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Sun B, da Costa KAS, Alrubayyi A, Kokici J, Fisher-Pearson N, Hussain N, D'Anna S, Piermatteo L, Salpini R, Svicher V, Kucykowicz S, Ghosh I, Burns F, Kinloch S, Simoes P, Bhagani S, Kennedy PTF, Maini MK, Bashford-Rogers R, Gill US, Peppa D. HIV/HBV coinfection remodels the immune landscape and natural killer cell ADCC functional responses. Hepatology 2024; 80:649-663. [PMID: 38687604 DOI: 10.1097/hep.0000000000000877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/23/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND AND AIMS HBV and HIV coinfection is a common occurrence globally, with significant morbidity and mortality. Both viruses lead to immune dysregulation including changes in natural killer (NK) cells, a key component of antiviral defense and a promising target for HBV cure strategies. Here we used high-throughput single-cell analysis to explore the immune cell landscape in people with HBV mono-infection and HIV/HBV coinfection, on antiviral therapy, with emphasis on identifying the distinctive characteristics of NK cell subsets that can be therapeutically harnessed. APPROACH AND RESULTS Our data show striking differences in the transcriptional programs of NK cells. HIV/HBV coinfection was characterized by an over-representation of adaptive, KLRC2 -expressing NK cells, including a higher abundance of a chemokine-enriched ( CCL3/CCL4 ) adaptive cluster. The NK cell remodeling in HIV/HBV coinfection was reflected in enriched activation pathways, including CD3ζ phosphorylation and ZAP-70 translocation that can mediate stronger antibody-dependent cellular cytotoxicity responses and a bias toward chemokine/cytokine signaling. By contrast, HBV mono-infection imposed a stronger cytotoxic profile on NK cells and a more prominent signature of "exhaustion" with higher circulating levels of HBsAg. Phenotypic alterations in the NK cell pool in coinfection were consistent with increased "adaptiveness" and better capacity for antibody-dependent cellular cytotoxicity compared to HBV mono-infection. Overall, an adaptive NK cell signature correlated inversely with circulating levels of HBsAg and HBV-RNA in our cohort. CONCLUSIONS This study provides new insights into the differential signature and functional profile of NK cells in HBV and HIV/HBV coinfection, highlighting pathways that can be manipulated to tailor NK cell-focused approaches to advance HBV cure strategies in different patient groups.
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Affiliation(s)
- Bo Sun
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Kelly A S da Costa
- Division of Infection and Immunity, Institute of Immunity and Transplantation, University College London, London, UK
| | | | - Jonida Kokici
- Division of Infection and Immunity, Institute of Immunity and Transplantation, University College London, London, UK
| | | | - Noshin Hussain
- Division of Infection and Immunity, Institute of Immunity and Transplantation, University College London, London, UK
| | - Stefano D'Anna
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Romina Salpini
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Stephanie Kucykowicz
- Division of Infection and Immunity, Institute of Immunity and Transplantation, University College London, London, UK
| | - Indrajit Ghosh
- Department of HIV, Mortimer Market Centre, CNWL NHS Trust, London, UK
| | - Fiona Burns
- The Ian Charleson Day Centre, Royal Free Hospital NHS Foundation Trust, London, UK
- UCL Faculty of Population Health Sciences, Institute for Global Health, University College London, London, UK
| | - Sabine Kinloch
- The Ian Charleson Day Centre, Royal Free Hospital NHS Foundation Trust, London, UK
| | - Pedro Simoes
- The Ian Charleson Day Centre, Royal Free Hospital NHS Foundation Trust, London, UK
| | - Sanjay Bhagani
- Division of Infection and Immunity, Institute of Immunity and Transplantation, University College London, London, UK
- Department of HIV Medicine, Royal Free Hospital NHS Foundation Trust, London, UK
| | - Patrick T F Kennedy
- Centre for Immunobiology, Barts Liver Centre, Barts & The London School of Medicine & Dentistry, QMUL, London, UK
| | - Mala K Maini
- Division of Infection and Immunity, Institute of Immunity and Transplantation, University College London, London, UK
| | | | - Upkar S Gill
- Centre for Immunobiology, Barts Liver Centre, Barts & The London School of Medicine & Dentistry, QMUL, London, UK
| | - Dimitra Peppa
- Division of Infection and Immunity, Institute of Immunity and Transplantation, University College London, London, UK
- Department of HIV, Mortimer Market Centre, CNWL NHS Trust, London, UK
- The Ian Charleson Day Centre, Royal Free Hospital NHS Foundation Trust, London, UK
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2
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Shah SHBU, Alavi M, Hajarizadeh B, Matthews G, Valerio H, Dore GJ. Liver-related mortality among people with hepatitis B and C: Evaluation of definitions based on linked healthcare administrative datasets. J Viral Hepat 2023; 30:520-529. [PMID: 36843500 PMCID: PMC10946991 DOI: 10.1111/jvh.13824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 02/28/2023]
Abstract
Routinely collected and linked healthcare administrative datasets could be used to monitor mortality among people with hepatitis B (HBV) and C (HCV). This study aimed to evaluate the concordance in records of liver-related mortality among people with an HBV or HCV notification, between data on hospitalization for end-stage liver disease (ESLD) and death certificates. In New South Wales, Australia, HBV and HCV notifications (1993-2017) were linked to hospital admissions (2001-2018), all-cause mortality (1993-2018) and cause-specific mortality (1993-2016) datasets. Hospitalization for ESLD was defined as a first-time hospital admission due to decompensated cirrhosis (DC) or hepatocellular carcinoma (HCC). Consistency of liver death definition of mortality following hospitalization for ESLD was compared with two death certificate-based definitions of liver deaths coded among primary and secondary cause-specific mortality data, including ESLD-related (deaths due to DC and HCC) and all-liver deaths (ESLD-related and other liver-related causes). Of 63,292 and 107,430 individuals with an HBV and HCV notification, there were 4478 (2.6%) post-ESLD hospitalization deaths, 5572 (3.3%) death certificate liver disease deaths and 2910 (1.7%) death certificate ESLD deaths. Between 2001 and 2016, among HBV post-ESLD hospitalization deaths (n = 891), 63% (562) had death certificate ESLD recorded, and 83% (741) had death certificate liver disease recorded. Between 2001 and 2016, among HCV post-ESLD hospitalization deaths (n = 3587), 58% (2082) had death certificate ESLD recorded, and 87% (3135) had death certificate liver disease recorded. At least one-third of death certificates with DC and HCC as cause of death had no mention of HBV, HCV or viral hepatitis. Our study identified limitations in estimating and tracking HBV and HCV liver disease mortality using death certificate-based data only. The optimum data for this purpose is either ESLD hospitalisations with vital status information or a combination of these with cause-specific death certificate data.
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Affiliation(s)
| | - Maryam Alavi
- The Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
| | | | - Gail Matthews
- The Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
| | - Heather Valerio
- The Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
| | - Gregory J. Dore
- The Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
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3
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Chang SS, Hu HY, Chen YC, Yen YF, Huang N. Late hepatitis C virus diagnosis among patients with newly diagnosed hepatocellular carcinoma: a case–control study. BMC Gastroenterol 2022; 22:425. [PMID: 36115934 PMCID: PMC9482748 DOI: 10.1186/s12876-022-02504-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/13/2022] [Indexed: 12/09/2022] Open
Abstract
Abstract
Background
New direct-acting antiviral therapies have revolutionized hepatitis C virus (HCV) infection therapy. Nonetheless, once liver cirrhosis is established, the risk of hepatocellular carcinoma (HCC) still exists despite virus eradication. Late HCV diagnosis hinders timely access to HCV treatment. Thus, we determined trends and risk factors associated with late HCV among patients with a diagnosis of HCC in Taiwan.
Methods
We conducted a population-based unmatched case–control study. 2008–2018 Claims data were derived from the Taiwan National Health Insurance Research Database. Individuals with an initial occurrence of liver cancer between 2012 and 2018 were included. The late HCV group were referred as individuals who were diagnosed with HCC within 3 years after HCV diagnosis. The control group were referred as individuals who were diagnosed more than 3 years after the index date. We used multivariable logistic models to explore individual- and provider-level risk factors associated with a late HCV diagnosis.
Results
A decreasing trend was observed in the prevalence of late HCV-related HCC diagnosis between 2012 and 2018 in Taiwan. On an individual level, male, elderly patients, patients with diabetes mellitus (DM), and patients with alcohol-related disease had significantly higher risks of late HCV-related HCC diagnosis. On a provider level, patients who were mainly cared for by male physicians, internists and family medicine physicians had a significantly lower risk of late diagnosis.
Conclusions
Elderly and patients who have DM and alcohol related disease should receive early HCV screening. In addition to comorbidities, physician factors also matter. HCV screening strategies shall take these higher risk patients and physician factors into consideration to avoid missing opportunities for early intervention.
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Trends in decompensated cirrhosis and hepatocellular carcinoma among people with a hepatitis B notification in New South Wales. JHEP Rep 2022; 4:100552. [PMID: 36119722 PMCID: PMC9478454 DOI: 10.1016/j.jhepr.2022.100552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/01/2022] [Accepted: 07/19/2022] [Indexed: 01/27/2023] Open
Abstract
Background & Aims Population-level trends and factors associated with HBV-related decompensated cirrhosis (DC), hepatocellular carcinoma (HCC), and liver-related mortality are crucial to evaluate the impacts of therapeutic interventions. Methods Trends in HBV-DC and -HCC diagnoses and liver-related mortality in New South Wales, Australia, were determined through linkage of HBV notifications (1993-2017) to hospital admissions (2001-2018), mortality (1993-2018), and cancer registry (1994-2014) databases. Late HBV notification was defined as notification at or within 2 years of a DC or HCC diagnosis. Cox proportional-hazards regression and multivariable logistic regression analyses were performed to evaluate associated factors. Results Among 60,660 people with a HBV notification, 1,276 (2.0%) DC and 1,087 (1.8%) HCC diagnoses, and 1,219 (2.0%) liver-related deaths were documented. Since the early 2000s, the number of DC and HCC diagnoses increased; however, age-standardised incidence decreased from 2.64 and 1.95 in 2003 to 1.14 and 1.09 per 1,000 person-years in 2017, respectively. Similarly, age-standardised liver mortality decreased from 2.60 in 2003 to 1.14 per 1,000 person-years in 2017. Among people with DC and HCC diagnoses, late HBV notification declined from 41% and 40% between 2001-2009 to 29% and 25% in 2010-2018, respectively. Predictors of DC diagnosis included older age (birth <1944, adjusted hazard ratio [aHR] 2.06, 95% CI 1.57–2.69), alcohol use disorder (aHR 4.82, 95% CI 3.96–5.87) and HCV co-infection (aHR 1.88, 95% CI 1.53–2.31). Predictors of HCC diagnosis included older age (birth <1944, aHR 3.94, 95% CI 2.91–5.32) and male sex (aHR 3.79, 95% CI 3.05–4.71). Conclusion In an era of improved antiviral therapies, the risk of HBV-related liver morbidity and mortality has declined. HCV co-infection and alcohol use disorder are key modifiable risk factors associated with the burden of HBV. Lay summary Rising hepatitis B-related morbidity and mortality is a major public health concern. However, the development of highly effective medicines against hepatitis B virus (HBV) has brought renewed optimism for its elimination by 2030. This study shows a steady decline in HBV-related liver morbidity and mortality in New South Wales, Australia. Moreover, late hepatitis notification has also declined, allowing individuals with HBV to have access to timely antiviral treatment. Despite this, hepatitis C co-infection and alcohol use disorder are key modifiable risk factors associated with HBV disease burden. To attain the desired benefits from highly effective antiviral treatment, managing comorbidities, including hepatitis C and high alcohol use, must improve among individuals with hepatitis B. The World Health Organization has set a 65% HBV mortality reduction target by 2030. Since the early 2000s, diagnoses of decompensated cirrhosis and HCC increased, but age-standardised incidence rates decreased. Age-standardised liver mortality rates decreased from 2.64 in 2003 to 0.97 per 1,000 person-years in 2017. Late HBV notification declined from 41% and 40% during 2001-2009 to 28% and 26% in 2010-2018, respectively. Hepatitis C co-infection and alcohol-use disorder are key modifiable risk factors associated with HBV disease burden.
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5
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Unchanging prevalence of late presentation to care among patients with chronic hepatitis B. Indian J Gastroenterol 2022; 41:362-368. [PMID: 36129613 DOI: 10.1007/s12664-021-01231-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/15/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND STUDY AIMS A recent consensus defines a delay in hepatitis B (HBV) diagnosis as presentation with late (hepatocellular carcinoma or decompensated cirrhosis) or advanced (fibrosis ≥ 3) stage disease. We aimed to determine the prevalence of late and advanced stage presentation among chronic HBV (CHB) patients and to determine factors associated with late and advanced stage presentation. METHODS Consecutive CHB patients seen from 1 January 2007 to 31 December 2018 were included and analyzed on January 2019. Time periods were divided into 2 periods (2007-2012 vs. 2013-2018). Patients were also divided into "Presentation with late stage" and "Presentation with advanced stage," and compared with "timely HBV diagnosis." RESULTS Out of the 782 patients, 138 (17.6%) presented with late stage while 67 (8.6%) presented with advanced stage, with no difference between the 2 time periods. Compared to patients with "timely HBV diagnosis," presentation with either late or advanced stage was more likely to be male, older, and diabetic patients, resorting to alcohol misuse and having abnormal liver chemistries (low albumin, high aspartate aminotransferase [AST], alanine aminotransferase [ALT], and international normalized ratio [INR]). Presentation with late stage liver disease was also associated with hepatitis B e antigen (HBeAg)-negative status and no family history of HBV. On multivariate analysis, male gender, older age, and alcohol misuse were associated with presentation with either late or advanced stage liver disease. CONCLUSIONS A quarter of CHB patients already have significant liver injury at the time of initial HBV diagnosis. The fact that presentation with late or advanced disease has not changed in 12 years emphasizes the importance of universal screening in endemic countries.
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Politi J, Guerras JM, Donat M, Belza MJ, Ronda E, Barrio G, Regidor E. Favorable impact in hepatitis C-related mortality following free access to direct-acting antivirals in Spain. Hepatology 2022; 75:1247-1256. [PMID: 34773281 DOI: 10.1002/hep.32237] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 11/01/2021] [Accepted: 11/05/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Free treatments for HCV infection with direct-acting antivirals became widespread in Spain in April 2015. We aimed to test whether, after this intervention, there was a more favorable change in population mortality from HCV-related than from non-HCV-related causes. APPROACH AND RESULTS Postintervention changes in mortality were assessed using uncontrolled before-after and single-group interrupted time series designs. All residents in Spain during 2001-2018 were included. Various underlying death causes were analyzed: HCV infection; other HCV-related outcomes (HCC, liver cirrhosis, and HIV disease); and non-C hepatitis, other liver diseases, and nonhepatic causes as control outcomes. Changes in mortality after the intervention were first assessed by rate ratios (RRs) between the postintervention and preintervention age-standardized mortality rates. Subsequently, using quasi-Poisson segmented regression models, we estimated the annual percent change (APC) in mortality rate in the postintervention and preintervention periods. All mortality rates were lower during the postintervention period, although RRs were much lower for HCV (0.53; 95% CI, 0.51-0.56) and HIV disease than other causes. After the intervention, there was a great acceleration of the downward mortality trend from HCV, whose APC went from -3.2% (95% CI, -3.6% to -2.8%) to -18.4% (95% CI, -20.6% to -16.3%). There were also significant accelerations in the downward trends in mortality from HCC and HIV disease, while they remained unchanged for cirrhosis and slowed or reversed for other causes. CONCLUSIONS These results suggest that the favorable changes in HCV-related mortality observed for Spain after April 2015 are attributable to scaling up free treatment with direct-acting antivirals and reinforce that HCV eradication is on the horizon.
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Affiliation(s)
- Julieta Politi
- National Epidemiology CenterInstituto de Salud Carlos IIIMadridSpain.,Preventive Medicine and Public Health Training Unit PSMar-UPF-ASPB (Parc de Salut Mar-Pompeu Fabra University, Agència de Salut Pública de Barcelona)BarcelonaSpain.,National School of Public HealthInstituto de Salud Carlos IIIMadridSpain
| | - Juan-Miguel Guerras
- National Epidemiology CenterInstituto de Salud Carlos IIIMadridSpain.,CIBER Epidemiología y Salud PúblicaMadridSpain
| | - Marta Donat
- National School of Public HealthInstituto de Salud Carlos IIIMadridSpain.,CIBER Epidemiología y Salud PúblicaMadridSpain
| | - María J Belza
- National School of Public HealthInstituto de Salud Carlos IIIMadridSpain.,CIBER Epidemiología y Salud PúblicaMadridSpain
| | - Elena Ronda
- CIBER Epidemiología y Salud PúblicaMadridSpain.,Preventive Medicine and Public Health AreaUniversidad de AlicanteAlicanteSpain
| | - Gregorio Barrio
- National School of Public HealthInstituto de Salud Carlos IIIMadridSpain.,CIBER Epidemiología y Salud PúblicaMadridSpain
| | - Enrique Regidor
- CIBER Epidemiología y Salud PúblicaMadridSpain.,Department of Public Health & Maternal and Child HealthFaculty of MedicineUniversidad ComplutenseMadridSpain.,Instituto de Investigación Sanitaria del Hospital Clínico San CarlosMadridSpain
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7
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Cheng R, Zhu F, Huang M, Zhang Q, Yan HH, Zhao XH, Luo FK, Li CM, Liu H, Liang GL, Huang CZ, Wang J. “Hepatitis virus indicator”----the simultaneous detection of hepatitis B and hepatitis C viruses based on the automatic particle enumeration. Biosens Bioelectron 2022; 202:114001. [DOI: 10.1016/j.bios.2022.114001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 12/11/2022]
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8
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Allard NL, MacLachlan JH, Tran L, Yussf N, Cowie BC. Time for universal hepatitis B screening for Australian adults. Med J Aust 2021; 215:103-105.e1. [PMID: 34120343 PMCID: PMC9290936 DOI: 10.5694/mja2.51114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Nicole L Allard
- WHO Collaborating Centre for Viral Hepatitis, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Jennifer H MacLachlan
- WHO Collaborating Centre for Viral Hepatitis, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Lien Tran
- WHO Collaborating Centre for Viral Hepatitis, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Nafisa Yussf
- WHO Collaborating Centre for Viral Hepatitis, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC
| | - Benjamin C Cowie
- WHO Collaborating Centre for Viral Hepatitis, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC.,Royal Melbourne Hospital, Melbourne, VIC
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Lapointe-Shaw L, Chung H, Holder L, Kwong JC, Sander B, Austin PC, Janssen HLA, Feld JJ. Diagnosis of Chronic Hepatitis B Pericomplication: Risk factors and Trends Over Time. Hepatology 2021; 73:2141-2154. [PMID: 32931613 DOI: 10.1002/hep.31557] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 08/17/2020] [Accepted: 08/31/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Hepatitis B virus (HBV) is a major cause of chronic liver disease, which can progress to cirrhosis, hepatocellular carcinoma, and death. A timely diagnosis allows for antiviral treatment, which can prevent liver-related complications. Conversely, a late diagnosis signals a missed opportunity for earlier care and treatment. Our objective was to measure the proportion of chronic HBV diagnoses that are made within 6 months of presentation with a liver disease-related complication and examine associated factors and trends over time. APPROACH AND RESULTS We used provincial laboratory data to identify patients with chronic HBV diagnosed from 2003 to 2014. We measured the proportion who experienced a liver disease complication (decompensated cirrhosis, hepatocellular carcinoma, or liver transplant) within ±6 months of their HBV diagnosis date. A multivariable logistic regression model was used to identify factors associated with HBV diagnosis pericomplication. Of 18,434 patients with chronic HBV, 1,279 (6.9%) developed an HBV-related complication during the follow-up period. Among these, 570 (44.6%) had a first diagnosis pericomplication. HBV diagnosis pericomplication did not decrease over time and was independently associated with older age at HBV diagnosis, rural residence, alcohol use, and moderate to high levels of comorbidity. Female patients, immigrants, and those with more outpatient physician visits were less likely to have an HBV diagnosis pericomplication. CONCLUSIONS A high proportion of patients with HBV-related complications are first diagnosed with HBV pericomplication. These signal missed opportunities for earlier detection and treatment. Our findings support expansion of HBV screening.
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Affiliation(s)
- Lauren Lapointe-Shaw
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto General Hospital Research Institute, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Department of Medicine, University Health Network, Toronto, ON, Canada.,Women's Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | | | | | - Jeffrey C Kwong
- ICES, Toronto, ON, Canada.,Department of Medicine, University Health Network, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Beate Sander
- Toronto General Hospital Research Institute, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Department of Medicine, University Health Network, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada.,Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Peter C Austin
- ICES, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Harry L A Janssen
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto General Hospital Research Institute, Toronto, ON, Canada.,Department of Medicine, University Health Network, Toronto, ON, Canada.,Toronto Centre for Liver Disease, Toronto, ON, Canada
| | - Jordan J Feld
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto General Hospital Research Institute, Toronto, ON, Canada.,Department of Medicine, University Health Network, Toronto, ON, Canada.,Toronto Centre for Liver Disease, Toronto, ON, Canada
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10
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Lapointe-Shaw L, Chung H, Sander B, Kwong JC, Holder L, Cerocchi O, Austin PC, Feld JJ. Peri-complication diagnosis of hepatitis C infection: Risk factors and trends over time. Liver Int 2021; 41:33-47. [PMID: 32956567 DOI: 10.1111/liv.14670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/31/2020] [Accepted: 09/03/2020] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Hepatitis C virus (HCV) is a common and treatable cause of cirrhosis and its complications, yet many chronically infected individuals remain undiagnosed until a late stage. We sought to identify the frequency of and risk factors for HCV diagnosis peri-complication, that is within six months of an advanced liver disease complication. METHODS This was a retrospective cohort study of Ontario residents diagnosed with chronic HCV infection between 2003 and 2014. HCV diagnosis peri-complication was defined as the occurrence of decompensated cirrhosis, hepatocellular carcinoma or liver transplant within ±6 months of HCV diagnosis. Multivariable logistic regression was used to identify risk factors for peri-complication diagnosis among all those diagnosed with HCV infection. RESULTS Our cohort included 39,515 patients with chronic HCV infection, of whom 4.2% (n = 1645) were diagnosed peri-complication; these represented 31.6% of the 5,202 patients who developed complications in the follow-up period. Peri-complication diagnosis became more common over the study period and was associated with increasing age among baby boomers, alcohol use, diabetes mellitus, chronic HBV co-infection and moderate to high levels of morbidity. Female sex, immigrant status, having more previous outpatient physician visits, a previous emergency department visit, a history of drug use or mental health visits were associated with reduced risk of peri-complication diagnosis. CONCLUSIONS Over a quarter of HCV-infected patients with complications were diagnosed peri-complication. This problem increased over time, suggesting a need to further expand HCV screening.
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Affiliation(s)
- Lauren Lapointe-Shaw
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| | | | - Beate Sander
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada.,Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada
| | - Jeffrey C Kwong
- ICES, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | | | | | - Peter C Austin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Jordan J Feld
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada.,Toronto Centre for Liver Disease and Toronto General Research Institute, Toronto, ON, Canada
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11
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Nanowire Aptamer-Sensitized Biosensor Chips with Gas Plasma-Treated Surface for the Detection of Hepatitis C Virus Core Antigen. COATINGS 2020. [DOI: 10.3390/coatings10080753] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Herein, we have demonstrated highly sensitive real-time biospecific detection of a protein marker of hepatitis C—the core antigen of hepatitis C virus (HCVcoreAg)—using a nanowire (NW) biosensor. The primary element of the NW-biosensor is a chip with p-type conductance, bearing silicon-on-insulator (SOI) nanowire structures on its surface. The nanowire structures are fabricated by gas-plasma treatment and electron beam lithography. The detection specificity was provided by sensitization of the sensor surface with aptamers against HCVcoreAg. The influence of buffer pH on the sensor response signal was studied. The effect of reverse polarity of the biosensor response signal with change from the acidic buffer pH to the neutral one was found. The lowest detectable HCVcoreAg concentration was determined to be 2.0 × 10−15 M in both acidic (pH 5.1) and neutral (pH 7.4) buffer solution. The proposed aptamer-sensitized sensor was also successfully applied to detect HCVcoreAg in serum samples of hepatitis C patients.
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12
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Sarin SK, Kumar M, Eslam M, George J, Al Mahtab M, Akbar SMF, Jia J, Tian Q, Aggarwal R, Muljono DH, Omata M, Ooka Y, Han KH, Lee HW, Jafri W, Butt AS, Chong CH, Lim SG, Pwu RF, Chen DS. Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission. Lancet Gastroenterol Hepatol 2020; 5:167-228. [PMID: 31852635 PMCID: PMC7164809 DOI: 10.1016/s2468-1253(19)30342-5] [Citation(s) in RCA: 310] [Impact Index Per Article: 77.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 07/20/2019] [Accepted: 08/02/2019] [Indexed: 02/06/2023]
Abstract
The Asia-Pacific region is home to more than half of the global population and accounted for 62·6% of global deaths due to liver diseases in 2015. 54·3% of global deaths due to cirrhosis, 72·7% of global deaths due to hepatocellular carcinoma, and more than two-thirds of the global burden of acute viral hepatitis occurred in this region in 2015. Chronic hepatitis B virus (HBV) infection caused more than half of the deaths due to cirrhosis in the region, followed by alcohol consumption (20·8%), non-alcoholic fatty liver disease (NAFLD; 12·1%), and chronic infection with hepatitis C virus (HCV; 15·7%). In 2015, HBV accounted for about half the cases of hepatocellular carcinoma in the region. Preventive strategies for viral hepatitis-related liver disease include increasing access to clean drinking water and sanitation. HBV vaccination programmes for neonates have been implemented by all countries, although birth-dose coverage is extremely suboptimal in some. Availability of screening tests for blood and tissue, donor recall policies, and harm reduction strategies are in their initial stages in most countries. Many governments have put HBV and HCV drugs on their essential medicines lists and the availability of generic versions of these drugs has reduced costs. Efforts to eliminate viral hepatitis as a public health threat, together with the rapid increase in per-capita alcohol consumption in countries and the epidemic of obesity, are expected to change the spectrum of liver diseases in the Asia-Pacific region in the near future. The increasing burden of alcohol-related liver diseases can be contained through government policies to limit consumption and promote less harmful patterns of alcohol use, which are in place in some countries but need to be enforced more strictly. Steps are needed to control obesity and NAFLD, including policies to promote healthy lifestyles and regulate the food industry. Inadequate infrastructure and insufficient health-care personnel trained in liver diseases are issues that also need to be addressed in the Asia-Pacific region. The policy response of most governments to liver diseases has thus far been inadequate and poorly funded. There must be a renewed focus on prevention, early detection, timely referral, and research into the best means to introduce and improve health interventions to reduce the burden of liver diseases in the Asia-Pacific region.
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Affiliation(s)
- Shiv K Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, India.
| | - Manoj Kumar
- Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, India
| | - Mohammed Eslam
- Storr Liver Centre, The Westmead Institute for Medical Research, University of Sydney and Westmead Hospital, Westmead, Australia
| | - Jacob George
- Storr Liver Centre, The Westmead Institute for Medical Research, University of Sydney and Westmead Hospital, Westmead, Australia
| | - Mamun Al Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Sheikh M Fazle Akbar
- Department of Pathology, Ehime University Proteo-Science Center, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Jidong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medial University, Beijing, China
| | - Qiuju Tian
- Liver Research Center, Beijing Friendship Hospital, Capital Medial University, Beijing, China
| | - Rakesh Aggarwal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | | | - Masao Omata
- Department of Gastroenterology, Yamanashi Central Hospital, Yamanashi, Japan; University of Tokyo, Tokyo, Japan
| | - Yoshihiko Ooka
- Department of Gastroenterology, Chiba University Hospital, Chiba, Japan
| | - Kwang-Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Won Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Wasim Jafri
- Department of Medicine, Section of Gastroenterology, The Aga Khan University, Karachi, Pakistan
| | - Amna S Butt
- Department of Medicine, Section of Gastroenterology, The Aga Khan University, Karachi, Pakistan
| | - Chern H Chong
- Division of Gastroenterology & Hepatology, National University Health System, Singapore; Division of General Medicine, Woodlands Health Campus, Singapore
| | - Seng G Lim
- Division of Gastroenterology & Hepatology, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Raoh-Fang Pwu
- National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei, Taiwan
| | - Ding-Shinn Chen
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Genomics Research Center, Academia Sinica, Taipei, Taiwan
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Alavi M, Law MG, Dore GJ. Reply to: "Pitfalls in measuring temporal trends for late diagnosis of viral hepatitis". J Hepatol 2019; 71:1254-1255. [PMID: 31668672 DOI: 10.1016/j.jhep.2019.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 07/12/2019] [Indexed: 12/04/2022]
Affiliation(s)
- Maryam Alavi
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.
| | - Matthew G Law
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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Wilton J, Samji H, Yu A, Krajden M, Janjua NZ. Reply to: "Pitfalls in measuring temporal trends for late diagnosis of viral hepatitis". J Hepatol 2019; 71:1256-1258. [PMID: 31653445 DOI: 10.1016/j.jhep.2019.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/21/2019] [Accepted: 09/19/2019] [Indexed: 12/04/2022]
Affiliation(s)
- James Wilton
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Hasina Samji
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Naveed Zafar Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
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15
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Pitfalls in measuring temporal trends for late diagnosis of viral hepatitis. J Hepatol 2019; 71:1251-1254. [PMID: 31648817 DOI: 10.1016/j.jhep.2019.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 06/07/2019] [Accepted: 06/17/2019] [Indexed: 01/27/2023]
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McDonald SA, Barclay ST, Hutchinson SJ, Stanley AJ, Fraser A, Dillon JF, Innes HA, Peters E, Kennedy N, Bathgate A, Bramley P, Morris J, Goldberg DJ, Hayes PC. Uptake of endoscopic screening for gastroesophageal varices and factors associated with variceal bleeding in patients with chronic hepatitis C infection and compensated cirrhosis, 2005-2016: a national database linkage study. Aliment Pharmacol Ther 2019; 50:425-434. [PMID: 31157411 DOI: 10.1111/apt.15320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 12/17/2018] [Accepted: 03/28/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Primary measures for preventing morbidity and mortality associated with bleeding gastroesophageal varices in cirrhotic patients include endoscopic screening. AIM To identify factors associated with (a) screening and (b) first hospital admission for variceal bleeding among cirrhotic hepatitis C virus (HCV) patients attending specialist care in Scotland. METHODS The Scottish Hepatitis C Clinical Database was linked to national hospitalisation and deaths records to identify all chronic HCV patients diagnosed with compensated cirrhosis in 2005-2016 (n = 2741). The adjusted odds of being screened by calendar year period were estimated using logistic regression, and the adjusted hazard ratio (HR) of a first variceal bleed using Cox regression. RESULTS About 34% were screened within the period starting 12 months before and ending 12 months after cirrhosis diagnosis. The proportion screened was stable in 2005-2010 at 42%, declining to 37% in 2011-2013 and 26% in 2014-2016. Odds of screening were decreased for age-groups <40 (OR = 0.61, 95% CI: 0.48-0.77) and 60+ years (OR = 0.67, 95% CI: 0.48-0.94), history of antiviral therapy (OR = 0.70, 95% CI: 0.55-0.89), and cirrhosis diagnosis in 2014-2015, compared with 2008-2010 (OR = 0.67, 95% CI: 0.52-0.86). Compared with 2008-2010, there was no evidence for an increased/decreased relative risk of a first variceal bleed in any other period, but viral clearance was associated with a lower risk (HR = 0.56, 95% CI: 0.32-0.97). CONCLUSIONS Overall screening uptake following cirrhosis diagnosis was low, and the decline in recent years is of concern. The stable bleeding risk over time may be attributable both to ongoing prevention initiatives and to changing diagnostic procedures creating a patient pool with milder disease in more recent years.
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Affiliation(s)
- Scott A McDonald
- School of Health and Life Sciences, Glasgow Caledonian University and Health Protection Scotland, Glasgow, UK
| | | | - Sharon J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University and Health Protection Scotland, Glasgow, UK
| | | | | | - John F Dillon
- School of Medicine, University of Dundee, Dundee, UK
| | - Hamish A Innes
- School of Health and Life Sciences, Glasgow Caledonian University and Health Protection Scotland, Glasgow, UK
| | - Erica Peters
- Queen Elizabeth University Hospital, Glasgow, UK
| | | | | | | | | | - David J Goldberg
- School of Health and Life Sciences, Glasgow Caledonian University and Health Protection Scotland, Glasgow, UK
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Alavi M, Law MG, Valerio H, Grebely J, Amin J, Hajarizadeh B, Selvey C, George J, Dore GJ. Declining hepatitis C virus-related liver disease burden in the direct-acting antiviral therapy era in New South Wales, Australia. J Hepatol 2019; 71:281-288. [PMID: 31078544 DOI: 10.1016/j.jhep.2019.04.014] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 03/27/2019] [Accepted: 04/01/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Population-level evidence for the impact of direct-acting antiviral (DAA) therapy on hepatitis C virus (HCV)-related disease burden is lacking. We aimed to evaluate trends in HCV-related decompensated cirrhosis and hepatocellular carcinoma (HCC) hospitalisation, and liver-related and all-cause mortality in the pre-DAA (2001-2014) and DAA therapy (2015-2017) eras in New South Wales, Australia. METHODS HCV notifications (1993-2016) were linked to hospital admissions (2001-2017) and mortality (1995-2017). Segmented Poisson regressions and Poisson regression were used to assess the impact of DAA era and factors associated with liver-related mortality, respectively. RESULTS Among 99,910 people with an HCV notification, 3.8% had a decompensated cirrhosis diagnosis and 1.8% had an HCC diagnosis, while 3.3% and 10.5% died of liver-related and all-cause mortality, respectively. In the pre-DAA era, the number of decompensated cirrhosis and HCC diagnoses, and liver-related and all-cause mortality consistently increased (incidence rate ratios 1.04 [95% CI 1.04-1.05], 1.08 [95% CI 1.07-1.08], 1.07 [95% CI 1.06-1.07], and 1.05 [95% CI 1.04-1.05], respectively) over each 6-monthly band. In the DAA era, decompensated cirrhosis diagnosis and liver-related mortality numbers declined (incidence rate ratios 0.97 [95% CI 0.95-0.99] and 0.96 [95% CI 0.94-0.98], respectively), and HCC diagnosis and all-cause mortality numbers plateaued (incidence rate ratio 1.00 [95% CI 0.97-1.03] and 1.01 [95% CI 1.00-1.02], respectively) over each 6-monthly band. In the DAA era, alcohol-use disorder (AUD) was common in patients diagnosed with decompensated cirrhosis and HCC (65% and 46% had a history of AUD, respectively). AUD was independently associated with liver-related mortality (incidence rate ratio 3.35; 95% CI 3.14-3.58). CONCLUSIONS In the DAA era, there has been a sharp decline in liver disease morbidity and mortality in New South Wales, Australia. AUD remains a major contributor to HCV-related liver disease burden, highlighting the need to address comorbidities. LAY SUMMARY Rising hepatitis C-related morbidity and mortality is a major public health issue. However, development of highly effective medicines against hepatitis C (called direct-acting antivirals or DAAs) means hepatitis C could be eliminated as a public health threat by 2030. This study shows a sharp decline in liver disease morbidity and mortality since the introduction of DAAs in New South Wales, Australia. Despite this, heavy alcohol use remains an important risk factor for liver disease among people with hepatitis C. To ensure that the benefits of new antiviral treatments are not compromised, management of major comorbidities, including heavy alcohol use must improve among people with hepatitis C.
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Affiliation(s)
- Maryam Alavi
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
| | - Matthew G Law
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Janaki Amin
- Department of Health Systems and Populations, Macquarie University, Sydney, NSW, Australia
| | | | - Christine Selvey
- Communicable Diseases Branch, Health Protection NSW, Sydney, NSW, Australia
| | - Jacob George
- Storr Liver Centre, Westmead Millennium Institute, University of Sydney and Westmead Hospital, Westmead, NSW, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
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18
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Lieveld FI, Smit C, Richter C, van Erpecum KJ, Spanier BWM, Gisolf EH, Vrolijk JM, Siersema PD, Hoepelman AIM, Reiss P, Arends JE. Liver decompensation in HIV/Hepatitis B coinfection in the combination antiretroviral therapy era does not seem increased compared to hepatitis B mono-infection. Liver Int 2019; 39:470-483. [PMID: 30411848 DOI: 10.1111/liv.14000] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 09/28/2018] [Accepted: 10/24/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS HIV/hepatitis B virus (HBV) coinfected subjects are thought to have faster progression to end-stage liver disease (ESLD) than HBV mono-infected subjects. We assessed whether this remains in the current cART-era. METHODS Data from subjects with follow-up completion post-2003 were compared between HIV/HBV coinfected subjects in the Dutch HIV Monitoring database and HBV mono-infected subjects from two centres. The primary outcomes of composite ESLD included portal hypertension, decompensated cirrhosis, hepatocellular carcinoma, liver transplantation and liver-related mortality. Outcomes were analysed using time-dependent cause-specific Cox regression models adjusted for follow-up time and relevant covariates. Subset-analyses were done in subjects with follow-up pre-2003. RESULTS In the 1336 co- vs 742 mono-infected subjects, coinfected subjects had no increased probability for ESLD compared to mono-infected subjects (cHR 0.7 (95% CI 0.4-1.1), but had increased probabilities for all-cause (cHR 7.4 [4.9-11.1]) and liver-related mortality (cHR 3.4 [1.6-7.5]). In the current combined cohort, treatment with tenofovir or entecavir was inversely associated with ESLD, all-cause and liver-related mortality (cHR 0.4 [95% CI 0.3-0.7], cHR 0.003 [0.001-0.01]), cHR 0.007 [0.001-0.05]). Other predictors for ESLD were older age, being of Sub-Sahara African descent, increased alanine aminotransferase levels and hepatitis C virus coinfection. While the probability for all-cause mortality was increased in coinfected subjects, this rate decreased compared to pre-2003 (HR 40.2 (95% CI: 8.7-186.2). CONCLUSIONS HIV/HBV coinfected patients no longer seem to be at increased risk for progression to ESLD compared to HBV mono-infected patients, likely due to widespread use of highly effective cART with dual HBV and HIV activity.
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Affiliation(s)
- Faydra I Lieveld
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Colette Smit
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Clemens Richter
- Department of Internal Medicine and Infectious Diseases, Rijnstate Hospital, Arnhem, The Netherlands
| | - Karel J van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bernhard W M Spanier
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Elisabeth H Gisolf
- Department of Internal Medicine and Infectious Diseases, Rijnstate Hospital, Arnhem, The Netherlands
| | - Jan M Vrolijk
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andy I M Hoepelman
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, The Netherlands.,Department of Global Health, Academic Medical Center and Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Joop E Arends
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
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Yan JY, Li ZQ, Yu ZJ, Kan QC. Management of individuals with chronic hepatitis B virus infection and persistent normal or mildly elevated aminotransferase levels. J Cell Biochem 2018; 120:6632-6641. [PMID: 30368885 DOI: 10.1002/jcb.27959] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 10/02/2018] [Indexed: 12/20/2022]
Abstract
No consensus exists with respect to positive hepatitis B virus (HBV) DNA results and persistent normal or mildly elevated alanine aminotransferase (ALT). The aim of this study is to investigate the appropriate management and prognosis of these populations with chronic hepatitis B (CHB). A total of 235 subjects with positive HBV DNA results and persistent normal or mildly elevated ALT were enrolled in this study. Liver biopsy and liver stiffness measurements (LSM) were performed in all participants at baseline. Antiviral therapy was initiated in patients with significant hepatic inflammation (G ≥ 2) and/or fibrosis (S ≥ 2). The patients were divided into entecavir and adefovir groups based on HBV DNA load (>2000 IU/mL vs <2000 IU/mL). The liver biopsies were repeated at 72 weeks for the patients received antiviral therapy. We found that 112 subjects were hepatitis B e antigen (HBeAg) positive, and 123 subjects were negative. The corresponding median ALTs were 46 (39.5-52.5) and 48 (41.5-57.0) U/mL, respectively. G ≥ 2 and/or S ≥ 2 diseases were present in 48.8% (82/168) of the HBeAg-positive and 51.2% (86/168) of HBeAg-negative patients, respectively. In addition, 96 HBeAg-positive and 72 HBeAg-negative patients were divided into entecavir and adefovir groups. Meanwhile, liver biopsies had greater diagnostic accuracy for determining cirrhosis than LSM (0.711 vs 1.0, P < 0.0001). At the end of the study period, undetectable HBV DNA levels and normal ALT levels were observed in CHB-infected patients. Furthermore, the patients showed histologic improvement at 72 weeks compared with baseline measurements (G, 1.72 ± 1.00 vs 0.73 ± 0.88, P = 0.0002; S, 1.484 ± 0.90 vs 0.99 ± 1.13, P < 0.0001). Collectively, liver biopsy enhanced diagnostic accuracy for CHB-infected individuals with persistent normal or mildly elevated aminotransferase levels. Moreover, antiviral therapy can improve or regress the hepatic fibrosis and cirrhosis.
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Affiliation(s)
- Jing-Ya Yan
- Department of Infectious Disease, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zhi-Qin Li
- Department of Infectious Disease, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zu-Jiang Yu
- Department of Infectious Disease, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Quan-Chen Kan
- Department of Infectious Disease, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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21
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Hajarizadeh B, Grebely J, Matthews GV, Martinello M, Dore GJ. Uptake of direct-acting antiviral treatment for chronic hepatitis C in Australia. J Viral Hepat 2018; 25:640-648. [PMID: 29274192 DOI: 10.1111/jvh.12852] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 11/01/2017] [Indexed: 12/12/2022]
Abstract
A government-funded interferon-free direct-acting antiviral (DAA) treatment programme for chronic hepatitis C virus (HCV) infection has been available in Australia since March 2016. This study assessed the levels and patterns of DAA treatment uptake during March-December 2016 in Australia and described the key features in the development of the programme. All prescriptions in Australia are submitted to the Pharmaceutical Benefits Scheme by dispensing pharmacies. Data on dispensed DAA prescriptions for a longitudinal cohort of individuals, representing a 10% random sample of the Pharmaceutical Benefits Scheme database, were used for estimating DAA treatment uptake and subgroup analyses. The estimated number of 32 400 individuals initiated DAA treatment in 2016, equating to 14% of people with chronic HCV infection in Australia. Most commonly prescribed DAA regimens included sofosbuvir/ledipasvir (56%, n = 18 020), sofosbuvir + daclatasvir (39%, n = 12 600) and sofosbuvir + other agents (4%, n = 1220). Among individuals initiated DAA treatment, 66% (n = 21 430) were men, 43% (n = 13 870) were ≤50 years old and 36% (n = 11 670) had cirrhosis. DAA prescriptions were 62% (n = 20 080) by specialists, 19% (n = 6000) by general practitioners (GP) and 20% (n = 6320) by other physicians. Proportion of individuals prescribed DAA by GPs increased from 8% to 31% and proportion of individuals ≤50 years old increased from 28% to 61% between March and December. In conclusion, rapid treatment scale-up was observed in the first 10 months of unrestricted DAA programme in Australia. The proportion of prescriptions by GPs increased over time, important for broadened access. A trend towards younger age treatment suggested the broadening of DAA-treated population, potentially including individuals at higher risk of HCV transmission.
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Affiliation(s)
- B Hajarizadeh
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - J Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - G V Matthews
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - M Martinello
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - G J Dore
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
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22
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The contribution of alcohol use disorder to decompensated cirrhosis among people with hepatitis C: An international study. J Hepatol 2018; 68:393-401. [PMID: 29107152 DOI: 10.1016/j.jhep.2017.10.019] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/21/2017] [Accepted: 10/07/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS The advent of direct-acting antivirals (DAAs) has led to ambitious targets for hepatitis C virus (HCV) elimination. However, in the context of alcohol use disorder the ability of DAAs to achieve these targets may be compromised. The aim of this study was to evaluate the contribution of alcohol use disorder to HCV-related decompensated cirrhosis in three settings. METHODS HCV notifications from British Columbia, Canada; New South Wales, Australia, and Scotland (1995-2011/2012/2013, respectively) were linked to hospital admissions (2001-2012/2013/2014, respectively). Alcohol use disorder was defined as non-liver-related hospitalisation due to alcohol use. Age-standardised decompensated cirrhosis incidence rates were plotted, associated factors were assessed using Cox regression, and alcohol use disorder-associated population attributable fractions (PAFs) were computed. RESULTS Among 58,487, 84,529, and 31,924 people with HCV in British Columbia, New South Wales, and Scotland, 2,689 (4.6%), 3,169 (3.7%), and 1,375 (4.3%) had a decompensated cirrhosis diagnosis, and 28%, 32%, and 50% of those with decompensated cirrhosis had an alcohol use disorder, respectively. Age-standardised decompensated cirrhosis incidence rates were considerably higher in people with alcohol use disorder in New South Wales and Scotland. Decompensated cirrhosis was independently associated with alcohol use disorder in British Columbia (aHR 1.92; 95% CI 1.76-2.10), New South Wales (aHR 3.68; 95% CI 3.38-4.00) and Scotland (aHR 3.88; 95% CI 3.42-4.40). The PAFs of decompensated cirrhosis-related to alcohol use disorder were 13%, 25%, and 40% in British Columbia, New South Wales and Scotland, respectively. CONCLUSIONS Alcohol use disorder was a major contributor to HCV liver disease burden in all settings, more distinctly in Scotland. The extent to which alcohol use would compromise the individual and population-level benefits of DAA therapy needs to be closely monitored. Countries, where appropriate, must develop strategies combining promotion of DAA treatment uptake with management of alcohol use disorders, if World Health Organization 2030 HCV mortality reduction targets are going to be achieved. LAY SUMMARY The burden of liver disease has been rising among people with hepatitis C globally. The recent introduction of highly effective medicines against hepatitis C (called direct-acting antivirals or DAAs) has brought renewed optimism to the sector. DAA scale-up could eliminate hepatitis C as a public health threat in the coming decades. However, our findings show heavy alcohol use is a major risk factor for liver disease among people with hepatitis C. If continued, heavy alcohol use could compromise the benefits of new antiviral treatments at the individual- and population-level. To tackle hepatitis C as a public health threat, where needed, DAA therapy should be combined with management of heavy alcohol use.
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Kanak MA, Shindo Y, SaiKumar P, Naziruddin B. Role of Inflammasomes in the Development of Gastrointestinal Diseases. EXPERIENTIA SUPPLEMENTUM (2012) 2018; 108:235-268. [PMID: 30536174 DOI: 10.1007/978-3-319-89390-7_10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Many diseases of the gastrointestinal tract have been attributed to chronic inflammation, and a few have identified the role of inflammasomes in their pathogenesis. Inflammasomes are a group of protein complexes comprising of several intracellular proteins that link the sensing of microbial products and metabolic stress to the proteolytic activation of the proinflammatory cytokines. Recent studies have implicated activation of several families of NOD-like receptors (NLRs) which are major components of inflammasomes in the development and exacerbation of many diseases of human systems. In this chapter, we discuss the role of inflammasomes in some of the most prevalent diseases of the gastrointestinal tract and highlight potential targets for treatment.
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Affiliation(s)
- Mazhar A Kanak
- Division of Transplantation, Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Yoshitaro Shindo
- Division of Transplantation, Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | | | - Bashoo Naziruddin
- Sammons Cancer Center, Baylor Simmons Transplant Institute, Dallas, TX, USA.
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Hansen JF, Hallager S, Øvrehus A, Weis N, Brehm Christensen P, Pedersen C. Late Presentation for Care Among Patients With Chronic Hepatitis C: Prevalence and Risk Factors. Open Forum Infect Dis 2017; 5:ofx257. [PMID: 29367939 PMCID: PMC5774505 DOI: 10.1093/ofid/ofx257] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/21/2017] [Indexed: 01/22/2023] Open
Abstract
Patients with chronic hepatitis C may have advanced fibrosis at first evaluation. Using the European Association for the Study of the Liver (EASL) definition (FibroScan® >9.5 kPa) for “late presenter for care” (LP), we found that 32% (169 of 527) of patients were LP. Being a LP was associated with increasing age and a history of alcohol overuse.
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Affiliation(s)
- Janne Fuglsang Hansen
- Department of Infectious Diseases, Odense University Hospital, Denmark.,Clinical Institute, University of Southern Denmark, Odense
| | - Sofie Hallager
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - Anne Øvrehus
- Department of Infectious Diseases, Odense University Hospital, Denmark.,Clinical Institute, University of Southern Denmark, Odense
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.,Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Peer Brehm Christensen
- Department of Infectious Diseases, Odense University Hospital, Denmark.,Clinical Institute, University of Southern Denmark, Odense
| | - Court Pedersen
- Department of Infectious Diseases, Odense University Hospital, Denmark.,Clinical Institute, University of Southern Denmark, Odense
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25
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Samji H, Yu A, Kuo M, Alavi M, Woods R, Alvarez M, Dore GJ, Tyndall M, Krajden M, Janjua NZ. Late hepatitis B and C diagnosis in relation to disease decompensation and hepatocellular carcinoma development. J Hepatol 2017; 67:909-917. [PMID: 28684103 DOI: 10.1016/j.jhep.2017.06.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/27/2017] [Accepted: 06/18/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS We measured the timing of hepatitis B virus (HBV) and hepatitis C virus (HCV) diagnoses relative to the detection of decompensated cirrhosis (DC) and hepatocellular carcinoma (HCC) as an indicator of late hepatitis diagnosis. METHODS HBV and HCV diagnoses were defined relative to the diagnosis of DC or HCC such that HBV/HCV diagnoses within two years prior, at the time of or after HCC or DC diagnosis were considered late. We performed multivariable logistic regression to assess factors associated with late HBV/HCV diagnoses among those with DC or HCC. RESULTS From 1990 to 2012, 778/32,664 HBV cases (2.4%) and 3,925/57,866 HCV cases (6.8%) developed DC while 628/32,644 HBV cases (1.9%) and 902/57,866 HCV cases (1.6%) developed HCC. Among HBV and HCV cases with DC, 49% and 40% respectively were late diagnoses, as were 46% and 31% of HBV and HCV cases with HCC, respectively. HBV late diagnosis declined from 100% in 1992 to 11% and 26% in 2011, while HCV late diagnosis declined from 100% in 1992 to 16% and 14% in 2011 for DC and HCC respectively. In multivariable modelling, late HBV diagnosis was associated with mental illness and a fewer number of physician visits in the five years prior to HBV diagnosis. Late HCV diagnosis was also associated with fewer physician visits, while those with illicit drug use were less likely to be diagnosed late. CONCLUSIONS The proportion of late diagnoses has declined over time. People with better engagement with the healthcare system and with risk activities were diagnosed earlier. Lay summary: Late diagnosis of HBV and HCV represents a missed opportunity to reduce the risk of serious liver disease. Our results identify successes in earlier diagnosis over time using risk-based testing as well as groups that are being missed for screening such as those who do not see a physician regularly and those with serious mental illness.
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Affiliation(s)
- Hasina Samji
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia V5Z 4R4, Canada; University of British Columbia, 2329 West Mall, Vancouver, British Columbia V6T 1Z4, Canada; Simon Fraser University, 8888 University Dr, Burnaby, British Columbia V5A 1S6, Canada
| | - Amanda Yu
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia V5Z 4R4, Canada
| | - Margot Kuo
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia V5Z 4R4, Canada
| | - Maryam Alavi
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, High St, Kensington, NSW 2052, Australia
| | - Ryan Woods
- BC Cancer Agency, 600 W 10th Ave, Vancouver, British Columbia V5Z 4E6, Canada
| | - Maria Alvarez
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia V5Z 4R4, Canada
| | - Gregory J Dore
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, High St, Kensington, NSW 2052, Australia
| | - Mark Tyndall
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia V5Z 4R4, Canada; University of British Columbia, 2329 West Mall, Vancouver, British Columbia V6T 1Z4, Canada
| | - Mel Krajden
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia V5Z 4R4, Canada; University of British Columbia, 2329 West Mall, Vancouver, British Columbia V6T 1Z4, Canada
| | - Naveed Z Janjua
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia V5Z 4R4, Canada; University of British Columbia, 2329 West Mall, Vancouver, British Columbia V6T 1Z4, Canada.
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26
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Waziry R, Grebely J, Amin J, Alavi M, Hajarizadeh B, George J, Matthews GV, Law M, Dore GJ. Survival following hospitalization with hepatocellular carcinoma among people notified with hepatitis B or C virus in Australia (2000-2014). Hepatol Commun 2017; 1:736-747. [PMID: 29404490 PMCID: PMC5678911 DOI: 10.1002/hep4.1073] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/27/2017] [Accepted: 06/29/2017] [Indexed: 12/23/2022] Open
Abstract
We assessed trends in HCC survival in patients with hepatitis B virus (HBV) or hepatitis C virus (HCV) infection in New South Wales, Australia. Data on HBV (n = 54,399) and HCV (n = 96,908) notifications (1993‐2012) were linked to a hospitalization database (July 2000‐June 2014), the New South Wales Cancer Registry, and the New South Wales Death Registry. A total of 725 (1.3%) first HBV‐hepatocellular carcinoma (HCC) and 1,309 (1.4%) first HCV‐HCC hospitalizations were included. Death occurred in 60.4% of HBV‐HCC and 69.6% of HCV‐HCC patients. Median survival following first HBV‐HCC hospitalization improved from 0.6 years (95% confidence interval [CI] 0.39‐1.28) in 2000‐2004 to 2.8 years (1.54‐5.54) in 2010‐2014. Median survival following first HCV‐HCC hospitalization was 0.8 years (0.45‐1.33) in 2000‐2004 and 0.9 (0.67‐1.18) in 2010‐2014. One‐year HBV‐HCC survival in 2010‐2014 compared to 2000‐2004 improved for those with (94% versus 81%) and without (42% versus 33%) potentially curative procedures (liver resection, liver transplantation, and radiofrequency ablation). Factors associated with improved survival following HBV‐HCC were later study period (hazard ratio [HR] = 0.74; 95% CI, 0.57‐0.97) and potentially curative procedures (liver resection, liver transplantation, and radiofrequency ablation) (HR = 0.23; 95% CI, 0.17‐0.29), while male gender (HR = 1.37; 95% CI, 1.03‐1.82), human immunodeficiency virus coinfection (HR = 3.06; 95% CI, 1.36‐6.88), and Charlson Comorbidity Index ≥3 (HR = 1.81; 95% CI, 1.35‐2.40) were associated with reduced survival. Factors associated with improved survival following HCC‐HCV were Asia‐Pacific country of birth (HR = 0.68; 95% CI, 0.55‐0.84) and potentially curative procedures (HR = 0.21; 95% CI, 0.17‐0.25), while age (HR = 1.01; 95% CI, 1.01‐1.02), rural place of residence (HR = 1.46; 95% CI, 1.22‐1.74), and human immunodeficiency virus coinfection (HR = 2.71; 95% CI, 1.19‐6.15) were associated with reduced survival. Conclusion: All‐cause survival following HBV‐HCC has improved considerably, suggesting an impact of more effective antiviral therapy and earlier HCC diagnosis; in contrast, all‐cause survival for HCV‐HCC is unchanged. (Hepatology Communications 2017;1:736–747)
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Affiliation(s)
- Reem Waziry
- The Kirby Institute UNSW Sydney Sydney Australia
| | | | - Janaki Amin
- Faculty of Medicine and Health Sciences Macquarie University Sydney Australia
| | - Maryam Alavi
- The Kirby Institute UNSW Sydney Sydney Australia
| | | | - Jacob George
- Storr Liver Unit Westmead Millennium Institute and Westmead Hospital, University of Sydney Sydney Australia
| | | | - Matthew Law
- The Kirby Institute UNSW Sydney Sydney Australia
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27
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Brown CR, Allard NL, MacLachlan JH, Cowie BC. Deaths from liver cancer continue to rise in Australia: is elimination by 2030 possible? Intern Med J 2017; 47:604-605. [DOI: 10.1111/imj.13393] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 12/12/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Chelsea R. Brown
- WHO Collaborating Centre for Viral Hepatitis, Victorian Infectious Diseases Reference Laboratory; Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity; Melbourne Victoria Australia
| | - Nicole L. Allard
- WHO Collaborating Centre for Viral Hepatitis, Victorian Infectious Diseases Reference Laboratory; Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity; Melbourne Victoria Australia
- Department of Medicine; University of Melbourne; Melbourne Victoria Australia
| | - Jennifer H. MacLachlan
- WHO Collaborating Centre for Viral Hepatitis, Victorian Infectious Diseases Reference Laboratory; Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity; Melbourne Victoria Australia
- Department of Medicine; University of Melbourne; Melbourne Victoria Australia
| | - Benjamin C. Cowie
- WHO Collaborating Centre for Viral Hepatitis, Victorian Infectious Diseases Reference Laboratory; Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity; Melbourne Victoria Australia
- Department of Medicine; University of Melbourne; Melbourne Victoria Australia
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28
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Ahn J, Liu B, Bhuket T, Wong RJ. Race/Ethnicity-Specific Outcomes Among Chronic Hepatitis C Virus Patients Listed for Liver Transplantation. Dig Dis Sci 2017; 62:1051-1057. [PMID: 28168576 DOI: 10.1007/s10620-017-4469-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 01/20/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic hepatitis C virus (HCV) infection is a leading cause of hepatocellular carcinoma (HCC) and need for liver transplantation (LT). It is unclear if HCV-related LT outcomes vary by race/ethnicity. AIMS We aim to evaluate ethnic disparities specifically among patients with chronic HCV in the USA. METHODS Using data from the United Network for Organ Sharing 2003-2013 LT registry, we evaluated race/ethnicity-specific disparities in LT waitlist survival and probability of receiving LT among chronic HCV patients listed for LT. RESULTS Among 43,478 HCV patients listed for LT (70.0% non-Hispanic white, 10.8% black, 16.3% Hispanic, 2.9% Asian), HCV-related LT waitlist registrations increased by 21.5% from 2003 to 2013. During this period, the proportion of HCV patients with HCC increased by 237%, and in 2013, HCV patients with HCC accounted for 33.0% of HCV-related waitlist registrations. When stratified by race/ethnicity, Hispanics with HCV had significantly lower waitlist mortality (OR 0.83; 95% CI 0.74-0.94; p < 0.01) compared to non-Hispanic whites, but no significant differences were seen among blacks and Asians. Furthermore, compared to non-Hispanic whites, Hispanics were significantly less likely to receive LT (OR 0.58; 95% CI 0.53-0.62; p < 0.001), but no differences were seen among blacks or Asians. CONCLUSION Among patients with chronic HCV in the USA, the MELD score has reduced race/ethnicity-specific disparities in waitlist mortality. However, Hispanic HCV patients had significantly better waitlist survival and lower probability of receiving LT, possibly reflecting slower disease progression compared to non-Hispanic whites with chronic HCV.
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Affiliation(s)
- Joseph Ahn
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Benny Liu
- Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, Highland Hospital - Highland Care Pavilion 5th Floor, Endoscopy Unit, 1411 East 31st Street, Oakland, CA, 94602, USA
| | - Taft Bhuket
- Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, Highland Hospital - Highland Care Pavilion 5th Floor, Endoscopy Unit, 1411 East 31st Street, Oakland, CA, 94602, USA
| | - Robert J Wong
- Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, Highland Hospital - Highland Care Pavilion 5th Floor, Endoscopy Unit, 1411 East 31st Street, Oakland, CA, 94602, USA.
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