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Jachs M, Sandmann L, Hartl L, Tergast T, Schwarz M, Bauer DJM, Balcar L, Ehrenbauer A, Hofer BS, Cornberg M, Lenzen H, Deterding K, Trauner M, Mandorfer M, Wedemeyer H, Reiberger T, Maasoumy B. Validation of Baveno VII criteria and other non-invasive diagnostic algorithms for clinically significant portal hypertension in hepatitis delta. J Hepatol 2024; 81:248-257. [PMID: 38479612 DOI: 10.1016/j.jhep.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/15/2024] [Accepted: 03/07/2024] [Indexed: 07/26/2024]
Abstract
BACKGROUND & AIMS Non-invasive tests (NITs) for clinically significant portal hypertension (CSPH) require validation in patients with hepatitis D virus (HDV)-related compensated advanced chronic liver disease (cACLD). Therefore, we aimed to validate existing NIT algorithms for CSPH in this context. METHODS Patients with HDV-cACLD (LSM ≥10 kPa or histological METAVIR F3/F4 fibrosis) who underwent paired HVPG and NIT assessment at Medical University of Vienna or Hannover Medical School between 2013 and 2023 were retrospectively included. Liver stiffness measurement (LSM), von Willebrand factor to platelet count ratio (VITRO), and spleen stiffness measurement (SSM) were assessed. Individual CSPH risk was calculated according to previously published models (ANTICIPATE, 3P/5P). The diagnostic performance of Baveno VII criteria and refined algorithms (Baveno VII-VITRO, Baveno VII-SSM) was evaluated. The prognostic utility of NITs was investigated in the main cohort and an independent, multicenter, validation cohort. RESULTS Fifty-one patients (HVPG ≥10 mmHg/CSPH prevalence: 62.7%, varices: 42.2%) were included. Patients with CSPH had significantly higher LSM (25.8 [17.2-31.0] vs. 14.0 [10.5-19.8] kPa; p <0.001), VITRO (n = 31, 3.5 [2.7-4.5] vs. 1.3 [0.6-2.0] %/[G/L]; p <0.001), and SSM (n = 20, 53.8 [41.7-75.5] vs. 24.0 [17.0-33.9] kPa; p <0.001). Composite CSPH risk models yielded excellent AUROCs (ANTICIPATE: 0.885, 3P: 0.903, 5P: 0.912). Baveno VII criteria ruled out CSPH with 100% sensitivity and ruled in CSPH with 84.2% specificity. The Baveno VII 'grey zone' (41.1%) was significantly reduced by Baveno VII-VITRO or Baveno VII-SSM algorithms, which maintained diagnostic accuracy. Hepatic decompensation within 2 years only occurred in patients who had CSPH or met Baveno VII rule-in criteria. The prognostic value of NITs was confirmed in the validation cohort comprising 92 patients. CONCLUSIONS Standalone and composite NIT/diagnostic algorithms are useful for CSPH diagnosis in patients with HDV-cACLD. Thus, NITs may be applied to identify and prioritize patients with CSPH for novel antiviral treatments against chronic hepatitis D. IMPACT AND IMPLICATIONS Non-invasive tests (NITs) for clinically significant portal hypertension (CSPH) have been developed to identify patients with compensated advanced chronic liver disease (cACLD) at risk of decompensation, but conflicting data has been published regarding the accuracy of liver stiffness measurement (LSM) for the staging of fibrosis in patients infected with hepatitis D virus (HDV). In our study, including 51 patients with HDV-cACLD, LSM- and lab-based NITs yielded high AUROCs for CSPH. Moreover, only patients with CSPH or high non-invasively assessed CSPH risk were at risk of decompensation within 2 years, with the prognostic value of NITs confirmed in a validation cohort. Thus, NITs should be applied and updated in yearly intervals in clinical routine to identify patients with HDV-cACLD at short-term risk of clinical events; NITs may also guide prioritization for novel antiviral treatment options.
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Affiliation(s)
- Mathias Jachs
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria; Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Lisa Sandmann
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany; D-SOLVE Consortium, an EU Horizon Europe Funded Project (No 101057917), Germany; Excellence Cluster RESIST, Excellence Initiative Hannover Medical School, Germany
| | - Lukas Hartl
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Tammo Tergast
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Michael Schwarz
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - David Josef Maria Bauer
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria; Department of Medicine IV, Klinik Ottakring, Vienna, Austria
| | - Lorenz Balcar
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Alena Ehrenbauer
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Benedikt Silvester Hofer
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany; D-SOLVE Consortium, an EU Horizon Europe Funded Project (No 101057917), Germany; Excellence Cluster RESIST, Excellence Initiative Hannover Medical School, Germany; German Center for Infection Research (DZIF), Hannover/Braunschweig, Germany; Centre for Individualised Infection Medicine, Helmholtz Centre for Infection Research/Hannover Medical School, Hannover, Germany
| | - Henrike Lenzen
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Katja Deterding
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Mattias Mandorfer
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany; D-SOLVE Consortium, an EU Horizon Europe Funded Project (No 101057917), Germany; Excellence Cluster RESIST, Excellence Initiative Hannover Medical School, Germany; German Center for Infection Research (DZIF), Hannover/Braunschweig, Germany
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
| | - Benjamin Maasoumy
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany; German Center for Infection Research (DZIF), Hannover/Braunschweig, Germany.
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Qiu X, Hadji A, Olivo A, Hodges A, Beertsen C, Anderson M, Rodgers M, Mbanya D, Elaborot S, Cloherty G. Evaluation of a fully automated high-throughput serology assay for detection of Hepatitis D virus antibodies. J Clin Virol 2024; 173:105689. [PMID: 38781633 DOI: 10.1016/j.jcv.2024.105689] [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: 01/03/2024] [Revised: 04/23/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND HDV antibody testing is recommended for universal screening and as the first line in an HDV double reflex testing strategy for effectively identifying patients with active infection for therapeutic treatments. OBJECTIVE The aim of this study is to evaluate the performance of a newly developed ARCHITECT HDV Total Ig (ARCHITECT HDV Ig) prototype assay. STUDY DESIGN Performance characteristics were determined for the ARCHITECT HDV Ig and a reference test, LIAISON XL Anti-HDV using a well-characterized specimen panel, comprising HDV RNA positive (n = 62) and negative (n = 70) samples, and healthy US blood donors. RESULTS Healthy US blood donors (n=200) showed 99.5% (199/200, 95%CI=97.65-99.98) specificity with ARCHITECT HDV Ig and 98.5 % (197/200, 95 %CI = 96.10-99.64) with LIAISON Anti-HDV. Among known HDV RNA positive samples, ARCHITECT HDV Ig detected 59/62 demonstrating 95.2 % sensitivity while LIAISON Anti-HDV sensitivity was 90.3 % (56/62). Among 101 HBV positive samples, 70 were reactive in the ARCHITECT test, 59 of which tested positive for HDV RNA for a positive predictive value (PPV) for the presence of HDV RNA was 84.3 %. For LIAISON Anti-HDV, 79 specimens were reactive and 56 contained HDV RNA: PPV for HDV RNA was 70.9 %. Among 70 HDV RNA negative samples, 39 were HBV positive. ARCHITECT HDV Ig negative predictive value (NPV) was 71.8 % and LIAISON Anti-HDV NPV was 41 % for the HBV positive group, respectively. CONCLUSION When compared to the LIASON Anti-HDV test, the ARCHITECT HDV Ig assay demonstrated enhanced sensitivity and specificity and better NPV and PPV values for HDV RNA status. The ARCHITECT HDV Ig assay represents a promising tool for universal screening of all HBsAg-positive persons.
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Affiliation(s)
- Xiaoxing Qiu
- Infectious Disease Research, Abbott, Core Diagnostics, Abbott Park, IL, United States
| | - Abbas Hadji
- Infectious Disease Research, Abbott, Core Diagnostics, Abbott Park, IL, United States.
| | - Ana Olivo
- Infectious Disease Research, Abbott, Core Diagnostics, Abbott Park, IL, United States
| | - Austin Hodges
- Infectious Disease Research, Abbott, Core Diagnostics, Abbott Park, IL, United States
| | - Carla Beertsen
- Endocrine Laboratory, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Mark Anderson
- Infectious Disease Research, Abbott, Core Diagnostics, Abbott Park, IL, United States
| | - Mary Rodgers
- Infectious Disease Research, Abbott, Core Diagnostics, Abbott Park, IL, United States
| | | | | | - Gavin Cloherty
- Infectious Disease Research, Abbott, Core Diagnostics, Abbott Park, IL, United States
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Le Guillou-Guillemette H, Pivert A, ElBara A, Vall M, Sang CNW, Veillon P, Ducancelle A, Bollahi MA, Mohamed MS, Lunel-Fabiani F. Prevalence, clinical and virological characteristics and short-term prognosis of hepatitis delta infection among patients with HIV/HBV in Nouakchott, Mauritania. J Viral Hepat 2024; 31:457-465. [PMID: 38771311 DOI: 10.1111/jvh.13950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 05/22/2024]
Abstract
Patients living with HIV infection (PLWH) are at risk of acquiring HBV and HDV. The present study aimed to determine the prevalence and characteristics of HIV-HDV-HBV tri-infection in comparison with HIV-HBV coinfection and to estimate severities and outcomes of associated liver diseases in Mauritanian PLWH. Two-hundred-ninety-two consecutive HBsAg-positive PLWH were included (mean age: 37 years). Clinical data were recorded. Anti-HDV antibodies, HBV and HDV viral loads (VLs) and genotype were determined. APRI, FIB-4 and FibroScan were performed to evaluate the severity of liver disease. The anti-HDV antibodies prevalence was 37% and HDV RNA was positive in 40.7% of patients. Genetic diversities were found with HDV genotype 1 (93%) and HBV genotypes D (42.5%) and E (38%). The HBV VL was detectable in 108 patients at inclusion, and mutations associated with HBV resistance were found in 20. For almost all variables studied, including FIB-4 and APRI scores, no significant differences were found between anti-HDV-Ab positive or negative patients. FibroScan examination, which was performed in 110 patients at end-of-follow-up showed higher, but NS values, in HDV positive patients. After a mean follow-up of 24.55 ± 8.01 months (n = 217 patients), a highly significant worsening of APRI and FIB-4 scores was found. Moreover, patients with HDV showed more severe liver disease progression despite an efficient therapy. In a substantial Mauritanian cohort of relatively young PLWH, we found high HDV prevalence and worsening liver disease. In high-risk countries, screening for HDV and providing appropriate follow-up and treatments are warranted in PLWH.
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Affiliation(s)
- Hélène Le Guillou-Guillemette
- Virology Department, Angers University Hospital, Angers, France
- HIFIH Laboratory EA 3859, Angers University, Angers, France
| | - Adeline Pivert
- Virology Department, Angers University Hospital, Angers, France
- HIFIH Laboratory EA 3859, Angers University, Angers, France
| | | | | | | | - Pascal Veillon
- Virology Department, Angers University Hospital, Angers, France
| | - Alexandra Ducancelle
- Virology Department, Angers University Hospital, Angers, France
- HIFIH Laboratory EA 3859, Angers University, Angers, France
| | | | | | - Françoise Lunel-Fabiani
- Virology Department, Angers University Hospital, Angers, France
- HIFIH Laboratory EA 3859, Angers University, Angers, France
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Ding Y, Guo H, Hong X, Li Q, Miao Z, Pan Q, Zheng K, Wang W. The distinct spatiotemporal evolutionary landscape of HBV and HDV largely determines the unique epidemic features of HDV globally. Mol Phylogenet Evol 2024; 197:108114. [PMID: 38825156 DOI: 10.1016/j.ympev.2024.108114] [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: 08/21/2023] [Revised: 05/07/2024] [Accepted: 05/26/2024] [Indexed: 06/04/2024]
Abstract
Chronic infection of hepatitis B virus (HBV) and hepatitis D virus (HDV) causes the most severe form of viral hepatitis. Due to the dependence on HBV, HDV was deemed to co-evolve and co-migrate with HBV. However, we previously found that the naturally occurred HDV/HBV combinations do not always reflect the most efficient virological adaptation (Wang et al., 2021). Moreover, regions with heavy HBV burden do not always correlate with high HDV prevalence (e.g., East Asia), and vice versa (e.g., Central Asia). Herein, we systematically elucidated the spatiotemporal evolutionary landscape of HDV to understand the unique epidemic features of HDV. We found that the MRCA of HDV was from South America around the late 13th century, was globally dispersed mainly via Central Asia, and evolved into eight genotypes from the 19th to 20th century. In contrast, the MRCA of HBV was from Europe ∼23.7 thousand years ago (Kya), globally dispersed mainly via Africa and East Asia, and evolved into eight genotypes ∼1100 years ago. When HDV stepped in, all present-day HBV genotypes had already formed and its global genotypic distribution had stayed stable geographically. Nevertheless, regionalized HDV adapted to local HBV genotypes and human lineages, contributing to the global geographical separation of HDV genotypes. Additionally, a sharp increase in HDV infections was observed after the 20th century. In conclusion, HDV exhibited a distinct spatiotemporal distribution path compared with HBV. This unique evolutionary relationship largely fostered the unique epidemic features we observe nowadays. Moreover, HDV infections may continue to ramp up globally, thus more efforts are urgently needed to combat this disease.
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Affiliation(s)
- Yibo Ding
- Department of Pathogen Biology and Immunology, Jiangsu Key Laboratory of Immunity and Metabolism, Jiangsu International Laboratory of Immunity and Metabolism, Xuzhou Medical University, Xuzhou, China
| | - Hongbo Guo
- Department of Pathogen Biology and Immunology, Jiangsu Key Laboratory of Immunity and Metabolism, Jiangsu International Laboratory of Immunity and Metabolism, Xuzhou Medical University, Xuzhou, China.
| | - Xinfang Hong
- Second Medical Center of PLA General Hospital, Beijing, China
| | - Qiudi Li
- Department of Pathogen Biology and Immunology, Jiangsu Key Laboratory of Immunity and Metabolism, Jiangsu International Laboratory of Immunity and Metabolism, Xuzhou Medical University, Xuzhou, China
| | - Zhijiang Miao
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China
| | - Qiuwei Pan
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.
| | - Kuiyang Zheng
- Department of Pathogen Biology and Immunology, Jiangsu Key Laboratory of Immunity and Metabolism, Jiangsu International Laboratory of Immunity and Metabolism, Xuzhou Medical University, Xuzhou, China.
| | - Wenshi Wang
- Department of Pathogen Biology and Immunology, Jiangsu Key Laboratory of Immunity and Metabolism, Jiangsu International Laboratory of Immunity and Metabolism, Xuzhou Medical University, Xuzhou, China.
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de Lédinghen V, Fougerou-Leurent C, Le Pabic E, Pol S, Alfaiate D, Lacombe K, Hilleret MN, Lascoux-Combe C, Minello A, Billaud E, Rosa I, Gervais A, Ratziu V, Ganne N, Pageaux GP, Leroy V, Loustaud-Ratti V, Mathurin P, Chas J, Jezequel C, Métivier S, Dumortier J, Arpurt JP, Asselah T, Roche B, Le Gruyer A, Valantin MA, Scholtès C, Gordien E, Tual C, Kortebi A, Coulibaly F, Rosenthal E, Subic-Levrero M, Roulot D, Zoulim F. Treatment with bulevirtide in HIV-infected patients with chronic hepatitis D: ANRS HD EP01 BuleDelta and compassionate cohort. JHEP Rep 2024; 6:101057. [PMID: 39045338 PMCID: PMC11264178 DOI: 10.1016/j.jhepr.2024.101057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 07/25/2024] Open
Abstract
Background & Aims In France, bulevirtide (BLV) became available in September 2019 through an early access program to treat patients with HDV. The aim of this analysis was to evaluate the efficacy and safety of BLV in patients with HIV and HDV coinfection. Methods Patients received BLV 2 mg ± pegylated interferon-α (pegIFNα) according to the physician's decision. The primary endpoint (per-protocol analysis) was the virological response rate at Week 48, defined as the proportion of patients with undetectable serum HDV RNA or a HDV RNA decline >2 log10 IU/ml from baseline. Results The characteristics of the 38 patients were as follows: 28 male, mean age 47.7 years, and mean baseline HDV RNA viral load 5.7 ± 1.2 log10 IU/ml. Median HIV viral load and mean CD4 count were 32 (30-65) copies/ml and 566 ± 307/mm3, respectively. Eight patients stopped treatment before Week 48. At Week 48, 10 of 19 patients (52.6%) in the 2 mg BLV group and five of seven patients (71.4%) in the 2 mg BLV + pegIFNɑ group had reached virological response (no HDV RNA available in four patients). At Week 48, seven of 19 patients in the 2 mg BLV group and three of six patients in the 2 mg BLV + pegIFNɑ group had a combined response (virological response and normal alanine aminotransferase level). Conclusions Adults living with HIV coinfected with HDV can be treated by BLV with a virological response in more than 50% of patients. The combination of BLV and pegIFNɑ showed a strong virological response. Impact and implications Bulevirtide is the only EMA-approved drug for HDV treatment, and we showed that it can be used in adults living with HIV, with an overall good tolerability. Bulevirtide induces a virological response in more than 50% of patients, suggesting that bulevirtide should be considered as a first-line therapy in this specific population. Bulevirtide in combination with pegIFNα could be used in patients without pegIFNα contraindication. No specific drug-drug interaction is reported. Bulevirtide is the only EMA-approved drug for HDV treatment, and we showed that it can be used in adults living with HIV, with an overall good tolerability. Bulevirtide induces a virological response in more than 50% of patients, suggesting that bulevirtide should be considered as a first-line therapy in this specific population. Bulevirtide in combination with pegIFNα could be used in patients without pegIFNα contraindication. No specific drug-drug interaction is reported. Bulevirtide is the only EMA-approved drug for HDV treatment, and we showed that it can be used in adults living with HIV, with an overall good tolerability. Bulevirtide induces a virological response in more than 50% of patients, suggesting that bulevirtide should be considered as a first-line therapy in this specific population. Bulevirtide in combination with pegIFNα could be used in patients without pegIFNα contraindication. No specific drug-drug interaction is reported.
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Affiliation(s)
- Victor de Lédinghen
- Hepatology Unit, Hôpital Haut Lévêque, Bordeaux University Hospital, Bordeaux, & INSERM U1312, Bordeaux University, Bordeaux, France
| | | | | | - Stanislas Pol
- Université Paris Cité; Centre Hospitalier Cochin Port Royal, DMU Cancérologie et spécialités médico-chirurgicales, Service d’Hépatologie, Paris, France
| | - Dulce Alfaiate
- Infectious Diseases Department, Hôpital de la Croix Rousse, Lyon University Hospitals, Lyon, France
| | - Karine Lacombe
- Sorbonne Université, Inserm IMPLESP, Infectious Diseases Unit, St Antoine Hospital, AP-HP, Paris, France
| | - Marie-Noëlle Hilleret
- Service d’Hépato-Gastroentérologie, Centre Hospitalier Universitaire, Grenoble, France
| | - Caroline Lascoux-Combe
- Assistance Publique des Hôpitaux de Paris, Hôpital Saint-Louis, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Anne Minello
- Service d’Hépato-Gastroentérologie, Centre Hospitalier Universitaire, Dijon, France
| | - Eric Billaud
- Service de Maladies Infectieuses, Centre Hospitalier Universitaire, Nantes, France
| | - Isabelle Rosa
- Service d’Hépato-Gastroentérologie, Centre Hospitalier Inter-communal, Créteil, France
| | - Anne Gervais
- Assistance Publique des Hôpitaux de Paris, Hôpital Bichat Claude Bernard, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Vlad Ratziu
- Sorbonne Université, Institute of Cardiometabolism and Nutrition, Hospital Pitié Salpêtrière, Paris, France
| | | | | | - Vincent Leroy
- Service d’Héatologie, AP-HP Henri Mondor, Créteil, France
| | - Véronique Loustaud-Ratti
- Hepato-gastroenterology Department, University Hospital Center and INSERM U 1248, Limoges University, Limoges, France
| | - Philippe Mathurin
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire, Lille, France
| | - Julie Chas
- France Assistance Publique des Hôpitaux de Paris, Hôpital Tenon, Service des Maladies Infectieuses et Tropicales, Paris, France
| | | | - Sophie Métivier
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire, Toulouse, France
| | - Jérôme Dumortier
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités digestives, et Université Claude Bernard Lyon 1, Lyon, France
| | - Jean-Pierre Arpurt
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Général, Avignon, France
| | - Tarik Asselah
- Université Paris-Cité, Centre de recherche sur l'inflammation, Inserm U1149, Department of Hepatology, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Beaujon, Clichy, France
| | - Bruno Roche
- France Assistance Publique des Hôpitaux de Paris, Hôpital Paul Brousse, Service d’Hépatologie, Villejuif, France
| | - Antonia Le Gruyer
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Général, Saint-Brieuc, France
| | - Marc-Antoine Valantin
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM U1136, Paris, France
| | - Caroline Scholtès
- Service de Virologie, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Emmanuel Gordien
- National Reference Centre for Viral Hepatitis B, C and Delta, Department of Virology, Paris-Seine-Saint-Denis University Hospitals, Bobigny, France
| | | | | | | | - Eric Rosenthal
- ANRS MIE, PariSanté Campus, 2 rue d’Oradour sur Glane, Paris, France
| | - Miroslava Subic-Levrero
- Hepatology Department, Hospices Civils de Lyon, INSERM U1052-CRCL; Université Claude Bernard Lyon 1, Lyon, France
| | | | - Fabien Zoulim
- Hepatology Department, Hospices Civils de Lyon, INSERM U1052-CRCL; Université Claude Bernard Lyon 1, Lyon, France
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Degasperi E, Anolli MP, Lampertico P. Advances in hepatitis delta research: emerging insights and future directions. Sex Transm Infect 2024; 100:310-317. [PMID: 38914473 DOI: 10.1136/sextrans-2023-056098] [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: 03/23/2024] [Accepted: 05/31/2024] [Indexed: 06/26/2024] Open
Abstract
OBJECTIVES Hepatitis delta virus (HDV) is a defective virus needing the envelope provided by hepatitis B virus (HBV) in order to enter liver cells and propagate. Chronic HDV infection is considered the most severe viral hepatitis, resulting in accelerated fibrosis progression until cirrhosis and its complications (hepatocellular carcinoma, liver decompensation) compared with HBV mono-infected patients. Off-label treatment with interferon has represented the only treatment option in the last 40 years, resulting in suboptimal virological response rates and being limited by safety issues especially in patients with advanced cirrhosis. Recently, the first HBV-HDV entry inhibitor Bulevirtide (BLV) has been approved by the European Medicines Agency (EMA) for treatment of chronic compensated HDV. METHODS This review summarises most recent updates on HDV epidemiology, diagnosis and treatment, with a special focus both on clinical trials and real-life studies about BLV. An overview on new HDV compounds under development is also provided. RESULTS BLV, the HBV-HDV entry inhibitor, has shown promising safety and efficacy data in clinical trials and in real-life studies, also in patients with advanced cirrhosis and portal hypertension. However, according to EMA label treatment is currently intended long-term until clinical benefit and predictors of responses are still undefined. The potential combination with PegIFNα seems to increase virological and clinical responses. New compounds are under development or in pipeline for treatment of HDV. CONCLUSION After more than 40 years since HDV discovery, new treatment options are currently available to provide efficient strategies for chronic hepatitis Delta.
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Affiliation(s)
- Elisabetta Degasperi
- Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy
| | - Maria Paola Anolli
- Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy
| | - Pietro Lampertico
- Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy
- CRC 'A. M. and A. Migliavacca' Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milano, Italy
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Tsengel A, Orgoi S, Damdinbazar O, Badarch BI, Ganbold U, Batsuuri B, Mukhtar Y, Bat-Erdene B, Lei L, Bazarsad T, Zandanbazar U, Yundendorj G. A decade of liver transplantation in Mongolia: Economic insights and cost analysis. HEALTH ECONOMICS REVIEW 2024; 14:55. [PMID: 39028435 PMCID: PMC11264777 DOI: 10.1186/s13561-024-00528-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 06/27/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Mongolia introduced liver transplantation 10 years ago, becoming the 46th country globally to successfully perform this procedure. However, the cost of liver transplantation treatment remains expensive in Mongolia, a lower-middle-income country. Thus, the need to calculate the cost of liver transplants, a highly-valued treatment, forms the basis for this study. METHODS This study employed a retrospective research design with secondary data. The primary dataset comprised 143 cases of liver transplantation performed at the First Central Hospital of Mongolia between 2011 and 2021. RESULTS The average cost of a liver transplant in Mongolia is $39,589 ± 10,308, with 79.6% being direct costs and 20.4% indirect costs. Of the direct costs, 71% were attributed to drugs, medical equipment, and supplies, while 8.6% accounted for salaries. In terms of the Model of End-Stage Liver Disease (MELD) scores, treatment costs were $39,205 ± 10,786 for patients with MELD ≤ 14 points, $40,296 ± 1,517 for patients with MELD 15-20 points, $39,352 ± 8,718 for patients with MELD 21-27 points, and $39,812 ± 9,954 for patients with MELD ≤ 28 points, with no statistically significant difference (P = 0.953). However, when calculated according to the Child-Turcotte-Pugh (CTP) score classification, treatment cost for CTP-A patients was $35,970 ± 6,879, for CTP-B patients $41,951 ± 12,195, and for CTP-C patients $37,396 ± 6,701, which was statistically significant (Р=0.015). CONCLUSION The average cost of liver transplantation treatment in Mongolia was $39,589. Despite medical facilities' capacity to treat up to 50 patients annually, the waiting list exceeds 300 individuals, highlighting significant unmet healthcare needs.
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Affiliation(s)
- Amarjargal Tsengel
- First Central Hospital of Mongolia, Ulaanbaatar, Mongolia
- Department of Health Policy, School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Sergelen Orgoi
- First Central Hospital of Mongolia, Organ Transplantation Center, Ulaanbaatar, Mongolia
| | - Otgonbayar Damdinbazar
- Division for Science and Technology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.
| | - Bat-Ireedui Badarch
- First Central Hospital of Mongolia, Organ Transplantation Center, Ulaanbaatar, Mongolia
| | - Urnultsaikhan Ganbold
- Diagnostic Imaging Center, First Central Hospital of Mongolia, Ulaanbaatar, Mongolia
| | - Batsaikhan Batsuuri
- First Central Hospital of Mongolia, Organ Transplantation Center, Ulaanbaatar, Mongolia
| | - Yerkyebulan Mukhtar
- Department of Epidemiology and Biostatistics, School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Batsaikhan Bat-Erdene
- Department of Surgery, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Liu Lei
- Guangdong provincial hospital, Southern Medical University, Baiyun, China
| | - Tserenbat Bazarsad
- First Central Hospital of Mongolia, Organ Transplantation Center, Ulaanbaatar, Mongolia
| | - Undarmaa Zandanbazar
- First Central Hospital of Mongolia, Organ Transplantation Center, Ulaanbaatar, Mongolia
| | - Gantugs Yundendorj
- Department of Health Policy, School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.
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Buti M, Wedemeyer H, Aleman S, Chulanov V, Morozov V, Sagalova O, Stepanova T, Gish RG, Lloyd A, Kaushik AM, Suri V, Manuilov D, Osinusi AO, Flaherty JF, Lampertico P. Patient-reported outcomes in chronic hepatitis delta: An exploratory analysis of the Phase III MYR301 trial of bulevirtide. J Hepatol 2024:S0168-8278(24)02337-7. [PMID: 39009085 DOI: 10.1016/j.jhep.2024.06.031] [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: 02/02/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND & AIMS Once-daily treatment of chronic hepatitis delta (CHD) with bulevirtide is well tolerated and associated with significant reductions in HDV RNA in the blood and in biochemical liver disease activity. This study explored the effects of 48-week bulevirtide treatment on health-related quality of life (HRQoL) in patients with CHD. METHODS In an open-label, randomised, Phase 3 trial, 150 patients with CHD and compensated liver disease were stratified by liver cirrhosis status and randomised 1:1:1 to no treatment (control), bulevirtide 2 mg/day, or bulevirtide 10 mg/day for 48 weeks. HRQoL was evaluated by the following patient-reported outcome (PRO) instruments at baseline, 24 weeks, and 48 weeks: EQ-5D-3L, Hepatitis Quality of Life Questionnaire (HQLQ), and Fatigue Severity Scale (FSS). RESULTS Patient characteristics and HRQoL scores were balanced at baseline between the treatment (2 mg, n = 49; 10 mg, n = 50) and control (n = 51) groups. Patients receiving 2-mg bulevirtide reported significant improvements compared with controls on the HQLQ domains of role physical, hepatitis-specific limitations, and hepatitis-specific health distress. Numerically higher scores for general health, hepatitis-specific limitations, and hepatitis-specific health distress domains were reported by patients with cirrhosis who received bulevirtide vs control. FSS scores remained stable across treatment groups throughout. At week 48, patients in the 2-mg group showed greater mean improvement from baseline in health status compared with controls on the EQ-5D-3L visual analogue scale. CONCLUSION PROs indicate that 48-week treatment with bulevirtide monotherapy may improve aspects of HRQoL in patients with CHD. IMPACT AND IMPLICATIONS Bulevirtide 2 mg is the only approved treatment for patients with chronic hepatitis delta (CHD) in the EU. Patients with CHD have worse quality of life scores than those with chronic hepatitis B. Bulevirtide treatment for 48 weeks reduced HDV RNA and alanine aminotransferase levels and was well tolerated among patients with CHD. For the first time, this study shows that patients who received bulevirtide therapy for 48 weeks reported improvements in physical and hepatitis-related quality of life domains compared to those who did not receive therapy (control group). CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier, NCT03852719.
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Affiliation(s)
- Maria Buti
- Liver Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBER-EHD) del Instituto Carlos III, Barcelona, Spain.
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology, Infectious Diseases, and Endocrinology, Medizinische Hochschule Hannover, Hannover, Germany
| | - Soo Aleman
- Department of Infectious Diseases, Karolinska Universitetssjukhuset, Karolinska lnstitutet, Stockholm, Sweden
| | - Vladimir Chulanov
- Department of Infectious Diseases, Sechenov University, Moscow, Russian Federation
| | | | - Olga Sagalova
- South Ural State Medical University, Chelyabinsk, Russian Federation
| | | | - Robert G Gish
- Robert G. Gish Consultants, LLC, San Diego, CA, USA; Hepatitis B Foundation, Doylestown, PA, USA
| | | | | | | | | | | | | | - Pietro Lampertico
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; CRC "A. M. and A. Migliavacca" Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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9
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Asselah T, Chulanov V, Lampertico P, Wedemeyer H, Streinu-Cercel A, Pântea V, Lazar S, Placinta G, Gherlan GS, Bogomolov P, Stepanova T, Morozov V, Syutkin V, Sagalova O, Manuilov D, Mercier RC, Ye L, Da BL, Chee G, Lau AH, Osinusi A, Bourliere M, Ratziu V, Pol S, Hilleret MN, Zoulim F. Bulevirtide Combined with Pegylated Interferon for Chronic Hepatitis D. N Engl J Med 2024; 391:133-143. [PMID: 38842520 DOI: 10.1056/nejmoa2314134] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND In a phase 3 trial, bulevirtide monotherapy led to a virologic response in patients with chronic hepatitis D. Pegylated interferon (peginterferon) alfa-2a is recommended by guidelines as an off-label treatment for this disease. The role of combination therapy with bulevirtide and peginterferon alfa-2a, particularly with regard to finite treatment, is unclear. METHODS In this phase 2b, open-label trial, we randomly assigned patients to receive peginterferon alfa-2a alone (180 μg per week) for 48 weeks; bulevirtide at a daily dose of 2 mg or 10 mg plus peginterferon alfa-2a (180 μg per week) for 48 weeks, followed by the same daily dose of bulevirtide for 48 weeks; or bulevirtide at a daily dose of 10 mg alone for 96 weeks. All the patients were followed for 48 weeks after the end of treatment. The primary end point was an undetectable level of hepatitis D virus (HDV) RNA at 24 weeks after the end of treatment. The primary comparison was between the 10-mg bulevirtide plus peginterferon alfa-2a group and the 10-mg bulevirtide monotherapy group. RESULTS A total of 24 patients received peginterferon alfa-2a alone, 50 received 2 mg and 50 received 10 mg of bulevirtide plus peginterferon alfa-2a, and 50 received 10 mg of bulevirtide monotherapy. At 24 weeks after the end of treatment, HDV RNA was undetectable in 17% of the patients in the peginterferon alfa-2a group, in 32% of those in the 2-mg bulevirtide plus peginterferon alfa-2a group, in 46% of those in the 10-mg bulevirtide plus peginterferon alfa-2a group, and in 12% of those in the 10-mg bulevirtide group. For the primary comparison, the between-group difference was 34 percentage points (95% confidence interval, 15 to 50; P<0.001). At 48 weeks after the end of treatment, HDV RNA was undetectable in 25% of the patients in the peginterferon alfa-2a group, in 26% of those in the 2-mg bulevirtide plus peginterferon alfa-2a group, in 46% of those in the 10-mg bulevirtide plus peginterferon alfa-2a group, and in 12% of those in the 10-mg bulevirtide group. The most frequent adverse events were leukopenia, neutropenia, and thrombocytopenia. The majority of adverse events were of grade 1 or 2 in severity. CONCLUSIONS The combination of 10-mg bulevirtide plus peginterferon alfa-2a was superior to bulevirtide monotherapy with regard to an undetectable HDV RNA level at 24 weeks after the end of treatment. (Funded by Gilead Sciences; MYR 204 ClinicalTrials.gov number, NCT03852433.).
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Affiliation(s)
- Tarik Asselah
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Vladimir Chulanov
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Pietro Lampertico
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Heiner Wedemeyer
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Adrian Streinu-Cercel
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Victor Pântea
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Stefan Lazar
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Gheorghe Placinta
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - George S Gherlan
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Pavel Bogomolov
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Tatyana Stepanova
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Viacheslav Morozov
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Vladimir Syutkin
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Olga Sagalova
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Dmitry Manuilov
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Renee-Claude Mercier
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Lei Ye
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Ben L Da
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Grace Chee
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Audrey H Lau
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Anu Osinusi
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Marc Bourliere
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Vlad Ratziu
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Stanislas Pol
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Marie-Noëlle Hilleret
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Fabien Zoulim
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
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10
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Wong RJ, Brosgart C, Wong SS, Feld J, Glenn J, Hamid S, Cohen C, Zovich B, Ward J, Wedemeyer H, Yurdaydin C, Gish R. Estimating the prevalence of hepatitis delta virus infection among adults in the United States: A meta-analysis. Liver Int 2024; 44:1715-1734. [PMID: 38563728 DOI: 10.1111/liv.15921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/05/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND AND AIMS Suboptimal awareness and low rates of hepatitis delta virus (HDV) testing contribute to underdiagnosis and gaps in accurate estimates of U.S. HDV prevalence. We aim to provide an updated assessment of HDV prevalence in the U.S. using a comprehensive literature review and meta-analysis approach. METHODS A comprehensive literature review of articles reporting HBsAg seroprevalence and anti-HDV prevalence was conducted to calculate country-specific rates and pooled prevalence of CHB and HDV using meta-analyses. Country-specific CHB and HDV rate estimates were combined with number of foreign-born (FB) persons in the U.S. in 2022 from U.S. Census Bureau to estimate total numbers of FB with CHB and HDV, respectively. These estimates were further combined with updated estimates of U.S.-born persons with CHB and HDV to yield the total number of persons with CHB and HDV. RESULTS In 2022, we estimated 1.971 million (M) (95% CI 1.547-2.508) persons with CHB; 1.547 M (95% CI 1.264-1.831) were FB and 0.424 M (95% CI: 0.282-0.678) were U.S.-born. The weighted average HDV prevalence among FB persons in the U.S. was 4.20% (64 938 [95% CI 33055-97 392] persons), among whom 45% emigrated from Asia, 25% from Africa, and 14% from Europe. When combined with updated estimates of U.S.-born persons with HDV, we estimate 75 005 (95% CI: 42187-108 393) persons with HDV in the U.S. CONCLUSIONS Including both FB and U.S.-born persons, we estimated that 1.971 M and 75 005 persons were living with CHB and HDV, respectively, in the U.S. in 2022.
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Affiliation(s)
- Robert J Wong
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California, USA
- Gastroenterology Section, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | - Carol Brosgart
- Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Steven S Wong
- S Wong Consulting, LLC, Mountain View, California, USA
| | - Jordan Feld
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - Jeffrey Glenn
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California, USA
- Gastroenterology Section, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | - Saeed Hamid
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Chari Cohen
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
| | | | - John Ward
- Coalition for Global Hepatitis Elimination, Task Force for Global Health, Decatur, Georgia, USA
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Cihan Yurdaydin
- Department of Gastroenterology and Hepatology, Koç University School of Medicine, Istanbul, Turkey
| | - Robert Gish
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
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11
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Alshiban NM, Aleyiydi MS, Nassar MS, Alhumaid NK, Almangour TA, Tawfik YM, Damiati LA, Almutairi AS, Tawfik EA. Epidemiologic and clinical updates on viral infections in Saudi Arabia. Saudi Pharm J 2024; 32:102126. [PMID: 38966679 PMCID: PMC11223122 DOI: 10.1016/j.jsps.2024.102126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024] Open
Abstract
In the past two decades, the world has witnessed devastating pandemics affecting the global healthcare infrastructure and disrupting society and the economy worldwide. Among all pathogens, viruses play a critical role that is associated with outbreaks due to their wide range of species, involvement of animal hosts, easily transmitted to humans, and increased rates of infectivity. Viral disease outbreaks threaten public health globally due to the challenges associated with controlling and eradicating them. Implementing effective viral disease control programs starts with ongoing surveillance data collection and analyses to detect infectious disease trends and patterns, which is critical for maintaining public health. Viral disease control strategies include improved hygiene and sanitation facilities, eliminating arthropod vectors, vaccinations, and quarantine. The Saudi Ministry of Health (MOH) and the Public Health Authority (also known as Weqayah) in Saudi Arabia are responsible for public health surveillance to control and prevent infectious diseases. The notifiable viral diseases based on the Saudi MOH include hepatitis diseases, viral hemorrhagic fevers, respiratory viral diseases, exanthematous viral diseases, neurological viral diseases, and conjunctivitis. Monitoring trends and detecting changes in these viral diseases is essential to provide proper interventions, evaluate the established prevention programs, and develop better prevention strategies. Therefore, this review aims to highlight the epidemiological updates of the recently reported viral infections in Saudi Arabia and to provide insights into the recent clinical treatment and prevention strategies.
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Affiliation(s)
- Noura M. Alshiban
- Advanced Diagnostics and Therapeutics Institute, Health Sector, King Abdulaziz City for Science and Technology, Riyadh 11442, Saudi Arabia
| | - Munirah S. Aleyiydi
- Advanced Diagnostics and Therapeutics Institute, Health Sector, King Abdulaziz City for Science and Technology, Riyadh 11442, Saudi Arabia
| | - Majed S. Nassar
- Advanced Diagnostics and Therapeutics Institute, Health Sector, King Abdulaziz City for Science and Technology, Riyadh 11442, Saudi Arabia
| | - Nada K. Alhumaid
- Advanced Diagnostics and Therapeutics Institute, Health Sector, King Abdulaziz City for Science and Technology, Riyadh 11442, Saudi Arabia
| | - Thamer A. Almangour
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Yahya M.K. Tawfik
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Laila A. Damiati
- Department of Biological Sciences, College of Science, University of Jeddah, Jeddah 23218, Saudi Arabia
| | | | - Essam A. Tawfik
- Advanced Diagnostics and Therapeutics Institute, Health Sector, King Abdulaziz City for Science and Technology, Riyadh 11442, Saudi Arabia
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12
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Giannini EG, Pasta A, Pieri G, Plaz Torres MC, Marseglia M, Pelizzaro F, Sangiovanni A, Cabibbo G, Ghittoni G, Di Marco M, Foschi FG, Guarino M, Biasini E, Saitta C, Campani C, Svegliati-Baroni G, Gasbarrini A, Brunetto MR, Magalotti D, Azzaroli F, Mega A, Sacco R, Nardone G, Sacerdoti D, Masotto A, Vidili G, Bucci L, Vitale A, Trevisani F. Characteristics and outcome of anti-hepatitis D virus positive patients with hepatocellular carcinoma. Liver Int 2024; 44:1588-1599. [PMID: 38426262 DOI: 10.1111/liv.15855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/20/2023] [Accepted: 01/07/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND & AIMS Chronic hepatitis D virus (HDV) often leads to end-stage liver disease and hepatocellular carcinoma (HCC). Comprehensive data pertaining to large populations with HDV and HCC are missing, therefore we sought to assess the characteristics, management, and outcome of these patients, comparing them to patients with hepatitis B virus (HBV) infection. METHODS We analysed the Italian Liver Cancer database focusing on patients with positivity for HBV surface antigen and anti-HDV antibodies (HBV/HDV, n = 107) and patients with HBV infection alone (n = 588). Clinical and oncological characteristics, treatment, and survival were compared in the two groups. RESULTS Patients with HBV/HDV had worse liver function [Model for End-stage Liver Disease score: 11 vs. 9, p < .0001; Child-Turcotte-Pugh score: 7 vs. 5, p < .0001] than patients with HBV. HCC was more frequently diagnosed during surveillance (72.9% vs. 52.4%, p = .0002), and the oncological stage was more frequently Milan-in (67.3% vs. 52.7%, p = .005) in patients with HBV/HDV. Liver transplantation was more frequently performed in HBV/HDV than in HBV patients (36.4% vs. 9.5%), while the opposite was observed for resection (8.4% vs. 20.1%, p < .0001), and in a competing risk analysis, HBV/HDV patients had a higher probability of receiving transplantation, independently of liver function and oncological stage. A trend towards longer survival was observed in patients with HBV/HDV (50.4 vs. 44.4 months, p = .106). CONCLUSIONS In patients with HBV/HDV, HCC is diagnosed more frequently during surveillance, resulting in a less advanced cancer stage in patients with more deranged liver function than HBV alone. Patients with HBV/HDV have a heightened benefit from liver transplantation, positively influencing survival.
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Affiliation(s)
- Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Pasta
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giulia Pieri
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Corina Plaz Torres
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mariarosaria Marseglia
- Division of Internal Medicine, Hepatobiliary Diseases and Immunoallergology, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Filippo Pelizzaro
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padua, Padua, Italy
| | - Angelo Sangiovanni
- Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Ospedale maggiore Policlinico and C.R.C. "A.M. & A. Migliavacca Center for Liver Disease", Milan, Italy
| | - Giuseppe Cabibbo
- Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, Gastroenterology & Hepatology Unit, University of Palermo, Palermo, Italy
| | | | | | | | - Maria Guarino
- Department of Clinical Medicine and Surgery, Diseases of the Liver and Biliary System Unit, University of Naples "Federico II", Naples, Italy
| | - Elisabetta Biasini
- Infectious Diseases and Hepatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Carlo Saitta
- Department of Clinical and Experimental Medicine, Clinical and Molecular Hepatology Unit, University of Messina, Messina, Italy
| | - Claudia Campani
- Department of Experimental and Clinical Medicine, Internal Medicine and Hepatology Unit, University of Florence, Florence, Italy
| | | | - Antonio Gasbarrini
- Liver Unit, CEMAD - Centro Malattie dell'Apparato Digerente, Medicina Interna e Gastroenterologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
| | - Maurizia Rossana Brunetto
- Department of Clinical and Experimental Medicine, Hepatology and Liver Physiopathology Laboratory, University Hospital of Pisa, Pisa, Italy
| | - Donatella Magalotti
- Division of Internal Medicine, Neurovascular and Hepatometabolic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Azzaroli
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Mega
- Gastroenterology Unit, Bolzano Regional Hospital, Bolzano, Italy
| | - Rodolfo Sacco
- Gastroenterology and Digestive Endoscopy Unit, Foggia University Hospital, Foggia, Italy
| | - Gerardo Nardone
- Department of Clinical Medicine and Surgery, Hepato-Gastroenterology Unit, University of Naples "Federico II", Naples, Italy
| | - David Sacerdoti
- Liver Unit, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Alberto Masotto
- Gastroenterology Unit, Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Gianpaolo Vidili
- Department of Medical, Surgical and Experimental Sciences, Clinica Medica Unit, University of Sassari, Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
| | - Laura Bucci
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-related Diseases, University of Bologna, Bologna, Italy
| | - Alessandro Vitale
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Franco Trevisani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-related Diseases, University of Bologna, Bologna, Italy
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13
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Schinas G, Antonopoulou N, Vamvakopoulou S, Tsachouridou O, Protopapas K, Petrakis V, Petrakis EC, Papageorgiou D, Metallidis S, Papadopoulos A, Barbounakis E, Kofteridis D, Panagopoulos P, Lekkou A, Paliogianni F, Akinosoglou K. Prevalence of Hepatitis D in People Living with HIV: A National Cross-Sectional Pilot Study. Viruses 2024; 16:1044. [PMID: 39066206 DOI: 10.3390/v16071044] [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: 04/26/2024] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 07/28/2024] Open
Abstract
This study assesses the prevalence of hepatitis D virus (HDV) in people living with HIV (PLWHIV) in Greece. Given the compounding effects of HDV and hepatitis B (HBV) on liver disease progression, as well as the emergence of new therapeutic options such as bulevirtide, understanding regional disparities and the epidemiological impact of such co-infections is vital. A cross-sectional analysis was conducted utilizing 696 serum samples from PLWHIV attending five major university hospitals. The methodology included HDV antibody detection by ELISA and HDV RNA confirmation. Of the 30 HBsAg-positive samples analyzed, the study population was primarily male (93%), with a median age of 54 years. Participants had been on antiretroviral therapy for a median of 10 years, and the median CD4 count was 738 (539-1006) copies/mL. Additional serological findings revealed a 7% prevalence of hepatitis C virus (HCV) IgG antibodies and a 55% prevalence of hepatitis A virus (HAV) IgG antibodies. Seroreactivity for syphilis (RPR/VDRL/TPHA positive) was identified in 33% of the participants. The results indicated a low HDV prevalence, with only one individual (3%) testing positive for anti-HDV IgG antibodies and none for HDV RNA. This indicates a lower prevalence of HDV among PLWHIV with chronic HBV in Greece compared to global data.
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Affiliation(s)
| | | | - Sofia Vamvakopoulou
- Department of Microbiology, University General Hospital of Patras, 26504 Patras, Greece
| | - Olga Tsachouridou
- Departments of Internal Medicine and Infectious Diseases, University General Hospital of Thessaloniki "AHEPA", 54636 Thessaloniki, Greece
| | - Konstantinos Protopapas
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, 12462 Athens, Greece
| | - Vasileios Petrakis
- Departments of Internal Medicine and Infectious Diseases, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Emmanouil C Petrakis
- Departments of Internal Medicine and Infectious Diseases, University General Hospital of Heraklion, 71500 Heraklion, Greece
| | | | - Simeon Metallidis
- Departments of Internal Medicine and Infectious Diseases, University General Hospital of Thessaloniki "AHEPA", 54636 Thessaloniki, Greece
| | - Antonios Papadopoulos
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, 12462 Athens, Greece
| | - Emmanouil Barbounakis
- Departments of Internal Medicine and Infectious Diseases, University General Hospital of Heraklion, 71500 Heraklion, Greece
| | - Diamantis Kofteridis
- Departments of Internal Medicine and Infectious Diseases, University General Hospital of Heraklion, 71500 Heraklion, Greece
| | - Periklis Panagopoulos
- Departments of Internal Medicine and Infectious Diseases, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Alexandra Lekkou
- Departments of Internal Medicine and Infectious Diseases, University General Hospital of Patras, 26504 Patras, Greece
| | - Fotini Paliogianni
- Department of Microbiology, University General Hospital of Patras, 26504 Patras, Greece
| | - Karolina Akinosoglou
- School of Medicine, University of Patras, 26504 Patras, Greece
- Departments of Internal Medicine and Infectious Diseases, University General Hospital of Patras, 26504 Patras, Greece
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14
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Crobu MG, Ravanini P, Impaloni C, Martello C, Bargiacchi O, Di Domenico C, Faolotto G, Macaluso P, Mercandino A, Riggi M, Quaglia V, Andreoni S, Pirisi M, Smirne C. Hepatitis C Virus as a Possible Helper Virus in Human Hepatitis Delta Virus Infection. Viruses 2024; 16:992. [PMID: 38932284 PMCID: PMC11209499 DOI: 10.3390/v16060992] [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: 05/16/2024] [Revised: 06/13/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024] Open
Abstract
Previous studies reported that the hepatitis C virus (HCV) could help disseminate the hepatitis D virus (HDV) in vivo through the unrelated hepatitis B virus (HBV), but with essentially inconclusive results. To try to shed light on this still-debated topic, 146 anti-HCV-positive subjects (of whom 91 HCV/HIV co-infected, and 43 with prior HCV eradication) were screened for anti-HDV antibodies (anti-HD), after careful selection for negativity to any serologic or virologic marker of current or past HBV infection. One single HCV/HIV co-infected patient (0.7%) tested highly positive for anti-HD, but with no positive HDV-RNA. Her husband, in turn, was a HCV/HIV co-infected subject with a previous contact with HBV. While conducting a thorough review of the relevant literature, the authors attempted to exhaustively describe the medical history of both the anti-HD-positive patient and her partner, believing it to be the key to dissecting the possible complex mechanisms of HDV transmission from one subject to another, and speculating that in the present case, it may have been HCV itself that behaved as an HDV helper virus. In conclusion, this preliminary research, while needing further validation in large prospective studies, provided some further evidence of a role of HCV in HDV dissemination in humans.
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Affiliation(s)
- Maria Grazia Crobu
- Laboratory of Molecular Virology, Maggiore della Carità Hospital, 28100 Novara, Italy; (M.G.C.); (P.R.); (C.I.); (C.M.); (C.D.D.); (G.F.); (P.M.); (A.M.); (M.R.); (V.Q.); (S.A.)
- Clinical Biochemistry Laboratory, Department of Laboratory Medicine, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Paolo Ravanini
- Laboratory of Molecular Virology, Maggiore della Carità Hospital, 28100 Novara, Italy; (M.G.C.); (P.R.); (C.I.); (C.M.); (C.D.D.); (G.F.); (P.M.); (A.M.); (M.R.); (V.Q.); (S.A.)
| | - Clotilde Impaloni
- Laboratory of Molecular Virology, Maggiore della Carità Hospital, 28100 Novara, Italy; (M.G.C.); (P.R.); (C.I.); (C.M.); (C.D.D.); (G.F.); (P.M.); (A.M.); (M.R.); (V.Q.); (S.A.)
| | - Claudia Martello
- Laboratory of Molecular Virology, Maggiore della Carità Hospital, 28100 Novara, Italy; (M.G.C.); (P.R.); (C.I.); (C.M.); (C.D.D.); (G.F.); (P.M.); (A.M.); (M.R.); (V.Q.); (S.A.)
| | - Olivia Bargiacchi
- Unit of Infectious Diseases, Maggiore della Carità Hospital, 28100 Novara, Italy;
| | - Christian Di Domenico
- Laboratory of Molecular Virology, Maggiore della Carità Hospital, 28100 Novara, Italy; (M.G.C.); (P.R.); (C.I.); (C.M.); (C.D.D.); (G.F.); (P.M.); (A.M.); (M.R.); (V.Q.); (S.A.)
| | - Giulia Faolotto
- Laboratory of Molecular Virology, Maggiore della Carità Hospital, 28100 Novara, Italy; (M.G.C.); (P.R.); (C.I.); (C.M.); (C.D.D.); (G.F.); (P.M.); (A.M.); (M.R.); (V.Q.); (S.A.)
| | - Paola Macaluso
- Laboratory of Molecular Virology, Maggiore della Carità Hospital, 28100 Novara, Italy; (M.G.C.); (P.R.); (C.I.); (C.M.); (C.D.D.); (G.F.); (P.M.); (A.M.); (M.R.); (V.Q.); (S.A.)
| | - Alessio Mercandino
- Laboratory of Molecular Virology, Maggiore della Carità Hospital, 28100 Novara, Italy; (M.G.C.); (P.R.); (C.I.); (C.M.); (C.D.D.); (G.F.); (P.M.); (A.M.); (M.R.); (V.Q.); (S.A.)
| | - Miriam Riggi
- Laboratory of Molecular Virology, Maggiore della Carità Hospital, 28100 Novara, Italy; (M.G.C.); (P.R.); (C.I.); (C.M.); (C.D.D.); (G.F.); (P.M.); (A.M.); (M.R.); (V.Q.); (S.A.)
| | - Vittorio Quaglia
- Laboratory of Molecular Virology, Maggiore della Carità Hospital, 28100 Novara, Italy; (M.G.C.); (P.R.); (C.I.); (C.M.); (C.D.D.); (G.F.); (P.M.); (A.M.); (M.R.); (V.Q.); (S.A.)
| | - Stefano Andreoni
- Laboratory of Molecular Virology, Maggiore della Carità Hospital, 28100 Novara, Italy; (M.G.C.); (P.R.); (C.I.); (C.M.); (C.D.D.); (G.F.); (P.M.); (A.M.); (M.R.); (V.Q.); (S.A.)
| | - Mario Pirisi
- Internal Medicine Unit, Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy;
| | - Carlo Smirne
- Internal Medicine Unit, Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy;
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15
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Kaushik A, Kim CH, Hofmann S, Janeiro MJ, Lloyd A, Aragão F. A Systematic Literature Review and Meta-Analysis of Primary Evidence Reporting Health-State Preference Values in Chronic Hepatitis B, C, and D. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024:S1098-3015(24)02737-2. [PMID: 38906373 DOI: 10.1016/j.jval.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 05/28/2024] [Accepted: 06/05/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVES Chronic viral hepatitis is associated with severe impairment and reduction in patient health-related quality of life because of the substantial morbidity associated with advanced liver disease. The aim of this study was to identify and synthesize utilities for chronic hepatitis B (cHBV), C (cHCV), and D (cHDV) through a systematic literature review (SLR) and meta-analyses. METHODS Electronic databases were searched from inception to May 2023 to identify primary studies reporting health-state utilities in English in patients aged 18 years and over, with cHBV, cHCV, or cHDV in the United States, the United Kingdom, Europe, Canada, Australia, or New Zealand. Meta-analyses were conducted for studies reporting a measure of uncertainty; model selection (fixed and random) was based on the observed levels of heterogeneity among studies. RESULTS A total of 24 studies met the inclusion criteria and were included in the meta-analyses. More studies meeting the inclusion criteria reported utilities for cHCV (n = 20) than for cHBV (n = 8); no studies reported utility values for cHDV. Although mean utilities were higher for cHBV compared with cHCV for any given health state, utilities decreased with disease progression toward cirrhosis health states. Meta-analyses in cHCV found a utility decline of 0.1 and 0.03, based on progression from noncirrhosis to compensated cirrhosis and for decompensation in established cirrhosis, respectively. CONCLUSIONS Chronic viral hepatitis is associated with a considerable impairment in health-related quality of life. Despite our findings, there is a need for more evidence on the lived experience in patients living with chronic hepatitis, notably in cHBV and cHDV.
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Affiliation(s)
| | | | | | | | - Andrew Lloyd
- Acaster Lloyd Consulting Ltd., London, England, UK
| | - Filipa Aragão
- Maple Health Group, New York, NY, USA; NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
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16
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Wranke A, Lobato C, Ceausu E, Dalekos GN, Rizzetto M, Turcanu A, Niro GA, Keskin O, Gherlan G, Abbas M, Ingiliz P, Muche M, Buti M, Jachs M, Vanwolleghem T, Cornberg M, Abbas Z, Yurdaydin C, Dörge P, Wedemeyer H. Long-term outcome of hepatitis delta in different regions world-wide: Results of the Hepatitis Delta International Network. Liver Int 2024. [PMID: 38888267 DOI: 10.1111/liv.16006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/23/2024] [Accepted: 05/23/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND AND AIMS Chronic hepatitis delta represents a major global health burden. Clinical features of hepatitis D virus (HDV) infection vary largely between different regions worldwide. Treatment approaches are dependent on the approval status of distinct drugs and financial resources. METHODS The Hepatitis Delta International Network (HDIN) registry involves researchers from all continents (Wranke, Liver International 2018). We here report long-term follow-up data of 648 hepatitis D patients recruited by 14 centres in 11 countries. Liver-related clinical endpoints were defined as hepatic decompensation (ascites, encephalopathy and variceal bleeding), liver transplantation, hepatocellular carcinoma or liver-related death. RESULTS Patient data were available from all continents but Africa: 22% from Eastern Mediterranean, 32% from Eastern Europe and Central Asia, 13% from Central and Southern Europe, 14% from South Asia (mainly Pakistan) and 19% from South America (mainly Brazil). The mean follow-up was 6.4 (.6-28) years. During follow-up, 195 patients (32%) developed a liver-related clinical event after 3.5 (±3.3) years. Liver cirrhosis at baseline and a detectable HDV RNA test during follow-up were associated with a worse clinical outcome in multivariate regression analysis while patients receiving interferon alfa-based therapies developed clinical endpoints less frequently. Patients from South Asia developed endpoints earlier and had the highest mortality. CONCLUSIONS The HDIN registry confirms the severity of hepatitis D and provides further evidence for HDV viraemia as a main risk factor for disease progression. Hepatitis D seems to take a particularly severe course in patients born in Pakistan. There is an urgent need to extend access to antiviral therapies and to provide appropriate education about HDV infection.
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Affiliation(s)
- Anika Wranke
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
- German Centre for Infection Research (DZIF), HepNet Study-House/German Liver Foundation, Hannover, Germany
| | - Cirley Lobato
- Centro de Ciências de Saúde e do Desporto, Universidade Federal do Acre, Rio Branco, Brazil
| | - Emanoil Ceausu
- Infectious Diseases, Dr. Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Mario Rizzetto
- Department of Internal Medicine-Gastroenterology, University of Torino, Torino, Italy
| | - Adela Turcanu
- Department of Gastroenterology, State University of Medicine "Nicolae Testemitanu", Chisinau, Republic of Moldova
| | - Grazia A Niro
- Division of Gastroenterology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Onur Keskin
- Medical Faculty, Ankara University, Ankara, Turkey
| | - George Gherlan
- Infectious Diseases, Dr. Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania
| | - Minaam Abbas
- Department of Hepatogastroenterology and Liver Transplantation, Ziauddin University Hospital Karachi, Karachi, Pakistan
| | | | - Marion Muche
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Clinical Nutrition), Charité, Berlin, Germany
| | - Maria Buti
- Liver Unit, Valle d'Hebron University Hospital and Ciberhed del Instituto CarlosIII, Barcelona, Spain
| | - Mathias Jachs
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Thomas Vanwolleghem
- Faculty of Medicine and Health Sciences, Laboratory of Experimental Medicine and Pediatrics, Viral Hepatitis Research group, University of Antwerp, Antwerp, Belgium
- European Reference Network RARE-LIVER
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
- German Centre for Infection Research (DZIF), HepNet Study-House/German Liver Foundation, Hannover, Germany
- D-SOLVE: EU-Funded Network on Individualized Management of Hepatitis D
- Centre for Individualized Infection Medicine (CiiM), c/o CRC, Hannover, Germany
| | - Zaigham Abbas
- Department of Hepatogastroenterology and Liver Transplantation, Ziauddin University Hospital Karachi, Karachi, Pakistan
| | - Cihan Yurdaydin
- Medical Faculty, Ankara University, Ankara, Turkey
- Department of Gastroenterology & Hepatology, Koc University Medical School, Istanbul, Turkey
| | - Petra Dörge
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
- German Centre for Infection Research (DZIF), HepNet Study-House/German Liver Foundation, Hannover, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
- German Centre for Infection Research (DZIF), HepNet Study-House/German Liver Foundation, Hannover, Germany
- D-SOLVE: EU-Funded Network on Individualized Management of Hepatitis D
- Centre for Individualized Infection Medicine (CiiM), c/o CRC, Hannover, Germany
- Hannover Medical School, Excellence Cluster RESIST, Hannover, Germany
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17
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Allweiss L, Volmari A, Suri V, Wallin JJ, Flaherty JF, Manuilov D, Downie B, Lütgehetmann M, Bockmann JH, Urban S, Wedemeyer H, Dandri M. Blocking viral entry with bulevirtide reduces the number of HDV-infected hepatocytes in human liver biopsies. J Hepatol 2024; 80:882-891. [PMID: 38340811 DOI: 10.1016/j.jhep.2024.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND & AIMS Bulevirtide (BLV) is a first-in-class entry inhibitor and the only approved treatment for patients chronically infected with HDV in Europe. We aimed to investigate the efficacy of BLV treatment in paired liver biopsies obtained at baseline and after 24 or 48 weeks of treatment. METHODS We performed a combined analysis of 126 paired liver biopsies derived from three clinical trials. In the phase II clinical trial MYR202, patients with chronic hepatitis D were randomised to receive 24 weeks of BLV at 2 mg, 5 mg or 10 mg/day. Patients in MYR203 (phase II) and MYR301 (phase III) received 48 weeks of BLV at 2 mg or 10 mg/day. Tenofovir disoproxil fumarate monotherapy or delayed treatment served as comparators. Virological parameters and infection-related host genes were assessed by qPCR and immunohistochemistry. RESULTS At week 24, median intrahepatic HDV RNA decline from baseline was 0.9Log10 with 2 mg (n = 7), 1.1Log10 with 5 mg (n = 5) and 1.4 Log10 with 10 mg (n = 7) of BLV. At week 48, median reductions were 2.2Log10 with 2 mg (n = 27) and 2.7Log10 with 10 mg (n = 37) of BLV, while HDV RNA levels did not change in the comparator arms. Notably, a drastic decline in the number of hepatitis delta antigen-positive hepatocytes and a concomitant decrease in transcriptional levels of inflammatory chemokines and interferon-stimulated genes was determined in all BLV-treatment arms. Despite the abundance of HBsAg-positive hepatocytes, replication and covalently closed circular DNA levels of the helper virus HBV were low and remained unaffected by BLV treatment. CONCLUSION Blocking viral entry diminishes signs of liver inflammation and promotes a strong reduction of HDV infection within the liver, thus suggesting that some patients may achieve HDV cure with long-term treatment. IMPACT AND IMPLICATIONS Chronic infection with HDV causes the most severe form of viral hepatitis, affecting approximately 12 million people worldwide. The entry inhibitor bulevirtide (BLV) is the only recently approved anti-HDV drug, which has proven efficacious and safe in clinical trials and real-word data. Here, we investigated paired liver biopsies at baseline and after 24 or 48 weeks of treatment from three clinical trials to understand the effect of the drug on viral and host parameters in the liver, the site of viral replication. We found that BLV treatment strongly reduces the number of HDV-infected cells and signs of liver inflammation. This data implies that blocking viral entry ameliorates liver inflammation and that prolonged treatment regimens might lead to HDV cure in some patients. This concept will guide the further development of therapeutic strategies and combination treatments for patients with CHD. CLINICAL TRIAL NUMBERS NCT03546621, NCT02888106, NCT03852719.
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Affiliation(s)
- Lena Allweiss
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Infection Research (DZIF), Hannover, Heidelberg and Hamburg-Lübeck-Borstel-Riems Partner Sites, Germany
| | - Annika Volmari
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | | | | | - Marc Lütgehetmann
- Department of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Infection Research (DZIF), Hannover, Heidelberg and Hamburg-Lübeck-Borstel-Riems Partner Sites, Germany
| | - Jan-Hendrik Bockmann
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Infection Research (DZIF), Hannover, Heidelberg and Hamburg-Lübeck-Borstel-Riems Partner Sites, Germany
| | - Stephan Urban
- Department of Infectious Diseases, Molecular Virology, University Hospital Heidelberg, Heidelberg, Germany; German Center for Infection Research (DZIF), Hannover, Heidelberg and Hamburg-Lübeck-Borstel-Riems Partner Sites, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; German Center for Infection Research (DZIF), Hannover, Heidelberg and Hamburg-Lübeck-Borstel-Riems Partner Sites, Germany
| | - Maura Dandri
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Infection Research (DZIF), Hannover, Heidelberg and Hamburg-Lübeck-Borstel-Riems Partner Sites, Germany.
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18
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Cadranel JFD, Zougmoré HT, Efole JRN, Hanslik B, Causse X, Rosa I, Lemaitre C, Mokhtari C, Baron A, Thevenot T, Medmoun M, Smadhi R, Fantognon G, Remy AJ, Macaigne G, Arondel Y, Arpurt JP, Bellaiche G, Bourlière M, De Kerguenec C, Heluwaert F, Verlynde J, Halfon P, Roulot D, Carrier P, Loustaud-Ratti V, Lemagoarou T. Hepatitis B Delta: assessment of the knowledge and practices of hepato-gastroenterologists practicing in non-academic settings in France. Eur J Gastroenterol Hepatol 2024; 36:735-741. [PMID: 38683191 DOI: 10.1097/meg.0000000000002707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
BACKGROUND Data on the management of Hepatitis B-Delta (HB-D) by hepatogastroenterologists (HGs) practicing in nonacademic hospitals or private practices are unknown in France. OBJECTIVE We aimed to evaluate the knowledge and practices of HGs practicing in nonacademic settings regarding HB-D. METHODS A Google form document was sent to those HGs from May to September 2021. RESULTS A total of 130 HGs (mean age, 45 years) have participated in this survey. Among HBsAg-positive patients, Delta infection was sought in only 89% of cases. Liver fibrosis was assessed using FibroScan in 77% of the cases and by liver biopsy in 81% of the cases. A treatment was proposed for patients with >F2 liver fibrosis in 49% of the cases regardless of transaminase levels and for all the patients by 39% of HGs. Responding HGs proposed a treatment using pegylated interferon in 50% of cases, bulevirtide in 45% of cases and a combination of pegylated interferon and bulevirtide in 40.5% of cases. Among the criteria to evaluate the treatment efficacy, a decrease or a normalization of transaminases was retained by 89% of responding HGs, a reduction of liver fibrosis score for 70% of them, an undetectable delta RNA and HBsAg for 55% of them and a 2 log 10 decline in delta viremia for 62% of the cases. CONCLUSION Hepatitis Delta screening was not systematically performed in HBsAg-positive patients despite the probable awareness and knowledge of the few responders who were able to prescribe treatments of hepatitis delta.
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Affiliation(s)
| | | | | | | | | | - Isabelle Rosa
- Department of Liver and Digestive Diseases, CHI Créteil
| | | | | | - Aurore Baron
- Department of Liver and Digestive Diseases, Corbeil
| | | | - Mourad Medmoun
- Department of Liver and Digestive Diseases, GHPSO, Creil
| | - Ryad Smadhi
- Department of Liver and Digestive Diseases, GHPSO, Creil
| | | | - André J Remy
- Department of Liver and Digestive Diseases, Perpignan
| | | | - Yves Arondel
- Department of Liver and Digestive Diseases, Haguenau
| | | | - Guy Bellaiche
- Department of Liver and Digestive Diseases, Aulnay-sous-bois
| | | | | | | | | | - Philippe Halfon
- Department of Internal Medicine and Infectious Diseases, Alphabio Laboratory Marseille, Marseille
| | | | - Paul Carrier
- Department of Liver and Digestive Diseases, Limoges
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Cardoso MF, Carvalho R, Correia FP, Branco JC, Costa MN, Martins A. Autoimmune Hepatitis Induced by Hepatitis Delta Virus: A Conundrum. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2024; 31:203-208. [PMID: 38836124 PMCID: PMC11149988 DOI: 10.1159/000531773] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 06/15/2023] [Indexed: 06/06/2024]
Abstract
Introduction The association of hepatitis delta virus (HDV) infection with positive autoantibodies and autoimmune features has been known for decades. However, to date, very few cases of clinical autoimmune hepatitis (AIH) have been reported in association with HDV infection, most of them being in the context of treatment with peginterferon. Case Report This case refers to a 46-year-old woman born in Guinea-Bissau who moved to Portugal in 2018 to investigate complaints of diffuse abdominal discomfort and nausea. Her initial work-up, including laboratory and liver histology, was consistent with type 1 AIH. She had HBe antigen-negative chronic hepatitis B virus infection with negative DNA and also a positive total anti-HDV antibody, with negative IgM and undetectable RNA. Therefore, after initiating prophylactic tenofovir difumarate, she was started on prednisolone followed by azathioprine, which was later stopped due to presumed hepatotoxicity. Repeated histology showed signs of viral superinfection, and she was treated with acyclovir due to a positive herpes simplex IgM, with HDV RNA remaining negative. A third flare in transaminases prompted the introduction of mycophenolate mofetil (MMF) after a thorough exclusion of additional causes of liver disease. About 6 months later, during another bout of hepatitis, HDV RNA was finally positive and classified as genotype 5. MMF was stopped, and, considering a contraindication to interferon, the patient was offered therapy with bulevirtide, which she refused for personal reasons as she is currently living in her home country. Discussion This is a challenging case of autoimmune or "autoimmune-like" hepatitis, probably induced by chronic HDV infection. High suspicion of HDV was essential because, had the case been interpreted as refractory AIH, with escalation of immunosuppression, a more severe course of the viral infection might have ensued. Recently, HDV suppression with bulevirtide was shown to reverse autoimmune liver disease. We hypothesize that the same could have happened to our patient, had she accepted this treatment.
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Affiliation(s)
- Mariana F Cardoso
- Gastroenterology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Rita Carvalho
- Gastroenterology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Fábio Pereira Correia
- Gastroenterology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Joana C Branco
- Gastroenterology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Mariana Nuno Costa
- Gastroenterology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Alexandra Martins
- Gastroenterology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
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Wang J, Pan Y, Xiong Y, Wu C, Huang R. Letter: Association of persistently high HBsAg levels during HBeAg-seropositive stage and hepatocellular carcinoma risk in chronic hepatitis B patients. Aliment Pharmacol Ther 2024; 59:1457-1458. [PMID: 38643497 DOI: 10.1111/apt.17971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
LINKED CONTENTThis article is linked to Lin et al papers. To view these articles, visit https://doi.org/10.1111/apt.17915 and https://doi.org/10.1111/apt.18009
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Affiliation(s)
- Jian Wang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
- Institute of Viruses and Infectious Diseases, Nanjing University, Nanjing, Jiangsu, China
| | - Yifan Pan
- Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ye Xiong
- Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Chao Wu
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
- Institute of Viruses and Infectious Diseases, Nanjing University, Nanjing, Jiangsu, China
| | - Rui Huang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
- Institute of Viruses and Infectious Diseases, Nanjing University, Nanjing, Jiangsu, China
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Wong RJ, Hirode G, Feld J, Wong SS, Brosgart C, Glenn J, Hamid S, Cohen C, Zovich B, Ward J, Wedemeyer H, Yurdaydin C, Gish R. An updated assessment of hepatitis delta prevalence among adults in Canada: A meta-analysis. J Viral Hepat 2024; 31:324-341. [PMID: 38619214 DOI: 10.1111/jvh.13939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 04/16/2024]
Abstract
Foreign-born (FB) persons represent a large proportion of adults with chronic hepatitis B (CHB) in Canada due to higher prevalence rates in countries of birth for FB persons. Suboptimal awareness and low rates of hepatitis delta virus (HDV) testing contribute to underdiagnosis and gaps in accurate estimates of Canada HDV prevalence. We aim to provide an assessment of CHB and HDV prevalence in Canada using a comprehensive literature review and meta-analysis. A comprehensive literature review of articles reporting HBsAg seroprevalence and anti-HDV prevalence was conducted to calculate country-specific rates and pooled prevalence of CHB and HDV using meta-analyses. Country-specific CHB and HDV rate estimates were combined with number of FB persons in Canada in 2021 from Statistics Canada to estimate total numbers of FB with CHB and HDV, respectively. These estimates were combined with estimates of Canada-born persons with CHB and HDV to yield the total number of persons with CHB and HDV. In 2021, we estimated 0.550 million (M) (95% CI 0.488-0.615) persons with CHB; 0.344 M (95% CI 0.288-0.401) were FB and 0.206 M (95% CI: 0.200-0.214) were Canada-born. The weighted average HDV prevalence among FB persons in Canada was 5.19% (17,848 [95% CI 9611-26,052] persons), among whom 50% emigrated from Asia and 31% from Africa. When combined with estimates of Canada-born persons with HDV, we estimate 35,059 (95% CI: 18,744-52,083) persons with HDV in Canada. In conclusion, we estimate 0.550 M and 35,059 persons living with CHB and HDV, respectively, in Canada in 2021.
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Affiliation(s)
- Robert J Wong
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California, USA
- Gastroenterology Section Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | - Grishma Hirode
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - Jordan Feld
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - Steven S Wong
- S Wong Consulting, LLC, Mountain View, California, USA
| | - Carol Brosgart
- Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Jeffrey Glenn
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California, USA
- Gastroenterology Section Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | - Saeed Hamid
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Chari Cohen
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
| | | | - John Ward
- Coalition for Global Hepatitis Elimination, Task Force for Global Health, Decatur, Georgia, USA
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Cihan Yurdaydin
- Department of Gastroenterology and Hepatology, Koç University School of Medicine, Istanbul, Turkey
| | - Robert Gish
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
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Kondili LA, Brancaccio G, Tosti ME, Coco B, Quaranta MG, Messina V, Ciancio A, Morisco F, Cossiga V, Claar E, Rosato V, Ciarallo M, Cacciola I, Ponziani FR, Cerrito L, Coppola R, Longobardi F, Biliotti E, Rianda A, Barbaro F, Coppola N, Stanzione M, Barchiesi F, Fagiuoli S, Viganò M, Massari M, Russo FP, Ferrarese A, Laccabue D, Di Marco V, Blanc P, Marrone A, Morsica G, Federico A, Ieluzzi D, Rocco A, Foschi FG, Soria A, Maida I, Chessa L, Milella M, Rosselli Del Turco E, Madonia S, Chemello L, Gentile I, Toniutto P, Bassetti M, Surace L, Baiocchi L, Pellicelli A, De Santis A, Puoti M, Degasperi E, Niro GA, Zignego AL, Craxi A, Raimondo G, Santantonio TA, Brunetto MR, Gaeta GB. A holistic evaluation of patients with chronic Hepatitis D virus (HDV) infection enrolled in the Italian PITER-B and delta cohort. Int J Infect Dis 2024; 146:107115. [PMID: 38801968 DOI: 10.1016/j.ijid.2024.107115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND AND AIMS We aimed to characterize the epidemiologic and comorbidities profiles of patients with chronic Hepatitis D (CHD) followed in clinical practice in Italy and explored their interferon (IFN) eligibility. METHODS This was a cross-sectional study of the PITER cohort consisting of consecutive HBsAg-positive patients from 59 centers over the period 2019-2023. Multivariable analysis was performed by logistic regression model. RESULTS Of 5492 HBsAg-positive enrolled patients, 4152 (75.6%) were screened for HDV, 422 (10.2%) were anti-HDV positive. Compared with HBsAg mono-infected, anti-HDV positive patients were more often younger, non-Italians, with a history of drug use, had elevated alanine transaminase (ALT), cirrhosis, or hepatocellular carcinoma (HCC). Compared with Italians, anti-HDV positive non-Italians were younger (42.2% age ≤ 40 years vs. 2.1%; P < 0.001), more often females (males 43.0% vs. 68.6%; P < 0.001) with less frequent cirrhosis and HCC. HDV-RNA was detected in 63.2% of anti-HDV-positive patients, who were more likely to have elevated ALT, cirrhosis, and HCC. Extrahepatic comorbidities were present in 47.4% of anti-HDV positive patients and could affect the eligibility of IFN-containing therapies in at least 53.0% of patients in care. CONCLUSIONS CHD affects young, foreign-born patients and older Italians, of whom two-thirds had cirrhosis or HCC. Comorbidities were frequent in both Italians and non-Italians and impacted eligibility for IFN.
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Affiliation(s)
- Loreta A Kondili
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy; UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy.
| | - Giuseppina Brancaccio
- Department of Molecular Medicine, Infectious Diseases, University of Padua, Padua, Italy
| | | | - Barbara Coco
- Hepatology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - Vincenzo Messina
- Department of Infectious Diseases, Sant'Anna Hospital, Caserta, Italy
| | - Alessia Ciancio
- Gastroenterology Unit, Città della Salute e della Scienza of Turin, University Hospital, Turin, Italy
| | - Filomena Morisco
- Liver and Biliary System Unit, Department of Clinical Medicine and Surgery, University of Naples, Naples, Italy
| | - Valentina Cossiga
- Liver and Biliary System Unit, Department of Clinical Medicine and Surgery, University of Naples, Naples, Italy
| | | | | | | | - Irene Cacciola
- Department of Internal Medicine, University Hospital of Messina, Messina, Italy
| | - Francesca Romana Ponziani
- Liver Unit, Digestive Disease Center, CEMAD Division of Internal Medicine and Gastroenterology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Lucia Cerrito
- Liver Unit, Digestive Disease Center, CEMAD Division of Internal Medicine and Gastroenterology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Roberta Coppola
- Department of Hepatology, Gragnano Hospital, Gragnano (NA), Italy
| | | | - Elisa Biliotti
- National Institute for Infectious Diseases, Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Alessia Rianda
- National Institute for Infectious Diseases, Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Francesco Barbaro
- Department of Medicine, Infectious Diseases Unit, University Hospital of Padua, Padua, Italy
| | - Nicola Coppola
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Stanzione
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Barchiesi
- Clinical Infectious Diseases, Polytechnic University of Marche, Ancona, Italy
| | - Stefano Fagiuoli
- Department of Medicine, University of Milan Bicocca & Gastroenterology Hepatology and Transplantation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Mauro Viganò
- Department of Medicine, University of Milan Bicocca & Gastroenterology Hepatology and Transplantation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Marco Massari
- Malattie Infettive, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Paolo Russo
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padua, Padua, Italy
| | - Alberto Ferrarese
- Gastroenterology Unit, University Hospital Borgo Trento, Verona, Italy
| | - Diletta Laccabue
- Department of Medicine and Surgery, Università degli Studi di Parma, Parma, Italy
| | - Vito Di Marco
- Biomedical Department of Internal and Specialistic Medicine University of Palermo, Unit of Gastroenterology and Hepatology, Palermo, Italy
| | - Pierluigi Blanc
- Infectious Disease Unit, Santa Maria Annunziata Hospital, Florence, Italy
| | - Aldo Marrone
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giulia Morsica
- Unit of Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandro Federico
- Hepato-Gastroenterology Division, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Alba Rocco
- Department of Clinical Medicine and Surgery, Hepato-Gastroenterology Unit, University of Naples Federico II, Naples, Italy
| | | | - Alessandro Soria
- Clinic of Infectious Diseases, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Ivana Maida
- Infectious and Tropical Diseases Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Luchino Chessa
- Liver Unit, University Hospital, Monserrato, Cagliari, Italy
| | - Michele Milella
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Elena Rosselli Del Turco
- Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Salvatore Madonia
- Department of Internal Medicine Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Liliana Chemello
- Department of Medicine-DIMED, Padua University, University Hospital, Padua, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Pierluigi Toniutto
- Hepatology and Liver Transplant Unit, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Matteo Bassetti
- Clinica Malattie Infettive, Università degli Studi di Genova, Policlinico S. Martino IRCCS, Genova, Italy
| | - Lorenzo Surace
- Ambulatorio di Epatologia e Infettivologia, Azienda Sanitaria Provinciale CZ-Distretto del Lametino, Lamezia Terme (CZ), Italy
| | | | | | - Adriano De Santis
- Department of Internal Medicine, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Massimo Puoti
- Infectious Disease Unit, Niguarda Hospital, Milan, Italy
| | | | - Grazia Anna Niro
- Division of Gastroenterology and Endoscopy, Fondazione IRCCS 'Casa Sollievo della Sofferenza', San Giovanni Rotondo, Foggia, Italy
| | - Anna Linda Zignego
- Department of Experimental and Clinical Medicine, Interdepartmental Centre MASVE, University of Florence, Italy
| | - Antonio Craxi
- Gastroenterology and Hepatology Unit, PROMISE, University of Palermo, Palermo, Italy
| | - Giovanni Raimondo
- Department of Internal Medicine, University Hospital of Messina, Messina, Italy
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Khabir M, Blanchet M, Angelo L, Loucif H, van Grevenynghe J, Bukong TN, Labonté P. Exosomes as Conduits: Facilitating Hepatitis B Virus-Independent Hepatitis D Virus Transmission and Propagation in Hepatocytes. Viruses 2024; 16:825. [PMID: 38932118 PMCID: PMC11209184 DOI: 10.3390/v16060825] [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: 04/16/2024] [Revised: 05/02/2024] [Accepted: 05/16/2024] [Indexed: 06/28/2024] Open
Abstract
A number of research studies, including ours, have spotlighted exosomes as critical facilitators of viral dissemination. While hepatitis B virus (HBV) transmission through exosomes has been studied, the focus on its satellite virus, the hepatitis delta virus (HDV), has been unexplored in this context. HDV, although being a defective virus, can replicate its genome autonomously within hepatocytes, independently of HBV. Investigations on Huh7 cells revealed an intriguing phenomenon: the HDV proteins, S-HDAg and L-HDAg, are transmitted between cells without a complete viral structure. Detailed analysis further revealed that the expression of these proteins not only bolstered exosome secretion but also ensured their enrichment within these vesicles. Our experimental approach utilized transfection of various plasmids to examine the role of HDV RNA and proteins in the process. One salient finding was the differential propagation of the HDV proteins S-HDAg and L-HDAg, suggesting intricate molecular mechanisms behind their transmission. Notably, the purity of our exosome preparations was monitored using markers such as TSG101 and CD81. Importantly, these exosomes were found to carry both HDV RNA and proteins, highlighting their role in HDV dissemination. This novel study underscores the role of exosomes in mediating the transmission of HDV components between hepatocytes independent of HBV. These revelations about the exosomal pathway of HDV transmission provide a foundation for the development of innovative therapeutic strategies against HDV infections.
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Affiliation(s)
| | | | | | | | | | | | - Patrick Labonté
- INRS–Centre Armand-Frappier Santé Biotechnologie, Laval, QC H7V 1B7, Canada; (M.K.); (M.B.); (L.A.); (H.L.); (J.v.G.); (T.N.B.)
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24
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Juang HH, Hsu CW, Chang KS, Iang SB, Lin YH, Chao M. Investigating the Genetic Diversity of Hepatitis Delta Virus in Hepatocellular Carcinoma (HCC): Impact on Viral Evolution and Oncogenesis in HCC. Viruses 2024; 16:817. [PMID: 38932110 PMCID: PMC11209585 DOI: 10.3390/v16060817] [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: 03/21/2024] [Revised: 05/16/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
Hepatitis delta virus (HDV), an RNA virus with two forms of the delta antigen (HDAg), relies on hepatitis B virus (HBV) for envelope proteins essential for hepatocyte entry. Hepatocellular carcinoma (HCC) ranks third in global cancer deaths, yet HDV's involvement remains uncertain. Among 300 HBV-associated HCC serum samples from Taiwan's National Health Research Institutes, 2.7% (8/300) tested anti-HDV positive, with 62.7% (5/8) of these also HDV RNA positive. Genotyping revealed HDV-2 in one sample, HDV-4 in two, and two samples showed mixed HDV-2/HDV-4 infection with RNA recombination. A mixed-genotype infection revealed novel mutations at the polyadenylation signal, coinciding with the ochre termination codon for the L-HDAg. To delve deeper into the possible oncogenic properties of HDV-2, the predominant genotype in Taiwan, which was previously thought to be less associated with severe disease outcomes, an HDV-2 cDNA clone was isolated from HCC for study. It demonstrated a replication level reaching up to 74% of that observed for a widely used HDV-1 strain in transfected cultured cells. Surprisingly, both forms of HDV-2 HDAg promoted cell migration and invasion, affecting the rearrangement of actin cytoskeleton and the expression of epithelial-mesenchymal transition markers. In summary, this study underscores the prevalence of HDV-2, HDV-4, and their mixed infections in HCC, highlighting the genetic diversity in HCC as well as the potential role of both forms of the HDAg in HCC oncogenesis.
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Affiliation(s)
- Horng-Heng Juang
- Department of Anatomy, Graduate Institute of Biomedical Sciences, School of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (H.-H.J.); (K.-S.C.)
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
| | - Chao-Wei Hsu
- Liver Research Center, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (C.-W.H.); (Y.-H.L.)
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Kang-Shuo Chang
- Department of Anatomy, Graduate Institute of Biomedical Sciences, School of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (H.-H.J.); (K.-S.C.)
| | - Shan-Bei Iang
- Department of Microbiology and Immunology and Division of Microbiology, Graduate Institute of Biomedical Sciences, School of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Yang-Hsiang Lin
- Liver Research Center, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (C.-W.H.); (Y.-H.L.)
| | - Mei Chao
- Liver Research Center, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (C.-W.H.); (Y.-H.L.)
- Department of Microbiology and Immunology and Division of Microbiology, Graduate Institute of Biomedical Sciences, School of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
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Wan P, Yang G, Cheng Q, Zhang X, Yue Z, Li M, Liu C, Yi Q, Jia Y, Liu J, Xing X, Sun B, Li Y. The role of inflammasome in chronic viral hepatitis. Front Cell Infect Microbiol 2024; 14:1382029. [PMID: 38817443 PMCID: PMC11137247 DOI: 10.3389/fcimb.2024.1382029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 05/02/2024] [Indexed: 06/01/2024] Open
Abstract
Infections of hepatotropic viruses cause a wide array of liver diseases including acute hepatitis, chronic hepatitis and the consequently developed cirrhosis and hepatocellular carcinoma (HCC). Among the five classical hepatotropic viruses, hepatitis B virus (HBV) and hepatitis C virus (HCV) usually infect human persistently and cause chronic hepatitis, leading to major troubles to humanity. Previous studies have revealed that several types of inflammasomes are involved in the infections of HBV and HCV. Here, we summarize the current knowledge about their roles in hepatitis B and C. NLRP3 inflammasome can be activated and regulated by HBV and HCV. It is found to exert antiviral function or mediates inflammatory response in viral infections depending on different experimental models. Besides NLRP3 inflammasome, IFI16 and AIM2 inflammasomes participate in the pathological process of hepatitis B, and NALP3 inflammasome may sense HCV infection in hepatocytes. The inflammasomes affect the pathological process of viral hepatitis through its downstream secretion of inflammatory cytokines interleukin-1β (IL-1β) and IL-18 or induction of pyroptosis resulting from cleaved gasdermin D (GSDMD). However, the roles of inflammasomes in different stages of viral infection remains mainly unclear. More proper experimental models of viral hepatitis should be developed for specific studies in future, so that we can understand more about the complexity of inflammasome regulation and multifunction of inflammasomes and their downstream effectors during HBV and HCV infections.
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Affiliation(s)
- Pin Wan
- Hubei Key Laboratory of Cognitive and Affective Disorders, Institute of Biomedical Sciences, School of Medicine, Jianghan University, Wuhan, China
- Foshan Institute of Medical Microbiology, Foshan, China
| | - Ge Yang
- Foshan Institute of Medical Microbiology, Foshan, China
| | - Qi Cheng
- Wuhan Jinyintan Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Xuelong Zhang
- Institute of Medical Microbiology, Department of Immunology and Microbiology, College of Life Science and Technology, Jinan University, Guangzhou, China
- Laboratory of Viral Pathogenesis & Infection Prevention and Control (Jinan University), Ministry of Education, Guangzhou, China
| | - Zhaoyang Yue
- Institute of Medical Microbiology, Department of Immunology and Microbiology, College of Life Science and Technology, Jinan University, Guangzhou, China
- Laboratory of Viral Pathogenesis & Infection Prevention and Control (Jinan University), Ministry of Education, Guangzhou, China
| | - Moran Li
- Institute of Medical Microbiology, Department of Immunology and Microbiology, College of Life Science and Technology, Jinan University, Guangzhou, China
- Laboratory of Viral Pathogenesis & Infection Prevention and Control (Jinan University), Ministry of Education, Guangzhou, China
| | - Chunlin Liu
- Institute of Medical Microbiology, Department of Immunology and Microbiology, College of Life Science and Technology, Jinan University, Guangzhou, China
- Laboratory of Viral Pathogenesis & Infection Prevention and Control (Jinan University), Ministry of Education, Guangzhou, China
| | - Qian Yi
- Institute of Medical Microbiology, Department of Immunology and Microbiology, College of Life Science and Technology, Jinan University, Guangzhou, China
- Laboratory of Viral Pathogenesis & Infection Prevention and Control (Jinan University), Ministry of Education, Guangzhou, China
| | - Yaling Jia
- Institute of Medical Microbiology, Department of Immunology and Microbiology, College of Life Science and Technology, Jinan University, Guangzhou, China
- Laboratory of Viral Pathogenesis & Infection Prevention and Control (Jinan University), Ministry of Education, Guangzhou, China
| | - Jinbiao Liu
- National “111” Center for Cellular Regulation and Molecular Pharmaceutics, Key Laboratory of Fermentation Engineering (Ministry of Education), Hubei Provincial Cooperative Innovation Center of Industrial Fermentation, Hubei Key Laboratory of Industrial Microbiology, Sino-German Biomedical Center, Hubei University of Technology, Wuhan, China
| | - Xiwen Xing
- Department of Biotechnology, College of Life Science and Technology, Jinan University, Guangzhou, China
| | - Binlian Sun
- Hubei Key Laboratory of Cognitive and Affective Disorders, Institute of Biomedical Sciences, School of Medicine, Jianghan University, Wuhan, China
| | - Yongkui Li
- Institute of Medical Microbiology, Department of Immunology and Microbiology, College of Life Science and Technology, Jinan University, Guangzhou, China
- Laboratory of Viral Pathogenesis & Infection Prevention and Control (Jinan University), Ministry of Education, Guangzhou, China
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Wedemeyer H, Aleman S, Brunetto M, Blank A, Andreone P, Bogomolov P, Chulanov V, Mamonova N, Geyvandova N, Morozov V, Sagalova O, Stepanova T, Berger A, Ciesek S, Manuilov D, Mercier RC, Da BL, Chee GM, Li M, Flaherty JF, Lau AH, Osinusi A, Schulze Zur Wiesch J, Cornberg M, Zeuzem S, Lampertico P. Bulevirtide monotherapy in patients with chronic HDV: Efficacy and safety results through week 96 from a phase III randomized trial. J Hepatol 2024:S0168-8278(24)00333-7. [PMID: 38734383 DOI: 10.1016/j.jhep.2024.05.001] [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: 01/22/2024] [Revised: 04/15/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND & AIMS Bulevirtide (BLV), a first-in-class entry inhibitor, is approved in Europe for the treatment of chronic hepatitis delta (CHD). BLV monotherapy was superior to delayed treatment at week (W) 48, the primary efficacy endpoint, in the MYR301 study (NCT03852719). Here, we assessed if continued BLV therapy until W96 would improve virologic and biochemical response rates, particularly among patients who did not achieve virologic response at W24. METHODS In this ongoing, open-label, randomized phase III study, patients with CHD (N = 150) were randomized (1:1:1) to treatment with BLV 2 mg/day (n = 49) or 10 mg/day (n = 50), each for 144 weeks, or to delayed treatment for 48 weeks followed by BLV 10 mg/day for 96 weeks (n = 51). Combined response was defined as undetectable hepatitis delta virus (HDV) RNA or a decrease in HDV RNA by ≥2 log10 IU/ml from baseline and alanine aminotransferase (ALT) normalization. Other endpoints included virologic response, ALT normalization, and change in HDV RNA. RESULTS Of 150 patients, 143 (95%) completed 96 weeks of the study. Efficacy responses were maintained and/or improved between W48 and W96, with similar combined, virologic, and biochemical response rates between BLV 2 and 10 mg. Of the patients with a suboptimal early virologic response at W24, 43% of non-responders and 82% of partial responders achieved virologic response at W96. Biochemical improvement often occurred independently of virologic response. Adverse events were mostly mild, with no serious adverse events related to BLV. CONCLUSIONS Virologic and biochemical responses were maintained and/or increased with longer term BLV therapy, including in those with suboptimal early virologic response. BLV monotherapy for CHD was safe and well tolerated through W96. IMPACT AND IMPLICATIONS In July 2023, bulevirtide was fully approved for the treatment of chronic hepatitis delta (CHD) in Europe based on clinical study results from up to 48 weeks of treatment. Understanding the efficacy and safety of bulevirtide over the longer term is important for healthcare providers. In this analysis, we demonstrate that bulevirtide monotherapy for 96 weeks in patients with CHD was associated with continued improvements in combined, virologic, and biochemical responses as well as liver stiffness from week 48 at both the 2 mg and 10 mg doses. Patients with suboptimal virologic responses to bulevirtide at week 24 also benefited from continued therapy, with the majority achieving virologic response or biochemical improvement by week 96. CLINICAL TRIALS GOV IDENTIFIER NCT03852719.
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Affiliation(s)
- Heiner Wedemeyer
- Medizinische Hochschule Hannover, Klinik für Gastroenterologie, Hepatologie, Infektiologie und Endokrinologie, Hannover, Germany.
| | - Soo Aleman
- Karolinska University Hospital/Karolinska Institute, Department of Infectious Diseases, Stockholm, Sweden
| | - Maurizia Brunetto
- University Hospital of Pisa, Hepatology Unit, Reference Center of the Tuscany Region for Chronic Liver Disease and Cancer, Pisa, Italy; University of Pisa, Department of Clinical and Experimental Medicine, Pisa, Italy
| | - Antje Blank
- Heidelberg University Medical Faculty, Heidelberg University Hospital, Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg, Germany
| | - Pietro Andreone
- University of Modena and Reggio Emilia, Internal Medicine, Baggiovara Hospital, Modena, Italy
| | - Pavel Bogomolov
- State Budgetary Institution of Health Care of Moscow Region, Moscow Regional Research Clinical Institute Named After M.F. Vladimirsky, Moscow, Russian Federation
| | - Vladimir Chulanov
- FSBI National Research Medical Center for Phthisiopulmonology and Infectious Diseases of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Nina Mamonova
- FSBI National Research Medical Center for Phthisiopulmonology and Infectious Diseases of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | | | | | - Olga Sagalova
- Federal State-Funded Institution of Higher Education, South Ural State Medical University of Ministry of Health of the Russian Federation, Chelyabinsk, Russian Federation
| | | | - Annemarie Berger
- Institute for Medical Virology, German Centre for Infection Research, External Partner Site Frankfurt, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Sandra Ciesek
- Institute for Medical Virology, German Centre for Infection Research, External Partner Site Frankfurt, University Hospital, Goethe University, Frankfurt am Main, Germany
| | | | | | - Ben L Da
- Gilead Sciences, Foster City, CA, United States
| | | | - Mingyang Li
- Gilead Sciences, Foster City, CA, United States
| | | | | | - Anu Osinusi
- Gilead Sciences, Foster City, CA, United States
| | - Julian Schulze Zur Wiesch
- Universitätsklinikum Hamburg-Eppendorf, Medizinische Klinik Studienambulanz Hepatologie, Hamburg, Germany
| | - Markus Cornberg
- Medizinische Hochschule Hannover, Klinik für Gastroenterologie, Hepatologie, Infektiologie und Endokrinologie, Hannover, Germany
| | - Stefan Zeuzem
- University Hospital Frankfurt, Department of Medicine, Frankfurt am Main, Germany
| | - Pietro Lampertico
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; CRC A. M. and A. Migliavacca Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Woo Y, Ma M, Okawa M, Saito T. Hepatocyte Intrinsic Innate Antiviral Immunity against Hepatitis Delta Virus Infection: The Voices of Bona Fide Human Hepatocytes. Viruses 2024; 16:740. [PMID: 38793622 PMCID: PMC11126147 DOI: 10.3390/v16050740] [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: 04/04/2024] [Revised: 04/24/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024] Open
Abstract
The pathogenesis of viral infection is attributed to two folds: intrinsic cell death pathway activation due to the viral cytopathic effect, and immune-mediated extrinsic cellular injuries. The immune system, encompassing both innate and adaptive immunity, therefore acts as a double-edged sword in viral infection. Insufficient potency permits pathogens to establish lifelong persistent infection and its consequences, while excessive activation leads to organ damage beyond its mission to control viral pathogens. The innate immune response serves as the front line of defense against viral infection, which is triggered through the recognition of viral products, referred to as pathogen-associated molecular patterns (PAMPs), by host cell pattern recognition receptors (PRRs). The PRRs-PAMPs interaction results in the induction of interferon-stimulated genes (ISGs) in infected cells, as well as the secretion of interferons (IFNs), to establish a tissue-wide antiviral state in an autocrine and paracrine manner. Cumulative evidence suggests significant variability in the expression patterns of PRRs, the induction potency of ISGs and IFNs, and the IFN response across different cell types and species. Hence, in our understanding of viral hepatitis pathogenesis, insights gained through hepatoma cell lines or murine-based experimental systems are uncertain in precisely recapitulating the innate antiviral response of genuine human hepatocytes. Accordingly, this review article aims to extract and summarize evidence made possible with bona fide human hepatocytes-based study tools, along with their clinical relevance and implications, as well as to identify the remaining gaps in knowledge for future investigations.
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Affiliation(s)
- Yein Woo
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Muyuan Ma
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Masashi Okawa
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- R&D Department, PhoenixBio USA Corporation, New York, NY 10006, USA
| | - Takeshi Saito
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- USC Research Center for Liver Diseases, Los Angeles, CA 90033, USA
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
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Su CW, Ochirkhuree B, Namdag B, Badamnachin B, Ganbold S, Gidaagaya S, Ganbold A, Yang SS, Duger D, Wu JC. Risk factors associated with hepatitis D virus infection and preventive strategies in Mongolia. J Chin Med Assoc 2024; 87:480-487. [PMID: 38417133 DOI: 10.1097/jcma.0000000000001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Hepatitis D virus (HDV) infection is highly prevalent in Mongolia. We aimed to identify the risk factors associated with HDV infection, propose preventive strategies, and evaluate the outcomes of a 3-year collaborative project between Taiwan and Mongolia. METHODS In 2016 and 2018, we conducted onsite visits to Mongolia. Mongolian investigators collected questionnaires focusing on risk factors, demographic characteristics, and serum samples for acute HDV infections. Furthermore, 19 Mongolian seed teachers participated in a 1-week workshop on infection control in Taiwan. Subsequently, these seed teachers trained more than 400 medical personnel in Mongolia. To assess secular changes in acute HDV infection, we reviewed the registration data from the National Center for Communicable Disease (NCCD) in Mongolia between 2011 and 2021. RESULTS Among the 194 Mongolian patients, 108 had dual infection with hepatitis B virus (HBV) and HDV, while 86 had acute hepatitis B (AHB). Patients with HBV/HDV dual infections were older (28.6 vs 25.5 years, p = 0.030) and had lower rates of positive hepatitis B e antigen in their sera, lower rates of serum HBV DNA exceeding 2000 IU/mL, and higher rates of having received dental treatment (59.4% vs 40.5%, p = 0.014) and injection therapy (64.2% vs 44.0%, p = 0.009) compared with those with AHB. Analysis of NCCD data revealed that new HDV infection cases were more prevalent between 2011 and 2015 (111.20 ± 29.79 cases/y) and decreased to 54.67 ± 27.34 cases/y between 2016 and 2021 ( p = 0.010). CONCLUSION Dental treatment and injections were associated with a higher risk of acute HDV infections in Mongolia. Through collaborative efforts, the incidence rate of HDV infection has declined in recent years.
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Affiliation(s)
- Chien-Wei Su
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Holistic and Multidisciplinary Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Internal Medicine, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Bayarmaa Ochirkhuree
- Gastroenterology Center, First Central Hospital of Mongolia, Ulaanbaatar, Mongolia
| | - Bira Namdag
- Department of Gastroenterology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Batsukh Badamnachin
- Emergency Department, National Center for Communicable Disease, Ulaanbaatar, Mongolia
| | - Sarangua Ganbold
- Hepatology Laboratory, National Center for Communicable Diseases, Ulaanbaatar, Mongolia
| | - Sarantuya Gidaagaya
- Department of Gastroenterology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Anar Ganbold
- Gastroenterology Center, First Central Hospital of Mongolia, Ulaanbaatar, Mongolia
| | - Sien-Sing Yang
- Liver Unit, Cathay General Hospital, Taipei, Taiwan, ROC
| | - Davaadorj Duger
- Department of Gastroenterology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Jaw-Ching Wu
- Institute of Clinical Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Cancer Progression Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Translational Division, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Díaz LA, Villota-Rivas M, Barrera F, Lazarus JV, Arrese M. The burden of liver disease in Latin America. Ann Hepatol 2024; 29:101175. [PMID: 37922988 DOI: 10.1016/j.aohep.2023.101175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/08/2023] [Indexed: 11/07/2023]
Abstract
Liver disease poses a substantial burden in Latin America. This burden is primarily attributed to a high level of alcohol consumption and the increasing prevalence of risk factors associated with metabolic dysfunction-associated steatotic liver disease (MASLD), such as sedentary lifestyles, easy access to ultra-processed foods, obesity, and type 2 diabetes mellitus. These epidemiological trends are cause for concern, especially considering that there are significant challenges in addressing them due to disparities in access to liver disease screening and care. In this article, we aim to provide an overview of the current situation regarding liver disease in Latin America. We also discuss recent multinational proposals designed to address the growing MASLD burden via its integration into existing non-communicable diseases policies, at both local and global levels. Additionally, we emphasize the urgent need to establish effective public health policies that target both MASLD risk factors and excessive alcohol consumption. Furthermore, we discuss the development of liver transplantation programs, areas for improvement in medical education and research capabilities, and how the fostering of extensive collaboration among all stakeholders is crucial for addressing liver disease in the region.
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Affiliation(s)
- Luis Antonio Díaz
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Observatorio Multicéntrico de Enfermedades Gastrointestinales (OMEGA), Santiago, Chile
| | - Marcela Villota-Rivas
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Francisco Barrera
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Observatorio Multicéntrico de Enfermedades Gastrointestinales (OMEGA), Santiago, Chile
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain; CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, NY, United States; Global NASH Council, Washington DC, United States
| | - Marco Arrese
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Observatorio Multicéntrico de Enfermedades Gastrointestinales (OMEGA), Santiago, Chile; Global NASH Council, Washington DC, United States.
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30
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Allweiss L, Cohen C, Dias J, Fumagalli V, Guo H, Harris JM, Hu J, Iannacone M, Isogawa M, Jeng WJ, Kim KH, Kramvis A, Li W, Lucifora J, Muramatsu M, Neuveut C, Ploss A, Pollicino T, Protzer U, Tan A, Tanaka Y, Tu T, Tsukuda S, Thimme R, Urban S, Watashi K, Yuan Z, Yeh SH, McKeating JA, Revill PA. Highlights from the 2023 International Meeting on the Molecular Biology of Hepatitis B virus. J Gen Virol 2024; 105:001978. [PMID: 38757942 PMCID: PMC11258880 DOI: 10.1099/jgv.0.001978] [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: 02/19/2024] [Accepted: 04/04/2024] [Indexed: 05/18/2024] Open
Abstract
Since its discovery in 1965, our understanding of the hepatitis B virus (HBV) replication cycle and host immune responses has increased markedly. In contrast, our knowledge of the molecular biology of hepatitis delta virus (HDV), which is associated with more severe liver disease, is less well understood. Despite the progress made, critical gaps remain in our knowledge of HBV and HDV replication and the mechanisms underlying viral persistence and evasion of host immunity. The International HBV Meeting is the leading annual scientific meeting for presenting the latest advances in HBV and HDV molecular virology, immunology, and epidemiology. In 2023, the annual scientific meeting was held in Kobe, Japan and this review summarises some of the advances presented at the Meeting and lists gaps in our knowledge that may facilitate the development of new therapies.
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Affiliation(s)
- HBV2023
- Various- see supplementary material
| | - Lena Allweiss
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Infection Research (DZIF), Braunschweig, Germany
| | | | - Joao Dias
- Laboratoire de Virologie Moléculaire, CNRS Université de Montpellier, Montpellier, France
| | - Valeria Fumagalli
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Haitao Guo
- Department of Microbiology and Molecular Genetics; Cancer Virology Program, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - James M. Harris
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jianming Hu
- Department of Microbiology and Immunology, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Matteo Iannacone
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Masanori Isogawa
- Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Wen-Juei Jeng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Kyun-Hwan Kim
- Department of Precision Medicine, School of Medicine, Sungkyunkwan University, Suwon, Republic of Korea
| | - Anna Kramvis
- Anna Kramvis Hepatitis Virus Diversity Research Unit, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Wenhui Li
- National Institute of Biological Sciences, Beijing, PR China
- Tsinghua Institute of Multidisciplinary Biomedical Research, Tsinghua University, Beijing, PR China
| | - Julie Lucifora
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France
| | - Masamichi Muramatsu
- Department of Infectious Disease Research, Institute of Biomedical Research and Innovation, Foundation for Biomedical Research and Innovation at Kobe, Kobe, Hyogo, Japan
| | - Christine Neuveut
- Laboratoire de Virologie Moléculaire, CNRS Université de Montpellier, Montpellier, France
| | - Alexander Ploss
- Department of Molecular Biology, Princeton University, Princeton, NJ, USA
| | - Teresa Pollicino
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Ulrike Protzer
- German Center for Infection Research (DZIF), Braunschweig, Germany
- Institute of Virology, School of Medicine and Health, Technical University of Munich/Helmholtz Munich, Munich, Germany
| | - Anthony Tan
- Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
| | - Yasuhito Tanaka
- Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Thomas Tu
- Storr Liver Centre, The Westmead Institute for Medical Research, The University of Sydney at Westmead Hospital, Westmead, NSW, Australia
- Centre for Infectious Diseases and Microbiology, Sydney Infectious Diseases Institute, The University of Sydney at Westmead Hospital, Westmead, NSW, Australia
| | - Senko Tsukuda
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Robert Thimme
- Department of Medicine II, University Hospital Freiburg, Breisgau, Germany
| | - Stephan Urban
- German Center for Infection Research (DZIF), Braunschweig, Germany
| | - Koichi Watashi
- Research Center for Drug and Vaccine Development, National Institute of Infectious Diseases, Tokyo, Japan
| | - Zhenghong Yuan
- Key Lab of Medical Molecular Virology, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Shiou-Hwei Yeh
- Graduate Institute of Microbiology, National Taiwan University College of Medicine, Taipei, Taiwan, ROC
- Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei, Taiwan, ROC
| | - Jane A. McKeating
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Chinese Academy of Medical Sciences Oxford Institute, University of Oxford, Oxford, UK
| | - Peter A. Revill
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Parkville, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne, Parkville, Victoria, Australia
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Stockdale AJ, Degasperi E. HDV RNA and liver disease progression: What do we know? Hepatology 2024; 79:983-985. [PMID: 38156968 DOI: 10.1097/hep.0000000000000663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/17/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Alexander J Stockdale
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Malawi-Liverpool-Wellcome Trust Research Programme, Blantyre, Malawi
| | - Elisabetta Degasperi
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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32
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Camps G, Maestro S, Torella L, Herrero D, Usai C, Bilbao-Arribas M, Aldaz A, Olagüe C, Vales A, Suárez-Amarán L, Aldabe R, Gonzalez-Aseguinolaza G. Protective role of RIPK1 scaffolding against HDV-induced hepatocyte cell death and the significance of cytokines in mice. PLoS Pathog 2024; 20:e1011749. [PMID: 38739648 PMCID: PMC11115361 DOI: 10.1371/journal.ppat.1011749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 05/23/2024] [Accepted: 04/16/2024] [Indexed: 05/16/2024] Open
Abstract
Hepatitis delta virus (HDV) infection represents the most severe form of human viral hepatitis; however, the mechanisms underlying its pathology remain incompletely understood. We recently developed an HDV mouse model by injecting adeno-associated viral vectors (AAV) containing replication-competent HBV and HDV genomes. This model replicates many features of human infection, including liver injury. Notably, the extent of liver damage can be diminished with anti-TNF-α treatment. Here, we found that TNF-α is mainly produced by macrophages. Downstream of the TNF-α receptor (TNFR), the receptor-interacting serine/threonine-protein kinase 1 (RIPK1) serves as a cell fate regulator, playing roles in both cell survival and death pathways. In this study, we explored the function of RIPK1 and other host factors in HDV-induced cell death. We determined that the scaffolding function of RIPK1, and not its kinase activity, offers partial protection against HDV-induced apoptosis. A reduction in RIPK1 expression in hepatocytes through CRISPR-Cas9-mediated gene editing significantly intensifies HDV-induced damage. Contrary to our expectations, the protective effect of RIPK1 was not linked to TNF-α or macrophage activation, as their absence did not alter the extent of damage. Intriguingly, in the absence of RIPK1, macrophages confer a protective role. However, in animals unresponsive to type-I IFNs, RIPK1 downregulation did not exacerbate the damage, suggesting RIPK1's role in shielding hepatocytes from type-I IFN-induced cell death. Interestingly, while the damage extent is similar between IFNα/βR KO and wild type mice in terms of transaminase elevation, their cell death mechanisms differ. In conclusion, our findings reveal that HDV-induced type-I IFN production is central to inducing hepatocyte death, and RIPK1's scaffolding function offers protective benefits. Thus, type-I IFN together with TNF-α, contribute to HDV-induced liver damage. These insights may guide the development of novel therapeutic strategies to mitigate HDV-induced liver damage and halt disease progression.
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Affiliation(s)
- Gracián Camps
- DNA & RNA Medicine Division, CIMA, University of Navarra, Instituto de Investigación Sanitaria de Navarra, IdisNA, Pamplona, Spain
| | - Sheila Maestro
- DNA & RNA Medicine Division, CIMA, University of Navarra, Instituto de Investigación Sanitaria de Navarra, IdisNA, Pamplona, Spain
| | - Laura Torella
- DNA & RNA Medicine Division, CIMA, University of Navarra, Instituto de Investigación Sanitaria de Navarra, IdisNA, Pamplona, Spain
| | - Diego Herrero
- DNA & RNA Medicine Division, CIMA, University of Navarra, Instituto de Investigación Sanitaria de Navarra, IdisNA, Pamplona, Spain
| | - Carla Usai
- DNA & RNA Medicine Division, CIMA, University of Navarra, Instituto de Investigación Sanitaria de Navarra, IdisNA, Pamplona, Spain
| | - Martin Bilbao-Arribas
- DNA & RNA Medicine Division, CIMA, University of Navarra, Instituto de Investigación Sanitaria de Navarra, IdisNA, Pamplona, Spain
| | - Ana Aldaz
- DNA & RNA Medicine Division, CIMA, University of Navarra, Instituto de Investigación Sanitaria de Navarra, IdisNA, Pamplona, Spain
| | - Cristina Olagüe
- DNA & RNA Medicine Division, CIMA, University of Navarra, Instituto de Investigación Sanitaria de Navarra, IdisNA, Pamplona, Spain
| | - Africa Vales
- DNA & RNA Medicine Division, CIMA, University of Navarra, Instituto de Investigación Sanitaria de Navarra, IdisNA, Pamplona, Spain
| | - Lester Suárez-Amarán
- DNA & RNA Medicine Division, CIMA, University of Navarra, Instituto de Investigación Sanitaria de Navarra, IdisNA, Pamplona, Spain
| | - Rafael Aldabe
- DNA & RNA Medicine Division, CIMA, University of Navarra, Instituto de Investigación Sanitaria de Navarra, IdisNA, Pamplona, Spain
| | - Gloria Gonzalez-Aseguinolaza
- DNA & RNA Medicine Division, CIMA, University of Navarra, Instituto de Investigación Sanitaria de Navarra, IdisNA, Pamplona, Spain
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Gish RG, Jacobson IM, Lim JK, Waters-Banker C, Kaushik A, Kim C, Cyhaniuk A, Wong RJ. Prevalence and characteristics of hepatitis delta virus infection in patients with hepatitis B in the United States: An analysis of the All-Payer Claims Database. Hepatology 2024; 79:1117-1128. [PMID: 37976395 PMCID: PMC11020024 DOI: 10.1097/hep.0000000000000687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/16/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND AND AIMS HDV leads to the most severe form of viral hepatitis; however, the prevalence of HDV is not well understood. Using real-world data from the All-Payer Claims Database, this study estimates the prevalence of HBV/HDV infection among the chronic HBV population and describes patient/clinical characteristics for adults with HBV/HDV infection in the United States. APPROACH AND RESULTS Adults (≥18 years) with ≥1 inpatient claim or ≥2 outpatient claims for HDV infection or HBV in the All-Payer Claims Database from January 1, 2014, to December 31, 2020, were identified. HDV prevalence was calculated as the proportion of patients with HBV/HDV infection among total patients with HBV infection. Patient characteristics, socioeconomic status, advanced liver complications (eg, cirrhosis, HCC), and comorbidities were assessed. A total of 6719 patients were diagnosed with HBV/HDV among 144,975 with HBV and 12 months of continuous data, for a prevalence of 4.6%. At diagnosis, 31.7% of patients with HBV/HDV had advanced liver complications, including compensated cirrhosis (16.3%) and decompensated cirrhosis (10.4%). Diabetes (50.5%), hypertension (49.8%), and HIV infection (30.9%) were the top 3 comorbidities. CONCLUSIONS In a large database capturing approximately 80% of the US-insured population, HBV/HDV infection prevalence was 4.6% among adults infected with HBV. Patients infected with HDV had high rates of baseline liver complications and other comorbidities at the time of diagnosis, suggesting potentially delayed diagnosis and/or treatment. Earlier identification of HBV/HDV infection among the population with HBV may provide opportunities to improve linkage to care and treatment, thereby reducing the risk of liver-related morbidity and mortality.
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Affiliation(s)
- Robert G. Gish
- The University of Nevada, Reno School of Medicine, Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas, Las Vegas, Nevada, USA
- UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, Hepatitis B Foundation, La Jolla, California, USA
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
- Loma Linda University, San Bernardino County, California, USA
| | | | - Joseph K. Lim
- Section of Digestive Diseases and Yale Liver Center, Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | - Chong Kim
- Gilead Sciences Inc., Foster City, California, USA
| | | | - Robert J. Wong
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine and Gastroenterology Section, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
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Gish RG, Wong RJ, Di Tanna GL, Kaushik A, Kim C, Smith NJ, Kennedy PT. Association of hepatitis delta virus with liver morbidity and mortality: A systematic literature review and meta-analysis. Hepatology 2024; 79:1129-1140. [PMID: 37870278 PMCID: PMC11019996 DOI: 10.1097/hep.0000000000000642] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/26/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND AND AIMS Studies have suggested that patients with chronic hepatitis B, either co- or superinfected, have more aggressive liver disease progression than those with the HDV. This systematic literature review and meta-analysis examined whether HDV RNA status is associated with increased risk of advanced liver disease events in patients who are HBsAg and HDV antibody positive. APPROACH AND RESULTS A total of 12 publications were included. Relative rates of progression to advanced liver disease event for HDV RNA+/detectable versus HDV RNA-/undetectable were extracted for analysis. Reported OR and HRs with 95% CI were pooled using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. The presence of HDV RNA+ was associated with an increased risk of any advanced liver disease event [random effect (95% CI): risk ratio: 1.48 (0.93, 2.33); HR: 2.62 (1.55, 4.44)]. When compared to the patients with HDV RNA- status, HDV RNA+ was associated with a significantly higher risk of progressing to compensated cirrhosis [risk ratio: 1.74 (1.24, 2.45)] decompensated cirrhosis [HR: 3.82 (1.60, 9.10)], HCC [HR: 2.97 (1.87, 4.70)], liver transplantation [HR: 7.07 (1.61, 30.99)], and liver-related mortality [HR: 3.78 (2.18, 6.56)]. CONCLUSIONS The patients with HDV RNA+ status have a significantly greater risk of liver disease progression than the patients who are HDV RNA-. These findings highlight the need for improved HDV screening and linkage to treatment to reduce the risk of liver-related morbidity and mortality.
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Affiliation(s)
- Robert G. Gish
- University of Nevada, Reno School of Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, USA
| | - Robert J. Wong
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Healthcare System, Stanford University School of Medicine, Palo Alto, California, USA
| | - Gian Luca Di Tanna
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland
| | - Ankita Kaushik
- Gilead Sciences Inc., Global Value and Access, Foster City, California, USA
| | - Chong Kim
- Gilead Sciences Inc., Global Value and Access, Foster City, California, USA
| | | | - Patrick T.F. Kennedy
- Barts Liver Centre, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Weichselbaum L, Njimi H, van den Wijngaert S, Dahma H, Nkuize M, Van Gossum M, Eisendrath P, Mulkay JP, Sersté T. A regular screening for hepatitis delta virus among chronic hepatitis B carriers improves the diagnostic of this infection and of subsequent cirrhosis development. United European Gastroenterol J 2024; 12:516-525. [PMID: 38520063 DOI: 10.1002/ueg2.12564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/26/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVE The prevalence of Hepatitis Delta Virus (HDV) is underestimated and the assessment of fibrosis is recommended for this infection. We tested the diagnostic impact of an annual screening for HDV serology in Hepatitis B Surface Antigen (HBs Ag) chronic carriers and followed the progression of fibrosis in these patients. METHODS Between January 2014 and October 2021, we annually tested all chronic HBs Ag-positive patients for HDV antibody (HDV Ab). Each HDV Ab positive patient underwent annually repeated elastometry. Patients with detectable HDV RNA levels (group 1) were compared to those with undetectable HDV RNA (group 2). RESULTS We identified 610 chronic HBs Ag-positive patients, and repeated screening for HDV Ab was performed in 534 patients. Sixty (11%) patients were HDV Ab positive at baseline and were considered as "coinfected". Seven cases of HDV superinfection were diagnosed through repeated screening. In co-infected patients, cirrhosis was initially diagnosed in 12/60 patients and developed in six patients during follow-up. HDV RNA PCR was performed in 57/67 patients and 27 had detectable levels (group 1). Cumulative incidence of cirrhosis at 7 years was 13.8% (95% CI 0-30) in group 1 and 0 (95% CI 0-0) in group 2 (p = 0.026). CONCLUSION A systematic screening for HDV in chronic HB Ag carriers revealed a high prevalence of HDV Ab. Repeated serological screening enables the diagnosis of superinfections in asymptomatic patients. Regular assessment of fibrosis using elastometry leads to the identification of incidental cirrhosis in patients with detectable HDV RNA.
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Affiliation(s)
- Laura Weichselbaum
- Department of Gastroenterology and Hepatology, CHU Saint-Pierre, Brussels, Belgium
- Department of Gastroenterology and Hepatology, CUB Erasme, Brussels, Belgium
| | - Hassane Njimi
- Department of Intensive Care, CUB Erasme, Brussels, Belgium
| | | | - Hafid Dahma
- Department of Microbiology, LHUB-ULB site Porte de Hal, Brussels, Belgium
| | - Marcel Nkuize
- Department of Gastroenterology and Hepatology, CHU Saint-Pierre, Brussels, Belgium
| | - Marc Van Gossum
- Department of Gastroenterology and Hepatology, CHU Saint-Pierre, Brussels, Belgium
| | - Pierre Eisendrath
- Department of Gastroenterology and Hepatology, CHU Saint-Pierre, Brussels, Belgium
- Department of Gastroenterology and Hepatology, CUB Erasme, Brussels, Belgium
| | - Jean-Pierre Mulkay
- Department of Gastroenterology and Hepatology, CHU Saint-Pierre, Brussels, Belgium
| | - Thomas Sersté
- Department of Gastroenterology and Hepatology, CHU Saint-Pierre, Brussels, Belgium
- Department of Gastroenterology and Hepatology, CUB Erasme, Brussels, Belgium
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Kushner T, Andrews RR. Addressing hepatitis delta in primary care practices in the US: a narrative review. Curr Med Res Opin 2024; 40:813-820. [PMID: 38487951 DOI: 10.1080/03007995.2024.2318004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/07/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE Infection with the hepatitis delta virus (HDV), a unique RNA virus that requires hepatitis B virus (HBV) antigens for its assembly, replication, and transmission, causes severe viral hepatitis. Compared to HBV monoinfection, HDV infection increases the risk of severe liver disease, necessity for liver transplant, and mortality. Global HDV prevalence estimates vary from 5% to 15% among persons with HBV, but screening guidelines for HDV are inconsistent; some recommend risk-based screening, while others recommend universal screening for all people with HBV. Among primary care providers (PCPs) in the US, there is a lack of awareness and/or insufficient adherence to current recommendations for the screening of HDV infection and management of chronic HDV. METHODS Publications were obtained by conducting literature searches between July and August 2022 using the PubMed database and by manual searches of the retrieved literature for additional references. Information was synthesized to highlight HDV screening and management strategies for PCPs. Best practices for PCPs based on current guidelines and comanagement strategies for patients with HBV and HDV infection were summarized. RESULTS We recommend universal screening for HDV in patients positive for hepatitis B surface antigen. Confirmed HDV infection should prompt evaluation by a liver specialist, if available, with whom the PCP can comanage the patient. PCPs should counsel patients on the expected course of the disease, lifestyle factors that may influence liver health, need for consistent disease monitoring and follow-up, and risk of disease transmission. Screening is suggested for sexual partners, household contacts, and family members, with HBV immunization recommended for those found to be susceptible. There are currently no US Food and Drug Administration-approved therapies for HDV infection; thus, management is limited to treatments for chronic HBV infection plus long-term monitoring of liver health. CONCLUSIONS PCPs can be a valuable point of care for patients to access HDV/HBV screening, HBV immunization, and education, and can comanage patients with HBV and/or HDV infection.
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Affiliation(s)
- Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Shenoy A, Fontana RJ. HDV screening in chronic HBV: An unmet need of growing importance. Hepatology 2024; 79:979-982. [PMID: 38088906 DOI: 10.1097/hep.0000000000000722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 01/25/2024]
Affiliation(s)
- Abhishek Shenoy
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
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Carpentier A. Cell Culture Models for Hepatitis B and D Viruses Infection: Old Challenges, New Developments and Future Strategies. Viruses 2024; 16:716. [PMID: 38793598 PMCID: PMC11125795 DOI: 10.3390/v16050716] [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: 04/11/2024] [Revised: 04/23/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024] Open
Abstract
Chronic Hepatitis B and D Virus (HBV and HDV) co-infection is responsible for the most severe form of viral Hepatitis, the Hepatitis Delta. Despite an efficient vaccine against HBV, the HBV/HDV infection remains a global health burden. Notably, no efficient curative treatment exists against any of these viruses. While physiologically distinct, HBV and HDV life cycles are closely linked. HDV is a deficient virus that relies on HBV to fulfil is viral cycle. As a result, the cellular response to HDV also influences HBV replication. In vitro studying of HBV and HDV infection and co-infection rely on various cell culture models that differ greatly in terms of biological relevance and amenability to classical virology experiments. Here, we review the various cell culture models available to scientists to decipher HBV and HDV virology and host-pathogen interactions. We discuss their relevance and how they may help address the remaining questions, with one objective in mind: the development of new therapeutic approaches allowing viral clearance in patients.
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Affiliation(s)
- Arnaud Carpentier
- Institute for Experimental Virology, TWINCORE Centre for Experimental and Clinical Infection Research, a Joint Venture between Hannover Medical School (MHH) and Helmholtz Centre for Infection Research (HZI), Feodor-Lynen-Strasse 7, 30625 Hannover, Germany;
- Cluster of Excellence RESIST (EXC 2155), Hannover Medical School, Hannover, Germany
- Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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Iacob S, Gheorghe L, Onica M, Huiban L, Pop CS, Brisc C, Sirli R, Ester C, Brisc CM, Diaconu S, Rogoveanu I, Sandulescu L, Vuletici D, Trifan A. Prospective study of hepatitis B and D epidemiology and risk factors in Romania: A 10-year update. World J Hepatol 2024; 16:640-649. [PMID: 38689751 PMCID: PMC11056896 DOI: 10.4254/wjh.v16.i4.640] [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: 12/06/2023] [Revised: 02/19/2024] [Accepted: 03/22/2024] [Indexed: 04/24/2024] Open
Abstract
BACKGROUND The global burden of hepatitis D virus (HDV) infection represents a major medical challenge and a public health crisis worldwide. However, there is a lack of accurate data on the epidemiology and risk factors for HDV. Hepatitis B virus (HBV) and HDV coinfection causes the most severe form of viral hepatitis, leading to a higher cumulative incidence of liver-related events compared with HBV monoinfection, including the need for liver transplantation and death. AIM To investigate the epidemiology, natural history, risk factors and clinical management of HBV and HDV coinfection in Romanian patients. METHODS This prospective study was conducted between January and July 2022 in six tertiary gastroenterology and hepatology referral centres in Romania. All consecutive adults admitted for any gastroenterology diagnosis who were HBV-positive were enrolled. Patients with acute hepatitis or incomplete data were excluded. Of the 25390 individuals who presented with any type of gastroenterology diagnosis during the study period, 963 met the inclusion criteria. Testing for anti-HDV antibodies and HDV RNA was performed for all participants. Demographic and risk factor data were collected by investigators using medical charts and patient questionnaires. All data were stored in an anonymized online database during the study. RESULTS The prevalence of HBV was 3.8%; among these patients, the prevalence of HBV/HDV coinfection was 33.1%. The median age of the study population was 54.0 years, and it consisted of 55.1% men. A higher prevalence of HBV/HDV coinfection was observed in patients 50-69 years old. Patients with HBV/HDV coinfection were significantly older than those with HBV monoinfection (P = 0.03). Multivariate multiple regression analysis identified female gender (P = 0.0006), imprisonment (P < 0.0001), older age at diagnosis (P = 0.01) and sexual contact with persons with known viral hepatitis (P = 0.0003) as significant risk factors for HDV. CONCLUSION This study shows that HDV infection among those with HBV remains endemic in Romania and updates our understanding of HDV epidemiology and associated risk factors. It emphasizes the need for systematic screening for HDV infection and collaborative initiatives for controlling and preventing HBV and HDV infection.
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Affiliation(s)
- Speranta Iacob
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
- Department of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Liana Gheorghe
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
- Department of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest 022328, Romania.
| | - Mirela Onica
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
- Department of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Laura Huiban
- Department of Gastroenterology, Grigore T Popa University of Medicine and Pharmacy, Iasi 700115, Romania
- Institute of Gastroenterology and Hepatology, Saint Spiridon County Hospital, Iasi 700111, Romania
| | - Corina Silvia Pop
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
- Department of Gastroenterology and Medical Oncology, University Emergency Clinical Hospital, Bucharest 050098, Romania
| | - Ciprian Brisc
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410087, Romania
- Department of Gastroenterology, Emergency County Hospital, Oradea 410169, Romania
| | - Roxana Sirli
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Gastroenterology and Hepatology, "Victor Babeş" University of Medicine and Pharmacy, Timisoara 300041, Romania
- Department of Gastroenterology and Hepatology, Timiş County Emergency Clinical Hospital "Pius Branzeu", Timisoara 300723, Romania
| | - Carmen Ester
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
- Department of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Cristina Mihaela Brisc
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410087, Romania
- Department of Gastroenterology, Emergency County Hospital, Oradea 410169, Romania
| | - Sorina Diaconu
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
- Department of Internal Medicine II and Gastroenterology, University Emergency Clinical Hospital, Bucharest 050098, Romania
| | - Ion Rogoveanu
- Department of Gastroenterology, University of Medicine and Pharmacy, Craiova 200349, Romania
- Department of Cardiology, Emergency County Hospital, Craiova 200642, Romania
| | - Larisa Sandulescu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova 200349, Romania
- Department of Gastroenterology, Emergency County Hospital, Craiova 200642, Romania
| | - Deiana Vuletici
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Gastroenterology and Hepatology, "Victor Babeş" University of Medicine and Pharmacy, Timisoara 300041, Romania
- Department of Gastroenterology and Hepatology, Timiş County Emergency Clinical Hospital "Pius Branzeu", Timisoara 300723, Romania
| | - Anca Trifan
- Institute of Gastroenterology and Hepatology, Saint Spiridon County Hospital, Iasi 700111, Romania
- Department of Gastroenterology, Faculty of Medicine, Grigore T Popa University of Medicine and Pharmacy, Iasi 700115, Romania
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40
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Lombardo D, Franzè MS, Caminiti G, Pollicino T. Hepatitis Delta Virus and Hepatocellular Carcinoma. Pathogens 2024; 13:362. [PMID: 38787214 PMCID: PMC11124437 DOI: 10.3390/pathogens13050362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/14/2024] [Accepted: 04/20/2024] [Indexed: 05/25/2024] Open
Abstract
The hepatitis D virus (HDV) is a compact, enveloped, circular RNA virus that relies on hepatitis B virus (HBV) envelope proteins to initiate a primary infection in hepatocytes, assemble, and secrete new virions. Globally, HDV infection affects an estimated 12 million to 72 million people, carrying a significantly elevated risk of developing cirrhosis, liver failure, and hepatocellular carcinoma (HCC) compared to an HBV mono-infection. Furthermore, HDV-associated HCC often manifests at a younger age and exhibits more aggressive characteristics. The intricate mechanisms driving the synergistic carcinogenicity of the HDV and HBV are not fully elucidated but are believed to involve chronic inflammation, immune dysregulation, and the direct oncogenic effects of the HDV. Indeed, recent data highlight that the molecular profile of HCC associated with HDV is unique and distinct from that of HBV-induced HCC. However, the question of whether the HDV is an oncogenic virus remains unanswered. In this review, we comprehensively examined several crucial aspects of the HDV, encompassing its epidemiology, molecular biology, immunology, and the associated risks of liver disease progression and HCC development.
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Affiliation(s)
| | | | | | - Teresa Pollicino
- Department of Clinical and Experimental Medicine, University Hospital of Messina, 98124 Messina, Italy; (D.L.); (M.S.F.); (G.C.)
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Amin I, Rafique S, Ali A, Ahmed N, Shahid M, Afzal S, Tahir S, Waqas M, Bibi S, Elgorban AM, Idrees M, Shah M, Syed A. Improving Access to Anti-HDV Testing: Development and Validation of an Affordable In-House ELISA Assay. ACS OMEGA 2024; 9:17137-17142. [PMID: 38645367 PMCID: PMC11024977 DOI: 10.1021/acsomega.3c09843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 04/23/2024]
Abstract
In certain low-income nations, the hepatitis Delta virus and hepatitis B virus (HBV) pose a serious medical burden, where the prevalence of hepatitis B surface antigen (HBsAg) is greater than 8%. Especially in rural places, irregular diagnostic exams are the main restriction and reason for underestimation. Utilizing serum samples from a Pakistani isolate, an internal ELISA for the quick identification of anti-HDV was created, and the effectiveness of the test was compared to a commercial diagnostic kit. HDV-positive serum samples were collected, and a highly antigenic domain of HDAg antigen was derived from them. This antigenic HDAg was expressed in a bacterial expression system, purified by Ni-chromatography, and confirmed by SDS-PAGE and Western blot analysis. The purified antigen was utilized to develop an in-house ELISA assay for anti-HDV antibody detection of the patient's serum samples at very low cost. Purified antigens and positive and negative controls can detect anti-HDV (antibodies) in ELISA plates. The in-house developed kit's efficiency was compared with that of a commercial kit (Witech Inc., USA) by the mean optical density values of both kits. No significant difference was observed (a P value of 0.576) by applying statistical analysis. The newly developed in-house ELISA is equally efficient compared to commercial kits, and these may be useful in regular diagnostic laboratories, especially for analyzing local isolates.
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Affiliation(s)
- Iram Amin
- Centre
of Excellence in Molecular Biology (CEMB), University of the Punjab, Lahore 54590, Pakistan
- Centre
of Applied Molecular Biology (CAMB), University
of the Punjab, Lahore 54590, Pakistan
| | - Shazia Rafique
- Centre
of Excellence in Molecular Biology (CEMB), University of the Punjab, Lahore 54590, Pakistan
| | - Amjad Ali
- Department
of Biotechnology and Genetic Engineering, Hazara University Mansehra, Mansehra 2100, Pakistan
| | - Nadeem Ahmed
- Centre
of Excellence in Molecular Biology (CEMB), University of the Punjab, Lahore 54590, Pakistan
| | - Muhammad Shahid
- Centre
of Excellence in Molecular Biology (CEMB), University of the Punjab, Lahore 54590, Pakistan
| | - Samia Afzal
- Centre
of Excellence in Molecular Biology (CEMB), University of the Punjab, Lahore 54590, Pakistan
| | - Saad Tahir
- Centre
of Excellence in Molecular Biology (CEMB), University of the Punjab, Lahore 54590, Pakistan
| | - Muhammad Waqas
- Department
of Biotechnology and Genetic Engineering, Hazara University Mansehra, Mansehra 2100, Pakistan
| | - Sadia Bibi
- Department
of Botany, University of Malakand, Dir (Lower), Chakdara 18800, Khyber Pakhtunkhwa, Pakistan
| | - Abdallah M. Elgorban
- Department
of Botany and Microbiology, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
| | - Muhammad Idrees
- Centre
of Excellence in Molecular Biology (CEMB), University of the Punjab, Lahore 54590, Pakistan
| | - Masaud Shah
- Department
of Physiology, Ajou University School of
Medicine, Suwon 16499, Republic
of Korea
| | - Asad Syed
- Department
of Botany and Microbiology, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
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Capasso M, Cossiga V, Guarino M, Ranieri L, Morisco F. The Role of Hepatitis Viruses as Drivers of Hepatocancerogenesis. Cancers (Basel) 2024; 16:1505. [PMID: 38672587 PMCID: PMC11048534 DOI: 10.3390/cancers16081505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/08/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
Recently, metabolic associated steatotic liver disease (MASLD) became the leading cause of chronic liver disease worldwide and one of the most frequent causes of hepatocellular carcinoma (HCC). Nonetheless, in this epidemiological trend, viral hepatitis remains the major driver in hepatic carcinogenesis. Globally, hepatitis B virus (HBV) is the leading cause of hepatocellular carcinoma, with an overall attributable risk of approximately 40%, followed by hepatitis C virus (HCV), which accounts for 28-30% of cases, with significant geographic variations between the Eastern and Western world. Considering all the etiologies, HCC risk increases proportionally with the progression of liver disease, but the risk is consistently higher in patients with viral triggers. This evidence indicates that both direct (due to the oncogenic properties of the viruses) and indirect (through the mechanisms of chronic inflammation that lead to cirrhosis) mechanisms are involved, alongside the presence of co-factors contributing to liver damage (smoking, alcohol, and metabolic factors) that synergistically enhance the oncogenic process. The aim of this review is to analyze the oncogenic role of hepatitis viruses in the liver, evaluating epidemiological changes and direct and indirect viral mechanisms that lead to liver cancer.
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Affiliation(s)
| | - Valentina Cossiga
- Diseases of the Liver and Biliary System Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (M.C.); (M.G.); (L.R.); (F.M.)
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Kim DS, Yoon YI, Kim BK, Choudhury A, Kulkarni A, Park JY, Kim J, Sinn DH, Joo DJ, Choi Y, Lee JH, Choi HJ, Yoon KT, Yim SY, Park CS, Kim DG, Lee HW, Choi WM, Chon YE, Kang WH, Rhu J, Lee JG, Cho Y, Sung PS, Lee HA, Kim JH, Bae SH, Yang JM, Suh KS, Al Mahtab M, Tan SS, Abbas Z, Shresta A, Alam S, Arora A, Kumar A, Rathi P, Bhavani R, Panackel C, Lee KC, Li J, Yu ML, George J, Tanwandee T, Hsieh SY, Yong CC, Rela M, Lin HC, Omata M, Sarin SK. Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation. Hepatol Int 2024; 18:299-383. [PMID: 38416312 DOI: 10.1007/s12072-023-10629-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/18/2023] [Indexed: 02/29/2024]
Abstract
Liver transplantation is a highly complex and challenging field of clinical practice. Although it was originally developed in western countries, it has been further advanced in Asian countries through the use of living donor liver transplantation. This method of transplantation is the only available option in many countries in the Asia-Pacific region due to the lack of deceased organ donation. As a result of this clinical situation, there is a growing need for guidelines that are specific to the Asia-Pacific region. These guidelines provide comprehensive recommendations for evidence-based management throughout the entire process of liver transplantation, covering both deceased and living donor liver transplantation. In addition, the development of these guidelines has been a collaborative effort between medical professionals from various countries in the region. This has allowed for the inclusion of diverse perspectives and experiences, leading to a more comprehensive and effective set of guidelines.
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Affiliation(s)
- Dong-Sik Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young-In Yoon
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Beom Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Jun Yong Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jongman Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Hyun Sinn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Jin Joo
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho Joong Choi
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki Tae Yoon
- Department of Internal Medicine, Pusan National University College of Medicine, Yangsan, Republic of Korea
| | - Sun Young Yim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Cheon-Soo Park
- Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Deok-Gie Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hae Won Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Won-Mook Choi
- Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Eun Chon
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Woo-Hyoung Kang
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Geun Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yuri Cho
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Ilsan, Republic of Korea
| | - Pil Soo Sung
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Han Ah Lee
- Department of Internal Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Ji Hoon Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Si Hyun Bae
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Mo Yang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Mamun Al Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Soek Siam Tan
- Department of Medicine, Hospital Selayang, Batu Caves, Selangor, Malaysia
| | - Zaigham Abbas
- Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Ananta Shresta
- Department of Hepatology, Alka Hospital, Lalitpur, Nepal
| | - Shahinul Alam
- Crescent Gastroliver and General Hospital, Dhaka, Bangladesh
| | - Anil Arora
- Department of Gastroenterology and Hepatology, Sir Ganga Ram Hospital New Delhi, New Delhi, India
| | - Ashish Kumar
- Department of Gastroenterology and Hepatology, Sir Ganga Ram Hospital New Delhi, New Delhi, India
| | - Pravin Rathi
- TN Medical College and BYL Nair Hospital, Mumbai, India
| | - Ruveena Bhavani
- University of Malaya Medical Centre, Petaling Jaya, Selangor, Malaysia
| | | | - Kuei Chuan Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jun Li
- College of Medicine, Zhejiang University, Hangzhou, China
| | - Ming-Lung Yu
- Department of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | | | | | | | | | - H C Lin
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Masao Omata
- Department of Gastroenterology, Yamanashi Central Hospital, Yamanashi, Japan
- University of Tokyo, Bunkyo City, Japan
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44
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Souleiman R, Cornberg M. [Diagnosis and treatment of viral hepatitis B and D in 2024]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2024; 65:296-307. [PMID: 38418664 DOI: 10.1007/s00108-024-01671-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 03/02/2024]
Abstract
Despite the availability of vaccines, hepatitis B remains a significant cause of fulminant hepatitis, liver cirrhosis and hepatocellular carcinoma worldwide. The increase in reported hepatitis B cases in Germany is attributed to factors such as immigration and the hepatitis B surface antigen (HBsAg) screening introduced in 2020 as part of health check-ups. The indication for treatment depends on various factors, including the level of hepatitis B virus (HBV) DNA and inflammatory activity. Nucleos(t)ide analogues are the preferred treatment option, but functional cure, defined as HBsAg loss, is rare. In principle, treatment with nucleos(t)ide analogues should usually be discontinued after loss of HBsAg, but can be stopped earlier under certain conditions and is currently the subject of ongoing research. Pregnancy and immunosuppression in the context of hepatitis B require special attention. In addition, a possible hepatitis D virus co-infection must always be taken into account, which is why every HBsAg-positive person should be tested for anti-HDV. Since 2020, the entry inhibitor bulevirtide has become a new treatment option alongside pegylated interferon alfa, which represents a significant advance in the treatment landscape.
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Affiliation(s)
- Roni Souleiman
- Klinik für Gastroenterologie, Hepatologie, Infektiologie, und Endokrinologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
- Zentrum für Individualisierte Infektionsmedizin (CiiM), Hannover, Deutschland
- Partnerstandort Hannover-Braunschweig, Deutsches Zentrum für Infektionsforschung (DZIF), Hannover, Deutschland
| | - Markus Cornberg
- Klinik für Gastroenterologie, Hepatologie, Infektiologie, und Endokrinologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
- Zentrum für Individualisierte Infektionsmedizin (CiiM), Hannover, Deutschland.
- Partnerstandort Hannover-Braunschweig, Deutsches Zentrum für Infektionsforschung (DZIF), Hannover, Deutschland.
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Parfut A, Tripon S, Gantner P, Chaffraix F, Laugel E, Wendling MJ, Erol F, Wiedemer C, Doffoel M, Saviano A, Royant M, Habersetzer F, Fafi-Kremer S, Velay A. Impact of anti-HDV reflex testing at HBs antigen positive discovery in a single center France: Support for primary HDV screening in France. J Clin Virol 2024; 171:105650. [PMID: 38350177 DOI: 10.1016/j.jcv.2024.105650] [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: 12/14/2023] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Hepatitis Delta virus (HDV) infection is a major cause of liver-related morbidity and mortality in patients infected with HBV, with a global HDV prevalence uncertain. In France, 2 to 5 % of HBs antigen (HBsAg) carriers present anti-HDV antibodies (anti-HDV). The EASL recommends testing for anti-HDV in all HBsAg-positive patients. Since January 2022, we have systematically carried out anti-HDV serology when a positive HBsAg is discovered (new HBsAg carriers). OBJECTIVES We evaluated the benefit of anti-HDV reflex testing after one year of practice by comparing anti-HDV and HBsAg serology data over the last six years, among the new HBsAg carriers and all the HBsAg carriers. STUDY DESIGN HBsAg and anti-HDV were screened using the Abbott Architect HBsAg quanti kit and the DIA.PRO HDVAb kit. Serological, demographic, virological, and clinical data were analyzed. RESULTS Implementing anti-HDV reflex testing leads to more than a 2-fold increase in diagnoses of HDV infection among all HBsAg carriers. If the anti-HDV positive rate remains stable among the new HBsAg carriers, a significant increase in the anti-HDV positive rate from 6.8 % to 10.3 % was observed considering all HBsAg carriers. Interestingly, the discovery of anti-HDV carriage increased from 3.9 % to 6.5 % in 2022, allowing earlier identification of HBV-HDV-infected patients and a fast referral to hepatologists for adequate clinical management and, in some cases, the introduction of bulevirtide-based therapy. CONCLUSIONS Our preliminary results at one year seem promising and evaluating the cost-effectiveness of reflex tests in real life with feedback would be helpful.
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Affiliation(s)
- Assilina Parfut
- Virology Laboratory, Strasbourg University Hospital, Strasbourg, France
| | - Simona Tripon
- Service Expert de Lutte Contre les Hépatites Virales d'Alsace (SELHVA), Pôle Hépato-Digestif, Strasbourg University Hospital, Strasbourg, France
| | - Pierre Gantner
- Unité Mixte de Recherche (UMR) S1109 Labex Transplantex, Institut National de la Santé et de la Recherche Médicale (Inserm) Fédération de Médecine Translationnelle, Strasbourg University, Strasbourg France, Department of Virology, Institut de Virologie, Strasbourg University Hospital, 3 rue Koeberlé, Strasbourg F67000, France
| | - Fréderic Chaffraix
- Service Expert de Lutte Contre les Hépatites Virales d'Alsace (SELHVA), Pôle Hépato-Digestif, Strasbourg University Hospital, Strasbourg, France
| | - Elodie Laugel
- Unité Mixte de Recherche (UMR) S1109 Labex Transplantex, Institut National de la Santé et de la Recherche Médicale (Inserm) Fédération de Médecine Translationnelle, Strasbourg University, Strasbourg France, Department of Virology, Institut de Virologie, Strasbourg University Hospital, 3 rue Koeberlé, Strasbourg F67000, France
| | | | - Furkan Erol
- Virology Laboratory, Strasbourg University Hospital, Strasbourg, France
| | - Carine Wiedemer
- Service Expert de Lutte Contre les Hépatites Virales d'Alsace (SELHVA), Pôle Hépato-Digestif, Strasbourg University Hospital, Strasbourg, France
| | - Michel Doffoel
- Service Expert de Lutte Contre les Hépatites Virales d'Alsace (SELHVA), Pôle Hépato-Digestif, Strasbourg University Hospital, Strasbourg, France
| | - Antonio Saviano
- Service Expert de Lutte Contre les Hépatites Virales d'Alsace (SELHVA), Pôle Hépato-Digestif, Strasbourg University Hospital, Strasbourg, France
| | - Maude Royant
- Service Expert de Lutte Contre les Hépatites Virales d'Alsace (SELHVA), Pôle Hépato-Digestif, Strasbourg University Hospital, Strasbourg, France
| | - François Habersetzer
- Service Hépato-Gastroentérologie et Pôle Hépato-Digestif, Hôpitaux Universitaire de Strasbourg, Université de Strasbourg, Inserm 1110, Strasbourg, Strasbourg, France
| | - Samira Fafi-Kremer
- Unité Mixte de Recherche (UMR) S1109 Labex Transplantex, Institut National de la Santé et de la Recherche Médicale (Inserm) Fédération de Médecine Translationnelle, Strasbourg University, Strasbourg France, Department of Virology, Institut de Virologie, Strasbourg University Hospital, 3 rue Koeberlé, Strasbourg F67000, France
| | - Aurélie Velay
- Unité Mixte de Recherche (UMR) S1109 Labex Transplantex, Institut National de la Santé et de la Recherche Médicale (Inserm) Fédération de Médecine Translationnelle, Strasbourg University, Strasbourg France, Department of Virology, Institut de Virologie, Strasbourg University Hospital, 3 rue Koeberlé, Strasbourg F67000, France.
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46
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Kondili LA, Lazarus JV, Jepsen P, Murray F, Schattenberg JM, Korenjak M, Craxì L, Buti M. Inequities in primary liver cancer in Europe: The state of play. J Hepatol 2024; 80:645-660. [PMID: 38237866 DOI: 10.1016/j.jhep.2023.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 12/01/2023] [Accepted: 12/11/2023] [Indexed: 02/12/2024]
Abstract
Given the increasing burden of liver cancer in Europe, it is crucial to investigate how social determinants of health (SDoH) affect liver cancer risk factors and access to care in order to improve health outcomes equitably. This paper summarises the available evidence on the differential distribution of liver cancer risk factors, incidence, and health outcomes in the European Economic Area and the United Kingdom from an SDoH perspective. Vulnerable and marginalised populations have low socio-economic and educational levels and are the most affected by liver cancer risk factors. Reasons for this include varied access to hepatitis B virus vaccination and limited access to viral hepatitis B and C screening, harm reduction, and treatment. Additionally, alcohol-related liver disease remains highly prevalent among individuals with low education, insecure employment, economic instability, migrants, and deprived populations. Moreover, significant variation exists across Europe in the proportion of adults with steatotic liver disease, overweight/obesity, and diabetes, based on geographical area, gender, socio-economic and educational background, and density of ultra-processed food outlets. Inequities in cirrhosis mortality rates have been reported, with the highest death rates among individuals living in socio-economically disadvantaged areas and those with lower educational levels. Furthermore, insufficient healthcare access for key populations with primary liver cancer is influenced by complex healthcare systems, stigmatisation, discrimination, low education, language barriers, and fear of disclosure. These challenges contribute to inequities in liver cancer care pathways. Future studies are needed to explore the different SDoH-interlinked effects on liver cancer incidence and outcomes in European countries. The ultimate goal is to develop evidence-based multilevel public health interventions that reduce the SDoH impact in precipitating and perpetuating the disproportionate burden of liver cancer in specific populations.
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Affiliation(s)
- Loreta A Kondili
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy, UniCamillus International Medical University, Rome, Italy
| | - Jeffrey V Lazarus
- CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, NY, USA; Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Peter Jepsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Frank Murray
- Beaumont Private Clinic, Beaumont, Dublin 9, Ireland
| | - Jörn M Schattenberg
- Department of Internal Medicine II, Saarland University Medical Center, Homburg and Saarland University, Saarbrücken, Germany
| | | | - Lucia Craxì
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Maria Buti
- Liver Unit, Hospital Universitario Vall d'Hebrón, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.
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47
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Abbas Z, Abbas M. Is there a need for universal double reflex testing of HBsAg-positive individuals for hepatitis D infection? World J Hepatol 2024; 16:300-303. [PMID: 38577532 PMCID: PMC10989316 DOI: 10.4254/wjh.v16.i3.300] [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: 12/03/2023] [Revised: 01/16/2024] [Accepted: 02/22/2024] [Indexed: 03/27/2024] Open
Abstract
Hepatitis D virus (HDV) can infect HBsAg-positive individuals, causing rapid fibrosis progression, early decompensation, increased hepatocellular carcinoma risk, and higher mortality than hepatitis B virus (HBV) mono-infection. Most countries lack high-quality HDV prevalence data, and the collection techniques employed often bias published data. In recent meta-analyses, HDV prevalence in HBsAg-positive patients reaches 5%-15% and is even significantly higher in endemic areas. Since HBV vaccination programs were implemented, HDV prevalence has decreased among younger populations. However, owing to immigrant influx, it has increased in some Western countries. The current practice of HDV screening in HBsAg-positive individuals is stepwise, based on physician's discretion, and limited to at-risk populations and may require numerous visits. Double reflex testing, which includes anti-HDV testing in all HBsAg-positive individuals and then HDV RNA testing for anti-HDV-positive ones, is uncommon. Reflex testing can identify more HDV infection cases and link identified patients to further care and follow-up. Moreover, laboratory-based double reflex screening is less biased than physician-led testing. Therefore, healthcare providers should learn about reflex testing, and federal and provincial hepatitis control programs should implement laboratory-based double reflex testing to obtain reliable HDV prevalence estimates. The test's cost-effectiveness depends on the number of HBV-positive patients screened to identify one HDV-positive patient. Such testing may be viable in areas with low HBsAg but high HDV prevalence. However, its economic impact on areas with low HDV prevalence needs further study.
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Affiliation(s)
- Zaigham Abbas
- Department of Hepatogastroenterology and Liver Transplantation, Dr. Ziauddin University Hospital, Karachi 75600, Sindh, Pakistan.
| | - Minaam Abbas
- Department of Medicine, University of Cambridge, Cambridge CB2 0SP, United Kingdom
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48
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Wang Y, Shen G, Lu R, Liu J, Zhang F, Wang H, Cai W, Zhang F. The prevalence of HDV among HBsAg-positive populations with and without HIV-1 in China. Int J Infect Dis 2024; 140:70-77. [PMID: 38218378 DOI: 10.1016/j.ijid.2023.12.014] [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: 10/23/2023] [Revised: 12/24/2023] [Accepted: 12/29/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Existing research has provided evidence of changes in hepatitis delta virus (HDV) prevalence worldwide. This study aimed to investigate the prevalence and molecular characteristics of HDV to elucidate its spread in China. METHODS A total of 3,000 samples were collected from 2,241 HBV monoinfections and 759 HBV/HIV-1 coinfections across 13 sites in northern, southern, western, and southwestern China. Serological and virological prevalence were determined by detecting anti-HDV antibodies and HDV RNA. RESULTS The study revealed a 2.63% (95% CI: 2.06-3.21) seroprevalence of HDV among HBV infections in China, exhibiting regional variation. HDV seroprevalence was notably higher at 7.91% (95% CI: 5.98-9.83) in HBV and HIV-1 coinfections. Region and HIV-1 infection were identified as risk factors for HDV infection. Virological prevalence was 0.67% (95% CI: 0.38-0.96) in HBV infections and 2.24% (95% CI: 1.18-3.29) in HBV/HIV-1 coinfections. The predominant HDV genotype in China was HDV-2a, followed by HDV-1. Participants with anti-HDV positivity demonstrated significantly higher proportions of abnormal liver dysfunction and elevated HBV DNA load (P < 0.001) compared to anti-HDV-negative participants. CONCLUSIONS This study highlights the HDV epidemic in China, sheds light on its geographical distribution and high-risk populations, and provides insights for developing strategies to manage the spread of HDV in the country.
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Affiliation(s)
- Yan Wang
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China; Clinical and Research Center for Infectious Diseases, Beijing Ditan Hospital, Beijing, China
| | - Guizhou Shen
- The first People's Hospital of Liangshan Yi Autonomous Prefecture, Sichuan, China
| | - Ruichao Lu
- Chest Hospital of Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Jun Liu
- Department of HIV/AIDS, Third People's Hospital of Kunming, Yunnan, China
| | - Feng Zhang
- Health Commission, Xinjiang Uyghur Autonomous Region, Xinjiang, China
| | - Hui Wang
- Third People's Hospital of Shenzhen, Second Affiliated Hospital of Southern University of Science and Technology, Guangdong, China
| | - Weiping Cai
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangdong, China
| | - Fujie Zhang
- Clinical and Research Center for Infectious Diseases, Beijing Ditan Hospital, Beijing, China.
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49
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Khalfi P, Denis Z, McKellar J, Merolla G, Chavey C, Ursic-Bedoya J, Soppa L, Szirovicza L, Hetzel U, Dufourt J, Leyrat C, Goldmann N, Goto K, Verrier E, Baumert TF, Glebe D, Courgnaud V, Gregoire D, Hepojoki J, Majzoub K. Comparative analysis of human, rodent and snake deltavirus replication. PLoS Pathog 2024; 20:e1012060. [PMID: 38442126 PMCID: PMC10942263 DOI: 10.1371/journal.ppat.1012060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 03/15/2024] [Accepted: 02/19/2024] [Indexed: 03/07/2024] Open
Abstract
The recent discovery of Hepatitis D (HDV)-like viruses across a wide range of taxa led to the establishment of the Kolmioviridae family. Recent studies suggest that kolmiovirids can be satellites of viruses other than Hepatitis B virus (HBV), challenging the strict HBV/HDV-association dogma. Studying whether kolmiovirids are able to replicate in any animal cell they enter is essential to assess their zoonotic potential. Here, we compared replication of three kolmiovirids: HDV, rodent (RDeV) and snake (SDeV) deltavirus in vitro and in vivo. We show that SDeV has the narrowest and RDeV the broadest host cell range. High resolution imaging of cells persistently replicating these viruses revealed nuclear viral hubs with a peculiar RNA-protein organization. Finally, in vivo hydrodynamic delivery of viral replicons showed that both HDV and RDeV, but not SDeV, efficiently replicate in mouse liver, forming massive nuclear viral hubs. Our comparative analysis lays the foundation for the discovery of specific host factors controlling Kolmioviridae host-shifting.
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Affiliation(s)
- Pierre Khalfi
- Institut de Génétique Moléculaire de Montpellier, University of Montpellier, CNRS, Montpellier, France
| | - Zoé Denis
- Institut de Génétique Moléculaire de Montpellier, University of Montpellier, CNRS, Montpellier, France
| | - Joe McKellar
- Institut de Génétique Moléculaire de Montpellier, University of Montpellier, CNRS, Montpellier, France
| | - Giovanni Merolla
- Institut de Génétique Moléculaire de Montpellier, University of Montpellier, CNRS, Montpellier, France
| | - Carine Chavey
- Institut de Génétique Moléculaire de Montpellier, University of Montpellier, CNRS, Montpellier, France
| | - José Ursic-Bedoya
- Institut de Génétique Moléculaire de Montpellier, University of Montpellier, CNRS, Montpellier, France
- Department of hepato-gastroenterology, Hepatology and Liver Transplantation Unit, Saint Eloi University Hospital, Montpellier, France
| | - Lena Soppa
- Institute of Medical Virology, National Reference Centre for Hepatitis B Viruses and Hepatitis D Viruses, German Center for Infection Research (DZIF, Partner Site Giessen-Marburg-Langen), Justus Liebig University Giessen, Giessen, Germany
| | - Leonora Szirovicza
- Medicum, Department of Virology, University of Helsinki, Helsinki, Finland
| | - Udo Hetzel
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - Jeremy Dufourt
- Institut de Génétique Moléculaire de Montpellier, University of Montpellier, CNRS, Montpellier, France
- Institut de Recherche en Infectiologie de Montpellier (IRIM), Université de Montpellier, CNRS UMR9004, Montpellier, France
| | - Cedric Leyrat
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - Nora Goldmann
- Institute of Medical Virology, National Reference Centre for Hepatitis B Viruses and Hepatitis D Viruses, German Center for Infection Research (DZIF, Partner Site Giessen-Marburg-Langen), Justus Liebig University Giessen, Giessen, Germany
| | - Kaku Goto
- Université de Strasbourg, Inserm, Institut de Recherche sur les Maladies Virales et Hépatiques UMR_S1110, Strasbourg, France
- Institut Hospitalo-Universitaire, Pôle Hépato-digestif, Nouvel Hôpital Civil, Strasbourg, France
| | - Eloi Verrier
- Université de Strasbourg, Inserm, Institut de Recherche sur les Maladies Virales et Hépatiques UMR_S1110, Strasbourg, France
- Institut Hospitalo-Universitaire, Pôle Hépato-digestif, Nouvel Hôpital Civil, Strasbourg, France
| | - Thomas F. Baumert
- Université de Strasbourg, Inserm, Institut de Recherche sur les Maladies Virales et Hépatiques UMR_S1110, Strasbourg, France
- Institut Hospitalo-Universitaire, Pôle Hépato-digestif, Nouvel Hôpital Civil, Strasbourg, France
| | - Dieter Glebe
- Institute of Medical Virology, National Reference Centre for Hepatitis B Viruses and Hepatitis D Viruses, German Center for Infection Research (DZIF, Partner Site Giessen-Marburg-Langen), Justus Liebig University Giessen, Giessen, Germany
| | - Valérie Courgnaud
- Institut de Génétique Moléculaire de Montpellier, University of Montpellier, CNRS, Montpellier, France
| | - Damien Gregoire
- Institut de Génétique Moléculaire de Montpellier, University of Montpellier, CNRS, Montpellier, France
| | - Jussi Hepojoki
- Medicum, Department of Virology, University of Helsinki, Helsinki, Finland
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - Karim Majzoub
- Institut de Génétique Moléculaire de Montpellier, University of Montpellier, CNRS, Montpellier, France
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Anolli MP, Renteria SU, Degasperi E, Borghi M, Facchetti F, Sambarino D, Perbellini R, Monico S, Ceriotti F, Lampertico P. Quantification of serum HDV RNA by Robogene 2.0 in HDV patients is significantly influenced by the extraction methods. Liver Int 2024; 44:831-837. [PMID: 38247385 DOI: 10.1111/liv.15795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 10/25/2023] [Accepted: 11/07/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND AND AIM Management of chronic hepatitis delta (CHD) requires reliable tests for HDV RNA quantification. The aim of the study was to compare two extraction methods for the quantification of HDV RNA in untreated and bulevirtide (BLV)-treated CHD patients. METHODS Frozen sera from untreated and BLV-treated CHD patients were tested in a single-centre study for HDV RNA levels (Robogene 2.0, Roboscreen GmbH, Leipzig, Germany; LOD 6 IU/mL) with two extraction methods: manual (INSTANT Virus RNA/DNA kit; Roboscreen GmbH, Leipzig, Germany) versus automated (EZ1 DSP Virus Kit; Qiagen, Hilden, Germany). BLV-treated patients were sampled at baseline and during therapy. RESULTS Two hundred sixty-four sera collected from 157 CHD (139 untreated, 18 BLV-treated) patients were analysed: age 51 (28-78), 59% males, 90% of European origin, 60% cirrhotics, ALT 85 (17-889) U/L, HBsAg 3.8 (1.7-4.6) Log IU/mL, 81% HBV DNA undetectable, 98% HDV genotype 1. Median HDV RNA was 4.53 (.70-8.10) versus 3.77 (.70-6.93) Log IU/mL by manual versus automated extraction (p < .0001). Manual extraction reported similar HDV RNA levels in 31 (20%) patients, higher in 119 (76%) [+.5 and +1 log10 in 60; > +1 log10 in 59] and lower in 7 (4%). Among 18 BLV-treated patients, rates of HDV RNA < LOD significantly differed between the two assays at Weeks 16 and 24 (0% vs. 22%, p = .02; 11% vs. 44%, p = .03), but not at later timepoints. By contrast, virological response rates were similar. CONCLUSIONS Quantification of HDV RNA by Robogene 2.0 is influenced by the extraction method, the manual extraction being 1 Log more sensitive.
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Affiliation(s)
- Maria Paola Anolli
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Uceda Renteria
- Virology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisabetta Degasperi
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Borghi
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Floriana Facchetti
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dana Sambarino
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo Perbellini
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Monico
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ferruccio Ceriotti
- Virology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pietro Lampertico
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan, Milan, Italy
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