Global reporting of progress towards elimination of hepatitis B and hepatitis C

Factors influencing hepatitis B vaccination intention and behavior among college students in Tibet: Insights from the expanded theory of planned behavior

Hepatitis B (Hep B) remains a critical public health issue globally, particularly in Tibet, where vaccination rates and influencing factors among college students are yet understudied. This study applies a cross-sectional design to investigate the Hep B vaccination rate among 1,126 college students in Tibet and utilizes the expanded theory of planned behavior (ETPB) to identify vaccination behavior intention (BI) and vaccination behavior (VB). Stratified cluster sampling across three universities was used to assess behavioral attitudes (BA), subjective norms (SN), perceived behavioral control (PBC), past vaccination history (PVH) and vaccination knowledge (VK), and used structural equation modeling (SEM) for model validation and multi-group comparison. Results indicated that 16.3% of students had received the Hep B vaccine. VK notably improved BA toward vaccination (β = 0.518, p < .001). BA (β = 0.232, p < .001), PBC (β = 0.239, p < .001), SN (β = 0.385, p < .001) positively influenced BI. However, PVH failed to predict BI. BI (β = 0.448, p < .001) and PVH (β = 0.127, p < .001) were significant predictors of VB. Significant ethnic variations were noted. The positive effect of PVH on VB (β = 0.151, p < .001) and the mediating role of PBC in VB (β = 0.076, p < .05) were significant among Tibetan students. The effect of VK on BA was stronger among Tibetans (β = 0.503, p < .05),while the impact of attitude on BI was more pronounced among Han students (β = 0.366, p < .05). The vaccination rate for Hep B among college students in Tibet is relatively low, and the ETPB model effectively explains their vaccination intentions and behaviors. Tailored intervention strategies for Tibetan and Han students are recommended to boost vaccination rates effectively.

Nanoparticle-based biosensor integrated with multiple cross-displacement amplification for visual and rapid identification of hepatitis B virus and hepatitis C virus

Infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) is a major contributor to liver-related morbidity and mortality worldwide. An accurate and rapid point-of-care (POC) diagnostic approach is the gateway for effective treatment and control of these infections. Here, for the first time, we integrated isothermal multiple cross-displacement amplification (MCDA) with a gold nanoparticle-based lateral flow biosensor (AuNPs-LFB) to successfully develop a novel HBV&HCV-MCDA-AuNPs-LFB assay for simultaneous accurate, sensitive, rapid, inexpensive, and visual identification of HBV and HCV agents. The two unique sets of MCDA degenerate primers were successfully designed targeting the S and 5' untranslated region (5'-UTR) genes from the major HBV genotypes (B, C, D, B/C recombinant, and C/D recombinant) and HCV subtypes in China (1b, 2a, 3a, 3b, and 6a), respectively. The optimal conditions for the MCDA reaction were confirmed to be 64°C for 35 min. The MCDA products were decoded visually using the AuNPs-LFB platform, which was devised for analyzing three targets, including HBV-MCDA, HCV-MCDA amplicons, and a chromatography control. The whole detection procedure, including rapid nucleic acid extraction (~10 min), MCDA reaction (35 min), and AuNPs-LFB interpretation (~2 min), can be completed within 50 min. The HBV&HCV-MCDA-AuNPs-LFB assay can detect the target genes (HBV-S and HCV-5'-UTR) with as low as 10 copies of gene-containing plasmid template per test and does not cross-react with other pathogens. Therefore, our preliminary results indicated that the HBV&HCV-MCDA-AuNPs-LFB assay developed in this study can potentially serve as a useful POC diagnostic tool for the identification of HBV and HCV infections.IMPORTANCEHepatitis B virus (HBV) and hepatitis C virus (HCV) infections have been regarded by the World Health Organization as major threats to human health, especially in low- and middle-income regions. Underdiagnosis of HBV/HCV is a particular challenge for achieving the World Health Organization's goal of eliminating HBV and HCV infections by 2030. Here, for the first time, we integrated isothermal multiple cross-displacement amplification (MCDA) with a gold nanoparticle-based lateral flow biosensor (AuNPs-LFB) to successfully develop a novel HBV&HCV-MCDA-AuNPs-LFB assay for simultaneous accurate, sensitive, rapid, inexpensive, and visual identification and differentiation of HBV and HCV agents.

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.

Chronic hepatitis B virus infection increases the risk of kidney disease while antiviral therapy for hepatitis B virus can decrease kidney disease risk

BACKGROUND

Extrahepatic manifestations of chronic hepatitis B virus (HBV) infection include development of kidney disease (KD). While anti-HBV treatment reduces the risk of liver-related events, the impact of HBV treatment on KD remains unclear. Using a large US-based electronic medical record (EMR) database, we examined whether patients with HBV are at higher risk of developing KD, whether the development of KD is associated with HBV-related liver disease, and whether anti-HBV treatment mitigates these risks.

METHODS

Data were queried from the IQVIA Ambulatory EMR database from 2006 to 2020. Propensity score matching was performed to better ensure balance across analyses. A Cox proportional hazards model was used to estimate hazard ratios (HRs) with 95% CIs for onset of KD between groups.

RESULTS

Among patients with and without HBV (n = 11,772 each), those with HBV were more than twice as likely to develop KD vs. matched controls without HBV infection (HR, 2.18 [95% CI, 1.90-2.50]; p < 0.001); most events occurred after age 55 years. Patients with HBV and concomitant hypertension, diabetes, or obesity had a greater likelihood for development of KD by age 75 years (19% with HBV vs. 6% without HBV); the cumulative probability of developing KD among patients with HBV along with concomitant comorbidities surpassed the additive risk of developing KD among those who had the comorbidities without HBV or only had HBV. Among patients with HBV, advanced liver disease was not significantly associated with KD. Patients treated with antivirals had a lower risk for KD compared with untreated HBV patients (HR, 0.61 [95% CI, 0.42-0.87]; p < 0.01).

CONCLUSIONS

HBV infection contributes to the development of KD, and anti-HBV treatment can lower KD risk. As such, clinicians should consider screening patients for HBV infection or initiating treatment early, particularly in patients with risk factors for KD.

Expanding treatment indications in chronic hepatitis B: Should we treat all patients?

Nucleos(t)ide analogues (NUCs) are first-line agents for chronic hepatitis B (CHB). Current guidelines provide recommendations for NUC initiation, yet the guidelines are complex and restrictive. Accumulating data on hepatitis B virus (HBV) replication and HBV integration suggests that there are no real quiescent disease phases in CHB, and treatment-ineligible patients in current guidelines still have substantial risks of cirrhosis and hepatocellular carcinoma. Expanding CHB treatment indications can effectively reduce the risks of liver-related complications. Furthermore, treatment indication expansion can be cost-effective, and can simplify care pathways to remove treatment barriers. Potential caveats for treatment expansion include risks of non-compliance, long-term side effects from NUCs, and poor patient acceptability. Nonetheless, these caveats are not insurmountable, and the benefits of treatment expansion outweigh the disadvantages. There is consensus among hepatologists in supporting treatment indication expansion, although expert panels have varying recommendations on treatment strategies. A treat-all approach, which involves treating all CHB patients, has also been proposed. A treat-all strategy is straightforward, and should yield the greatest benefits from a population health perspective. However, the feasibility of new treatment strategies, especially the treat-all approach, is influenced by multiple factors including local epidemiology, healthcare resource availability, and socioeconomic factors. A one-size-fits-all approach is not optimal, and treatment expansion strategies that are tailored based on local data should yield the greatest impact toward hepatitis elimination.

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.

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.

Hepatitis B knowledge and stigma in the United Arab Emirates

Globally, there are 1.2 million new chronic Hepatitis B Virus (HBV) infections every year. The UAE is a low-endemic region where no previous studies have explored HBV stigma. This study aims to evaluate the UAE's population HBV knowledge, HBV vaccine attitudes, and stigmatizing attitudes towards the HBV infection. A cross-sectional study was conducted to evaluate knowledge and stigma; the previously-developed and validated stigma scale (Hepatitis B Virus - Stigma Scale, HBV-SS) was used. A total of 601 responses were retained for analysis in both python-3 and R. Chi-squared, Mann-Whitney U and Kruskal-Wallis tests were used for bivariate analyses and ordinary least squares (OLS) regression was used for linear modelling. Confirmatory factor analysis (CFA) was conducted, and goodness-of-fit was evaluated. Overall, 77.5%, (n = 466/601) reported having some knowledge regarding HBV, only 19.3% (n = 90/466) had good knowledge regarding HBV, with most gaps occurring with symptoms, complications, and treatment of the infection. However, 84.03% (n = 505/601) were interested in learning more about the virus. Only 57.6% (n = 346/601) were aware of the existence of the vaccine; however, attitudes to it were overwhelmingly positive. Overall, non-stigmatising attitudes dominated; however, both labelling and separating domains highlighted specific items with highly stigmatising attitudes. CFA showed the HBV-SS model to have acceptable/good goodness-of-fit. OLS identified higher knowledge levels among healthcare workers and those with higher perceived knowledge. Only perceived knowledge was a significant predictor of lower stigma beyond the bivariate level. The UAE population has shown low levels of knowledge but overall non-stigmatising attitudes. It is imperative that campaigns focus on improving general population HBV infection and vaccine knowledge while also solidifying the widespread level of vaccine acceptance and non-stigmatising attitudes.

The impact of HBV, HCV, or syphilis infections on embryo and pregnancy outcomes in couples undergoing IVF treatment: a matched cohort study

STUDY QUESTION

Do infectious diseases (hepatitis B virus [HBV], hepatitis C virus [HCV], and syphilis) impact embryo quality, pregnancy, and neonatal outcomes following a complete IVF cycle?

SUMMARY ANSWER

Infections with HBV, HCV, or syphilis do not have detrimental impacts on live birth rates or neonatal outcomes in couples following a complete IVF cycle.

WHAT IS KNOWN ALREADY

Maternal or paternal infections with HBV, HCV, or syphilis may decrease the clinical pregnancy rate, result in poorer embryo outcomes, and lower offspring birth weight. However, there is significant controversy regarding these effects across existing studies, highlighting the need for further research.

STUDY DESIGN SIZE DURATION

This is a retrospective matched cohort study. Data were obtained from the clinical database of couples who underwent IVF treatment at a single academically affiliated fertility clinic from January 2011 to December 2019, with follow-up extending to December 2020. Out of 180 666 complete cycles recorded, 2443 cycles fulfilled our inclusion criteria.

PARTICIPANTS/MATERIALS SETTING METHODS

In cycles that fulfilled our inclusion criteria, there were 1997 cycles in the HBV study group, 154 cycles in the HCV study group, and 292 cycles in the syphilis study group. Each study cycle was paired with four controls based on participant age and the timing of IVF treatment, resulting in 7988 controls for the HBV group, 616 controls for the HCV group, and 1169 controls for the syphilis group. Infections could be either single-parent or biparental. The primary outcome was live birth per complete cycle (i.e. fresh cycle plus subsequent frozen-thawed cycles). Subgroup analyses were conducted dividing cycles into maternal infection and paternal infection.

MAIN RESULTS AND THE ROLE OF CHANCE

In the HBV group, pregnancy outcomes (clinical pregnancy, miscarriage, and live birth rates) and neonatal birth weight were similar to that of the controls. In the HCV group, no significant differences from the controls were observed except for a lower clinical pregnancy rate in the study group (36.4% vs 42.2%, adjusted β and 95% CI: 0.62 [0.39-0.96]). Similarly, no significant differences were found in pregnancy or neonatal outcomes between the syphilis group and the control group. As for subgroup analyses, the male-only HBV infection subgroup showed a higher miscarriage rate in the study group than in the control group (22.5% vs 17.7%, adjusted β and 95% CI: 1.56 [1.07-2.28]). For the HCV and syphilis subgroups, none of the outcomes showed significant differences between either the female-only infection or male-only infection subgroups and the controls.

LIMITATIONS REASONS FOR CAUTION

Although potential confounders were considered and adjusted for, residual bias may still exist due to the study design. The inclusion of participants solely from a single center limited the generalizability of our findings to a broader context.

WIDER IMPLICATIONS OF THE FINDINGS

We presented a comprehensive overview of the impact of prevalent infectious diseases on IVF outcomes, hoping to address uncertainties surrounding the decisions of couples infected with these diseases and to assist in preventing adverse reproductive outcomes in clinical practice.

STUDY FUNDING/COMPETING INTERESTS

This study was supported by the National Natural Science Foundation of China (82204052), the National Key R&D Program of China (2022YFC2705305), and the Clinical key project of Peking University Third Hospital (BYSYZD2023007). The authors declare no competing interests.

TRIAL REGISTRATION NUMBER

N/A.

Peer-Assisted Telemedicine for Hepatitis C in People Who Use Drugs: A Randomized Controlled Trial

BACKGROUND

Hepatitis C virus (HCV) elimination requires treating people who use drugs (PWUD), yet <10% of PWUD in the United States access HCV treatment; access is especially limited in rural communities.

METHODS

We randomized PWUD with HCV viremia and past 90-day injection drug or nonprescribed opioid use in 7 rural Oregon counties to peer-assisted telemedicine HCV treatment (TeleHCV) versus peer-assisted referral to local providers (enhanced usual care [EUC]). Peers supported screening and pretreatment laboratory evaluation for all participants and facilitated telemedicine visits, medication delivery, and adherence for TeleHCV participants. Generalized linear models estimated group differences in HCV viral clearance (primary outcome) and HCV treatment initiation and completion (secondary outcomes).

RESULTS

Of the 203 randomized participants (100 TeleHCV, 103 EUC), most were male (62%), White (88%), with recent houselessness (70%), and used methamphetamines (88%) or fentanyl/heroin (58%) in the past 30 days. Eighty-five of 100 TeleHCV participants (85%) initiated treatment versus 13 of 103 (12%) EUC participants (relative risk [RR], 6.7 [95% confidence interval {CI}, 4.0-11.3]; P < .001). Sixty-three of 100 (63%) TeleHCV participants versus 16 of 103 (16%) EUC participants achieved viral clearance 12 weeks after anticipated treatment completion date (RR, 4.1 [95% CI: 2.5-6.5]; P < .001).

CONCLUSIONS

The Peer TeleHCV treatment model substantially increased HCV treatment initiation and viral clearance compared to EUC. Replication in other rural and low-resource settings could further World Health Organization HCV elimination goals by expanding and decentralizing treatment access for PWUD. Clinical Trials Registration. NCT04798521.

Pathogenic Mechanisms of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)-Associated Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is the sixth most common cancer and the third leading cause of cancer deaths worldwide. The etiology of HCC has now dramatically changed from viral hepatitis to metabolic dysfunction-associated steatotic liver disease (MASLD). The main pathogenesis of MASLD-related HCC is the hepatic lipid accumulation of hepatocytes, which causes chronic inflammation and the subsequent progression of hepatic fibrosis. Chronic hepatic inflammation generates oxidative stress and DNA damage in hepatocytes, which contribute to genomic instability, resulting in the development of HCC. Several metabolic and molecular pathways are also linked to chronic inflammation and HCC in MASLD. In particular, the MAPK and PI3K-Akt-mTOR pathways are upregulated in MASLD, promoting the survival and proliferation of HCC cells. In addition, MASLD has been reported to enhance the development of HCC in patients with chronic viral hepatitis infection. Although there is no approved medication for MASLD besides resmetirom in the USA, there are some preventive strategies for the onset and progression of HCC. Sodium-glucose cotransporter-2 (SGLT2) inhibitor, a class of medications, has been reported to exert anti-tumor effects on HCC by regulating metabolic reprogramming. Moreover, CD34-positive cell transplantation improves hepatic fibrosis by promoting intrahepatic angiogenesis and supplying various growth factors. Furthermore, exercise improves MASLD through an increase in energy consumption as well as changes in chemokines and myokines. In this review, we summarize the recent progress made in the pathogenic mechanisms of MASLD-associated HCC. Furthermore, we introduced new therapeutic strategies for preventing the development of HCC based on the pathogenesis of MASLD.

High prevalence of hepatitis C virus infection among adolescents and young adults attending HIV and sexual health clinics

BACKGROUND

The prevalence of hepatitis C virus (HCV) infection among Thai adults is 0.5%-1.0%. This study aims to determine the prevalence of HCV infection among adolescents and young adults (AYA) accessing HIV/sexual health clinics.

METHODS

A cross-sectional study was conducted among AYA aged 15-24 years attending HIV/sexual health clinics in Bangkok, Thailand. The HCV infection prevalence, defined by anti-HCV antibody positivity using rapid diagnostic tests (SD BIOSENSOR, Korea), were reported with proportions and a 95% confidence interval (CI). Multivariate logistic regression was performed to identify factors associated with HCV infection.

RESULTS

From March to August 2023, 300 AYAs with a median age of 21 (interquartile range 20-23) years were enrolled into the study. One-third (29.7%) were people living with HIV (PLHIV). The overall prevalence of HCV infection was 2.7% (95%CI 1.2-5.2). Prevalence was higher among PLHIV (5.6%) compared to AYA without HIV (1.4%) (p-value 0.053). The factor most significantly associated with HCV infection was people who used drugs (adjusted odds ratio 15.3, 95% CI 2.9-82.0, p-value 0.001).

CONCLUSIONS

History of drug use was associated with the highest HCV infection prevalence. PLHIV had a trend of higher prevalence. HCV screening in HIV/sexual health clinics is recommended for early detection, treatment, and transmission reduction.

Hepatitis B Hospitalizations in Brazil: Temporal and Regional Patterns from 2008 to 2023

Hepatitis B remains a significant global public health concern, particularly in low- and middle-income countries, where prevention and control measures often face challenges. In Brazil, substantial efforts have been made over the years to combat the burden caused by hepatitis B through public health interventions, including vaccination programs, antenatal screening, and prevention of vertical transmission. However, despite these advancements, disparities in disease trends persist across regions and vulnerable populations, requiring ongoing analysis and intervention. This study aimed to analyze the trend in hospital admissions for hepatitis B in Brazil from 2008 to 2023. Data were collected from the SUS Hospital Information System. Statistical analyses were conducted using the Joinpoint Regression Program (version 5.0.2), applying a 5% significance level to identify significant trends over the study period. A total of 19,735 hospitalizations for hepatitis B were recorded during the study period. The overall trend showed a significant decline in hospital admissions, reflecting the effectiveness of public health interventions such as expanded vaccination coverage, screening programs, and prevention strategies. Despite this overall decline, notable regional disparities were observed. The midwest region exhibited an increasing trend in hospitalizations, contrasting with the national decline. Furthermore, a concerning rise in hospital admissions among infants under one year of age was identified, indicating potential shortcomings in the prevention of the vertical transmission of the virus. This study highlights both the successes and persistent challenges in controlling hepatitis B hospitalizations in Brazil. Maintaining high vaccination coverage and implementing targeted public health campaigns for vulnerable populations are crucial for sustaining progress. The regional disparities and failures in vertical transmission prevention require continued attention and intervention to advance toward the goal of eliminating hepatitis B as a public health threat in Brazil.

The Natural History of Hepatitis C Virus Infection and Disease in the Era of Curative Therapy with Direct-Acting Antivirals

The availability of highly effective direct-acting antivirals (DAAs) that cure individuals infected with HCV has changed completely the natural history of HCV infection and chronic hepatitis C. In sustained responders to DAAs, the most common clinical-pathologic outcome has become liver disease regression, cirrhosis re-compensation, and the de-listing of transplant candidates. However, careful scrutiny of liver disease cofactors and outcome predictors in treated patients is mandatory for an appropriate personalized surveillance of the residual risk for hepatocellular carcinoma. Since successful treatment with DAAs does not confer protective immunity against HCV reinfection, an effective vaccine is critically needed to control HCV infection. Meanwhile, it is mandatory to enhance universal access to DAAs, to test asymptomatic high-risk groups who are the main source of transmission, and to screen people who inject drugs (PWID), men who have sex with men (MSM), and sex workers, and to assure safe medical procedures with the provision of disposable needle and syringes.

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

BACKGROUND AND AIMS

The year 2023 marked the 10-year anniversary of the launch of direct-acting antivirals (DAAs) for the treatment of the hepatitis C virus (HCV). HCV treatment trends by country, region, and globally are important to monitor 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 (UI): 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 the 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 (WHO) 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.

Genotype 3 is linked to worse liver disease progression in hepatitis C patients even after SVR following DAA therapy

Background and aims

HCV genotype (GT) 3 is associated with rapid liver disease progression. However, the liver disease progression and its risk factors in patients with HCV GT 3 infection after sustained virological response (SVR) following direct-acting antivirals (DAAs) remain unclear. Therefore, we aimed to investigate the liver disease progression of patients with GT 3 after SVR.

Methods

This was a retrospective cohort study of patients with HCV infection who achieved SVR by DAAs. The clinical outcome was overall liver disease progression (OLDP), defined as newly diagnosed compensated liver cirrhosis, decompensated liver cirrhosis, or hepatocellular carcinoma. The incidence of OLDP was evaluated by Kaplan-Meier analysis. Cox regression analysis identified the risk factors for OLDP.

Results

A total of 409 patients (46.9% GT3) were followed for 43.7 (32.9, 58.7) months. The incidence of OLDP was higher in patients with GT 3 (4.63/100PY) than non-GT 3 (0.60/100PY; P < 0.001). According to Cox multivariate analysis, GT 3 was significantly associated with OLDP (HR 6.41, 95% CI 1.82 - 22.56; P=0.004). The predictors of OLDP in patients with GT 3 were HCV recurrence (HR 12.15, 95% CI 3.18 - 46.46; P < 0.001) and FIB-4 > 3.25 (HR 16.40, 95% CI 1.03 - 39.81; P = 0.046) at baseline.

Conclusion

HCV GT 3-infected patients remain at a higher risk of OLDP even after achieving SVR by DAAs, especially patients with advanced liver fibrosis and at high risk for reinfection or virological late relapse.

Molecular mechanisms behind the inhibitory effects of ginsenoside Rg3 on hepatic fibrosis: a review

Hepatitis is a chronic inflammatory liver disease and an important cause of liver fibrosis, which can progress to cirrhosis and even hepatocellular carcinoma if left untreated. However, liver fibrosis is a reversible disease, so finding new intervention targets and molecular markers is the key to preventing and treating liver fibrosis. Ginseng, the roots of Panax ginseng C. A. Meyer, is a precious Traditional Chinese Medicines with high medicinal value and is known as the "king of all herbs", and its active ingredient, ginsenoside Rg3 is a rare saponin and a new class of drug, one of the most thoroughly and extensively studied in a large number of studies. Ginsenoside Rg3 is an active ingredient extracted from ginseng that possesses a variety of biological activities, including anti-inflammatory, antioxidant, and anti-fibrotic effects. Several studies have suggested that ginsenoside Rg3 may help reduce hepatic inflammation and oxidative stress, thereby slowing the progression of liver fibrosis. Ginsenoside Rg3 may have some therapeutic effects on liver fibrosis, and the underlying molecular mechanisms behind these effects are attributed to cellular autophagy, apoptosis, and anti-inflammation, as well as the modulation of antioxidant activity and multiple signaling pathways. The molecular mechanisms behind the inhibitory effect of ginsenoside Rg3 on hepatic fibrosis are reviewed, with a view to providing reference for related studies.

Baseline Viral Load and On-Treatment Hepatocellular Carcinoma Risk in Chronic Hepatitis B: A Multinational Cohort Study

BACKGROUND & AIMS

Hepatocellular carcinoma (HCC) risk persists in patients with chronic hepatitis B (CHB) despite antiviral therapy. The relationship between pre-treatment baseline hepatitis B virus (HBV) viral load and HCC risk during antiviral treatment remains uncertain.

METHODS

This multinational cohort study aimed to investigate the association between baseline HBV viral load and on-treatment HCC risk in 20,826 noncirrhotic, hepatitis B e antigen (HBeAg)-positive and HBeAg-negative patients with baseline HBV DNA levels ≥2000 IU/mL (3.30 log10 IU/mL) who initiated entecavir or tenofovir treatment. The primary outcome was on-treatment HCC incidence, stratified by baseline HBV viral load as a categorical variable.

RESULTS

In total, 663 patients developed HCC over a median follow-up of 4.1 years, with an incidence rate of 0.81 per 100 person-years (95% confidence interval [CI], 0.75-0.87). Baseline HBV viral load was significantly associated with HCC risk in a non-linear parabolic pattern, independent of other factors. Patients with baseline viral load between 6.00 and 7.00 log10 IU/mL had the highest on-treatment HCC risk (adjusted hazard ratio, 4.28; 95% CI, 2.15-8.52; P < .0001) compared with those with baseline viral load ≥8.00 log10 IU/mL, who exhibited the lowest HCC risk.

CONCLUSION

Baseline viral load showed a significant, non-linear, parabolic association with HCC risk during antiviral treatment in noncirrhotic patients with CHB. Early initiation of antiviral treatment based on HBV viral load may help prevent irreversible HCC risk accumulation in patients with CHB.

The Changing Demographics and Epidemiology of Hepatocellular Carcinoma

The epidemiology of hepatocellular carcinoma (HCC) has shifted significantly in the last 2 decades with non-viral etiologies such as metabolic dysfunction-associated steatotic liver disease and alcohol-associated liver disease on the rise. Key factors include the global obesity epidemic and the resurgence of alcohol use disorder, both of which were exacerbated by the coronavirus disease 2019 pandemic. While these non-viral etiologies of HCC are becoming the leading cause in developed countries, the potential impact of immigration patterns on Hepatitis B virus epidemiology cannot be ignored. The risk of HCC remains significant in individuals with cirrhosis and viral hepatitis after curative treatments.

Health disparities in cirrhosis care and liver transplantation

Morbidity and mortality from cirrhosis are substantial and increasing. Health disparities in cirrhosis and liver transplantation are reflective of inequities along the entire spectrum of chronic liver disease care, from screening and diagnosis to prevention and treatment of liver-related complications. The key populations experiencing disparities in health status and healthcare delivery include racial and ethnic minority groups, sexual and gender minorities, people of lower socioeconomic status and underserved rural communities. These disparities lead to delayed diagnosis of chronic liver disease and complications of cirrhosis (for example, hepatocellular carcinoma), to differences in treatment of chronic liver disease and its complications, and ultimately to unequal access to transplantation for those with end-stage liver disease. Calling out these disparities is only the first step towards implementing solutions that can improve health equity and clinical outcomes for everyone. Multi-level interventions along the care continuum for chronic liver disease are needed to mitigate these disparities and provide equitable access to care.

Prospect of emerging treatments for hepatitis B virus functional cure

Functional cure, defined as sustained hepatitis B surface antigen (HBsAg) seroclearance with unquantifiable hepatitis B virus (HBV) DNA at 24 weeks off treatment, is a favorable treatment endpoint in chronic hepatitis B (CHB). Nonetheless, functional cure is rarely attained with the current treatment modalities of nucleos(t)ide analogues (NUCs) and pegylated interferon alpha. Multiple novel virus-targeting agents and immunomodulators are under development for HBV with functional cure as the treatment goal. Among virus-targeting agents, antisense oligonucleotides and small-interfering RNAs are the most advanced in the developmental pipeline, and can induce potent and sustainable HBsAg suppression. The other virus-targeting agents have varying effects on HBsAg and HBV DNA, depending on the drug mechanism. In contrast, immunomodulators have modest effects on HBsAg and have limited roles in monotherapy. Multiple combination regimens incorporating RNA interference agents with immunomodulators have been studied through many ongoing clinical trials. These combination strategies demonstrate synergistic effects in inducing functional cure, and will likely be the future direction of development. Despite the promising results, research is warranted to optimize treatment protocols and to establish criteria for NUC withdrawal after novel therapies. Functional cure is now an attainable target in CHB, and the emerging novel therapeutics will revolutionize CHB management.

Production and characterization of monoclonal antibodies against hepatitis B e-antigen and their potential application for development of HBeAg detection ELISA

Despite global vaccination efforts, hepatitis B virus (HBV) infection remains a major health threat, causing over a million deaths annually. Hepatitis B e-antigen (HBeAg) is an indicator of HBV replication and high infectivity. HBeAg is an essential serological marker for monitoring response to treatment and/or determining the stage of chronic HBV infection. Here, we produced a panel of mouse hybridomas secreting monoclonal antibodies (MAbs) to HBeAg by fusing a mouse myeloma cell line with splenocytes from mice immunized with recombinant HBeAg. Anti-HBe MAbs were then characterized by competition ELISA and Western blotting. We designed and optimized an in-house sandwich ELISA using HBeAg-specific rabbit polyclonal and mouse monoclonal antibodies. The diagnostic performance of the assay was then compared to a commercial HBeAg detection ELISA kit using 176 HBeAg[-] and 44 HBeAg[+] serum samples, showing a significant positive correlation (r = 0.8250; P < 0.0001). The in-house ELISA showed reasonable sensitivity (97.56 %) and specificity (99.40 %), with a cut-off value and area under the curve of 0.193 and 0.9884, respectively. Additionally, the assay showed high repeatability, with intra- and inter-assay coefficients of variation of 2.46 % and 11.38 %, respectively. Our designed HBeAg-detecting sandwich ELISA has the potential for use in clinical diagnosis.

Moving diagnosis of liver fibrosis into the community

Chronic liver disease (CLD) is a leading cause of death worldwide, with alcohol consumption and metabolic risk factors accounting for the majority of cases of CLD in many developed countries. Currently, specific strategies for the early diagnosis of CLD are lacking and consequently most cases are diagnosed at an advanced stage, which is associated with negative consequences for disease management and prognosis. Screening for CLD is based on either detection of chronic viral hepatitis B and C, or detection of liver fibrosis in patients with steatotic liver disease related to alcohol or metabolic dysfunction. Non-invasive tools, including serological and imaging-based tests, can be used to detect liver fibrosis. Clinical practice guidelines recommend screening for liver fibrosis using algorithms that combine different non-invasive tests, with widely available but low accuracy tests, such as FIB-4, recommended as a first screening step in the primary care setting, and other tests with lower availability but higher accuracy, such as transient elastography or the enhanced liver fibrosis test, recommended as a second step. There are different pathways for early detection of patients with CLD from primary to specialised care, with primary care providers being key for early detection, management and referral of patients. In addition, interventions targeting metabolic risk factors and alcohol consumption should be carried out in collaboration between specialists and primary care. In this review, we describe liver fibrosis from the community perspective, highlighting gaps in knowledge on how to define the optimal combination of tests, target population, the ideal pathway of care for CLD, and how to increase implementation of programmes for early diagnosis of liver diseases in clinical practice.

A Comprehensive Review of Antiviral Therapy for Hepatitis C: The Long Journey from Interferon to Pan-Genotypic Direct-Acting Antivirals (DAAs)

The treatment landscape for hepatitis C virus (HCV) infection has transformed over the past few decades, evolving from the limited efficacy of interferon (IFN) monotherapy to the highly successful pan-genotypic direct-acting antivirals (DAAs) used today. Initially, alpha-interferon monotherapy, introduced in the 1990s, was the standard treatment, yet it provided low sustained virological response (SVR) rates and caused significant adverse effects, limiting its utility. The development of pegylated interferon (peg-IFN) improved the pharmacokinetic profile of IFN, allowing for less frequent dosing and modestly improved response rates. When combined with ribavirin, peg-IFN achieved higher SVR rates, especially in non-genotype 1 HCV infections, but the combination also brought additional side effects, such as anemia and depression. The advent of the first-generation DAAs, such as telaprevir and boceprevir, marked a significant milestone. Combined with peg-IFN and ribavirin, these protease inhibitors boosted response rates in patients with genotype 1 HCV. However, high rates of adverse effects and drug resistance remained challenges. Second-generation DAAs, like sofosbuvir and ledipasvir, introduced IFN-free regimens with improved safety profiles and efficacy. The most recent advances are pan-genotypic DAAs, including glecaprevir-pibrentasvir and sofosbuvir-velpatasvir, which offer high SVR rates across all genotypes, shorter treatment durations, and fewer side effects. Current pan-genotypic regimens represent a cornerstone in HCV therapy, providing an accessible and effective solution globally.

The neutrophil-lymphocyte ratio as a risk factor for all-cause mortality among individuals with resolved HBV infection: evidence from the NHANES 1999-2018

Background

Inflammation is a critical component in the process of resolved hepatitis B virus (HBV) infection. The neutrophil-to-lymphocyte ratio (NLR) serves as a sensitive indicator of systemic inflammation and immune activation. Our study aimed to investigate the correlation between elevated NLR levels and the risk of all-cause mortality in patients with resolved HBV infection. Additionally, we evaluated the potential mediating effect of diabetes mellitus (DM) on this correlation.

Methods

Our study enrolled 1,146 adult patients with resolved HBV infection from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2018. We utilized the Restricted Cubic Splines (RCS) and Maximum Selection Rank Statistical Method (MSRSM) to analyze the relationship between the NLR and the risk of all-cause mortality. The impact of NLR was evaluated using a weighted multivariate Cox regression model, and the model's predictive accuracy was assessed using time-dependent Receiver Operating Characteristic (ROC) curves. An intermediary analysis was conducted to explore the potential influence of DM on the observed relationship.

Results

During follow-up period of 103.54 ± 4.90 months, we recorded 207 deaths among the study participants. The analysis using the RCS method revealed a significant positive correlation between the NLR and the risk of all-cause mortality. Those with elevated NLR levels faced a substantially higher mortality risk compared to those with lower levels, as indicated by a Hazard Ratio (HR) of 1.84, with a 95% Confidence Interval (CI) of 1.17 to 2.89 (p < 0.05). The predictive accuracy of the model was substantial, as evidenced by the Area Under the Curve (AUC) for ROC curves at 3, 5, and 10 years, which were 0.873, 0.870, and 0.862, respectively. Furthermore, mediation analysis indicated that DM significantly influenced the relationship between the NLR and mortality, with a mediation effect of 6.57% (95% Confidence Interval [CI]: 0.64 to 15%; p = 0.02).

Conclusion

Elevated NLR is significantly associated with an increased risk of all-cause mortality in patients with resolved HBV infection. Concurrently, DM acts as a partial mediator of this association.

Differences in the intrahepatic expression of immune checkpoint molecules on T cells and natural killer cells in chronic HBV patients

Background

Patients with chronic hepatitis B virus (HBV) infection are characterized by impaired immune response that fails to eliminate HBV. Immune checkpoint molecules (ICMs) control the amplitude of the activation and function of immune cells, which makes them the key regulators of immune response.

Methods

We performed a multiparametric flow cytometry analysis of ICMs and determined their expression on intrahepatic lymphocyte subsets in untreated and treated patients with HBV in comparison with non-pathological liver tissue.

Results

The liver of untreated HBV patients exhibited a high accumulation of PD-1+CD8+ T cells, while the frequencies of 4-1BB+ T cells, 4-1BB+ natural killer (NK) cells, and TIM-3+CD8+ T cells were the highest in the chronic hepatitis phase. Our findings showed that the HBeAg status is linked to a distinct immune phenotype of intrahepatic CD8+ T cells and NK cells characterized by high expression of ICMs, particularly 4-1BB. Importantly, antiviral treatment partially restored the normal expression of ICMs. Finally, we described important differences in ICM expression between intrahepatic and circulating NK cells in HBV patients.

Conclusions

Our study shows clear differences in the intrahepatic expression of ICMs on NK cells and T cells in chronic HBV patients depending on their clinical stage.

Prevention of liver cancer in the era of next-generation antivirals and obesity epidemic

Preventive interventions are expected to substantially improve the prognosis of patients with primary liver cancer, predominantly HCC and cholangiocarcinoma. HCC prevention is challenging in the face of the evolving etiological landscape, particularly the sharp increase in obesity-associated metabolic disorders, including metabolic dysfunction-associated steatotic liver disease. Next-generation anti-HCV and HBV drugs have substantially reduced, but not eliminated, the risk of HCC and have given way to new challenges in identifying at-risk patients. The recent development of new therapeutic agents and modalities has opened unprecedented opportunities to refine primary, secondary, and tertiary HCC prevention strategies. For primary prevention (before exposure to risk factors), public health policies, such as universal HBV vaccination, have had a substantial prognostic impact. Secondary prevention (after or during active exposure to risk factors) includes regular HCC screening and chemoprevention. Emerging biomarkers and imaging modalities for HCC risk stratification and detection may enable individual risk-based personalized and cost-effective HCC screening. Clinical studies have suggested the potential utility of lipid-lowering, antidiabetic/obesity, and anti-inflammatory agents for secondary prevention, and some of them are being evaluated in prospective clinical trials. Computational and experimental studies have identified potential chemopreventive strategies directed at diverse molecular, cellular, and systemic targets for etiology-specific and/or agnostic interventions. Tertiary prevention (in conjunction with curative-intent therapies for HCC) is an area of active research with the development of new immune-based neoadjuvant/adjuvant therapies. Cholangiocarcinoma prevention may advance with recent efforts to elucidate risk factors. These advances will collectively lead to substantial improvements in liver cancer mortality rates.

HCV and HBV genotypes: vital in the progression of HCV/ HBV co-infection

BACKGROUND

Viral hepatitis is the major contributor to liver cirrhosis and hepatocellular carcinoma (HCC). Studies indicated that the co-infection of hepatitis C and hepatitis B virus also prompts liver damage progression. Therefore, in the present study, the prevalence of HCV-HBV co-infection and the impact of HCV-HBV co-infection on the progression of liver damage was evaluated amongst the HCV-infected patients in Pakistan.

METHODS

In this study 2500 HCV-positive patients were recruited from Pakistan. The presence and prevalence of HCV and HBV was confirmed through ELISA and nested PCR. To determine the liver damage due to viral infection levels of ALT, ALP, and total bilirubin were also determined. Diagnostic history of patients was thoroughly documented through serological tests and liver biopsy reports. Viral genotypes and viral loads were determined through multiplex polymerase chain reaction (PCR) and time PCR, respectively.

RESULTS

The study outcomes showed that 12.5% of the HCV-infected patients were co-infected with HBV. Co-infection development was more common in females than in males, and females were at a higher risk of developing the infection (p-value = < 0.0001, OR = 2.437). Despite the variation among different age groups, there was no significant difference in co-infection prevalence. HCV genotype 3a was found to be most prevalent while in HBV genotype D was found to be prevalent among the patients. The HCV patients frequently developed co-infection with HBV genotype D. It was also determined that viral load for HBV genotype D was higher compared to non-D genotypes while for HCV viral load was higher in non-3a genotypes.

CONCLUSIONS

This study evaluated the prevalence of HCV and HBV co-infection among HCV-positive patients, revealing that 12.5% patients were co-infected with HBV. Co-infection was more common in females, who had a higher risk of developing it. The study also revealed that HBV genotype D was the most prevalent in co-infected patients, with no significant age-related differences in co-infection rates.

Real-world experience with nucleos(t)ide analogue therapy and patient survival rates in chronic viral hepatitis B treatment centers in Eritrea

Real-world data on treatment outcomes or the quality of large-scale chronic hepatitis B (CHB) treatment programs in sub-Saharan Africa (SSA) is extremely difficult to obtain. In this study, we aimed to provide data on the prevalence and incidence of mortality, loss to follow-up (LFTU), and their associated factors in patients with CHB in three treatment centres in Eritrea. Additional information includes baseline clinical profiles of CHB patients initiated on nucleos(t)ide analogue (NUCs) along with a comparison of treatment with Tenofovir disoproxil fumarate (TDF) vs. TDF + Lamuvudine (LAM) using specific biochemical, haematological and virologic parameters. A multicenter retrospective cohort study was conducted on CHB patients in Asmara, Eritrea (2018-2021). Demographic, clinical, and laboratory information was collected from medical records using a structured checklist. Relevant parametric and nonparametric statistics were employed to explore treatment outcomes and to evaluate differences between groups. Where appropriate, Kaplan-Meier (KM) curves and univariate and multivariate Cox regression models were implemented. A two-sided p-value < 0.05 was considered significant. A total of 413 patients with HBV (median age (IQR) at diagnosis: 39 (IQR: 28-50 years; females: 118(28.6%); followed for a total of 22,921 person days) were studied. HBV/HIV co-infection was observed in 15(3.6%) and baseline ALT and AST were elevated in 99(31.2%) and 101(32.8%), respectively. The Fibrosis-4 (FIB-4) index estimates suggested that cirrhosis was highly likely in 33 (14%) patients with 49 (20.8%) patients in the indeterminate FIB-4 score category. During the follow-up period, 4.6% (95% CI: 2.5-6.6%) died, while 23.9% (95% CI: 19.8-28%) were LTFU. In the adjusted Cox proportional hazards model, LTFU were independently associated with baseline serum HBV DNA (IU/mL) (aHR = 1.3, 95% CI 1.04-1.7; p-value = 0.02); Not initiated on NUC (aHR = 3.9, 95% CI: 1.1-13.7, p-value = 0.02); and FIB-4 Score (aHR = 1.05, 95% CI: 1-1.1; p-value = 0.01). Of the 413 patients enrolled in the study, 98 cases (23.73%) were initiated on treatment. In the head-to-head comparison of the results in TDF and TDF + LAM after 12 weeks of treatment, VR was observed in 14(45.2%) vs. 17(54.8%), respectively, translating into an overall VR of 60.7% (95% CI 46.9-74.6). Furthermore, VR in TDF vs. TDF + LAM were similar, 14(45.2%) vs. 17(54.4%) respectively, p-value = 0.3). This study uncovered multiple systems- and patient-centered gaps in the three HBV treatment programs in Asmara, Eritrea. These include late presentation, high incidence of LTFU, inconsistencies in routine data, and poor data management. Interventions should target improvements in laboratory infrastructure, adherence to patient monitoring guidelines, HBV literacy, better tracking of patients, and documentation of patient's information.

Global Elimination of Hepatitis C Virus

Hepatitis C virus (HCV) is predominantly transmitted through parenteral exposures to infectious blood or body fluids. In 2019, approximately 58 million people worldwide were infected with HCV, and 290,000 deaths occurred due to hepatitis C-related conditions, despite hepatitis C being curable. There are substantial barriers to elimination, including the lack of widespread point-of-care diagnostics, cost of treatment, stigma associated with hepatitis C, and challenges in reaching marginalized populations, such as people who inject drugs. The World Health Organization (WHO) has set goals to eliminate hepatitis C by 2030. Several countries, including Australia, Egypt, Georgia, and Rwanda, have made remarkable progress toward hepatitis C elimination. In the United States, the Biden-Harris administration recently issued a plan for the national elimination of hepatitis C. Global progress has been uneven, however, and will need to accelerate considerably to reach the WHO's 2030 goals. Nevertheless, the global elimination of hepatitis C is within reach and should remain a high public health priority.

Modeling of randomized hepatitis C vaccine trials: Bridging the gap between controlled human infection models and real-word testing

Global elimination of chronic hepatitis C (CHC) remains difficult without an effective vaccine. Since injection drug use is the leading cause of hepatitis C virus (HCV) transmission in Western Europe and North America, people who inject drugs (PWID) are an important population for testing HCV vaccine effectiveness in randomized-clinical trials (RCTs). However, RCTs in PWID are inherently challenging. To accelerate vaccine development, controlled human infection (CHI) models have been suggested as a means to identify effective vaccines. To bridge the gap between CHI models and real-world testing, we developed an agent-based model simulating a two-dose vaccine to prevent CHC in PWID, representing 32,000 PWID in metropolitan Chicago and accounting for networks and HCV infections. We ran 500 trial simulations under 50 and 75% assumed vaccine efficacy (aVE) and sampled HCV infection status of recruited in silico PWID. The mean estimated vaccine efficacy (eVE) for 50 and 75% aVE was 48% (SD ± 12) and 72% (SD ± 11), respectively. For both conditions, the majority of trials (∼71%) resulted in eVEs within 1 SD of the mean, demonstrating a robust trial design. Trials that resulted in eVEs >1 SD from the mean (lowest eVEs of 3 and 35% for 50 and 75% aVE, respectively), were more likely to have imbalances in acute infection rates across trial arms. Modeling indicates robust trial design and high success rates of finding vaccines to be effective in real-life trials in PWID. However, with less effective vaccines (aVEs∼50%) there remains a higher risk of concluding poor vaccine efficacy due to post-randomization imbalances.

Cross-sectional study of hepatitis B virus infection in female breast cancer patients in China for the first time diagnosed

BACKGROUND

The correlation between breast cancer and hepatitis B virus (HBV) remains inconclusive. This study aims to explore the serological status of HBV infection and past infection in different age groups of female breast cancer patients, patients with benign breast diseases, and individuals undergoing routine physical examinations.

METHODS

Serum data on HBV serological markers were collected and analyzed from 6072 female breast cancer patients first diagnosed from September 2012 to July 2020 at the First Affiliated Hospital of Chongqing Medical University, along with 4019 women with benign breast diseases and 54,740 healthy females undergoing routine physical examinations in the same period. The data were stratified by age for comparison between groups.

RESULTS

The prevalence of HBV infection and past infection in the breast cancer group (7.9%, 55.1%) was higher than that in the benign breast disease group (6.5%, 39.1%) and the healthy females group(5.0%, 17.6%);the rate of only HBV surface antibody positivity (HBsAb ( +)) in the breast cancer group (10.3%) was lower than that in the benign breast disease group (26.9%) and the healthy females group (49.2%), with significant differences between the three groups (p < 0.05). Stratified by age, the prevalence of HBV infection in the breast cancer group (8%, 8.9%) and benign breast disease group (7.75%, 8.1%)was higher than that in the healthy females group (4.5%, 6.3%) in the 30-39 and 40-49 age group, respectively. The past infection rate of HBV in the breast cancer group (24.8%, 45.0%) was higher than that in the benign breast disease group (16.1%, 35.4%) in the ≤ 29 and 30-39 age group, respectively.. The past infection rate of HBV in the breast cancer group was higher than that in the healthy females group in all age groups, while the rate of only HBsAb ( +) in the breast cancer group was lower than that in the benign breast disease group and the routine physical examination group in all age groups.

CONCLUSIONS

Breast cancer women and women with benign breast diseases have higher rates of hepatitis B virus infection and previous infections, with more significant differences among middle-aged women. Breast cancer women and women with benign breast diseases have lower rates of only HBsAb ( +) for HBV.

Higher FIB-4 index at baseline predicts development of liver cancer in a community-based cohort with viral hepatitis

Hepatitis B and C (HBV and HCV) testing has been performed in Japan since 2002 and is subsidized by central and prefectural governments. A follow-up program for HBV- or HCV-infected persons was started at that time in Ishikawa Prefecture. This study analyzed the long-term follow-up data from this program. In total, 1029 participants in the Ishikawa Hepatitis Follow-up Program (HBV-infected, n = 535; HCV-infected, n = 494) were enrolled. Clinical data between the first visit and the most recent visit by March 2019 were collected. In the HBV-infected group, 384 persons (71.8%) were asymptomatic carriers, 133 (24.9%) developed chronic hepatitis, 15 (2.8%) developed compensated liver cirrhosis, and 3 (0.6%) developed decompensated liver cirrhosis. Ninety (16.8%) were treated with nucleotide/nucleoside analogs. Sixteen (3.0%) developed liver cancer. In the HCV-infected group, 427 persons (86.4%) developed chronic hepatitis, 46 (9.3%) developed compensated liver cirrhosis, and 21 (4.3%) developed decompensated liver cirrhosis. Forty-eight (9.7%) developed liver cancer. Three hundred and seventy-eight (76.5%) received antiviral therapy (a direct-acting antiviral in 166, interferon-based treatment followed by a direct-acting antiviral in 73, and interferon-based treatment in 139). The subsidy system was used by 270 persons (71.4%). Sustained virological response was confirmed in 340 persons (68.8%). A higher FIB-4 index at the first visit was a significant risk factor for liver cancer in HBV-infected and HCV-infected persons. The Ishikawa Hepatitis Follow-up Program has revealed the clinical course of HBV and HCV infection in community-dwelling individuals. The results will be used for micro-elimination at a prefectural level.

Impact of Nucleos(t)ide Analogs on Major Clinical Outcomes in Patients With Chronic Hepatitis B: A 10-Year French Nationwide Cohort Study

BACKGROUND

Conflicting results have been reported on the impact of tenofovir versus entecavir on liver-related outcomes.

AIMS

To explore trends in clinical outcomes in chronic hepatitis B virus (HBV)-infected patients and compare the impact of tenofovir versus entecavir on the risk of hepatocellular carcinoma (HCC), liver transplantation (LT) and mortality.

METHODS

We used the French National Health Insurance Databases (SNDS) to identify HBV-infected patients. We quantified the excess clinical burden from 2012 to 2021 by comparing the HBV-infected cohort with a general population cohort, using 1:1 exact matching on birth date, sex, social deprivation index and follow-up start date. The risks of mortality, HCC and LT were compared between patients treated with tenofovir and entecavir using inverse probability weighting.

RESULTS

A total of 101,740 patients were matched to the general population. From 2012 to 2021, the average annual decreases in excess mortality, incidence of HCC and LT were 3.7%, 8.0% and 11.9%, respectively (p for trend < 0.001). During the same period, the nucleos(t)ide analog (NUC) treatment coverage significantly increased, particularly after 2016 (p < 0.001). Among 14,054 treatment-naïve patients starting tenofovir (n = 7426) or entecavir (n = 6628), we observed no difference in the composite outcome of mortality, LT or HCC (HR, 1.09; 95% CI, 0.95-1.24). Tenofovir was associated with an increased risk of HCC compared with entecavir (HR, 1.31; 95% CI, 1.07-1.62).

CONCLUSIONS

Tenofovir was associated with a higher risk of HCC compared with entecavir, although no difference in the composite outcome of mortality or liver-related events was observed between the two treatments.

Surveillance Following Hepatitis B Surface Antigen Loss: An Issue Requiring Attention

Due to the lack of agents that directly target covalently closed circular DNA and integrated HBV DNA in hepatocytes, achieving a complete cure for chronic hepatitis B (CHB) remains challenging. The latest guidelines recommend (hepatitis B surface antigen) HBsAg loss as the ideal treatment target for improving liver function, histopathology, and long-term prognosis. However, even after HBsAg loss, hepatitis B virus can persist, with a risk of recurrence, reactivation, cirrhosis, and hepatocellular carcinoma. Therefore, follow-up and surveillance are still necessary. With increasing treatment options available for achieving HBsAg loss in patients with CHB, developing effective surveillance strategies has become crucial. Recent studies on outcomes following HBsAg loss provide new insights for refining current surveillance strategies, though further improvement is needed through long-term observation and follow-up.

Computational design and validation of small molecule inhibitors for type III phosphatidylinositol-4-kinase alpha, a hepatitis C drug target

According to World Health Organization reports of the year 2022, nearly 242,000 people died from hepatitis C that causes liver cirrhosis and hepatocellular carcinoma. Phosphatidylinositol-4-kinase type III alpha (PI4KIIIα), a lipid kinase interacts with the hepatitis C virus non-structural 5 A protein (NS5A) to produce phosphoinositol-4-phosphate (PI4P), which enriches the hepatitis C virus replication complex. Patients with hepatitis C virus infection in the liver have been associated with increased levels of PI4P at the endoplasmic reticulum. To initiate viral replication, the hepatitis C virus must assemble numerous host cellular proteins into distinct membrane replication structures. A crucial element of these replication organelles is PI4KIIIα. Therefore, inhibition of PI4KIIIα is one of the most needed therapeutic approaches for the treatment of the disease. In this direction, a combination of pharmacophore-based virtual screening, molecular docking, molecular dynamics (MD) simulations were studied for PI4KIIIα. The stability of the complexes throughout MD simulations was evaluated from their binding free energies, post-MD analysis, and further the drug-like properties of the selected molecules were analyzed. Six molecules were finally selected as the likely hit molecules based on binding free energies, normal mode analysis, and their drug-like properties. The findings of this work suggest that the selected small molecules may be used as lead molecules for the development of novel PI4KIIIα inhibitors. It is also anticipated that these thorough studies will be helpful in the structure-based drug design of PI4KIIIα inhibitors.

Risk factors for hepatocellular carcinoma in cirrhosis: A comprehensive analysis from a decade-long study

BACKGROUND

Cirrhosis is a significant risk factor for the development of hepatocellular carcinoma (HCC). Variability in HCC risk among patients with cirrhosis is notable, particularly when considering the diverse etiologies of cirrhosis.

AIM

To identify specific risk factors contributing to HCC development in patients with cirrhosis.

METHODS

This retrospective study analyzed data from cirrhotic patients at Beijing Youan Hospital from January 1, 2012 to September 30, 2022 with at least 6 mo of follow-up. Patient demographics, medical histories, etiologies, and clinical characteristics were examined. Cox regression analysis was used to analyze correlations of the above parameters with hepatocarcinogenesis, while competing risk regression was used to estimate their adjusted hazard ratios accounting for death. The cumulative incidence was plotted over time.

RESULTS

Overall, 5417 patients with cirrhosis (median age: 54 years; 65.8% males) were analyzed. Hepatitis B virus (HBV) was the most common etiology (23.3%), with 25% (n = 1352) developing HCC over a 2.9-year follow-up period. Patients with multiple etiologies had the HCC highest incidence (30.3%), followed by those with HBV-related cirrhosis (29.5%). Significant risk factors included male sex, advanced age, hepatitis C virus (HCV) infection, elevated blood ammonia, and low platelet count. Men had a higher 5-year HCC risk than women (37.0% vs 31.5%). HBV, HCV, and HBV/HCV co-infected patients had 5-year risks of HCC of 45.8%, 42.9%, and 48.1%, respectively, compared to 29.5% in nonviral hepatitis cases, highlighting the significant HCC risk from viral hepatitis, especially HBV, and underscores the importance of monitoring these high-risk groups.

CONCLUSION

In conclusion, HBV-related cirrhosis strongly correlates with HCC, with male sex, older age, viral hepatitis, elevated blood ammonia, and lower albumin and platelet levels increasing the risk of HCC.

Screening for STIs: Results of a Health-Promotion Programme in a Portuguese University

Sexually Transmitted Infections (STIs) are an important and growing public health concern. Implementation of screening programmes and awareness campaigns are crucial to mitigate this problem. A university in the central region of Portugal has devised a health-promotion programme, named Protection+, specifically directed towards the sexual health of the university community. The present study aimed to evaluate the results of the different actions undertaken as part of the health-promotion programme during the 2023-2024 academic year. Chlamydia, gonorrhoea, trichomoniasis and infection with Mycoplasma genitalium were assessed through real-time polymerase chain reaction protocols. Syphilis, infection with HIV, HBV and HCV were assessed through immunological assays. The adherence to the health-promotion programme after the awareness campaigns was also evaluated. STIs have been diagnosed in 13.7% of the 475 screened participants. Chlamydia was the STI most frequently diagnosed (8.4%), followed by infection with M. genitalium (2.3%), T. pallidum (2.0%) and N. gonorrhoeae (1.1%). HIV, HBV and HCV were diagnosed in a residual number of cases, and T. vaginalis was not detected in any of the screened participants. At the time of diagnosis, more than half of the infected patients were asymptomatic. After the implementation of awareness campaigns, an increase in the adherence to STI screening was observed, with the expected simultaneous increase in STI diagnoses. The high prevalence of STIs, particularly chlamydia, in the university population, along with the asymptomatic nature of these infections, demonstrated the importance of STI screenings and the implementation of campaigns that raise awareness on the prevention and consequences of untreated STIs.

Global, Regional, and National Trends in Liver Disease-Related Mortality Across 112 Countries From 1990 to 2021, With Projections to 2050: Comprehensive Analysis of the WHO Mortality Database

BACKGROUND

Liver disease causes over two million deaths annually worldwide, comprising approximately 4% of all global fatalities. We aimed to analyze liver disease-related mortality trends from 1990 to 2021 using the World Health Organization (WHO) Mortality Database and forecast global liver disease-related mortality rates up to 2050.

METHODS

This study examined age-standardized liver disease-related death rates from 1990 to 2021, employing data from the WHO Mortality Database across 112 countries across five continents. The rates over time were calculated using a locally weighted scatter plot smoother curve, with weights assigned based on the population of each country. Furthermore, this study projected liver disease-related mortality rates up to 2050 using a Bayesian age-period-cohort (BAPC) model. Additionally, a decomposition analysis was conducted to discern influencing factors such as population growth, aging, and epidemiological changes.

RESULTS

The estimated global age-standardized liver disease-related mortality rates surged significantly from 1990 to 2021 across 112 countries, rising from 103.4 deaths per 1,000,000 people (95% confidence interval [CI], 88.16, 118.74) in 1990 to 173.0 deaths per 1,000,000 people (95% CI, 155.15, 190.95) in 2021. This upward trend was particularly pronounced in low- and middle-income countries, in Africa, and in populations aged 65 years and older. Moreover, age-standardized liver disease-related mortality rates were correlated with a lower Human Development Index (P < 0.001) and sociodemographic index (P = 0.001). According to the BAPC model, the projected trend indicated a sustained and substantial decline in liver disease-related mortality rates, with an estimated decrease from 185.08 deaths per 1,000,000 people (95% CI, 179.79, 190.63) in 2021 to 156.29 (112.32, 214.77) in 2050. From 1990 to 2021, age-standardized liver disease-related deaths surged primarily due to epidemiological changes, whereas from 1990 to 2050, the impact of population aging and growth became the primary contributing factors to the overall increase.

CONCLUSION

Global age-standardized liver disease-related mortality has increased significantly and continues to emerge as a crucial global public health issue. Further investigation into liver disease-related mortality rates in Africa is needed, and updating policies is necessary to effectively manage the global burden of liver disease.

Clinical outcomes of untreated adults living with chronic hepatitis B in The Gambia: an analysis of data from the prospective PROLIFICA cohort study

BACKGROUND

Expanding antiviral therapy to people with chronic hepatitis B virus (HBV) infection who are ineligible to receive treatment under current international criteria has been increasingly debated. Evidence to support this approach is scarce, especially in Africa. We aimed to address this knowledge gap by analysing the clinical outcomes of people with chronic hepatitis B in The Gambia who were untreated and ineligible for antiviral therapy at diagnosis.

METHODS

Between Dec 7, 2011, and Jan 24, 2014, we implemented the prospective PROLIFICA cohort study in The Gambia. Participants with chronic hepatitis B aged 16 years or older were recruited after large-scale, community-based HBV screening; blood bank-based HBV screening in Edward Francis Small Teaching Hospital, Banjul; and prospective follow-up of HBsAg-positive individuals via historical, population-based HBsAg serosurveys in two rural villages (Keneba and Manduar). Participants underwent HBV serology and other laboratory tests, fasting FibroScan, and abdominal ultrasound. Survival data were collected between Dec 7, 2011, and Aug 17, 2021. Between Oct 9, 2018, and Aug 17, 2021, all HBsAg-positive participants enrolled in the 2011-14 cohort were invited for a reassessment. For this analysis, we included HBsAg-positive people and excluded all participants who were eligible for treatment according to the 2012 European Association for the Study of the Liver (EASL) criteria at baseline and those who were treated irrespective of treatment eligibility. The primary outcome was all-cause mortality, assessed in all treatment-ineligible and treatment-naive participants with follow-up data. The secondary outcome, analysed in those who were reassessed, was disease progression, defined as becoming eligible for antivirals per 2017 EASL criteria; having an increase in liver fibrosis of at least one stage; or having a clinical diagnosis of hepatic decompensation or hepatocellular carcinoma.

FINDINGS

943 HBsAg-positive people with chronic hepatitis B were recruited to the PROLIFICA study. Of these 943, 58 (6%) fulfilled 2012 EASL treatment eligibility criteria at baseline, 35 (4%) were ineligible for treatment but received antiviral therapy, and 44 (5%) were immediately lost to follow-up. Thus, 806 (85%) participants were analysed for the primary outcome (486 [60%] were male and 320 [40%] were female). After a median follow-up of 6·11 years (IQR 5·34-6·80), 708 (88%) participants were confirmed to be alive at last surveillance, 71 (9%) were lost to follow-up and were censored, and 27 (3%) died, giving an all-cause mortality rate of 582 per 100 000 person-years (95% CI 399-849). Of the 27 people who died, five (19%) had liver-related deaths. Of 708 participants confirmed to be alive, 544 (77%) attended follow-up and were assessed for the secondary outcome. Disease progression occurred in 36 (7%) participants: five (1%) became newly eligible for antiviral therapy per EASL 2017 criteria without liver fibrosis progression; 18 (3%) had liver fibrosis progression alone; 13 (2%) had liver fibrosis progression and newly fulfilled the treatment criteria; and none had hepatic decompensation or developed hepatocellular carcinoma. In multivariable analysis adjusted for sex and age, only a baseline HBV DNA of 20 000 IU/mL or more, compared with the baseline HBV DNA of 2000 IU/mL or lower as the reference, was significantly associated with liver disease progression (odds ratio 5·39, 95% CI 1·37-21·23).

INTERPRETATION

Among people with chronic hepatitis B who were ineligible for antiviral therapy in The Gambia, all-cause mortality and liver disease progression were low. The clinical benefit of expanding antiviral therapy in this subgroup of patients remains uncertain.

FUNDING

European Commission, Medical Research Council UK Research and Innovation, and Gilead Sciences.

Treatment decisions based on HBV DNA

The most common cause of hepatocellular carcinoma (HCC) worldwide is chronic hepatitis B virus (HBV) infection (CHB). Long-term suppression of HBV replication by antiviral treatment reduces the risk of HCC and mortality. Nonetheless, only 2.2% of CHB patients globally received the treatment in 2019. Current international CHB guidelines recommend antiviral treatment only in subsets of patients with clear evidence of liver damage as evidenced by elevation of alanine aminotransferase (ALT). This review aims to provide existing evidence that the risk of HCC is significantly associated with serum levels of HBV DNA, and the association is non-linear parabolic, in both untreated and treated CHB patients, regardless of HBeAg status or ALT levels. Therefore, the decision for the antiviral treatment should be based on serum HBV DNA levels and age, rather than ALT levels or liver biopsy, to reduce or prevent the risk of HCC in CHB patients. The potential impact and cost-effectiveness data on early antiviral treatment initiation were also collated.

Global elimination of HBV: Is it really achievable?

Hepatitis B virus (HBV) infection is a major cause of premature death worldwide. In 2016, the World Health Organization (WHO) called for HBV elimination and set up very ambitious elimination targets. The development of effective vaccines, accurate diagnostic tools and safe antiviral drugs make HBV elimination a realistic goal. However, the most constrained-resource regions, which bear the highest burden of HBV, are facing major challenges in implementing strategies to reduce HBV incidence and mortality. Developing simplified approaches adapted to resource-limited settings and scaling up interventions for the prevention and control of HBV globally are urgently needed. Whether HBV elimination will be achieved in an equitable manner and in a reasonable timeframe remains highly uncertain.

Diversity, geographical distribution and predictive factors of Hepatitis C virus genotypes and subtypes in Rwanda

BACKGROUND

Existing data on the prevalence of hepatitis C virus (HCV) genotypes and subtypes in Rwanda need to be strengthened. The aim of this study was to identify HCV genotypes and subtypes among HCV-infected patients, as well as their geographical distribution in Rwanda, and to identify the social and economic factors that could influence HCV epidemiology which would make it possible to target national preventive and management actions for infected patients.

METHODS

This study included 560 patients with confirmed chronic HCV infection. Patients were recruited from various health facilities in the four provinces of Rwanda as well as in the City of Kigali and had never received treatment with direct-acting antiviral (DAAs). HCV viral loads were measured using Cobas® AmpliPrep/Cobas® TaqMan® HCV Quantitative Test, version 2.0. HCV genotyping was performed using an in-house sequencing protocol targeting the NS5B central region. Genotypic HCV prevalence was correlated with patient geographic location, sociodemographic, behavioral, lifestyle, and clinical factors.

RESULTS

HCV genotype 4 was detected in 99.3% of the patients, while genotype 3 was identified in 0.7%. A total of eight (8) HCV subtypes were detected, with 4k being the predominant subtype nationwide (49.5%), followed by subtypes 4r (21.2%), 4q (16.2%), 4v (7.9%), 4b (2.0%), 4l (1.8%), 4c and 3h represent 0.7% each. Our findings reveal subtype distribution variations among provinces. Subtype 4k was prevalent across regions, particularly in Kigali (64.0%) and the Eastern Province (61.6%). Subtype 4q was more common in the northern province (40.7%), 4r in the southern (43.9%) and western provinces (37.1%), and 4v in the eastern province (17.8%). Farmers exhibit a distinct infection profile compared to other occupations, showing a lower prevalence of subtype 4k but a higher prevalence of subtype 4r.

CONCLUSIONS

Our study revealed that HCV infection is unevenly distributed in Rwanda, dominated by HCV genotype 4, with considerable heterogeneity in the repartition of the different subtypes. We found potential associations between rural/urban lifestyles and HCV subtype profiles. Determined HCV distribution and diversity can serve as basis not only for HCV infection awareness and prevention campaigns, but also success and guidance for personalized treatment.

Recompensation of Chronic Hepatitis C-Related Decompensated Cirrhosis Following Direct-Acting Antiviral Therapy: Prospective Cohort Study From a Hepatitis C Virus Elimination Program

BACKGROUND & AIMS

Chronic hepatitis C-related decompensated cirrhosis is associated with lower sustained virologic response (SVR)-12 rates and variable regression of disease severity after direct-acting antiviral agents. We assessed rates of SVR-12, recompensation (Baveno VII criteria), and survival in such patients.

METHODS

Between July 2018 and July 2023, patients with decompensated chronic hepatitis C-related cirrhosis after direct-acting antiviral agents treatment were evaluated for SVR-12 and then had 6-monthly follow-up.

RESULTS

Of 6516 patients with cirrhosis, 1152 with decompensated cirrhosis (age 53.2 ± 11.5 years; 63% men; Model for End-stage Liver Disease-Sodium [MELD-Na]: 16.5 ± 4.6; 87% genotype 3) were enrolled. SVR-12 was 81.8% after 1 course; ultimately SVR was 90.8% after additional treatment. Decompensation events included ascites (1098; 95.3%), hepatic encephalopathy (191; 16.6%), and variceal bleeding (284; 24.7%). Ascites resolved in 86% (diuretic withdrawal achieved in 24% patients). Recompensation occurred in 284 (24.7%) at a median time of 16.5 (interquartile range, 14.5-20.5) months. On multivariable Cox proportional hazards analysis, low bilirubin (adjusted hazard ratio [aHR], 0.6; 95% confidence interval [CI], 0.5-0.8; P < 0.001), international normalized ratio (aHR, 0.2; 95% CI, 0.1-0.3; P < 0.001), absence of large esophageal varices (aHR, 0.4; 95% CI, 0.2-0.9; P = 0.048), or gastric varices (aHR, 0.5; 95% CI, 0.3-0.7; P = 0.022) predicted recompensation. Portal hypertension progressed in 158 (13.7%) patients, with rebleed in 4%. Prior decompensation with variceal bleeding (aHR, 1.6; 95% CI, 1.2-2.8; P = 0.042), and presence of large varices (aHR, 2.9; 95% CI, 1.3-6.5; P < 0.001) were associated with portal hypertension progression. Further decompensation was seen in 221 (19%); 145 patients died and 6 underwent liver transplantation. A decrease in MELDNa of ≥3 was seen in 409 (35.5%) and a final MELDNa score of <10 was seen in 335 (29%), but 2.9% developed hepatocellular carcinoma despite SVR-12.

CONCLUSIONS

SVR-12 in hepatitis C virus-related decompensated cirrhosis in a predominant genotype 3 population led to recompensation in 24.7% of patients over a follow-up of 4 years in a public health setting. Despite SVR-12, new hepatic decompensation evolved in 19% and hepatocellular carcinoma developed in 2.9% of patients. (ClinicalTrials.gov, Number: NCT03488485).

Effectiveness of sofosbuvir-based treatments for patients with hepatitis C virus genotype 6 infection: a real-world study from East China

Background

Over the past decade, the proportion of hepatitis C virus (HCV) genotypes (GT) 1 and 2 has decreased in almost all regions of China, while GT 3 and 6 have emerged as new challenges. GT 6 is unique in many respects, like high genetic variability and emerging resistant variants. This study aims to assess the efficacy of sofosbuvir (SOF)-based treatments in patients with GT 6 chronic hepatitis C (CHC).

Methods

A retrospective analysis was conducted on patients with GT 6 HCV infection, who were diagnosed between July 2018 and May 2023. All patients received a 12-week course of SOF-based treatments. The primary efficacy endpoint was sustained virologic response (SVR), which is defined as having undetectable HCV RNA at 12 weeks after treatment completion (SVR12). The efficacy data for SVR12 were analyzed using both the evaluated population (EP) and per-protocol population (PP). For the PP populations, efficacy data were stratified using Forrester plots.

Results

A total of 201 patients were included in the study. In PP population, the end of treatment virological response rate was 99.48% (190/191), the SVR12 rate was 99.31% (143/144), and the SVR24 rate was 100.00% (75/75). Only one patient with genotype 6a experienced a relapse 12 weeks after the completion of treatment, but her HCV RNA was undetectable both at the end of treatment and 24 weeks after the end of treatment. Additionally, the normalization rates of alanine transaminase (ALT) and aspartate aminotransferase (AST) were significantly higher at the end of treatment (EOT) compared to baseline (27.36% vs. 93.03%, 36.32% vs. 95.02%, p < 0.001). Significant improvements were observed in the levels of total bilirubin, ALT, AST, albumin, globulin, albumin/globulin ratio, gamma-glutamyl transferase, alkaline phosphatase, platelet, fibrosis-4 (FIB-4), and aspartate transaminase to platelet ratio index (APRI) between baseline and EOT (p < 0.05).

Conclusion

SOF-based treatments achieved high virological and biochemical response rates in patients with HCV GT 6 infection.

Elimination of HCV Infection: Recent Epidemiological Findings, Barriers, and Strategies for the Coming Years

Hepatitis C is a disease for which in approximately 30 years we have gone from the discovery of the causative agent in 1989, to the introduction of direct-acting antiviral (DAAs) therapies starting from 2011, and to a proposal for its elimination in 2016, with some countries being on track for this goal. Elimination efforts, in the absence of a vaccine, rely on prevention measures and antiviral therapies. However, treatment rates have declined in recent years and are not considered adequate to achieve this goal at a global level. This poses a great epidemiological challenge, as HCV in many countries still causes a significant burden and most infected people are not yet diagnosed. Consequently, efforts are needed at different levels with common purposes: to facilitate access to screening and diagnosis and to improve linkage to care pathways. In this review, we discuss the latest epidemiological findings on HCV infection, the obstacles to its elimination, and strategies that are believed to be useful to overcome these obstacles but are applied unevenly across the world.

One-step, rapid, nanoparticle-based biosensor platform for the simultaneous identification of hepatitis B virus and hepatitis C virus in clinical applications

OBJECTIVES

Viral hepatitis caused by hepatitis B virus (HBV) and hepatitis C virus (HCV) infections remain a major global public health challenge, particularly in low- and middle-income countries. It is crucial to utilize a pointof-care (POC) testing platform that is sensitive, specific, rapid, and user-friendly for screening and diagnosis of the two infections. Here, a novel molecular diagnostic assay, integrating multiplex loop-mediated isothermal amplification with a gold nanoparticle-based lateral flow biosensor (mLAMP-AuNPs-LFB) was developed and applied for one-step, visual, rapid, sensitive, and specific identification of HBV and HCV.

METHODS

The AuNPs-based LFB was devised and constructed for the simultaneous detection of HBV and HCV. The HBV-LAMP and HCV-LAMP primers were designed against the S and 5'-untranslated region (5'-UTR) genes from the major HBV genotypes (B, C, D, B/C recombinant, and C/D recombinant) and HCV subtypes (1b, 2a, 3a, 3b, and 6a) in China, respectively. Our assay conditions, both multiplex-LAMP amplification temperature and time were optimized. The sensitivity and specificity of our assay were tested, and the feasibility of our assay was verified through clinical samples.

RESULTS

The AuNPs-based LFB used here was successfully manufactured according to our devise manual. The two unique independent primer pairs were successfully designed based on the S and 5'-UTR genes, respectively. The optimal mLAMP-AuNPs-LFB detection process, involving rapid nucleic acid isolation (10 min), mLAMP (63 °C for 35 min), and visual AuNPs-LFB interpretation (less than 2 min), could be completed within 50 min. The HBV&HCV-mLAMP-AuNPs-LFB assay can detect the target genes (HBV-S and HCV-5'-UTR) with as low as 20 copies of plasmid template per test, and the specificity was 100% for the experimental pathogens.

CONCLUSIONS

The preliminary results manifested that our mLAMP-AuNPs-LFB assay is a valuable tool and has tremendous potential as a POC testing approach for HBV and HCV identification, especially in undeveloped regions.