuity pathway analysis (IPA) were used to identify the regulation of crucial biological functions and pathways involved in HCV progression. HCV differentially regulated the expression of genes involved in apoptosis, cell structure, signal transduction, proliferation, metabolism, cytokine signaling, immune response, cell adhesion and maintenance, and post translational modifications by pathway analysis. There was an increasing trend of proliferative and cell growth related genes and shutting down of immune response as the disease progress mild to moderate to advanced stage cirrhosis. The myriad of changes in gene expression showed more chances of developing liver cancer in patients infected with HCV genotype 3a in a systematic manner. The identified gene set can act as disease markers for prediction, whether the fibrosis lead to cirrhosis and its association with end stage liver disease development.
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Affiliation(s)
- Bushra Ijaz
- Centre of Excellence in Molecular Biology, University of the Punjab, Lahore, Pakistan
| | - Waqar Ahmad
- Centre of Excellence in Molecular Biology, University of the Punjab, Lahore, Pakistan.,School of Biological Sciences, The University of Queensland, Australia.,College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates
| | - Trina Das
- Division of Transplantation, Department of Surgery, School of Medicine, University of Washington, Seattle, WA, USA
| | - Khadija Shabbiri
- School of Biological Sciences, The University of Queensland, Australia
| | - Tayyab Husnain
- Centre of Excellence in Molecular Biology, University of the Punjab, Lahore, Pakistan
| | - Sajida Hassan
- Centre of Excellence in Molecular Biology, University of the Punjab, Lahore, Pakistan.,Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
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31
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Assoumou L, Thormann F, Soulié C, Caby F, Dudoit Y, Marcelin AG, Goudot P, Blanc C, Coriat P, Katlama C, Costagliola D, Pourcher V. Routine screening for HIV, hepatitis B virus and hepatitis C virus in individuals undergoing oral and maxillofacial surgery. HIV Med 2019; 20:353-358. [PMID: 30924598 DOI: 10.1111/hiv.12732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Given the effectiveness of treatment of HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, there are considerable benefits associated with determining HIV/HBV/HCV status. We evaluated the feasibility and acceptability of systematic screening and subsequent care in an oral and maxillofacial surgery department. METHODS The anaesthesiologists proposed screening for HIV, HBV and HCV to all individuals of unknown infection status undergoing surgery between 19 April 2016 and 19 April 2017. The endpoints were the rates of test offer, acceptance/refusal and new diagnoses. Seropositive individuals were referred to infectious disease specialists. Associations between age, sex or surgery type and test offer (eligible individuals) or acceptance/refusal (those offered testing) were investigated. RESULTS Of the 1407 individuals attending the department, 1322 were eligible for inclusion in the study. Testing was proposed to 899 individuals [68%; 95% confidence interval (CI) 65-71%], 831 of whom accepted the offer (92.4%; 95% CI 90.5-94.1%). Results were obtained for 787 individuals (41 samples were uncollected and three were invalid). Age was the only factor associated with test offer in multivariable analysis [odds ratio (OR) 0.90; 95% CI 0.84-0.97, per additional 10 years], and no factor was associated with acceptance. Of the five, three and eight individuals testing positive for HIV, HBV and HCV, four, two and one patient, respectively, reported prior knowledge of seropositivity. The new diagnosis rate was 0.13% (95% CI 0-0.7%) for HIV and HBV, and 0.89% (95% CI 0.36-1.82%) for HCV [three positive polymerase chain reaction (PCR) tests]. All individuals newly diagnosed with HIV or HCV infection received specific antiviral treatment. CONCLUSIONS Rates of screening offer and acceptance were high. Substantial screening resources are required to decrease the impact of the hidden epidemics of HIV, HBV and HCV infections.
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Affiliation(s)
- L Assoumou
- Institut Pierre Louis d'épidémiologie et de Santé Publique (iPLESP), INSERM, Sorbonne Université, Paris, France
| | - F Thormann
- Département d'anesthésie-réanimation, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - C Soulié
- Laboratoire de virologie, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), INSERM, Sorbonne Université, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - F Caby
- Institut Pierre Louis d'épidémiologie et de Santé Publique (iPLESP), INSERM, Sorbonne Université, Paris, France.,Service de Maladies Infectieuses, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Y Dudoit
- Service de Maladies Infectieuses, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - A-G Marcelin
- Laboratoire de virologie, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), INSERM, Sorbonne Université, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - P Goudot
- Service de Chirurgie orale et Maxillo-faciale, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - C Blanc
- Service de Maladies Infectieuses, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - P Coriat
- Département d'anesthésie-réanimation, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - C Katlama
- Institut Pierre Louis d'épidémiologie et de Santé Publique (iPLESP), INSERM, Sorbonne Université, Paris, France.,Service de Maladies Infectieuses, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - D Costagliola
- Institut Pierre Louis d'épidémiologie et de Santé Publique (iPLESP), INSERM, Sorbonne Université, Paris, France
| | - V Pourcher
- Service de Maladies Infectieuses, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France.,HIV Pathogenesis and Immune Aging Team, Immunity and Infectious Diseases Research Center, INSERM, Sorbonne Université, Paris, France
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32
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Kileng H, Gutteberg T, Goll R, Paulssen EJ. Screening for hepatitis C in a general adult population in a low-prevalence area: the Tromsø study. BMC Infect Dis 2019; 19:189. [PMID: 30808290 PMCID: PMC6390317 DOI: 10.1186/s12879-019-3832-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 02/19/2019] [Indexed: 12/15/2022] Open
Abstract
Background Chronic hepatitis C virus (HCV) infection can progress to cirrhosis and end-stage liver disease in a substantial proportion of patients. The infection is frequently asymptomatic, leaving many infected individuals unaware of the diagnosis until complications occur. This advocates the screening of healthy individuals. The aim of this study was to estimate the prevalence of HCV infection in the general adult population of the municipality of Tromsø, Norway, and to evaluate the efficiency of such an approach in a presumed low-prevalence area. Methods The study was part of the seventh survey of the Tromsø Study (Tromsø 7) in 2015–2016. Sera from 20,946 individuals aged 40 years and older were analysed for antibodies to HCV (anti-HCV). A positive anti-HCV test was followed up with a new blood test for HCV RNA, and the result of any previous laboratory HCV data were recorded. Samples positive for anti-HCV and negative for HCV RNA were tested with a recombinant immunoblot assay. All HCV RNA positive individuals were offered clinical evaluation. Results Among 20,946 participants, HCV RNA was detected in 33 (0.2%; 95% CI: 0.1–0.3), of whom 13 (39.4%; 95% CI: 22.7–56.1) were unaware of their infection. The anti-HCV test was confirmed positive in 134 individuals (0.6%; 95% CI: 0.5–0.7) with the highest prevalence in the age group 50–59 years. Current or treatment-recovered chronic HCV-infection was found in 85 individuals (0.4%; 95% CI: 0.3–0.5) and was associated with an unfavorable psychosocial profile. Conclusion In this population-based study, the prevalence of viraemic HCV infection was 0.2%. A substantial proportion (39%) of persons with viraemic disease was not aware of their infectious status, which suggests that the current screening strategy of individuals with high risk of infection may be an inadequate approach to identify chronic HCV infection hidden in the general population.
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Affiliation(s)
- H Kileng
- Gastroenterology and Nutrition Research Group, Department of Clinical Medicine, UiT The Arctic University of Tromsø, 9037, Tromsø, Norway. .,Department of Internal Medicine, Section of Gastroenterology, University Hospital of North Norway, Tromsø, Norway.
| | - T Gutteberg
- Research group for Host Microbe Interactions, Department of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
| | - R Goll
- Gastroenterology and Nutrition Research Group, Department of Clinical Medicine, UiT The Arctic University of Tromsø, 9037, Tromsø, Norway.,Department of Internal Medicine, Section of Gastroenterology, University Hospital of North Norway, Tromsø, Norway
| | - E J Paulssen
- Gastroenterology and Nutrition Research Group, Department of Clinical Medicine, UiT The Arctic University of Tromsø, 9037, Tromsø, Norway.,Department of Internal Medicine, Section of Gastroenterology, University Hospital of North Norway, Tromsø, Norway
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33
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Cacoub P, Desbois AC, Comarmond C, Saadoun D. Impact of sustained virological response on the extrahepatic manifestations of chronic hepatitis C: a meta-analysis. Gut 2018; 67:2025-2034. [PMID: 29703790 DOI: 10.1136/gutjnl-2018-316234] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/15/2018] [Accepted: 04/05/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Extrahepatic manifestations of HCV are responsible for morbidity and mortality in many chronically infected patients. New, interferon-free antiviral treatment regimens, which present the opportunity to treat all HCV-infected patients, call for a better understanding of the benefits of treating non-cirrhotic chronically infected individuals. METHODS A systematic review was conducted. Identified studies from targeted database searches on Embase and Medline were screened. The methodological quality of the included publications was evaluated. Random-effect model meta-analyses were performed. Strength of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS Data were extracted from a total of 48 identified studies. Achieving sustained virological response (SVR) was associated with reduced extrahepatic mortality (vs no SVR, OR 0.44 (95% CI 0.28 to 0.67)). SVR was associated with higher complete remissions in patients with cryoglobulinemia vasculitis (OR 20.76 (6.73 to 64.05)) and a higher objective response in those with malignant B-cell lymphoproliferative diseases (OR 6.49 (2.02 to 20.85)). Achieving SVR was also associated with reduced insulin resistance at follow-up (OR 0.42 (0.33 to 0.53)) and a significant protective effect on the incidence of diabetes (OR 0.34 (0.21 to 0.56)). Lack of randomised data comparing SVR versus non-SVR patients for the relevant extrahepatic indications attenuated these analyses. CONCLUSION Antiviral therapy can reduce extrahepatic manifestations related to HCV when SVR is achieved. Higher quality data, and reporting over longer follow-up periods, will be required to thoroughly explore comprehensive HCV treatment strategies.
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Affiliation(s)
- Patrice Cacoub
- Sorbonne Universités, UPMC Univ Paris, Paris, France.,Inflammation-Immunopathology-Biotherapy Department, DHU i2B, Paris, France.,INSERM, UMRS 959, Paris, France.,Department of Internal Medicine and Clinical Immunology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Anne Claire Desbois
- Sorbonne Universités, UPMC Univ Paris, Paris, France.,Inflammation-Immunopathology-Biotherapy Department, DHU i2B, Paris, France.,INSERM, UMRS 959, Paris, France.,Department of Internal Medicine and Clinical Immunology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Cloe Comarmond
- Sorbonne Universités, UPMC Univ Paris, Paris, France.,Inflammation-Immunopathology-Biotherapy Department, DHU i2B, Paris, France.,INSERM, UMRS 959, Paris, France.,Department of Internal Medicine and Clinical Immunology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - David Saadoun
- Sorbonne Universités, UPMC Univ Paris, Paris, France.,Inflammation-Immunopathology-Biotherapy Department, DHU i2B, Paris, France.,INSERM, UMRS 959, Paris, France.,Department of Internal Medicine and Clinical Immunology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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34
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Ravaioli F, Colecchia A, Dajti E, Marasco G, Alemanni LV, Tamè M, Azzaroli F, Brillanti S, Mazzella G, Festi D. Spleen stiffness mirrors changes in portal hypertension after successful interferon-free therapy in chronic-hepatitis C virus patients. World J Hepatol 2018; 10:731-742. [PMID: 30386466 PMCID: PMC6206152 DOI: 10.4254/wjh.v10.i10.731] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 07/27/2018] [Accepted: 08/13/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate changes in spleen stiffness measurements (SSMs) and other non-invasive tests (NITs) after treatment with direct-acting antivirals (DAAs) and identify predictors of SSM change after sustained virological response (SVR).
METHODS We retrospectively analysed 146 advanced-chronic liver disease (ACLD) patients treated with DAA with available paired SSM at baseline and SVR24. Liver stiffness (LSM), spleen diameter (SD), platelet count (PLT) and liver stiffness-spleen diameter to platelet ratio score(LSPS) were also investigated. LSM ≥ 21 kPa was used as a cut-off to rule-in clinically significant portal hypertension (CSPH). SSM reduction > 20% from baseline was defined as significant.
RESULTS SSM significantly decreased at SVR24, in both patients with and without CSPH; in 44.8% of cases, SSM reduction was > 20%. LSPS significantly improved in the entire cohort at SVR24; SD and PLT changed significantly only in patients without CSPH. LSM significantly decreased in 65.7% of patients and also in 2/3 patients in whom SSM did not decrease. The independent predictor of decreased SSM was median relative change of LSM. CSPH persisted in 54.4% patients after SVR. Delta LSM and baseline SSM were independent factors associated with CSPH persistence.
CONCLUSION SSM and other NITs significantly decrease after SVR, although differently according to the patient’s clinical condition. SSM faithfully reflects changes in portal hypertension and could represent a useful NIT for the follow-up of these patients.
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Affiliation(s)
- Federico Ravaioli
- Gastroenterology Unit, Sant’Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy
| | - Antonio Colecchia
- Gastroenterology Unit, Sant’Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy
- Unit of Gastroenterology, Borgo Trento University Hospital, Verona 37100, Italy
| | - Elton Dajti
- Gastroenterology Unit, Sant’Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy
| | - Giovanni Marasco
- Gastroenterology Unit, Sant’Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy
| | - Luigina Vanessa Alemanni
- Gastroenterology Unit, Sant’Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy
| | - Mariarosa Tamè
- Gastroenterology Unit, Sant’Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy
| | - Francesco Azzaroli
- Gastroenterology Unit, Sant’Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy
| | - Stefano Brillanti
- Gastroenterology Unit, Sant’Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy
| | - Giuseppe Mazzella
- Gastroenterology Unit, Sant’Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy
| | - Davide Festi
- Gastroenterology Unit, Sant’Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy
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35
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Sherbuk JE, McManus KA, Rogawski McQuade ET, Knick T, Henry Z, Dillingham R. Hepatitis C Within a Single Health System: Progression Along the Cascade to Cure Is Higher for Those With Substance Misuse When Linked to a Clinic With Embedded Support Services. Open Forum Infect Dis 2018; 5:ofy202. [PMID: 30255113 PMCID: PMC6147287 DOI: 10.1093/ofid/ofy202] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 09/13/2018] [Indexed: 12/20/2022] Open
Abstract
Background Hepatitis C is now curable for most individuals, and national goals for elimination have been established. Transmission persists, however, particularly in nonurban regions affected by the opioid epidemic. To reach goals of elimination, barriers to treatment must be identified. Methods In this open cohort of all individuals diagnosed with active hepatitis C from 2010 to 2016 at a large medical center, we identified patient and clinic characteristics associated with our primary outcome, sustained virologic response (SVR). We performed a subgroup analysis for those with documented substance misuse. Results SVR was achieved in 1544 (41%) of 3790 people with active hepatitis C. In a multivariable Poisson regression model, SVR was more likely in individuals diagnosed outpatient (incident rate ratio [IRR], 1.7; 95% confidence interval [CI], 1.5-2.0), living in close proximity to the medical center (IRR, 1.2; 95% CI, 1.1-1.3), with private insurance (IRR, 1.1; 95% CI, 1.0-1.3), and with cirrhosis (IRR, 1.4; 95% CI, 1.3-1.5). Achieving SVR was less likely in those qualifying as indigent (IRR, 0.8; 95% CI, 0.8-0.9) and those with substance misuse (IRR, 0.8; 95% CI, 0.7-0.9). In the subgroup analysis of those with substance misuse, SVR rates were higher in those linked to the infectious diseases clinic, which has embedded support services, than those linked to the gastroenterology clinic, which does not (IRR, 1.4; 95% CI, 1.1-1.9). Conclusions Social determinants of health including proximity to care and poverty impacted achievement of SVR. Those with substance misuse, a high-priority population for treatment of hepatitis C, had better outcomes when receiving care in a clinic with embedded support services.
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Affiliation(s)
- J E Sherbuk
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia
| | - K A McManus
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia
| | - E T Rogawski McQuade
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia
| | - T Knick
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia
| | - Z Henry
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia
| | - R Dillingham
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia
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36
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Espinosa C, Jhaveri R, Barritt AS. Unique Challenges of Hepatitis C in Infants, Children, and Adolescents. Clin Ther 2018; 40:1299-1307. [PMID: 30107999 DOI: 10.1016/j.clinthera.2018.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/13/2018] [Accepted: 07/16/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE Hepatitis C, a chronic disease with deadly consequences, is no longer predominantly a disease of older people. METHODS A limited search was conducted of the relevant literature on 2 topics: (1) the impact of hepatitis C on infants exposed by vertical transmission; and (2) the impact of hepatitis C infection on infected children and adolescents. The findings were supplemented by the first-hand experience of the authors. FINDINGS Young people, including women of childbearing age, infants, children, and adolescents, are being especially affected by hepatitis C infection secondary to the intravenous drug use and opioid epidemic. Unfortunately, estimates of disease in young populations are all misleading because universal screening has not been implemented. IMPLICATIONS Lack of implementation of policies for screening and therapy on most affected populations will be responsible for perpetuation of this infection. In the era of highly effective therapy and a regimen that is approved by the US Food and Drug Administration for children, this outcome is unacceptable.
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Affiliation(s)
- Claudia Espinosa
- Division of Pediatric Infectious Disease, University of Louisville School of Medicine, Louisville, Kentucky.
| | - Ravi Jhaveri
- Division of Infectious Disease, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - A Sidney Barritt
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
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37
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Zhang ZH, Jiang BC, Liu XH, Zhang MX, Li ZSN, Zhu GZ. Interleukin-7 Regulates T Follicular Helper Cell Function in Patients with Chronic Hepatitis C. Viral Immunol 2018; 31:417-425. [PMID: 29672235 DOI: 10.1089/vim.2018.0010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Signaling through interleukin (IL)-7 is essential and required for development, differentiation, proliferation, and homeostasis of T cells. However, the role of IL-7 in regulation of CD4+ T cells in chronic viral infections was not fully elucidated. Thus, the aim of the current study was to investigate the immunomodulatory activity of IL-7 to T follicular helper (Tfh) cells and its contribution to pathogenesis of chronic HCV, hepatitis C virus (HCV) infection. A total of 47 patients with chronic hepatitis C and 19 normal controls were enrolled. Serum IL-7 and proportion of Tfh cells was measured. The regulatory function of IL-7 to Tfh cells was also investigated in CD4+ T cells and CD4+ T/HCVcc-infected Huh7.5 cell cocultured system. Serum IL-7 concentration was significantly downregulated in patients with chronic hepatitis C, and was negatively correlated with HCV RNA level. Tfh frequency and Tfh-associated cytokines (IL-21 and IL-6) were also reduced in chronic HCV-infected patients. Moreover, recombinant IL-7 stimulation elevated proportion of Tfh cells and IL-21/IL-6 secretion in both HCV-specific and nonspecific manners. Furthermore, IL-7-treated CD4+ T cells exhibited elevated antiviral activities without killing infected hepatocytes, which presented as inhibition of HCV RNA, induction of antiviral proteins, and promotion of cytokine production (especially IL-21) in cocultured system. This process might be dependent on IL-6 secretion. The current data revealed that IL-7 regulated HCV-specific and nonspecific activated Tfh cells, which might contribute to viral clearance. IL-7 could be a potential therapeutic agent for the treatment of chronic hepatitis C.
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Affiliation(s)
- Zhi-Hong Zhang
- 1 Department of Clinical Laboratory Medicine, The Affiliated Hospital to Changchun University of Chinese Medicine , Changchun, Jilin Province, China
| | - Ben-Chun Jiang
- 1 Department of Clinical Laboratory Medicine, The Affiliated Hospital to Changchun University of Chinese Medicine , Changchun, Jilin Province, China
| | - Xiao-Hong Liu
- 2 The Geriatric Department, The First Bethune Hospital of Jilin University , Changchun, Jilin Province, China
| | - Meng-Xuan Zhang
- 3 Clinical Medicine College, Changchun University of Chinese Medicine , Changchun, Jilin Province, China
| | - Zhen-Sheng-Nan Li
- 4 Clinical Medicine College, Jilin University , Changchun, Jilin Province, China
| | - Guang-Ze Zhu
- 1 Department of Clinical Laboratory Medicine, The Affiliated Hospital to Changchun University of Chinese Medicine , Changchun, Jilin Province, China
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Abstract
Hepatitis B virus and hepatitis C virus have received a significant amount of attention in recent years, and both viruses share a significant amount of similarities with one another beyond just that they both primarily target the liver. In recent years, cases of both infections have been fueled by a nationwide epidemic of injection drug use. Most relevant to this audience, they are both transmitted from mother to child. The increased cases in young adults combined with mother to child transmission translate into more exposed infants that will need to be managed and followed. Screening of pregnant women for hepatitis B infection coupled with appropriate treatment and prophylaxis measures are incredibly effective to preventing transmission. Prevention of hepatitis C infection is not yet possible, but advances in antiviral therapy make interruption of transmission a future possibility.
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Affiliation(s)
- Claudia M Espinosa
- Division of Pediatric Infectious Diseases, University of Louisville School of Medicine, Louisville, KY
| | - Ravi Jhaveri
- Division of Infectious Diseases, Department of Pediatrics, UNC School of Medicine, Campus Box 7231, Chapel Hill, NC 27599-7231.
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Maughan A, Ogbuagu O. Pegylated interferon alpha 2a for the treatment of hepatitis C virus infection. Expert Opin Drug Metab Toxicol 2018; 14:219-227. [PMID: 29271660 DOI: 10.1080/17425255.2018.1421173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Treatments for hepatitis C virus (HCV) infection have advanced rapidly in the last decade. Pegylated interferon alpha 2a (PEG-IFN alpha 2a) alone, in combination with ribavirin and with or without direct acting antivirals (DAAs) is modestly effective in the treatment of chronic HCV infection. Areas covered: The review describes the chemistry, pharmacokinetic and pharmacodynamic properties, clinical efficacy, safety and drug-drug interaction profiles of PEG-IFN alpha 2a. Expert opinion: Despite the availability of DAAs and its formidable toxicity profile, PEG-IFN alpha 2a retains a role for the treatment of acute HCV and chronic HCV infection in resource limited settings and for end-stage renal disease patients and others who cannot access DAAs or are DAA-ineligible. Knowledge of pharmacogenetic profiles which favor successful treatment outcomes with IFN-based therapies may allow for selection of best candidates for the regimen.
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Affiliation(s)
- Ashly Maughan
- a Yale AIDS Program, Section of Infectious Diseases , Yale University School of Medicine , New Haven , CT , USA
| | - Onyema Ogbuagu
- a Yale AIDS Program, Section of Infectious Diseases , Yale University School of Medicine , New Haven , CT , USA
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Briggs AL. Pharmacists' increasing involvement in hepatitis C management and prevention. J Am Pharm Assoc (2003) 2018; 58:5-6. [DOI: 10.1016/j.japh.2017.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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