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Fahmy AM, Hammad MS, Mabrouk MS, Al-Atabany WI. On leveraging self-supervised learning for accurate HCV genotyping. Sci Rep 2024; 14:15463. [PMID: 38965254 PMCID: PMC11224313 DOI: 10.1038/s41598-024-64209-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/06/2024] [Indexed: 07/06/2024] Open
Abstract
Hepatitis C virus (HCV) is a major global health concern, affecting millions of individuals worldwide. While existing literature predominantly focuses on disease classification using clinical data, there exists a critical research gap concerning HCV genotyping based on genomic sequences. Accurate HCV genotyping is essential for patient management and treatment decisions. While the neural models excel at capturing complex patterns, they still face challenges, such as data scarcity, that exist a lot in computational genomics. To overcome this challenges, this paper introduces an advanced deep learning approach for HCV genotyping based on the graphical representation of nucleotide sequences that outperforms classical approaches. Notably, it is effective for both partial and complete HCV genomes and addresses challenges associated with imbalanced datasets. In this work, ten HCV genotypes: 1a, 1b, 2a, 2b, 2c, 3a, 3b, 4, 5, and 6 were used in the analysis. This study utilizes Chaos Game Representation for 2D mapping of genomic sequences, employing self-supervised learning using convolutional autoencoder for deep feature extraction, resulting in an outstanding performance for HCV genotyping compared to various machine learning and deep learning models. This baseline provides a benchmark against which the performance of the proposed approach and other models can be evaluated. The experimental results showcase a remarkable classification accuracy of over 99%, outperforming traditional deep learning models. This performance demonstrates the capability of the proposed model to accurately identify HCV genotypes in both partial and complete sequences and in dealing with data scarcity for certain genotypes. The results of the proposed model are compared to NCBI genotyping tool.
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Affiliation(s)
- Ahmed M Fahmy
- Computer Science program, School of Information Technology and Computer Science (ITCS), Nile University, Sheikh Zayed City, Egypt.
| | - Muhammed S Hammad
- Biomedical Engineering Department, Faculty of Engineering, Helwan University, Cairo, Egypt
| | - Mai S Mabrouk
- Biomedical informatics program, School of Information Technology and Computer Science (ITCS), Nile University, Sheikh Zayed City, Egypt
| | - Walid I Al-Atabany
- Biomedical informatics program, School of Information Technology and Computer Science (ITCS), Nile University, Sheikh Zayed City, Egypt
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Dietz J, Graf C, Berg CP, Port K, Deterding K, Buggisch P, Peiffer KH, Vermehren J, Dultz G, Geier A, Reiter FP, Bruns T, Schattenberg JM, Durmashkina E, Gustot T, Moreno C, Trauth J, Discher T, Fischer J, Berg T, Kremer AE, Müllhaupt B, Zeuzem S, Sarrazin C. Rare HCV subtypes and retreatment outcomes in a cohort of European DAA-experienced patients. JHEP Rep 2024; 6:101072. [PMID: 39006503 PMCID: PMC11246049 DOI: 10.1016/j.jhepr.2024.101072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 07/16/2024] Open
Abstract
Background and Aims Data on the prevalence and characteristics of so-called rare HCV genotypes (GTs) in larger cohorts is limited. This study investigates the frequency of rare GT and resistance-associated substitutions and the efficacy of retreatment in a European cohort. Methods A total of 129 patients with rare GT1-6 were included from the European resistance database. NS3, NS5A, and NS5B were sequenced and clinical parameters and retreatment efficacies were collected retrospectively. Results Overall 1.5% (69/4,656) of direct-acting antiviral (DAA)-naive and 4.4% (60/1,376) of DAA-failure patients were infected with rare GT. Although rare GTs were almost equally distributed throughout GT1-6 in DAA-naive patients, we detected mainly rare GT4 (47%, 28/60 GT4; of these n = 17, subtype 4r) and GT3 (25%, 15/60 GT3, of these n = 8, subtype 3b) among DAA-failures. A total of 62% (37/60) of DAA failures had not responded to first-generation regimes and the majority was infected with rare GT4 (57%, 21/37). In contrast, among patients with failure to pangenotypic DAA regimens (38%, 23/60), infections with rare GT3 were overrepresented (57%, 13/23). Although NS5A RASs were uncommon in rare GT2, GT5a, and GT6, we observed combined RASs in rare GT1, GT3, and GT4 at positions 28, 30, 31, which can be considered as inherent. DAA failures with completed follow-up of retreatment, achieved a high SVR rate (94%, 45/48 modified intention-to-treat analysis; 92%, 45/49 intention-to-treat). Three patients with GT4f, 4r, or 3b, respectively, had virological treatment failure. Conclusions In this European cohort, rare HCV GT were uncommon. Accumulation of specific rare GT in DAA-failure patients suggests reduced antiviral activities of DAA regimens. The limited global availability of pangenotypic regimens for first line therapy as well as multiple targeted regimens for retreatment could result in HCV elimination targets being delayed. Impact and implications Data on the prevalence and characteristics of rare HCV genotypes (GT) in larger cohorts are still scarce. This study found low rates of rare HCV GTs among European HCV-infected patients. In direct-acting antiviral (DAA)-failure patients, rare GT3 subtypes accumulated after pangenotypic DAA treatment and rare GT4 after first generation DAA failure and viral resistance was detected at NS5A positions 28, 30, and 31. The limited global availability of pangenotypic DAA regimens for first line therapy as well as multiple targeted regimens for retreatment could result in HCV elimination targets being delayed.
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Affiliation(s)
- Julia Dietz
- Medical Clinic 1, Department of Medicine, Goethe University, Frankfurt, Germany
- German Center for Infection Research (DZIF), External Partner Site Frankfurt, Germany
| | - Christiana Graf
- Medical Clinic 1, Department of Medicine, Goethe University, Frankfurt, Germany
- German Center for Infection Research (DZIF), External Partner Site Frankfurt, Germany
- Department of Internal Medicine II, University Hospital Munich, Munich, Germany
| | - Christoph P. Berg
- Department of Internal Medicine I, University of Tübingen, Tübingen, Germany
| | - Kerstin Port
- Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule Hannover, Hannover, Germany
| | - Katja Deterding
- Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule Hannover, Hannover, Germany
| | - Peter Buggisch
- Institute for Interdisciplinary Medicine IFI, Hamburg, Germany
| | - Kai-Henrik Peiffer
- Medical Clinic 1, Department of Medicine, Goethe University, Frankfurt, Germany
- Department of Internal Medicine B, University of Münster, Münster, Germany
| | - Johannes Vermehren
- Medical Clinic 1, Department of Medicine, Goethe University, Frankfurt, Germany
| | - Georg Dultz
- Medical Clinic 1, Department of Medicine, Goethe University, Frankfurt, Germany
| | - Andreas Geier
- Division of Hepatology, Department of Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Florian P. Reiter
- Division of Hepatology, Department of Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Tony Bruns
- Department of Medicine III, University Hospital Aachen, Aachen, Germany
| | - Jörn M. Schattenberg
- Department of Internal Medicine II, Saarland University Medical Center Homburg, Homburg, Germany
- Saarland University, Saarbrücken, Germany
| | | | - Thierry Gustot
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Christophe Moreno
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Janina Trauth
- Department of Internal Medicine II, Section of Infectious Diseases, Justus-Liebig-University Giessen, Giessen, Germany
- German Lung Center (DZL), Giessen, Germany
| | - Thomas Discher
- Department of Internal Medicine II, Section of Infectious Diseases, Justus-Liebig-University Giessen, Giessen, Germany
- German Lung Center (DZL), Giessen, Germany
| | - Janett Fischer
- Section of Hepatology, Department of Gastroenterology and Rheumatology, University Hospital Leipzig, Leipzig, Germany
| | - Thomas Berg
- Section of Hepatology, Department of Gastroenterology and Rheumatology, University Hospital Leipzig, Leipzig, Germany
| | - Andreas E. Kremer
- Swiss Hepato-Pancreato-Biliary Center and Department of Gastroenterology and Hepatology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Beat Müllhaupt
- Swiss Hepato-Pancreato-Biliary Center and Department of Gastroenterology and Hepatology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Stefan Zeuzem
- Medical Clinic 1, Department of Medicine, Goethe University, Frankfurt, Germany
- German Center for Infection Research (DZIF), External Partner Site Frankfurt, Germany
| | - Christoph Sarrazin
- Medical Clinic 1, Department of Medicine, Goethe University, Frankfurt, Germany
- German Center for Infection Research (DZIF), External Partner Site Frankfurt, Germany
- Medizinische Klinik 2, St. Josefs-Hospital, Wiesbaden, Germany
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Noskov S, Arefeva A, Radaeva K, Makarenko I, Gefen M, Drai R. Bioequivalence Study of Velpatasvir/Sofosbuvir Oral Coated Tablets in Healthy Volunteers Under Fasting Conditions. Clin Pharmacol Drug Dev 2024. [PMID: 38881205 DOI: 10.1002/cpdd.1435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/14/2024] [Indexed: 06/18/2024]
Abstract
This study was conducted as a single-site, open-label, randomized, replicated crossover trial with 4 treatment periods. The aim was to evaluate the bioequivalence of a generic test drug containing velpatasvir and sofosbuvir compared to an established brand-name medication in healthy White subjects under fasting conditions. Blood samples were collected at specified intervals up to 72 hours after dosing to measure the concentrations of velpatasvir and sofosbuvir using a certified high-performance liquid chromatography with tandem mass spectrometry method. The bioequivalence of the 2 formulations was confirmed when statistical analysis showed that confidence intervals for the log-transformed peak concentration and area under the concentration-time curve from time 0 to the last quantifiable sample were within an acceptable range from 80% to 125%. Criteria for bioequivalence were met for both area under the concentration-time curve from time 0 until the last quantifiable sample and peak concentration parameters. No adverse effects were reported during this trial in both groups.
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Affiliation(s)
| | | | | | | | - Maria Gefen
- R&D Center, GEROPHARM, Saint-Petersburg, Russia
| | - Roman Drai
- R&D Center, GEROPHARM, Saint-Petersburg, Russia
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Li H, Huang H, Huang W, Du M, Long D, Xu G, Mei W, Huang K. Hepatitis C virus subtype diversity and transmission clusters characteristics among drug users in Zhuhai, South China. BMC Infect Dis 2024; 24:451. [PMID: 38685009 PMCID: PMC11057121 DOI: 10.1186/s12879-024-09323-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 04/15/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection poses a major public health challenge globally, especially among injecting drug users. China has the world's largest burden of HCV infections. However, little is known about the characteristics of transmission networks among drug user populations. This study aims to investigate the molecular epidemiology and transmission characteristics of HCV infections among drug users in Zhuhai, a bustling port city connecting Mainland China and its Special Administrative Regions. METHODS Participants enrolled in this study were drug users incarcerated at Zhuhai's drug rehabilitation center in 2015. Their sociodemographic and behavioral information, including gender, promiscuity, drug use method, and so forth, was collected using a standardized questionnaire. Plasmas separated from venous blood were analyzed for HCV infection through ELISA and RT-PCR methods to detect anti-HCV antibodies and HCV RNA. The 5'UTR fragment of the HCV genome was amplified and further sequenced for subtype identifications and phylogenetic analysis. The phylogenetic tree was inferred using the Maximum Likelihood method based on the Tamura-Nei model, and the transmission cluster network was constructed using Cytoscape3.8.0 software with a threshold of 0.015. Binary logistic regression models were employed to assess the factors associated with HCV infection. RESULTS The overall prevalence of HCV infection among drug users was 44.37%, with approximately 19.69% appearing to clear the HCV virus successfully. Binary logistic regression analysis revealed that those aged over 40, engaging in injecting drug use, and being native residents were at heightened risk for HCV infection among drug user cohorts. The predominant HCV subtypes circulating among those drug users were 6a (60.26%), followed by 3b (16.7%), 3a (12.8%), 1b (6.41%) and 1a (3.85%), respectively. Molecular transmission network analysis unveiled the presence of six transmission clusters, with the largest propagation cluster consisting of 41 individuals infected with HCV subtype 6a. Furthermore, distinct transmission clusters involved eight individuals infected with subtype 3b and seven with subtype 3a were also observed. CONCLUSION The genetic transmission networks revealed a complex transmission pattern among drug users in Zhuhai, emphasizing the imperative for a targeted and effective intervention strategy to mitigate HCV dissemination. These insights are pivotal for shaping future national policies on HCV screening, treatment, and prevention in port cities.
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Affiliation(s)
- Hongxia Li
- Zhuhai Center for Disease Control and Prevention, Zhuhai, Guangdong, China
- School of Public Health, Jinan University, Guangzhou, Guangdong, China
| | - Huitao Huang
- Zhuhai Center for Disease Control and Prevention, Zhuhai, Guangdong, China
| | - Wenyan Huang
- Zhuhai Center for Disease Control and Prevention, Zhuhai, Guangdong, China
| | - Man Du
- Zhuhai Center for Disease Control and Prevention, Zhuhai, Guangdong, China
| | - Dongling Long
- Zhuhai Center for Disease Control and Prevention, Zhuhai, Guangdong, China
| | - Guangxian Xu
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, Guangdong, China.
| | - Wenhua Mei
- Zhuhai Center for Disease Control and Prevention, Zhuhai, Guangdong, China.
- School of Public Health, Jinan University, Guangzhou, Guangdong, China.
| | - Kaisong Huang
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, Guangdong, China.
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Peschel G, Weigand K, Grimm J, Müller M, Buechler C. Serum omentin-1 is correlated with the severity of liver disease in patients with chronic hepatitis C. World J Hepatol 2023; 15:1315-1324. [PMID: 38223417 PMCID: PMC10784814 DOI: 10.4254/wjh.v15.i12.1315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/03/2023] [Accepted: 11/21/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND Patients with chronic hepatitis C virus (HCV) infection have increased serum omentin-1. Omentin-1 is an anti-inflammatory adipokine, and higher levels may be a direct effect of HCV infection. Successful elimination of HCV by direct acting antivirals almost normalized circulating levels of various molecules with a role in inflammation. AIM To evaluate the effect of HCV infection on serum omentin-1, serum omentin-1 levels of HCV patients were measured before therapy and at 12 wk after therapy end. Associations of serum omentin-1 with parameters of inflammation and liver function were explored at both time points. Serum omentin-1 levels of patients with and without liver cirrhosis, which was defined by ultrasound or the fibrosis-4 (FIB-4) score, were compared. METHODS Serum omentin-1 levels were measured by enzyme-linked immunosorbent assay in 84 chronic HCV patients before therapy and at 12 wk after therapy end where sustained virological response 12 (SVR12) was achieved in all patients. Serum omentin-1 of 14 non-infected controls was measured in parallel. RESULTS In patients with chronic HCV, serum omentin-1 levels were not related to viral load or viral genotype. HCV patients with liver steatosis and HCV patients with diabetes had serum omentin-1 levels comparable to patients not suffering from these conditions. Serum omentin-1 levels at SVR12 were similar in comparison to pretreatment levels. In addition, serum levels did not differ between HCV-infected patients and non-infected controls. Serum omentin-1 levels did not correlate with leukocyte count or C-reactive protein. Positive correlations of serum omentin-1 with bilirubin and the model for end-stage liver disease score (MELD) were detected before therapy and at SVR12 in the whole cohort. Bilirubin and the MELD score also positively correlated with serum omentin-1 levels in the subgroup of patients with ultrasound diagnosed liver cirrhosis before therapy. At SVR12, serum omentin-1 levels of patients with liver cirrhosis negatively correlated with albumin. Before therapy start, patients with high FIB-4 scores had increased serum omentin-1 in comparison to patients with a low score. Serum omentin-1 levels of patients with liver cirrhosis defined by ultrasound were increased at baseline and at SVR12. CONCLUSION Present study showed that liver cirrhosis, but not HCV infection per se, is related to elevated serum omentin-1 levels.
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Affiliation(s)
- Georg Peschel
- Department of Internal Medicine I, University Hospital Regensburg, Regensburg 93053, Germany
- Department of Internal Medicine, Klinikum Fürstenfeldbruck, Fürstenfeldbruck 82256, Germany
| | - Kilian Weigand
- Department of Internal Medicine I, University Hospital Regensburg, Regensburg 93053, Germany
- Department of Gastroenterology, Gemeinschaftsklinikum Mittelrhein, Koblenz 56073, Germany
| | - Jonathan Grimm
- Department of Internal Medicine I, University Hospital Regensburg, Regensburg 93053, Germany
| | - Martina Müller
- Department of Internal Medicine I, University Hospital Regensburg, Regensburg 93053, Germany
| | - Christa Buechler
- Department of Internal Medicine I, University Hospital Regensburg, Regensburg 93053, Germany.
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Merli M, Rattotti S, Spina M, Re F, Motta M, Piazza F, Orsucci L, Ferreri AJ, Perbellini O, Dodero A, Vallisa D, Pulsoni A, Santoro A, Sacchi P, Zuccaro V, Chimienti E, Russo F, Visco C, Zignego AL, Marcheselli L, Passamonti F, Luminari S, Paulli M, Bruno R, Arcaini L. Direct-Acting Antivirals as Primary Treatment for Hepatitis C Virus-Associated Indolent Non-Hodgkin Lymphomas: The BArT Study of the Fondazione Italiana Linfomi. J Clin Oncol 2022; 40:4060-4070. [PMID: 35714311 PMCID: PMC9746784 DOI: 10.1200/jco.22.00668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE We prospectively treated patients with hepatitis C virus (HCV)-associated indolent lymphomas with genotype-appropriate direct-acting antivirals (DAAs) with the aim to evaluate virologic and hematologic outcomes. No prospective studies in this setting have been published so far. METHODS FIL_BArT is a prospective, multicenter, phase II trial that evaluated genotype-appropriate DAAs in untreated HCV-positive patients with indolent lymphomas without criteria for immediate conventional antilymphoma treatment. The primary objective was sustained virologic response, whereas the main secondary objectives were overall response rate of lymphoma and progression-free survival. RESULTS Forty patients were enrolled, including 27 with marginal zone lymphoma. Median age was 68 years. Extranodal sites were involved in 14 cases (35%). Main genotypes were 1 in 16 patients and 2 in 21 patients. All patients received genotype-guided DAAs: 17 ledipasvir/sofosbuvir, eight sofosbuvir plus ribavirin, and 15 sofosbuvir/velpatasvir. All patients achieved sustained virologic response (100%). DAAs were well tolerated, with only two grade 3-4 adverse events. Overall response rate of lymphoma was 45%, including eight patients (20%) achieving complete response and 10 (25%) partial response, whereas 16 exhibited stable disease and six progressed. With a median follow-up of 37 months, two patients died (3-year overall survival 93%; 95% CI, 74 to 98) and three additional patients progressed, with a 3-year progression-free survival of 76% (95% CI, 57 to 87). CONCLUSION HCV eradication by DAAs was achieved in 100% of HCV-positive patients with indolent lymphomas not requiring immediate conventional treatment and resulted in non-negligible rate of lymphoma responses. Treatment with DAAs should be considered as the first-line therapy in this setting.
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Affiliation(s)
- Michele Merli
- Division of Hematology, University Hospital Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Sara Rattotti
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Michele Spina
- Division of Medical Oncology and Immune-related Tumors, Centro di Riferimento Oncologico IRCCS, Aviano, Italy
| | - Francesca Re
- Division of Hematology and BMT Center, Azienda Ospedaliera Universitaria, Parma, Italy
| | - Marina Motta
- Division of Hematology, ASST Spedali Civili, Brescia, Italy
| | - Francesco Piazza
- Hematology and Clinical Immunology Unit, Department of Medicine—DIMED, University of Padova, Padova, Italy
| | - Lorella Orsucci
- Division of Hematology, Città della Salute e della Scienza di Torino, Torino, Italy
| | | | - Omar Perbellini
- Division of Hematology, San Bortolo Hospital, Vicenza, Italy
| | - Anna Dodero
- Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Daniele Vallisa
- Division of Hematology, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Alessandro Pulsoni
- Department of Translational and Precision Medicine, Sapienza University of Roma, Roma, Italy
| | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Research Hospital-Humanitas Cancer Center, Milano, Italy
| | - Paolo Sacchi
- Division of Infectious and Tropical Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valentina Zuccaro
- Division of Infectious and Tropical Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Emanuela Chimienti
- Division of Medical Oncology and Immune-related Tumors, Centro di Riferimento Oncologico IRCCS, Aviano, Italy
| | - Filomena Russo
- Division of Hematology and BMT Center, Azienda Ospedaliera Universitaria, Parma, Italy
| | - Carlo Visco
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Anna Linda Zignego
- Department of Clinical and Experimental Medicine, Interdepartmental Hepatology Center MASVE, University of Firenze, Firenze, Italy
| | | | - Francesco Passamonti
- Division of Hematology, University Hospital Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, University of Insubria, Varese, Italy,Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Stefano Luminari
- Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy,Division of Hematology, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
| | - Marco Paulli
- Unit of Anatomic Pathology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy,Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Raffaele Bruno
- Division of Infectious and Tropical Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy,Department of Clinical, Surgical, Diagnostic, and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Luca Arcaini
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy,Department of Molecular Medicine, University of Pavia, Pavia, Italy,Luca Arcaini, MD, Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy; e-mail:
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Gupta N, Manirambona L, Shumbusho F, Kabihizi J, Murangwa A, Serumondo J, Makuza JD, Nsanzimana S, Muvunyi CM, Mukabatsinda C, Musabeyezu E, Camus G, Grant PM, Kateera F. Safety and efficacy of sofosbuvir–velpatasvir–voxilaprevir for re-treatment of chronic hepatitis C virus infection in patients with previous direct-acting antiviral treatment failure in Rwanda (SHARED-3): a single-arm trial. Lancet Gastroenterol Hepatol 2022; 7:542-551. [DOI: 10.1016/s2468-1253(21)00399-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 12/13/2022]
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Jia Y, Yue W, Gao Q, Tao R, Zhang Y, Fu X, Liu Y, Liu L, Feng Y, Xia X. Characterization of a Novel Hepatitis C Subtype, 6xj, and Its Consequences for Direct-Acting Antiviral Treatment in Yunnan, China. Microbiol Spectr 2021; 9:e0029721. [PMID: 34479413 PMCID: PMC8552672 DOI: 10.1128/spectrum.00297-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/21/2021] [Indexed: 12/17/2022] Open
Abstract
Hepatitis C virus (HCV) has a high rate of genetic variability, with eight genotypes and 91 subtypes. The genetic diversity of HCV genotype 6 (HCV-6) is the highest with 31 subtypes, and this genotype is prevalent in Southeast Asia. In this study, we investigated 160 individuals with chronic hepatitis C in Yunnan Province, China. Using reverse transcription (RT)-PCR and Sanger sequencing, 147 cases were successfully amplified and genotyped as 3b (4.9%), 3a (19.73%), 6n (12.24%), 1b (7.48%), 2a (6.12%), 6a (2.04%), 1a (0.68%), 6v (0.68%), and 6xa (0.68%), with eight sequences remaining unclassified. Subsequently, the eight nearly full-length genomes were successfully amplified and analyzed. The eight complete coding sequences formed a phylogenetic group that was distinct from the previously assigned HCV-6 subtypes and clustered with two previously unnamed HCV-6 sequences. Furthermore, Simplot analysis showed no recombination and the p-distance was more than 15% in comparison to the 6a to 6xi subtypes. Taken together, we identified a new HCV-6 subtype, 6xj, which originated approximately in 1775 according to Bayesian analyses. Moreover, all eight individuals received follow-up assessments at 44 weeks from the beginning of their 12-week treatments of sofosbuvir/velpatasvir (after-treatment week 32). One case relapsed at after-treatment week 32. Next-generation sequencing (NGS) was conducted and showed that the treatment failure case had two suspected antiviral resistance mutations, NS5A V28M (a change of V to M at position 28) and NS5B A442V, compared with the baseline. Overall, this newly identified 6xj subtype further confirmed the high diversity of the HCV-6 genotype. The newly identified resistance-associated amino acid substitutions may help inform future clinical treatments. IMPORTANCE This study investigated the genetic diversity of hepatitis C virus (HCV), particularly in relation to genotype 6, which is prevalent in Yunnan, China, and is often difficult to treat successfully. We identified a new HCV-6 subtype, 6xj, which is an ancient strain. Moreover, all eight individuals with the novel subtype received follow-up assessments at 44 weeks from the beginning of their treatments. One case relapsed after 8 months of withdrawal. NGS was conducted and showed that the isolate from the treatment failure case had two suspected antiviral resistance mutations, NS5A V28M and NS5B A442V, compared with the baseline. Overall, this newly identified 6xj subtype further confirmed the high diversity of the HCV-6 genotype. The newly identified resistance-associated amino acid substitutions may help inform future clinical treatments. We believe that our study makes a significant contribution to the literature based on the results described above.
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Affiliation(s)
- Yuanyuan Jia
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China
| | - Wei Yue
- Department of Infectious Diseases and Liver Diseases, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Qinghua Gao
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China
| | - Rui Tao
- Department of Infectious Diseases and Liver Diseases, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Yaxiang Zhang
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China
| | - Xiaoyang Fu
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China
| | - Yang Liu
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China
| | - Li Liu
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China
| | - Yue Feng
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China
| | - Xueshan Xia
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China
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9
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Hassanien KS, El-Sayed ESM, Ismail RS, Zakarya ZM, Helal GK. Association between interleukin 28B polymorphism and sustained virological response to sofosbuvir plus daclatasvir in chronic hepatitis C genotype 4 Egyptian patients. J Clin Pharm Ther 2021; 46:942-949. [PMID: 33768560 DOI: 10.1111/jcpt.13417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/02/2021] [Accepted: 03/12/2021] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Sofosbuvir has been approved as the first nonstructural protein 5B polymerase inhibitor with pan-genotypic activity against the hepatitis C (HCV) virus. Daclatasvir is a first-in-class hepatitis C virus nonstructural protein 5A replication complex inhibitor. We aimed to evaluate the usefulness of the reference single nucleotide polymorphism (rs12979860) interleukin 28B (CC genotype) for predicting sustained virological response to sofosbuvir plus daclatasvir in Egyptian patients infected with HCV-4. METHODS Samples were collected at week zero. One hundred and thirty-one patients who reached the end of treatment (at week 12) were divided into three groups, according to their interleukin 28B genotype: Group A included 31 patients (CC genotype), group B included 79 patients (CT genotype) and group C had 21 patients (TT genotype). All patients received treatment for 3 months in the form of sofosbuvir plus daclatasvir with ribavirin (in case of cirrhotic patients) or without ribavirin (in case of non-cirrhotic patients). RESULTS AND DISCUSSION Sustained virological response rate was significantly higher in patients with IL28B (CC genotype) vs. (non-CC genotype) (100 vs.88%) (p < 0.0001).These patients also showed lower rates of post-treatment relapse and non-response, compared with the CT and TT patients (0% vs. (7.59% and 28.5%, respectively) (p < 0.0001). Also, patients with CC genotype showed higher sustained virological response than non-CC genotypes on both cirrhotic (100% vs. 68.75%) and non-cirrhotic patients (100% vs. 91.66%) (p ≤ 0.0001). WHAT IS NEW AND CONCLUSION Our results suggest that IL28B genotype contributes to the prediction of response to sofosbuvir plus daclatasvir.
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Affiliation(s)
| | | | - Raed S Ismail
- Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt
| | | | - Gouda K Helal
- Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt
- Faculty of Pharmacy, Heliopolis University, Cairo, Egypt
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10
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Real-World Outcomes in Historically Underserved Patients with Chronic Hepatitis C Infection Treated with Glecaprevir/Pibrentasvir. Infect Dis Ther 2021; 10:2203-2222. [PMID: 34125405 PMCID: PMC8572930 DOI: 10.1007/s40121-021-00455-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/06/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction Glecaprevir/pibrentasvir is approved for treating chronic hepatitis C virus (HCV) genotypes (GT) 1–6. We evaluated real-world effectiveness, safety, and patient-reported outcomes of glecaprevir/pibrentasvir in underserved patient populations, focusing on persons who use drugs infected with HCV. Methods Data were pooled from nine countries (13 November 2017–31 January 2020). Patients had HCV GT1–6, with or without compensated cirrhosis, with or without prior HCV treatment and received glecaprevir/pibrentasvir consistent with local label at their physician’s discretion. Patients with prior direct-acting antiviral exposure were excluded from efficacy and quality-of-life analyses. The percentage of patients achieving sustained virologic response at post-treatment week 12 (SVR12) was assessed. Mean changes from baseline to SVR12 visit in 36-Item Short-Form Health Survey mental and physical component summary scores were reported. Safety was assessed in patients receiving at least one dose of glecaprevir/pibrentasvir. Results Of 2036 patients, 1701 (83.5%) received 8-week glecaprevir/pibrentasvir. In 1684 patients with sufficient follow-up, SVR12 rates were 98.0% (1651/1684) overall, 98.1% (1432/1459) in 8-week treated patients, 97.0% (519/535) in persons who use drugs, and greater than 95% across subgroups. Mean changes from baseline in mental and physical component summary scores were 3.7 and 2.4, respectively. One glecaprevir/pibrentasvir-related serious adverse event was reported; six glecaprevir/pibrentasvir-related adverse events led to discontinuation. Conclusions Glecaprevir/pibrentasvir was highly effective, well tolerated, and improved quality of life in HCV-infected persons who use drugs and other underserved patients. Trial Registration These multinational post-marketing observational studies are registered with ClinicalTrials.gov, number NCT03303599. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00455-1.
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11
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Loureiro D, Castelnau C, Tout I, Boyer N, Narguet S, Menasria Benazzouz S, Louis Z, Pons-Kerjean N, Giuly N, Marcellin P, Mansouri A, Asselah T. New therapies for hepatitis delta virus infection. Liver Int 2021; 41 Suppl 1:30-37. [PMID: 34155804 DOI: 10.1111/liv.14838] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 12/11/2022]
Abstract
Hepatitis delta virus (HDV) infection is a defective virus requiring hepatitis B virus (HBV) for its complete replication cycle. HDV is a small hepatotropic RNA virus and around 15 to 25 million people worldwide are living with chronic hepatitis delta (CHD) infection. However, the prevalence of HDV may be underestimated, and screening is frequently insufficient. HDV infection remains endemic in several regions including Central and West Africa, the Mediterranean basin, the Middle East, Eastern Europe, Northern Asia, certain areas of Southeast Asia and the Amazon basin of South America. The best preventive strategy to decrease HDV infection is to improve coverage of the prophylactic HBV vaccine. HDV infection may occur by HBV-HDV co-infection or superinfection, and the latter is usually more severe. CHD is associated with a higher risk of cirrhosis and hepatocellular carcinoma (HCC) compared to HBV mono-infection. Pegylated interferon alpha (PEG-IFNα) therapy is limited by moderate effectiveness (around 20%) and its adverse effects. The entry inhibitor, bulevirtide (BLV, Hepcludex® ), which was recently approved in Europe at a dose of 2 mg in sub-cutaneous injection per day, is indicated for the treatment of CHD in adult patients with compensated liver disease and positive HDV viremia. BLV can be administrated in monotherapy or in combination with PEG-IFNα. Nucleos(t)ide analogues can be used in combination for underlying HBV infection. The optimal treatment duration has not yet been determined and treatment should be continued if a clinical benefit is observed. There are other promising therapies such as IFN lambda (IFNλ) (immunomodulator), lonafarnib (prenylation inhibitor) and nucleic acid polymers (Inhibitors of HBsAg release). In this review, we will present an update on CHD and future promising treatments.
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Affiliation(s)
- Dimitri Loureiro
- Centre de recherche sur l'inflammation, Université de Paris, Inserm, CNRS, Paris, France.,Department of Hepatology, AP-HP, Hôpital Beaujon, Clichy, France
| | - Corinne Castelnau
- Centre de recherche sur l'inflammation, Université de Paris, Inserm, CNRS, Paris, France.,Department of Hepatology, AP-HP, Hôpital Beaujon, Clichy, France
| | - Issam Tout
- Centre de recherche sur l'inflammation, Université de Paris, Inserm, CNRS, Paris, France.,Department of Hepatology, AP-HP, Hôpital Beaujon, Clichy, France
| | - Nathalie Boyer
- Centre de recherche sur l'inflammation, Université de Paris, Inserm, CNRS, Paris, France.,Department of Hepatology, AP-HP, Hôpital Beaujon, Clichy, France
| | - Stéphanie Narguet
- Centre de recherche sur l'inflammation, Université de Paris, Inserm, CNRS, Paris, France.,Department of Hepatology, AP-HP, Hôpital Beaujon, Clichy, France
| | - Sabrina Menasria Benazzouz
- Centre de recherche sur l'inflammation, Université de Paris, Inserm, CNRS, Paris, France.,Department of Hepatology, AP-HP, Hôpital Beaujon, Clichy, France
| | - Zeina Louis
- Centre de recherche sur l'inflammation, Université de Paris, Inserm, CNRS, Paris, France.,Service de Pharmacie, AP-HP, Hôpital Beaujon, Clichy, France
| | - Nathalie Pons-Kerjean
- Centre de recherche sur l'inflammation, Université de Paris, Inserm, CNRS, Paris, France.,Service de Pharmacie, AP-HP, Hôpital Beaujon, Clichy, France
| | - Nathalie Giuly
- Centre de recherche sur l'inflammation, Université de Paris, Inserm, CNRS, Paris, France.,Department of Hepatology, AP-HP, Hôpital Beaujon, Clichy, France
| | - Patrick Marcellin
- Centre de recherche sur l'inflammation, Université de Paris, Inserm, CNRS, Paris, France.,Department of Hepatology, AP-HP, Hôpital Beaujon, Clichy, France
| | - Abdellah Mansouri
- Centre de recherche sur l'inflammation, Université de Paris, Inserm, CNRS, Paris, France.,Department of Hepatology, AP-HP, Hôpital Beaujon, Clichy, France
| | - Tarik Asselah
- Centre de recherche sur l'inflammation, Université de Paris, Inserm, CNRS, Paris, France.,Department of Hepatology, AP-HP, Hôpital Beaujon, Clichy, France
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12
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Cheng XD, Xu HF, Wei F, Jiang LX, Zhou HZ. The genotype analysis of the hepatitis C virus in Heilongjiang Province, China. Medicine (Baltimore) 2021; 100:e25203. [PMID: 33950918 PMCID: PMC8104223 DOI: 10.1097/md.0000000000025203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 02/25/2021] [Indexed: 01/04/2023] Open
Abstract
Introduction: Hepatitis C virus (HCV) infection is a major public health issue. HCV genotype identification is clinically important to tailor the dosage and duration of treatment, and recombination in intra-patient populations of HCV may lead to the generation of escape mutants, as previously observed for other RNA viruses. Up to now, there is no study assessing HCV genotypes and subtypes in Heilongjiang Province, China.Methods: To determine genotype and phylogenetic analysis of HCV in Heilongjiang Province is crucial. In this study, we amplified 3 genome regions (5'UTR, E1, and NS5B) of 30 HCV patients in Heilongjiang Province, amplified products were analyzed by bioinformatics.Results: We found that 23 specimens had concordant subtypes in the 3 gene regions (2a and 1b), 7 HCV patients were considered the recombinants, the recombination pattern of the 7 HCV patients in the 5'UTR, E1, and NS5B region as followed: 1b/2a/1b, 2a/2a/1b, 1b/2a/2a, 1b/2a/1b, 1b/2a/1b, 1b/2a/1b, 2a/2a/1b.Conclusions: The findings in the present study showed that a higher recombination rate (23%) than other researches, and the recombination of 2a/1b in the 5'UTR, E1, and NS5B region was only found in the present study up to now.
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Affiliation(s)
- Xue-Di Cheng
- Department of Clinical Laboratory, The Affiliated Hospital of Qingdao University, Qingdao, Shandong
- Department of Laboratory Diagnosis, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, PR China
| | - Hua-Feng Xu
- Department of Laboratory Diagnosis, Heilongjiang Provincial Hospital
| | - Feng Wei
- Department of Laboratory Diagnosis, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, PR China
| | - Li-Xin Jiang
- Department of Laboratory Diagnosis, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, PR China
| | - Hai-Zhou Zhou
- Department of Laboratory Diagnosis, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, PR China
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13
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Matthew AN, Leidner F, Lockbaum GJ, Henes M, Zephyr J, Hou S, Desaboini NR, Timm J, Rusere LN, Ragland DA, Paulsen JL, Prachanronarong K, Soumana DI, Nalivaika EA, Yilmaz NK, Ali A, Schiffer CA. Drug Design Strategies to Avoid Resistance in Direct-Acting Antivirals and Beyond. Chem Rev 2021; 121:3238-3270. [PMID: 33410674 PMCID: PMC8126998 DOI: 10.1021/acs.chemrev.0c00648] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Drug resistance is prevalent across many diseases, rendering therapies ineffective with severe financial and health consequences. Rather than accepting resistance after the fact, proactive strategies need to be incorporated into the drug design and development process to minimize the impact of drug resistance. These strategies can be derived from our experience with viral disease targets where multiple generations of drugs had to be developed to combat resistance and avoid antiviral failure. Significant efforts including experimental and computational structural biology, medicinal chemistry, and machine learning have focused on understanding the mechanisms and structural basis of resistance against direct-acting antiviral (DAA) drugs. Integrated methods show promise for being predictive of resistance and potency. In this review, we give an overview of this research for human immunodeficiency virus type 1, hepatitis C virus, and influenza virus and the lessons learned from resistance mechanisms of DAAs. These lessons translate into rational strategies to avoid resistance in drug design, which can be generalized and applied beyond viral targets. While resistance may not be completely avoidable, rational drug design can and should incorporate strategies at the outset of drug development to decrease the prevalence of drug resistance.
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Affiliation(s)
- Ashley N. Matthew
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, Massachusetts 01605, United States
- Virginia Commonwealth University
| | - Florian Leidner
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, Massachusetts 01605, United States
| | - Gordon J. Lockbaum
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, Massachusetts 01605, United States
| | - Mina Henes
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, Massachusetts 01605, United States
| | - Jacqueto Zephyr
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, Massachusetts 01605, United States
| | - Shurong Hou
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, Massachusetts 01605, United States
| | - Nages Rao Desaboini
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, Massachusetts 01605, United States
| | - Jennifer Timm
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, Massachusetts 01605, United States
- Rutgers University
| | - Linah N. Rusere
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, Massachusetts 01605, United States
- Raybow Pharmaceutical
| | - Debra A. Ragland
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, Massachusetts 01605, United States
- University of North Carolina, Chapel Hill
| | - Janet L. Paulsen
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, Massachusetts 01605, United States
- Schrodinger, Inc
| | - Kristina Prachanronarong
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, Massachusetts 01605, United States
- Icahn School of Medicine at Mount Sinai
| | - Djade I. Soumana
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, Massachusetts 01605, United States
- Cytiva
| | - Ellen A. Nalivaika
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, Massachusetts 01605, United States
| | - Nese Kurt Yilmaz
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, Massachusetts 01605, United States
| | - Akbar Ali
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, Massachusetts 01605, United States
| | - Celia A Schiffer
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, Massachusetts 01605, United States
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14
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El-Fattah MA. Predictive power of Interleukin-28B gene variants for outcome of Hepatitis C Virus genotype 4 in Egyptians: A systematic review and meta-analysis. Clin Res Hepatol Gastroenterol 2021; 45:101480. [PMID: 32622719 DOI: 10.1016/j.clinre.2020.06.006] [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: 11/03/2019] [Revised: 05/09/2020] [Accepted: 06/01/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND An advanced liver fibrosis did not abolish an Egyptian ethnicity as a favourable predictor for hepatitis C genotype 4 (HCV-GT4) outcome, that raises genetic issues. PATIENTS AND METHODS Multiple databases were searched from inception up to 1 April, 2020 for all studies included Egyptians, whose were genotyped for Interleukin-28B (IL-B28) in the setting of HCV. The pooled odds ratios (ORs) were based on a fixed or random effect model as appropriate. RESULTS In total, 33 studies included 5,538 Egyptians from 9 governorates. Of these, 4088 patients had chronic HCV-GT4, 373 resolvers (spontaneously cleared the virus), and 1077 non-infected subjects. The pooled prevalence of CC and CT/TT rs12979860 genotypes among chronic HCV-GT4 were 32%, and 68%, respectively. The pooled sustained virologic response (SVR) was achieved in 54% of 2,622 patients received Pegylated-interferon and Ribavirin. Compared with chronic HCV-infected patients, the favorable CC genotype was over-represented in the healthy subjects (30% vs. 45%), and HCV resolvers (28% vs. 59%). The CC genotype carriers were two-times more likely to resist HCV infection (vs. CT/TT OR=1.93, P<0.001), three-times (OR=3.31, P<0.001) to clear the virus spontaneously, and six-times to achieve interferon-induced SVR (ORcorrected=6.03; P<0.001). The rs8099917 TT carriers were associated with a higher rate of SVR (vs. wild GT/GG, 74% vs. 38%), with 3-fold probability achieving SVR (ORcorrected=3.42, P<0.001). CONCLUSIONS Polymorphisms near the IL-28B gene protect against infection and persistence of HCV, and predict SVR.
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Affiliation(s)
- Mohamed Abd El-Fattah
- Department of Internal Medicine, Faculty of Medicine, Suez Canal University, Ring Road, Ismailia City, Ismailia 41522, Egypt.
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15
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Sultan A, Bane A, Braimoh G, Debes JD. Treatment of Hepatitis C Genotypes 1 to 5 in Sub-Saharan Africa Using Direct-Acting Antivirals. Am J Trop Med Hyg 2021; 103:2083-2084. [PMID: 32828136 DOI: 10.4269/ajtmh.20-0367] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
There is limited knowledge of the use of direct acting antivirals (DAAs) for the treatment of hepatitis C virus (HCV) in sub-Saharan Africa. We prospectively evaluated individuals infected with HCV genotypes 1 to 5 in Addis Ababa, Ethiopia. Liver fibrosis was assessed by AST-platelet ratio index score and cirrhosis by imaging and laboratory values. All 164 individuals completed treatment. The majority of patients had genotype 4 (76%), and 19% of participants showed evidence of cirrhosis. Sustained virologic response (SVR) across all genotypes was 98.8%. In those with cirrhosis, SVR was 93.5% and in non-cirrhotics 100%. Our study demonstrates broad genotype successful treatment of HCV with DAAs in sub-Saharan Africa, demonstrating the feasibility of HCV elimination in resource-limited settings.
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Affiliation(s)
- Amir Sultan
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abate Bane
- Adera Gastroenterology and Hepatology Center, Addis Ababa, Ethiopia.,College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Grace Braimoh
- Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Jose D Debes
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.,Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota
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16
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da Silva DL, Nunes HM, Freitas PEB. Natural prevalence of NS3 gene resistance-associated substitutions (RASs) in patients with chronic hepatitis C from the state of Pará/Brazil. Virus Res 2020; 292:198251. [PMID: 33259871 DOI: 10.1016/j.virusres.2020.198251] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 12/26/2022]
Abstract
The resistance of hepatitis C virus (HCV) to direct-acting antiviral agents, used in chronic hepatitis C treatment, consists of a natural process resulting from resistance-associated substitutions (RASs) at specific amino acid regions. To identify and establish the natural prevalence of RASs in the NS3 gene in patients with chronic hepatitis C in the state of Pará, northern Brazil. Molecular analysis was performed on a total of 35 patients infected with HCV genotype 1, who were treatment-naive to protease inhibitors. HCV RNA was extracted from plasma and the NS3 region was amplified and submitted to DNA sequencing (Sanger). The general natural prevalence of RASs in the NS3 gene was 37.5 % (Y56F and S122T). The substitutions Y56F (34.3 %), S122T (3.1 %), V132I (15.6 %) and V170I (9.3 %) were identified. Y56F and S122T provide resistance to the protease inhibitors grazoprevir and simeprevir, respectively. All amino acid substitutions in the NS3 gene, including RASs, identified in patients from the state of Pará were present in other Brazilian studies. The natural presence of RASs in this study reflects the elevated genetic variability of HCV.
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17
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Dietz J, Kalinina OV, Vermehren J, Peiffer KH, Matschenz K, Buggisch P, Niederau C, Schattenberg JM, Müllhaupt B, Yerly S, Ringelhan M, Schmid RM, Antoni C, Müller T, Schulze Zur Wiesch J, Piecha F, Moradpour D, Deterding K, Wedemeyer H, Moreno C, Berg T, Berg CP, Zeuzem S, Welsch C, Sarrazin C. Resistance-associated substitutions in patients with chronic hepatitis C virus genotype 4 infection. J Viral Hepat 2020; 27:974-986. [PMID: 32396998 DOI: 10.1111/jvh.13322] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 03/20/2020] [Accepted: 04/07/2020] [Indexed: 12/13/2022]
Abstract
Data on the prevalence of resistance-associated substitutions (RASs) and their implications for treatment with direct-acting antivirals (DAAs) are sparse in European patients with HCV genotype 4. This study investigated RASs before and after DAA failure in different genotype 4 subtypes and evaluated retreatment efficacies. Samples of 195 genotype 4-infected patients were collected in the European Resistance Database and investigated for NS3, NS5A and NS5B RASs. Retreatment efficacies in DAA failure patients were analysed retrospectively. After NS5A inhibitor (NS5Ai) failure, subtype 4r was frequent (30%) compared to DAA-naïve patients (5%) and the number of NS5A RASs was significantly higher in subtype 4r compared to 4a or 4d (median three RASs vs no or one RAS, respectively, P < .0001). RASsL28V, L30R and M31L pre-existed in subtype 4r and were maintained after NS5Ai failure. Typical subtype 4r RASs were located in subdomain 1a of NS5A, close to membrane interaction and protein-protein interaction sites that are responsible for multimerization and hence viral replication. Retreatment of 37 DAA failure patients was highly effective with 100% SVR in prior SOF/RBV, PI/SOF and PI/NS5Ai failures. Secondary virologic failures were rare (n = 2; subtype 4d and 4r) and only observed in prior NS5Ai/SOF failures (SVR 90%). In conclusion, subtype 4r harboured considerably more RASs compared to other subtypes. A resistance-tailored retreatment using first- and second-generation DAAs was highly effective with SVR rates ≥90% across all subtypes and first-line treatment regimens.
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Affiliation(s)
- Julia Dietz
- Department of Internal 1, University Hospital, Goethe University, Frankfurt, Germany.,German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany
| | - Olga V Kalinina
- Helmholtz Centre for Infection Research (HZI), Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Saarbrücken, Germany.,Medical Faculty, Saarland University, Homburg, Germany
| | - Johannes Vermehren
- Department of Internal 1, University Hospital, Goethe University, Frankfurt, Germany.,German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany
| | - Kai-Henrik Peiffer
- Department of Internal 1, University Hospital, Goethe University, Frankfurt, Germany.,German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany
| | | | - Peter Buggisch
- Institute for Interdisciplinary Medicine IFI, Hamburg, Germany
| | - Claus Niederau
- St. Josef-Hospital, Katholisches Klinikum Oberhausen, Oberhausen, Germany
| | - Jörn M Schattenberg
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Beat Müllhaupt
- Swiss Hepato-Pancreato-Biliary Center and Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Sabine Yerly
- Laboratory of Virology, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | - Marc Ringelhan
- Department of Internal Medicine II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Roland M Schmid
- Department of Internal Medicine II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Christoph Antoni
- Department of Medicine II, Heidelberg University Hospital at Mannheim, Mannheim, Germany
| | - Tobias Müller
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Julian Schulze Zur Wiesch
- Department of Internal Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Site, Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Felix Piecha
- Department of Internal Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Darius Moradpour
- Division of Gastroenterology and Hepatology, University Hospital Lausanne, Lausanne, Switzerland
| | - Katja Deterding
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany.,Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule Hannover, Hannover, Germany.,German Center for Infection Research (DZIF), Partner Site, Hannover-Braunschweig, Hannover, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany.,Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule Hannover, Hannover, Germany.,German Center for Infection Research (DZIF), Partner Site, Hannover-Braunschweig, Hannover, Germany
| | - Christophe Moreno
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Thomas Berg
- Department of Gastroenterology and Rheumatology, University Hospital Leipzig, Leipzig, Germany
| | - Christoph P Berg
- Department of Internal Medicine I, University of Tübingen, Tübingen, Germany
| | - Stefan Zeuzem
- Department of Internal 1, University Hospital, Goethe University, Frankfurt, Germany.,German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany
| | - Christoph Welsch
- Department of Internal 1, University Hospital, Goethe University, Frankfurt, Germany.,German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany
| | - Christoph Sarrazin
- Department of Internal 1, University Hospital, Goethe University, Frankfurt, Germany.,German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany.,St. Josefs-Hospital, Medizinische Klinik II, Wiesbaden, Germany
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18
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Efficacy of NS5A inhibitors against unusual and potentially difficult-to-treat HCV subtypes commonly found in sub-Saharan Africa and South East Asia. J Hepatol 2020; 73:794-799. [PMID: 32470499 DOI: 10.1016/j.jhep.2020.05.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 04/22/2020] [Accepted: 05/12/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS The efficacy of NS5A inhibitors against several less common subtypes of hepatitis C virus (HCV) is poorly characterised. Some subtypes including 3b, 3g, 6u and 6v commonly harbour amino acid residues in NS5A that may confer resistance to direct-acting antivirals (DAAs) in other common subtypes. Data from patients also suggest that 1l and 4r with amino acid substitutions at positions 28-31 and 93 in NS5A are relatively resistant to DAA therapy. METHODS In this study, we tested the efficacy of daclatasvir, elbasvir, ledipasvir, pibrentasvir and velpatasvir against these subtypes using the SGR-JFH1 replicon backbone. RESULTS NS5A inhibitors showed different levels of efficacy with only pibrentasvir effective against all tested subtypes. Daclatasvir and ledipasvir were ineffective against 6u and 6v (half maximal effective concentration [EC50] values of 239-321 nM) while 3b and 3g were only susceptible to pibrentasvir. Analysis of effects of individual mutations indicated that Q30R in 1l increased the EC50 of ledipasvir by 18-fold, conferring intermediate resistance, while those of L31M and Y93H in 4r induced increases in EC50 values of 2,100- and 3,575-fold (high-level resistance). CONCLUSION The high ledipasvir EC50 values of 1l with the Q30R substitution, 4r L31M and 4r Y93H may explain the treatment failure in patients who were infected with these viruses and treated with ledipasvir + sofosbuvir. This study also shows the ineffectiveness of the first generation NS5A inhibitors against 6u and 6v, and confirms the inherent resistance of 3b and 3g to most NS5A inhibitors. Clinical studies to confirm in vivo sensitivity to NS5A inhibitors are urgently needed so that rational, effective treatment strategies may be developed for unusual subtypes. LAY SUMMARY Little is known about the efficacy of NS5A inhibitors against some "unusual" hepatitis C virus (HCV) subtypes including 1l, 3b, 3g, 4r, 6u and 6v. In this study, we manufactured HCV replicons which express the NS5A protein from the unusual HCV subtypes 1l, 3b, 3g, 4r, 6u, 6v. We then tested the effect of the NS5A inhibitors daclatasvir, elbasvir, ledipasvir, pibrentasvir and velpatasvir on blocking replication, using these replicons. We show that these replicons are resistant at some level to all NS5A inhibitors other than pibrentasvir.
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19
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Yao BB, Fredrick LM, Schnell G, Kowdley KV, Kwo PY, Poordad F, Nguyen K, Lee SS, George C, Wong F, Gane E, Abergel A, Spearman CW, Nguyen T, Hung Le M, Pham TTT, Mensa F, Asselah T. Efficacy and safety of glecaprevir/pibrentasvir in patients with HCV genotype 5/6: An integrated analysis of phase 2/3 studies. Liver Int 2020; 40:2385-2393. [PMID: 32445613 PMCID: PMC7539968 DOI: 10.1111/liv.14535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/17/2020] [Accepted: 05/17/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS Hepatitis C virus (HCV) has high genetic diversity with six major genotypes (GT) GT1-6 and global distribution. HCV GT5 and 6 are rare with < 10 million people infected worldwide. Data on direct-acting antiviral use in these rare HCV genotypes are limited. The study aimed to evaluate the efficacy and safety of glecaprevir/pibrentasvir (G/P) in a pooled analysis of phase 2/3 trials in HCV GT5 or 6-infected patients without cirrhosis or with compensated cirrhosis. METHODS Patients with chronic HCV GT5 or 6 infection received oral G/P (300 mg/120 mg) once daily for 8 or 12 weeks. The primary efficacy endpoint was sustained virological response at post-treatment week 12 (SVR12) in the intention-to-treat population. RESULTS One hundred eighty-one patients were evaluated; 56 with HCV GT5 and 125 with HCV GT6. The majority were treatment-naïve (88%) and non-cirrhotic (85%). Overall SVR12 rate with 8- or 12-week G/P treatment was 98% (178/181). Eight-week treatment with G/P yielded SVR12 rates of 95% (21/22) in HCV GT5- and 99% (69/70) in HCV GT6-infected non-cirrhotic patients. Eight- and 12-week treatment of patients with compensated cirrhosis achieved SVR12 rates of 100% (10/10) and 94% (17/18) respectively. The G/P regimen was well-tolerated; 3% (6/181) Grade 3 or higher adverse events, and no serious adverse events were attributed to G/P or led to study drug discontinuation. CONCLUSIONS This integrated dataset demonstrates a high SVR12 rate following 8-week G/P treatment in patients with HCV GT5 (96%) or GT6 (99%) infection without cirrhosis or with compensated cirrhosis.
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Affiliation(s)
| | | | | | - Kris V. Kowdley
- Elson S. Floyd College of MedicineWashington State UniversitySpokaneWAUSA
| | - Paul Y. Kwo
- Stanford University School of MedicinePalo AltoCAUSA
| | - Fred Poordad
- The Texas Liver InstituteUniversity of Texas HealthSan AntonioTXUSA
| | - Kinh Nguyen
- National Hospital for Tropical DiseasesHanoiVietnam
| | | | | | - Florence Wong
- Toronto General HospitalUniversity of TorontoTorontoONCanada
| | - Edward Gane
- Auckland Clinical StudiesAucklandNew Zealand
| | - Armand Abergel
- Centre Hospitalier Universitaire EstaingClermont FerrandFrance
| | - Catherine W. Spearman
- Division of HepatologyDepartment of MedicineFaculty of Health SciencesUniversity of Cape Town and Groote Schuur HospitalCape TownSouth Africa
| | - Tuan Nguyen
- Alvarado Hospital Medical CenterSan DiegoCAUSA
| | - Manh Hung Le
- Hospital for Tropical DiseasesHo Chi MinhVietnam
| | | | | | - Tarik Asselah
- Department of HepatologyCentre de Recherche sur l’InflammationINSERM UMR 1149Université Paris DiderotAP‐HP Hôpital BeaujonClichyFrance
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20
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Tran AN, Lim JK. Hepatitis C: How Good Are Real-Life Data and Do Generics Work. Gastroenterol Clin North Am 2020; 49:279-299. [PMID: 32389363 DOI: 10.1016/j.gtc.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Chronic hepatitis C virus infection remains a national and global public health burden and is associated with significant morbidity and mortality. Oral direct-acting antiviral combination regimens have excellent tolerability and efficacy with rates exceeding 90%. Sustained virologic response is associated with significant improvements in clinical outcomes. However, translation of sustained virologic response rates from trials to community settings has been poor with interferon-based regimens. We review and summarize key datasets from major real-world observational cohort studies. We review preliminary data from oral generic direct-acting antiviral formulations. Future real-world studies are needed to further clarify optimal treatment strategies for difficult-to-treat populations.
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Affiliation(s)
- Ashley N Tran
- Section of Digestive Diseases, Yale Liver Center, Yale University School of Medicine, New Haven, CT, USA
| | - Joseph K Lim
- Section of Digestive Diseases, Yale Liver Center, Yale University School of Medicine, New Haven, CT, USA; Yale Viral Hepatitis Program, Yale University School of Medicine, 333 Cedar Street, LMP 1080, New Haven, CT 06520-8019, USA.
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21
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Asselah T, Pol S, Hezode C, Loustaud-Ratti V, Leroy V, Ahmed SNS, Ozenne V, Bronowicki JP, Larrey D, Tran A, Alric L, Nguyen-Khac E, Robertson MN, Hanna GJ, Brown D, Asante-Appiah E, Su FH, Hwang P, Hall JD, Guidoum A, Hagen K, Haber BA, Talwani R, Serfaty L. Efficacy and safety of elbasvir/grazoprevir for 8 or 12 weeks for hepatitis C virus genotype 4 infection: A randomized study. Liver Int 2020; 40:1042-1051. [PMID: 31765046 DOI: 10.1111/liv.14313] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/11/2019] [Accepted: 11/18/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Hepatitis C virus (HCV) genotype (GT) 4 infection is prevalent in sub-Saharan Africa and the Middle East, particularly in Egypt. This study evaluated the safety and efficacy of elbasvir/grazoprevir administered for 8 and 12 weeks in participants with HCV GT4 infection. METHODS In this partially randomized, open-label multicentre study conducted in France (NCT03111108; Protocol MK5172-096), treatment-naive participants with GT4 infection and F0-F2 fibrosis were randomized 2:1 to elbasvir (50 mg)/grazoprevir (100 mg) for 8 or 12 weeks. Treatment-naive participants with F3-F4 fibrosis and all treatment-experienced participants (F0-F4) were assigned to elbasvir/grazoprevir for 12 weeks. The primary endpoint was sustained virologic response (SVR) 12 weeks after the end of therapy. RESULTS One hundred and seventeen participants were enrolled. Among treatment-naive participants with F0-F2 fibrosis, SVR was achieved by 94% (50/53) and 96% (26/27) of those receiving elbasvir/grazoprevir for 8 or 12 weeks, respectively, and four participants relapsed. In the 12-week arm, 95% (35/37) achieved SVR and two participants relapsed. NS5A resistance-associated substitutions were present at baseline and virologic failure in five of the participants with relapse. Drug-related adverse events occurred in 42% (n = 22) and 50% (n = 32) of participants receiving 8 and 12 weeks of treatment, respectively. No participant discontinued treatment owing to an adverse event. CONCLUSION These data confirm the efficacy of elbasvir/grazoprevir administered for 12 weeks in treatment-experienced individuals with HCV GT4 infection and those with advanced fibrosis. Treatment-naive individuals with mild fibrosis can be treated effectively with an 8-week regimen.
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Affiliation(s)
- Tarik Asselah
- Department of Hepatology and Gastroenterology, University Paris Diderot, Sorbonne Paris Cité, CRI, UMR 1149 INSERM, Paris, France.,Department of Hepatology, AP-HP Hôpital Beaujon, Clichy, France
| | - Stanislas Pol
- Department of Hepatology, APHP Hôpital Cochin/Université Paris Descartes/INSERM U1223, Institut Pasteur, Paris, France
| | - Christophe Hezode
- Department of Hepatology, Henri Mondor Hospital, APHP, University of Paris-Est, INSERM U955, Créteil, France
| | - Veronique Loustaud-Ratti
- Department of Hepatology and Gastroenterology, CHU de Limoges, U850 INSERM, Université Limoges, Limoges, France
| | | | - Si Nafa Si Ahmed
- Department of Hepatology and Gastroenterology, Pȏle de Recherche Clinique, Hôpital Saint Joseph, Marseille, France
| | - Violaine Ozenne
- Department of Hepatology and Gastroenterology, Hôpital Saint Antoine, Paris, France
| | | | - Dominique Larrey
- Department of Hepatology, Hôpital Saint Eloi, Ecole de Médecine de Montpellier, Montpellier, France
| | - Albert Tran
- Department of Gastroenterology, Université Côte d'Azur, Nice, France.,Centre Digestif, CHU de Nice, Nice, France.,INSERM, U1065, C3M, Team 8, Nice, France
| | - Laurent Alric
- Department of Internal Medicine/Gastroenterology, CHU de Toulouse, Toulouse, France
| | - Eric Nguyen-Khac
- Department of Hepatology and Gastroenterology, CHU de Amiens, Amiens, France
| | | | - George J Hanna
- Department of Infectious Diseases, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Deborah Brown
- Department of Infectious Diseases, Merck & Co., Inc., Kenilworth, NJ, USA
| | | | - Feng-Hsiu Su
- Department of Infectious Diseases, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Peggy Hwang
- Department of Infectious Diseases, Merck & Co., Inc., Kenilworth, NJ, USA
| | | | - Amir Guidoum
- Department of Infectious Diseases, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Karin Hagen
- Department of Infectious Diseases, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Barbara A Haber
- Department of Infectious Diseases, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Rohit Talwani
- Department of Infectious Diseases, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Lawrence Serfaty
- Department of Hepatology, Hôpital de Hautepierre, Universitaires de Strasbourg, Strasbourg, France
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22
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Shiha G, Soliman R, Mikhail NNH, Easterbrook P. An educate, test and treat model towards elimination of hepatitis C infection in Egypt: Feasibility and effectiveness in 73 villages. J Hepatol 2020; 72:658-669. [PMID: 31734097 DOI: 10.1016/j.jhep.2019.11.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 09/13/2019] [Accepted: 11/04/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Egypt has one of the highest burdens of HCV infection worldwide. It has a large treatment programme, but reaching rural communities represents a major challenge. We report on the feasibility and effectiveness of a comprehensive community-based HCV prevention, testing and treatment model whose goal was to eliminate infection from all adult villagers. METHODS An HCV "educate, test and treat" programme was implemented in 73 villages across 7 governorates in Egypt between 06/2015 and 06/2018. The programme model comprised community mobilisation facilitated by a network of village promoters to support the education, testing and treatment of patients, as well as fundraising in the local community. Comprehensive testing, linkage to care and treatment were provided for all eligible villagers aged 12 to 80 years. RESULTS Of 221,855 eligible villagers, 204,749 (92.3%, 95% CI 91.6-93.5) were screened for HCV antibody and HBsAg, of whom 33,839 (16.5%, 95% CI 12.2-16.1) and 763 (0.4%, 95% CI 0.3-0.5) were positive, respectively. Nearly all 33,839 HCV antibody positive individuals had a sample immediately collected for HCV RNA testing, and 15,892 were HCV RNA positive. The overall prevalence of HCV viraemia was 7.8%. A total of 14,495 (91.2%, 95% CI 89.9-96.4) patients received treatment within a median of 2.1 weeks from serological diagnosis (IQR 0.6-3.3 weeks) and a sustained virological response was achieved among 14,238 of the treated cases (98.3%, 95% CI 96.7-98.6). Cirrhosis was present in 3,192 patients (20.1%), of whom 166 (5.2%) were diagnosed with hepatocellular carcinoma. There was treatment coverage and cure of 84.6% of the estimated 17,137 infected persons aged 12-80 years across the 73 villages. CONCLUSION In this study of more than 200,000 villagers, we demonstrated the feasibility and effectiveness of a community-based "educate, test and treat" programme as a model for the elimination of HCV infection in rural communities. LAY SUMMARY A large community-based educate, test and treat hepatitis C programme was conducted in more than 200,000 villagers across 73 villages in Egypt. This study demonstrates that a simplified care model can achieve high uptake of testing, linkage to care and treatment, with high cure rates. We consider this a model for the elimination of hepatitis C virus infection in rural communities, which can be applied to other countries highly affected by hepatitis C.
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Affiliation(s)
- Gamal Shiha
- Internal Medicine Department, Faculty of Medicine, Mansoura University, Egypt; Egyptian Liver Research Institute and Hospital (ELRIAH), Mansoura, Egypt.
| | - Reham Soliman
- Egyptian Liver Research Institute and Hospital (ELRIAH), Mansoura, Egypt; Tropical Medicine Department, Faculty of Medicine, Port Said University, Egypt
| | - Nabiel N H Mikhail
- Egyptian Liver Research Institute and Hospital (ELRIAH), Mansoura, Egypt; Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut University, Egypt
| | - Philippa Easterbrook
- Global Hepatitis Programme, HIV Department, World Health Organization, Geneva, Switzerland
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23
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Asselah T, Loureiro D, Tout I, Castelnau C, Boyer N, Marcellin P, Mansouri A. Future treatments for hepatitis delta virus infection. Liver Int 2020; 40 Suppl 1:54-60. [PMID: 32077603 DOI: 10.1111/liv.14356] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 12/26/2019] [Indexed: 02/06/2023]
Abstract
Around 15-20 million people develop chronic hepatitis delta virus worldwide. Hepatitis delta virus (HDV) is a defective RNA virus requiring the presence of the hepatitis B virus surface antigen (HBsAg) to complete its life cycle. HDV infects hepatocytes using the hepatitis B virus (HBV) receptor, the sodium taurocholate cotransporting polypeptide (NTCP). The HDV genome is a circular single-stranded RNA which encodes for a single hepatitis delta antigen (HDAg) that exists in two forms (S-HDAg and L-HDAg), and its replication is mediated by the host RNA polymerases. The HBsAg-coated HDV virions contain a ribonucleoprotein (RNP) formed by the RNA genome packaged with small and large HDAg. Farnesylation of the L-HDAg is the limiting step for anchoring this RNP to HBsAg, and thus for assembling, secreting and propagating virion particles. There is an important risk of morbidity and mortality caused by end-stage liver disease and hepatocellular carcinoma with HDV and current treatment is pegylated-interferon (PEG-IFN) for 48 weeks with no other options in patients who fail treatment. The ideal goal for HDV treatment is the clearance of HBsAg, but a reasonably achievable goal is a sustained HDV virological response (negative HDV RNA 6 months after stopping treatment). New drug development must take into account the interaction of HBV and HDV. In this review, we will present the new insights in the HDV life cycle that have led to the development of novel classes of drugs and discuss antiviral approaches in phase II and III of development: bulevirtide (entry inhibitor), lonafarnib, (prenylation inhibitor) and REP 2139 (HBsAg release inhibitor).
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Affiliation(s)
- Tarik Asselah
- CRI, UMR 1149, Inserm, University Paris Diderot, Sorbonne Paris Cité, Paris, France.,Department of Hepatology, AP-HP Hôpital Beaujon, Clichy, France
| | - Dimitri Loureiro
- CRI, UMR 1149, Inserm, University Paris Diderot, Sorbonne Paris Cité, Paris, France.,Department of Hepatology, AP-HP Hôpital Beaujon, Clichy, France
| | - Issam Tout
- CRI, UMR 1149, Inserm, University Paris Diderot, Sorbonne Paris Cité, Paris, France.,Department of Hepatology, AP-HP Hôpital Beaujon, Clichy, France
| | - Corinne Castelnau
- CRI, UMR 1149, Inserm, University Paris Diderot, Sorbonne Paris Cité, Paris, France.,Department of Hepatology, AP-HP Hôpital Beaujon, Clichy, France
| | - Nathalie Boyer
- CRI, UMR 1149, Inserm, University Paris Diderot, Sorbonne Paris Cité, Paris, France.,Department of Hepatology, AP-HP Hôpital Beaujon, Clichy, France
| | - Patrick Marcellin
- CRI, UMR 1149, Inserm, University Paris Diderot, Sorbonne Paris Cité, Paris, France.,Department of Hepatology, AP-HP Hôpital Beaujon, Clichy, France
| | - Abdellah Mansouri
- CRI, UMR 1149, Inserm, University Paris Diderot, Sorbonne Paris Cité, Paris, France.,Department of Hepatology, AP-HP Hôpital Beaujon, Clichy, France
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24
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Efficacy and safety of treatment of chronic hepatitis C with sofosbuvir and ribavirin with or without peginterferon: a French prospective real-life cohort study of unselected 211 patients. Eur J Gastroenterol Hepatol 2019; 31:1270-1274. [PMID: 31219848 DOI: 10.1097/meg.0000000000001450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Sofosbuvir is the first directly-acting antiviral for the treatment of hepatitis C virus. First, the regimens were combinations with sofosbuvir+ribavirin (SR) or with sofosbuvir+ribavirin and pegylated-interferon α-2a (SPR) with cure rates around 90%. The aim of this study was to report the results of these combinations in 'real-life' in France. MATERIALS AND METHODS Main features of patients treated with SR or SPR in 24 hospitals were collected. Undetectable hepatitis C virus week 12 viral load after treatment defined sustained virological response (SVR12). Statistics were performed using StatView software for descriptive analysis and χ for the sub-groups comparisons. RESULTS Two hundred and eleven patients were analyzed. The average age was 56.1. One hundred and seventy-one (89%) patients had a fibrosis score of at least 3. Seventy-nine patients were infected by a genotype 1 (G1). One hundred and thirteen patients were treated with SR and 95 with SPR. In naive patients: with SPR for 12 weeks, SVR12 was 93% in G1, 100% in G3 and 83% in G4. With SR for 12 weeks, SVR12 was 100% in G2 patients (6/6). The safety of these regimens was satisfactory with only two patients who had to stop P due to severe side effects. Multivariate analysis shows a higher SVR in SPR versus SR (odds ratio = 1.28; P = 0.05) and in G2 or G3 versus others (odds ratio = 1.56; P = 0.04). Moreover, Child-Pugh score B or C (P = 0.02), platelets count under 100G/l (P = 0.05) or a past event of ascites (P = 0.04) was independently associated with less SVR. CONCLUSION This multicenter large study confirms the good results of SR for 12 weeks in G2 naive patients. Finally, a decompensated cirrhosis, a past event of ascites and a baseline low platelet count were strongly associated with poor response.
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25
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Boerekamps A, Vanwolleghem T, van der Valk M, van den Berk GE, van Kasteren M, Posthouwer D, Dofferhoff ASM, van Hoek B, Ramsoekh D, Koopsen J, Schinkel J, Florence E, Arends JE, Rijnders BJ. 8 weeks of sofosbuvir/ledipasvir is effective in DAA-naive non-cirrhotic HCV genotype 4 infected patients (HEPNED-001 study). J Hepatol 2019; 70:554-557. [PMID: 30527953 DOI: 10.1016/j.jhep.2018.10.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/28/2018] [Accepted: 10/08/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Anne Boerekamps
- Department of Internal Medicine and Infectious Diseases, Erasmus MC, Rotterdam, the Netherlands
| | - Thomas Vanwolleghem
- Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium; Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands
| | - Marc van der Valk
- Division of Infectious Diseases, Amsterdam Infection and Immunity Institute, Academic Medical Center, Amsterdam, the Netherlands
| | - Guido E van den Berk
- Department of Internal Medicine and Infectious Diseases, OLVG, Amsterdam, the Netherlands
| | - Marjo van Kasteren
- Department of Internal Medicine and Infectious Diseases, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands
| | - Dirk Posthouwer
- Department of Internal Medicine and Medical Microbiology, Maastricht Universitair Medisch Centrum+, Maastricht, the Netherlands
| | - Anthonius S M Dofferhoff
- Department of Internal Medicine and Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bart van Hoek
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Dewkoemar Ramsoekh
- Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, the Netherlands
| | - Jelle Koopsen
- Department of Medical Microbiology, Section of Clinical Virology, Academic Medical Center, Amsterdam, the Netherlands
| | - Janke Schinkel
- Department of Medical Microbiology, Section of Clinical Virology, Academic Medical Center, Amsterdam, the Netherlands
| | - Eric Florence
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Joop E Arends
- Department of Internal Medicine and Infectious Diseases, Universitair Medisch Centrum Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Bart J Rijnders
- Department of Internal Medicine and Infectious Diseases, Erasmus MC, Rotterdam, the Netherlands.
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26
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Hedskog C, Parhy B, Chang S, Zeuzem S, Moreno C, Shafran SD, Borgia SM, Asselah T, Alric L, Abergel A, Chen JJ, Collier J, Kapoor D, Hyland RH, Simmonds P, Mo H, Svarovskaia ES. Identification of 19 Novel Hepatitis C Virus Subtypes-Further Expanding HCV Classification. Open Forum Infect Dis 2019; 6:ofz076. [PMID: 30949527 PMCID: PMC6440686 DOI: 10.1093/ofid/ofz076] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/01/2019] [Accepted: 02/19/2019] [Indexed: 01/08/2023] Open
Abstract
Background Hepatitis C virus (HCV) is currently classified into 8 genotypes and 86 subtypes. The objective of this study was to characterize novel HCV subtypes and to investigate the impact of subtypes on treatment outcome. Methods Full-genome sequencing was performed on HCV plasma samples with <85% sequence homology of NS3, NS5A, and/or NS5B to HCV genotype (GT) 1–8 reference strains. Results A total of 14 653 patients with GT1–6 HCV infection were enrolled in clinical studies of sofosbuvir-based regimens. For the majority of the patients, a specific subtype could be assigned based on a close genetic relationship to previously described subtypes. However, for 19 patients, novel subtypes were identified with <85% homology compared with previously described subtypes. These novel subtypes had the following genotypes: 9 in GT2, 5 in GT4, 2 in GT6, and 1 each in GT1, GT3, and GT5. Despite the presence of polymorphisms at resistance-associated substitution positions, 18 of the 19 patients treated with sofosbuvir-containing therapy achieved SVR12. Conclusions Nineteen novel HCV subtypes were identified, suggesting an even greater genetic diversity of HCV subtypes than previously recognized.
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Affiliation(s)
| | | | | | - Stefan Zeuzem
- Johann Wolfgang Goethe University Hospital, Frankfurt, Germany
| | - Christophe Moreno
- CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | | | | | - Tarik Asselah
- INSERM UMR 1149, AP-HP Hôpital Beaujon, Université Paris Diderot and Centre de Recherche sur l'Inflammation, Clichy, France
| | | | | | | | | | | | | | - Peter Simmonds
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Hongmei Mo
- Gilead Sciences Inc, Foster City, California
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Challenges and perspectives of direct antivirals for the treatment of hepatitis C virus infection. J Hepatol 2018; 69:1178-1187. [PMID: 30006068 DOI: 10.1016/j.jhep.2018.07.002] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 07/01/2018] [Accepted: 07/03/2018] [Indexed: 12/14/2022]
Abstract
Treatment of chronic hepatitis C virus infection has been revolutionised by the development of direct-acting antivirals (DAAs). All-oral, once-daily, 8- to 12-week treatment regimens are now standard of care, with viral eradication possible in >95% of patients across different populations. Despite these advances, several unresolved issues remain, including treatment of patients with hepatitis C virus genotype 3, chronic kidney disease, and those in whom DAA therapy has previously failed. Glecaprevir/pibrentasvir and sofosbuvir/velpatasvir/voxilaprevir are the most recently approved DAA regimens. Given the overwhelming success of modern DAA-based therapies, glecaprevir/pibrentasvir and sofosbuvir/velpatasvir/voxilaprevir are also likely to represent the last DAAs to be approved. Both are pangenotypic, once-daily, all-oral DAA combinations that have the potential to close the gaps in the current DAA treatment portfolio. Herein, we review the challenges associated with current DAAs and how these two regimens may be implemented in existing treatment algorithms.
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Schnell G, Krishnan P, Tripathi R, Beyer J, Reisch T, Irvin M, Dekhtyar T, Lu L, Ng TI, Xie W, Pilot-Matias T, Collins C. Hepatitis C virus genetic diversity by geographic region within genotype 1-6 subtypes among patients treated with glecaprevir and pibrentasvir. PLoS One 2018; 13:e0205186. [PMID: 30286205 PMCID: PMC6171933 DOI: 10.1371/journal.pone.0205186] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/20/2018] [Indexed: 12/24/2022] Open
Abstract
Hepatitis C virus (HCV) is genetically diverse and includes 7 genotypes and 67 confirmed subtypes, and the global distribution of each HCV genotype (GT) varies by geographic region. In this report, we utilized a large dataset of NS3/4A and NS5A sequences isolated from 2348 HCV GT1-6-infected patients treated with the regimen containing glecaprevir/pibrentasvir (GLE/PIB) to assess genetic diversity within HCV subtypes by geographic region using phylogenetic analyses, and evaluated the prevalence of baseline amino acid polymorphisms in NS3 and NS5A by region/country and phylogenetic cluster. Among 2348 NS3/4A and NS5A sequences, phylogenetic analysis identified 6 genotypes and 44 subtypes, including 3 GT1, 8 GT2, 3 GT3, 13 GT4, 1 GT5, and 16 GT6 subtypes. Phylogenetic analysis of HCV subtype 1a confirmed the presence of two clades, which differed by geographic region distribution and NS3 Q80K prevalence. We detected phylogenetic clustering by country in HCV subtypes 1a, 1b, 2a, 2b, and 5a, suggesting that genetically distinct virus lineages are circulating in different countries. In addition, two clades were detected in HCV GT4a and GT6e, and NS5A amino acid polymorphisms were differentially distributed between the 2 clades in each subtype. The prevalence of NS3 and NS5A baseline polymorphisms varied substantially by genotype and subtype; therefore, we also determined the activity of GLE or PIB against replicons containing NS3/4A or NS5A from HCV GT1-6 clinical samples representing 6 genotypes and 21 subtypes overall. GLE and PIB retained activity against the majority of HCV replicons containing NS3/4A or NS5A from HCV GT1-6 clinical samples, with a median EC50 of 0.29 nM for GLE and 1.1 pM for PIB in a transient replicon assay. The data presented in this report expands the available data on HCV epidemiology, subtype diversity by geographic region, and NS3 and NS5A baseline polymorphism prevalence.
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Affiliation(s)
- Gretja Schnell
- Research & Development, AbbVie Inc., North Chicago, Illinois, United States of America
| | - Preethi Krishnan
- Research & Development, AbbVie Inc., North Chicago, Illinois, United States of America
| | - Rakesh Tripathi
- Research & Development, AbbVie Inc., North Chicago, Illinois, United States of America
| | - Jill Beyer
- Research & Development, AbbVie Inc., North Chicago, Illinois, United States of America
| | - Thomas Reisch
- Research & Development, AbbVie Inc., North Chicago, Illinois, United States of America
| | - Michelle Irvin
- Research & Development, AbbVie Inc., North Chicago, Illinois, United States of America
| | - Tatyana Dekhtyar
- Research & Development, AbbVie Inc., North Chicago, Illinois, United States of America
| | - Liangjun Lu
- Research & Development, AbbVie Inc., North Chicago, Illinois, United States of America
| | - Teresa I. Ng
- Research & Development, AbbVie Inc., North Chicago, Illinois, United States of America
| | - Wangang Xie
- Research & Development, AbbVie Inc., North Chicago, Illinois, United States of America
| | - Tami Pilot-Matias
- Research & Development, AbbVie Inc., North Chicago, Illinois, United States of America
| | - Christine Collins
- Research & Development, AbbVie Inc., North Chicago, Illinois, United States of America
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Krishnan P, Pilot-Matias T, Schnell G, Tripathi R, Ng TI, Reisch T, Beyer J, Dekhtyar T, Irvin M, Xie W, Larsen L, Mensa FJ, Collins C. Pooled Resistance Analysis in Patients with Hepatitis C Virus Genotype 1 to 6 Infection Treated with Glecaprevir-Pibrentasvir in Phase 2 and 3 Clinical Trials. Antimicrob Agents Chemother 2018; 62:e01249-18. [PMID: 30061289 PMCID: PMC6153825 DOI: 10.1128/aac.01249-18] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 07/26/2018] [Indexed: 12/21/2022] Open
Abstract
Over 2,200 patients infected with hepatitis C virus (HCV) genotypes (GT) 1 to 6, with or without cirrhosis, who were treatment naive or experienced to interferon, ribavirin, and/or sofosbuvir were treated with glecaprevir/pibrentasvir for 8, 12, or 16 weeks in eight registrational phase 2 and 3 clinical studies. High rates of sustained virologic response at 12 weeks postdosing (SVR12) were achieved with a <1% virologic failure (VF) rate. The prevalence of baseline polymorphisms (BPs) in NS3 at amino acid position 155 or 168 was low (<3%) in patients infected with GT1, GT2, GT3, GT4, and GT6, while 41.9% of the GT5-infected patients had NS3-D168E; BPs were not detected at position 156 in NS3. The prevalence of NS5A-BPs was high across genotypes, driven by common polymorphisms at amino acid position 30 or 31 in GT2, 58 in GT4, and 28 in GT6. The prevalence of NS5A T/Y93 polymorphisms was 5.5% in GT1, 4.9% in GT3, and 12.5% in GT6. Consistent with the activity of glecaprevir and pibrentasvir against most amino acid polymorphisms in vitro, BPs in NS3 and/or NS5A did not have an impact on treatment outcome for patients infected with GT1 to GT6, with the exception of treatment-experienced GT3-infected patients treated for 12 weeks, for whom a 16-week regimen of glecaprevir/pibrentasvir was required to achieve SVR12 rates of ≥95%. Among the 22 patients experiencing VF, treatment-emergent substitutions were detected in NS3 in 50% of patients and in NS5A in 82% of patients, frequently as a combination of substitutions that conferred resistance to glecaprevir and/or pibrentasvir. The glecaprevir/pibrentasvir regimen, when the recommended durations are used, allows for a pan-genotypic treatment option without the need for baseline resistance testing.
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Affiliation(s)
- Preethi Krishnan
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
| | | | - Gretja Schnell
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
| | - Rakesh Tripathi
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
| | - Teresa I Ng
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
| | - Thomas Reisch
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
| | - Jill Beyer
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
| | - Tatyana Dekhtyar
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
| | - Michelle Irvin
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
| | - Wangang Xie
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
| | - Lois Larsen
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
| | - Federico J Mensa
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
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A village without hepatitis C in Egypt: will micro-elimination lead to macro-elimination? Lancet Gastroenterol Hepatol 2018; 3:734-736. [PMID: 30030069 DOI: 10.1016/s2468-1253(18)30178-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/23/2018] [Indexed: 12/21/2022]
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Applegate TL, Fajardo E, Sacks JA. Hepatitis C Virus Diagnosis and the Holy Grail. Infect Dis Clin North Am 2018; 32:425-445. [DOI: 10.1016/j.idc.2018.02.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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