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Elias KM, Khan SR, Stadler E, Schlub TE, Cromer D, Polizzotto MN, Kent SJ, Turner T, Davenport MP, Khoury DS. Viral clearance as a surrogate of clinical efficacy for COVID-19 therapies in outpatients: a systematic review and meta-analysis. THE LANCET. MICROBE 2024; 5:e459-e467. [PMID: 38583464 DOI: 10.1016/s2666-5247(23)00398-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 04/09/2024]
Abstract
BACKGROUND Surrogates of antiviral efficacy are needed for COVID-19. We aimed to investigate the relationship between the virological effect of treatment and clinical efficacy as measured by progression to severe disease in outpatients treated for mild-to-moderate COVID-19. METHODS In this systematic review and meta-analysis, we searched PubMed, Scopus, and medRxiv from database inception to Aug 16, 2023, for randomised placebo-controlled trials that tested virus-directed treatments (ie, any monoclonal antibodies, convalescent plasma, or antivirals) in non-hospitalised individuals with COVID-19. We only included studies that reported both clinical outcomes (ie, rate of disease progression to hospitalisation or death) and virological outcomes (ie, viral load within the first 7 days of treatment). We extracted summary data from eligible reports, with discrepancies resolved through discussion. We used an established meta-regression model with random effects to assess the association between clinical efficacy and virological treatment effect, and calculated I2 to quantify residual study heterogeneity. FINDINGS We identified 1718 unique studies, of which 22 (with a total of 16 684 participants) met the inclusion criteria, and were in primarily unvaccinated individuals. Risk of bias was assessed as low in 19 of 22 studies for clinical outcomes, whereas for virological outcomes, a high risk of bias was assessed in 11 studies, some risk in ten studies, and a low risk in one study. The unadjusted relative risk of disease progression for each extra log10 copies per mL reduction in viral load in treated compared with placebo groups was 0·12 (95% CI 0·04-0·34; p<0·0001) on day 3, 0·20 (0·08-0·50; p=0·0006) on day 5, and 0·53 (0·30-0·94; p=0·030) on day 7. The residual heterogeneity in our meta-regression was estimated as low (I2=0% [0-53] on day 3, 0% [0-71] on day 5, and 0% [0-43] on day 7). INTERPRETATION Despite the aggregation of studies with differing designs, and evidence of risk of bias in some virological outcomes, this review provides evidence that treatment-induced acceleration of viral clearance within the first 5 days after treatment is a potential surrogate of clinical efficacy to prevent hospitalisation with COVID-19. This work supports the use of viral clearance as an early phase clinical trial endpoint of therapeutic efficacy. FUNDING Australian Government Department of Health, Medical Research Future Fund, and Australian National Health and Medical Research Council.
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Affiliation(s)
- Karen M Elias
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Shanchita R Khan
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Eva Stadler
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Timothy E Schlub
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Deborah Cromer
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mark N Polizzotto
- Clinical Hub for Interventional Research and John Curtin School of Medical Research, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia; Canberra Regional Cancer Centre, The Canberra Hospital, Canberra, ACT, Australia
| | - Stephen J Kent
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Melbourne Sexual Health Centre and Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Tari Turner
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Miles P Davenport
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - David S Khoury
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
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Zhou XJ, Good SS, Pietropaolo K, Huang Q, Moussa A, Hammond JM, Sommadossi JP. Bemnifosbuvir (BEM, AT-527), a novel nucleotide analogue inhibitor of the hepatitis C virus NS5B polymerase. Expert Opin Investig Drugs 2024; 33:9-17. [PMID: 38265202 DOI: 10.1080/13543784.2024.2305137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/10/2024] [Indexed: 01/25/2024]
Abstract
INTRODUCTION Chronic hepatitis C virus (HCV) persists as a public health concern worldwide. Consequently, optimizing HCV therapy remains an important objective. While current therapies are generally highly effective, advanced antiviral agents are needed to maximize cure rates with potentially shorter treatment durations in a broader patient population, particularly those patients with advanced diseases who remain difficult to treat. AREAS COVERED This review summarizes the in vitro anti-HCV activity, preclinical pharmacological properties of bemnifosbuvir (BEM, AT-527), a novel prodrug that is metabolically converted to AT-9010, the active guanosine triphosphate analogue that potently and selectively inhibits several viral RNA polymerases, including the HCV NS5B polymerase. Results from clinical proof-of-concept and phase 2 combination studies are also discussed. EXPERT OPINION BEM exhibits potent pan-genotype activity against HCV, and has favorable safety, and drug interaction profiles. BEM is approximately 10-fold more potent than sofosbuvir against HCV genotypes (GT) tested in vitro. When combined with a potent NS5A inhibitor, BEM is expected to be a promising once-daily oral antiviral for chronic HCV infection of all genotypes and fibrosis stages with potentially short treatment durations.
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Affiliation(s)
- Xiao-Jian Zhou
- Departments of Preclinical and Clinical Development, Atea Pharmaceuticals, Boston, MA, USA
| | - Steven S Good
- Departments of Preclinical and Clinical Development, Atea Pharmaceuticals, Boston, MA, USA
| | - Keith Pietropaolo
- Departments of Preclinical and Clinical Development, Atea Pharmaceuticals, Boston, MA, USA
| | - Qi Huang
- Departments of Preclinical and Clinical Development, Atea Pharmaceuticals, Boston, MA, USA
| | - Adel Moussa
- Departments of Preclinical and Clinical Development, Atea Pharmaceuticals, Boston, MA, USA
| | - Janet Mj Hammond
- Departments of Preclinical and Clinical Development, Atea Pharmaceuticals, Boston, MA, USA
| | - Jean-Pierre Sommadossi
- Departments of Preclinical and Clinical Development, Atea Pharmaceuticals, Boston, MA, USA
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Sharma R, Bhattu M, Tripathi A, Verma M, Acevedo R, Kumar P, Rajput VD, Singh J. Potential medicinal plants to combat viral infections: A way forward to environmental biotechnology. ENVIRONMENTAL RESEARCH 2023; 227:115725. [PMID: 37001848 DOI: 10.1016/j.envres.2023.115725] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/15/2023] [Accepted: 03/18/2023] [Indexed: 05/08/2023]
Abstract
The viral diseases encouraged scientific community to evaluate the natural antiviral bioactive components rather than protease inhibitors, harmful organic molecules or nucleic acid analogues. For this purpose, medicinal plants have been gaining tremendous importance in the field of attenuating the various kinds of infectious and non-infectious diseases. Most of the commonly used medicines contains the bioactive components/phytoconstituents that are generally extracted from medicinal plants. Moreover, the medicinal plants offer many advantages for the recovery applications of infectious disease especially in viral infections including HIV-1, HIV-2, Enterovirus, Japanese Encephalitis Virus, Hepatitis B virus, Herpes Virus, Respiratory syncytial virus, Chandipura virus and Influenza A/H1N1. Considering the lack of acceptable drug candidates and the growing antimicrobial resistance to existing drug molecules for many emerging viral diseases, medicinal plants may offer best platform to develop sustainable/efficient/economic alternatives against viral infections. In this regard, for exploring and analyzing large volume of scientific data, bibliometric analysis was done using VOS Viewer shedding light on the emerging areas in the field of medicinal plants and their antiviral activity. This review covers most of the plant species that have some novel bioactive compound like gnidicin, gniditrin, rutin, apigenin, quercetin, kaempferol, curcumin, tannin and oleuropin which showed high efficacy to inhibit the several disease causing virus and their mechanism of action in HIV, Covid-19, HBV and RSV were discussed. Moreover, it also delves the in-depth mechanism of medicinal with challenges and future prospective. Therefore, this work delves the key role of environment in the biological field.
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Affiliation(s)
- Rhydum Sharma
- University Centre for Research and Development, Chandigarh University, Mohali, 140413, Punjab, India
| | - Monika Bhattu
- Department of Chemistry, University Centre for Research and Development, Chandigarh University, Mohali, Punjab, 140413, India
| | - Ashutosh Tripathi
- University Centre for Research and Development, Chandigarh University, Mohali, 140413, Punjab, India
| | - Meenakshi Verma
- Department of Chemistry, University Centre for Research and Development, Chandigarh University, Mohali, Punjab, 140413, India.
| | - Roberto Acevedo
- San Sebastián University, Campus Bellavista 7, Santiago, Chile
| | - Pradeep Kumar
- Department of Botany, MMV, Banaras Hindu University, Varanasi, 221005, India
| | - Vishnu D Rajput
- Academy of Biology and Biotechnology, Southern Federal University, Rostov-on-Don, 344090, Russia
| | - Jagpreet Singh
- Department of Chemistry, University Centre for Research and Development, Chandigarh University, Mohali, Punjab, 140413, India.
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El Messaoudi S, Lemenuel-Diot A, Gonçalves A, Guedj J. A Semi-mechanistic Model to Characterize the Long-Term Dynamics of Hepatitis B Virus Markers During Treatment With Lamivudine and Pegylated Interferon. Clin Pharmacol Ther 2023; 113:390-400. [PMID: 36408671 DOI: 10.1002/cpt.2798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/07/2022] [Indexed: 11/22/2022]
Abstract
Antiviral treatments against hepatitis B virus (HBV) suppress viral replication but do not eradicate the virus, and need therefore to be taken lifelong to avoid relapse. Mathematical models can be useful to support the development of curative anti-HBV agents; however, they mostly focus on short-term HBV DNA data and neglect the complex host-pathogen interaction. This work aimed to characterize the effect of treatment with lamivudine and/or pegylated interferon (Peg-IFN) in 1,300 patients (hepatitis B envelope antigen (HBeAg)-positive and HBeAg-negative) treated for 1 year. A mathematical model was developed incorporating two populations of infected cells, namely I 1 , with a high transcriptional activity, that progressively evolve into I 2 , at a rate δ tr , representing cells with integrated HBV DNA that have a lower transcriptional activity. Parameters of the model were estimated in patients treated with lamivudine or Peg-IFN alone (N = 894), and the model was then validated in patients treated with lamivudine plus Peg-IFN (N = 436) to predict the virological response after a year of combination treatment. Lamivudine had a larger effect in blocking viral production than Peg-IFN (99.4-99.9% vs. 91.8-95.1%); however, Peg-IFN had a significant immunomodulatory effect, leading to an enhancement of the loss rates of I 1 (×1.7 in HBeAg-positive patients), I 2 (> ×7 irrespective of HBeAg status), and δ tr (×4.6 and ×2.0 in HBeAg-positive and HBeAg-negative patients, respectively). Using this model, we were able to describe the synergy of the different effects occurring during treatment with combination and predicted an effect of 99.99% on blocking viral production. This framework can therefore support the optimization of combination therapy with new anti-HBV agents.
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Affiliation(s)
- Selma El Messaoudi
- Université Paris Cité, Institut National de la Santé et de la Recherche Médicale, Infection, Antimicrobials, Modelling, Evolution, Paris, France
| | - Annabelle Lemenuel-Diot
- Pharmaceutical Sciences, Roche Pharmaceutical Research and Early Development, Roche Innovation Center, Basel, Switzerland
| | - Antonio Gonçalves
- Université Paris Cité, Institut National de la Santé et de la Recherche Médicale, Infection, Antimicrobials, Modelling, Evolution, Paris, France
| | - Jérémie Guedj
- Université Paris Cité, Institut National de la Santé et de la Recherche Médicale, Infection, Antimicrobials, Modelling, Evolution, Paris, France
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Flower B, Hung LM, Mccabe L, Ansari MA, Le Ngoc C, Vo Thi T, Vu Thi Kim H, Nguyen Thi Ngoc P, Phuong LT, Quang VM, Dang Trong T, Le Thi T, Nguyen Bao T, Kingsley C, Smith D, Hoglund RM, Tarning J, Kestelyn E, Pett SL, van Doorn R, Van Nuil JI, Turner H, Thwaites GE, Barnes E, Rahman M, Walker AS, Day JN, Chau NVV, Cooke GS. Efficacy of ultra-short, response-guided sofosbuvir and daclatasvir therapy for hepatitis C in a single-arm mechanistic pilot study. eLife 2023; 12:e81801. [PMID: 36622106 PMCID: PMC9870305 DOI: 10.7554/elife.81801] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/23/2022] [Indexed: 01/10/2023] Open
Abstract
Background World Health Organization has called for research into predictive factors for selecting persons who could be successfully treated with shorter durations of direct-acting antiviral (DAA) therapy for hepatitis C. We evaluated early virological response as a means of shortening treatment and explored host, viral and pharmacokinetic contributors to treatment outcome. Methods Duration of sofosbuvir and daclatasvir (SOF/DCV) was determined according to day 2 (D2) virologic response for HCV genotype (gt) 1- or 6-infected adults in Vietnam with mild liver disease. Participants received 4- or 8-week treatment according to whether D2 HCV RNA was above or below 500 IU/ml (standard duration is 12 weeks). Primary endpoint was sustained virological response (SVR12). Those failing therapy were retreated with 12 weeks SOF/DCV. Host IFNL4 genotype and viral sequencing was performed at baseline, with repeat viral sequencing if virological rebound was observed. Levels of SOF, its inactive metabolite GS-331007 and DCV were measured on days 0 and 28. Results Of 52 adults enrolled, 34 received 4 weeks SOF/DCV, 17 got 8 weeks and 1 withdrew. SVR12 was achieved in 21/34 (62%) treated for 4 weeks, and 17/17 (100%) treated for 8 weeks. Overall, 38/51 (75%) were cured with first-line treatment (mean duration 37 days). Despite a high prevalence of putative NS5A-inhibitor resistance-associated substitutions (RASs), all first-line treatment failures cured after retreatment (13/13). We found no evidence treatment failure was associated with host IFNL4 genotype, viral subtype, baseline RAS, SOF or DCV levels. Conclusions Shortened SOF/DCV therapy, with retreatment if needed, reduces DAA use in patients with mild liver disease, while maintaining high cure rates. D2 virologic response alone does not adequately predict SVR12 with 4-week treatment. Funding Funded by the Medical Research Council (Grant MR/P025064/1) and The Global Challenges Research 70 Fund (Wellcome Trust Grant 206/296/Z/17/Z).
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Affiliation(s)
- Barnaby Flower
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
- Department of Infectious Disease, Imperial College LondonLondonUnited Kingdom
| | - Le Manh Hung
- Hospital for Tropical DiseasesHo Chi Minh CityVietnam
| | - Leanne Mccabe
- MRC Clinical Trials Unit at UCL, University College LondonLondonUnited Kingdom
| | - M Azim Ansari
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Chau Le Ngoc
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
| | - Thu Vo Thi
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
| | - Hang Vu Thi Kim
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
| | | | | | - Vo Minh Quang
- Hospital for Tropical DiseasesHo Chi Minh CityVietnam
| | | | - Thao Le Thi
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
| | - Tran Nguyen Bao
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
| | - Cherry Kingsley
- Department of Infectious Disease, Imperial College LondonLondonUnited Kingdom
| | - David Smith
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Richard M Hoglund
- Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Faculty of Tropical MedicineBangkokThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford UniversityOxfordUnited Kingdom
| | - Joel Tarning
- Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Faculty of Tropical MedicineBangkokThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford UniversityOxfordUnited Kingdom
| | - Evelyne Kestelyn
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford UniversityOxfordUnited Kingdom
| | - Sarah L Pett
- MRC Clinical Trials Unit at UCL, University College LondonLondonUnited Kingdom
| | - Rogier van Doorn
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford UniversityOxfordUnited Kingdom
- Oxford University Clinical Research UnitHanoiVietnam
| | - Jennifer Ilo Van Nuil
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford UniversityOxfordUnited Kingdom
| | - Hugo Turner
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College LondonLondonUnited Kingdom
| | - Guy E Thwaites
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford UniversityOxfordUnited Kingdom
| | - Eleanor Barnes
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford UniversityOxfordUnited Kingdom
| | - Motiur Rahman
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford UniversityOxfordUnited Kingdom
| | - Ann Sarah Walker
- MRC Clinical Trials Unit at UCL, University College LondonLondonUnited Kingdom
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- The National Institute for Health Research, Oxford Biomedical Research Centre, University of OxfordOxfordUnited Kingdom
| | - Jeremy N Day
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford UniversityOxfordUnited Kingdom
| | | | - Graham S Cooke
- Department of Infectious Disease, Imperial College LondonLondonUnited Kingdom
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Delattre R, Seurat J, Haddad F, Nguyen TT, Gaborieau B, Kane R, Dufour N, Ricard JD, Guedj J, Debarbieux L. Combination of in vivo phage therapy data with in silico model highlights key parameters for pneumonia treatment efficacy. Cell Rep 2022; 39:110825. [PMID: 35584666 DOI: 10.1016/j.celrep.2022.110825] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 10/19/2021] [Accepted: 04/25/2022] [Indexed: 12/13/2022] Open
Abstract
The clinical (re)development of bacteriophage (phage) therapy to treat antibiotic-resistant infections faces the challenge of understanding the dynamics of phage-bacteria interactions in the in vivo context. Here, we develop a general strategy coupling in vitro and in vivo experiments with a mathematical model to characterize the interplay between phage and bacteria during pneumonia induced by a pathogenic strain of Escherichia coli. The model allows the estimation of several key parameters for phage therapeutic efficacy. In particular, it quantifies the impact of dose and route of phage administration as well as the synergism of phage and the innate immune response on bacterial clearance. Simulations predict a limited impact of the intrinsic phage characteristics in agreement with the current semi-empirical choices of phages for compassionate treatments. Model-based approaches will foster the deployment of future phage-therapy clinical trials.
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Affiliation(s)
- Raphaëlle Delattre
- Institut Pasteur, Université Paris Cité, CNRS UMR6047, Bacteriophage Bacterium Host, Paris 75015, France; Université Paris Cité, INSERM U1137, IAME, Paris 75006, France
| | - Jérémy Seurat
- Université Paris Cité, INSERM U1137, IAME, Paris 75006, France
| | - Feyrouz Haddad
- Institut Pasteur, Université Paris Cité, CNRS UMR6047, Bacteriophage Bacterium Host, Paris 75015, France; Université Paris Cité, INSERM U1137, IAME, Paris 75006, France
| | - Thu-Thuy Nguyen
- Université Paris Cité, INSERM U1137, IAME, Paris 75006, France
| | - Baptiste Gaborieau
- Institut Pasteur, Université Paris Cité, CNRS UMR6047, Bacteriophage Bacterium Host, Paris 75015, France; Université Paris Cité, INSERM U1137, IAME, Paris 75006, France; APHP, Hôpital Louis Mourier, DMU ESPRIT, Service de Médecine Intensive Réanimation, Colombes, France
| | - Rokhaya Kane
- Institut Pasteur, Université Paris Cité, CNRS UMR6047, Bacteriophage Bacterium Host, Paris 75015, France
| | - Nicolas Dufour
- Centre Hospitalier René Dubos, Médecine Intensive Réanimation, Cergy Pontoise 95503, France
| | - Jean-Damien Ricard
- Université Paris Cité, INSERM U1137, IAME, Paris 75006, France; APHP, Hôpital Louis Mourier, DMU ESPRIT, Service de Médecine Intensive Réanimation, Colombes, France
| | - Jérémie Guedj
- Université Paris Cité, INSERM U1137, IAME, Paris 75006, France.
| | - Laurent Debarbieux
- Institut Pasteur, Université Paris Cité, CNRS UMR6047, Bacteriophage Bacterium Host, Paris 75015, France.
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Four Weeks Treatment with Glecaprevir/Pibrentasvir + Ribavirin-A Randomized Controlled Clinical Trial. Viruses 2022; 14:v14030614. [PMID: 35337021 PMCID: PMC8948928 DOI: 10.3390/v14030614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/14/2022] [Indexed: 01/25/2023] Open
Abstract
Enhancing treatment uptake for hepatitis C to achieve the elimination goals set by the World Health Organization could be achieved by reducing the treatment duration. The aim of this study was to compare the sustained virological response at week 12 (SVR12) after four weeks of glecaprevir/pibrentasvir (GLE/PIB) + ribavirin compared to eight weeks of GLE/PIB and to estimate predictors for SVR12 with four weeks of treatment through a multicenter open label randomized controlled trial. Patients were randomized 2:1 (4 weeks:8 weeks) and stratified by genotype 3 and were treatment naïve of all genotypes and without significant liver fibrosis. A total of 27 patients were analyzed for predictors for SVR12, including 15 from the first pilot phase of the study. In the ‘modified intention to treat’ group, 100% (7/7) achieved cure after eight weeks and for patients treated for four weeks the SVR12 was 58.3% (7/12). However, patients with a baseline viral load <2 mill IU/mL had 93% SVR12. The study closed prematurely due to the low number of included patients due to the COVID-19 pandemic. Our results suggest that viral load should be taken into account when considering trials of short course treatment.
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Arya RK, Verros GD, Thapliyal D. Towards a Mathematical Model for the Viral Progression in the Pharynx. Healthcare (Basel) 2021; 9:healthcare9121766. [PMID: 34946492 PMCID: PMC8701019 DOI: 10.3390/healthcare9121766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/16/2021] [Accepted: 12/16/2021] [Indexed: 12/03/2022] Open
Abstract
In this work, a comprehensive model for the viral progression in the pharynx has been developed. This one-dimension model considers both Fickian diffusion and convective flow coupled with chemical reactions, such as virus population growth, infected and uninfected cell accumulation as well as virus clearance. The effect of a sterilizing agent such as an alcoholic solution on the viral progression in the pharynx was taken into account and a parametric analysis for the effect of kinetic rate parameters on virus propagation was made. Moreover, different conditions caused by further medical treatment, such as a decrease in virus yield per infected cell, were examined. It is shown that the infection fails to establish by decreasing the virus yield per infected cell. It is believed that this work could be used to further investigate the medical treatment of viral progression in the pharynx.
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Affiliation(s)
- Raj Kumar Arya
- Department of Chemical Engineering, Dr. B. R. Ambedkar National Institute of Technology, Jalandhar 144011, India;
- Correspondence: or
| | - George D. Verros
- Laboratory of Polymer and Colour Chemistry and Technology, Department of Chemistry, Aristotle University of Thessaloniki (AUTH), P.O. Box 454, Plagiari, Epanomi, 57500 Thessaloniki, Greece;
| | - Devyani Thapliyal
- Department of Chemical Engineering, Dr. B. R. Ambedkar National Institute of Technology, Jalandhar 144011, India;
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Reau N, Sulkowski MS, Thomas E, Sundaram V, Xu Q, Cheng WH, Marx SE, Hayes OA, Manthena SR, Chirikov V, Dylla DE, Brooks H, Carabino JM, Saab S. Epidemiology and Clinical Characteristics of Individuals with Hepatitis C Virus Infection in the United States, 2017-2019. Adv Ther 2021; 38:5777-5790. [PMID: 34704194 PMCID: PMC8548268 DOI: 10.1007/s12325-021-01928-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/17/2021] [Indexed: 12/12/2022]
Abstract
Introduction Hepatitis C virus (HCV) is the most common bloodborne chronic infection in the US. Following approval of highly effective, direct-acting antivirals in 2014, the diagnostic and treatment rates for HCV infection in the US have evolved. This study assessed the number of individuals with HCV screening or diagnostic testing and the clinical characteristics and treatment of HCV-infected individuals between 2017 and 2019. Methods Individuals screened for HCV antibody and/or tested for HCV ribonucleic acid (RNA) from 2017 to 2019 by two large US laboratory companies were included in this analysis. Clinical characteristics, such as HCV genotype, fibrosis stage, HIV coinfection and demographics, were assessed in HCV RNA-positive individuals. HCV treatment and subsequent achievement of sustained virologic response were imputed using data-driven algorithms based on successive viral load decline and negativity. Results From 2017 to 2019, the number of individuals tested for HCV antibody increased by 5.7%, from 7,580,303 in 2017 to 8,009,081 in 2019. The percentage of individuals tested who were HCV antibody positive was stable, ranging from 5.0% in 2017 to 4.9% in 2018 and 2019. The number of HCV RNA-positive individuals decreased by 5.0% from 382,500 in 2017 to 363,532 in 2019. Of HCV RNA-positive individuals, the proportions with genotype (GT) 3 and minimal fibrosis increased over time; proportions of individuals aged < 40 years increased, while the proportion aged 50 to 59 years decreased. Treatment rates increased from 23.4% in 2017 to 26.8% in 2019. Conclusions The percentage of HCV antibody-positive individuals remained stable from 2017 to 2019. The number of individuals tested HCV RNA positive decreased over the years. Demographics shifted toward a younger population with less fibrosis and higher rates of GT3. More than 70% of diagnosed individuals were not treated during this interval, highlighting a need for unfettered access to treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01928-y.
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Affiliation(s)
- Nancy Reau
- Rush University Medical Center, Chicago, IL, USA
| | | | - Emmanuel Thomas
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Vinay Sundaram
- Department of Medicine and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | | | | | | | | | | | | | | | - Sammy Saab
- UCLA Medical Center, 200 Medical Plaza Driveway, Los Angeles, CA, 90095, USA.
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10
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Shemesh M, Lochte S, Piehler J, Schreiber G. IFNAR1 and IFNAR2 play distinct roles in initiating type I interferon-induced JAK-STAT signaling and activating STATs. Sci Signal 2021; 14:eabe4627. [PMID: 34813358 DOI: 10.1126/scisignal.abe4627] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Maya Shemesh
- Department of Biomolecular Sciences, Weizmann Institute of Science, Rehovot, Israel
| | - Sara Lochte
- Department of Biology and Center of Cellular Nanoanalytics, University of Osnabrück, 49076 Osnabrück, Germany
| | - Jacob Piehler
- Department of Biology and Center of Cellular Nanoanalytics, University of Osnabrück, 49076 Osnabrück, Germany
| | - Gideon Schreiber
- Department of Biomolecular Sciences, Weizmann Institute of Science, Rehovot, Israel
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11
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Flower B, McCabe L, Le Ngoc C, Le Manh H, Le Thanh P, Dang Trong T, Vo Thi T, Vu Thi Kim H, Nguyen Tat T, Phan Thi Hong D, Nguyen Thi Chau A, Dinh Thi T, Tran Thi Tuyet N, Tarning J, Kingsley C, Kestelyn E, Pett SL, Thwaites G, Nguyen Van VC, Smith D, Barnes E, Ansari MA, Turner H, Rahman M, Walker AS, Day J, Cooke GS. High Cure Rates for Hepatitis C Virus Genotype 6 in Advanced Liver Fibrosis With 12 Weeks Sofosbuvir and Daclatasvir: The Vietnam SEARCH Study. Open Forum Infect Dis 2021; 8:ofab267. [PMID: 34337093 PMCID: PMC8320300 DOI: 10.1093/ofid/ofab267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/16/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Genotype 6 is the most genetically diverse lineage of hepatitis C virus, and it predominates in Vietnam. It can be treated with sofosbuvir with daclatasvir (SOF/DCV), the least expensive treatment combination globally. In regional guidelines, longer treatment durations of SOF/DCV (24 weeks) are recommended for cirrhotic individuals, compared with other pangenotypic regimens (12 weeks), based on sparse data. Early on-treatment virological response may offer means of reducing length and cost of therapy in patients with liver fibrosis. METHODS In this prospective trial in Vietnam, genotype 6-infected adults with advanced liver fibrosis or compensated cirrhosis were treated with SOF/DCV. Day 14 viral load was used to guide duration of therapy: participants with viral load <500 IU/mL at day 14 were treated with 12 weeks of SOF/DCV and those ≥500 IU/mL received 24 weeks. Primary endpoint was sustained virological response (SVR). RESULTS Of 41 individuals with advanced fibrosis or compensated cirrhosis who commenced treatment, 51% had genotype 6a and 34% had 6e. The remainder had 6h, 6k, 6l, or 6o. One hundred percent had viral load <500 IU/mL by day 14, meaning that all received 12 weeks of SOF/DCV. One hundred percent achieved SVR12 despite a high frequency of putative NS5A inhibitor resistance-associated substitutions at baseline. CONCLUSIONS Prescribing 12 weeks of SOF/DCV results in excellent cure rates in this population. These data support the removal of costly genotyping in countries where genotype 3 prevalence is <5%, in keeping with World Health Organization guidelines. NS5A resistance-associated mutations in isolation do not affect efficacy of SOF/DCV therapy. Wider evaluation of response-guided therapy is warranted.
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Affiliation(s)
- Barnaby Flower
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
- Department of Infectious Disease, Imperial College London, United Kingdom
| | - Leanne McCabe
- MRC Clinical Trials Unit at UCL, University College London, United Kingdom
| | - Chau Le Ngoc
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | - Hung Le Manh
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | | | - Thu Vo Thi
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | - Hang Vu Thi Kim
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | - Thanh Nguyen Tat
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | - Dao Phan Thi Hong
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | - An Nguyen Thi Chau
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | - Tan Dinh Thi
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | - Nga Tran Thi Tuyet
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | - Joel Tarning
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - Cherry Kingsley
- Department of Infectious Disease, Imperial College London, United Kingdom
| | - Evelyne Kestelyn
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | - Sarah L Pett
- MRC Clinical Trials Unit at UCL, University College London, United Kingdom
| | - Guy Thwaites
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | | | | | | | | | - Hugo Turner
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, United Kingdom
| | - Motiur Rahman
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | - Ann Sarah Walker
- Department of Infectious Disease, Imperial College London, United Kingdom
| | - Jeremy Day
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | - Graham S Cooke
- Department of Infectious Disease, Imperial College London, United Kingdom
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12
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Lim SY, Osuna CE, Best K, Taylor R, Chen E, Yoon G, Kublin JL, Schalk D, Schultz-Darken N, Capuano S, Safronetz D, Luo M, MacLennan S, Mathis A, Babu YS, Sheridan WP, Perelson AS, Whitney JB. A direct-acting antiviral drug abrogates viremia in Zika virus-infected rhesus macaques. Sci Transl Med 2021; 12:12/547/eaau9135. [PMID: 32522808 DOI: 10.1126/scitranslmed.aau9135] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 03/20/2020] [Indexed: 01/02/2023]
Abstract
Zika virus infection in humans has been associated with serious reproductive and neurological complications. At present, no protective antiviral drug treatment is available. Here, we describe the testing and evaluation of the antiviral drug, galidesivir, against Zika virus infection in rhesus macaques. We conducted four preclinical studies in rhesus macaques to assess the safety, antiviral efficacy, and dosing strategies for galidesivir (BCX4430) against Zika virus infection. We treated 70 rhesus macaques infected by various routes with the Puerto Rico or Thai Zika virus isolates. We evaluated galidesivir administered as early as 90 min and as late as 72 hours after subcutaneous Zika virus infection and as late as 5 days after intravaginal infection. We evaluated the efficacy of a range of galidesivir doses with endpoints including Zika virus RNA in plasma, saliva, urine, and cerebrospinal fluid. Galidesivir dosing in rhesus macaques was safe and offered postexposure protection against Zika virus infection. Galidesivir exhibited favorable pharmacokinetics with no observed teratogenic effects in rats or rabbits at any dose tested. The antiviral efficacy of galidesivir observed in the blood and central nervous system of infected animals warrants continued evaluation of this compound for the treatment of flaviviral infections.
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Affiliation(s)
- So-Yon Lim
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Christa E Osuna
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Katharine Best
- Merck Science Center, Cambridge, MA 02141, USA.,Los Alamos National Laboratory, Los Alamos, NM 87545, USA
| | - Ray Taylor
- BioCryst Pharmaceuticals, Birmingham, AL 35244, USA
| | - Elsa Chen
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Gyeol Yoon
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Jessica L Kublin
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Dane Schalk
- Wisconsin National Primate Research Center, Madison, WI 53715, USA
| | | | - Saverio Capuano
- Wisconsin National Primate Research Center, Madison, WI 53715, USA
| | - David Safronetz
- National Microbiology Laboratory, 1015 Arlington Street, Winnipeg, R3E 3R2 Manitoba, Canada
| | - Ma Luo
- National Microbiology Laboratory, 1015 Arlington Street, Winnipeg, R3E 3R2 Manitoba, Canada
| | | | | | | | | | | | - James B Whitney
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA. .,Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
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13
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Cosson V, Feng S, Jaminion F, Lemenuel-Diot A, Parrott N, Paehler A, Bo Q, Jin Y. How Semiphysiological Population Pharmacokinetic Modeling Incorporating Active Hepatic Uptake Supports Phase II Dose Selection of RO7049389, A Novel Anti-Hepatitis B Virus Drug. Clin Pharmacol Ther 2021; 109:1081-1091. [PMID: 33523474 PMCID: PMC8048879 DOI: 10.1002/cpt.2184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/16/2021] [Indexed: 01/17/2023]
Abstract
The pharmacokinetics (PK) of RO7049389, a new hepatitis B virus (HBV) core protein allosteric modulator of class I, and of its active metabolite M5 were studied in fasted and fed conditions after single and multiple once‐a‐day and twice‐a‐day doses in healthy subjects and patients with HBV. The nonlinearity of the pharmacokinetics, the large variability, the small sample size per dose arms, the higher plasma exposure in Asians, and the heterogeneity in patient baseline characteristics seen in phase I studies made the ethnic sensitivity assessment and the selection of the recommended phase II dose difficult. A population PK model, simultaneously modeling RO7049389 and M5, was developed to characterize the complex PK, quantify ethnicity (i.e., Asian vs. non‐Asian) and gender effects on the PK of RO7049389 and M5, and infer the quantity of RO7049389 in liver relative to plasma. Exposures in the liver are of particular importance for dose selection since the liver is the site of action of the compound. The model described and reproduced the population PK profiles as well as the between‐subject variability of RO7049389 and its metabolite. It could show that the PK is similar between healthy subjects and in HBV patients, once the ethnicity and gender effects are accounted for. The model predicts that, despite a large difference in the plasma exposure of RO7049389 between Asians and non‐Asians, the exposure in the liver is comparable, allowing the use of the same dose to treat Asian and non‐Asian patients. This model provides a valuable basis to develop this new anti‐HBV drug and to define optimal dosing.
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Affiliation(s)
- Valérie Cosson
- Pharmaceutical Sciences, Roche Pharma Research & Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Sheng Feng
- Pharmaceutical Sciences, Roche Pharma Research & Early Development, Roche Innovation Center Shanghai, Shanghai, China
| | - Felix Jaminion
- Pharmaceutical Sciences, Roche Pharma Research & Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Annabelle Lemenuel-Diot
- Pharmaceutical Sciences, Roche Pharma Research & Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Neil Parrott
- Pharmaceutical Sciences, Roche Pharma Research & Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Axel Paehler
- Pharmaceutical Sciences, Roche Pharma Research & Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Qingyan Bo
- Immunology, Infectious Diseases and Ophthalmology Discovery and Translational Area, Roche Pharma Research & Early Development, Roche Innovation Center Shanghai, Shanghai, China
| | - Yuyan Jin
- Pharmaceutical Sciences, Roche Pharma Research & Early Development, Roche Innovation Center Shanghai, Shanghai, China
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14
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Balagopal A, Smeaton LM, Quinn J, Venuto CS, Morse GD, Vu V, Alston-Smith B, Cohen DE, Santana-Bagur JL, Anthony DD, Sulkowski MS, Wyles DL, Talal AH. Intrahepatic Viral Kinetics During Direct-Acting Antivirals for Hepatitis C in Human Immunodeficiency Virus Coinfection: The AIDS Clinical Trials Group A5335S Substudy. J Infect Dis 2021; 222:601-610. [PMID: 32201883 DOI: 10.1093/infdis/jiaa126] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 03/20/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Direct-acting antivirals (DAAs) targeting hepatitis C virus (HCV) have revolutionized outcomes in human immunodeficiency virus (HIV) coinfection. METHODS We examined early events in liver and plasma through A5335S, a substudy of trial A5329 (paritaprevir/ritonavir, ombitasvir, dasabuvir, with ribavirin) that enrolled chronic genotype 1a HCV-infected persons coinfected with suppressed HIV: 5 of 6 treatment-naive enrollees completed A5335S. RESULTS Mean baseline plasma HCV ribonucleic acid (RNA) = 6.7 log10 IU/mL and changed by -4.1 log10 IU/mL by Day 7. In liver, laser capture microdissection was used to quantify HCV. At liver biopsy 1, mean %HCV-infected cells = 25.2% (95% confidence interval [CI], 7.4%-42.9%), correlating with plasma HCV RNA (Spearman rank correlation r = 0.9); at biopsy 2 (Day 7 in 4 of 5 participants), mean %HCV-infected cells = 1.0% (95% CI, 0.2%-1.7%) (P < .05 for change), and DAAs were detectable in liver. Plasma C-X-C motif chemokine 10 (CXCL10) concentrations changed by mean = -160 pg/mL per day at 24 hours, but no further after Day 4. CONCLUSIONS We conclude that HCV infection is rapidly cleared from liver with DAA leaving <2% HCV-infected hepatocytes at Day 7. We extrapolate that HCV eradication could occur in these participants by 63 days, although immune activation might persist. Single-cell longitudinal estimates of HCV clearance from liver have never been reported previously and could be applied to estimating the minimum treatment duration required for HCV infection.
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Affiliation(s)
- Ashwin Balagopal
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Laura M Smeaton
- Harvard T.H. Chan School of Public Health, Boston, Masachussetts, USA
| | - Jeffrey Quinn
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Charles S Venuto
- Center for Health + Technology, University of Rochester, Rochester, New York, USA
| | - Gene D Morse
- Center for Integrated Global Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Vincent Vu
- Harvard T.H. Chan School of Public Health, Boston, Masachussetts, USA
| | | | | | | | | | - Mark S Sulkowski
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David L Wyles
- University of Colorado School of Medicine, Denver, Colorado, USA
| | - Andrew H Talal
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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15
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Best K, Barouch DH, Guedj J, Ribeiro RM, Perelson AS. Zika virus dynamics: Effects of inoculum dose, the innate immune response and viral interference. PLoS Comput Biol 2021; 17:e1008564. [PMID: 33471814 PMCID: PMC7817008 DOI: 10.1371/journal.pcbi.1008564] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 11/27/2020] [Indexed: 12/11/2022] Open
Abstract
Experimental Zika virus infection in non-human primates results in acute viral load dynamics that can be well-described by mathematical models. The inoculum dose that would be received in a natural infection setting is likely lower than the experimental infections and how this difference affects the viral dynamics and immune response is unclear. Here we study a dataset of experimental infection of non-human primates with a range of doses of Zika virus. We develop new models of infection incorporating both an innate immune response and viral interference with that response. We find that such a model explains the data better than models with no interaction between virus and the immune response. We also find that larger inoculum doses lead to faster dynamics of infection, but approximately the same total amount of viral production. The relationship between the infecting dose of a pathogen and the subsequent viral dynamics is unclear in many disease settings, and this relationship has implications for both the timing and the required efficacy of antiviral therapy. Since experimental challenge studies often employ higher doses of virus than would generally be present in natural infection assessment of this relationship is particularly important for translation of findings. In this study we used mathematical modelling of viral load data from a multi-dose study of Zika virus infection in a macaque model to describe the impact of varying the dose of Zika virus on model parameters, and developed a novel mathematical model incorporating viral interference with the innate immune response.
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Affiliation(s)
- Katharine Best
- Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
| | - Dan H. Barouch
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, United States of America
| | | | - Ruy M. Ribeiro
- Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
- Laboratório de Biomatemática, Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Alan S. Perelson
- Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
- * E-mail:
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16
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Lingas G, Rosenke K, Safronetz D, Guedj J. Lassa viral dynamics in non-human primates treated with favipiravir or ribavirin. PLoS Comput Biol 2021; 17:e1008535. [PMID: 33411731 PMCID: PMC7817048 DOI: 10.1371/journal.pcbi.1008535] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 01/20/2021] [Accepted: 11/13/2020] [Indexed: 02/07/2023] Open
Abstract
Lassa fever is an haemorrhagic fever caused by Lassa virus (LASV). There is no vaccine approved against LASV and the only recommended antiviral treatment relies on ribavirin, despite limited evidence of efficacy. Recently, the nucleotide analogue favipiravir showed a high antiviral efficacy, with 100% survival obtained in an otherwise fully lethal non-human primate (NHP) model of Lassa fever. However the mechanism of action of the drug is not known and the absence of pharmacokinetic data limits the translation of these results to the human setting. Here we aimed to better understand the antiviral effect of favipiravir by developping the first mathematical model recapitulating Lassa viral dynamics and treatment. We analyzed the viral dynamics in 24 NHPs left untreated or treated with ribavirin or favipiravir, and we put the results in perspective with those obtained with the same drugs in the context of Ebola infection. Our model estimates favipiravir EC50 in vivo to 2.89 μg.mL-1, which is much lower than what was found against Ebola virus. The main mechanism of action of favipiravir was to decrease virus infectivity, with an efficacy of 91% at the highest dose. Based on our knowledge acquired on the drug pharmacokinetics in humans, our model predicts that favipiravir doses larger than 1200 mg twice a day should have the capability to strongly reduce the production infectious virus and provide a milestone towards a future use in humans.
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Affiliation(s)
| | - Kyle Rosenke
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, Montana, USA
| | - David Safronetz
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada.,Zoonotic Diseases and Special Pathogens, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
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17
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Hernandez-Vargas EA. Modeling Viral Infections. SYSTEMS MEDICINE 2021. [DOI: 10.1016/b978-0-12-801238-3.11620-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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18
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Affiliation(s)
- Nicholas A Meanwell
- Small Molecule Drug Discovery, Bristol Myers Squibb Research and Early Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Gunda I Georg
- College of Pharmacy, University of Minnesota, 717 Delaware Street SE, Minneapolis, Minnesota 55414, United States
| | - Shaomeng Wang
- University of Michigan, Departments of Internal Medicine, Pharmacology and Medicinal Chemistry and Michigan Center for Therapeutic Innovation, Ann Arbor, Michigan 48109, United States
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19
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Zitzmann C, Kaderali L, Perelson AS. Mathematical modeling of hepatitis C RNA replication, exosome secretion and virus release. PLoS Comput Biol 2020; 16:e1008421. [PMID: 33151933 PMCID: PMC7671504 DOI: 10.1371/journal.pcbi.1008421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/17/2020] [Accepted: 10/06/2020] [Indexed: 01/04/2023] Open
Abstract
Hepatitis C virus (HCV) causes acute hepatitis C and can lead to life-threatening complications if it becomes chronic. The HCV genome is a single plus strand of RNA. Its intracellular replication is a spatiotemporally coordinated process of RNA translation upon cell infection, RNA synthesis within a replication compartment, and virus particle production. While HCV is mainly transmitted via mature infectious virus particles, it has also been suggested that HCV-infected cells can secrete HCV RNA carrying exosomes that can infect cells in a receptor independent manner. In order to gain insight into these two routes of transmission, we developed a series of intracellular HCV replication models that include HCV RNA secretion and/or virus assembly and release. Fitting our models to in vitro data, in which cells were infected with HCV, suggests that initially most secreted HCV RNA derives from intracellular cytosolic plus-strand RNA, but subsequently secreted HCV RNA derives equally from the cytoplasm and the replication compartments. Furthermore, our model fits to the data suggest that the rate of virus assembly and release is limited by host cell resources. Including the effects of direct acting antivirals in our models, we found that in spite of decreasing intracellular HCV RNA and extracellular virus concentration, low level HCV RNA secretion may continue as long as intracellular RNA is available. This may possibly explain the presence of detectable levels of plasma HCV RNA at the end of treatment even in patients that ultimately attain a sustained virologic response. Approximately 70 million people are chronically infected with hepatitis C virus (HCV), which if left untreated may lead to cirrhosis and liver cancer. However, modern drug therapy is highly effective and hepatitis C is the first chronic virus infection that can be cured with short-term therapy in almost all infected individuals. The within-host transmission of HCV occurs mainly via infectious virus particles, but experimental studies suggest that there may be additional receptor-independent cell-to-cell transmission by exosomes that carry the HCV genome. In order to understand the intracellular HCV lifecycle and HCV RNA spread, we developed a series of mathematical models that take both exosomal secretion and viral secretion into account. By fitting these models to in vitro data, we found that secretion of both HCV RNA as well as virus probably occurs and that the rate of virus assembly is likely limited by cellular co-factors on which the virus strongly depends for its own replication. Furthermore, our modeling predicted that the parameters governing the processes in the viral lifecycle that are targeted by direct acting antivirals are the most sensitive to perturbations, which may help explain their ability to cure this infection.
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Affiliation(s)
- Carolin Zitzmann
- University Medicine Greifswald, Institute of Bioinformatics and Center for Functional Genomics of Microbes, Greifswald, Germany
- Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
| | - Lars Kaderali
- University Medicine Greifswald, Institute of Bioinformatics and Center for Functional Genomics of Microbes, Greifswald, Germany
| | - Alan S. Perelson
- Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
- * E-mail:
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20
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Martinello M, Orkin C, Cooke G, Bhagani S, Gane E, Kulasegaram R, Shaw D, Tu E, Petoumenos K, Marks P, Grebely J, Dore GJ, Nelson M, Matthews GV. Short-Duration Pan-Genotypic Therapy With Glecaprevir/Pibrentasvir for 6 Weeks Among People With Recent Hepatitis C Viral Infection. Hepatology 2020; 72:7-18. [PMID: 31652357 DOI: 10.1002/hep.31003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/21/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND AIMS Among treatment-naive individuals with chronic hepatitis C viral (HCV) infection and without cirrhosis, glecaprevir/pibrentasvir for 8 weeks is recommended. The aim of this analysis was to evaluate the efficacy of glecaprevir/pibrentasvir for 6 weeks in people with acute and recent HCV infection. APPROACH AND RESULTS In this open-label, single-arm, multicenter, international pilot study, adults with recent HCV (duration of infection < 12 months) received glecaprevir/pibrentasvir 300/120 mg daily for 6 weeks. Primary infection was defined by first positive anti-HCV antibody and/or HCV RNA within 6 months of enrollment and either acute clinical hepatitis within the past 12 months (symptomatic seroconversion illness or alanine aminotransferase > 10 × upper limit of normal) or anti-HCV antibody seroconversion within 18 months. Reinfection was defined as new positive HCV RNA within 6 months of enrollment and evidence of prior spontaneous or treatment-induced clearance. The primary endpoint was sustained virologic response at 12 weeks posttreatment (SVR12). Thirty men (median age 43 years, 90% men who have sex with men) received treatment, of whom 77% (n = 23) were human immunodeficiency virus-positive, 47% (n = 14) had ever injected drugs, and 13% (n = 4) had HCV reinfection. The majority had HCV genotype 1 (83%, n = 25), followed by genotype 4 (10%, n = 3) and genotype 3 (7%, n = 2). At baseline, median estimated duration of infection was 29 weeks (range 13, 52) and median HCV RNA was 6.2 log10 IU/mL (range 0.9, 7.7). SVR12 in the intention-to-treat and per-protocol populations was achieved in 90% (27/30) and 96% (27/28), respectively. There was one case of relapse, and there were two cases of nonvirological failure (death, n = 1; loss to follow-up, n = 1). No treatment-related serious adverse events were seen. CONCLUSIONS Glecaprevir/pibrentasvir for 6 weeks was highly effective among people with acute and recent HCV infection, supporting further evaluation of shortened-duration pan-genotypic therapy in this setting.
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Affiliation(s)
- Marianne Martinello
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia.,St. Vincent's Hospital, Sydney, Australia.,Department of Infectious Diseases, Blacktown Mt. Druitt Hospital, Sydney, Australia
| | | | - Graham Cooke
- Department of Infectious Diseases, Imperial College NHS Trust, St. Mary's Hospital, London, UK
| | - Sanjay Bhagani
- Department of Infectious Diseases/HIV Medicine, Royal Free Hospital, London, UK
| | - Edward Gane
- New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand
| | | | - David Shaw
- Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, Australia
| | - Elise Tu
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | - Kathy Petoumenos
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | - Philippa Marks
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | - Jason Grebely
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | - Gregory J Dore
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia.,St. Vincent's Hospital, Sydney, Australia
| | - Mark Nelson
- Chelsea and Westminster Hospital, London, UK
| | - Gail V Matthews
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia.,St. Vincent's Hospital, Sydney, Australia
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21
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McCabe L, White IR, Chau NVV, Barnes E, Pett SL, Cooke GS, Walker AS. The design and statistical aspects of VIETNARMS: a strategic post-licensing trial of multiple oral direct-acting antiviral hepatitis C treatment strategies in Vietnam. Trials 2020; 21:413. [PMID: 32423467 PMCID: PMC7236096 DOI: 10.1186/s13063-020-04350-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 04/25/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Eliminating hepatitis C is hampered by the costs of direct-acting antiviral treatment and the need to treat hard-to-reach populations. Access could be widened by shortening or simplifying treatment, but limited research means it is unclear which approaches could achieve sufficiently high cure rates to be acceptable. We present the statistical aspects of a multi-arm trial designed to test multiple strategies simultaneously and a monitoring mechanism to detect and stop individual randomly assigned groups with unacceptably low cure rates quickly. METHODS The VIETNARMS trial will factorially randomly assign patients to two drug regimens, three treatment-shortening strategies or control, and adjunctive ribavirin or no adjunctive ribavirin with shortening strategies (14 randomly assigned groups). We will use Bayesian monitoring at interim analyses to detect and stop recruitment into unsuccessful strategies, defined by more than 0.95 posterior probability that the true cure rate is less than 90% for the individual randomly assigned group (non-comparative). Final comparisons will be non-inferiority for regimens (margin 5%) and strategies (margin 10%) and superiority for adjunctive ribavirin. Here, we tested the operating characteristics of the stopping guideline for individual randomly assigned groups, planned interim analysis timings and explored power at the final analysis. RESULTS A beta (4.5, 0.5) prior for the true cure rate produces less than 0.05 probability of incorrectly stopping an individual randomly assigned group with a true cure rate of more than 90%. Groups with very low cure rates (<60%) are very likely (>0.9 probability) to stop after about 25% of patients are recruited. Groups with moderately low cure rates (80%) are likely to stop (0.7 probability) before overall recruitment finishes. Interim analyses 7, 10, 13 and 18 months after recruitment commences provide good probabilities of stopping inferior individual randomly assigned groups. For an overall true cure rate of 95%, power is more than 90% to confirm non-inferiority in the regimen and strategy comparisons, regardless of the control cure rate, and to detect a 5% absolute difference in the ribavirin comparison. CONCLUSIONS The operating characteristics of the stopping guideline are appropriate, and interim analyses can be timed to detect individual randomly assigned groups that are highly likely to have suboptimal performance at various stages. Therefore, our design is suitable for evaluating treatment-shortening or -simplifying strategies. TRIAL REGISTRATION ISRCTN registry: ISRCTN61522291. Registered on 4 October 2019.
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Affiliation(s)
- Leanne McCabe
- Medical Research Council Clinical Trials Unit at University College London, 90 High Holborn, WC1V 6LJ London, UK
| | - Ian R. White
- Medical Research Council Clinical Trials Unit at University College London, 90 High Holborn, WC1V 6LJ London, UK
| | | | | | - Sarah L. Pett
- Medical Research Council Clinical Trials Unit at University College London, 90 High Holborn, WC1V 6LJ London, UK
| | | | - A. Sarah Walker
- Medical Research Council Clinical Trials Unit at University College London, 90 High Holborn, WC1V 6LJ London, UK
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22
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Zitzmann C, Schmid B, Ruggieri A, Perelson AS, Binder M, Bartenschlager R, Kaderali L. A Coupled Mathematical Model of the Intracellular Replication of Dengue Virus and the Host Cell Immune Response to Infection. Front Microbiol 2020; 11:725. [PMID: 32411105 PMCID: PMC7200986 DOI: 10.3389/fmicb.2020.00725] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 03/27/2020] [Indexed: 12/15/2022] Open
Abstract
Dengue virus (DV) is a positive-strand RNA virus of the Flavivirus genus. It is one of the most prevalent mosquito-borne viruses, infecting globally 390 million individuals per year. The clinical spectrum of DV infection ranges from an asymptomatic course to severe complications such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS), the latter because of severe plasma leakage. Given that the outcome of infection is likely determined by the kinetics of viral replication and the antiviral host cell immune response (HIR) it is of importance to understand the interaction between these two parameters. In this study, we use mathematical modeling to characterize and understand the complex interplay between intracellular DV replication and the host cells' defense mechanisms. We first measured viral RNA, viral protein, and virus particle production in Huh7 cells, which exhibit a notoriously weak intrinsic antiviral response. Based on these measurements, we developed a detailed intracellular DV replication model. We then measured replication in IFN competent A549 cells and used this data to couple the replication model with a model describing IFN activation and production of IFN stimulated genes (ISGs), as well as their interplay with DV replication. By comparing the cell line specific DV replication, we found that host factors involved in replication complex formation and virus particle production are crucial for replication efficiency. Regarding possible modes of action of the HIR, our model fits suggest that the HIR mainly affects DV RNA translation initiation, cytosolic DV RNA degradation, and naïve cell infection. We further analyzed the potential of direct acting antiviral drugs targeting different processes of the DV lifecycle in silico and found that targeting RNA synthesis and virus assembly and release are the most promising anti-DV drug targets.
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Affiliation(s)
- Carolin Zitzmann
- Center for Functional Genomics of Microbes, Institute of Bioinformatics, University Medicine Greifswald, Greifswald, Germany.,Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, NM, United States
| | - Bianca Schmid
- Department of Infectious Diseases, Molecular Virology, Heidelberg University, Heidelberg, Germany
| | - Alessia Ruggieri
- Department of Infectious Diseases, Molecular Virology, Heidelberg University, Heidelberg, Germany
| | - Alan S Perelson
- Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, NM, United States
| | - Marco Binder
- Research Group "Dynamics of Early Viral Infection and the Innate Antiviral Response", Division Virus-Associated Carcinogenesis (F170), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ralf Bartenschlager
- Department of Infectious Diseases, Molecular Virology, Heidelberg University, Heidelberg, Germany
| | - Lars Kaderali
- Center for Functional Genomics of Microbes, Institute of Bioinformatics, University Medicine Greifswald, Greifswald, Germany
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23
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Madelain V, Mentré F, Baize S, Anglaret X, Laouénan C, Oestereich L, Nguyen THT, Malvy D, Piorkowski G, Graw F, Günther S, Raoul H, de Lamballerie X, Guedj J. Modeling Favipiravir Antiviral Efficacy Against Emerging Viruses: From Animal Studies to Clinical Trials. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2020; 9:258-271. [PMID: 32198838 PMCID: PMC7239338 DOI: 10.1002/psp4.12510] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/30/2019] [Indexed: 12/14/2022]
Abstract
In 2014, our research network was involved in the evaluation of favipiravir, an anti-influenza polymerase inhibitor, against Ebola virus. In this review, we discuss how mathematical modeling was used, first to propose a relevant dosing regimen in humans, and then to optimize its antiviral efficacy in a nonhuman primate (NHP) model. The data collected in NHPs were finally used to develop a model of Ebola pathogenesis integrating the interactions among the virus, the innate and adaptive immune response, and the action of favipiravir. We conclude the review of this work by discussing how these results are of relevance for future human studies in the context of Ebola virus, but also for other emerging viral diseases for which no therapeutics are available.
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Affiliation(s)
| | | | - Sylvain Baize
- UBIVE, Institut Pasteur, Centre International de Recherche en Infectiologie, Lyon, France
| | - Xavier Anglaret
- INSERM, UMR 1219, Université de Bordeaux, Bordeaux, France.,Programme PACCI/site ANRS de Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | | | - Lisa Oestereich
- Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg, Germany
| | | | - Denis Malvy
- INSERM, UMR 1219, Université de Bordeaux, Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Géraldine Piorkowski
- UMR "Emergence des Pathologies Virales" (EPV: Aix-Marseille University - IRD 190 - Inserm 1207 - EHESP) - Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Frederik Graw
- Center for Modeling and Simulation in the Biosciences (BIOMS), BioQuant-Center, Heidelberg University, Heidelberg, Germany
| | - Stephan Günther
- Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg, Germany
| | - Hervé Raoul
- Laboratoire P4 Inserm-Jean Mérieux, US003 Inserm, Lyon, France
| | - Xavier de Lamballerie
- UMR "Emergence des Pathologies Virales" (EPV: Aix-Marseille University - IRD 190 - Inserm 1207 - EHESP) - Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
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24
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Venuto CS, Cramer YS, Rosenkranz SL, Sulkowski M, Wyles DL, Cohen DE, Schmidt J, Alston‐Smith BL, Morse GD. Raltegravir pharmacokinetics before and during treatment with ombitasvir, paritaprevir/ritonavir plus dasabuvir in adults with human immunodeficiency virus-1 and hepatitis C virus coinfection: AIDS Clinical Trials Group sub-study A5334s. Br J Clin Pharmacol 2020; 86:132-142. [PMID: 31656054 PMCID: PMC6983509 DOI: 10.1111/bcp.14148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/23/2019] [Accepted: 10/01/2019] [Indexed: 01/01/2023] Open
Abstract
AIMS AIDS Clinical Trials Group study A5334s evaluated the pharmacokinetics of raltegravir before and during combined administration of ombitasvir, paritaprevir/ritonavir, plus dasabuvir (OBV/PTV/r + DSV) and weight-based ribavirin in human immunodeficiency virus (HIV) and hepatitis C virus (HCV) coinfected adults. The pharmacokinetics of OBV/PTV/r + DSV during raltegravir coadministration were also characterized. METHODS Adults living with HIV/HCV coinfection receiving steady-state raltegravir (400 mg twice daily) with 2 nucleos(t)ide analogues were enrolled. Pharmacokinetics of raltegravir were assessed prior to HCV therapy, and 4 weeks later following initiation of OBV/PTV/r (25/150/100 mg) once daily + DSV (250 mg) twice daily. Geometric mean ratios (GMRs) and 90% confidence intervals (CIs) were used to compare the following: raltegravir pharmacokinetics with HCV therapy (week 4) vs before HCV therapy (week 0); OBV/PTV/r and DSV pharmacokinetics vs historical healthy controls; raltegravir pharmacokinetics at week 0 vs historical control adults living with HIV. RESULTS Eight of 11 participants had decreased raltegravir exposures after initiation of HCV therapy. The GMRs (90% CI) for maximum concentration and area under the concentration-time curve of raltegravir with vs without HCV therapy were 0.68 (0.38-1.19) and 0.82 (0.58-1.17), respectively. Comparing OBV/PTV/r pharmacokinetics in healthy controls, A5334s study participants demonstrated generally lower maximum concentration and area under the concentration-time curve values by 41-82% and 4-73%, respectively. Raltegravir exposures tended to be higher in A5334s study participants compared to adults living with HIV. CONCLUSIONS The majority of participants' plasma raltegravir exposures were lower after initiation of HCV therapy in coinfected adults; however, confidence intervals were wide.
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25
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Cabalak M, Bal T, Onlen Y, Demir M. Incidence and predictors of direct-acting antiviral treatment failure in Turkish patients with chronic hepatitis C genotype 1b infection. Trop Doct 2019; 50:141-146. [PMID: 31810415 DOI: 10.1177/0049475519892082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Evaluation of the incidence and predictors of failure of direct-acting antiviral treatment for hepatitis C virus genotype 1b patients is important. Our retrospective cohort study assessed 172 Turkish patients who had received a full course of such treatment and could be checked for sustained virologic response. The overall treatment failure rate was 2.9% (5/172), all of whom relapsed. In three of these cases with sequencing data available, all had NS5A resistance-associated substitution. Multivariate analysis revealed that a 1 mg/dL increase in pre-treatment total bilirubin level was associated with a sevenfold increased likelihood of treatment failure. The baseline level of total bilirubin was the only significant independent predictor of direct-acting antiviral treatment failure.
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Affiliation(s)
- Mehmet Cabalak
- Assistant professor, Department of Infection Disease and Clinical Microbiology, Mustafa Kemal University School of Medicine, Hatay, Turkey
| | - Tayibe Bal
- Assistant professor, Department of Infection Disease and Clinical Microbiology, Mustafa Kemal University School of Medicine, Hatay, Turkey
| | - Yusuf Onlen
- Professor, Department of Infection Disease and Clinical Microbiology, Mustafa Kemal University School of Medicine, Hatay, Turkey
| | - Mehmet Demir
- Professor, Department of Gastroenterology, Mustafa Kemal University School of Medicine, Hatay, Turkey
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26
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Raja R, Baral S, Dixit NM. Interferon at the cellular, individual, and population level in hepatitis C virus infection: Its role in the interferon-free treatment era. Immunol Rev 2019; 285:55-71. [PMID: 30129199 DOI: 10.1111/imr.12689] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The advent of powerful direct-acting antiviral agents (DAAs) has revolutionized the treatment of hepatitis C. DAAs cure nearly all patients with short duration, oral treatments. Significant efforts are now underway to optimize DAA-based treatments. We discuss the potential role of interferon in this optimization. Clinical studies present compelling evidence that DAAs perform better in treatment-naive individuals than in individuals who previously failed treatment with interferon, a surprising correlation because interferon and DAAs are thought to act independently. Recent mathematical models explore a mechanistic hypothesis underlying this correlation. The hypothesis invokes the action of interferon at the cellular, individual, and population levels. Strong interferon responses prevent the productive infection of cells, reduce viral replication, and impede the development of resistance to DAAs in infected individuals and improve cure rates elicited by DAAs in treated populations. The models develop descriptions of these processes, integrate them into a comprehensive framework, and capture clinical data quantitatively, providing a successful test of the hypothesis. Individuals with strong endogenous interferon responses thus present a promising subpopulation for reducing DAA treatment durations. This review discusses the conceptual advances made by the models, highlights the new insights they unravel, and examines their applicability to optimize DAA-based treatments.
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Affiliation(s)
- Rubesh Raja
- Department of Chemical Engineering, Indian Institute of Science, Bangalore, India
| | - Subhasish Baral
- Department of Chemical Engineering, Indian Institute of Science, Bangalore, India
| | - Narendra M Dixit
- Department of Chemical Engineering, Indian Institute of Science, Bangalore, India.,Centre for Biosystems Science and Engineering, Indian Institute of Science, Bangalore, India
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27
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Raja R, Pareek A, Newar K, Dixit NM. Mutational pathway maps and founder effects define the within-host spectrum of hepatitis C virus mutants resistant to drugs. PLoS Pathog 2019; 15:e1007701. [PMID: 30934020 PMCID: PMC6459561 DOI: 10.1371/journal.ppat.1007701] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 04/11/2019] [Accepted: 03/13/2019] [Indexed: 12/11/2022] Open
Abstract
Knowledge of the within-host frequencies of resistance-associated amino acid variants (RAVs) is important to the identification of optimal drug combinations for the treatment of hepatitis C virus (HCV) infection. Multiple RAVs may exist in infected individuals, often below detection limits, at any resistance locus, defining the diversity of accessible resistance pathways. We developed a multiscale mathematical model to estimate the pre-treatment frequencies of the entire spectrum of mutants at chosen loci. Using a codon-level description of amino acids, we performed stochastic simulations of intracellular dynamics with every possible nucleotide variant as the infecting strain and estimated the relative infectivity of each variant and the resulting distribution of variants produced. We employed these quantities in a deterministic multi-strain model of extracellular dynamics and estimated mutant frequencies. Our predictions captured database frequencies of the RAV R155K, resistant to NS3/4A protease inhibitors, presenting a successful test of our formalism. We found that mutational pathway maps, interconnecting all viable mutants, and strong founder effects determined the mutant spectrum. The spectra were vastly different for HCV genotypes 1a and 1b, underlying their differential responses to drugs. Using a fitness landscape determined recently, we estimated that 13 amino acid variants, encoded by 44 codons, exist at the residue 93 of the NS5A protein, illustrating the massive diversity of accessible resistance pathways at specific loci. Accounting for this diversity, which our model enables, would help optimize drug combinations. Our model may be applied to describe the within-host evolution of other flaviviruses and inform vaccine design strategies.
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Affiliation(s)
- Rubesh Raja
- Department of Chemical Engineering, Indian Institute of Science, Bangalore, India
| | - Aditya Pareek
- Department of Chemical Engineering, Indian Institute of Science, Bangalore, India
| | - Kapil Newar
- Department of Chemical Engineering, Indian Institute of Science, Bangalore, India
| | - Narendra M. Dixit
- Department of Chemical Engineering, Indian Institute of Science, Bangalore, India
- Centre for Biosystems Science and Engineering, Indian Institute of Science, Bangalore, India
- * E-mail:
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28
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Baumert TF, Berg T, Lim JK, Nelson DR. Status of Direct-Acting Antiviral Therapy for Hepatitis C Virus Infection and Remaining Challenges. Gastroenterology 2019; 156:431-445. [PMID: 30342035 PMCID: PMC6446912 DOI: 10.1053/j.gastro.2018.10.024] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/05/2018] [Accepted: 10/08/2018] [Indexed: 12/12/2022]
Abstract
Chronic infection with hepatitis C virus is a major cause of liver disease and hepatocellular carcinoma worldwide. After the discovery of hepatitis C virus 3 decades ago, the identification of the structure of the viral proteins, combined with high-throughput replicon models, enabled the discovery and development of direct-acting antivirals. These agents have revolutionized patient care, with cure rates of more than 90%. We review the status of direct-acting antiviral therapies for hepatitis C virus infection and discuss remaining challenges. We highlight licensed compounds, discuss the potential to shorten therapy even further, and review different options for treatment failure and resistance. We also provide an overview of clinical experience with generic agents and evidence for their efficacy. Finally, we discuss the need for new drugs and outline promising targets for future therapies.
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Affiliation(s)
- Thomas F Baumert
- INSERM, U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Strasbourg, France; Université de Strasbourg, Strasbourg, France; Pôle Hépato-digestif, Institut Hospitalo-Universitaire, Nouvel Hôpital Civil, Strasbourg, France.
| | - Thomas Berg
- Section of Hepatology, Clinic for Gastroenterology and Rheumatology, University Clinic Leipzig, Leipzig, Germany
| | - Joseph K Lim
- Section of Digestive Diseases and Yale Liver Center, Yale University School of Medicine, New Haven, Connecticut
| | - David R Nelson
- Department of Medicine, University of Florida, Gainesville, Florida.
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29
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Abstract
Viruses are a main cause of disease worldwide and many are without effective therapeutics or vaccines. A lack of understanding about how host responses work to control viral spread is one factor limiting effective management. How different immune components regulate infection dynamics is beginning to be better understood with the help of mathematical models. These models have been key in discriminating between hypotheses and in identifying rates of virus growth and clearance, dynamical control by different host factors and antivirals, and synergistic interactions during multi-pathogen infections. A recent focus in evaluating model predictions in the laboratory and clinic has illuminate the accuracy of models for a variety of viruses and highlighted the critical nature of theoretical approaches in virology. Here, I discuss recent model-driven exploration of host-pathogen interactions that have illustrated the importance of model validation in establishing the model's predictive capability and in defining new biology.
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30
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Martinello M, Bhagani S, Gane E, Orkin C, Cooke G, Dore GJ, Petoumenos K, Applegate TL, Tu E, Marks P, Pagani N, Grebely J, Nelson M, Matthews GV. Shortened therapy of eight weeks with paritaprevir/ritonavir/ombitasvir and dasabuvir is highly effective in people with recent HCV genotype 1 infection. J Viral Hepat 2018; 25:1180-1188. [PMID: 29660224 DOI: 10.1111/jvh.12917] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/12/2018] [Indexed: 12/13/2022]
Abstract
Paritaprevir/ritonavir/ombitasvir and dasabuvir with or without ribavirin for 12 weeks are approved for treatment of chronic HCV genotype 1 infection. This study assessed the efficacy of shortened duration paritaprevir/ritonavir/ombitasvir and dasabuvir with or without ribavirin for 8 weeks among people with recent HCV infection. In this open-label single-arm trial conducted in Australia, England and New Zealand, adults with recent HCV (duration of infection <12 months) received paritaprevir/ritonavir/ombitasvir and dasabuvir (with weight-based ribavirin for genotypes 1a and 1, no subtype) for 8 weeks. The primary endpoint was sustained virological response at 12 weeks post-treatment (SVR12) in the intention-to-treat (ITT) population. Thirty people (median age 38 years, male 93%) commenced treatment (with ribavirin, 97%), of whom 77% (n = 23) were HIV-positive, 93% (n = 28) had genotype 1a infection and 53% (n = 16) had ever injected drugs. Median maximum ALT in the preceding 12 months was 433 IU/L (IQR 321, 1012). Acute clinical hepatitis with ALT > 10 x ULN was documented in 83% (n = 25); one participant (3%) had jaundice. At baseline, median estimated duration of infection was 30 weeks (range 11, 51), and median HCV RNA was 5.7 log10 IU/mL (range 2.7, 7.3). SVR12 was achieved in 97% (29/30; early discontinuation at week 2, n = 1; per protocol 100%, 29/29). No relapse or reinfection was observed. In conclusion, paritaprevir/ritonavir/ombitasvir and dasabuvir (with ribavirin) for eight weeks were highly effective among HIV-positive and HIV-negative individuals with recent HCV infection. These data support the use of this shortened duration direct-acting antiviral regimen in this population.
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Affiliation(s)
- M Martinello
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.,Department of Infectious Diseases and Immunology, St Vincent's Hospital, Sydney, NSW, Australia
| | - S Bhagani
- Department of Infectious Diseases/HIV Medicine, Royal Free Hospital, London, UK
| | - E Gane
- New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand
| | - C Orkin
- Barts Health, Royal London Hospital, London, UK
| | - G Cooke
- Department of Infectious Diseases, Imperial College NHS Trust, St Mary's Hospital, London, UK
| | - G J Dore
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.,Department of Infectious Diseases and Immunology, St Vincent's Hospital, Sydney, NSW, Australia
| | - K Petoumenos
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - T L Applegate
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - E Tu
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - P Marks
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - N Pagani
- Chelsea and Westminster Hospital, London, UK
| | - J Grebely
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - M Nelson
- Chelsea and Westminster Hospital, London, UK
| | - G V Matthews
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.,Department of Infectious Diseases and Immunology, St Vincent's Hospital, Sydney, NSW, Australia
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31
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Abstract
Recent Zika virus outbreaks have been associated with severe outcomes, especially during pregnancy. A great deal of effort has been put toward understanding this virus, particularly the immune mechanisms responsible for rapid viral control in the majority of infections. Identifying and understanding the key mechanisms of immune control will provide the foundation for the development of effective vaccines and antiviral therapy. Here, we outline a mathematical modeling approach for analyzing the within-host dynamics of Zika virus, and we describe how these models can be used to understand key aspects of the viral life cycle and to predict antiviral efficacy.
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Affiliation(s)
- Katharine Best
- Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, NM 87545
| | - Alan S. Perelson
- Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, NM 87545
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32
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Affiliation(s)
- Alan S Perelson
- Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - Ruy M Ribeiro
- Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, NM, USA
- Laboratorio de Biomatematica, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
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33
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Zitzmann C, Kaderali L. Mathematical Analysis of Viral Replication Dynamics and Antiviral Treatment Strategies: From Basic Models to Age-Based Multi-Scale Modeling. Front Microbiol 2018; 9:1546. [PMID: 30050523 PMCID: PMC6050366 DOI: 10.3389/fmicb.2018.01546] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 06/21/2018] [Indexed: 12/14/2022] Open
Abstract
Viral infectious diseases are a global health concern, as is evident by recent outbreaks of the middle east respiratory syndrome, Ebola virus disease, and re-emerging zika, dengue, and chikungunya fevers. Viral epidemics are a socio-economic burden that causes short- and long-term costs for disease diagnosis and treatment as well as a loss in productivity by absenteeism. These outbreaks and their socio-economic costs underline the necessity for a precise analysis of virus-host interactions, which would help to understand disease mechanisms and to develop therapeutic interventions. The combination of quantitative measurements and dynamic mathematical modeling has increased our understanding of the within-host infection dynamics and has led to important insights into viral pathogenesis, transmission, and disease progression. Furthermore, virus-host models helped to identify drug targets, to predict the treatment duration to achieve cure, and to reduce treatment costs. In this article, we review important achievements made by mathematical modeling of viral kinetics on the extracellular, intracellular, and multi-scale level for Human Immunodeficiency Virus, Hepatitis C Virus, Influenza A Virus, Ebola Virus, Dengue Virus, and Zika Virus. Herein, we focus on basic mathematical models on the population scale (so-called target cell-limited models), detailed models regarding the most important steps in the viral life cycle, and the combination of both. For this purpose, we review how mathematical modeling of viral dynamics helped to understand the virus-host interactions and disease progression or clearance. Additionally, we review different types and effects of therapeutic strategies and how mathematical modeling has been used to predict new treatment regimens.
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Affiliation(s)
- Carolin Zitzmann
- Institute of Bioinformatics and Center for Functional Genomics of Microbes, University Medicine Greifswald, Greifswald, Germany
| | - Lars Kaderali
- Institute of Bioinformatics and Center for Functional Genomics of Microbes, University Medicine Greifswald, Greifswald, Germany
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34
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Venugopal V, Padmanabhan P, Raja R, Dixit NM. Modelling how responsiveness to interferon improves interferon-free treatment of hepatitis C virus infection. PLoS Comput Biol 2018; 14:e1006335. [PMID: 30001324 PMCID: PMC6057683 DOI: 10.1371/journal.pcbi.1006335] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 07/24/2018] [Accepted: 06/28/2018] [Indexed: 12/14/2022] Open
Abstract
Direct-acting antiviral agents (DAAs) for hepatitis C treatment tend to fare better in individuals who are also likely to respond well to interferon-alpha (IFN), a surprising correlation given that DAAs target specific viral proteins whereas IFN triggers a generic antiviral immune response. Here, we posit a causal relationship between IFN-responsiveness and DAA treatment outcome. IFN-responsiveness restricts viral replication, which would prevent the growth of viral variants resistant to DAAs and improve treatment outcome. To test this hypothesis, we developed a multiscale mathematical model integrating IFN-responsiveness at the cellular level, viral kinetics and evolution leading to drug resistance at the individual level, and treatment outcome at the population level. Model predictions quantitatively captured data from over 50 clinical trials demonstrating poorer response to DAAs in previous non-responders to IFN than treatment-naïve individuals, presenting strong evidence supporting the hypothesis. Model predictions additionally described several unexplained clinical observations, viz., the percentages of infected individuals who 1) spontaneously clear HCV, 2) get chronically infected but respond to IFN-based therapy, and 3) fail IFN-based therapy but respond to DAA-based therapy, resulting in a comprehensive understanding of HCV infection and treatment. An implication of the causal relationship is that failure of DAA-based treatments may be averted by adding IFN, a strategy of potential use in settings with limited access to DAAs. A second, wider implication is that individuals with greater IFN-responsiveness would require shorter DAA-based treatment durations, presenting a basis and a promising population for response-guided therapy.
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Affiliation(s)
- Vishnu Venugopal
- Department of Chemical Engineering, Indian Institute of Science, Bangalore, India
| | - Pranesh Padmanabhan
- Department of Chemical Engineering, Indian Institute of Science, Bangalore, India
| | - Rubesh Raja
- Department of Chemical Engineering, Indian Institute of Science, Bangalore, India
| | - Narendra M. Dixit
- Department of Chemical Engineering, Indian Institute of Science, Bangalore, India
- Centre for Biosystems Science and Engineering, Indian Institute of Science, Bangalore, India
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35
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Chirikov VV, Marx SE, Manthena SR, Strezewski JP, Saab S. Development of a Comprehensive Dataset of Hepatitis C Patients and Examination of Disease Epidemiology in the United States, 2013-2016. Adv Ther 2018; 35:1087-1102. [PMID: 29949038 DOI: 10.1007/s12325-018-0721-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Chronic infection with hepatitis C virus (HCV) is a leading cause of liver disease and infectious disease deaths. While recent and emerging treatment options for HCV patients have enabled higher rates of sustained virologic response (SVR), the demographic, clinical, geographic, and payer characteristics of the estimated 3.4 million chronic HCV patients in the USA are poorly understood. The goal of this study was to create a dataset describing the current HCV patient landscape in the USA. METHODS Data from two large national laboratory companies representing the majority of US patients screened for HCV antibody and/or tested for HCV RNA from 2013 through 2016 were organized into the present study dataset. Age, gender, payer channel, 3-digit ZIP code and ordering physician specialty, and 3-digit ZIP code information were available for all patients. Among RNA-positive patients, additional clinical characteristics included HCV genotype, fibrosis stage, renal function, and HIV status. Initiating treatment and attaining cure were imputed using data-driven algorithms based on successive RNA viral load measurements. RESULTS The number of RNA-positive HCV patients increased from 200,066 patients in 2013 to 469,550 in 2016. The availability of clinical data measurements and rates of treatment initiation increased over the study period, indicating improved care engagement for HCV patients. Treatment and cure rates varied by age, disease severity, geographic location, and payer channel. Sensitivity and specificity of the cure prediction algorithms were consistently above 0.90, validating the robustness of the data imputation approach. CONCLUSION This is the largest, most comprehensive dataset available to describe the current US HCV patient landscape. Our results highlight that the epidemiology of HCV is evolving with an increasing number of patients who are younger and have milder disease than described in previous years. Results of this study should help guide efforts toward the elimination of HCV in this country. Future work will focus on factors associated with varying treatment and cure patterns and describing recent changes in the HCV patient landscape. FUNDING AbbVie. Plain language summary available for this article.
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Affiliation(s)
- Viktor V Chirikov
- Pharmerit International, LP 4350 East-West Highway Suite 1110, Bethesda, MD, 20814, USA
| | - Steven E Marx
- AbbVie, 26525 Riverwoods Blvd, Mettawa, IL, 60048, USA.
| | | | | | - Sammy Saab
- UCLA Medical Center, 200 UCLA Medical Plaza, Suite 214, Los Angeles, CA, 90095, USA
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36
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Martinello M, Hajarizadeh B, Grebely J, Dore GJ, Matthews GV. Management of acute HCV infection in the era of direct-acting antiviral therapy. Nat Rev Gastroenterol Hepatol 2018; 15:412-424. [PMID: 29773899 DOI: 10.1038/s41575-018-0026-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The management of acute HCV infection has not been standardized following the availability of direct-acting antiviral agents (DAAs) for chronic HCV infection, and substantial uncertainty exists regarding the optimal treatment regimen and duration. Despite the lack of direct evidence, the 2016 American Association for the Study of Liver Diseases (AASLD)-Infectious Diseases Society of America (IDSA) guidelines supported "the same regimens for acute HCV as recommended for chronic HCV infection … owing to high efficacy and safety", whereas the 2016 European Association for the Study of the Liver (EASL) guidelines recommended sofosbuvir-ledipasvir, sofosbuvir-velpatasvir or sofosbuvir plus daclatasvir for 8 weeks in acute HCV infection, with a longer duration of 12 weeks recommended for those infected with HIV and/or baseline HCV RNA levels >1,000,000 IU/ml. This Review outlines the epidemiology, natural history and diagnosis of acute HCV infection and provides contemporary information on DAAs for acute and recent HCV infection. The Review also discusses the 2016 AASLD-IDSA and EASL recommendations for acute HCV infection management in light of available evidence and highlights key differences in study populations and design that influence interpretation. We focus on populations at high risk of HCV transmission and acquisition, including people who inject drugs and HIV-positive men who have sex with men, and highlight the potential effects of diagnosis and treatment of acute HCV infection in contributing to HCV elimination.
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Affiliation(s)
- Marianne Martinello
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW, Sydney, NSW, Australia.
| | - Behzad Hajarizadeh
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW, Sydney, NSW, Australia
| | - Jason Grebely
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW, Sydney, NSW, Australia
| | - Gregory J Dore
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW, Sydney, NSW, Australia
| | - Gail V Matthews
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW, Sydney, NSW, Australia
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37
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Baral S, Roy R, Dixit NM. Modeling how reversal of immune exhaustion elicits cure of chronic hepatitis C after the end of treatment with direct-acting antiviral agents. Immunol Cell Biol 2018; 96:969-980. [PMID: 29744934 PMCID: PMC6220890 DOI: 10.1111/imcb.12161] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 04/26/2018] [Accepted: 04/30/2018] [Indexed: 12/11/2022]
Abstract
A fraction of chronic hepatitis C patients treated with direct‐acting antivirals (DAAs) achieved sustained virological responses (SVR), or cure, despite having detectable viremia at the end of treatment (EOT). This observation, termed EOT+/SVR, remains puzzling and precludes rational optimization of treatment durations. One hypothesis to explain EOT+/SVR, the immunologic hypothesis, argues that the viral decline induced by DAAs during treatment reverses the exhaustion of cytotoxic T lymphocytes (CTLs), which then clear the infection after treatment. Whether the hypothesis is consistent with data of viral load changes in patients who experienced EOT+/SVR is unknown. Here, we constructed a mathematical model of viral kinetics incorporating the immunologic hypothesis and compared its predictions with patient data. We found the predictions to be in quantitative agreement with patient data. Using the model, we unraveled an underlying bistability that gives rise to EOT+/SVR and presents a new avenue to optimize treatment durations. Infected cells trigger both activation and exhaustion of CTLs. CTLs in turn kill infected cells. Due to these competing interactions, two stable steady states, chronic infection and viral clearance, emerge, separated by an unstable steady state with intermediate viremia. When treatment during chronic infection drives viremia sufficiently below the unstable state, spontaneous viral clearance results post‐treatment, marking EOT+/SVR. The duration to achieve this desired reduction in viremia defines the minimum treatment duration required for ensuring SVR, which our model can quantify. Estimating parameters defining the CTL response of individuals to HCV infection would enable the application of our model to personalize treatment durations.
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Affiliation(s)
- Subhasish Baral
- Department of Chemical Engineering, Indian Institute of Science, Bangalore, Karnataka, India
| | - Rahul Roy
- Department of Chemical Engineering, Indian Institute of Science, Bangalore, Karnataka, India.,Centre for Biosystems Science and Engineering, Indian Institute of Science, Bangalore, Karnataka, India.,Molecular Biophysics Unit, Indian Institute of Science, Bangalore, Karnataka, India
| | - Narendra M Dixit
- Department of Chemical Engineering, Indian Institute of Science, Bangalore, Karnataka, India.,Centre for Biosystems Science and Engineering, Indian Institute of Science, Bangalore, Karnataka, India
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38
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Murray JM, Ribeiro RM. Special Issue "Mathematical Modeling of Viral Infections". Viruses 2018; 10:v10060303. [PMID: 29866993 PMCID: PMC6024780 DOI: 10.3390/v10060303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 05/28/2018] [Indexed: 12/23/2022] Open
Affiliation(s)
- John M Murray
- School of Mathematics and Statistics, UNSW Australia, Sydney 2052, Australia.
- Cancer Research Division, Cancer Council NSW, Woolloomooloo NSW 2011, Australia.
| | - Ruy M Ribeiro
- Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, NM 87545, USA.
- Laboratorio de Biomatematica, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal.
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39
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Øvrehus ALH, Krarup H, Birkemose I, Holm DK, Mössner B, Ernst A, Christensen PB. Four weeks of ledipasvir/sofosbuvir and ribavirin with or without pegylated interferon for chronic hepatitis C in non-cirrhotic people who inject drugs. A randomized trial. J Hepatol 2018; 68:840-842. [PMID: 29223370 DOI: 10.1016/j.jhep.2017.11.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 11/23/2017] [Accepted: 11/27/2017] [Indexed: 01/26/2023]
Affiliation(s)
- Anne L H Øvrehus
- Department of Infectious Diseases, Odense University Hospital, Denmark.
| | - Henrik Krarup
- Section of Molecular Diagnostics and Clinical Biochemistry, Aalborg University Hospital, Denmark
| | - Inge Birkemose
- Odense Drug Treatment Center, Odense Municipality, Denmark
| | - Dorte K Holm
- Department of Clinical Immunology, Odense University Hospital, Denmark
| | - Belinda Mössner
- Department of Infectious Diseases, Odense University Hospital, Denmark
| | - Anja Ernst
- Section of Molecular Diagnostics and Clinical Biochemistry, Aalborg University Hospital, Denmark
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40
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Fourati S, Guedj J, Chevaliez S, Nguyen THT, Roudot-Thoraval F, Ruiz I, Soulier A, Scoazec G, Varaut A, Poiteau L, Francois M, Mallat A, Hézode C, Pawlotsky JM. Viral kinetics analysis and virological characterization of treatment failures in patients with chronic hepatitis C treated with sofosbuvir and an NS5A inhibitor. Aliment Pharmacol Ther 2018; 47:665-673. [PMID: 29271114 DOI: 10.1111/apt.14478] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/02/2017] [Accepted: 11/29/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND The combination of sofosbuvir (SOF) plus an NS5A inhibitor for 12 weeks is highly efficacious in patients with chronic hepatitis C. As the costs of generic production of sofosbuvir and NS5A inhibitor are rapidly decreasing, the combination of these DAAs will be the standard treatment in most low- to middle-income countries in the future. AIM To identify key predictors of response that can be used to tailor treatment decisions. METHODS A cohort of 216 consecutive patients infected with HCV genotype 1 (1a: n = 57; 1b: n = 77), 2 (n = 4), 3 (n = 33) or 4 (n = 44) were treated with sofosbuvir (SOF) + daclatasvir (n = 176) or SOF + ledipasvir (n = 40) for 12 weeks. The viral kinetics was analysed using the biphasic model and the cure boundary was used to predict time to clear HCV. RESULTS The overall SVR rate was high (94.4%; n = 204), regardless of the time to viral suppression or low-level viraemia at the end of treatment. The model-based predicted HCV RNA levels at the end of treatment could not differentiate patients who did from those who did not achieve SVR. The presence of NS5A resistance-associated substitutions [position 28 (OR = 70.3, P<.001) and/or 31 (OR = 61.6, P = .002)] at baseline was predictive of virological failure in cirrhotic patients but was not associated with on-treatment viral kinetics. CONCLUSION This real-world study confirms the excellent results of clinical trials with therapies based on a combination of SOF plus an NS5A inhibitor. It suggests that a personalized approach including baseline NS5A inhibitor resistance testing may inform treatment decisions in cirrhotic patients.
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Affiliation(s)
- S Fourati
- Department of Virology, Henri Mondor Hospital, National Reference Center for Viral Hepatitis B, C and D, University of Paris-Est, Créteil, France.,INSERM U955, Créteil, France
| | - J Guedj
- INSERM U1137, IAME, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - S Chevaliez
- Department of Virology, Henri Mondor Hospital, National Reference Center for Viral Hepatitis B, C and D, University of Paris-Est, Créteil, France.,INSERM U955, Créteil, France
| | | | - F Roudot-Thoraval
- Department of Public Health, Henri Mondor Hospital, University of Paris-Est, Créteil, France
| | - I Ruiz
- INSERM U955, Créteil, France.,Department of Hepatology, Henri Mondor Hospital, University of Paris-Est, Créteil, France
| | - A Soulier
- Department of Virology, Henri Mondor Hospital, National Reference Center for Viral Hepatitis B, C and D, University of Paris-Est, Créteil, France.,INSERM U955, Créteil, France
| | - G Scoazec
- Department of Hepatology, Henri Mondor Hospital, University of Paris-Est, Créteil, France
| | - A Varaut
- Department of Hepatology, Henri Mondor Hospital, University of Paris-Est, Créteil, France
| | - L Poiteau
- Department of Virology, Henri Mondor Hospital, National Reference Center for Viral Hepatitis B, C and D, University of Paris-Est, Créteil, France.,INSERM U955, Créteil, France
| | - M Francois
- Department of Hepatology, Henri Mondor Hospital, University of Paris-Est, Créteil, France
| | - A Mallat
- Department of Hepatology, Henri Mondor Hospital, University of Paris-Est, Créteil, France
| | - C Hézode
- Department of Hepatology, Henri Mondor Hospital, University of Paris-Est, Créteil, France
| | - J-M Pawlotsky
- Department of Virology, Henri Mondor Hospital, National Reference Center for Viral Hepatitis B, C and D, University of Paris-Est, Créteil, France.,INSERM U955, Créteil, France
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41
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Emmanuel B, Wilson EM, O'Brien TR, Kottilil S, Lau G. Shortening the duration of therapy for chronic hepatitis C infection. Lancet Gastroenterol Hepatol 2017; 2:832-836. [PMID: 28802815 PMCID: PMC5737004 DOI: 10.1016/s2468-1253(17)30053-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/31/2017] [Accepted: 02/01/2017] [Indexed: 12/11/2022]
Abstract
Combination direct-acting antiviral therapy of 8-24 weeks is highly effective for the treatment of chronic hepatitis C infection. However, shortening the treatment duration to less than 8 weeks could potentially reduce overall treatment costs and improve adherence. Here we explore the arguments for and against the development of short-duration regimens and existing data on treatment for 6 weeks or less among patients with chronic hepatitis C virus genotype 1 infection. Additionally, we identify potential predictors of response to short-course combination therapies with direct-acting antiviral drugs that might be explored in future clinical trials.
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Affiliation(s)
- Benjamin Emmanuel
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Eleanor M Wilson
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Thomas R O'Brien
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Shyam Kottilil
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - George Lau
- Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong, China
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42
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Nguyen THT, Guedj J, Uprichard SL, Kohli A, Kottilil S, Perelson AS. The paradox of highly effective sofosbuvir-based combination therapy despite slow viral decline: can we still rely on viral kinetics? Sci Rep 2017; 7:10233. [PMID: 28860456 PMCID: PMC5579268 DOI: 10.1038/s41598-017-09776-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/28/2017] [Indexed: 02/07/2023] Open
Abstract
High sustained virologic response (SVR) rates have been observed after 6 weeks of anti-HCV treatment using sofosbuvir, ledipasvir and a non-nucleoside polymerase-inhibitor (GS-9669) or a protease-inhibitor (GS-9451) and after 12 weeks with sofosbuvir + ledipasvir. Here we analyze the viral kinetics observed during these treatments to decipher the origin of the rapid cure and to evaluate the possibility of further reducing treatment duration. We found that viral kinetics were surprisingly slow in all treatment groups and could not reproduce the high SVR rates observed. Based on experimental results suggesting that NS5A- or protease-inhibitors can generate non-infectious virus, we incorporated this effect into a mathematical model. We found that to predict observed SVR rates it was necessary to assume that ledipasvir, GS-9669 and GS-9451 rapidly reduce virus infectivity. We predicted with this model that 4 weeks of triple therapy could be sufficient to achieve SVR in patients with undetectable viremia at week 1, but would be suboptimal in general. In conclusion, the rapid cure rate achieved with these combinations is largely disconnected from viral loads measured during treatment. A model assuming that rapid cure is due to a drug effect of generating non-infectious virus could be a basis for future response guided therapy.
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Affiliation(s)
- Thi Huyen Tram Nguyen
- IAME, UMR 1137, INSERM, F-75018 Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, F-75018, Paris, France
| | - Jérémie Guedj
- IAME, UMR 1137, INSERM, F-75018 Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, F-75018, Paris, France. .,Hopital Henri Mondor, Université Paris-Est, Creteil, France.
| | - Susan L Uprichard
- Department of Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| | - Anita Kohli
- Dignity Health, St. Joseph's Hospital, Phoenix, Arizona, USA
| | - Shyam Kottilil
- Laboratory of Immunoregulation, NIAID, NIH, Bethesda, MD, USA
| | - Alan S Perelson
- Theoretical Biology and Biophysics Group, Los Alamos National Laboratory, Los Alamos, NM, USA
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43
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Shortening HCV therapy: science meets public health. Lancet Gastroenterol Hepatol 2017; 2:771-772. [PMID: 28802817 DOI: 10.1016/s2468-1253(17)30215-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 06/14/2017] [Indexed: 01/09/2023]
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44
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Zika plasma viral dynamics in nonhuman primates provides insights into early infection and antiviral strategies. Proc Natl Acad Sci U S A 2017; 114:8847-8852. [PMID: 28765371 DOI: 10.1073/pnas.1704011114] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The recent outbreak of Zika virus (ZIKV) has been associated with fetal abnormalities and neurological complications, prompting global concern. Here we present a mathematical analysis of the within-host dynamics of plasma ZIKV burden in a nonhuman primate model, allowing for characterization of the growth and clearance of ZIKV within individual macaques. We estimate that the eclipse phase for ZIKV, the time between cell infection and viral production, is most likely short (∼4 h), the median within-host basic reproductive number R0 is 10.7, the rate of viral production is rapid (>25,000 virions d-1), and the lifetime of an infected cell while producing virus is ∼5 h. We also estimate that the minimum number of virions produced by an infected cell over its lifetime is ∼5,500. We assess the potential effect of an antiviral treatment that blocks viral replication, showing that the median time to undetectable plasma viral load (VL) can be reduced from ∼5 d to ∼3 d with a drug concentration ∼15 times the drug's EC50 when treatment is given prophylactically starting at the time of infection. In the case of favipiravir, a polymerase inhibitor with activity against ZIKV, we predict a dose of 150 mg/kg given twice a day initiated at the time of infection can reduce the peak median VL by ∼3 logs and shorten the time to undetectable median VL by ∼2 d, whereas treatment given 2 d postinfection is mostly ineffective in accelerating plasma VL loss in macaques.
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45
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Short article: Viral dynamics among hepatitis C virus chronic infected patients during direct-acting antiviral agents therapy: impact for monitoring and optimizing treatment duration. Eur J Gastroenterol Hepatol 2017; 29:781-785. [PMID: 28410351 DOI: 10.1097/meg.0000000000000882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Direct-acting antiviral agents (DAAs) have provided an ultimate treatment duration of 12 weeks for most hepatitis C virus (HCV)-infected patients. The opportunity to reduce treatment duration to 6 or 8 weeks is being evaluated. Here, the HCV viral dynamics at short times during HCV therapies and its implications for monitoring and optimizing treatment duration have been assessed. PATIENTS AND METHODS HCV chronic infected patients who began HCV therapy (March 2014 to June 2015) at a reference hospital of the Northwest of Spain were selected. HCV-RNA was quantified at different short time points during HCV therapy using Abbott RealTime HCV assay. Epidemiological, clinical, and virological data were recorded. RESULTS Eleven HCV-infected patients were included; 90.9% had cirrhosis (>12.5 kPa) and 72.7% were treatment-experienced. HCV genotype 1b was the most prevalent (72.7%). All of the combinations were pegylated interferon-free and all included ribavirin. The median HCV-RNA (log IU/ml) at baseline was 5.8 (5.4-6.1); the decline between baseline and day 3, weeks 4, 8, and 12 was 3.2, 4.8, 5.1, and 5.6, respectively. Fewer than 50% of patients achieved undetectable viral load at weeks 4 and 8; however, all patients achieved a sustained virologic response at 12 weeks. CONCLUSION Rapid and high HCV-RNA decline was observed among HCV-infected patients under DAA-based regimens, especially for those without cirrhosis. Despite low rates of patients with undetectable HCV-RNA at weeks 4 and 8, all achieved a sustained virologic response at 12 weeks. These findings suggest that the time points to monitor HCV-RNA during DAA therapies and the treatment duration need to be optimized.
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46
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Martinello M, Grebely J, Matthews GV. Direct-acting antivirals for acute HCV: how short can we go? Lancet Gastroenterol Hepatol 2017; 2:316-318. [PMID: 28397692 DOI: 10.1016/s2468-1253(17)30043-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 02/16/2017] [Indexed: 11/27/2022]
Affiliation(s)
| | - Jason Grebely
- Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia
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47
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Nguyen VK, Klawonn F, Mikolajczyk R, Hernandez-Vargas EA. Analysis of Practical Identifiability of a Viral Infection Model. PLoS One 2016; 11:e0167568. [PMID: 28036339 PMCID: PMC5201286 DOI: 10.1371/journal.pone.0167568] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 11/16/2016] [Indexed: 11/27/2022] Open
Abstract
Mathematical modelling approaches have granted a significant contribution to life sciences and beyond to understand experimental results. However, incomplete and inadequate assessments in parameter estimation practices hamper the parameter reliability, and consequently the insights that ultimately could arise from a mathematical model. To keep the diligent works in modelling biological systems from being mistrusted, potential sources of error must be acknowledged. Employing a popular mathematical model in viral infection research, existing means and practices in parameter estimation are exemplified. Numerical results show that poor experimental data is a main source that can lead to erroneous parameter estimates despite the use of innovative parameter estimation algorithms. Arbitrary choices of initial conditions as well as data asynchrony distort the parameter estimates but are often overlooked in modelling studies. This work stresses the existence of several sources of error buried in reports of modelling biological systems, voicing the need for assessing the sources of error, consolidating efforts in solving the immediate difficulties, and possibly reconsidering the use of mathematical modelling to quantify experimental data.
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Affiliation(s)
- Van Kinh Nguyen
- Systems Medicine of Infectious Diseases, Department of Systems Immunology and Braunschweig Integrated Centre of Systems Biology, Helmholtz Centre for Infection Research, Braunschweig, Germany
- Epidemiology Department, Ho Chi Minh University of Medicine and Pharmacy, Ho Chi Minh, Vietnam
- PhD Programme “Epidemiology”, Braunschweig-Hannover, Germany
| | - Frank Klawonn
- Biostatistics, Helmholtz Centre for Infection Research, Braunschweig, Germany
- Department of Computer Science, Ostfalia University, Wolfenbüttel, Germany
| | - Rafael Mikolajczyk
- Epidemiological and Statistical Methods, Helmholtz Centre for Infection Research, Braunschweig, Germany
- German Centre for Infection Research, site Hannover-Braunschweig, Germany
- Hannover Medical School, Hannover, Germany
- [Institute of] Medical Epidemiology, Biometry and Informatics, Martin-Luther University Halle-Wittenberg, Germany
| | - Esteban A. Hernandez-Vargas
- Systems Medicine of Infectious Diseases, Department of Systems Immunology and Braunschweig Integrated Centre of Systems Biology, Helmholtz Centre for Infection Research, Braunschweig, Germany
- * E-mail:
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48
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Scagnolari C, Turriziani O, Monteleone K, Pierangeli A, Antonelli G. Consolidation of molecular testing in clinical virology. Expert Rev Anti Infect Ther 2016; 15:387-400. [PMID: 28002969 DOI: 10.1080/14787210.2017.1271711] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The development of quantitative methods for the detection of viral nucleic acids have significantly improved our ability to manage disease progression and to assess the efficacy of antiviral treatment. Moreover, major advances in molecular technologies during the last decade have allowed the identification of new host genetic markers associated with antiviral drug response but have also strongly revolutionized the way we see and perform virus diagnostics in the coming years. Areas covered: In this review, we describe the history and development of virology diagnostic methods, dedicating particular emphasis on the gradual evolution and recent advances toward the introduction of multiparametric platforms for the syndromic diagnosis. In parallel, we outline the consolidation of viral genome quantification practice in different clinical settings. Expert commentary: More rapid, accurate and affordable molecular technology can be predictable with particular emphasis on emerging techniques (next generation sequencing, digital PCR, point of care testing and syndromic diagnosis) to simplify viral diagnosis in the next future.
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Affiliation(s)
- Carolina Scagnolari
- a Laboratory of Virology, Department of Molecular Medicine, and Istituto Pasteur Italia-Cenci Bolognetti Foundation , 'Sapienza' University of Rome , Rome , Italy
| | - Ombretta Turriziani
- a Laboratory of Virology, Department of Molecular Medicine, and Istituto Pasteur Italia-Cenci Bolognetti Foundation , 'Sapienza' University of Rome , Rome , Italy
| | - Katia Monteleone
- a Laboratory of Virology, Department of Molecular Medicine, and Istituto Pasteur Italia-Cenci Bolognetti Foundation , 'Sapienza' University of Rome , Rome , Italy
| | - Alessandra Pierangeli
- a Laboratory of Virology, Department of Molecular Medicine, and Istituto Pasteur Italia-Cenci Bolognetti Foundation , 'Sapienza' University of Rome , Rome , Italy
| | - Guido Antonelli
- a Laboratory of Virology, Department of Molecular Medicine, and Istituto Pasteur Italia-Cenci Bolognetti Foundation , 'Sapienza' University of Rome , Rome , Italy
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Mathematical Models for Immunology: Current State of the Art and Future Research Directions. Bull Math Biol 2016; 78:2091-2134. [PMID: 27714570 PMCID: PMC5069344 DOI: 10.1007/s11538-016-0214-9] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 09/26/2016] [Indexed: 01/01/2023]
Abstract
The advances in genetics and biochemistry that have taken place over the last 10 years led to significant advances in experimental and clinical immunology. In turn, this has led to the development of new mathematical models to investigate qualitatively and quantitatively various open questions in immunology. In this study we present a review of some research areas in mathematical immunology that evolved over the last 10 years. To this end, we take a step-by-step approach in discussing a range of models derived to study the dynamics of both the innate and immune responses at the molecular, cellular and tissue scales. To emphasise the use of mathematics in modelling in this area, we also review some of the mathematical tools used to investigate these models. Finally, we discuss some future trends in both experimental immunology and mathematical immunology for the upcoming years.
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Lau G, Benhamou Y, Chen G, Li J, Shao Q, Ji D, Li F, Li B, Liu J, Hou J, Sun J, Wang C, Chen J, Wu V, Wong A, Wong CLP, Tsang STY, Wang Y, Bassit L, Tao S, Jiang Y, Hsiao HM, Ke R, Perelson AS, Schinazi RF. Efficacy and safety of 3-week response-guided triple direct-acting antiviral therapy for chronic hepatitis C infection: a phase 2, open-label, proof-of-concept study. Lancet Gastroenterol Hepatol 2016; 1:97-104. [PMID: 27917405 PMCID: PMC5131925 DOI: 10.1016/s2468-1253(16)30015-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND To shorten the course of direct-acting antiviral agents for chronic hepatitis C virus (HCV) infection, we examined the antiviral efficacy and safety of 3 weeks of response-guided therapy with an NS3 protease inhibitor and dual NS5A inhibitor-NS5B nucleotide analogue. METHODS In this open-label, phase 2a, single centre study, Chinese patients with chronic HCV genotype 1b infection without cirrhosis were randomly allocated by a computer program to one of three treatment groups (sofosbuvir, ledipasvir, and asunaprevir; sofosbuvir, daclatasvir, and simeprevir; or sofosbuvir, daclatasvir, and asunaprevir) until six patients in each group (1:1:1) achieved an ultrarapid virological response (plasma HCV RNA <500 IU/mL by day 2, measured by COBAS TaqMan HCV test, version 2.0). Patients with an ultrarapid virological response received 3 weeks of therapy. Patients who did not achieve an ultrarapid response were switched to sofosbuvir and ledipasvir for either 8 weeks or 12 weeks. The primary endpoint was the proportion of patients with a sustained virological response at 12 weeks (SVR12) after treatment completion, analysed in the intention-to-treat population. All patients who achieved an ultrarapid virological response were included in the safety analysis. This trial is registered with ClinicalTrials.gov, number NCT02470858. FINDINGS Between April 5, 2015, and April 15, 2015, 26 eligible patients were recruited. 12 patients were assigned to sofosbuvir, ledipasvir, and asunaprevir; six to sofosbuvir, daclatasvir, and simeprevir; and eight to sofosbuvir, daclatasvir, and asunaprevir. Six patients in each group achieved an ultrarapid virological response (18 [69%]). All patients with an ultrarapid virological response who were given 3 weeks of triple therapy achieved SVR12. The most common adverse events were fatigue (one [17%] of six patients receiving sofosbuvir, ledipasvir, and asunaprevir; one [17%] of six patients receiving sofosbuvir, daclatasvir, and simeprevir; and two [33%] of six patients receiving sofosbuvir, daclatasvir, and asunaprevir) and headache (one [17%] patient in each group). No patients experienced any serious adverse events. INTERPRETATION In this proof-of-concept study, all patients with chronic HCV without cirrhosis who achieved an ultrarapid virological response on triple direct-acting antiviral regimens by day 2 and received 3 weeks of treatment were cured, with excellent tolerability. By shortening the duration of therapy from the currently recommended 12 weeks to 3 weeks, we could drastically reduce the cost of therapy and the rate of adverse events. Further large-scale studies should be done to confirm our findings. FUNDING Center for AIDS Research, National Institutes of Health, US Department of Energy, National Center for Research Resources and the Office of Research Infrastructure Programs, Cheng Si-Yuan (China-International) Hepatitis Research Foundation, and Humanity and Health Medical Group.
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Affiliation(s)
| | - Yves Benhamou
- Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong, Hong Kong SAR, China (Prof G Lau MD, C Wang MD, J Chen PhD, V Wu BSc, A Wong BSc, Y Wang PhD); Second Liver Cirrhosis Diagnosis and Treatment Center (Prof G Lau, Prof G Chen MD, Prof Q Shao MD, D Ji MD, F Li MD, B Li MD, J Liu MD) and Institute of Infectious Disease (Prof J Li MD), 302 Hospital, Beijing, China; Service d’Hépatologie, Hôpital Pitié-Salpêtrière, Paris, France (Y Benhamou MD); State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China (Prof J Hou MD, Prof J Sun MD, C Wang); Hong Kong Molecular Pathology Diagnostic Centre, Hong Kong SAR, China (C L P Wong PhD, S T Y Tsang PhD); Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA (L Bassit PhD, S Tao PhD, Y Jiang PhD, H-M Hsiao MS, Prof R F Schinazi PhD); Theoretical Biology and Biophysics, MS-K710, Los Alamos National Laboratory, Los Alamos, NM, USA (R Ke PhD, A S Perelson PhD); and Department of Mathematics, North Carolina State University, Raleigh, NC, USA (R Ke)
| | - Guofeng Chen
- Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong, Hong Kong SAR, China (Prof G Lau MD, C Wang MD, J Chen PhD, V Wu BSc, A Wong BSc, Y Wang PhD); Second Liver Cirrhosis Diagnosis and Treatment Center (Prof G Lau, Prof G Chen MD, Prof Q Shao MD, D Ji MD, F Li MD, B Li MD, J Liu MD) and Institute of Infectious Disease (Prof J Li MD), 302 Hospital, Beijing, China; Service d’Hépatologie, Hôpital Pitié-Salpêtrière, Paris, France (Y Benhamou MD); State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China (Prof J Hou MD, Prof J Sun MD, C Wang); Hong Kong Molecular Pathology Diagnostic Centre, Hong Kong SAR, China (C L P Wong PhD, S T Y Tsang PhD); Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA (L Bassit PhD, S Tao PhD, Y Jiang PhD, H-M Hsiao MS, Prof R F Schinazi PhD); Theoretical Biology and Biophysics, MS-K710, Los Alamos National Laboratory, Los Alamos, NM, USA (R Ke PhD, A S Perelson PhD); and Department of Mathematics, North Carolina State University, Raleigh, NC, USA (R Ke)
| | - Jin Li
- Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong, Hong Kong SAR, China (Prof G Lau MD, C Wang MD, J Chen PhD, V Wu BSc, A Wong BSc, Y Wang PhD); Second Liver Cirrhosis Diagnosis and Treatment Center (Prof G Lau, Prof G Chen MD, Prof Q Shao MD, D Ji MD, F Li MD, B Li MD, J Liu MD) and Institute of Infectious Disease (Prof J Li MD), 302 Hospital, Beijing, China; Service d’Hépatologie, Hôpital Pitié-Salpêtrière, Paris, France (Y Benhamou MD); State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China (Prof J Hou MD, Prof J Sun MD, C Wang); Hong Kong Molecular Pathology Diagnostic Centre, Hong Kong SAR, China (C L P Wong PhD, S T Y Tsang PhD); Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA (L Bassit PhD, S Tao PhD, Y Jiang PhD, H-M Hsiao MS, Prof R F Schinazi PhD); Theoretical Biology and Biophysics, MS-K710, Los Alamos National Laboratory, Los Alamos, NM, USA (R Ke PhD, A S Perelson PhD); and Department of Mathematics, North Carolina State University, Raleigh, NC, USA (R Ke)
| | - Qing Shao
- Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong, Hong Kong SAR, China (Prof G Lau MD, C Wang MD, J Chen PhD, V Wu BSc, A Wong BSc, Y Wang PhD); Second Liver Cirrhosis Diagnosis and Treatment Center (Prof G Lau, Prof G Chen MD, Prof Q Shao MD, D Ji MD, F Li MD, B Li MD, J Liu MD) and Institute of Infectious Disease (Prof J Li MD), 302 Hospital, Beijing, China; Service d’Hépatologie, Hôpital Pitié-Salpêtrière, Paris, France (Y Benhamou MD); State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China (Prof J Hou MD, Prof J Sun MD, C Wang); Hong Kong Molecular Pathology Diagnostic Centre, Hong Kong SAR, China (C L P Wong PhD, S T Y Tsang PhD); Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA (L Bassit PhD, S Tao PhD, Y Jiang PhD, H-M Hsiao MS, Prof R F Schinazi PhD); Theoretical Biology and Biophysics, MS-K710, Los Alamos National Laboratory, Los Alamos, NM, USA (R Ke PhD, A S Perelson PhD); and Department of Mathematics, North Carolina State University, Raleigh, NC, USA (R Ke)
| | - Dong Ji
- Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong, Hong Kong SAR, China (Prof G Lau MD, C Wang MD, J Chen PhD, V Wu BSc, A Wong BSc, Y Wang PhD); Second Liver Cirrhosis Diagnosis and Treatment Center (Prof G Lau, Prof G Chen MD, Prof Q Shao MD, D Ji MD, F Li MD, B Li MD, J Liu MD) and Institute of Infectious Disease (Prof J Li MD), 302 Hospital, Beijing, China; Service d’Hépatologie, Hôpital Pitié-Salpêtrière, Paris, France (Y Benhamou MD); State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China (Prof J Hou MD, Prof J Sun MD, C Wang); Hong Kong Molecular Pathology Diagnostic Centre, Hong Kong SAR, China (C L P Wong PhD, S T Y Tsang PhD); Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA (L Bassit PhD, S Tao PhD, Y Jiang PhD, H-M Hsiao MS, Prof R F Schinazi PhD); Theoretical Biology and Biophysics, MS-K710, Los Alamos National Laboratory, Los Alamos, NM, USA (R Ke PhD, A S Perelson PhD); and Department of Mathematics, North Carolina State University, Raleigh, NC, USA (R Ke)
| | - Fan Li
- Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong, Hong Kong SAR, China (Prof G Lau MD, C Wang MD, J Chen PhD, V Wu BSc, A Wong BSc, Y Wang PhD); Second Liver Cirrhosis Diagnosis and Treatment Center (Prof G Lau, Prof G Chen MD, Prof Q Shao MD, D Ji MD, F Li MD, B Li MD, J Liu MD) and Institute of Infectious Disease (Prof J Li MD), 302 Hospital, Beijing, China; Service d’Hépatologie, Hôpital Pitié-Salpêtrière, Paris, France (Y Benhamou MD); State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China (Prof J Hou MD, Prof J Sun MD, C Wang); Hong Kong Molecular Pathology Diagnostic Centre, Hong Kong SAR, China (C L P Wong PhD, S T Y Tsang PhD); Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA (L Bassit PhD, S Tao PhD, Y Jiang PhD, H-M Hsiao MS, Prof R F Schinazi PhD); Theoretical Biology and Biophysics, MS-K710, Los Alamos National Laboratory, Los Alamos, NM, USA (R Ke PhD, A S Perelson PhD); and Department of Mathematics, North Carolina State University, Raleigh, NC, USA (R Ke)
| | - Bing Li
- Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong, Hong Kong SAR, China (Prof G Lau MD, C Wang MD, J Chen PhD, V Wu BSc, A Wong BSc, Y Wang PhD); Second Liver Cirrhosis Diagnosis and Treatment Center (Prof G Lau, Prof G Chen MD, Prof Q Shao MD, D Ji MD, F Li MD, B Li MD, J Liu MD) and Institute of Infectious Disease (Prof J Li MD), 302 Hospital, Beijing, China; Service d’Hépatologie, Hôpital Pitié-Salpêtrière, Paris, France (Y Benhamou MD); State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China (Prof J Hou MD, Prof J Sun MD, C Wang); Hong Kong Molecular Pathology Diagnostic Centre, Hong Kong SAR, China (C L P Wong PhD, S T Y Tsang PhD); Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA (L Bassit PhD, S Tao PhD, Y Jiang PhD, H-M Hsiao MS, Prof R F Schinazi PhD); Theoretical Biology and Biophysics, MS-K710, Los Alamos National Laboratory, Los Alamos, NM, USA (R Ke PhD, A S Perelson PhD); and Department of Mathematics, North Carolina State University, Raleigh, NC, USA (R Ke)
| | - Jialiang Liu
- Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong, Hong Kong SAR, China (Prof G Lau MD, C Wang MD, J Chen PhD, V Wu BSc, A Wong BSc, Y Wang PhD); Second Liver Cirrhosis Diagnosis and Treatment Center (Prof G Lau, Prof G Chen MD, Prof Q Shao MD, D Ji MD, F Li MD, B Li MD, J Liu MD) and Institute of Infectious Disease (Prof J Li MD), 302 Hospital, Beijing, China; Service d’Hépatologie, Hôpital Pitié-Salpêtrière, Paris, France (Y Benhamou MD); State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China (Prof J Hou MD, Prof J Sun MD, C Wang); Hong Kong Molecular Pathology Diagnostic Centre, Hong Kong SAR, China (C L P Wong PhD, S T Y Tsang PhD); Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA (L Bassit PhD, S Tao PhD, Y Jiang PhD, H-M Hsiao MS, Prof R F Schinazi PhD); Theoretical Biology and Biophysics, MS-K710, Los Alamos National Laboratory, Los Alamos, NM, USA (R Ke PhD, A S Perelson PhD); and Department of Mathematics, North Carolina State University, Raleigh, NC, USA (R Ke)
| | - Jinlin Hou
- Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong, Hong Kong SAR, China (Prof G Lau MD, C Wang MD, J Chen PhD, V Wu BSc, A Wong BSc, Y Wang PhD); Second Liver Cirrhosis Diagnosis and Treatment Center (Prof G Lau, Prof G Chen MD, Prof Q Shao MD, D Ji MD, F Li MD, B Li MD, J Liu MD) and Institute of Infectious Disease (Prof J Li MD), 302 Hospital, Beijing, China; Service d’Hépatologie, Hôpital Pitié-Salpêtrière, Paris, France (Y Benhamou MD); State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China (Prof J Hou MD, Prof J Sun MD, C Wang); Hong Kong Molecular Pathology Diagnostic Centre, Hong Kong SAR, China (C L P Wong PhD, S T Y Tsang PhD); Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA (L Bassit PhD, S Tao PhD, Y Jiang PhD, H-M Hsiao MS, Prof R F Schinazi PhD); Theoretical Biology and Biophysics, MS-K710, Los Alamos National Laboratory, Los Alamos, NM, USA (R Ke PhD, A S Perelson PhD); and Department of Mathematics, North Carolina State University, Raleigh, NC, USA (R Ke)
| | - Jian Sun
- Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong, Hong Kong SAR, China (Prof G Lau MD, C Wang MD, J Chen PhD, V Wu BSc, A Wong BSc, Y Wang PhD); Second Liver Cirrhosis Diagnosis and Treatment Center (Prof G Lau, Prof G Chen MD, Prof Q Shao MD, D Ji MD, F Li MD, B Li MD, J Liu MD) and Institute of Infectious Disease (Prof J Li MD), 302 Hospital, Beijing, China; Service d’Hépatologie, Hôpital Pitié-Salpêtrière, Paris, France (Y Benhamou MD); State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China (Prof J Hou MD, Prof J Sun MD, C Wang); Hong Kong Molecular Pathology Diagnostic Centre, Hong Kong SAR, China (C L P Wong PhD, S T Y Tsang PhD); Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA (L Bassit PhD, S Tao PhD, Y Jiang PhD, H-M Hsiao MS, Prof R F Schinazi PhD); Theoretical Biology and Biophysics, MS-K710, Los Alamos National Laboratory, Los Alamos, NM, USA (R Ke PhD, A S Perelson PhD); and Department of Mathematics, North Carolina State University, Raleigh, NC, USA (R Ke)
| | - Cheng Wang
- Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong, Hong Kong SAR, China (Prof G Lau MD, C Wang MD, J Chen PhD, V Wu BSc, A Wong BSc, Y Wang PhD); Second Liver Cirrhosis Diagnosis and Treatment Center (Prof G Lau, Prof G Chen MD, Prof Q Shao MD, D Ji MD, F Li MD, B Li MD, J Liu MD) and Institute of Infectious Disease (Prof J Li MD), 302 Hospital, Beijing, China; Service d’Hépatologie, Hôpital Pitié-Salpêtrière, Paris, France (Y Benhamou MD); State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China (Prof J Hou MD, Prof J Sun MD, C Wang); Hong Kong Molecular Pathology Diagnostic Centre, Hong Kong SAR, China (C L P Wong PhD, S T Y Tsang PhD); Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA (L Bassit PhD, S Tao PhD, Y Jiang PhD, H-M Hsiao MS, Prof R F Schinazi PhD); Theoretical Biology and Biophysics, MS-K710, Los Alamos National Laboratory, Los Alamos, NM, USA (R Ke PhD, A S Perelson PhD); and Department of Mathematics, North Carolina State University, Raleigh, NC, USA (R Ke)
| | - Jing Chen
- Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong, Hong Kong SAR, China (Prof G Lau MD, C Wang MD, J Chen PhD, V Wu BSc, A Wong BSc, Y Wang PhD); Second Liver Cirrhosis Diagnosis and Treatment Center (Prof G Lau, Prof G Chen MD, Prof Q Shao MD, D Ji MD, F Li MD, B Li MD, J Liu MD) and Institute of Infectious Disease (Prof J Li MD), 302 Hospital, Beijing, China; Service d’Hépatologie, Hôpital Pitié-Salpêtrière, Paris, France (Y Benhamou MD); State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China (Prof J Hou MD, Prof J Sun MD, C Wang); Hong Kong Molecular Pathology Diagnostic Centre, Hong Kong SAR, China (C L P Wong PhD, S T Y Tsang PhD); Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA (L Bassit PhD, S Tao PhD, Y Jiang PhD, H-M Hsiao MS, Prof R F Schinazi PhD); Theoretical Biology and Biophysics, MS-K710, Los Alamos National Laboratory, Los Alamos, NM, USA (R Ke PhD, A S Perelson PhD); and Department of Mathematics, North Carolina State University, Raleigh, NC, USA (R Ke)
| | - Vanessa Wu
- Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong, Hong Kong SAR, China (Prof G Lau MD, C Wang MD, J Chen PhD, V Wu BSc, A Wong BSc, Y Wang PhD); Second Liver Cirrhosis Diagnosis and Treatment Center (Prof G Lau, Prof G Chen MD, Prof Q Shao MD, D Ji MD, F Li MD, B Li MD, J Liu MD) and Institute of Infectious Disease (Prof J Li MD), 302 Hospital, Beijing, China; Service d’Hépatologie, Hôpital Pitié-Salpêtrière, Paris, France (Y Benhamou MD); State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China (Prof J Hou MD, Prof J Sun MD, C Wang); Hong Kong Molecular Pathology Diagnostic Centre, Hong Kong SAR, China (C L P Wong PhD, S T Y Tsang PhD); Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA (L Bassit PhD, S Tao PhD, Y Jiang PhD, H-M Hsiao MS, Prof R F Schinazi PhD); Theoretical Biology and Biophysics, MS-K710, Los Alamos National Laboratory, Los Alamos, NM, USA (R Ke PhD, A S Perelson PhD); and Department of Mathematics, North Carolina State University, Raleigh, NC, USA (R Ke)
| | - April Wong
- Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong, Hong Kong SAR, China (Prof G Lau MD, C Wang MD, J Chen PhD, V Wu BSc, A Wong BSc, Y Wang PhD); Second Liver Cirrhosis Diagnosis and Treatment Center (Prof G Lau, Prof G Chen MD, Prof Q Shao MD, D Ji MD, F Li MD, B Li MD, J Liu MD) and Institute of Infectious Disease (Prof J Li MD), 302 Hospital, Beijing, China; Service d’Hépatologie, Hôpital Pitié-Salpêtrière, Paris, France (Y Benhamou MD); State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China (Prof J Hou MD, Prof J Sun MD, C Wang); Hong Kong Molecular Pathology Diagnostic Centre, Hong Kong SAR, China (C L P Wong PhD, S T Y Tsang PhD); Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA (L Bassit PhD, S Tao PhD, Y Jiang PhD, H-M Hsiao MS, Prof R F Schinazi PhD); Theoretical Biology and Biophysics, MS-K710, Los Alamos National Laboratory, Los Alamos, NM, USA (R Ke PhD, A S Perelson PhD); and Department of Mathematics, North Carolina State University, Raleigh, NC, USA (R Ke)
| | - Chris L P Wong
- Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong, Hong Kong SAR, China (Prof G Lau MD, C Wang MD, J Chen PhD, V Wu BSc, A Wong BSc, Y Wang PhD); Second Liver Cirrhosis Diagnosis and Treatment Center (Prof G Lau, Prof G Chen MD, Prof Q Shao MD, D Ji MD, F Li MD, B Li MD, J Liu MD) and Institute of Infectious Disease (Prof J Li MD), 302 Hospital, Beijing, China; Service d’Hépatologie, Hôpital Pitié-Salpêtrière, Paris, France (Y Benhamou MD); State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China (Prof J Hou MD, Prof J Sun MD, C Wang); Hong Kong Molecular Pathology Diagnostic Centre, Hong Kong SAR, China (C L P Wong PhD, S T Y Tsang PhD); Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA (L Bassit PhD, S Tao PhD, Y Jiang PhD, H-M Hsiao MS, Prof R F Schinazi PhD); Theoretical Biology and Biophysics, MS-K710, Los Alamos National Laboratory, Los Alamos, NM, USA (R Ke PhD, A S Perelson PhD); and Department of Mathematics, North Carolina State University, Raleigh, NC, USA (R Ke)
| | - Stella T Y Tsang
- Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong, Hong Kong SAR, China (Prof G Lau MD, C Wang MD, J Chen PhD, V Wu BSc, A Wong BSc, Y Wang PhD); Second Liver Cirrhosis Diagnosis and Treatment Center (Prof G Lau, Prof G Chen MD, Prof Q Shao MD, D Ji MD, F Li MD, B Li MD, J Liu MD) and Institute of Infectious Disease (Prof J Li MD), 302 Hospital, Beijing, China; Service d’Hépatologie, Hôpital Pitié-Salpêtrière, Paris, France (Y Benhamou MD); State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China (Prof J Hou MD, Prof J Sun MD, C Wang); Hong Kong Molecular Pathology Diagnostic Centre, Hong Kong SAR, China (C L P Wong PhD, S T Y Tsang PhD); Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA (L Bassit PhD, S Tao PhD, Y Jiang PhD, H-M Hsiao MS, Prof R F Schinazi PhD); Theoretical Biology and Biophysics, MS-K710, Los Alamos National Laboratory, Los Alamos, NM, USA (R Ke PhD, A S Perelson PhD); and Department of Mathematics, North Carolina State University, Raleigh, NC, USA (R Ke)
| | - Yudong Wang
- Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong, Hong Kong SAR, China (Prof G Lau MD, C Wang MD, J Chen PhD, V Wu BSc, A Wong BSc, Y Wang PhD); Second Liver Cirrhosis Diagnosis and Treatment Center (Prof G Lau, Prof G Chen MD, Prof Q Shao MD, D Ji MD, F Li MD, B Li MD, J Liu MD) and Institute of Infectious Disease (Prof J Li MD), 302 Hospital, Beijing, China; Service d’Hépatologie, Hôpital Pitié-Salpêtrière, Paris, France (Y Benhamou MD); State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China (Prof J Hou MD, Prof J Sun MD, C Wang); Hong Kong Molecular Pathology Diagnostic Centre, Hong Kong SAR, China (C L P Wong PhD, S T Y Tsang PhD); Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA (L Bassit PhD, S Tao PhD, Y Jiang PhD, H-M Hsiao MS, Prof R F Schinazi PhD); Theoretical Biology and Biophysics, MS-K710, Los Alamos National Laboratory, Los Alamos, NM, USA (R Ke PhD, A S Perelson PhD); and Department of Mathematics, North Carolina State University, Raleigh, NC, USA (R Ke)
| | - Leda Bassit
- Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong, Hong Kong SAR, China (Prof G Lau MD, C Wang MD, J Chen PhD, V Wu BSc, A Wong BSc, Y Wang PhD); Second Liver Cirrhosis Diagnosis and Treatment Center (Prof G Lau, Prof G Chen MD, Prof Q Shao MD, D Ji MD, F Li MD, B Li MD, J Liu MD) and Institute of Infectious Disease (Prof J Li MD), 302 Hospital, Beijing, China; Service d’Hépatologie, Hôpital Pitié-Salpêtrière, Paris, France (Y Benhamou MD); State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China (Prof J Hou MD, Prof J Sun MD, C Wang); Hong Kong Molecular Pathology Diagnostic Centre, Hong Kong SAR, China (C L P Wong PhD, S T Y Tsang PhD); Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA (L Bassit PhD, S Tao PhD, Y Jiang PhD, H-M Hsiao MS, Prof R F Schinazi PhD); Theoretical Biology and Biophysics, MS-K710, Los Alamos National Laboratory, Los Alamos, NM, USA (R Ke PhD, A S Perelson PhD); and Department of Mathematics, North Carolina State University, Raleigh, NC, USA (R Ke)
| | - Sijia Tao
- Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong, Hong Kong SAR, China (Prof G Lau MD, C Wang MD, J Chen PhD, V Wu BSc, A Wong BSc, Y Wang PhD); Second Liver Cirrhosis Diagnosis and Treatment Center (Prof G Lau, Prof G Chen MD, Prof Q Shao MD, D Ji MD, F Li MD, B Li MD, J Liu MD) and Institute of Infectious Disease (Prof J Li MD), 302 Hospital, Beijing, China; Service d’Hépatologie, Hôpital Pitié-Salpêtrière, Paris, France (Y Benhamou MD); State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China (Prof J Hou MD, Prof J Sun MD, C Wang); Hong Kong Molecular Pathology Diagnostic Centre, Hong Kong SAR, China (C L P Wong PhD, S T Y Tsang PhD); Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA (L Bassit PhD, S Tao PhD, Y Jiang PhD, H-M Hsiao MS, Prof R F Schinazi PhD); Theoretical Biology and Biophysics, MS-K710, Los Alamos National Laboratory, Los Alamos, NM, USA (R Ke PhD, A S Perelson PhD); and Department of Mathematics, North Carolina State University, Raleigh, NC, USA (R Ke)
| | - Yong Jiang
- Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong, Hong Kong SAR, China (Prof G Lau MD, C Wang MD, J Chen PhD, V Wu BSc, A Wong BSc, Y Wang PhD); Second Liver Cirrhosis Diagnosis and Treatment Center (Prof G Lau, Prof G Chen MD, Prof Q Shao MD, D Ji MD, F Li MD, B Li MD, J Liu MD) and Institute of Infectious Disease (Prof J Li MD), 302 Hospital, Beijing, China; Service d’Hépatologie, Hôpital Pitié-Salpêtrière, Paris, France (Y Benhamou MD); State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China (Prof J Hou MD, Prof J Sun MD, C Wang); Hong Kong Molecular Pathology Diagnostic Centre, Hong Kong SAR, China (C L P Wong PhD, S T Y Tsang PhD); Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA (L Bassit PhD, S Tao PhD, Y Jiang PhD, H-M Hsiao MS, Prof R F Schinazi PhD); Theoretical Biology and Biophysics, MS-K710, Los Alamos National Laboratory, Los Alamos, NM, USA (R Ke PhD, A S Perelson PhD); and Department of Mathematics, North Carolina State University, Raleigh, NC, USA (R Ke)
| | - Hui-Mien Hsiao
- Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong, Hong Kong SAR, China (Prof G Lau MD, C Wang MD, J Chen PhD, V Wu BSc, A Wong BSc, Y Wang PhD); Second Liver Cirrhosis Diagnosis and Treatment Center (Prof G Lau, Prof G Chen MD, Prof Q Shao MD, D Ji MD, F Li MD, B Li MD, J Liu MD) and Institute of Infectious Disease (Prof J Li MD), 302 Hospital, Beijing, China; Service d’Hépatologie, Hôpital Pitié-Salpêtrière, Paris, France (Y Benhamou MD); State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China (Prof J Hou MD, Prof J Sun MD, C Wang); Hong Kong Molecular Pathology Diagnostic Centre, Hong Kong SAR, China (C L P Wong PhD, S T Y Tsang PhD); Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA (L Bassit PhD, S Tao PhD, Y Jiang PhD, H-M Hsiao MS, Prof R F Schinazi PhD); Theoretical Biology and Biophysics, MS-K710, Los Alamos National Laboratory, Los Alamos, NM, USA (R Ke PhD, A S Perelson PhD); and Department of Mathematics, North Carolina State University, Raleigh, NC, USA (R Ke)
| | - Ruian Ke
- Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong, Hong Kong SAR, China (Prof G Lau MD, C Wang MD, J Chen PhD, V Wu BSc, A Wong BSc, Y Wang PhD); Second Liver Cirrhosis Diagnosis and Treatment Center (Prof G Lau, Prof G Chen MD, Prof Q Shao MD, D Ji MD, F Li MD, B Li MD, J Liu MD) and Institute of Infectious Disease (Prof J Li MD), 302 Hospital, Beijing, China; Service d’Hépatologie, Hôpital Pitié-Salpêtrière, Paris, France (Y Benhamou MD); State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China (Prof J Hou MD, Prof J Sun MD, C Wang); Hong Kong Molecular Pathology Diagnostic Centre, Hong Kong SAR, China (C L P Wong PhD, S T Y Tsang PhD); Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA (L Bassit PhD, S Tao PhD, Y Jiang PhD, H-M Hsiao MS, Prof R F Schinazi PhD); Theoretical Biology and Biophysics, MS-K710, Los Alamos National Laboratory, Los Alamos, NM, USA (R Ke PhD, A S Perelson PhD); and Department of Mathematics, North Carolina State University, Raleigh, NC, USA (R Ke)
| | - Alan S Perelson
- Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong, Hong Kong SAR, China (Prof G Lau MD, C Wang MD, J Chen PhD, V Wu BSc, A Wong BSc, Y Wang PhD); Second Liver Cirrhosis Diagnosis and Treatment Center (Prof G Lau, Prof G Chen MD, Prof Q Shao MD, D Ji MD, F Li MD, B Li MD, J Liu MD) and Institute of Infectious Disease (Prof J Li MD), 302 Hospital, Beijing, China; Service d’Hépatologie, Hôpital Pitié-Salpêtrière, Paris, France (Y Benhamou MD); State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China (Prof J Hou MD, Prof J Sun MD, C Wang); Hong Kong Molecular Pathology Diagnostic Centre, Hong Kong SAR, China (C L P Wong PhD, S T Y Tsang PhD); Center for AIDS Research, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA (L Bassit PhD, S Tao PhD, Y Jiang PhD, H-M Hsiao MS, Prof R F Schinazi PhD); Theoretical Biology and Biophysics, MS-K710, Los Alamos National Laboratory, Los Alamos, NM, USA (R Ke PhD, A S Perelson PhD); and Department of Mathematics, North Carolina State University, Raleigh, NC, USA (R Ke)
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