1
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Krings A, Schmidt D, Meixenberger K, Bannert N, Münstermann D, Tiemann C, Kollan C, Gunsenheimer-Bartmeyer B. Decreasing prevalence and stagnating incidence of Hepatitis C-co-infection among a cohort of HIV-1-positive patients, with a majority of men who have sex with men, in Germany, 1996-2019. J Viral Hepat 2022; 29:465-473. [PMID: 35302675 DOI: 10.1111/jvh.13670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/08/2022] [Accepted: 02/16/2022] [Indexed: 12/09/2022]
Abstract
Co-infection with Hepatitis C virus (HCV) among HIV-positive patients leads to accelerated progression of liver disease and AIDS. Due to increased HCV prevalence and incidence, co-infection requires monitoring trends among HIV-positive individuals. This will help target prevention strategies and support to reach the global goals of eliminating viral hepatitis as a public health threat. In this analysis HCV prevalence and incidence were determined for the years 1996-2019 from yearly blood samples and questionnaire details among HIV-1-positive patients, with a majority of men who have sex with men, belonging to a nationwide, multicentre observational, prospective cohort study. The results show that HCV prevalence for acute/chronic and resolved infection increased until 2014 to 12%. Since then, prevalence of acute/chronic HCV infection rapidly decreased and prevalence of resolved infections showed a steady increase. HCV incidence was highest in 2010 and lowest in 2017; however, no significant change in HCV incidence could be seen over the years. Therefore, the introduction of directly-acting antiviral agents for HCV treatment notably decreased prevalence and potentially incidence of acute/chronic HCV infection. Nevertheless, prevalence and incidence of HCV among these HIV-1-positive study participants remain high compared with the general population and justify the need for continuous HCV prevention and treatment efforts among HIV-positive individuals.
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Affiliation(s)
- Amrei Krings
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.,Postgraduate Training for Applied Epidemiology, Robert Koch Institute, Berlin, Germany.,European Program for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Daniel Schmidt
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | | | - Norbert Bannert
- Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | | | | | - Christian Kollan
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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2
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Dudareva S, Faber M, Zimmermann R, Bock CT, Offergeld R, Steffen G, Enkelmann J. [Epidemiology of viral hepatitis A to E in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:149-158. [PMID: 35029725 PMCID: PMC8758919 DOI: 10.1007/s00103-021-03478-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/08/2021] [Indexed: 12/18/2022]
Abstract
Viral hepatitis A to E describes various infectious inflammations of the liver parenchyma that are caused by the hepatitis viruses A to E (HAV, HBV, HCV, HDV, and HEV). Although the clinical pictures are similar, the pathogens belong to different virus families and differ in terms of pathogenesis, transmission routes, clinical course, prevention, and therapy options. In Germany, there is mandatory reporting according to the Infection Protection Act (IfSG) for direct or indirect laboratory evidence and for suspicion, illness, and death of viral hepatitis. The data are transmitted to the Robert Koch Institute.In this article, on the basis of published studies and notification data, we describe the epidemiology of hepatitis A to E as well as current challenges and prevention approaches. In particular, the latter contains the improvement of existing vaccination recommendations (hepatitis A and B); improvement of access to prevention, testing, and care including therapy with antiviral drugs (hepatitis B, C, and D) and the detection and prevention of foodborne infections and outbreaks; and improvements in the field of food safety (hepatitis A and E).
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Affiliation(s)
- Sandra Dudareva
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland.
| | - Mirko Faber
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Ruth Zimmermann
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - C-Thomas Bock
- Abteilung für Infektionskrankheiten, Robert Koch-Institut, Berlin, Deutschland
| | - Ruth Offergeld
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Gyde Steffen
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Julia Enkelmann
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
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3
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Hüppe D, Stoehr A, Buggisch P, Mauss S, Klinker H, Teuber G, Hidde D, Lohmann K, Bondin M, Wedemeyer H. The changing characteristics of patients infected with chronic hepatitis C virus from 2014 to 2019: Real-world data from the German Hepatitis C-Registry (DHC-R). J Viral Hepat 2021; 28:1474-1483. [PMID: 34339561 DOI: 10.1111/jvh.13586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/13/2021] [Accepted: 07/24/2021] [Indexed: 12/26/2022]
Abstract
The number of patients diagnosed with hepatitis C virus (HCV) is markedly higher than the number initiating treatment indicating gaps in the care cascade, likely centred around reaching at-risk populations. Understanding changing characteristics of patients with HCV allows for targeted programs that increase linkage to care. We investigated changes in demographic and clinical characteristics of patients registered in the German Hepatitis C-Registry (DHC-R) from 1 January 2014 to 31 December 2019. The DHC-R is an ongoing, noninterventional, multicentre, prospective, observational cohort registry including 327 German centres. Patient characteristics were analysed over time in 7 phases for all patients completing a screening visit. Overall, 14,357 patients were enrolled. The percentage of treatment-naïve/non-cirrhotic patients increased from 34.4% in phase 1 (1 January-31 December 2014) to 68.2% in phase 7 (1 August-31 December 2019). The proportion of migrants, alcohol users, people who inject drugs, and those receiving opiate substitution therapy increased in later registry phases. Most patients (60.1%) were receiving comedication at baseline. The most prescribed comedications were drugs used to treat opioid dependence which increased from 9.2% in phase 1 to 24.0% in phase 7. The patients' mean age decreased from 52.3 years in phase 1 to 48.7 years in phase 7. From 2014 to 2019, the proportion of at-risk patients enrolling in the registry increased. To eliminate viral hepatitis as a major public health threat, a continued commitment to engaging underserved populations into the HCV care cascade is needed.
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Affiliation(s)
- Dietrich Hüppe
- Gastroenterologische Gemeinschaftspraxis Herne, Herne, Germany
| | | | - Peter Buggisch
- Institut für Interdisziplinäre Medizin, Hamburg, Germany
| | - Stefan Mauss
- Centre for HIV and Hepatogastroenterology, Duesseldorf, Germany
| | - Hartwig Klinker
- Medizinische Klinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | | | - Dennis Hidde
- AbbVie Germany GmbH & Co. KG, Wiesbaden, Germany
| | | | | | - Heiner Wedemeyer
- Leberstiftungs-GmbH Deutschland, Hannover, Germany.,Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany.,Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
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4
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Westermann C, Wendeler D, Nienhaus A. Hepatitis C in healthcare personnel: follow-up analysis of treatments with direct-acting antiviral agents. J Occup Med Toxicol 2021; 16:34. [PMID: 34429125 PMCID: PMC8383415 DOI: 10.1186/s12995-021-00320-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 07/26/2021] [Indexed: 12/15/2022] Open
Abstract
Background Hepatitis C infections (HCV) are associated with an increase in morbidity and mortality. The aim of this study is to update the results of treatment with direct-acting antiviral agents (DAAs) using a larger population of healthcare personnel (HP) and a longer observation period. Methods Secondary data analysis of DAA treatment administered to HP (with confirmed occupational acquired HCV infection) between 1 January 2014 and 30 December 2018, is based on statutory accident insurance data from Germany. The end points of the study were results of a monitoring carried out 12 and 24 weeks after the end of treatment (sustained virological response, SVR), as well as side effects and the assessment of reduced work ability after treatment. Multivariate logistic regression models were constructed to investigate predictors of SVR. Results The study population (n = 305) mainly comprised HP with a genotype 1 infection. The average age was 63 (SD 10) and 77% were female. Two thirds of the HP suffered from fibrosis or cirrhosis, and had experience of treatment. Statistically, men were significantly more likely to suffer from cirrhosis than women (60% compared to 21%, p < 0.001). The end-of-treatment response (ETR) rate was 99% and the SVR12 and SVR24 rates were 98%. Liver cirrhosis proved to be a predictor of a statistically significant reduction in success rates. Conclusion DAA treatment leads to high SVR. Early HCV treatment is associated with higher SVR. Supplementary Information The online version contains supplementary material available at 10.1186/s12995-021-00320-4.
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Affiliation(s)
- Claudia Westermann
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf (UKE), Martinistr. 52, 20146, Hamburg, Germany.
| | - Dana Wendeler
- Department for Occupational Medicine, Hazardous Substances and Public Health (AGG), German Social Accident Insurance, Institution for the Health and Welfare Services (BGW), Pappelallee 33-37, 22089, Hamburg, Germany
| | - Albert Nienhaus
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf (UKE), Martinistr. 52, 20146, Hamburg, Germany.,Department for Occupational Medicine, Hazardous Substances and Public Health (AGG), German Social Accident Insurance, Institution for the Health and Welfare Services (BGW), Pappelallee 33-37, 22089, Hamburg, Germany
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5
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Sarrazin C, Boesecke C, Golsabahi‐Broclawski S, Moog G, Negro F, Silaidos C, Patel P, Lohmann K, Spinner CD, Walcher S, Wedemeyer H, Wörns M. Hepatitis C virus: Current steps toward elimination in Germany and barriers to reaching the 2030 goal. Health Sci Rep 2021; 4:e290. [PMID: 34136654 PMCID: PMC8177898 DOI: 10.1002/hsr2.290] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/24/2021] [Accepted: 04/13/2021] [Indexed: 11/25/2022] Open
Abstract
Hepatitis C virus (HCV) affects over 70 million people globally, with an estimated 399 000 HCV-related deaths in 2016. The World Health Organization (WHO) has set a goal to eliminate HCV by 2030. Despite the availability of direct-acting antivirals-highly effective and well-tolerated therapies for HCV-many patients infected with HCV in Germany have not initiated treatment, including a majority of those who are aware of their positive diagnosis. Barriers to screening, diagnosis, and treatment are major factors taking many countries off track for HCV elimination by 2030. Identifying country-specific barriers and challenges, particularly in at-risk populations such as people who inject drugs or men who have sex with men, has the potential to create tailored programs and strategies to increase access to screening or treatment and engage at-risk populations. This review aims to report the current steps toward HCV elimination in Germany, the country-specific barriers and challenges that will potentially prevent reaching the 2030 HCV elimination goal and describe good practice examples to overcome these barriers.
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Affiliation(s)
- Christoph Sarrazin
- Department of Internal Medicine and Liver CenterSt. Josefs‐Hospital Wiesbaden and Viral Hepatitis Research Group, Goethe‐University Hospital FrankfurtFrankfurtGermany
| | - Christoph Boesecke
- Department of Medicine IUniversity Hospital BonnBonnGermany
- German Centre for Infection Research (DZIF)Partner‐site Bonn‐CologneBonnGermany
| | | | - Gero Moog
- Gastroenterologische Praxis im MarienkrankenhausKasselGermany
| | - Francesco Negro
- Divisions of Gastroenterology and Hepatology and of Clinical PathologyGeneva University HospitalsGenevaSwitzerland
| | | | | | | | - Christoph D. Spinner
- Department of Internal Medicine II, School of Medicine, University Hospital Rechts der IsarTechnical University of MunichMunichGermany
- German Centre for Infection Research (DZIF), Partner Site MunichMunichGermany
| | | | - Heiner Wedemeyer
- Department of GastroenterologyHepatology and Endocrinology, Hannover Medical SchoolHannoverGermany
- Leberstiftungs‐GmbH DeutschlandHannoverGermany
| | - Marcus‐Alexander Wörns
- First Department of MedicineUniversity Medical Centre of the Johannes Gutenberg‐UniversityMainzGermany
- Cirrhosis Centre Mainz (CCM)University Medical Centre of the Johannes Gutenberg‐UniversityMainzGermany
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6
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Buggisch P, Heiken H, Mauss S, Weber B, Jung MC, Görne H, Heyne R, Hinrichsen H, Hidde D, König B, Pires dos Santos AG, Niederau C, Berg T. Barriers to initiation of hepatitis C virus therapy in Germany: A retrospective, case-controlled study. PLoS One 2021; 16:e0250833. [PMID: 33970940 PMCID: PMC8109809 DOI: 10.1371/journal.pone.0250833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/14/2021] [Indexed: 01/18/2023] Open
Abstract
Despite the availability of highly effective and well-tolerated direct-acting antivirals, not all patients with chronic hepatitis C virus infection receive treatment. This retrospective, multi-centre, noninterventional, case-control study identified patients with chronic hepatitis C virus infection initiating (control) or not initiating (case) treatment at 43 sites in Germany from September 2017 to June 2018. It aimed to compare characteristics of the two patient populations and to identify factors involved in patient/physician decision to initiate/not initiate chronic hepatitis C virus treatment, with a particular focus on historical barriers. Overall, 793 patients were identified: 573 (72%) who received treatment and 220 (28%) who did not. In 42% of patients, the reason for not initiating treatment was patient wish, particularly due to fear of treatment (17%) or adverse events (13%). Other frequently observed reasons for not initiating treatment were in accordance with known historical barriers for physicians to initiate therapy, including perceived or expected lack of compliance (14.5%), high patient age (10.9%), comorbidities (15.0%), alcohol abuse (9.1%), hard drug use (7.7%), and opioid substitution therapy (4.5%). Patient wish against therapy was also a frequently reported reason for not initiating treatment in the postponed (35.2%) and not planned (47.0%) subgroups; of note, known historical factors were also common reasons for postponing treatment. Real-world and clinical trial evidence is accumulating, which suggests that such historical barriers do not negatively impact treatment effectiveness. Improved education is key to facilitate progress towards the World Health Organization target of eliminating viral hepatitis as a major public health threat by 2030.
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Affiliation(s)
- Peter Buggisch
- ifi-Institute for Interdisciplinary Medicine, Hamburg, Germany
| | | | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Düsseldorf, Germany
| | - Bernd Weber
- Praxiszentrum Friedrichsplatz / Competence Center Addiction, Kassel, Germany
| | | | - Herbert Görne
- MediZentrum Hamburg, Praxis für Suchtmedizin, Hamburg, Germany
| | | | | | - Dennis Hidde
- AbbVie Deutschland GmbH & Co. KG, Wiesbaden, Germany
| | - Bettina König
- AbbVie Deutschland GmbH & Co. KG, Wiesbaden, Germany
| | | | - Claus Niederau
- Katholisches Klinikum Oberhausen, St. Josef-Hospital, Klinik für Innere Medizin, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Oberhausen, Germany
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
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7
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[How to assess the elimination of viral hepatitis B, C, and D in Germany? Outcomes of an interdisciplinary workshop]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 64:77-90. [PMID: 33326051 PMCID: PMC7772161 DOI: 10.1007/s00103-020-03260-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/20/2020] [Indexed: 12/15/2022]
Abstract
Hintergrund Die Weltgesundheitsorganisation (WHO) hat 2016 eine Strategie zur Eliminierung von Hepatitis-B-, -C- und -D-Virusinfektionen verfasst und Indikatoren zum Monitoring des Fortschritts definiert. Das Robert Koch-Institut hat 2019 ein interdisziplinäres Arbeitstreffen zur Verbesserung der Datenlage veranstaltet. Ziele Ziele waren die Vernetzung der Akteure, die Erstellung einer Übersicht zu den in Deutschland vorhandenen Datenquellen zu Hepatitis B, C und D und die Diskussion methodischer Aspekte. Material und Methoden Die für Deutschland relevanten WHO-Indikatoren wurden extrahiert und es wurde bestimmt, wie diese anhand vorliegender Daten konstruiert werden können. Bei dem Arbeitstreffen mit AkteurInnen aus dem öffentlichen Gesundheitsdienst, aus Kliniken, Laboren, von Krankenkassen, Forschungsinstituten, Datenhaltern und Registern wurden in Arbeitsgruppen Erhebungsmethoden diskutiert, welche dazu dienen können, fehlende Daten zu ermitteln. Die Datenquellen und Daten wurden hinsichtlich Qualität, Vollständigkeit sowie praktischer Umsetzbarkeit evaluiert und priorisiert. Ergebnisse Für die Allgemeinbevölkerung können die Indikatoren zu Prävention, Testung, Diagnose, Behandlung, Heilung, Folgeschäden und Mortalität aus Diagnose‑, Versorgungs- und Registerdaten, Daten aus Laboren und klinischen Zentren sowie einzelnen Studien konstruiert werden. Datenquellen für vulnerable Gruppen beschränken sich auf einzelne Studien zu Drogengebrauchenden, Männern, die Sex mit Männern haben, und HIV-Ko-Infizierten. Daten für MigrantInnen, Inhaftierte und SexarbeiterInnen sind kaum verfügbar; ebenso fehlen aktuelle Daten zur Krankheitslast chronischer Hepatitisinfektionen in der Allgemeinbevölkerung. Diskussion Für alle ausgewählten Indikatoren konnten Datenquellen, ihre Besonderheiten und Limitationen identifiziert werden. Im nächsten Schritt gilt es, die entwickelten Ideen in konkrete Projekte mit einzelnen Datenhaltern umzusetzen. Zusatzmaterial online Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00103-020-03260-2) enthalten.
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8
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Runge M, Krensel M, Westermann C, Bindl D, Nagels K, Augustin M, Nienhaus A. Cost-Effectiveness Analysis of Direct-Acting Antiviral Agents for Occupational Hepatitis C Infections in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E440. [PMID: 31936470 PMCID: PMC7013637 DOI: 10.3390/ijerph17020440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 02/07/2023]
Abstract
Around 1% of the world's population is infected with hepatitis C. The introduction of new direct-acting antiviral agents (DAAs) in 2014 has substantially improved hepatitis C treatment outcomes. Our objective was to evaluate the long-term cost effectiveness of DAAs in health care personnel (HP) with confirmed occupational diseases in Germany. A standardised database from a German statutory accident insurance was used to analyse the cost-effectiveness ratio for the DAA regimen in comparison with interferon-based triple therapies. Taking account of the clinical progression of the disease, a Markov model was applied to perform a base case analysis for a period of 20 years. The robustness of the results was determined using a univariate deterministic sensitivity analysis. The results show that treatment with DAAs is more expensive, but also more effective than triple therapies. The model also revealed that the loss of 3.23 life years can be averted per patient over the 20 years. Compared to triple therapies, DAA treatment leads to a higher sustained virologic response (SVR). Although this results in a decrease of costs in the long term, e.g., pension payments, DAA therapy will cause greater expense in the future due to the high costs of the drugs.
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Affiliation(s)
- Melanie Runge
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), University Medical Centre Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany; (M.R.); (A.N.)
| | - Magdalene Krensel
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany; (M.K.); (M.A.)
| | - Claudia Westermann
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), University Medical Centre Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany; (M.R.); (A.N.)
| | - Dominik Bindl
- Chair of Healthcare Management and Health Services Research, University of Bayreuth, 95445 Bayreuth, Germany; (D.B.); (K.N.)
| | - Klaus Nagels
- Chair of Healthcare Management and Health Services Research, University of Bayreuth, 95445 Bayreuth, Germany; (D.B.); (K.N.)
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany; (M.K.); (M.A.)
| | - Albert Nienhaus
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), University Medical Centre Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany; (M.R.); (A.N.)
- Department of Occupational Medicine, Hazardous Substances and Public Health, Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), 22089 Hamburg, Germany
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9
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Martinello M, Yee J, Bartlett SR, Read P, Baker D, Post JJ, Finlayson R, Bloch M, Doyle J, Shaw D, Hellard M, Petoumenos K, Lin L, Marks P, Applegate T, Dore GJ, Matthews GV. Moving Towards Hepatitis C Microelimination Among People Living With Human Immunodeficiency Virus in Australia: The CEASE Study. Clin Infect Dis 2019; 71:1502-1510. [DOI: 10.1093/cid/ciz985] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/02/2019] [Indexed: 12/19/2022] Open
Abstract
Abstract
Background
Microelimination of hepatitis C virus (HCV) among people living with human immunodeficiency virus (HIV) may be feasible in Australia, given unrestricted access to direct-acting antiviral (DAA) therapy from 2016. Our aim was to evaluate progress towards elimination goals within HIV/HCV-coinfected adults in Australia following universal DAA access.
Methods
The CEASE prospective cohort study enrolled adults with HIV/HCV, irrespective of viremic status, from 14 primary and tertiary clinics in Australia. Annual and cumulative HCV treatment uptake, outcome, and HCV RNA prevalence were evaluated, with follow-up through May 2018 (median follow-up, 2.63 years). Factors associated with DAA uptake were analyzed.
Results
Between July 2014 and March 2017, 402 participants who were HIV/HCV antibody positive were enrolled (95% male [80% gay and bisexual men,], 13% cirrhosis, 80% history of injecting drug use [39% currently injecting]). Following universal DAA access, annual HCV treatment uptake in those eligible increased from 7% and 11% per year in 2014 and 2015, respectively, to 80% in 2016. By 2018, cumulative HCV treatment uptake in those ever eligible for treatment was 91% (336/371). HCV viremic prevalence declined from 82% (95% CI, 78–86%) in 2014 to 8% (95% CI, 6–12%) in 2018. Reinfection was reported in only 5 participants for a reinfection incidence of 0.81 per 100 person-years (95% CI, 0.34–1.94).
Conclusions
High uptake and effectiveness of unrestricted DAA therapy in Australia have permitted rapid treatment scale-up, with a dramatic reduction in HCV infection burden and low reinfection rate among people living with HIV, suggesting that microelimination is feasible.
Clinical Trials Registration
NCT02102451.
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Affiliation(s)
- Marianne Martinello
- The Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
- St Vincent’s Hospital, Sydney, New South Wales, Australia
- Blacktown Mt Druitt Hospital, Blacktown, New South Wales, Australia
| | - Jasmine Yee
- The Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Sofia R Bartlett
- The Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Phillip Read
- Kirketon Road Clinic, Sydney, New South Wales, Australia
| | - David Baker
- East Sydney Doctors, Sydney, New South Wales, Australia
| | - Jeffrey J Post
- The Albion Centre, Sydney, New South Wales, Australia
- Prince of Wales Hospital, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Robert Finlayson
- Taylor Square Private Clinic, Sydney, New South Wales, Australia
| | - Mark Bloch
- Holdsworth House Medical Practice, Sydney, New South Wales, Australia
| | - Joseph Doyle
- Burnet Institute, Melbourne, Victoria, Australia
| | - David Shaw
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, Victoria, Australia
- Alfred Hospital, Melbourne, Victoria, Australia
| | - Kathy Petoumenos
- The Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Lanni Lin
- The Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Philippa Marks
- The Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Tanya Applegate
- The Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Gregory J Dore
- The Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
- St Vincent’s Hospital, Sydney, New South Wales, Australia
| | - Gail V Matthews
- The Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
- St Vincent’s Hospital, Sydney, New South Wales, Australia
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10
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Ridruejo E, Cheinquer H, Marciano S, Mendizabal M, Piñero F, Wolff FH, de Araujo A, Coelho Borges S, Kliemann D, Fleck A, de Maman Í, Nader LA, Garrastazul P, Bermúdez C, Haddad L, Gadano A, Silva M. B.A.R.C.O.S. (Brazilian Argentine Hepatitis C Collaborative Observational Study): Effectiveness and clinical outcomes of HCV treatment with daclatasvir and sofosbuvir with or without ribavirin. J Viral Hepat 2019; 26:1200-1209. [PMID: 31141239 DOI: 10.1111/jvh.13148] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/17/2019] [Accepted: 05/14/2019] [Indexed: 12/22/2022]
Abstract
Real-world data evaluating the effectiveness of direct-acting antivirals (DAAs) in hepatitis C virus (HCV) treatment have been reported from different regions. Our aim was to evaluate the effectiveness and clinical outcomes of daclatasvir (DCV) and sofosbuvir (SOF) ± ribavirin (RBV) in a prospective multicentre cohort study including patients from Argentina and Brazil who received DCV/SOF ± RBV for 12 or 24 weeks from 2015 to 2018. Multivariable logistic regression models were carried out to identify factors associated with failure to achieve sustained virologic response (SVR) as a primary end point, and to death, decompensation, hepatocellular carcinoma (HCC) or liver transplantation (LT) as a composite secondary end point. From a total of 1517 patients treated with DCV/SOF, 906 completed 12 weeks post-treatment evaluation and were included in the analysis. Overall SVR12 rate was 96.1% (95% CI: 94.6%-97.2%), and 95% (95% CI: 92.8%-96.6%) in patients with cirrhosis. LT recipients and presence of cirrhosis were independently associated with failure to achieve SVR. During post-SVR12 follow-up, cumulative incidence of the secondary end point was 2.4% (95% CI: 1.5%-3.6%); two patients died from nonliver-related causes and two from HCC, five underwent LT, 12 developed HCC and 17 patients developed hepatic decompensation. Independent variables associated with these composite secondary end points were prior to HCV treatment and presence of cirrhosis. In conclusion, although the high pangenotypic effectiveness of DCV/SOF ± RBV was confirmed in our real-life cohort, patients with compensated and decompensated cirrhosis showed higher risk of non-SVR and complication appearance during treatment or after achieving SVR.
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Affiliation(s)
- Ezequiel Ridruejo
- Hepatology Section, Department of Medicine, Centro de Educación Médica e Investigaciones Clínicas, Norberto Quirno 'CEMIC', Buenos Aires, Argentina.,Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Presidente Derqui, Buenos Aires, Argentina.,Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina
| | - Hugo Cheinquer
- Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina.,Gastroenterology and Hepatology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Sebastián Marciano
- Liver Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.,Research Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Manuel Mendizabal
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Presidente Derqui, Buenos Aires, Argentina.,Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina
| | - Federico Piñero
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Presidente Derqui, Buenos Aires, Argentina.,Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina
| | - Fernando H Wolff
- Gastroenterology and Hepatology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Alexandre de Araujo
- Gastroenterology and Hepatology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Silvia Coelho Borges
- Gastroenterology and Hepatology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Dimas Kliemann
- Gastroenterology and Hepatology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Alfeu Fleck
- Gastroenterology and Hepatology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Ítalo de Maman
- Gastroenterology and Hepatology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Lysandro A Nader
- Gastroenterology and Hepatology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Patricia Garrastazul
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Presidente Derqui, Buenos Aires, Argentina
| | - Carla Bermúdez
- Liver Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Leila Haddad
- Liver Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Adrián Gadano
- Liver Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.,Research Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Marcelo Silva
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Presidente Derqui, Buenos Aires, Argentina.,Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina
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11
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Mattlinger C, Thumfart JO, Heinen W, Michels H, Berres M, Vogt M, Jansky M. [Hepatitis C virus seroprevalence and dependency on country of origin of refugees in Rhineland-Palatinate, Germany in 2015]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 61:1472-1480. [PMID: 30225596 DOI: 10.1007/s00103-018-2816-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Hepatitis C, a liver disease transmitted by the hepatitis C virus (HCV), can result in liver cirrhosis and hepatocellular carcinoma (HCC). According to WHO estimates for 2015, approximately 71 million people worldwide are chronically infected with HCV, representing 1% of the world population. Worldwide migration movements lead to immigration from HCV high- to low-prevalence countries. There are, however, no published data available on HCV seroprevalence and its correlation with the country of origin in current unselected larger refugee populations (>1000 people) having entered Europe/Germany. OBJECTIVES Documentation and evaluation of hepatitis C seroprevalence and its correlation with the country of origin of refugees in Rhineland-Palatinate/Germany in 2015. METHODS As part of routine diagnostics during the initial medical examination, 12,880 refugees in Rhineland-Palatinate were screened for HCV antibodies in 2015. The data have been analyzed retrospectively and anonymously. RESULTS The collective comprising 12,880 refugees showed a HCV seroprevalence of 1.5%. This is higher than the HCV prevalence of the general German population (0.5%). In particular, a correlation between HCV seroprevalence and the country of origin could be demonstrated. CONCLUSIONS To reach the 2030 HCV-elimination target of the WHO, national and international recommendations to screen refugees/migrants from HCV high-prevalence countries for HCV should be emphasized. The chronically infected should be treated in accordance with HCV-guidelines. National, easily accessible information on HCV high-prevalence countries is required by attending physicians.
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Affiliation(s)
- Christina Mattlinger
- Zentrum für Allgemeinmedizin und Geriatrie, Abteilung Allgemeinmedizin, Universitätsmedizin Mainz, Am Pulverturm 13, 55131, Mainz, Deutschland.
| | | | - Wilma Heinen
- Gesundheitsamt der Kreisverwaltung Trier-Saarburg, Trier, Deutschland
| | - Harald Michels
- Gesundheitsamt der Kreisverwaltung Trier-Saarburg, Trier, Deutschland
| | - Manfred Berres
- RheinAhrCampus Remagen, Hochschule Koblenz, Remagen, Deutschland.,Institut für Medizinische Biometrie, Epidemiologie und Informatik, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Manfred Vogt
- Abteilung Humanmedizin, Landesuntersuchungsamt Rheinland-Pfalz, Koblenz, Deutschland
| | - Michael Jansky
- Zentrum für Allgemeinmedizin und Geriatrie, Abteilung Allgemeinmedizin, Universitätsmedizin Mainz, Am Pulverturm 13, 55131, Mainz, Deutschland
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12
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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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13
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Westermann C, Wendeler D, Nienhaus A. Hepatitis C in healthcare personnel: secondary data analysis of therapies with direct-acting antiviral agents. J Occup Med Toxicol 2018; 13:16. [PMID: 29849741 PMCID: PMC5970510 DOI: 10.1186/s12995-018-0197-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 05/08/2018] [Indexed: 12/15/2022] Open
Abstract
Background Hepatitis C Virus (HCV) infections are blood-borne, generally chronic and are associated with increased morbidity and mortality. The aim of this study is to describe the results of therapies with direct-acting antiviral agents (DAAs) in healthcare personnel. Methods Secondary data analysis using data from the Statutory Accident Insurance of the Health and Welfare Service. The study surveyed DAA therapies administered to insured parties (healthcare personnel with an HCV infection recognised as an occupational disease) in Germany between 01/01/2014 and 30/11/2016. The end points were results of monitorings carried out twelve weeks after the end of treatment (SVR12), side effects and the results of the assessment of reduced work ability after treatment. Multivariate logistic regression models were constructed to model SVR12. Results The study population (n = 180) comprised 74% women, 90% of the participants had an HCV genotype 1 infection. Two-thirds had fibrosis or cirrhosis and were treatment experienced. The most common combined therapy was ledipasvir and sofosbuvir (49%). A DAA therapy with ribavirin was administered in 20% of cases, with (pegylated) interferon and ribavirin used in 2% of cases. The majority of therapies were completed without any side effects. The overall SVR12 rate was 94%. Significant independent predictor of decrease odds of SVR12 was liver cirrhosis. Positive effects on the healthcare personnel’s work ability were observed after successful therapy. Conclusion High SVR12 rates were achieved in the sample population, with positive effects on their work ability. Early HCV therapy seems reasonable due to the increased chance of successful treatment of the infection. Electronic supplementary material The online version of this article (10.1186/s12995-018-0197-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Claudia Westermann
- 1Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf (UKE), Martinistr. 52, 20146 Hamburg, Germany
| | - Dana Wendeler
- Department of Occupational Medicine, Hazardous Substances and Public Health, Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Pappelallee 33-37, 22089 Hamburg, Germany
| | - Albert Nienhaus
- 1Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf (UKE), Martinistr. 52, 20146 Hamburg, Germany.,Department of Occupational Medicine, Hazardous Substances and Public Health, Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Pappelallee 33-37, 22089 Hamburg, Germany
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14
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Salmon D, Mondelli MU, Maticic M, Arends JE. The benefits of hepatitis C virus cure: Every rose has thorns. J Viral Hepat 2018; 25:320-328. [PMID: 29112304 DOI: 10.1111/jvh.12823] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 09/19/2017] [Indexed: 02/06/2023]
Abstract
To examine mid-term benefits on hepatic complications, extrahepatic clinical syndromes and quality of life associated with HCV cure; to review the few safety issues linked to oral direct-acting antivirals (DAAs); and to discuss the potential population benefits of reducing the burden of HCV infection. DAAs cure HCV infection in more than 95% of patients. The halting of liver inflammation and fibrosis progression translates into both hepatic and extrahepatic benefits and reduces the need for liver transplantation. A reduction in the frequency of extrahepatic manifestations such as mixed cryoglobulinaemia and vasculitis and improvements in quality of life and fatigue have also been described. A few safety issues linked to DAAs such as the potential recurrence of aggressive HCC, the flares of hepatitis B virus in patients with overt or occult HBV infection are been discussed. Curing HCV infection also has a high potential to reduce the burden of HCV infection at the population level. With widespread scaling up of HCV treatment, several modeling studies suggest that major reductions in HCV prevalence and incidence are possible, and that elimination of viral hepatitis is an achievable target by 2030.
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Affiliation(s)
- D Salmon
- Division of Infectious Diseases and Immunology, Center for Diagnosis, Paris Centre University Hospitals, APHP, Paris Descartes University, Paris, France
| | - M U Mondelli
- Division of Infectious Diseases and Immunology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - M Maticic
- Faculty of Medicine, Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | - J E Arends
- Department of Internal Medicine, Infectious diseases section, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
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15
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Lemoine M, Cooke GS. The Egyptian hepatitis C programme: A model of HCV treatment intervention? J Hepatol 2018; 68:638-639. [PMID: 29409777 DOI: 10.1016/j.jhep.2018.01.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 01/25/2018] [Indexed: 01/27/2023]
Affiliation(s)
- M Lemoine
- Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, UK.
| | - G S Cooke
- Division of Infectious Diseases, St Mary's Hospital, Imperial College London, UK
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16
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Brouard C, Boussac-Zarebska M, Silvain C, Durand J, de Lédinghen V, Pillonel J, Delarocque-Astagneau E. Rapid and large-scale implementation of HCV treatment advances in France, 2007-2015. BMC Infect Dis 2017; 17:784. [PMID: 29262788 PMCID: PMC5738822 DOI: 10.1186/s12879-017-2889-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 12/06/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The last decade was marked by major advances in HCV treatment with the introduction of first wave protease inhibitors (1st-wave PIs, telaprevir or boceprevir) in 2011 and second direct-acting antivirals (2nd-wave DAAs) in 2014, that followed low effective pegylated interferon α / ribavirin bitherapy. We estimated the number of patients initiating HCV treatment in France between 2007 and 2015 according to the type of therapy, described their demographical characteristics, and estimated how many were cured with 2nd-wave DAAs in 2014-2015. METHODS Individual data from the national health insurance information system were analysed. HCV treatment initiation was defined as a drug reimbursement in the absence of any reimbursement for the same drug in the previous six weeks. RESULTS Between 2007 and 2015, 72,277 patients initiated at least one HCV treatment. The annual number of patients initiating treatment decreased from 2007 (~13,300) to 2010 (~10,000). It then increased with the introduction of 1st-wave PIs (~12,500 in 2012), before decreasing again in 2013 (~8400). A marked increase followed upon the approval of 2nd-wave DAAs in 2014 (~11,600). Approximately, 8700 and 14,700 patients initiated 2nd-wave DAAs in 2014 and 2015, respectively, corresponding to an estimated 20,300 cured patients in 2014-2015. Patients initiating HCV treatment were mostly male (~65% throughout the 9-year period). Women were older than men (mean age: 55.0 vs. 48.9). Increasing age was associated with more advanced treatment. Among patients initiating 2nd-wave DAAs, the proportions of those under 40 and over 79 years old increased between 2014 and 2015, whereas the proportion of those previously treated for HCV 2007 onwards declined. CONCLUSIONS Successive advances in HCV treatment have been rapidly and widely implemented in France. With the announcement of universal access to DAAs in mid-2016 and price reductions, access to 2nd-wave DAAs is expected to expand even more.
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Affiliation(s)
- Cécile Brouard
- Santé publique France, the national public health agency, Saint-Maurice, France
| | | | | | - Julien Durand
- Santé publique France, the national public health agency, Saint-Maurice, France
| | - Victor de Lédinghen
- Investigation Centre of Liver Fibrosis, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France
| | - Josiane Pillonel
- Santé publique France, the national public health agency, Saint-Maurice, France
| | - Elisabeth Delarocque-Astagneau
- INSERM 1181, Biostatistics, Biomathematics, Pharmacoepidemiology, and Infectious Diseases (B2PHI), Paris, France
- Institut Pasteur, B2PHI, Paris, France
- Versailles Saint-Quentin University, UMR 1181, B2PHI, Montigny-le-Bretonneux, France
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17
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Müller J, Schmidt D, Kollan C, Lehmann M, Bremer V, Zimmermann R. High variability of TB, HIV, hepatitis C treatment and opioid substitution therapy among prisoners in Germany. BMC Public Health 2017; 17:843. [PMID: 29065873 PMCID: PMC5655863 DOI: 10.1186/s12889-017-4840-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 10/06/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND In Germany, medical care of prisoners is completely separated from extramural health care. The extent and quality of medical care among prisoners in Germany are therefore largely unknown. We performed a secondary data analysis of pharmacy sales data for tuberculosis (TB), HIV, hepatitis C (HCV) and opioid substitution treatment (OST) delivered to prisons in 11 federal states (FS) in Germany between 01/2012 and 03/2013. The aims of this study were to assess (i) the treatment availability for the selected diseases and OST in German prisons, (ii) the proportion of prisoners treated per FS and overall for TB, HIV, HCV and OST during the study period. METHODS Substances unique to or typically used for the treatment of each disease were defined as marker substances with defined daily doses (DDD). For each marker substance we assessed the cumulative number of DDD, the average daily number of DDD (DDDd) and average treatment prevalence per day in percent (adTP). Accordingly, the DDDd represents one person treated per day and the adTP means the proportion of prisoners treated per day. We compared the adTP of the diseases with previously measured prevalences. RESULTS We obtained data from pharmacies supplying prisons in 11 of 16 German FS. Of the included prisons, 41% were supplied with medicines for TB, 71% for HIV and 58% for HCV and OST. Twice as many delivered marker substances for TB were indicated for the continuation phase and chemoprevention than the intensive phase. The HIV adTP ranged from 0.06% to 0.94%, HCV adTP ranged from 0.03% to 0.59% and OST adTP ranged from 0% to 7.90%. The overall adTP for the respective treatment was 0.39% for HIV, 0.12% for HCV and 2.18% for OST. CONCLUSIONS According to our findings treatment rates for TB were consistent with the expected TB prevalence, at least in Berlin. HIV treatment seems to be offered to an adequate proportion of estimated infected prisoners. In contrast, the HCV treatment prevalence was low. High variation among FS in provision of all treatments, particularly of OST, point to inconsistent treatment practices, although nationwide extramural treatment guidelines for Germany exist.
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Affiliation(s)
- Jana Müller
- Department of Infectious Disease Epidemiology, HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Daniel Schmidt
- Department of Infectious Disease Epidemiology, HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany. .,Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Christian Kollan
- Department of Infectious Disease Epidemiology, HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Marc Lehmann
- Head of Medical Services in the Berlin state prison system, Berlin, Germany
| | - Viviane Bremer
- Department of Infectious Disease Epidemiology, HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Ruth Zimmermann
- Department of Infectious Disease Epidemiology, HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
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18
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Negotiating better discounts for DAA therapy is critical to achieve HCV elimination by 2030. J Hepatol 2017; 67:419-420. [PMID: 28411042 DOI: 10.1016/j.jhep.2017.03.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/02/2017] [Indexed: 12/04/2022]
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19
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Zimmermann R, Kollan C, Ingiliz P, Mauss S, Schmidt D, Bremer V. Reply to: "Negotiating better discounts for DAA therapy is critical to achieve HCV elimination by 2030". J Hepatol 2017; 67:420-422. [PMID: 28412291 DOI: 10.1016/j.jhep.2017.03.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 03/30/2017] [Indexed: 12/04/2022]
Affiliation(s)
- Ruth Zimmermann
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Germany.
| | - Christian Kollan
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Germany
| | | | - Stefan Mauss
- Centre for HIV and Hepatogastroenterology, Duesseldorf, Germany
| | - Daniel Schmidt
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Germany; Charité University Medicine, Berlin, Germany
| | - Viviane Bremer
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Germany
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20
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Martin NK, Vickerman P, Hickman M. How to eliminate HCV infection by antiviral treatment. J Hepatol 2017; 67:5-6. [PMID: 28323120 DOI: 10.1016/j.jhep.2017.03.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 03/07/2017] [Indexed: 12/04/2022]
Affiliation(s)
- Natasha K Martin
- Division of Global Public Health, University of California San Diego, United States; School of Social and Community Medicine, University of Bristol, United Kingdom.
| | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol, United Kingdom
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21
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Höner Zu Siederdissen C, Buggisch P, Böker K, Schott E, Klinker H, Pathil A, Pfeiffer-Vornkahl H, Berg T, Sarrazin C, Hüppe D, Manns MP, Mauss S. Treatment of hepatitis C genotype 1 infection in Germany: effectiveness and safety of antiviral treatment in a real-world setting. United European Gastroenterol J 2017; 6:213-224. [PMID: 29511551 DOI: 10.1177/2050640617716607] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 05/24/2017] [Indexed: 12/18/2022] Open
Abstract
Background In pivotal studies with direct-acting antivirals (DAAs), rates of sustained virological response in hepatitis C genotype 1 infection are >90%. Objective The objective of this article is to assess real-world safety and effectiveness of DAA treatment in a prospective multicenter registry study. Methods The German Hepatitis C-Registry includes 6606 patients with genotype 1 from 246 centers, treated between February 2014 and June 2016 at the discretion of the physician. Results A total of 4846 patients completed treatment and follow-up; 51% of these patients were treatment experienced and 28% had liver cirrhosis. Comorbidities were reported in 76% of patients, including HIV co-infection in 8%. SVR12 was 92% with 91% in GT1a and 93% in GT1b. HIV co-infected patients (n = 247) had an SVR12 of 92%. Treatment was discontinued prematurely in 2.5%. In multivariate analysis, SVR12 was dependent on the choice of antiviral regimen (OR 1.33 (1.24-1.43); p < 0.001), negatively associated with presence of liver cirrhosis (OR 0.71 (0.56-0.89); p < 0.003) and positively associated with female gender (OR 1.52 (1.21-1.91); p < 0.001). Conclusion Data from this real-world registry show SVR12 rates close to those obtained in clinical studies. Discontinuation rates are low, confirming good tolerance of the regimens and good adherence of patients (Trial registration number DRKS00009717, German Clinical Trials Register, DRKS).
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Affiliation(s)
| | - Peter Buggisch
- ifi-institute for Interdisciplinary Medicine, Hamburg, Germany
| | | | - Eckart Schott
- Charité Campus Virchow-Klinikum (CVK), Berlin, Germany
| | | | - Anita Pathil
- Universitätsklinikum Heidelberg, Heidelberg, Germany
| | | | - Thomas Berg
- Universitätsklinikum Leipzig, Leipzig, Germany
| | | | - Dietrich Hüppe
- Gastroenterologische Gemeinschaftspraxis Herne, Herne, Germany
| | - Michael P Manns
- Hannover Medical School, Department of Gastroenterology, Hepatology and Endocrinology, Hannover, Germany
| | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Düsseldorf, Germany
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