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Ramadan MS, Boccia F, Moretto SM, De Gregorio F, Gagliardi M, Iossa D, Durante-Mangoni E, Zampino R. Cardiovascular Risk in Patients with Chronic Hepatitis C Treated with Direct Acting Antivirals. J Clin Med 2022; 11:jcm11195781. [PMID: 36233646 PMCID: PMC9572655 DOI: 10.3390/jcm11195781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Chronic hepatitis C (CHC) is associated with hepatic and extrahepatic complications, including cardiovascular disease (CVD). The effects of sustained virological response (SVR) and liver fibrosis on CVD risk are not well established. Aims: We aim to assess the dynamics of Fibrosis-4 (FIB-4) and Atherosclerotic Cardiovascular Disease 2013 (ASCVD) scores up to three years after direct acting antivirals (DAA) treatment and explore the time-dependent association between the two scores. Methods: We included consecutive CHC patients treated with DAA and followed up with them for three years. Outcomes were changes from baseline (before DAA) in ASCVD and FIB-4 scores, measured at the end of treatment, 12-, 24-, and 36-months follow-up. Results: In total, 91 patients with CHC were finally included (median age: 66 years (IQR = 58−72 years); 43% females). Median follow-up was 2 years (1−3 years) and all patients reached SVR. The ASCVD score did not significantly change from baseline (Mean = 17.2%, 95% CI 14.1, 20.3), but the FIB-4 score significantly decreased at any time-point by an average of 0.8 (95% CI 0.78, 0.82, p < 0.001). Elevated FIB-4 scores at one (β = 1.16, p < 0.001) and three years (β = 2.52, p < 0.001) were associated with an increased ASCVD score. Clinically, two participants- with non-decreasing FIB-4 scores after treatment- had acute coronary syndrome at the end of treatment and one year follow-up, respectively. Conclusions: In our study, we found that FIB-4 and ASCVD scores exhibited a positive correlation irrespective of time-point after treatment. Larger studies are essential to further investigate the utility of FIB-4 scores in cardiovascular risk assessment.
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Affiliation(s)
- Mohammad Said Ramadan
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’ Napoli, 80138 Naples, Italy
| | - Filomena Boccia
- Department of Advanced Medical and Surgical Sciences, University of Campania ‘L. Vanvitelli’, 81031 Naples, Italy
| | - Simona Maria Moretto
- Department of Advanced Medical and Surgical Sciences, University of Campania ‘L. Vanvitelli’, 81031 Naples, Italy
| | - Fabrizio De Gregorio
- Department of Advanced Medical and Surgical Sciences, University of Campania ‘L. Vanvitelli’, 81031 Naples, Italy
| | - Massimo Gagliardi
- Department of Advanced Medical and Surgical Sciences, University of Campania ‘L. Vanvitelli’, 81031 Naples, Italy
| | - Domenico Iossa
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale E. Ruggieri, 80131 Naples, Italy
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’ Napoli, 80138 Naples, Italy
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale E. Ruggieri, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-081-7062475; Fax: +39-081-7702645
| | - Rosa Zampino
- Department of Advanced Medical and Surgical Sciences, University of Campania ‘L. Vanvitelli’, 81031 Naples, Italy
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale E. Ruggieri, 80131 Naples, Italy
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2
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Lam JO, Hurley LB, Lai JB, Saxena V, Seo S, Chamberland S, Quesenberry CP, Champsi JH, Ready J, Chiao EY, Marcus JL, Silverberg MJ. Cancer in People with and without Hepatitis C Virus Infection: Comparison of Risk Before and After Introduction of Direct-Acting Antivirals. Cancer Epidemiol Biomarkers Prev 2021; 30:2188-2196. [PMID: 34583968 PMCID: PMC8667334 DOI: 10.1158/1055-9965.epi-21-0742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/11/2021] [Accepted: 09/15/2021] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Chronic hepatitis C virus (HCV) infection is a leading cause of liver cancer. The association of HCV infection with extrahepatic cancers, and the impact of direct-acting antiviral (DAA) treatment on these cancers, is less well known. METHODS We conducted a cohort study in a healthcare delivery system. Using electronic health record data from 2007 to 2017, we determined cancer incidence, overall and by type, in people with HCV infection and by DAA treatment status. All analyses included comparisons with a reference population of people without HCV infection. Covariate-adjusted Poisson models were used to estimate incidence rate ratios. RESULTS 2,451 people with HCV and 173,548 people without HCV were diagnosed with at least one type of cancer. Compared with people without HCV, those with HCV were at higher risk for liver cancer [adjusted incidence rate ratio (aIRR) = 31.4, 95% confidence interval (CI) = 28.9-34.0], hematologic cancer (aIRR = 1.3, 95% CI = 1.1-1.5), lung cancer (aIRR = 1.3, 95% CI = 1.2-1.5), pancreatic cancer (aIRR = 2.0, 95% CI = 1.6-2.5), oral/oropharynx cancer (aIRR = 1.4, 95% CI = 1.1-1.8), and anal cancer (aIRR = 1.6, 95% CI = 1.1-2.4). Compared with people without HCV, the aIRR for liver cancer was 31.9 (95% CI = 27.9-36.4) among DAA-untreated and 21.2 (95% CI = 16.8-26.6) among DAA-treated, and the aIRR for hematologic cancer was 1.5 (95% CI = 1.1-2.0) among DAA-untreated and 0.6 (95% CI = 0.3-1.2) among DAA-treated. CONCLUSIONS People with HCV infection were at increased risk of liver cancer, hematologic cancer, and some other extrahepatic cancers. DAA treatment was associated with reduced risk of liver cancers and hematologic cancers. IMPACT DAA treatment is important for reducing cancer incidence among people with HCV infection.
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Affiliation(s)
- Jennifer O Lam
- Division of Research, Kaiser Permanente Northern California, Oakland, California.
| | - Leo B Hurley
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Jennifer B Lai
- San Rafael Medical Center, Kaiser Permanente Northern California, San Rafael, California
| | - Varun Saxena
- South San Francisco Medical Center, Kaiser Permanente Northern California, South San Francisco, California
- University of California San Francisco, San Francisco, California
| | - Suk Seo
- Antioch Medical Center, Kaiser Permanente Northern California, Antioch, California
- Walnut Creek Medical Center, Kaiser Permanente Northern California, Walnut Creek, California
| | - Scott Chamberland
- Regional Pharmacy, Kaiser Permanente Northern California, Oakland, California
| | | | - Jamila H Champsi
- South San Francisco Medical Center, Kaiser Permanente Northern California, South San Francisco, California
| | - Joanna Ready
- Santa Clara Medical Center, Kaiser Permanente Northern California, Santa Clara, California
| | - Elizabeth Y Chiao
- Department of General Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Baylor College of Medicine, Houston, Texas
| | - Julia L Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California
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3
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Su X, Zhao X, Deng JL, Li SN, Du X, Dong JZ, Ma CS. Antiviral treatment for hepatitis C is associated with a reduced risk of atherosclerotic cardiovascular outcomes: A systematic review and meta-analysis. J Viral Hepat 2021; 28:664-671. [PMID: 33452699 DOI: 10.1111/jvh.13469] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 12/13/2022]
Abstract
Hepatitis C virus infection (HCV) may be associated with a greater risk of cardiovascular disease (CVD), and the evidence for whether antiviral therapy for HCV could reduce the risk of CVD events is inconsistent. The aim of this meta-analysis was to investigate the association between anti-HCV treatment and the risk of CVD. We searched PubMed, EMBASE and Cochrane Library databases from inception to 20 August 2020. The pooled hazard ratio (HR) with 95% confidence interval (CI) of the risk of CVD events [any CVD, coronary artery disease (CAD) and stroke] was calculated using the random-effects model. A total of eleven studies, including 309,470 subjects, were enrolled in this meta-analysis. Among those, four studies reported on any CVD between anti-HCV-treated and anti-HCV-untreated patients, five studies reported on CAD, and five studies reported on stroke. Also, five studies reported on any CVD between patients with sustained virological response (SVR) and without SVR. Overall, antiviral therapy for HCV was associated with a reduced risk of any CVD (HR = 0.64, 95% CI: 0.50-0.83), CAD (HR = 0.73, 95% CI: 0.55-0.96) and stroke (HR = 0.74, 95% CI: 0.64-0.86). Besides, we found that SVR was associated with a significant decrease in any CVD compared with non-SVR (HR = 0.74, 95% CI: 0.60-0.92). In conclusion, this meta-analysis demonstrated that antiviral therapy for HCV was associated with a reduced risk of CVD events. In addition, the risk of CVD events was lower in individuals with SVR compared with those without SVR.
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Affiliation(s)
- Xin Su
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, China
| | - Xin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, China
| | - Jia-Long Deng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, China
| | - Song-Nan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, China
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, China
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Simpson H, Manley P, Lawler J, Morey S, Buchanan E, Hewett M, Knowles J, Miller C, McCarron B, Valappil M, McPherson S. Distance to treatment as a factor for loss to follow up of hepatitis C patients in North East England. J Public Health (Oxf) 2020; 41:700-706. [PMID: 30351415 DOI: 10.1093/pubmed/fdy190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 09/21/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND A large proportion of the 200 000 HCV-infected individuals in the UK are undiagnosed or lost to follow-up. Engaging known infected individuals in treatment is essential for elimination. METHODS Using PHE surveillance data and HCV treatment registers from North East of England (NE) treatment centres for 1997-2016, we estimated the number of HCV cases not linked to treatment and the proportion with active infection. We compared distances of treated and untreated cases to treatment services, and assessed the effect of expanding HCV treatment into existing drug and alcohol treatment centres in the NEE on treatment accessibility. RESULTS The odds of being treated was associated with distance to treatment services. Confirmatory results for ~50% were not reported to PHE NE. Overall, 3385 patients reported to PHE NE had no record of treatment; we estimated 1621 of these may have been lost to follow-up after confirmation of active infection. CONCLUSIONS Poor access to healthcare services may contribute to under-diagnosis or loss to follow-up. Expanding HCV treatment delivery into NEE drug and alcohol treatment centres would improve the accessibility of treatment services to people infected with/at risk of HCV. This may increase the proportion receiving treatment and support progress towards elimination.
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Affiliation(s)
- H Simpson
- London School of Hygiene and Tropical Medicine, London, UK
| | - P Manley
- Field Epidemiology Service Newcastle, National Infection Service, Public Health England, Newcastle upon Tyne, UK
| | - J Lawler
- Public Health England, North East Health Protection Team, Newcastle upon Tyne, UK
| | - S Morey
- Department of Health and Life Science, Northumbria University, Newcastle upon Tyne, UK
| | - E Buchanan
- Viral Hepatitis Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - M Hewett
- Viral Hepatitis Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - J Knowles
- Centre for Infection, James Cook University Hospital, Middlesbrough, UK
| | - C Miller
- Viral Hepatitis Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - B McCarron
- Centre for Infection, James Cook University Hospital, Middlesbrough, UK
| | - M Valappil
- Viral Hepatitis Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Public Health Laboratory North East, PHE, Newcastle upon Tyne, UK
| | - S McPherson
- Viral Hepatitis Service, Newcastle upon Tyne Hospitals NHS Foundation Trust (Institute of Cellular Medicine, Newcastle University), Newcastle upon Tyne, UK
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5
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Alessio L, Onorato L, Sangiovanni V, Borrelli F, Manzillo E, Esposito V, Simeone F, Martini S, Capoluongo N, Leone S, Di Filippo G, D'Abbraccio M, Aprea L, Megna AS, Milano E, Rizzo V, Saracino A, Coppola N. DAA-based treatment for HIV-HCV-coinfected patients: analysis of factors of sustained virological response in a real-life study. Antivir Ther 2020; 25:193-201. [PMID: 32314978 DOI: 10.3851/imp3353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The aim of the present study was to evaluate in HIV-infected patients treated with a direct-acting antiviral agent (DAA)-based regimen the variables associated with sustained virological response (SVR) and the trend in biochemical parameters and clinical events during and after DAA regimen. METHODS We performed a multicentre retrospective cohort study, enrolling all 243 HIV-HCV-coinfected adult patients treated with DAAs between January 2015 and December 2018 in one of the nine participating Infectious Disease Centers in southern Italy, eight in Campania and one in Apulia. RESULTS Of the 243 patients enrolled, 233 (95.9%) obtained an SVR at 12 weeks (SVR12). Of the 10 patients with non-SVR, 7 were tested for NS3, NS5A and NS5B resistance-associated substitutions (RASs) by sequencing analysis and 6 showed at least 1 major RAS in 1 HCV region (all in NS5A, 2 in NS5B and 1 in NS3). Comparing the 233 patients achieving SVR and the 10 non-achievers, no variable was independently associated with non-SVR. During and after DAA regimen, no modification in the biochemical parameters and clinical events was observed; however, the serum cholesterol and low-density lipoprotein (LDL) levels showed an increase (from 159 ±41.3 mg/dl at baseline to 174 ±44.5 mg/dl at week 12 after stopping treatment, P<0.001, and from 92 ±34.6 mg/dl to 109.4 ±73.7 mg/dl, P=0.002, respectively). CONCLUSIONS The treatment with DAAs led to a high SVR12 rate in HIV-HCV-coinfected subjects, irrespective of epidemiological, clinical or virological characteristics. However, the DAA regimen was associated with an increase in total- and LDL-cholesterol, to be taken into account in the management of HIV infection.
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Affiliation(s)
- Loredana Alessio
- Infectious Diseases Unit, AORN Sant'Anna e San Sebastiano, Caserta, Italy
| | - Lorenzo Onorato
- Infectious Diseases Unit, AORN Sant'Anna e San Sebastiano, Caserta, Italy.,Department of Mental Health and Preventive Medicine, Section of Infectious Diseases, University of Campania "L. Vanvitelli", Naples, Italy
| | | | | | - Elio Manzillo
- VIII Infectious Diseases Unit, AORN dei Colli, P.O. Cotugno, Naples, Italy
| | - Vincenzo Esposito
- Immunodeficiency and Gender Related Infectious Diseases Unit, Department of Infectious Disease and Infectious Emergencies, AORN dei Colli, P.O. Cotugno, Naples, Italy
| | - Filomena Simeone
- Infectious Diseases Unit, AORN Sant'Anna e San Sebastiano, Caserta, Italy
| | - Salvatore Martini
- Department of Mental Health and Preventive Medicine, Section of Infectious Diseases, University of Campania "L. Vanvitelli", Naples, Italy
| | - Nicolina Capoluongo
- Department of Mental Health and Preventive Medicine, Section of Infectious Diseases, University of Campania "L. Vanvitelli", Naples, Italy
| | | | | | - Maurizio D'Abbraccio
- Immunodeficiency and Gender Related Infectious Diseases Unit, Department of Infectious Disease and Infectious Emergencies, AORN dei Colli, P.O. Cotugno, Naples, Italy
| | - Lucia Aprea
- VIII Infectious Diseases Unit, AORN dei Colli, P.O. Cotugno, Naples, Italy
| | | | - Eugenio Milano
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | - Viviana Rizzo
- Immunodeficiency and Gender Related Infectious Diseases Unit, Department of Infectious Disease and Infectious Emergencies, AORN dei Colli, P.O. Cotugno, Naples, Italy
| | - Annalisa Saracino
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | - Nicola Coppola
- Infectious Diseases Unit, AORN Sant'Anna e San Sebastiano, Caserta, Italy.,Department of Mental Health and Preventive Medicine, Section of Infectious Diseases, University of Campania "L. Vanvitelli", Naples, Italy
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6
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Kuna L, Jakab J, Smolic R, Wu GY, Smolic M. HCV Extrahepatic Manifestations. J Clin Transl Hepatol 2019; 7:172-182. [PMID: 31293918 PMCID: PMC6609844 DOI: 10.14218/jcth.2018.00049] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 02/21/2019] [Accepted: 03/17/2019] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) has been shown to affect many tissues other than liver. However, of the many extrahepatic manifestations (EMs) that have been associated with HCV, including cryoglobulinemia, lymphoma, insulin resistance, type 2 diabetes and neurological disorders, only a few have been shown to be directly related to HCV infection of extrahepatic tissues. HCV-triggered immune-mediated mechanisms account for most of the EMs. It is estimated that up to 74% of patients with chronic hepatitis C can develop at least one EM. All HCV patients with EMs should be considered for antiviral therapy, although not all will resolve with sustained virological response.
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Affiliation(s)
- Lucija Kuna
- Department of Pharmacology and Biochemistry, Faculty of Dental Medicine and Health, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Jelena Jakab
- Department of Pathophysiology and Physiology with Immunology, Faculty of Dental Medicine and Health, J. J. Strossmayer University of Osijek, Osijek, Croatia
- Department of Internal Medicine, Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Robert Smolic
- Department of Pathophysiology and Physiology with Immunology, Faculty of Dental Medicine and Health, J. J. Strossmayer University of Osijek, Osijek, Croatia
- Department of Pharmacology, Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - George Y Wu
- Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA
| | - Martina Smolic
- Department of Pharmacology and Biochemistry, Faculty of Dental Medicine and Health, J. J. Strossmayer University of Osijek, Osijek, Croatia
- Department of Pharmacology, Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia
- *Correspondence to: Martina Smolic, Department of Pharmacology, J. J. Strossmayer University of Osijek Faculty of Medicine Osijek, J. Huttlera 4, Osijek 31000, Croatia. Tel: + 385-31-512-800, Fax: +385-31-512-833, E-mail:
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Lledó G, Benítez-Gutiérrez L, Arias A, Requena S, Cuervas-Mons V, de Mendoza C. Benefits of hepatitis C cure with antivirals: why test and treat? Future Microbiol 2019; 14:425-435. [PMID: 30900911 DOI: 10.2217/fmb-2019-0041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Chronic hepatitis C virus (HCV) infection is one of the major causes of death worldwide due to infectious agents. The advent of direct-acting antivirals has dramatically improved the chance of HCV elimination, even for patients with decompensated cirrhosis. Along with HCV cure, benefits are recognized in terms of regression of liver fibrosis and risk of hepatocellular carcinoma. Furthermore, beyond hepatic outcomes, several extrahepatic benefits may result from sustained HCV eradication, including improvements in the neurocognitive function and reduced cardiovascular disease risk. Finally, there is no doubt that the individual success of direct-acting antivirals is largely contributing to halt HCV transmission globally, in the absence of an effective HCV prophylactic vaccine.
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Affiliation(s)
- Gema Lledó
- Internal Medicine Department, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | - Ana Arias
- Internal Medicine Department, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Silvia Requena
- Internal Medicine Department, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain.,Internal Medicine Laboratory, Research Institute Puerta de Hierro-Segovia de Arana, Madrid, Spain
| | - Valentín Cuervas-Mons
- Internal Medicine Department, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain.,Internal Medicine Laboratory, Research Institute Puerta de Hierro-Segovia de Arana, Madrid, Spain.,Universidad Autónoma, Madrid. Spain
| | - Carmen de Mendoza
- Internal Medicine Department, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain.,Internal Medicine Laboratory, Research Institute Puerta de Hierro-Segovia de Arana, Madrid, Spain.,San Pablo-CEU University, Madrid. Spain
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8
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Younossi ZM, Henry L, P Ong J, Tanaka A, Eguchi Y, Mizokami M, Lim YS, Dan YY, Yu ML, Stepanova M. Systematic review with meta-analysis: extrahepatic manifestations in chronic hepatitis C virus-infected patients in East Asia. Aliment Pharmacol Ther 2019; 49:644-653. [PMID: 30761562 DOI: 10.1111/apt.15131] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 08/21/2018] [Accepted: 12/16/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although the prevalence of extrahepatic manifestations of chronic hepatitis C virus (HCV) infection has been reported from Western countries, their prevalence in East Asian countries is not well known. AIM To perform a systematic review to quantify the prevalence of selected extrahepatic manifestations of HCV among patients from East Asia. METHODS Medline, CINAHL, EMBASE, Cochrane and country-specific databases were reviewed according to standard guidelines for meta-analyses. Only articles with patients from East Asian countries were included. RESULTS After review, 34 articles were selected (Japan = 9; China = 5, Korea = 3, Taiwan = 16, multiple countries = 1) with 646 228 subjects, 66 436 with HCV. Mean age for HCV-infected patients was 56 years (range 41-72 years), 50% were male (range 26%-73%). The pooled prevalence of type 2 diabetes in East Asian HCV patients was 19.0% (95% confidence interval 15.6%-22.9%) (n = 19 studies) with an increased risk when compared to non-HCV: odds ratio (OR) 1.58 (1.28-1.94). The prevalence of chronic kidney disease in HCV was 9.2% (5.0%-16.2%) (n = 7 studies), also with a significantly increased risk: OR=1.98 (1.41-2.77). Pooled prevalence of cardiovascular disease in HCV was 8.6% (3.5%-19.9%) (n = 6 studies), also with an increased risk: OR = 1.55 (1.21-1.98). The prevalence of lichen planus in HCV was 8.9% (3.6%-20.6%) (n = 6 studies) while the prevalence of rheumatoid arthritis was 4.5% (0.6%-25.7%) (n = 4 studies). CONCLUSIONS These data show increased risk of developing extrahepatic manifestations in East Asian patients with HCV. Both hepatic and extrahepatic manifestations of the infection should be used to accurately determine the total burden of the disease in the region.
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9
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Health-related quality of life in hepatitis C patients who achieve sustained virological response to direct-acting antivirals: a comparison with the general population. Qual Life Res 2019; 28:1477-1484. [PMID: 30666549 DOI: 10.1007/s11136-019-02111-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE To compare health-related quality of life (HRQoL) between hepatitis C patients who achieve sustained virological response (SVR) to direct-acting antivirals and a sex- and age-paired sample of the general population. METHODS HRQoL was evaluated in patients recruited in Navarre, Spain, from May 2016 to April 2017 at baseline and after SVR, using the EQ-5D-5L questionnaire. Both results were compared to those of general population of the same sex and age obtained from the 2011/12 National Health Survey in Spain. Observed/expected (O/E) ratios for health dimensions and differences between O-E in EQ-5D utility and visual analogical scale (VAS) scores were calculated. RESULTS 206 patients were studied. Before treatment, patients had more problems than the general population in every domain of EQ-5D-5L, except in self-care dimension (O/E = 1.1). After SVR, patients continued having more limitation, especially for usual activities (O/E = 3.1), anxiety/depression (O/E = 2.8) and EQ-5D utility (- 0.086, p < 0.001); however, differences in VAS score between patients and general population disappeared (74.8 vs 76.5, p = 0.210). F0-F1 patients with SVR had minor differences with the general population in EQ-5D-5L dimensions, utility and VAS score. Although cirrhotic patients also reduced that difference, they still had worse HRQoL, especially in usual activities, self-care, EQ-5D utility (- 0.152, p < 0.001) and VAS score (- 8.5, p = 0.005). CONCLUSIONS HRQoL of chronic hepatitis C patients remains lower than that of the general population despite viral clearance, with primary problems in usual activities and anxiety/depression. Knowledge of these on-going problems despite cure serves to guide healthcare interventions and patient's follow-up.
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10
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Zubkin ML, Abdurakhmanov DT, Sagalova OI, Bakulin IG, Maevskaya MV, Ivashkin VT. Persistent mixed cryoglobulinemia after successful antiviral treatment of chronic hepatitis C virus infection: What's the next? Scand J Gastroenterol 2018; 53:883-884. [PMID: 29966445 DOI: 10.1080/00365521.2018.1477988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- M L Zubkin
- a Scientific Research Institute of Epidemiology and Microbiology n.a. Gabrichevskii , Moscow , Russia
| | | | - O I Sagalova
- c South Ural State Medical University , Chelyabinsk , Russia
| | - I G Bakulin
- d North-Western State Medical University n.a. Mechnikov , St.-Petersburg , Russia
| | - M V Maevskaya
- b Sechenov First Moscow State Medical University , Moscow , Russia
| | - V T Ivashkin
- b Sechenov First Moscow State Medical University , Moscow , Russia
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Impact of successful treatment with direct-acting antiviral agents on health-related quality of life in chronic hepatitis C patients. PLoS One 2018; 13:e0205277. [PMID: 30300395 PMCID: PMC6177189 DOI: 10.1371/journal.pone.0205277] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 09/22/2018] [Indexed: 12/23/2022] Open
Abstract
Background Direct-acting antivirals (DAA) have demonstrated high efficacy to achieve sustained virological response (SVR) in chronic hepatitis C patients. We aim to assess the change in health-related quality of life (HRQoL) among patients successfully treated, and to identify predictors of this variation. Methods In a prospective observational study, patients with chronic hepatitis C who started DAA therapy between May 2016 and April 2017 completed the EQ-5D-5L questionnaire at baseline and 12 weeks after the end of therapy before knowing the virological result. Analysis included all patients with SVR. Results Median baseline EQ-5D-5L scores of the 206 enrolled patients were 0.857 utility and 70.0 visual analogue scale (VAS). Following SVR, a reduction occurred in the proportion of patients with mobility problems (35% vs 24%, p = 0.012), pain/discomfort (60% vs 42%, p<0.001) and anxiety/depression (57% vs 44%, p = 0.012), with an increase in utility (+0.053, p<0.001) and VAS (+10, p<0.001). Score improvements were also observed in cirrhotic (+0.048 utility, p = 0.027; +15 VAS, p<0.001) and HIV co-infected patients (+0.039 utility, p = 0.036; +5 VAS, p = 0.002). In multivariate analyses, middle age (45–64 years) and baseline anxiety/depression were associated to greater improvement in utility after SVR, and moderate-advanced liver fibrosis and cirrhosis to greater increase in VAS score. Low baseline values were associated to greater improvements in utility value and VAS score. Conclusions The cure of chronic hepatitis C infection with DAA has a short term positive impact on HRQoL with improvement in mobility, pain/discomfort, anxiety/depression, utility value and VAS score. Patients with poor baseline HRQoL were the most beneficed.
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Ridruejo E, Mendizabal M, Silva MO. Rationale for treating hepatitis C virus infection in patients with mild to moderate chronic kidney disease. Hemodial Int 2018; 22 Suppl 1:S97-S103. [PMID: 29694730 DOI: 10.1111/hdi.12651] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Ezequiel Ridruejo
- Hepatology Section, Department of Medicine; Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno “CEMIC”; Ciudad Autónoma de Buenos Aires; Argentina
- Hepatology and Liver Transplant Unit; Hospital Universitario Austral; Pilar; Provincia de Buenos Aires; Argentina
- Latin American Liver Research, Educational and Awareness Network (LALREAN); Pilar; Provincia de Buenos Aires; Argentina
| | - Manuel Mendizabal
- Hepatology and Liver Transplant Unit; Hospital Universitario Austral; Pilar; Provincia de Buenos Aires; Argentina
- Latin American Liver Research, Educational and Awareness Network (LALREAN); Pilar; Provincia de Buenos Aires; Argentina
| | - Marcelo O. Silva
- Hepatology and Liver Transplant Unit; Hospital Universitario Austral; Pilar; Provincia de Buenos Aires; Argentina
- Latin American Liver Research, Educational and Awareness Network (LALREAN); Pilar; Provincia de Buenos Aires; Argentina
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Liu A, Gui S, Zhang L, Chen Z, Tang Y, Xiao M, Wang J, Liu W, Jin X, Zhu J, Lu X. Production of bioactive liver-targeting interferon Mu-IFN-CSP by soluble prokaryotic expression. AMB Express 2017; 7:192. [PMID: 29086199 PMCID: PMC5662524 DOI: 10.1186/s13568-017-0493-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 10/25/2017] [Indexed: 12/03/2022] Open
Abstract
A novel liver-targeting interferon (IFN-CSP) was successfully over-expressed in our previous work. The in vitro and in vivo investigation revealed that IFN-CSP has significant anti-hepatitis B virus (HBV) effect and liver-targeting capacity. However, due to the IFN-CSP tends to form inclusion bodies in recombinant Escherichia coli (E. coli), efficient production of the soluble liver-targeting interferon is a challenge. In view of biomedical application, novel strategies for efficiently expressing liver-targeting interferon and overcoming its poor solubility are necessary and important. In the present study, a modified mu-IFN-CSP was designed base on the amino acid mutant of the native IFN-CSP. Meanwhile, the coding sequence of mu-IFN-CSP was optimized for E. coli preferred codon and the induction conditions for expression were optimized by an orthogonal test. After amino acid mutant, codon optimization and induction conditions optimization, the solubility of Mu-IFN-CSP in E. coli was up to 98.4%. The structural comparison and molecular dynamic simulation showed that the Mu-IFN-CSP formed three structure changes and were more stable than the native IFN-CSP. Tissue sections binding assays revealed that Mu-IFN-CSP was also able to specific binding to liver. In vitro anti-HBV activity assays showed that the soluble Mu-IFN-CSP has improved anti-HBV effect in HepG2.2.15 cells compared to the native IFN-CSP. The present study reports for the first time that liver-targeting interferon Mu-IFN-CSP can be expressed as soluble form, and also contributes to further support its application as liver-targeting anti-HBV medicine.
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