Global change in hepatitis C virus prevalence and cascade of care between 2015 and 2020: a modelling study

Evaluation of an anti-HCV chemiluminescence assay: Enhancing diagnostic accuracy and reducing false positives in hepatitis C screening

OBJECTIVES

Detection of antibodies is recommended for the diagnosis and effective treatment of hepatitis C. This study evaluated the performance of a new chemiluminescence assay for detecting hepatitis C virus (HCV) antibodies and compared it with previous assays using a comprehensive set of routine and borderline samples.

METHODS

A total of 2,216 serum samples were included in this study, comprising of 2,121 routine clinical samples and 95 borderline cases (COI range: 0.9-5.0). We compared the Anti-HCV-2 assay's (Mindray Diagnostics, Shenzhen, China) performance with the Anti-HCV-1 assay, assessing key parameters including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Precision was tested using replicate samples, and accuracy was validated through confirmatory RIBA (Mikrogen GmbH, Neuried, Germany) and Elecsys Anti-HCV assays (Roche Diagnostics, Mannheim, Germany). Interference testing was conducted to assess the assay's robustness against common substances found in clinical samples.

RESULTS

The Anti-HCV-2 assay demonstrated high sensitivity (98.2 %), specificity (99.1 %), and accuracy (98.7 %) in routine clinical samples. For borderline cases, the accuracy of Anti-HCV-2 was significantly higher (96.84 %) compared to Anti-HCV-1 (3.16 %). Precision testing showed a coefficient of variation (CV) of <2 %, indicating excellent reproducibility. Anti-interference testing confirmed that the Anti-HCV-2 assay performed consistently across samples with common interferences, such as hemolysis and lipemia.

CONCLUSION

The Anti-HCV-2 assay outperforms the Anti-HCV-1 assay in terms of accuracy, reproducibility, and reliability, especially in the range of borderline, making it a valuable tool for routine HCV screening.

Performance of the cobas 5800 System for Hepatitis B virus DNA and Hepatitis C virus RNA quantification

Hepatitis B and C infections are an underdiagnosed global health problem. Measurement of HBV DNA or HCV RNA levels using nucleic acid-based molecular diagnostic assays has been established as the standard of care for assessing diagnosis, guiding the treatment decision, and evaluating responses to antiviral therapy. In the present study, we examined the performance of the cobas 5800 System for HBV DNA and HCV RNA quantification in a large series of patients chronically infected. Specificity of the cobas HBV and HCV Tests on the 5800 System was high (99.1 % and 100 %, respectively). Linearity using the AcroMetrix panels was excellent. Repeatability and intermediate precision coefficients of variation were within 5 %. Of the 334 clinical specimens tested in parallel on the cobas 5800 and cobas 4800 Systems for HBV and the m2000 RealTime or Alinity m Systems for HCV, only 12 (3.6 %) yielded discrepant results that were at or near the limit of quantification of the cobas 5800 assays. The correlation between viral load results was extremely high, and only weak bias were observed across the entire range of concentrations tested without clinical impact in patients who are eligible for antiviral therapy. This comparison study demonstrated equivalent performance of the new cobas 5800 System compared with other molecular platforms widely used in clinical practice for HBV DNA and HCV RNA quantification. The cobas 5800 System can be confidently used in clinical practice. A few clinical specimens with low viral loads may be missed. Further studies are warranted to confirm or refute this finding.

"It's not just running the test": Operator experiences of implementing a decentralised hepatitis C point-of-care testing program in Australia

BACKGROUND

The decentralisation of hepatitis C virus (HCV) point-of-care testing is a core part of Australia's strategy to meet WHO elimination targets. However, little is known about the experiences of providers implementing these interventions and thus what is needed to improve integration. The study aim was to understand operator experiences, including the challenges and enablers, of implementing point-of-care testing as part of a National Point-of-Care Testing Program.

METHODS

Providers who were enrolled in the National Program and qualified to perform point-of-care testing were invited to participate in semi-structured qualitative interviews between April and August 2023. Data were analysed according to iterative categorisation and themes were organised according to Service delivery, Resources, and Governance-elements of the Health Systems Dynamics Framework.

RESULTS

Of the 31 participants, most were from New South Wales (n = 17), were practicing clinicians (n = 18), worked in outpatient or community health clinics (n = 21), and had no previous experience using a molecular point-of-care testing device (n = 24). Many participants struggled to deliver HCV testing and treatment according to national HCV management guidelines. Some participants avoided using the point-of-care testing device altogether. Others found it challenging to manage the administrative load of delivering the National Program, including planning outreach and following-up clients. These challenges were exacerbated by workforce shortages, difficult-to-navigate IT systems, and a lack of specific implementation advice from Program leadership.

CONCLUSIONS

This study illustrates several challenges to and enablers of adopting a decentralised HCV point-of-care testing program, highlighting the need to further explore what providers require to effectively implement these interventions.

Immunosenescence and immunotherapy in elderly patients with hepatocellular carcinoma

Liver cancer, more specifically hepatocellular carcinoma (HCC), is a global health issue and one of the dominant causes of cancer death around the world. In the past few decades, remarkable advances have been achieved in the systemic therapy of HCC. Immune checkpoint inhibitors (ICIs) have become a therapy mainstay for advanced HCC and have shown promise in the neoadjuvant therapy before resection. Despite these significant advancements, the compositions and functions of the immune system occur various alterations with age, called "immunosenescence", which may affect the antitumor effects and safety of ICIs, thus raising concerns that immunosenescence may impair elderly patients' response to ICIs. Therefore, it is important to learn more about the immunosenescence characteristics of elderly patients. However, the real-world elderly HCC patients may be not accurately represented by the elderly patients included in the clinical trials, affecting the generalizability of the efficacy and safety profiles from the clinical trials to the real-world elderly patients. This review summarizes the characteristics of immunosenescence and its influence on HCC progression and immunotherapy efficacy as well as provides the latest progress in ICIs available for HCC and discusses their treatment efficacy and safety on elderly patients. In the future, more studies are needed to clarify the mechanisms of immunosenescence in HCC, and to find sensitive screening tools or biomarkers to identify the patients who may benefit from ICIs.

Acceptability and usability of oral fluid HCV self-testing among health-facility users from Brazil: a cross-sectional study of 685 participants

INTRODUCTION AND OBJECTIVES

HCV Self-Testing (HCVST) can be used to uptake HCV testing. We aimed to evaluate the acceptability/usability and re-reading/re-testing agreement of oral fluid HCVST among health-facility users in the Primary Care Systemin Brazil.

MATERIALS AND METHODS

Consecutive people aged 18‒79 years using the Primary Care System (PCS) from 04-July-2022 to 30-September-2022 were invited for this cross-sectional study. The professional use OraQuick® HCV Rapid Antibody Test was used as a HCVST prototype. Oral fluid HCVST was performed relying on a step-by-step video and written/pictorial instructions. Usability was assessed by observed errors and documented need of assistance by a Healthcare Worker (HCW). After HCVST, a second HCV test was performed by the HCW using the same test-kit. Re-reading and re-testing concordances were evaluated (Cohen's kappa, κ). Post-testing participant's perspectives were assessed.

RESULTS

685 participants (74.5% female; median age = 52 [IQR 39‒61] years, 52.5% with schooling ≤ 10 years) were included. Major observed errors [%(95%CI)] were incorrect sample collection [32.8% (29.4‒36.5)] and wrong placing the test device in the tube [15.0% (12.6‒17.9)]. A total of 35.6% (95% CI 32.1‒39.3) of participants needed assistance in at least one step of HCVST. Re-reading and re-testing agreements were 95.2% (κ = 0.56) and 99.7% (κ = 0.67; n = 626 excluding invalid tests), respectively. After HCVST, 93% felt safe, 99% would be willing to test again, and 99% would recommend HCVST. Most participants rated the HCVST experience as easy (73%) or very easy (24%).

CONCLUSION

Oral-fluid HCVST was feasible and well-accepted among users of the PCS in Brazil. HCVST can be an alternative to scale-up HCV testing.

Prevalence-based screening by anti-HCV reflex HCV antigen test and accessible post-screening care towards elimination of hepatitis C in rural villages

BACKGROUND

One major barrier to the goals of hepatitis C virus (HCV) elimination is identification and linkage-to-care for those with HCV infection. The aim of this research was to develop a strategy to help achieve HCV elimination in remote rural villages.

METHODS

According to the maps of the township- and village-specific testing rates and prevalence rates of anti-HCV produced by the Public Health Bureau of Yunlin County, a high anti-HCV prevalent township Sihhu and four nearby villages were selected for an intensive screening with anti-HCV reflex HCV antigen test. A temporary outreach hepatology clinic was set in Sihhu Township Health Center to enhance accessibility for post-screening care of those positive for HCV antigen.

RESULTS

The population aged ≥ 40 years of the included villages at time of survey was 18,018 with 5,343 (29.7%, range 18.8-39.7%) having ever been previously screened, and 1,503 responded to this screening. The crude screening coverage rate increased to 38.0% (range 27.6-47.2%) after this screening campaign. The prevalence rates of anti-HCV and HCV antigen were 17.3% and 8.3% respectively, with the rate of antigenemia (HCV antigen/anti-HCV) being 48.1%. The number needed to test (NNT) to find a candidate for anti-viral treatment was 12. Patients can choose any medical institution for consultation based on their preference. The local health centers could trace the consultation status of all 125 HCV patients, with 119 of them receiving direct-acting antiviral (DAA) treatment. Out of the 125 patients with positive HCV antigen, 75 were evaluated at the outreach clinic, with 70 ultimately receiving DAA treatment at the outreach clinic and 5 receiving treatment at other hospitals. Evaluable sustained virological response rate for the 70 patients was 97%.

CONCLUSION

Prevalence-based screening and accessible outreach clinic can help accelerate HCV elimination in rural villages.

The macroeconomic burden of hepatitis C and the economic benefit of accelerated investments in China

BACKGROUND

Hepatitis C virus (HCV) poses a significant health and economic burden worldwide, with China bearing a considerable portion of this burden. Chinese treatment coverage remains low, and the full economic implications of achieving these goals are not well understood.

OBJECTIVE

This study aims to evaluate the macroeconomic burden of HCV from 2023 to 2050, as well as the investments required, health benefits, cost-effectiveness, net economic benefit, and the impact on economic growth associated with achieving WHO hepatitis C intervention coverage targets more rapidly during this period.

METHODS

A dynamic compartmental model was used to simulate the transmission, progression, and cascade of care for HCV patients in China. Intervention costs and healthcare costs were calculated using the cost-of-illness (COI) method. A health-augmented macroeconomic model projected macroeconomic outcomes. Scenarios were developed to evaluate different time points for achieving coverage targets.

RESULTS

The projected macroeconomic burden of HCV from 2023 to 2050 is $1.17 trillion. Achieving WHO targets by 2030 is expected to spend $69.72 (95% UI $66.22-$73.68) billion but will avert 0.66(95% UI 0.58-0.74) million hepatocellular carcinoma (HCC) cases, and 1.10(95% UI 1.03-1.18) million HCV-related deaths compared to status quo. Faster achievement of coverage targets is associated with investments becoming cost-effective sooner and facilitating greater economic growth.

CONCLUSION

Achieving the WHO Global Health Sector Strategy diagnosis and treatment coverage targets by 2030 in China is projected to be cost-effective and result in significant health and economic benefits. The findings underscore the importance of increased investment in hepatitis C elimination efforts in China.

New drugs and their performance 10 years after approval: a systematic analysis

More than 10,000 drugs are available on today's market in Germany, with an increasing number receiving institutional approval every year. However, their general efficacy and utility for patients are often not thoroughly analyzed and, in some cases, remain questionable. The lack of systematic analysis for these parameters hinders learning from failures and successes. As a result, there is a risk of wasting resources by the pharmaceutical industry and approving new drugs that offer no additional benefit to patients in need of innovative treatments. Therefore, we set out to analyze the evolution of new drugs with innovative principles over 10 years after approval by the European Medicines Agency (EMA). We focused on drugs approved from 2004 to 2011, excluding protein kinase inhibitors and monoclonal antibodies, and identified 190 new drugs using the Arzneiverordnungsreport (AVR, Drug prescription report). With data from the Wissenschaftliches Institut der Ortskrankenkassen (WidO, Scientific Institute of the General Local Health Insurance Fund, AOK), we analyzed their number of prescriptions, sales, defined daily doses (DDD), and daily costs. We then extended our analysis with a focus on Rote-Hand-Briefe (RHB, Direct Healthcare Professional Communication). We identified factors of success, which was defined as a drug appearing in the top 3000. We then conducted a detailed analysis of outliers in terms of sales, focusing on parameters such as indications, innovation regarding their mechanism of action, relative costs, competition, pharmacological properties, and clinical studies. The analysis of both the most and least successful, allowed us to identify clear correlations and determine potential red flags as well as green flags regarding pharmaceutical sales. Nearly half (49%) of the drugs analyzed met our success criterion, most very early (66% within the first 2 years). Most of these drugs also showed a notable progression in the drug rankings over the years. Thirty percent of all analyzed drugs received RHBs, with most of them (84% of the said 30%) receiving at least one deemed potentially influential regarding sales. The successful drugs were more often subject to these potentially influential RHBs than their non-successful counterparts, and most of the potentially influential RHBs were related to adverse drug reactions (53%) or indications or contraindications (14.8%). Based on the analysis of the tops and flops, we conclude that market success, measured by sales, is influenced by multiple factors. These include indication(s), innovation, the competitive landscape, costs, and pharmacological aspects as well as studies regarding the efficacy and the adverse drug reactions of the drug. These results underline the necessity of a multifactorial approach based on value-adding to assess potential new drugs by pharmaceutical companies.

Long-Term Hepatic and Extrahepatic Outcomes of Chronic Hepatitis C Patients After Sofosbuvir-Based Treatment (LONGHEAD Study)

BACKGROUND/AIMS

Direct-acting antivirals (DAAs) are highly effective in treating hepatitis C virus (HCV) infection. The long-term hepatic and extrahepatic outcomes of DAAs in chronic hepatitis C (CHC) patients receiving curative antivirals are elusive.

METHODS

CHC patients were retrieved from two phase III sofosbuvir-based clinical trials conducted from 2013-2014. Patients who achieved a sustained virological response have been followed prospectively for 5 years since 2016. A propensity score-matched interferon-based historical control with a 1:3 ratio was used for comparison. Quality of life (QoL) was measured by the SF-36, liver fibrosis was measured by electrography, and fibrosis-related markers were followed annually in the prospective cohort.

RESULTS

A total of 160 DAA- and 480 interferon-treated patients were enrolled. Twenty-eight patients developed hepatocellular carcinoma (HCC) over a follow-up period of 4424 person-years (annual incidence: 0.6%). The incidence of HCC did not differ significantly between the DAA cohort and interferon-treated patients (P = 0.07). Cox regression analysis revealed that FIB-4 was the only factor independently associated with HCC development (hazard ratio [HR]: 95% confidence interval [CI] 3.59/1.68-7.66, P = 0.001). The incidence of newly developed cardio-cerebrovascular disease was 13.8 per 1000 person-years and 0.9 per 1000 person-years in interferon-treated patients and the DAA cohort, respectively (P < 0.001). Interferon-based patients had a significantly greater incidence of cardio-cerebrovascular disease (HR/CI 3.39/1.28-8.96, P = 0.014). There was a substantial decrease in liver stiffness (Ptrend = 0.08) and M2BPGi (Ptrend = 0.05) and a significant reduction in LOXL2 (Ptrend = 0.02) over 5 years. A significant decrease in QoL was observed in role limitations due to physical health and emotional problems, whereas the other parameters were maintained consistently throughout the 5 years of follow-up.

CONCLUSIONS

HCV eradication by DAAs improved liver- and non-liver-related outcomes, constantly promoted liver fibrosis regression, and maintained quality of life after HCV cure.

CLINICAL TRIAL NUMBER

NCT03042520.

Facilitating access to direct-acting antivirals in a community-based point-of-diagnosis model for hepatitis C treatment: The role of the pharmacy team in the no one waits (NOW) study

BACKGROUND

Despite simplified hepatitis C virus (HCV) treatment algorithms, insurance-related barriers prevent same-day HCV treatment upon diagnosis in the US. We assessed how direct partnerships with a pharmacy team facilitated HCV treatment initiation among socially marginalized populations in a community setting.

METHODS

The No One Waits (NOW) Study, a single-arm trial conducted between July 1, 2020, and October 31, 2021, in San Francisco, CA, targeted individuals experiencing homelessness, injecting drugs, and eligible for simplified HCV treatment. Upon positive HCV RNA results, participants were enrolled in same-day treatment and given a 2-week sofosbuvir/velpatasvir (SOF/VEL) starter pack. Additional insurance-provided SOF/VEL was requested for 12 weeks of treatment. If insurance-provided medication was unavailable, SOF/VEL was provided using the study supply. We describe the sustained partnership with a specialty pharmacy team that was necessary for the NOW model's success.

RESULTS

Eighty-seven participants started treatment at diagnosis. Most were unsheltered (61 %), actively injecting drugs (80 %), and had incomes below the federal poverty line (97 %). 90 % transitioned to insurance-covered treatment before completion, with pharmacy members assisting participants in navigating insurance authorization, medication transport, and financial assistance.

CONCLUSION

A sustained partnership with a specialty pharmacy team was critical in transitioning participants to insurance-covered treatment quickly and overcoming barriers, while the study-provided 2-week starter pack facilitated same-day treatment at the point of diagnosis.

Liver cancer in 2021: Global Burden of Disease study

BACKGROUND & AIMS

The epidemiology of adult primary liver cancer continues to evolve, owing to the increasing prevalence of metabolic disease, rising alcohol consumption, advances in vaccination for HBV, and antiviral therapy for HCV. Disparities in care and the burden of liver cancer between populations persist. We assess trends in the burden of liver cancer and contributions by various etiologies across 204 countries and territories from 2010 to 2021.

METHODS

Utilizing the methodological framework of the Global Burden of Disease Study 2021, we analyzed global and regional temporal trends in incidence and mortality, and the contributions of various etiologies of liver disease.

RESULTS

In 2021, there were an estimated 529,202 incident cases and 483,875 deaths related to liver cancer. From 2010 to 2021, global liver cancer incident cases and deaths increased by 26% and 25%, respectively. Age-standardized incidence rates (ASIRs) and death rates (ASDRs) for liver cancer declined globally, but rose in the Americas and Southeast Asia. HBV remained the dominant cause of global incident liver cancer cases and deaths. MASLD (metabolic dysfunction-associated steatotic liver disease) was the only etiology of liver cancer with rising ASIRs and ASDRs. By contrast, ASIRs and ASDRs remained stable for alcohol-related liver cancer, and declined for HBV- and HCV-related liver cancer.

CONCLUSIONS

While age-adjusted incidence and deaths from liver cancer have started to decline, the absolute number of incident cases and deaths continues to increase. Population growth and aging contribute to the observed disconnect in the temporal trends of absolute cases and rates. Disparities remain, and the incidence and mortality associated with MASLD-related liver cancer continue to rise.

IMPACT AND IMPLICATIONS

Liver cancer remains a major cause of death globally, but its causes and burden in various regions are changing. This study highlights that new diagnoses and deaths related to liver cancer continue to rise. Age-adjusted death rates of liver cancer related to viral hepatitis are declining but remain high. By contrast, age-adjusted death rates of liver cancer related to MASLD (metabolic dysfunction-associated steatotic liver disease) are rising. Sustained efforts and resources are needed to eliminate viral hepatitis, reverse current trends in heavy alcohol use, and tackle the metabolic risk factors of MASLD.

Adapted hepatitis C virus clone infects innate immunity-deficient mouse hepatocytes with minimal human HCV entry factors

Background & Aims

Hepatitis C virus (HCV) has a narrow species tropism and cannot infect mice. To understand HCV species tropism and to develop better animal models, we adapted HCV to infect mouse cells deficient in innate immunity and with minimal human HCV host factors.

Methods

HCV was adapted via passaging an HCV infectious virus clone several times in human hepatoma cells, mouse liver cells, and eventually primary mouse hepatocytes deficient in innate immunity and ectopically expressing human occludin and human CD81. Using RNAseq the sequence of the adapted virus was analyzed, and several clones were generated to study replication and infection kinetics as well as neutralization assays in several human/mouse cell lines and primary hepatocytes from human, mouse, and macaques.

Results

Accumulation of 35 non-synonymous and 66 synonymous mutations correlated with >1,000-fold enhanced production of infectious progeny from primary mouse hepatocytes. These mutations did not confer drug resistance or evasion from innate immunity. They did not enhance fitness in human or macaque hepatocytes. We show that non-synonymous mutations are necessary and sufficient for adaptation, and that changes to the glycoproteins are not essential. Mutations outside of viral envelope proteins enhanced specific infectivity and facilitated viral spread in murine cells.

Conclusions

This study reveals key viral factors governing HCV species tropism. The mouse-adapted HCV opens up possibilities for the development of animal models to analyze HCV pathogenesis, immune control, and vaccine development.

Impact and implications

This work demonstrates the feasibility in principle of HCV adaptation to replication in and infection of non-human cells. This is made possible by a manageable number of non-synonymous mutations and opens up new ways to elucidate the principles of HCV species tropism and to develop important animal models for HCV research in the long term.

Estimating the impact of direct acting antiviral therapy on the prevalence of hepatitis C virus infection using phylogenetics

INTRODUCTION

Australia has provided unrestricted subsidized access to direct-acting antiviral (DAA) treatment for hepatitis C virus (HCV) infection since 2016. Epidemiological surveillance estimates suggest prevalence of chronic HCV infection has declined since 2016, but these estimates are not separated by genotype and may not capture 'hidden' infected populations, notably the most marginalized groups affected, including people who inject drugs and people in prison. This study used phylogenetics to assess whether epidemiological estimates of declining HCV prevalence in the prisons of New South Wales, Australia due to DAA scale up could be reproduced.

METHOD

Near-full-length 280 HCV consensus sequences (GT1a: n = 140, GT3a: n = 140) sampled between 2006 - 2019 from two prison-based cohort studies in NSW were used for phylogenetic estimates. These included 110 acute infection sequences (GT1a: n = 48, GT3a: n = 62) which were considered in a separate sensitivity analysis given the differences in virus mutation rates in acute and chronic infection. Changes in the effective population size of infected people for each genotype were explored with BEAST software suite (v1.10) using a coalescent Bayesian skyline approach.

RESULTS

Both the main and sensitivity analyses for GT3a showed a reduction in the effective population size with the latter showing a 36 % decline between 2011-2019 which is more concordant with the decline estimated from non-phylogenetic methods. A decline of similar magnitude was not demonstrated for GT1a. Overall, the analyses using acute infection sequences only were closer to the trends of independent epidemiological estimates.

CONCLUSIONS

An adequately powered Bayesian evolutionary analysis using acute stage infection sequences may reproduce the decline in HCV infections observed by traditional epidemiological methods during DAA scale up.

Hepatitis B associated with severe COVID-19: a nationwide cohort study in Sweden

PURPOSE

Individuals with severe liver disease are more vulnerable to severe COVID-19, but the association between chronic hepatitis B virus (HBV) infection and severe COVID-19 remains unclear. This study evaluates this relationship.

METHODS

We analysed nationwide Swedish data from national databases and healthcare registers, identifying laboratory-confirmed COVID-19 cases from February 2020 to April 2021. Chronic HBV infection was classified into cases with and without cirrhosis. Multivariable logistic regression assessed the association between HBV and severe COVID-19, adjusting for demographics, comorbidities, vaccination, and socioeconomic factors.

RESULTS

Among 1,057,174 COVID-19 cases, 2,902 had chronic HBV infection, which was associated with increased risk of severe COVID-19 (adjusted odds ratio [aOR] 1.242, 95% confidence interval [CI] 1.097-1.403). This risk was significantly higher in HBV individuals with cirrhosis (aOR 2.463, CI 1.546-3.892) compared to those without cirrhosis (aOR 1.183, CI 1.039-1.343). While overall COVID-19 mortality was not significantly elevated in the HBV cohort, patients with cirrhosis showed a higher, though nonsignificant, mortality risk (aOR 2.350, CI 0.921-5.203).

CONCLUSION

This nationwide study highlights an increased risk of severe COVID-19 in individuals with chronic HBV, particularly those with cirrhosis. Geographic and socioeconomic factors further influence outcomes. These findings underscore the need to consider HBV status in COVID-19 risk assessments. Future studies should explore these associations in the context of evolving SARS-CoV-2 variants and widespread vaccination.

TeleHCV: A single-visit protocol and minimal passive remote monitoring are sufficient to achieve high SVR with a sofosbuvir-velpatasvir regimen

AIM

Chronic Hepatitis-C Virus (HCV) treatment has evolved significantly in recent years with Direct-Acting Antivirals (DAAs). The traditional care cascade includes several steps that limit its impact, and simplification protocols have emerged. Therefore, the authors explore a simplified treatment strategy for HCV in a healthcare system with limited access to specialized care.

SUBJECT AND METHODS

Chronic HCV, DAA-naïve patients waiting for in-person specialized care were invited to a single-arm non-inferiority trial to evaluate a simplified treatment protocol with a single face-to-face appointment and minimal monitoring of antiviral therapy. The unique visit consisted of an HCV presentation followed by individual medical consultation, blood tests, and delivery of sofosbuvir-velpatasvir pills for a 12-week treatment. Patients were remotely monitored without scheduled on-treatment appointments or phone calls. After treatment, teleconsultation using video was offered. The primary outcome was Sustained Virological Response (SVR) 12-weeks post-treatment. It was analyzed with Intention-To-Treat (ITT) and Per-Protocol (PP) approaches.

CLINICALTRIALS

gov: NCT04039698.

RESULTS

The authors included 144 patients, of which 54.2 % were male, mean age was 52 years. Most individuals (84.7 %) had an APRI score < 1. All patients received at least one dose of DAA, 139 completed antiviral therapy, and 131 had SVR evaluation. The ITT SVR rate was 90.3 % (130/144 patients; 95 % CI 84.2 %‒94.6 %), and the PP SVR was 99.2 % (130/131 patients; 95 % CI 95.8 %‒100 %). Eighty-three adverse events were reported, and 93 % were handled with remote care.

CONCLUSION

This simplified strategy achieved a high SVR rate in a population with restricted access to specialized care. Telehealth tools and minimal monitoring are promising components for policies aimed at HCV elimination.

Enhancing public health surveillance: SARIMAX model incorporating Baidu search index for HCV prediction in China

BACKGROUND

Hepatitis C virus (HCV) has become a serious global public health issue. Existing study has confirmed the potential role of internet search data in the prediction of infectious diseases. This study aims to explore predictive models suitable for HCV, providing references and recommendations for actively responding to the World Health Organization's strategy to eliminate HCV by 2030.

METHODS

We collected the publicly available daily reported case numbers of HCV and the daily search volume of HCV-related keywords in Baidu Search Index (BSI) from January 2011 to September 2023. Identify keywords highly correlated with HCV using Spearman rank correlation and time series cross-correlation analysis to construct a comprehensive search index. Finally, seasonal autoregressive integrated moving average (SARIMA) and seasonal autoregressive integrated moving average with exogenous variables (SARIMAX) models were developed based on monthly HCV case numbers and the comprehensive search index (CSI). The performance of these predictive models was evaluated using mean absolute error (MAE), root mean square error (RMSE), and mean absolute percentage error (MAPE).

RESULTS

From January 2011 to September 2023, China reported a cumulative total of 2,949,160 HCV cases, with a monthly average case number of 19,276. The incidence of HCV is highest in March each year, with a slight decrease in February, exhibiting a seasonal cycle pattern. Influenced by the COVID-19 pandemic, the incidence of HCV showed a notable decrease in 2020 and 2022, but overall, it has been on an upward trend. After correlation analysis, a total of five keywords were included, with a potential time lag of 0 months for the keywords. The selected SARIMA(0,1,1)(2,1,1)(12) + CSI(Lag = 0) model produced lower errors in both fitting and forecasting than the SARIMA(0,1,1)(2,1,1)(12) model: MAE (706.7052 versus 759.1066 and 1754.05 versus 3940.86), RMSE (973.3811 versus 1123.343 and 2733.02 versus 4846.49), MAPE (3.72% versus 4.08% and 0.12% versus 0.24%).

CONCLUSIONS

The findings suggest that the SARIMA(0,1,1)(2,1,1)(12) + CSI(Lag = 0) model exhibits superior predictive performance, maintaining accuracy even when faced with the public health emergency of COVID-19. The proposed SARIMAX model in the study will provide more robust support for achieving the 2030 HCV dynamic zero strategy.

Prevalence of Hepatitis C viral infection in Ghana: A systematic review and meta-analysis protocol

Background Hepatitis C virus (HCV) infection remains a major public health concern for many countries. A recent survey report in Ghana revealed a national HCV prevalence rate of 4.6% in a population of 35 million but with notably higher regional variations ranging from 8.6 to 14.4%. Considering that Ghana is targeting micro-elimination of HCV as part of the STOP Hepatitis C project, it is prudent to estimate the current epidemiological burden of hepatitis C for evidence-based policymaking, public health research, and program direction. An initial search of the literature showed a previous review that spanned from 1995 to 2015. The gap of almost 10 years may not reflect the current burden of hepatitis C in Ghana, hence this review. A systematic literature search will be performed in the major electronic databases and search engines including PubMed, Embase, Web of Science, CINAHL, and African Journals Online (AJOL). There will be a search for articles reporting on the prevalence of hepatitis C in Ghana from 2016 to 2024 in these databases. The protocol is registered with PROSPERO (CRD42024592505).

Update on hepatitis C virus management

PURPOSE OF REVIEW

Despite the efficacy of direct-acting antiviral (DAA) therapy, hepatitis C virus (HCV) remains a significant contributor to liver-related morbidity and mortality. This review summarizes the approach to HCV treatment, the simplified treatment algorithm for most patients, the management of special populations, and future directions for HCV interventions.

RECENT FINDINGS

Pan genotypic DAA regimens have high cure rates and can be managed by nonspecialist providers, and the simplified treatment approach provides a clear algorithm for workup and treatment decisions among treatment-naive patients without decompensated cirrhosis. Additionally, advancements in point of care diagnostics have the potential to further expand access to screening and linkage to care. Despite these breakthroughs, barriers to accessing care and the stigmatization of high-risk populations continue to undercut progress towards HCV elimination. Continued implementation of innovative screening and treatment strategies are required to overcome rising HCV prevalence.

SUMMARY

HCV cure is achievable for nearly all patients, but reaching HCV elimination goals will require a comprehensive approach that increases screening, expands access to simplified treatment, and avoids stigmatization of at-risk populations. Targeting healthcare disparities and removing barriers to treatment uptake are crucial to achieving elimination targets.

Epidemiological trends of hepatitis C incidence and death in Mainland China between 2004 and 2018 and its predictions to 2030

INTRODUCTION

This study aimed to evaluate the epidemiological trends and spatial-temporal distribution of hepatitis C virus (HCV) in mainland China.

METHODS

HCV monthly incidence surveillance data from 2004 to 2018 was mainly available from the Public Health Sciences Data Center of China. Five models (Bayesian age-period-cohort, BAPC; Auto-regressive integrated moving average, Auto_arima; Exponential smoothing, ETS; Prophet; Earth) were used to forecast the incidence. Temporal-spatial scanning analysis was conducted to visualize the grading of hepatitis C incidence in mainland China.

RESULTS

This study observed 180 months of data from January 2004 and December 2018. A total of 2,278,280 hepatitis C cases and 1771 deaths were reported, with an average annual reported incidence rate of 11.24/100,000. The BAPC model indicated that the indexes (mean absolute error, MAE; mean absolute percentage error, MAPE; mean squared error, MSE; root mean square error, RMSE) in the BAPC model were better than those of the other models (4.33 × 10- 6, 0.03, 2.34 × 10- 11, 4.84 × 10- 6), and annual reported HCV incidence in mainland China would remain at a high level of 17.92/100,000 until 2030. Spatial-temporal aggregation analysis indicated that the time range of the first-class aggregation area was from January 1, 2012 to December 31, 2018, and the aggregation area was in Xinjiang, Qinghai, Gansu, Tibet, Ningxia, Inner Mongolia, Sichuan, Shaanxi, Shanxi, Chongqing, Hebei, Beijing, Henan and Yunnan provinces (relative risk, RR = 2.15, log-likelihood ratio, LLR = 129946.01, P < 0.001).

CONCLUSIONS

In summary, this study showed that the incidence of HCV in mainland China continued to be high, and BAPC model suggested that this trend will continue until at least 2030. In order to effectively control the HCV epidemic, it was necessary to strengthen blood safety management, expand screening for high-risk population, improve public awareness of HCV, and provide timely and effective antiviral treatment in potentially high-risk areas.

Blood-Borne Infection Prevention in Combat Sports: Position Statement of the Association of Ringside Physicians

ABSTRACT

The Association of Ringside Physicians (ARP) emphasizes the importance of screening combat sports athletes for blood-borne infections, including hepatitis B, HIV, and hepatitis C, to mitigate transmission risks and ensure participant safety. Although transmission of hepatitis B and C and HIV in combat sports is rare, protecting athletes is of utmost importance. It is the recommendation of the ARP that all fighters participating in combat sports, in which the presence of blood is a common occurrence and is allowed during competition, should undergo testing for HIV, hepatitis B (HBV), and hepatitis C (HCV). Testing should be conducted using serum samples, because rapid tests are not considered acceptable for accurate results. Testing for HBV, HCV, and HIV should optimally be done within 3 months of competition, but within 6 months is acceptable. Athletes whose tests suggest active HBV, HCV, or HIV infection should be disqualified from competition in sports where blood is common and allowed. Athletes with cured prior HCV infection may be cleared for competition in all combat sports. Athletes with prior HBV infection and no detectable HBV DNA in blood can be cleared for competition in all combat sports. Athletes with latent HBV infection with detectable HBV DNA in blood have a small risk of disease reactivation, so they should not be cleared.

Estimated number of people infected with hepatitis B and C virus in Germany in 2013: a baseline prevalence estimate using the workbook method

Introduction

Hepatitis B (HBV) and hepatitis C (HCV) viral infections are uncommon in Germany, though these infections have a higher prevalence among certain subpopulations, such as some first-generation migrant groups, people who inject drugs (PWID), and HIV-positive men who have sex with men (HIV+MSM). Repeated estimates of the number of people infected with HBV and HCV are essential to facilitate the monitoring and elimination efforts by 2030. We estimated the total number of people infected with HBV and HCV in Germany, and the number in each specific subpopulation. We based our calculations on data from 2013, a year that we strategically chose to coincide with the availability of data from serological surveys, the advent of highly effective antiviral therapy for HCV, and significant migrant flows in the following years.

Methods

We used the workbook method, a technique that combines subpopulation size and prevalence data. We included different population groups (general population excluding vulnerable groups, migrants stratified by nationality, people who inject opioids (PWIO) and HIV+MSM). We estimated the number of people infected with HBV and the number of people infected with HCV. Estimates of the number of people infected with HBV and HCV are reported with the lower and upper confidence limits.

Results

We estimated 228,000 (179,000-291,000) HBV-infected adults (≥ 18 years of age) in Germany in 2013, of whom 41% (n = 93,000 [52,000-169,000]) were in the general population excluding vulnerable groups. Another 58% (132,000; 126,000-137,000) were migrants, 1.0% (2,400; 900-6,200) PWIO and 0.4% (1,000; 800-1,400) were HIV+MSM. We estimated 214,000 (135,000-340,000) HCV-infected adults in Germany in 2013, of whom 47% (100,000; 38,000-267,000) were in the general population excluding vulnerable groups, 26.0% (56,000; 47,000-66,000) were migrants, 26% (56,000; 50,000-62,000) were PWIO, and 1.0% (2,500; 2,200-2,800) were HIV+MSM, respectively.

Discussion

Our results indicate that more than half of HBV-infected individuals were migrants, and more than half of HCV-infected individuals were PWIO or migrants. This highlights the importance of including relevant subpopulations in national estimates, surveillance, prevention, and therapy. Our estimates serve as a baseline reference for subsequent updates and ongoing monitoring of HBV and HCV epidemiology in Germany.

Direct-acting antivirals (DAA) positively affect depression and cognitive function in patients with chronic hepatitis C

The aim of the study was to determine how depression and cognitive dysfunction in patients with chronic hepatitis C virus (HCV) infection are affected by treatment with direct-acting antivirals (DAA). Fifty-two chronic hepatitis C patients underwent neurocognitive and psychological evaluation before therapy and 5-6 months later. Depression was measured by Beck Depression Inventory (BDI), anxiety by State-Trait Anxiety inventory (STAI), neuroticism by Eysenck Personality Inventory (N/EPO-R), while Ruff Figural Fluency Test (RFFT), Wisconsin Card Sorting Test (WCST), The Grooved Pegboard Test (GPT), and California Verbal Learning Test (CVLT) were used to assess neurocognitive function. There was significant positive change in BDI scores (8.8 ± 6.6 vs 6.1 ± 6.1; p < 0.0001) while the most striking improvement in cognitive tests was observed for CVLT sum of immediate recall from Trial-1 to Trial-5 (50.9 ± 10.0 to 54.1 ± 10.0; p = 0.0005) and RFFT, where the number of unique designs increased from 77.2 ± 21.0 to 86.1 ± 28.3 (p < 0.0001). These differences remained significant when patients with advanced (METAVIR grade F3/F4) and those with mild (grade F0/F1/F2) liver disease were analyzed separately, although in general the improvements were more pronounced in the former group. In conclusion, in chronic HCV infection the brain function is markedly improved by DAA treatment.

Temporal and geospatial patterns of hepatitis C virus prevalence: a longitudinal examination using national health insurance service data in the Republic of Korea (2005-2022)

BACKGROUND

Viral hepatitis, recognized as a significant global public health threat by the World Health Organization (WHO), has spurred efforts to establish elimination goals by 2030. In Republic of Korea (Korea), the prevalence of Hepatitis C virus (HCV) infection exhibits significant regional disparities, necessitating tailored infection control measures at the regional level. This study aimed to analyze the HCV prevalence trend by area (region/town) in Korea, from 2005 to 2022, and identify the areas requiring priority management.

METHODS

A comprehensive analysis of HCV prevalence trends across different geographical regions and towns from 2005 to 2022 was conducted. Using data from the National Health Insurance Service, individuals diagnosed with acute or chronic HCV during this period were included in the analysis. HCV prevalence was adjusted by area, year, sex, and age. Additionally, trends in annual percent changes (APC) and average APC (AAPC) in HCV prevalence were examined using Joinpoint regression analysis.

RESULTS

Age, sex, and region adjusted HCV prevalence per 100,000 people declined from 151 in 2005 to 98 in 2022. During the 18 years, the highest HCV prevalence was recorded in the southern regions of Korea (Busan, Jeonnam, and Gyeongnam) and in the towns of Namhae-gun of Gyeongnam, Boeun-gun of Chungbuk, and Sunchang-gun of Jeonbuk. The age-, sex-, and region-adjusted annual HCV prevalence decreased significantly at an APC of -2.5% (95% confidence interval [CI]: -3.5, -1.4) and AAPC of -2.7% (95%CI: -4.3, -1.0). By town, the prevalence decreased the most in Boeun-gun of Chungbuk (AAPC: -23.7%; 95%CI: -30.2, -16.5) and increased the most in Gunwi-gun of Gyeongbuk (AAPC: 3.0%; 95%CI: 1.1, 4.9).

CONCLUSIONS

Over 18 years, a notable decline in HCV prevalence was observed in Korea, although this trend exhibited regional disparities. To effectively achieve the WHO hepatitis elimination goals by 2030, targeted interventions should prioritize areas with persistent or emerging prevalence.

Thrombospondin 2 as a Predictive Biomarker for HCC in Hepatitis C Patients: A Longitudinal Study Following DAA Therapy

This multicentre study investigated the dynamics of thrombospondin 2 (TSP2) levels during direct-acting antiviral (DAA) therapy in hepatitis C virus (HCV) infected patients and evaluated TSP2's potential as a predictive marker for hepatocellular carcinoma (HCC). All 134 participants achieved sustained virological response at 12 weeks (SVR12) with DAA therapy, and serum TSP2 levels significantly decreased from before and after treatment (p < 0.001). During the median follow-up period of 6.0 years, HCC after DAA therapy was observed in 16 patients (11.9%). Patients with serum TSP2 High (≥ 32 ng/mL) at SVR12 had a significantly higher cumulative occurrence of HCC than did those without (26.5% vs. 7.0%, p = 0.0033). A multivariate Cox proportional hazards model identified male gender (HR 4.84, p = 0.005), HCC history (HR 4.61, p = 0.017) and TSP2 High (HR 3.93, p = 0.009) as significant independent predictors of HCC occurrence after DAA therapy. The model had a high concordance index of 0.878. Additionally, combining TSP2 High and FIB-4 High (≥ 3.538) at SVR12 yielded high specificity and negative predictive value (0.941 and 0.917, respectively) for predicting HCC. Kaplan-Meier analysis showed a higher HCC incidence in the TSP2 High + FIB-4 High group (log-rank p < 0.0001). In conclusion, TSP2 may be a promising biomarker for personalised HCC surveillance in DAA-treated hepatitis C patients.

Risk of de novo HCC in patients with MASLD following direct-acting antiviral-induced cure of HCV infection

BACKGROUND & AIMS

Data are limited on the risk of de novo hepatocellular carcinoma (HCC) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) who have achieved sustained virologic response at off-treatment week 12 (SVR12) using direct-acting antivirals (DAAs) for HCV.

METHODS

A total of 1,598 eligible patients received biannual alpha-fetoprotein (AFP) and liver imaging surveillance to detect de novo HCC after achieving SVR12. MASLD was defined as presence of controlled attenuation parameter (CAP) ≥248 dB/m and ≥1 cardiometabolic risk factor (CMRF). Cumulative HCC incidence was compared between patients with/without MASLD. We built univariable and multivariable Cox proportional hazards models to evaluate factors associated with HCC. Sensitivity analysis was performed using the Fine-Gray subdistribution hazards model. Additionally, we evaluated the mediation effect of MASLD on CMRFs and of CMRFs on MASLD for HCC using mediation analysis with bootstrapping.

RESULTS

The incidence rate of HCC was 1.44 per 100 person-years of follow-up (95% CI 1.19-1.74). Patients with MASLD had a higher cumulative HCC incidence than those without MASLD (log-rank test, p <0.001). Multivariable Cox regression analysis revealed that in addition to age, sex, liver stiffness measurement, platelet count, and AFP, MASLD (adjusted hazard ratio 2.07; 95% CI 1.36-3.16; p <0.001) was independently associated with HCC. This finding was confirmed by the Fine-Gray model, which showed a subdistribution hazard ratio of 2.07 (95% CI 1.34-3.19, p <0.001) for MASLD. MASLD significantly mediated CMRFs for HCC development.

CONCLUSION

After achieving SVR12, patients with MASLD exhibited an increased HCC risk compared to those without MASLD. Vigilant HCC surveillance and control of CMRFs to mitigate the effect of MASLD on HCC remain crucial for this population.

IMPACT AND IMPLICATIONS

The risk of de novo hepatocellular carcinoma (HCC) among patients with metabolic dysfunction-associated steatotic liver disease (MASLD) who have attained a sustained virologic response to direct-acting antivirals remains to be confirmed. In this study, recruiting 1,598 patients in Taiwan, individuals with MASLD had an approximately two-fold increased risk of de novo HCC compared to those without MASLD after achieving a sustained virologic response. MASLD significantly mediated cardiometabolic risk factors for HCC development. Our findings underscore the critical importance of pharmacological interventions and proactive lifestyle modifications to control cardiometabolic risk factors in patients with MASLD, as well as the need for vigilant HCC surveillance to ensure favorable outcomes following HCV eradication.

Global, regional, and national estimates of hepatitis C virus (HCV) infection incidence among people who inject drugs and number of new annual HCV infections attributable to injecting drug use: a multi-stage analysis

BACKGROUND

Measuring progress towards the WHO 2030 target for hepatitis C virus (HCV) elimination among people who inject drugs (PWID)-an incidence of two or fewer infections per 100 person-years-has been challenging due to insufficient data. We aimed to estimate HCV incidence among PWID before and since 2015, progress towards the 2030 target, and the number of new annual HCV infections attributable to injecting drug use since 2015.

METHODS

Four sequential steps were taken to estimate country-specific HCV incidence. First, we estimated HCV incidence from HCV antibody prevalence by duration of injecting using force-of-infection (FOI) modelling. Second, using Bayesian random-effects meta-analysis, we pooled FOI-derived estimates with any direct HCV incidence estimates from a published global meta-analysis, by country. Third, for countries with no FOI-derived or direct HCV incidence data, we applied incidence estimates from a published multi-country dynamic mathematical model. Fourth, for countries for which incidence could not be estimated using any of the aforementioned methods but that had data on overall HCV antibody prevalence (ie, not stratified by duration of injecting), we used a regression model to predict incidence based on prevalence and average duration of injecting. WHO regional and global HCV incidence, incidence rate ratios (IRRs) for 2015-21 versus pre-2015, and relative decline needed to achieve the 2030 WHO target were derived and weighted by the country-specific number of PWID at risk (ie, those who were HCV RNA-negative), provided that data from at least five countries were available within a WHO region. New annual HCV infections attributable to injecting drug use were estimated by multiplying country-specific HCV incidence for the 2015-21 period by the number of HCV RNA-negative PWID; for countries with no HCV incidence data but with evidence of an existing PWID population, incidence was imputed using the corresponding WHO regional incidence.

FINDINGS

For the pre-2015 period, 146 HCV incidence estimates from 81 countries were included: 52 (36%) direct, 61 (42%) FOI-derived, and 33 (23%) regression-based estimates. For 2015-21, 114 estimates from 97 countries were included: 20 (18%) direct, 18 (16%) FOI-derived, 68 (60%) dynamic model-derived, and eight (7%) regression-based. Globally, pooled HCV incidence was 13·9 per 100 person-years (95% uncertainty interval [UI] 11·9-16·4) for pre-2015 and 8·6 per 100 person-years (7·1-10·7) for 2015-21. Based on a subset of countries with data for both periods, incidence was lower in the Western Pacific (IRR 0·32 [95% UI 0·23-0·50]), Eastern Mediterranean (0·67 [0·50-0·89]), and European (0·79 [0·63-1·02]) regions in 2015-21 versus pre-2015, but no difference was observed in the Americas. Insufficient data prevented comparisons over time for the African and South-East Asia regions and globally. Based on 2015-21 HCV incidence, the global decline needed to meet the 2030 WHO target is 76·7% (95% UI 71·8-81·3), while the global number of new annual HCV infections attributable to injecting drug use was 833 760 (95% UI 493 716-1 544 395) among the 187 countries with documented evidence of a population of PWID.

INTERPRETATION

A substantial increase in HCV treatment and prevention is needed globally to achieve the WHO 2030 HCV elimination target for incidence among PWID.

FUNDING

WHO and the Wellcome Trust.

Direct-acting antiviral treatment outcomes in people infected with endemic compared to epidemic hepatitis C virus subtypes in England

BACKGROUND

Current evidence suggests reduced efficacy of direct-acting antiviral (DAA) treatment among people with endemic Hepatitis C virus (HCV) subtypes rare to high-income countries. We aimed to determine real-world DAA treatment outcomes of people with endemic HCV subtypes in England.

METHODS

Data were collected through a national treatment program. People who had their virus subtyped between 2019-2023, were resident in England and had an outcome recorded for their first DAA treatment episode, were included. Subtypes were divided into epidemic and endemic in England; endemic subtypes were confirmed with whole genome sequencing and resistance associated substitutions (RAS) were determined. Logistic regression was used to determine associations between treatment outcome and exposure variables.

RESULTS

In people with an outcome recorded, 93 with an endemic and 8671 with an epidemic HCV subtype were identified, of whom 49.5% (46/93) and 91.8% (7953/8668) achieved a sustained virological response at 12 weeks post end of DAA treatment (SVR12), respectively. In the multivariable model, people with an endemic subtype had 93% (aOR 0.07 95%CI 0.04-0.12, P=<0.001) reduced odds of achieving SVR12. Treatment with sofosbuvir/velpatasvir or glecaprevir/pibrentasvir was successful for genotypes 1, 2, 4 and 5 (SVR12 100%, n=13) but not 3 (27.3%, n=22) endemic subtypes. Sofosbuvir/velpatasvir/voxilaprevir was successful for GT3 endemic subtypes at retreatment (SVR12 11/12, 91.7%). Treatment failures for genotypes 1, 3 and 4 were likely mediated by naturally occurring baseline NS5A RAS (median n=2).

DISCUSSION

This study provides further evidence that endemic HCV subtypes lead to sub-optimal DAA efficacy, which may impact global HCV elimination.

Treatment of chronic hepatitis C infection: strategies to address poor therapy adherence

INTRODUCTION

Non-adherence to any therapy may be related to skipping drug doses, discontinuation of therapy, or loss of follow-up. It leads to the ineffectiveness of treatment, which is associated with obvious individual health losses, significant social and financial costs, and, in the case of infectious diseases, epidemiological consequences resulting from the possibility of further spread of infection.

AREAS COVERED

This review article analyses the causes and effects of non-adherence to treatment in patients infected with the hepatitis C virus (HCV). It also presents strategies to reduce the risk of non-adherence, which can be implemented by simplifying the treatment process, improving the flow of information between the doctor and the patient, as well as improving patients' knowledge about hepatitis C infection, and facilitating the understanding of the risks associated with non-adherence.

EXPERT OPINION

Since the treatment of HCV infections is highly effective in almost all patients who complete medication, no new drugs are to be expected in the coming years. Therefore, the primary attention in the global elimination of HCV will be focused on screening programs, improving the availability of drugs, and reducing the risk of non-adherence.

The next viral pandemic-where do we stand?

The world is presently undergoing a recovery phase following the unexpected challenges posed by the coronavirus disease 2019 (COVID-19) pandemic. The loss of lives and the economic setbacks experienced by the global population will require considerable time to address. It is clear that future outbreaks, epidemics, or even pandemic caused by unknown bacterial, fungal, or viral pathogens are inevitable. In this context, public health front-liners will be essential in minimizing the impact of such incidents. This mini-review briefly discusses sociocultural issues, diagnostic capacities, surveillance, and screening strategies for potential future viral pandemic - referred to as Pandemic X. Additionally, it addresses treatment responses, vaccine development efforts, scientific advancements, policy considerations, and prospects for science communication related to forthcoming viral pandemics. While this review does not encompass all scientific approaches available on these topics, it aims to serve as a guideline for informing public health sectors about appropriate measures that should be undertaken.

Cost-Effectiveness of Screening and Treating Chronic Hepatitis C Virus Infection in Zimbabwe

BACKGROUND

The aim of this study was to assess the cost effectiveness of a screening and treatment intervention approach for chronic HCV infection in Zimbabwe.

METHODS

Using a decision tree and a validated Markov model, we estimated the lifetime costs and health effects of screening for and treating HCV infections from a healthcare perspective. We evaluated three screening strategies, namely the following: i. no screening; ii. screening among the general population; and iii. screening among high-risk groups. Incremental cost effectiveness ratios were calculated for the strategies that were not dominated. We used deterministic and probabilistic sensitivity analyses to explore the impacts of parameter uncertainty on cost effectiveness outcomes.

RESULTS

The strategy of screening among high-risk groups and treating with sofosbuvir/velpatasvir had an incremental cost of USD 1201 and incremental quality-adjusted life years (QALY) of 2.01, yielding an incremental cost effectiveness ratio (ICER) of USD 604 per QALY gained as compared to no screening. The ICER was below the 0.5 times the gross domestic product per capita parameter (USD 796), making the intervention potentially cost effective. The strategy to screen among the general population was dominated, because it costed more and resulted in fewer QALYs than its comparators.

CONCLUSIONS

Screening for HCV among high-risk populations followed by treatment using sofosbuvir/velpatasvir is cost effective under the assumptions made in this study.

The association between drug injection duration and hepatitis C prevalence among people who inject drugs in Iran

People who inject drugs (PWID) are at higher risk of hepatitis C virus (HCV) due to their behaviors such as shared injection. Employing appropriate modeling approaches is crucial for accurately evaluating the impact of other variables on outcomes, in this case, HCV seropositivity. This study aimed to assess the non-linear effect of injection duration on HCV seropositivity. From July 2019 to March 2020, 2,684 PWID in Iran were recruited. The binary outcome variable was HCV serostatus (positive vs. negative), determined by detecting HCV antibodies. The non-linear effect of injection duration on HCV seropositivity was assessed using a multilevel Generalized Additive Model in R software, adjusting the effects of other variables in the analysis. We found a non-linear effect of injection duration on HCV seropositivity status (p-value < 0.001). The probability of HCV seropositivity increased with injection duration, though this relationship was non-linear. Initially, the probability rises faster; however, this effect diminishes as the injection duration extends. An initial sharp increase in HCV risk was seen during the first 20 years of injection. HCV seropositivity was notably associated with ever HIV seropositivity (OR [Odds Ratio] = 10.54, 95% CI [Confidence Interval]: 5.39, 20.61, p-value < 0.001), ever having injected methamphetamine (OR = 1.72, 95% CI: 1.33, 2.22, p-value < 0.001), being currently married (OR = 0.67, 95% CI: 0.48, 0.93, p-value = 0.018), ever shared needle/syringe with others (OR = 2.63, 95% CI: 1.32, 5.22, p-value = 0.006), and ever being incarcerated (OR = 1.97, 95% CI: 1.50, 2.58, p-value < 0.001). Our study contributes to the field by demonstrating that a non-linear approach can reveal patterns of risk that linear models might fail to capture. These findings indicate that the relationship between injection duration and HCV seropositivity can be more complex than previously understood, underscoring the importance of employing more advanced modeling techniques in future research.

Inherited Hemophilia-A Multidimensional Chronic Disease That Requires a Multidisciplinary Approach

BACKGROUND

Articular damage is a marker of hereditary hemophilia, especially affecting the large joints of the upper and lower limbs. This retrospective study aimed to emphasize that hereditary coagulopathies, specifically hemophilia A and B, require a multidisciplinary approach due to their complex nature. The primary objectives of the paper are to determine the prevalence of hemophilic arthropathy among individuals with hemophilia in the northeastern region of Romania, identify the most frequently affected joints, and assess whether there is a correlation between the development of hemophilic arthropathy, the type of hemophilia, and the treatment received. The secondary objectives of the work are to identify a series of particularities regarding the occurrence of the comorbidities depending on the type of hemophilia and the treatment and severity of arthropathies.

MATERIALS AND METHODS

We conducted a retrospective study that included 36 adults with hemophilia A and B. The status of the osteoarticular system was evaluated using the modified Hemophilia Joint Health Score (mHJHS). Twelve joints were evaluated using the following parameters: swelling, duration of swelling, muscle atrophy, joint pain, crepitus on motion, flexion loss, and extension loss.

RESULTS AND DISCUSSIONS

The most severe damage was found in the joints of the knees, ankles, elbows, and wrists. In the knees, severe damage was noted significantly more frequently in the right knee (50% vs. 33.3%; p = 0.001). In the ankles, a higher frequency of mild damage to the left ankle was noted (44.4% vs. 27.8%; p = 0.002). The severe form of hemophilia was correlated with severe joint damage (p < 0.05). Comorbidities like cardiovascular disease, obesity, viral infection (HCV infection), and gastrointestinal disease were found in the hemophilia population of our study. All patients with HCV infection had severe joint damage, while 38.5% of patients without HCV infection had mild joint damage, and 30.8% had no joint damage (p = 0.001). In all patients with HCV virus infection, the treatment was short-term substitution (intermittent prophylaxis), while in 53.8% of patients without HCV virus infection, the treatment consisted of continuous prophylaxis (p = 0.001).

CONCLUSIONS

It is currently essential to determine methods for comprehensive hemophilia care that involves multidisciplinary medical services necessary for the diagnosis, treatment, and management of the condition and its complications and comorbidities.

Epidemiological characteristics and treatment challenges of chronic hepatitis C in the kashi region of xinjiang china: A retrospective investigation from 2018 to 2022

Due to the emergence of direct-acting antiviral (DAA), more attention has been devoted to the prevalence and antiviral treatment of chronic hepatitis C in the Kashi region of Xinjiang, China, over the past decade. This study aimed to investigate the epidemiology, genotype (GT) distribution, diagnosis, and antiviral treatment of chronic hepatitis C virus (HCV) infection in this region from 2018 to 2022 and to highlight the challenges in achieving effective management. This retrospective study included individuals with HCV antibody (HCV-Ab) positivity at the First People's Hospital of Kashi from January 1, 2018, to August 31, 2022. Clinical data, including HCV RNA data, GT distribution, and DAA treatment history, were collected. Patients were followed up via telephone to assess treatment adherence and reasons for refusal. The HCV-Ab positivity rate increased from 1.7% in 2018 to 2.9% in 2022. Among the 4,928 HCV-Ab-positive individuals, 2174 (44%) underwent HCV RNA testing, with 1,088 (22%) confirmed positive. Of these patients, 707 were genotyped, with GT1b (70.7%) being the most prevalent GT. Due to limited access to DAA, only 327 (30%) RNA-positive patients received antiviral treatment, 243 (74%) of whom completed the course. Barriers to receiving DAA included high costs, low disease awareness, and limited healthcare access. These findings underscore the severity of the chronic HCV epidemic in Kashi, where healthcare access is inadequate, including limited HCV RNA testing and DAA treatment coverage. Tailored public health interventions and improvements in healthcare infrastructure are essential for better managing chronic HCV infection in this high-burden region.

Awareness of hepatitis C prevention and treatment and high-risk behaviors among the general population in Anhui Province: a cross-sectional study

Background

The World Health Organization (WHO) set the goal of "eliminating viral hepatitis as a major public health threat by 2030" in 2016. In 2021, the National Health Commission of China (NHCC), issued an action plan to help achieve the WHO's goal of eliminating the Hepatitis C virus by 2030. Therefore, the primary objective of this study was to investigate the awareness of knowledge of hepatitis C prevention and treatment and high-risk behaviors among the general population of Anhui Province.

Methods

Stratified sampling method had been used to select participants to conduct a survey from June 2021 to September 2021 in Anhui Province. Multivariate logistic regression model was used to reveal the influencing factors of participants' awareness and the self-selected high-risk behaviors of HCV infection.

Results

The crude and standard awareness rates of hepatitis C were 56.12% (95% CI: 54.15-58.11%) and 53.74% (95% CI: 53.72-53.75%), respectively. Among the 2,423 participants, 83.2% knew that blood or blood products can lead to hepatitis C infection, but only 44.2% knew that people infected with HCV can look healthy. Multivariate logistic regression model analysis showed that age group, education level, and geographic location were the important factors influencing hepatitis C awareness. In the last year, 1,113 people (45.9%) reported that they had high-risk behaviors for hepatitis C infection. Multivariate logistic regression model analysis revealed that hepatitis C awareness, gender, marital status, and geographic location were the important factors influencing the self-selected high-risk behaviors.

Conclusion

The findings indicated that the general population in Anhui Province has low awareness of HCV prevention and treatment and a certain degree of history of high-risk behavior for hepatitis C. In the future, more information and health education on hepatitis C is needed, with particular attention to the older adult, those with low education levels, and the central and southern regions of Anhui Province. We also should strengthen the education of females and married, divorced or widowed individuals to recognize and avoid high-risk behaviors for hepatitis C in their lives. By narrowing the gap between knowledge and behavior, we can contribute to the goal of eliminating hepatitis C by 2030.

CRIPSR-Cas for hepatitis virus: a systematic review and meta-analysis of diagnostic test accuracy studies

Background and aims

Hepatitis viruses pose a significant global health challenge, necessitating accurate and efficient diagnostic methods. The CRISPR-Cas system, renowned for gene editing, shows potential tool in virus detection. This systematic review and meta-analysis aims to evaluate the diagnostic accuracy of CRISPR-Cas-based tests for hepatitis viruses, aiming to provide evidence for their effectiveness in clinical settings.

Methods

Studies from Web of Science, PubMed, and CNKI were analyzed. A bivariate random-effects model was employed to compute pooled estimates for sensitivity, specificity, and the area under the summary receiver operating characteristic (SROC) curve. Additionally, the methodological quality of the studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool.

Results

Following a rigorous screening process, 14 studies meeting our inclusion criteria were selected from an initial pool of 657 studies. The pooled sensitivity and specificity of the CRISPR-Cas system in hepatitis virus detection showed high sensitivity (0.99, 95% CI: 0.95-1.00) and specificity (0.99, 95% CI: 0.93-1.00) with SROC area 1.00 (95% CI: 0.99-1.00). However, considering the notable heterogeneity among the included studies, subgroup analyses and meta-regression were conducted. These analyses revealed that the type of hepatitis virus detected and the format of the final result presentation could be potential sources of this heterogeneity.

Conclusion

This systematic review and meta-analysis demonstrates the high diagnostic accuracy of CRISPR-Cas system in detecting hepatitis viruses. However, conclusions are limited by study number and quality. Therefore, more high-quality data are still needed to support this conclusion.

Feasibility of implementing viral hepatitis services into a correctional service facility in Cape Town, South Africa

BACKGROUND

Hepatitis B virus (HBV) and hepatitis C virus (HCV) are estimated to be of the most prevalent infectious diseases in correctional settings worldwide. However, viral hepatitis services have not been routinely integrated into South African correctional facilities. We aimed to assess prevalence of HBV infection and HCV infection among people accessing HIV services and assess the feasibility of viral hepatitis service integration in a South African correctional centre.

METHODS

Voluntarily participating people in a correctional services facility were offered free hepatitis B surface antigen (HBsAg) and anti-HCV point-of-care testing in addition to routine HIV testing and treatment services on a first-come, first-served basis during June 2021-March 2022. Off-site laboratory testing (HBV and HCV molecular testing and non-invasive liver fibrosis staging) and screening for hepatocellular carcinoma informed further management. A general practitioner at the facility managed participants, with virtual support from hepatologists. Data on age and history of injecting was collected and point-of-care and laboratory results were recorded. Data were analysed using descriptive statistics.

RESULTS

The median age of the 765 people who participated was 32.5 years (IQR 27.5 - 38.2), with 2.2% (17/765) reporting having ever injected a drug. The sample prevalence was 3.9% (30/765) for HBV infection, 0.5% (3/665) for HCV infection, and 1.2% (9/765) for HIV-HBV coinfection. Thirty people had reactive HBsAg point-of-care tests. Among those with reactive HBsAg point-of-care tests 90.0% (27/30) received work-up, among whom 48.1% (13/27) were monitored, 44.4% (12/27) were placed on treatment and two people were released before a management plan could be finalised. Of those treated 33.3% (4/12) started tenofovir/emtricitabine and 66.7% (8/12) antiretroviral therapy. Of the eligible participants, 27.3% (201/735) received at least one hepatitis B vaccine dose and 26.9% (54/201) received three doses. All three participants who had confirmed HCV infection were started on direct-acting antivirals. Of the two completing treatment one achieved sustained virological response at 12 weeks (SVR12), one person was released before SVR12 was done. One person was lost to follow-up. No clinical adverse events were reported.

CONCLUSION

There was a notable viral hepatitis burden among people in this correctional centre and integration of viral hepatitis services into the existing HIV services was acceptable and feasible. Further efforts to sustain and expand access to viral hepatitis services in South African correctional centres could catalyse national viral hepatitis elimination efforts.

Dried blood spot: A diagnostic detection method for HBV, HCV and HIV nucleic acid using a single drop of blood

The global strategy to eradicate Hepatitis B (HBV), Hepatitis C (HCV), and HIV by 2030 is critical due to their impact and challenges to healthcare systems. HCV is curable, but HBV and HIV are only suppressible, with a vaccine available solely for HBV. Innovative diagnostic methods are needed, especially for high-risk populations like people who inject drugs (PWID). This study validates a dried blood spot (DBS) nucleic acid amplification test (NAAT) using the Hologic Panther system for detecting HBV, HCV, and HIV. The method was used to screen among PWID in the Capital Region of Denmark. The DBS method demonstrated high sensitivity, with a 95 % limit of detection (LoD) of 2711 IU/mL for HBV, 525 IU/mL for HCV, and 4022 copies/mL for HIV. Screening of 83 PWID in Denmark revealed a 13 % prevalence of active HCV infection, offering significant benefits in settings where traditional venous access is difficult.

Road to Hepatitis C Elimination in Israel: Improvements in Linkage to Care (2009-2020)

INTRODUCTION

Disrupted linkage to care is a major barrier to hepatitis C virus (HCV) elimination leading to high attrition rates. This study aimed to describe (1) flow through the HCV care-cascade (2009-2020), and (2) monthly patterns in HCV care during the coronavirus disease 2019 (COVID-19) pandemic (2020) in Israel.

METHODS

Data were obtained from Maccabi Healthcare Services, a 2.6-million-member healthcare provider in Israel. Flow through the HCV care-cascade in 2009-2020 was described from individuals' first positive HCV antibody (Ab+) test to sustained virological response (SVR), and monthly data were obtained on individuals newly attaining a given stage in the HCV care-cascade in 2020.

RESULTS

Among 2809 new patients who were Ab+, 2651 (94.4%) had an HCV polymerase chain reaction (PCR) test, and 1417 (50.4%) were PCR+ during the study. Median time from Ab+ to PCR+ was 3.9 years, with 39.7% PCR+ within 12 months. Median time from PCR+ to HCV treatment was 3.3 years, with 639 (55.5%) of patients who were PCR+ purchasing direct-acting anti-viral agents (DAAs), and 413/416 patients attained SVR. A significant reduction was observed in the time from first HCV detection (Ab+) to HCV confirmation (PCR+) and from PCR+ test to HCV treatment purchase in the pre-DAA era compared to the post-DAA. Monthly data during 2020 (Part B) indicates a decline in the numbers of patients receiving HCV care during the first pandemic-related closure.

CONCLUSION

Real-world data from a nationally representative healthcare provider database suggest that HCV linkage to care improved over time alongside increased access to DAAs, despite observed declines in access to care in 2020.

Real-Life Efficacy and Safety of Glecaprevir/Pibrentasvir Pediatric Formulation for Chronic Hepatitis C Infection in Children Aged 3 to 12 Years: A Case Series of 6 Patients

PURPOSE

Glecaprevir/pibrentasvir (GLE/PIB) has been approved by the European Medicines Agency and by US Food and Drug Administration for the treatment of children and adolescents aged 3 to 12 years with chronic hepatitis C (CHC) virus infection. The aim of this study was to confirm the real-world effectiveness and safety of GLE/PIB pediatric formulations in children aged 3 to 12 years with CHC.

METHODS

This case series describes a pediatric population (3 to ≤12 years of age) treated with a weight-based dose of GLE/PIB pediatric formulation once daily for 8 weeks. The effectiveness end point was a sustained virologic response 12 weeks after the end of treatment. Safety was assessed on adverse events and clinical/laboratory data.

FINDINGS

Six patients (median age 6 years; interquartile range, 3 years) were enrolled and treated between March 2023 and December 2023. Genotype distribution was as follows: 4 of 6 genotype 1 (60%), 1 of 6 genotype 2 (20%), and 1 of 6 genotype 3 (20%). Median viral load at baseline was 541,000 IU/mL (interquartile range, 641,000 IU/mL). All (100%) patients completed treatment. Sustained virologic response (SVR) 12 weeks after the end of treatment was 100%. No virologic relapse or breakthrough was observed. No adverse events occurred.

IMPLICATIONS

This study confirmed the real-life effectiveness and safety profile of an 8-week treatment with GLE/PIB for CHC in children aged 3 to 12 years.

Acceptability of hepatitis C testing using point-of-care testing and dried blood spot collection among people at risk of hepatitis C infection

BACKGROUND

Hepatitis C (HCV) testing innovations such as dried blood spot (DBS) and point-of-care testing should have fewer client-related barriers than traditional diagnostic pathways, yet there is limited evidence on their acceptability among people who inject drugs. To address this gap, this study sought to evaluate the acceptability of DBS and point-of-care testing among people at risk of HCV infection and understand the circumstances in which such testing is most preferred.

METHODS

Participants were recruited from community sites involved in the Australian HCV Point-of-Care Testing Program. Inclusion criteria were aged ≥18 years, sufficient proficiency in the English language, history of HCV testing at least once, and informed consent. Between June and August 2023, in-depth, semi-structured interviews were conducted via telephone with clients on their perceptions and experiences of HCV DBS and point-of-care testing. Data were coded and analysed thematically with Sekhon's theoretical framework of acceptability.

RESULTS

Forty participants were interviewed: 18 had previously received HCV DBS testing, 8 had received HCV point-of-care testing, 8 had experience with both, and 6 had no prior experience with either test. Most participants preferred point-of-care compared to DBS and venepuncture due to the shorter time to result and some identified that this reduced anxiety while waiting for results (burden). Among participants in this study, many felt that the provision of non-judgemental care was more important than whether testing was performed by peers (ethicality). Many participants indicated a preference for assisted collection when compared to self-collected or mail testing service (self-efficacy).

CONCLUSION

Applying Sekhon's acceptability framework highlighted remaining service gaps to bridge client HCV testing experiences, including enhanced education on testing modalities and their results, an increased need for non-judgemental care, and the use of peer support in community settings.

A triad of somatic mutagenesis converges in self-reactive B cells to cause a virus-induced autoimmune disease

The unexplained association between infection and autoimmune disease is strongest for hepatitis C virus-induced cryoglobulinemic vasculitis (HCV-cryovas). To analyze its origins, we traced the evolution of pathogenic rheumatoid factor (RF) autoantibodies in four HCV-cryovas patients by deep single-cell multi-omic analysis, revealing three sources of B cell somatic mutation converged to drive the accumulation of a large disease-causing clone. A method for quantifying low-affinity binding revealed recurring antibody variable domain combinations created by V(D)J recombination that bound self-immunoglobulin G (IgG) but not viral E2 antigen. Whole-genome sequencing revealed thousands of somatic mutations, numerically comparable to chronic lymphocytic leukemia and normal memory B cells, but with 1-2 corresponding to driver mutations found recurrently in B cell leukemia and lymphoma. V(D)J hypermutation created autoantibodies with compromised solubility in complex with self-IgG. In this virus-induced autoimmune disease, infection promotes a catastrophic confluence of somatic mutagenesis in the descendants of a single B cell.

Prevalence and Risk Factors of Occult HCV Infection in the Adult Population of Mexico City

Occult HCV infection (OCI) is defined by the presence of HCV RNA in hepatocytes and/or peripheral blood mononuclear cells (PBMCs) without detectable HCV RNA or anti-HCV antibodies in plasma. OCI is underrecognized and may contribute to HCV transmission. This study estimated OCI prevalence and associated risk factors in adults from Mexico City. Methods: A retrospective cross-sectional study was conducted, analyzing 507 general population volunteers. Demographic data and potential risk factors were collected via questionnaire. Anti-HCV detection was performed using two techniques: immunochromatographic rapid test and chemiluminescent microparticle immunoassay (CMIA). Nested PCR was employed to detect HCV RNA in plasma and PBMCs. Positive samples were genotyped through sequencing and phylogenetic analysis of the Core/E1 region. Results: Of 507 participants, four were anti-HCV positive. HCV RNA was found in PBMCs of 27 individuals, while plasma samples tested negative, indicating a 5.3% OCI prevalence. OCI was significantly associated with blood donation (p = 0.015), drug use (p = 0.019), particularly cocaine (p = 0.001), and endoscopy (p = 0.043). Genotypes 1b, 1a, 2b, 3a, and 2j were detected in OCI cases. Conclusions: OCI prevalence in Mexico City's general population is notable, with significant links to blood donation, cocaine use, and endoscopy. Enhanced diagnostic strategies are crucial to detect OCI and mitigate HCV transmission.

Liver diseases: epidemiology, causes, trends and predictions

As a highly complex organ with digestive, endocrine, and immune-regulatory functions, the liver is pivotal in maintaining physiological homeostasis through its roles in metabolism, detoxification, and immune response. Various factors including viruses, alcohol, metabolites, toxins, and other pathogenic agents can compromise liver function, leading to acute or chronic injury that may progress to end-stage liver diseases. While sharing common features, liver diseases exhibit distinct pathophysiological, clinical, and therapeutic profiles. Currently, liver diseases contribute to approximately 2 million deaths globally each year, imposing significant economic and social burdens worldwide. However, there is no cure for many kinds of liver diseases, partly due to a lack of thorough understanding of the development of these liver diseases. Therefore, this review provides a comprehensive examination of the epidemiology and characteristics of liver diseases, covering a spectrum from acute and chronic conditions to end-stage manifestations. We also highlight the multifaceted mechanisms underlying the initiation and progression of liver diseases, spanning molecular and cellular levels to organ networks. Additionally, this review offers updates on innovative diagnostic techniques, current treatments, and potential therapeutic targets presently under clinical evaluation. Recent advances in understanding the pathogenesis of liver diseases hold critical implications and translational value for the development of novel therapeutic strategies.

Number of people treated for hepatitis C virus infection in 2014-2023 and applicable lessons for new HBV and HDV therapies

BACKGROUND & AIMS

The year 2023 marked the 10-year anniversary of the launch of direct-acting antivirals (DAAs) for the treatment of hepatitis C virus (HCV). Monitoring HCV treatment trends by country, region, and globally is important to assess progress toward the World Health Organization's 2030 elimination targets. Additionally, the historical patterns can help predict the treatment uptake for future therapies for other liver diseases.

METHODS

The number of people living with HCV (PLHCV) treated between 2014-2023 across 119 countries was estimated using national HCV registries, reported DAA sales data, pharmaceutical companies' reports, and estimates provided by national experts. For the countries with no available data, the average estimate of the corresponding Global Burden of Disease region was used.

RESULTS

An estimated 13,816,000 (95% uncertainty intervals: 13,221,000-16,415,000) PLHCV were treated, of whom 12,748,000 (12,226,000-15,231,000) were treated with DAAs, of which 11,081,000 (10,542,000-13,338,000) were sofosbuvir-based DAA regimens. Country-level data accounted for 97% of these estimates. In high-income countries, there was a 41% drop in treatment from its peak, and reimbursement was a large predictor of treatment. In low- and middle-income countries, price played an important role in expanding treatment access through the public and private markets, and treatment continues to increase slowly after a sharp drop at the end of the Egyptian national program.

CONCLUSIONS

In the last 10 years, 21% of all HCV infections were treated with DAAs. Regional and temporal variations highlight the importance of active screening strategies. Without program enhancements, the number of treated PLHCV stalled in every country/region, which may not reflect a lower prevalence but may instead reflect the diminishing returns of existing strategies.

IMPACT AND IMPLICATIONS

Long-term hepatitis C virus (HCV) infection can lead to cirrhosis and liver cancer. Since 2014, these infections can be effectively treated with 8-12 weeks of oral therapies. In 2015, the World Health Organization established targets to eliminate HCV by 2030, which included treatment targets for member countries. The current study examines HCV treatment patterns across 119 countries and regions from 2014 to 2023 to assess the impact of national programs. This study can assist physicians and policymakers in understanding treatment patterns within similar regions or income groups and in utilizing historical data to refine their strategies in the future.

Real-world efficacy and safety of universal 8-week glecaprevir/pibrentasvir in patients with chronic hepatitis C with early chronic kidney disease or pre-end-stage renal disease: Insights from a nationwide hepatisis C virus registry in Taiwan

An 8-week regimen of glecaprevir/pibrentasvir is recommended for treatment-naïve patients with chronic hepatitis C (CHC). In alignment with the Taiwanese government's objective to eliminate hepatitis C by 2025, this study aimed to provide real-world evidence on the use of this regimen in treatment-naïve patients with chronic kidney disease (CKD) by using data from the Taiwan Association for the Study of the Liver HCV Registry (TACR). CKD was defined by an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2 or higher with proteinuria persisting for over 3 months. Patients were categorized as having early CKD (eGFR ≥45 mL/min/1.73 m2) or pre-end-stage renal disease (pre-ESRD) (eGFR <45 mL/min/1.73 m2). Among 1072 patients who received at least one dose of the regimen, 1054 had available data for assessing sustained virologic response at 12 weeks posttreatment (SVR12). The overall SVR12 rate was 99.6%, with rates of 99.7% for pre-ESRD patients and 99.6% for early CKD patients. Subgroup analysis showed 100% efficacy for genotype 3 and dyslipidemia, 99.5% for diabetes, 99.4% for cardiovascular disease, 96.9% for a history of cerebral vascular accident, and 95.5% for patients with a history of drug injection or HIV co-infection. Adverse events were reported in 16.8% of patients, with 0.8% experiencing serious events, and only two cases were treatment-related. Renal function significantly improved, with overall eGFR increasing from 39.2 to 41.9 mL/min/1.73 m2. Early CKD patients showed an eGFR rise from 53.5 to 57.1, while pre-ESRD patients improved from 27.1 to 29.2 at SVR12. The study concluded that the 8-week regimen is highly effective, well-tolerated, and associated with significant renal function improvement in treatment-naïve CHC patients with both early CKD and pre-ESRD.