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Moulaei K, Sharifi H, Bahaadinbeigy K, Haghdoost AA, Nasiri N. Machine learning for prediction of viral hepatitis: A systematic review and meta-analysis. Int J Med Inform 2023; 179:105243. [PMID: 37806178 DOI: 10.1016/j.ijmedinf.2023.105243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/21/2023] [Accepted: 10/01/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Lack of accurate and timely diagnosis of hepatitis poses obstacles to effective treatment, disease progression prevention, complication reduction, and life-saving interventions of patients. Utilizing machine learning can greatly enhance the achievement of timely and precise disease diagnosis. Therefore, we carried out this systematic review and meta-analysis to explore the performance of machine learning algorithms in predicting viral hepatitis. METHODS Using an extensive literature search in PubMed, Scopus, and Web of Science databases until June 15, 2023, English publications on hepatitis prediction using machine learning algorithms were included. Two authors independently extracted pertinent information from the selected studies. The PRISMA 2020 checklist was followed for study selection and result reporting. The risk of bias was checked using the International Journal of Medical Informatics (IJMEDI) checklist. Data were analyzed using the 'metandi' command in Stata 17. RESULTS Twenty-one original studies were included, covering 82 algorithms. Sixteen studies utilized five algorithms to predict hepatitis B. Ten studies used five algorithms for hepatitis C prediction. For hepatitis B prediction, the SVM algorithms demonstrated the highest sensitivity (90.0%; 95% confidence interval (CI): 77.0%-96.0%), specificity (94%; 95% CI: 90.0%-97.0%), and a diagnostic odds ratio (DOR) of 145 (95% CI: 37.0-559.0). In the case of hepatitis C, the KNN algorithms exhibited the highest sensitivity (80%; 95% CI:30.0%-97.0%), specificity (95%; 95% CI: 58.0%-99.0%), and DOR (72; 95% CI: 3.0-1644.0) for prediction. CONCLUSION SVM and KNN demonstrated superior performance in predicting hepatitis. The proper algorithm along with clinical practice could improve hepatitis prediction and management.
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Affiliation(s)
- Khadijeh Moulaei
- Department of Health Information Technology, Faculty of Paramedical, Ilam University of Medical Sciences, Ilam, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Ali Akbar Haghdoost
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Naser Nasiri
- School of Public Health, Jiroft University of Medical Sciences, Jiroft, Kerman, Iran.
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Pheng P, Meyer L, Ségéral O, Chea P, Yi S, Tuot S, Kaldor JM, Saphonn V. Hepatitis C seroprevalence among people living with HIV/AIDS and pregnant women in four provinces in Cambodia: an integrated bio-behavioral survey. BMC Infect Dis 2022; 22:177. [PMID: 35193496 PMCID: PMC8862396 DOI: 10.1186/s12879-022-07163-2] [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: 11/17/2021] [Accepted: 02/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background Understanding the extent of viral hepatitis burden in specific subgroups, such as pregnant women and people living with HIV/AIDS (PLWHA), and their geographic distribution is essential for evidence-informed policy and mobilizing resources for targeted treatment and prevention efforts. However, in Cambodia, the epidemiology of hepatitis C remains uncertain. We estimated the hepatitis C virus (HCV) burden and transmission risk factors among PLWHA and pregnant women attending antenatal care (ANC) in Cambodia. Methods Between March and April 2016, we conducted a cross-sectional survey in four diverse geographical areas: the capital city of Phnom Penh and three provinces. We collected information on demographic characteristics and risk behaviors and performed HCV antibody (Anti-HCV) testing among pregnant women attending public ANC clinics and among those receiving HIV care at the hospitals. We computed the prevalence of HCV among the two population subsets and performed logistic regression analyses to identify risk factors associated with HCV antibody positivity. Results Of 935 participants enrolled, 510 (54.6%) were pregnant women and 425 (45.4%) were PLWHA. Anti-HCV prevalence was significantly higher in PLWHA than in pregnant women (29/425, 6.8% vs 5/510, 0.9%, P < 0.001). Of the geographic regions, Preah Sihanouk province (Southwest) had the highest anti-HCV prevalence among PLWHA (12.0%, P = 0.031). There was no significant geographic difference in anti-HCV prevalence among pregnant women. In multivariable analyses (data subset to PLWHA), HCV infection was significantly associated with having a family member positive for HCV (OR = 7.6 [95% CI: 1.01–57.84], P = 0.048) and a history of intravenous medication injection in the last 5 years (OR = 7.1 [95% CI: 2.79–18.10], P < 0.001). Conclusions HCV infection is relatively common among Cambodian PLWHA, likely related to intravenous medication injection and intra-familial viral transmission. Systematic HCV testing and care among PLWHA (and possibly their family members) might be necessary. Setting up a surveillance system for HCV might also be beneficial for some geographical regions and populations. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07163-2.
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Affiliation(s)
- Phearavin Pheng
- University of Health Sciences, 73 Monivong Boulevard, Phnom Penh, 12201, Cambodia. .,Ecole Doctorale de Santé Publique, Service de Santé Publique du GH Hôpitaux, Universitaires de Paris Sud, Université Paris-Saclay, Inserm CESP U1018, Paris, France.
| | - Laurence Meyer
- Ecole Doctorale de Santé Publique, Service de Santé Publique du GH Hôpitaux, Universitaires de Paris Sud, Université Paris-Saclay, Inserm CESP U1018, Paris, France
| | - Olivier Ségéral
- University of Health Sciences, 73 Monivong Boulevard, Phnom Penh, 12201, Cambodia
| | - Phalla Chea
- University of Health Sciences, 73 Monivong Boulevard, Phnom Penh, 12201, Cambodia
| | - Siyan Yi
- KHANA Center for Population Health Research, Phnom Penh, Cambodia.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Center for Global Health Research, Touro University California, Vallejo, CA, USA
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia.,Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Faculty of Social Sciences and Humanity, Royal University of Phnom Penh, Phnom Penh, Cambodia
| | | | - Vonthanak Saphonn
- University of Health Sciences, 73 Monivong Boulevard, Phnom Penh, 12201, Cambodia
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Jaquet A, Muula G, Ekouevi DK, Wandeler G. Elimination of Viral Hepatitis in Low and Middle-Income Countries: Epidemiological Research Gaps. CURR EPIDEMIOL REP 2021; 8:89-96. [PMID: 34532216 PMCID: PMC8443244 DOI: 10.1007/s40471-021-00273-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The purpose of our review was to summarize current recommendations on testing strategies, antiviral therapy eligibility and monitoring, and prevention of mother-to-child transmission of chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, and to highlight major research gaps in low and middle-income countries (LMIC), with a particular focus on sub-Saharan Africa (SSA). RECENT FINDINGS While data on the prevalence of HBV and HCV infections in LMIC are increasing, current knowledge on liver-related complications as well as on treatment outcomes remains limited. Furthermore, very little information is available on the feasibility and cost-effectiveness of large-scale testing and management strategies in high-prevalence settings. The availability of policy-relevant data is particularly scarce in SSA, which accounts for a significant part of the global burden of chronic viral hepatitis. SUMMARY Current recommendations on the management and monitoring of chronic viral hepatitis rely mainly on data from high-income settings. The global elimination of viral hepatitis will only be achieved if prevention, testing, and treatment strategies tailored to specific LMIC are implemented. In order to inform scalable and cost-effective interventions, dedicated research initiatives have to be undertaken. Future studies will have to include the evaluation of innovative testing strategies, the validation of simplified methods to diagnose liver cirrhosis and hepatocellular carcinoma, and the monitoring of long-term treatment outcomes and toxicity. In addition, national plans to achieve the elimination of HBV mother-to-child transmission are urgently needed, including effective ways to test pregnant women, treat those who are eligible, and ensure birth dose vaccination is given to all newborns.
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Affiliation(s)
- Antoine Jaquet
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), UMR, 1219 Bordeaux, France
| | - Guy Muula
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Didier K. Ekouevi
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), UMR, 1219 Bordeaux, France
- Département de santé publique, Faculté des Sciences de la santé, Faculté des Sciences de la santé, Université de Lomé, Lomé, Togo
- Programme PACCI, site ANRS, Abidjan, Côte d’Ivoire
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, Inselspital, University of Bern, 3010 Bern, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Poudel KC, Poudel-Tandukar K. High prevalence and genotype distribution of hepatitis C virus in people living with HIV in Kathmandu, Nepal. Infect Dis (Lond) 2021; 53:521-530. [PMID: 33729860 DOI: 10.1080/23744235.2021.1898046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) co-infection is still a significant cause of morbidity and mortality among HIV-positive individuals in many resource-limited countries. As prevalence rates of co-infection using the serological diagnosis of HCV infection might be imprecise, estimates of prevalence using polymerase chain reaction (PCR) confirmed diagnosis is needed to guide HCV treatment efforts among HIV-positive individuals in resource-limited countries. METHODS We conducted this community-based cross-sectional study among 280 HIV-positive individuals recruited through the networks of five non-government organizations working with HIV-positive individuals in Kathmandu, Nepal. We collected blood samples from each participant and tested all the anti-HCV positive samples for HCV-RNA and genotypes. We calculated the prevalence of HCV/HIV co-infection and examined factors associated with it using multivariable logistic regression analysis. We also calculated the proportion of infection by different HCV genotypes and investigated HCV seroconversion. RESULTS The prevalence of HCV/HIV co-infection was 29.6% (95% CI 24.25-34.95). History of a lifetime injecting drug use was associated with a higher likelihood of HCV/HIV co-infection (p < .001). Of the 81 individuals whose serum samples were available for genotype assessment, 55.7% tested positive for genotype 3A, 36.7% for genotype 1A and the remaining samples' genotype was undetermined (7.6%). Of the 100 anti-HCV positive samples, 17 (17.0%) tested negative for HCV RNA. CONCLUSIONS High prevalence of HCV/HIV co-infection, distribution of prevalent HCV genotype 1A and 3A and HCV seroconversion rate have important implications for the public health system in guiding HCV treatment and control efforts among HIV-positive individuals.
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Affiliation(s)
- Krishna C Poudel
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA.,Institute for Global Health, University of Massachusetts Amherst, Amherst, MA, USA
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Grant P, Shumbusho F, Van Nuil JI, Kateera F, Mukherjee J, Kabahizi J, Ntaganda F, Nsanzimana S, Mbituyumuremyi A, Damascene MJ, Muvunyi CM, Mukabatsinda C, Musabeyezu E, Ntirenganya C, Gupta N. Safety and Efficacy of Limited Laboratory Monitoring for Hepatitis C Treatment: A Blinded Clinical Trial in Rwanda. Hepatol Commun 2020; 4:569-576. [PMID: 32258951 PMCID: PMC7109339 DOI: 10.1002/hep4.1482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/10/2019] [Indexed: 11/29/2022] Open
Abstract
Direct-acting antivirals for hepatitis C virus (HCV) are highly effective and well-tolerated. However, only a small percentage of HCV-infected individuals globally have received therapy. Reducing the complexity of monitoring during HCV therapy, if shown to be safe, could facilitate greater access to HCV services, particularly in resource-limited settings such as sub-Saharan Africa. We enrolled a total of 300 patients who were chronically infected with genotype 4 HCV in Rwanda and treated them with fixed-dose ledispasvir/sofosbuvir for 12 weeks. For 60 consecutive participants enrolled, we blinded the study clinician to on-treatment laboratory results. We compared the efficacy, safety, and tolerability in those with blinded laboratory results to those with standard laboratory monitoring. Baseline characteristics among those with blinded laboratory values were comparable to those with standard monitoring. Among both groups, the median age was 63 years, and the median HCV viral load was 5.9 log (versus 64 years and 6.0 log, respectively). Sustained virologic response rates at 12 weeks after treatment completion were similar in those with blinded laboratories (87%) compared to those with standard laboratory monitoring (87%). There was no increase in adverse events in those with blinded laboratory results, and no participants discontinued the study medication because of an adverse event. Conclusion: On-treatment laboratory monitoring did not improve patient outcomes in those treated with ledispasvir/sofosbuvir. Eliminating this monitoring in treatment programs in resource-limited settings may facilitate and accelerate scale-up of HCV therapy.
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Affiliation(s)
- Philip Grant
- Division of Infectious DiseasesStanford UniversityPalo AltoCA
| | | | | | | | - Joia Mukherjee
- Partners In HealthRwinkwavuRwanda
- Department of Global Health and Social MedicineHarvard Medical SchoolBostonMA
| | | | | | | | | | | | | | | | | | | | - Neil Gupta
- Partners In HealthRwinkwavuRwanda
- Department of Global Health and Social MedicineHarvard Medical SchoolBostonMA
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Mohamed Z, Mbwambo J, Rwegasha J, Mgina N, Doulla B, Mwakale P, Tuaillon E, Chevaliez S, Shimakawa Y, Taylor‐Robinson SD, Thursz MR, Brown AS, Lemoine M. In-field evaluation of Xpert® HCV viral load Fingerstick assay in people who inject drugs in Tanzania. Liver Int 2020; 40:514-521. [PMID: 31778282 PMCID: PMC7079170 DOI: 10.1111/liv.14315] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/06/2019] [Accepted: 11/15/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although novel hepatitis C virus (HCV) RNA point-of-care technology has the potential to enhance the diagnosis in resource-limited settings, very little real-world validation of their utility exists. We evaluate the performance of HCV RNA quantification using the Xpert® HCV viral load Fingerstick assay (Xpert® HCV VL Fingerstick assay) as compared to the World Health Organisation pre-qualified plasma Xpert® HCV VL assay among people who inject drugs (PWID) attending an opioid agonist therapy (OAT) clinic in Dar-es-Salaam, Tanzania. METHODS Between December 2018 and February 2019, consecutive HCV seropositive PWID attending the OAT clinic provided paired venous and Fingerstick samples for HCV RNA quantification. These were processed onsite using the GeneXpert® platform located at the Central tuberculosis reference laboratory. RESULTS A total of 208 out of 220 anti-HCV-positive participants recruited (94.5%) had a valid Xpert® HCV VL result available; 126 (61%; 95% CI 53.8-67.0) had detectable and quantifiable HCV RNA. About 188 (85%) participants had paired plasma and Fingerstick whole blood samples; the sensitivity and specificity for the quantification of HCV RNA levels were 99.1% and 98.7% respectively. There was an excellent correlation (R2 = .95) and concordance (mean difference 0.13 IU/mL, (95% CI -0.9 to 0.16 IU/mL) in HCV RNA levels between plasma samples and Fingerstick samples. CONCLUSION This study found excellent performance of the Xpert® HCV VL Fingerstick assay for HCV RNA detection and quantification in an African-field setting. Its clinical utility represents an important watershed in overcoming existing challenges to HCV diagnosis, which should play a crucial role in HCV elimination in Africa.
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Affiliation(s)
- Zameer Mohamed
- Department of HepatologyImperial College LondonSt Mary's HospitalLondonUK
| | - Jessie Mbwambo
- Department of PsychiatryMuhimbili National HospitalMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - John Rwegasha
- Department of GastroenterologyMuhimbili National HospitalDar es SalaamTanzania
| | - Nicodem Mgina
- Tanzania Central Tuberculosis Reference LaboratoryMuhimbili National HospitalDar es SalaamTanzania
| | - Basra Doulla
- Tanzania Central Tuberculosis Reference LaboratoryMuhimbili National HospitalDar es SalaamTanzania
| | - Promise Mwakale
- Department of BioethicsMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Edouard Tuaillon
- INSERM U 1058Université Montpellier 1MontpellierFrance
- Département de Bactériologie‐VirologieCHU MontpellierMontpellierFrance
| | - Stephane Chevaliez
- Department of VirologyFrench National Reference Center for Viral Hepatitis B, C and DeltaHopital Henri MondorUniversité Paris‐EstCréteilFrance
| | - Yusuke Shimakawa
- Unité d'Épidémiologie des Maladies ÉmergentesInstitut PasteurParisFrance
| | | | - Mark R. Thursz
- Department of HepatologyImperial College LondonSt Mary's HospitalLondonUK
| | - Ashley S. Brown
- Department of HepatologyImperial College LondonSt Mary's HospitalLondonUK
| | - Maud Lemoine
- Department of HepatologyImperial College LondonSt Mary's HospitalLondonUK
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Mendizabal M, Alonso C, Silva MO. Overcoming barriers to hepatitis C elimination. Frontline Gastroenterol 2019; 10:207-209. [PMID: 31288259 PMCID: PMC6583574 DOI: 10.1136/flgastro-2018-101114] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/03/2019] [Accepted: 01/15/2019] [Indexed: 02/04/2023] Open
Affiliation(s)
- Manuel Mendizabal
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina,Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina
| | - Cristina Alonso
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina,Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina
| | - Marcelo O Silva
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina,Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina
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Zając M, Muszalska I, Sobczak A, Dadej A, Tomczak S, Jelińska A. Hepatitis C - New drugs and treatment prospects. Eur J Med Chem 2019; 165:225-249. [PMID: 30685524 DOI: 10.1016/j.ejmech.2019.01.025] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/11/2019] [Accepted: 01/11/2019] [Indexed: 12/19/2022]
Abstract
Hepatitis C virus (HCV) affects approx. 3% of the world's population and accounts for ca 300 000 deaths per year. 80% of individuals with HCV develop chronic symptoms which, when untreated, may cause cirrhosis (27%) or hepatocellular carcinoma (25%). The hepatitis C virus is a (+)ssRNA enveloped virus of the family Flaviviridae. Seven major HCV genotypes and their subtypes (a, b) have been identified. In the 1990s, interferons alpha-2 were used in the treatment of HCV and in the next decade HCV therapy was based on pegylated interferon alpha-2 in combination with ribavirin. Since 2011, interferons alpha, DNA and RNA polymerase inhibitors, NS3/4A RNA protease inhibitors, NS5 RNA serine protease inhibitors, NS5B RNA polymerase inhibitors have been approved for clinical use. Monotherapy is avoided in medication due to rapidly developing viral resistance. A total of 113 papers were included comprising original publications and reviews. The paper reviews the molecular targets and chemical structures of drugs used in HCV treatment. Indications and contraindications for anti-HCV drugs are also discussed together with application regimens.
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Affiliation(s)
- Marianna Zając
- Poznan University of Medicinal Sciences, Department of Pharmaceutical Chemistry, Grunwaldzka Str. 6, 60-780, Poznań, Poland
| | - Izabela Muszalska
- Poznan University of Medicinal Sciences, Department of Pharmaceutical Chemistry, Grunwaldzka Str. 6, 60-780, Poznań, Poland.
| | - Agnieszka Sobczak
- Poznan University of Medicinal Sciences, Department of Pharmaceutical Chemistry, Grunwaldzka Str. 6, 60-780, Poznań, Poland
| | - Adrianna Dadej
- Poznan University of Medicinal Sciences, Department of Pharmaceutical Chemistry, Grunwaldzka Str. 6, 60-780, Poznań, Poland
| | - Szymon Tomczak
- Poznan University of Medicinal Sciences, Department of Pharmaceutical Chemistry, Grunwaldzka Str. 6, 60-780, Poznań, Poland
| | - Anna Jelińska
- Poznan University of Medicinal Sciences, Department of Pharmaceutical Chemistry, Grunwaldzka Str. 6, 60-780, Poznań, Poland
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Mathur P, Kottilil S, Wilson E. Use of Ribavirin for Hepatitis C Treatment in the Modern Direct-acting Antiviral Era. J Clin Transl Hepatol 2018; 6:431-437. [PMID: 30637222 PMCID: PMC6328726 DOI: 10.14218/jcth.2018.00007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 06/04/2018] [Accepted: 06/24/2018] [Indexed: 12/24/2022] Open
Abstract
Ribavirin, once a staple of hepatitis C treatment, has significant drawbacks, including treatment-limiting side effects, the requirement for intensive laboratory monitoring, the need for frequent dose adjustments, and teratogenicity. These factors make it difficult to escalate ribavirin-based HCV treatment to most infected patients globally. Most studies have shown comparable response rates between ribavirin-inclusive and ribavirin-sparing regimens in uncomplicated patient populations. However, ribavirin is still used in the management of patients who have failed previous therapy as well as those with decompensated liver disease. In this review, we explore the evidence supporting the use of ribavirin in the current climate of hepatitis C treatment with oral combination direct-acting antiviral agents.
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Affiliation(s)
- Poonam Mathur
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Shyamasundaran Kottilil
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Eleanor Wilson
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
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Kronfli N, Nitulescu R, Cox J, Moodie EEM, Wong A, Cooper C, Gill J, Walmsley S, Martel‐Laferrière V, Hull MW, Klein MB. Previous incarceration impacts access to hepatitis C virus (HCV) treatment among HIV-HCV co-infected patients in Canada. J Int AIDS Soc 2018; 21:e25197. [PMID: 30460791 PMCID: PMC6246945 DOI: 10.1002/jia2.25197] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 10/02/2018] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The prevalence of hepatitis C virus (HCV) is far higher in prison settings than in the general population; thus, micro-elimination strategies must target people in prison to eliminate HCV. We aimed to examine incarceration patterns and determine whether incarceration impacts HCV treatment uptake among Canadian HIV-HCV co-infected individuals in the direct-acting antiviral (DAA) era. METHODS The Canadian Co-Infection Cohort prospectively follows HIV-HCV co-infected people from 18 centres. HCV RNA-positive participants with available baseline information on incarceration history were included and followed from 21 November 2013 (when second-generation DAAs were approved by Health Canada) until 30 June 2017. A Cox proportional hazards model was used to assess the effect of time-updated incarceration status on time to treatment uptake, adjusting for patient-level characteristics known to be associated with treatment uptake in the DAA era. RESULTS Overall, 1433 participants (1032/72% men) were included; 67% had a history of incarceration and 39% were re-incarcerated at least once. Compared to those never incarcerated, previously incarcerated participants were more likely to be Indigenous, earn <$1500 CAD/month, report current or past injection drug use and have poorly controlled HIV. There were 339 second-generation DAA treatment initiations during follow-up (18/100 person-years). Overall, 48% of participants never incarcerated were treated (27/100 person-years) compared to only 31% of previously incarcerated participants (15/100 person-years). Sustained virologic response (SVR) rates at 12 weeks were 95% and 92% respectively. After adjusting for other factors, participants with a history of incarceration (adjusted hazard ratio (aHR): 0.7, 95% CI: 0.5 to 0.9) were less likely to initiate treatment, as were those with a monthly income <$1500 (aHR: 0.7, 95% CI: 0.5 to 0.9) or who reported current injection drug use (aHR: 0.7, 95% CI: 0.4 to 1.0). Participants with undetectable HIV RNA (aHR: 2.1, 95% CI: 1.6 to 2.9) or significant fibrosis (aHR: 1.5, 95% CI: 1.2 to 1.9) were more likely to initiate treatment. CONCLUSIONS The majority of HIV-HCV co-infected persons had a history of incarceration. Those previously incarcerated were 30% less likely to access treatment in the DAA era even after accounting for several patient-level characteristics. With SVR rates above 90%, HCV elimination may be possible if treatment is expanded for this vulnerable and neglected group.
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Affiliation(s)
- Nadine Kronfli
- Division of Infectious Diseases/Chronic Viral Illness ServiceDepartment of MedicineGlen siteMcGill University Health CentreMontrealQCCanada
| | - Roy Nitulescu
- Research Institute of the McGill University Health CentreMontrealQCCanada
| | - Joseph Cox
- Division of Infectious Diseases/Chronic Viral Illness ServiceDepartment of MedicineGlen siteMcGill University Health CentreMontrealQCCanada
- Department of Epidemiology, Biostatistics, and Occupational HealthMcGill UniversityMontrealQCCanada
| | - Erica EM Moodie
- Department of Epidemiology, Biostatistics, and Occupational HealthMcGill UniversityMontrealQCCanada
| | - Alexander Wong
- Department of MedicineUniversity of SaskatchewanReginaSKCanada
| | - Curtis Cooper
- Department of MedicineUniversity of OttawaOttawaONCanada
| | - John Gill
- Department of MedicineUniversity of CalgaryCalgaryABCanada
| | - Sharon Walmsley
- University Health NetworkTorontoONCanada
- CIHR Canadian HIV Trials NetworkVancouverBCCanada
| | | | - Mark W Hull
- Department of MedicineUniversity of British ColumbiaVancouverBCCanada
- British Columbia Centre for Excellence in HIV/AIDSVancouverBCCanada
| | - Marina B Klein
- Division of Infectious Diseases/Chronic Viral Illness ServiceDepartment of MedicineGlen siteMcGill University Health CentreMontrealQCCanada
- CIHR Canadian HIV Trials NetworkVancouverBCCanada
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Ekouevi DK, Coffie PA, Tchounga BK, Poda A, Jaquet A, Dabis F, Eholie SP. Prevalence of hepatitis C among HIV-1, HIV-2 and dually reactive patients: A multi-country cross-sectional survey in West Africa. J Public Health Afr 2018; 9:871. [PMID: 30687482 PMCID: PMC6325423 DOI: 10.4081/jphia.2018.871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 07/05/2018] [Indexed: 02/06/2023] Open
Abstract
Little is known on the impact of HIV-2 infection on HCV viral replication. The aim of the study was to compare HCV prevalence and viral replication based on HIV types in West Africa. A cross-sectional survey was conducted within the IeDEA HIV-2 West Africa cohort from March to December 2012. All HIVinfected adult patients who attended participating HIV clinics during the study period were included. Blood samples were collected and re-tested for HIV type discrimination, HCV serology and viral load. A total of 767 patients were enrolled: 186 HIV-1, 431 HIV-2 and 150 HIV-1&2 dually reactive. At time of sampling, 531 (69.2%) were on ART and median CD4+ cell count was 472/mm3. Thirty (3.9%, 95% CI 2.7-5.5) patients were anti-HCV positive (4.3% in HIV-1, 4.0% in HIV-1&2 dually reactive and 3.7% in HIV-2; p=0.91). Detectable HCV RNA was identified in 21 (70.0%) patients (100% in HIV-1 and HIV- 1&2 dually reactive vs. 43.8% in HIV-2; p=0.003). Systematic screening should be promoted and performed in this population, since HCV is now potentially curable in sub- Saharan Africa.
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Affiliation(s)
- Didier K Ekouevi
- Université de Lomé, Département de Santé Publique, Lomé-Togo.,ISPED, Université de Bordeaux & Centre INSERM U1219 - Bordeaux Population Health, Bordeaux, France.,Programme PACCI, site de recherche ANRS, Abidjan, Côte d'Ivoire
| | - Patrick A Coffie
- ISPED, Université de Bordeaux & Centre INSERM U1219 - Bordeaux Population Health, Bordeaux, France.,Programme PACCI, site de recherche ANRS, Abidjan, Côte d'Ivoire.,Département de Dermatologie et d'Infectiologie, UFR des Sciences Médicales, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire
| | - Boris K Tchounga
- ISPED, Université de Bordeaux & Centre INSERM U1219 - Bordeaux Population Health, Bordeaux, France.,Programme PACCI, site de recherche ANRS, Abidjan, Côte d'Ivoire.,Département de Dermatologie et d'Infectiologie, UFR des Sciences Médicales, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire
| | - Armel Poda
- Université Polytechnique de Bobo, Institut Supérieur des Sciences de la Santé, Bobo-Dioulasso, Burkina Faso.,Hôpital de Jour de Bobo, Service des Maladies Infectieuses (CHU Souro Sanou), Bobo-Dioulasso, Burkina Faso
| | - Antoine Jaquet
- ISPED, Université de Bordeaux & Centre INSERM U1219 - Bordeaux Population Health, Bordeaux, France
| | - François Dabis
- ISPED, Université de Bordeaux & Centre INSERM U1219 - Bordeaux Population Health, Bordeaux, France.,Programme PACCI, site de recherche ANRS, Abidjan, Côte d'Ivoire.,Département de Dermatologie et d'Infectiologie, UFR des Sciences Médicales, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire
| | - Serge P Eholie
- Programme PACCI, site de recherche ANRS, Abidjan, Côte d'Ivoire.,Département de Dermatologie et d'Infectiologie, UFR des Sciences Médicales, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire.,Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
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Martin NK, Boerekamps A, Hill AM, Rijnders BJA. Is hepatitis C virus elimination possible among people living with HIV and what will it take to achieve it? J Int AIDS Soc 2018; 21 Suppl 2:e25062. [PMID: 29633560 PMCID: PMC5978712 DOI: 10.1002/jia2.25062] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 12/28/2017] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The World Health Organization targets for hepatitis C virus (HCV) elimination include a 90% reduction in new infections by 2030. Our objective is to review the modelling evidence and cost data surrounding feasibility of HCV elimination among people living with HIV (PLWH), and identify likely components for elimination. We also discuss the real-world experience of HCV direct acting antiviral (DAA) scale-up and elimination efforts in the Netherlands. METHODS We review modelling evidence of what intervention scale-up is required to achieve WHO HCV elimination targets among HIV-infected (HIV+) people who inject drugs (PWID) and men who have sex with men (MSM), review cost-effectiveness of HCV therapy among PLWH and discuss economic implications of elimination. We additionally use the real-world experience of DAA scale-up in the Netherlands to illustrate the promise and potential challenges of HCV elimination strategies in MSM. Finally, we summarize key components of the HCV elimination response among PWLH. RESULTS AND DISCUSSION Modelling indicates HCV elimination among HIV+ MSM and PWID is potentially achievable but requires combination treatment and either harm reduction or behavioural risk reductions. Preliminary modelling indicates elimination among HIV+ PWID will require elimination efforts among PWID more broadly. Treatment for PLWH and high-risk populations (PWID and MSM) is cost-effective in high-income countries, but costs of DAAs remain a barrier to scale-up worldwide despite the potential low production price ($50 per 12 week course). In the Netherlands, universal DAA availability led to rapid uptake among HIV+ MSM in 2015/16, and a 50% reduction in acute HCV incidence among HIV+ MSM from 2014 to 2016 was observed. In addition to HCV treatment, elimination among PLWH globally also likely requires regular HCV testing, development of low-cost accurate HCV diagnostics, reduced costs of DAA therapy, broad treatment access without restrictions, close monitoring for HCV reinfection and retreatment, and harm reduction and/or behavioural interventions. CONCLUSIONS Achieving WHO HCV Elimination targets is potentially achievable among HIV-infected populations. Among HIV+ PWID, it likely requires HCV treatment scale-up combined with harm reduction for both HIV+ and HIV- populations. Among HIV+ MSM, elimination likely requires both HCV treatment and behaviour risk reduction among the HIV+ MSM population, the latter of which to date has not been observed. Lower HCV diagnostic and treatment costs will be key to ensuring scale-up of HCV testing and treatment without restriction, enabling elimination.
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Affiliation(s)
- Natasha K Martin
- Division of Global Public HealthUniversity of CaliforniaSan DiegoCAUSA
- School of Social and Community MedicineUniversity of BristolBristolUnited Kingdom
| | - Anne Boerekamps
- Department of Internal MedicineDivision of Infectious DiseasesErasmus MC University Medical CenterRotterdamthe Netherlands
| | - Andrew M Hill
- Department of Translational MedicineUniversity of LiverpoolLiverpoolUnited Kingdom
| | - Bart J A Rijnders
- Department of Internal MedicineDivision of Infectious DiseasesErasmus MC University Medical CenterRotterdamthe Netherlands
- Department of Medical Microbiology and Infectious DiseasesErasmus MC University Medical CenterRotterdamthe Netherlands
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13
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Kelly ML, Riordan SM, Bopage R, Lloyd AR, Post JJ. Capacity of non-invasive hepatic fibrosis algorithms to replace transient elastography to exclude cirrhosis in people with hepatitis C virus infection: A multi-centre observational study. PLoS One 2018; 13:e0192763. [PMID: 29438397 PMCID: PMC5811020 DOI: 10.1371/journal.pone.0192763] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 01/30/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Achievement of the 2030 World Health Organisation (WHO) global hepatitis C virus (HCV) elimination targets will be underpinned by scale-up of testing and use of direct-acting antiviral treatments. In Australia, despite publically-funded testing and treatment, less than 15% of patients were treated in the first year of treatment access, highlighting the need for greater efficiency of health service delivery. To this end, non-invasive fibrosis algorithms were examined to reduce reliance on transient elastography (TE) which is currently utilised for the assessment of cirrhosis in most Australian clinical settings. MATERIALS AND METHODS This retrospective and prospective study, with derivation and validation cohorts, examined consecutive patients in a tertiary referral centre, a sexual health clinic, and a prison-based hepatitis program. The negative predictive value (NPV) of seven non-invasive algorithms were measured using published and newly derived cut-offs. The number of TEs avoided for each algorithm, or combination of algorithms, was determined. RESULTS The 850 patients included 780 (92%) with HCV mono-infection, and 70 (8%) co-infected with HIV or hepatitis B. The mono-infected cohort included 612 men (79%), with an overall prevalence of cirrhosis of 16% (125/780). An 'APRI' algorithm cut-off of 1.0 had a 94% NPV (95%CI: 91-96%). Newly derived cut-offs of 'APRI' (0.49), 'FIB-4' (0.93) and 'GUCI' (0.5) algorithms each had NPVs of 99% (95%CI: 97-100%), allowing avoidance of TE in 40% (315/780), 40% (310/780) and 40% (298/749) respectively. When used in combination, NPV was retained and TE avoidance reached 54% (405/749), regardless of gender or co-infection. CONCLUSIONS Non-invasive algorithms can reliably exclude cirrhosis in many patients, allowing improved efficiency of HCV assessment services in Australia and worldwide.
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Affiliation(s)
- Melissa Louise Kelly
- Department of Infectious Diseases, Prince of Wales Hospital, Randwick, NSW, Australia
- Department of Medicine, The Albion Centre, Surry Hills, NSW, Australia
- Population Heath, Justice Health & Forensic Mental Health Network, Malabar, NSW Australia
| | - Stephen M. Riordan
- Prince of Wales Clinical School, School of Medicine, UNSW, Kensington, NSW, Australia
- Gastrointestinal and Liver Unit, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Rohan Bopage
- Department of Medicine, The Albion Centre, Surry Hills, NSW, Australia
| | - Andrew R. Lloyd
- Department of Infectious Diseases, Prince of Wales Hospital, Randwick, NSW, Australia
- Population Heath, Justice Health & Forensic Mental Health Network, Malabar, NSW Australia
- The Kirby Institute, Viral Immunology Systems Program, Kensington, NSW, Australia
| | - Jeffrey John Post
- Department of Infectious Diseases, Prince of Wales Hospital, Randwick, NSW, Australia
- Department of Medicine, The Albion Centre, Surry Hills, NSW, Australia
- Population Heath, Justice Health & Forensic Mental Health Network, Malabar, NSW Australia
- Prince of Wales Clinical School, School of Medicine, UNSW, Kensington, NSW, Australia
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Petruzziello A, Marigliano S, Loquercio G, Coppola N, Piccirillo M, Leongito M, Azzaro R, Izzo F, Botti G. Hepatitis C Virus (HCV) genotypes distribution among hepatocellular carcinoma patients in Southern Italy: a three year retrospective study. Infect Agent Cancer 2017. [DOI: 10.1186/s13027-017-0162-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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15
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Siddique MS, Shoaib S, Saad A, Iqbal HJ, Durrani N. Rapid virological&End treatment response of patients treated with Sofosbuvir in Chronic Hepatitis C. Pak J Med Sci 2017; 33:813-817. [PMID: 29067045 PMCID: PMC5648944 DOI: 10.12669/pjms.334.12785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 05/03/2017] [Accepted: 08/03/2017] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To determineRapid & End treatment response of patients treated with Sofosbuvir in Chronic Hepatitis C at tertiary care hospital. METHODS It was an observational study conducted at Memon Medical Institute from January 2016 to July 2017. The inclusion criteria for patients was 18 years of age or older, having chronic infection with HCV. Total=201 received sofosbuvir with or without interferon in our OPDs. Patients were categorized into Treatment naïve, treatment experienced and decompensated chronic liver disease. Pregnant patients and those not willing to participate were excluded. Initially genotyping and Quantitative HCV RNA test was done. RESULTS A total of 201 subjects were included in the study with mean age of the patients was 46.22± 14.41 years. Of 201 patients, n= 131 (65.2%) chronic hepatitis C, compensated cirrhosis n= 47(23.4%), and with decompensated cirrhosis n=23(11.4%). Most commonly genotype 3 n= 180 (89.6%) was present followed by genotype 1 n=9(4.5%), genotype 2 n=1(0.5%), genotype 4 n=1(0.5%). Of patients with genotype 3, 123 received dual therapy and 57 were given triple therapy. After one month of therapy HCV RNA by PCR, 200(99.5%) achieved RVR, 199(99%) achieved ETR and SVR achieved in 178(88.5%) while remaining 1 patient did not achieved RVR, 2 ETR and 12 patients did not achieved SVR and remaining 11 SVR lost follow up. CONCLUSION Sofosbuvir has shown to be very effective andsuccessfulwith achievement of virological response with little or no resistance in all genotypes mainly genotype 3 treated in our study population. The promising results of our study will aid in better outcomes and therefore help in eradication of the virus.
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Affiliation(s)
- Muhammad Shoaib Siddique
- Dr. Muhammad ShoaibSiddique, FCPS Gastroenterology. Consultant Gastroenterologists, Memon Medical Institute & Hospital, Karachi, Pakistan
| | - Sana Shoaib
- Dr. Sana Shoaib, FCPS Medicine. Consultant Medicine, Memon Medical Institute & Hospital, Karachi, Pakistan
| | - Alvia Saad
- Dr. AlviaSaad, FCPS Registrar General Medicine. Incharge Emergency, Memon Medical Institute & Hospital, Karachi, Pakistan
| | - Hamna Javed Iqbal
- HamnaJavedIqbal, Student, Research Coordinator, Memon Medical Hospital, Karachi, Memon Medical Institute & Hospital, Karachi, Pakistan
| | - Noureen Durrani
- NoureenDurrani, Statistician & Researcher, Memon Medical Institute & Hospital, Karachi, Pakistan
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16
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El Kassas M, Elbaz T, Hafez E, Wifi MN, Esmat G. Discovery and preclinical development of dasabuvir for the treatment of hepatitis C infection. Expert Opin Drug Discov 2017; 12:635-642. [PMID: 28440681 DOI: 10.1080/17460441.2017.1322955] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Hepatitis C virus (HCV) is a leading cause of liver-related morbidity and mortality. Positively, the introduction of new directly-acting antivirals (DAAs) have led to dramatic improvements in response rates to antiviral therapy. Furthermore, newer generations of DAAs have demonstrated better safety profiles as well as efficacy than older generations. Current treatment recommendations are based on different combinations of DAAs. Current combination therapies rely on agents that target the different steps of viral replication by using different molecules from various DAAs families. Areas covered: In this review, the authors summarize data from of one of the recently developed NS5B polymerase inhibitors, dasabuvir, formerly known as ABT-333. Herein, the authors discuss the drug discovery data for dasabuvir including data from preclinical, toxicological resistance studies. The authors also review dasabuvir's clinical efficacy across various clinical challenges, in addition to its limitations in clinical practice. Expert opinion: Dasabuvir represents an important medical advance when used as a combination therapy for HCV. Unfortunately, it does present limitations like low genotypic coverage and further research is still required to address some of the lingering issues.
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Affiliation(s)
- Mohamed El Kassas
- a Endemic Medicine Department, Faculty of Medicine , Helwan University , Cairo , Egypt
| | - Tamer Elbaz
- b Endemic Hepatogastroenterology, Faculty of Medicine , Cairo University , Cairo , Egypt
| | - Enas Hafez
- c Clinical Pharmacy Unit, New Cairo Viral Hepatitis Treatment Unit , Cairo , Egypt
| | - Mohamed Naguib Wifi
- d Internal Medicine Department, Faculty of Medicine , Cairo University , Cairo , Egypt
| | - Gamal Esmat
- b Endemic Hepatogastroenterology, Faculty of Medicine , Cairo University , Cairo , Egypt
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17
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Umutesi J, Simmons B, Makuza JD, Dushimiyimana D, Mbituyumuremyi A, Uwimana JM, Ford N, Mills EJ, Nsanzimana S. Prevalence of hepatitis B and C infection in persons living with HIV enrolled in care in Rwanda. BMC Infect Dis 2017; 17:315. [PMID: 28464899 PMCID: PMC5414306 DOI: 10.1186/s12879-017-2422-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 04/26/2017] [Indexed: 02/07/2023] Open
Abstract
Background Hepatitis B (HBV) and C (HCV) are important causes of morbidity and mortality in people living with human immunodeficiency virus (HIV). The burden of these co-infections in sub-Saharan Africa is still unclear. We estimated the prevalence of the hepatitis B surface antigen (HBsAg) and hepatitis C antibody (HCVAb) among HIV-infected individuals in Rwanda and identified factors associated with infection. Methods Between January 2016 and June 2016, we performed systematic screening for HBsAg and HCVAb among HIV-positive individuals enrolled at public and private HIV facilities across Rwanda. Results were analyzed to determine marker prevalence and variability by demographic factors. Results Overall, among 117,258 individuals tested, the prevalence of HBsAg and HCVAb was 4.3% (95% confidence interval [CI] (4.2–4.4) and 4.6% (95% CI 4.5–4.7) respectively; 182 (0.2%) HIV+ individuals were co-infected with HBsAg and HCVAb. Prevalence was higher in males (HBsAg, 5.4% [5.1–5.6] vs. 3.7% [3.5–3.8]; HCVAb, 5.0% [4.8–5.2] vs. 4.4% [4.3–4.6]) and increased with age; HCVAb prevalence was significantly higher in people aged ≥65 years (17.8% [16.4–19.2]). Prevalence varied geographically. Conclusion HBV and HCV co-infections are common among HIV-infected individuals in Rwanda. It is important that viral hepatitis prevention and treatment activities are scaled-up to control further transmission and reduce the burden in this population. Particular efforts should be made to conduct targeted screening of males and the older population. Further assessment is required to determine rates of HBV and HCV chronicity among HIV-infected individuals and identify effective strategies to link individuals to care and treatment.
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Affiliation(s)
- Justine Umutesi
- HIV/AIDS & STIs Diseases Division, Rwanda Biomedical Centre, Kigali, Rwanda
| | | | - Jean D Makuza
- HIV/AIDS & STIs Diseases Division, Rwanda Biomedical Centre, Kigali, Rwanda
| | | | | | - Jean Marie Uwimana
- HIV/AIDS & STIs Diseases Division, Rwanda Biomedical Centre, Kigali, Rwanda
| | - Nathan Ford
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | | | - Sabin Nsanzimana
- HIV/AIDS & STIs Diseases Division, Rwanda Biomedical Centre, Kigali, Rwanda. .,Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland. .,Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland.
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Chabrol F, David PM, Krikorian G. Rationing hepatitis C treatment in the context of austerity policies in France and Cameroon: A transnational perspective on the pharmaceuticalization of healthcare systems. Soc Sci Med 2017; 187:243-250. [PMID: 28392011 DOI: 10.1016/j.socscimed.2017.03.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 03/24/2017] [Accepted: 03/27/2017] [Indexed: 01/18/2023]
Abstract
New powerful drugs against hepatitis C can cure the disease, but they are not widely distributed because their exorbitant prices are destabilizing healthcare systems in both African and European countries. This article takes access to hepatitis C treatments since 2013 in France and in Cameroon as a lens to analyze the rationing of pharmaceutical treatments in relation to recent transformations of health systems. Access to these treatments is analyzed thanks to ethnographic observation and interviews lead in Paris and Yaoundé, with patients, associations, health professionals and public health experts. In Cameroon, rationing takes place through various layers of socio-economic restrictions, and no patient organization advocates for hepatitis treatment. In France, access to hepatitis C treatments has become politicized, and collective mobilizations have denounced rationing as a threat to the promise of universal social security. In this study, we examine Africa's long experience with rationing in the context of structural adjustment, and we bring together experiences in France and Cameroon. This article analyses the phenomenon of the pharmaceuticalization of healthcare systems, that is to say the growing use of pharmaceuticals in healthcare systems, by documenting the social and political construction of scarcity. Indeed, whereas pharmaceuticalization is a concept that has often been used in situations of drugs abundance, a parallel analysis of rationing highlights a political economy of pharmaceuticals that shapes public health debates and policies according to an economy of scarcity, especially in times of austerity.
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Affiliation(s)
- Fanny Chabrol
- Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale, SESSTIM, UMR 912 Inserm, IRD, Aix-Marseille Université, 27 boulevard Jean Moulin, 13385 Marseille, France; Centre de Recherche, Médecine, Sciences, Santé, Santé mentale, Société, CERMES 3, UMR 988 Inserm, CNRS, EHESS, Université Paris 5 Descartes, 7, rue Guy Môquet, 94801 Villejuif, France.
| | - Pierre-Marie David
- Laboratoire SPHERE, UMR 7219, Université Paris Diderot, bâtiment Condorcet, case 70935 rue Thomas Mann 75205 Paris cedex 13, France.
| | - Gaëlle Krikorian
- IRIS, Institut de Recherche Interdisciplinaire sur les enjeux Sociaux, UMR 8156 CNRS, U997 Inserm, EHESS, Université Paris 13, 190 avenue de France 75244 Paris cedex 13, France.
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Gupta N, Kabahizi J, Mukabatsinda C, Walker TD, Musabeyezu E, Kiromera A, Van Nuil JI, Steiner K, Mukherjee J, Nsanzimana S, Mbituyumuremyi A. "Waiting for DAAs": A retrospective chart review of patients with untreated hepatitis C in Rwanda. PLoS One 2017; 12:e0174148. [PMID: 28323868 PMCID: PMC5360324 DOI: 10.1371/journal.pone.0174148] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 03/03/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Access to treatment for hepatitis C virus (HCV) in sub-Saharan Africa is extremely limited. With the advent of direct acting antivirals (DAAs), highly effective and easy-to-deliver oral regimens are now available on the global market. This study was conducted to understand the background and characteristics of a national cohort of patients with HCV infection enrolled in care and awaiting therapy with DAAs. METHODS AND FINDINGS We conducted a retrospective chart review of all adult patients with confirmed HCV infection who were currently enrolled in care and treatment at the four existing hepatitis referral centers in Rwanda. Patient charts at these centers were reviewed, and routinely collected data were recorded and analyzed. Overall, 253 patients were identified; median age was 56 years (IQR: 43, 65), and 149 (58.9%) were female. Median viral load was 688,736 IU/ml and 96.7% were HCV genotype 4. As classified by FIB-4 score, 64.8% of the patients had moderate to severe fibrosis. Fibrosis stage was associated with age (OR 1.12, CI 1.09-1.17), but not with time since diagnosis, gender, treatment center, or type of insurance. There was a low frequency of documented co-morbid conditions, including hypertension, diabetes, HIV, and hepatitis B virus. CONCLUSIONS Compared to an estimated 55,000 patients eligible for HCV treatment in Rwanda, this study identified only 253 patients currently diagnosed and engaged in care, highlighting an immense treatment gap in HCV, likely due to the lack of accessible and affordable screening, diagnostic, and treatment modalities. The patients that were enrolled in care had a disproportionately advanced fibrosis stage, possibly indicating late presentation to care or lack of treatment options. In the context of newly available and effective treatment options, this study supports the overall need to accelerate access to HCV screening, diagnostics, and care and treatment services in resource-limited settings in sub-Saharan Africa.
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Affiliation(s)
- Neil Gupta
- Division of Global Health Equity, Brigham & Women’s Hospital, Boston, Massachusetts, United States of America
- Partners In Health / Inshuti Mu Buzima, Rwinkwavu, Rwanda
| | | | | | | | | | | | | | - Kevin Steiner
- Division of Global Health Equity, Brigham & Women’s Hospital, Boston, Massachusetts, United States of America
| | - Joia Mukherjee
- Division of Global Health Equity, Brigham & Women’s Hospital, Boston, Massachusetts, United States of America
- Partners In Health / Inshuti Mu Buzima, Rwinkwavu, Rwanda
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Abstract
With the arrival of all-oral directly acting antiviral (DAA) therapy with high cure rates, the promise of hepatitis C virus (HCV) eradication is within closer reach. The availability of generic DAAs has improved access to countries with constrained resources. However, therapy is only one component of the HCV care continuum, which is the framework for HCV management from identifying patients to cure. The large number of undiagnosed HCV cases is the biggest concern, and strategies to address this are needed, as risk factor screening is suboptimal, detecting <20% of known cases. Improvements in HCV confirmation through either reflex HCV RNA screening or ideally a sensitive point of care test are needed. HCV notification (e.g., Australia) may improve diagnosis (proportion of HCV diagnosed is 75%) and may lead to benefits by increasing linkage to care, therapy and cure. Evaluations for cirrhosis using non-invasive markers are best done with a biological panel, but they are only moderately accurate. In resource-constrained settings, only generic HCV medications are available, and a combination of sofosbuvir, ribavirin, ledipasvir or daclatasvir provides sufficient efficacy for all genotypes, but this is likely to be replaced with pangenetypic regimens such as sofosbuvir/velpatasvir and glecaprevir/pibrentaasvir. In conclusion, HCV management in resource-constrained settings is challenging on multiple fronts because of the lack of infrastructure, facilities, trained manpower and equipment. However, it is still possible to make a significant impact towards HCV eradication through a concerted effort by individuals and national organisations with domain expertise in this area.
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Affiliation(s)
- Seng Gee Lim
- Division of Gastroenterology and Hepatology, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore.
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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21
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Generic Direct Acting Antiviral Treatment: The First Step Towards Elimination of Hepatitis C in Iran. HEPATITIS MONTHLY 2017. [DOI: 10.5812/hepatmon.45788] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Kandeel A, Genedy M, El-Refai S, Funk AL, Fontanet A, Talaat M. The prevalence of hepatitis C virus infection in Egypt 2015: implications for future policy on prevention and treatment. Liver Int 2017; 37:45-53. [PMID: 27275625 PMCID: PMC5145777 DOI: 10.1111/liv.13186] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 05/25/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS In 2015, a national Egyptian health issue survey was conducted to describe the prevalence of hepatitis C virus (HCV) infection. In this paper, we describe the HCV burden in 2015, compare the results with the national survey conducted in 2008, and discuss the implications of the new findings on prevention of HCV in Egypt. METHODS A multistage probability sampling approach was used, similar to the national demographic survey conducted in 2008. More than 90% of sampled individuals complied with the interview and provided blood samples. RESULTS In the 15-59-year age groups, the prevalence of HCV antibody was found to be 10.0% (95% CI 9.5-10.5) and that of HCV RNA to be 7.0% (95% CI 6.6-7.4). In children, 1-14 years old, the prevalence of HCV antibody and HCV RNA were 0.4% (95% CI 0.3-0.5) and 0.2% (95% CI 0.1-0.3) respectively. Approximately, 3.7 million persons have chronic HCV infection in the age group 15-59 in 2015. An estimated 29% reduction in HCV RNA prevalence has been seen since 2008, which is largely attributable to the ageing of the group infected 40-50 years ago during the mass schistosomiasis treatment campaigns. Prevention efforts may have also contributed to this decline, with an estimated 75% (95% CI 6-45) decrease in HCV incidence in the 0-19 year age groups over the past 20 years. CONCLUSIONS These findings can be used to shape future HCV prevention policies in Egypt.
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Affiliation(s)
- Amr Kandeel
- Ministry of Health and Population, Cairo, Egypt
| | | | | | | | - Arnaud Fontanet
- Institut Pasteur, Paris, France.,Conservatoire National des Arts et Métiers, Paris, France
| | - Maha Talaat
- Global Disease Detection Regional Center, US Centers for Disease Control and Prevention, Cairo, Egypt.,US Naval Medical Research Unit, No.3, Cairo, Egypt
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Taaffe J, Wilson D. Mobilising a global response to hepatitis: Lessons learned from the HIV movement. Glob Public Health 2016; 13:473-488. [PMID: 27748158 DOI: 10.1080/17441692.2016.1233989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hepatitis caused by hepatitis B and C virus is increasingly becoming a significant global health threat, with widespread prevalence that may have severe disease and economic impacts in the future. Yet, preventative measures are not implemented universally and high costs of medicines limits treatment efforts. The global response to HIV/AIDS faced similar issues, but overcame them through a global movement that brought attention to the crisis and ultimately resulted in the creation and implementation of and access to better tools for HIV prevention and treatment. This also included effective policies and programmes behind and supporting the movement. Such could be done for hepatitis, specifically using lessons from the HIV response. Here, we will discuss the current and potentially severe future burden of hepatitis globally, the challenges in addressing this epidemic, and how principles applied from the global HIV response can facilitate a successful and similar hepatitis movement.
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Estimating the Impact of Expanding Treatment Coverage and Allocation Strategies for Chronic Hepatitis C in a Direct Antiviral Agent Era. PLoS One 2016; 11:e0163095. [PMID: 27631382 PMCID: PMC5025017 DOI: 10.1371/journal.pone.0163095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 09/03/2016] [Indexed: 02/07/2023] Open
Abstract
Hepatitis C virus (HCV) infection is an important worldwide public health problem, and most of the global HCV burden is in low- to middle-income countries. This study aimed to estimate the future burden of chronic hepatitis C (CHC) and the impact of public health policies using novel antiviral agents in Thailand. A mathematical model of CHC transmission dynamics was constructed to examine the disease burden over the next 20 years using different treatment strategies. We compared and evaluated the current treatment (PEGylated interferon and ribavirin) with new treatments using novel direct-acting antiviral agents among various treatment policies. Thailand’s CHC prevalence was estimated to decrease 1.09%–0.19% in 2015–2035. Expanding treatment coverage (i.e., a five-fold increment in treatment accessibility) was estimated to decrease cumulative deaths (33,007 deaths avoided, 25.5% reduction) from CHC-related decompensated cirrhosis and hepatocellular carcinoma (HCC). The yearly incidence of HCC-associated HCV was estimated to decrease from 2,305 to 1,877 cases yearly with expanding treatment coverage. A generalized treatment scenario (i.e., an equal proportional distribution of available treatment to individuals at all disease stages according to the number of cases at each stage) was predicted to further reduce death from HCC (9,170 deaths avoided, 11.3% reduction) and the annual incidence of HCC (i.e., a further decrease from 1,877 to 1,168 cases yearly, 37.7% reduction), but cumulative deaths were predicted to increase (by 3,626 deaths, 3.7% increase). Based on the extensive coverage scenario and the generalized treatment scenario, we estimated near-zero death from decompensated cirrhosis in 2031. In conclusion, CHC-related morbidity and mortality in Thailand are estimated to decrease dramatically over the next 20 years. Treatment coverage and allocation strategies are important factors that affect the future burden of CHC in resource-limited countries like Thailand.
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Petruzziello A, Marigliano S, Loquercio G, Cozzolino A, Cacciapuoti C. Global epidemiology of hepatitis C virus infection: An up-date of the distribution and circulation of hepatitis C virus genotypes. World J Gastroenterol 2016; 22:7824-7840. [PMID: 27678366 PMCID: PMC5016383 DOI: 10.3748/wjg.v22.i34.7824] [Citation(s) in RCA: 516] [Impact Index Per Article: 64.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/28/2016] [Accepted: 08/08/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To review Hepatitis C virus (HCV) prevalence and genotypes distribution worldwide.
METHODS We conducted a systematic study which represents one of the most comprehensive effort to quantify global HCV epidemiology, using the best available published data between 2000 and 2015 from 138 countries (about 90% of the global population), grouped in 20 geographical areas (with the exclusion of Oceania), as defined by the Global Burden of Diseases project (GBD). Countries for which we were unable to obtain HCV genotype prevalence data were excluded from calculations of regional proportions, although their populations were included in the total population size of each region when generating regional genotype prevalence estimates.
RESULTS Total global HCV prevalence is estimated at 2.5% (177.5 million of HCV infected adults), ranging from 2.9% in Africa and 1.3% in Americas, with a global viraemic rate of 67% (118.9 million of HCV RNA positive cases), varying from 64.4% in Asia to 74.8% in Australasia. HCV genotype 1 is the most prevalent worldwide (49.1%), followed by genotype 3 (17.9%), 4 (16.8%) and 2 (11.0%). Genotypes 5 and 6 are responsible for the remaining < 5%. While genotypes 1 and 3 are common worldwide, the largest proportion of genotypes 4 and 5 is in lower-income countries. Although HCV genotypes 1 and 3 infections are the most prevalent globally (67.0% if considered together), other genotypes are found more commonly in lower-income countries where still account for a significant proportion of HCV cases.
CONCLUSION A more precise knowledge of HCV genotype distribution will be helpful to best inform national healthcare models to improve access to new treatments.
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Muzembo BA, Akita T, Matsuoka T, Tanaka J. Systematic review and meta-analysis of hepatitis C virus infection in the Democratic Republic of Congo. Public Health 2016; 139:13-21. [PMID: 27450441 DOI: 10.1016/j.puhe.2016.06.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/25/2016] [Accepted: 06/16/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Hepatitis C virus (HCV) infection is endemic in the Democratic Republic of the Congo (DRC), where the prevalence of HCV antibodies (anti-HCV) is reported to range from 0.2% to 13.7%. However, the reported prevalence rates have been inconsistent. Therefore, a meta-analysis of observational studies was conducted to provide updates on the prevalence of HCV infection in the DRC. STUDY DESIGN Systematic review and meta-analysis. METHODS Medline, EMBASE and Google Scholar were searched for publications reporting on HCV infection in the DRC up to autumn 2015. In addition, a manual search was undertaken to detect relevant papers. Studies performed in groups at low risk of HCV (blood donors and pregnant women) were used for the meta-analysis. The random effects model was used to estimate the pooled prevalence of anti-HCV. RESULTS Sixteen studies with 13,799 participants (aged 6 months-71 years) met the inclusion criteria. The studies were performed in blood donors, pregnant women, military personnel, individuals with human immunodeficiency virus, children, commercial sex workers, Congolese patients living in Canada, patients with sickle cell disease and hospitalized patients. The reviewed studies revealed the presence of anti-HCV in almost all studied age groups and did not differ between sexes. The pooled prevalence of anti-HCV was 2.9% [95% confidence interval 1.5-4.3%]. Subgroup analyses revealed that the prevalence rates of anti-HCV in blood donors and pregnant women were 2.7% (95% confidence interval: 1.1-4.4%) and 3.3% (1.4-5.1%), respectively. CONCLUSIONS HCV infection remains an issue of public concern in the DRC, demonstrating a need for adequate hepatitis control programmes. Efforts must be made to virtually eliminate transfusion-transmitted HCV throughout the country.
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Affiliation(s)
- B A Muzembo
- Department of Epidemiology, Infectious Disease Control and Prevention, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - T Akita
- Department of Epidemiology, Infectious Disease Control and Prevention, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - T Matsuoka
- Department of Epidemiology, Infectious Disease Control and Prevention, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - J Tanaka
- Department of Epidemiology, Infectious Disease Control and Prevention, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
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Chu CE, Wu F, He X, Zhou K, Cheng Y, Cai W, Geng E, Volberding P, Tucker JD. Hepatitis C Virus Treatment Access Among Human Immunodeficiency Virus and Hepatitis C Virus (HCV)-Coinfected People Who Inject Drugs in Guangzhou, China: Implications for HCV Treatment Expansion. Open Forum Infect Dis 2016; 3:ofw065. [PMID: 27419150 PMCID: PMC4943171 DOI: 10.1093/ofid/ofw065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 03/18/2016] [Indexed: 01/08/2023] Open
Abstract
Background. Hepatitis C virus (HCV) treatment access among human immunodeficiency virus (HIV)/HCV-coinfected people who inject drugs is poor, despite a high burden of disease in this population. Understanding barriers and facilitators to HCV treatment uptake is critical to the implementation of new direct-acting antivirals. Methods. We conducted in-depth interviews with patients, physicians, and social workers at an HIV treatment facility and methadone maintenance treatment centers in Guangzhou, China to identify barriers and facilitators to HCV treatment. We included patients who were in various stages of HCV treatment and those who were not treated. We used standard qualitative methods and organized data into themes. Results. Interview data from 29 patients, 8 physicians, and 3 social workers were analyzed. Facilitators and barriers were organized according to a modified Consolidated Framework for Implementation Research schematic. Facilitators included patient trust in physicians, hope for a cure, peer networks, and social support. Barriers included ongoing drug use, low HCV disease knowledge, fragmented reimbursement systems, HIV exceptionalism, and stigma. Conclusions. Expanding existing harm reduction programs, HIV treatment programs, and social services may facilitate scale-up of direct-acting antivirals globally. Improving integration of ancillary social and mental health services within existing HIV care systems may facilitate HCV treatment access.
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Affiliation(s)
- Carissa E Chu
- School of Medicine, University of California San Francisco; UNC-Project China, Guangzhou
| | - Feng Wu
- School of Sociology and Anthropology, Sun Yat-sen University , Guangzhou
| | - Xi He
- Guangzhou Eighth People's Hospital , China
| | - Kali Zhou
- Guangzhou Eighth People's Hospital , China
| | - Yu Cheng
- School of Sociology and Anthropology, Sun Yat-sen University , Guangzhou
| | | | - Elvin Geng
- School of Medicine, University of California San Francisco
| | | | - Joseph D Tucker
- UNC-Project China, Guangzhou; School of Sociology and Anthropology, Sun Yat-sen University, Guangzhou; Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill
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Hepatitis C in HIV-infected individuals: a systematic review and meta-analysis of estimated prevalence in Africa. J Int AIDS Soc 2016; 19:20711. [PMID: 27293220 PMCID: PMC4904089 DOI: 10.7448/ias.19.1.20711] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 04/26/2016] [Accepted: 05/10/2016] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Although hepatitis C virus (HCV) screening is recommended for all HIV-infected patients initiating antiretroviral therapy, data on epidemiologic characteristics of HCV infection in resource-limited settings are scarce. METHODS We searched PubMed and EMBASE for studies assessing the prevalence of HCV infection among HIV-infected individuals in Africa and extracted data on laboratory methods used. Prevalence estimates from individual studies were combined for each country using random-effects meta-analysis. The importance of study design, population and setting as well as type of test (anti-HCV antibody tests and polymerase chain reactions) was examined with meta-regression. RESULTS Three randomized controlled trials, 28 cohort studies and 121 cross-sectional analyses with 108,180 HIV-infected individuals from 35 countries were included. The majority of data came from outpatient populations (55%), followed by blood donors (15%) and pregnant women (14%). Based on estimates from 159 study populations, anti-HCV positivity prevalence ranged between 3.3% (95% confidence interval (CI) 1.8-4.7) in Southern Africa and 42.3% (95% CI 4.1-80.5) in North Africa. Study design, type of setting and age distribution did not influence this prevalence significantly. The prevalence of replicating HCV infection, estimated from data of 29 cohorts, was 2.0% (95% CI 1.5-2.6). Ten studies from nine countries reported the HCV genotype of 74 samples, 53% were genotype 1, 24% genotype 2, 14% genotype 4 and 9% genotypes 3, 5 or 6. CONCLUSIONS The prevalence of anti-HCV antibodies is high in HIV-infected patients in Africa, but replicating HCV infection is rare and varies widely across countries.
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Nguyen Truong T, Laureillard D, Lacombe K, Duong Thi H, Pham Thi Hanh P, Truong Thi Xuan L, Chu Thi N, Luong Que A, Vu Hai V, Nagot N, Tuaillon E, Dominguez S, Lemoine M. High Proportion of HIV-HCV Coinfected Patients with Advanced Liver Fibrosis Requiring Hepatitis C Treatment in Haiphong, Northern Vietnam (ANRS 12262). PLoS One 2016; 11:e0153744. [PMID: 27148964 PMCID: PMC4858210 DOI: 10.1371/journal.pone.0153744] [Citation(s) in RCA: 13] [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: 12/02/2015] [Accepted: 04/04/2016] [Indexed: 02/06/2023] Open
Abstract
Rationale and Aims Screening and treatment for chronic hepatitis C are very limited in Vietnam and clinical data on HCV-related liver disease in HIV-coinfected people are almost inexistent. This study aimed to assess the severity of liver fibrosis and its risk factors in HIV-HCV coinfected patients in Haiphong, Northern Vietnam. Methods A cross-sectional study was conducted at a HIV outpatient clinic. Consecutive HIV treated adults with positive HCV serology completed a standardised epidemiological questionnaire and had a comprehensive liver assessment including hepatic elastography (Fibroscan®, Echosens). Results From February to March 2014, 104 HIV-HCV coinfected patients receiving antiretroviral therapy (ART) were prospectively enrolled (99 males, median age: 35.8 (32.7–39.6) years, median CD4 count: 504 (361–624) /mm3. Of them, 93 (89.4%) had detectable HCV RNA (median 6.19 (4.95–6.83 Log10 IU/mL). Patients were mainly infected with genotypes 1a/1b (69%) and genotypes 6a/6e (26%). Forty-three patients (41.3%) had fibrosis ≥F2 including 24 patients (23.1%) with extensive fibrosis (F3) and/or cirrhosis (F4). In univariate analysis, excessive alcohol consumption, estimated time duration from HCV infection, nevirapine and lopinavir-based ARV regimen and CD4 nadir were associated factors of extensive fibrosis/cirrhosis. Alcohol abuse was the only independent factor of extensive fibrosis in multivariate analysis. Using Fibroscan® as a gold standard, the high thresholds of AST-to-platelet ratio index (APRI) and fibrosis-4 score (FIB-4) had very good performances for the diagnosis of extensive fibrosis/cirrhosis (Se: 90 and 100%, Sp:84 and 81%, AUROCs = 0.93, 95%CI: 0.86–0.99 and 0.96 (0.92–0.99), respectively). Conclusion In this study, nearly 25% of HIV-HCV coinfected patients successfully treated with ART have extensive fibrosis or cirrhosis, and therefore require urgently HCV treatment.
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Affiliation(s)
- Tam Nguyen Truong
- University of Medicine Pham Ngoc Thach, Ho Chi Minh City, Vietnam
- INSERM U1058 "Pathogenesis and Control of Chronic Infections", Montpellier, France
| | - Didier Laureillard
- INSERM U1058 "Pathogenesis and Control of Chronic Infections", Montpellier, France
- Department of Infectious and Tropical Diseases, Caremeau University Hospital, Nîmes, France
| | - Karine Lacombe
- Department of Infectious and Tropical Diseases, Saint-Antoine Hospital, AP-HP, Paris, France
- Sorbonne Universités, UPMC Université Paris 06, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
| | - Huong Duong Thi
- Department of Public Health, University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Phuc Pham Thi Hanh
- Department of Infectious and Tropical Diseases, Viet Tiep Hospital, Hai Phong, Vietnam
| | | | - Nga Chu Thi
- Department of virology, Viet Tiep hospital, Haiphong, Vietnam
| | - Anh Luong Que
- Department of virology, Viet Tiep hospital, Haiphong, Vietnam
| | - Vinh Vu Hai
- Department of Infectious and Tropical Diseases, Viet Tiep Hospital, Hai Phong, Vietnam
| | - Nicolas Nagot
- INSERM U1058 "Pathogenesis and Control of Chronic Infections", Montpellier, France
- Department of epidemiology, University Hospital, Montpellier, France
| | - Edouard Tuaillon
- INSERM U1058 "Pathogenesis and Control of Chronic Infections", Montpellier, France
- Department of bacteriology and virology, University Hospital, Montpellier, France
| | - Stéphanie Dominguez
- Department of clinical immunology, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Maud Lemoine
- Department of Hepatology, St Mary’s Hospital, Imperial College, London, United Kingdom
- * E-mail:
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Csete J, Kamarulzaman A, Kazatchkine M, Altice F, Balicki M, Buxton J, Cepeda J, Comfort M, Goosby E, Goulão J, Hart C, Kerr T, Lajous AM, Lewis S, Martin N, Mejía D, Camacho A, Mathieson D, Obot I, Ogunrombi A, Sherman S, Stone J, Vallath N, Vickerman P, Zábranský T, Beyrer C. Public health and international drug policy. Lancet 2016; 387:1427-1480. [PMID: 27021149 PMCID: PMC5042332 DOI: 10.1016/s0140-6736(16)00619-x] [Citation(s) in RCA: 305] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In September 2015, the member states of the United Nations endorsed sustainable development goals (SDG) for 2030 that aspire to human rights-centered approaches to ensuring the health and well-being of all people. The SDGs embody both the UN Charter values of rights and justice for all and the responsibility of states to rely on the best scientific evidence as they seek to better humankind. In April 2016, these same states will consider control of illicit drugs, an area of social policy that has been fraught with controversy, seen as inconsistent with human rights norms, and for which scientific evidence and public health approaches have arguably played too limited a role. The previous UN General Assembly Special Session (UNGASS) on drugs in 1998 – convened under the theme “a drug-free world, we can do it!” – endorsed drug control policies based on the goal of prohibiting all use, possession, production, and trafficking of illicit drugs. This goal is enshrined in national law in many countries. In pronouncing drugs a “grave threat to the health and well-being of all mankind,” the 1998 UNGASS echoed the foundational 1961 convention of the international drug control regime, which justified eliminating the “evil” of drugs in the name of “the health and welfare of mankind.” But neither of these international agreements refers to the ways in which pursuing drug prohibition itself might affect public health. The “war on drugs” and “zero-tolerance” policies that grew out of the prohibitionist consensus are now being challenged on multiple fronts, including their health, human rights, and development impact. The Johns Hopkins – Lancet Commission on Drug Policy and Health has sought to examine the emerging scientific evidence on public health issues arising from drug control policy and to inform and encourage a central focus on public health evidence and outcomes in drug policy debates, such as the important deliberations of the 2016 UNGASS on drugs. The Johns Hopkins-Lancet Commission is concerned that drug policies are often colored by ideas about drug use and drug dependence that are not scientifically grounded. The 1998 UNGASS declaration, for example, like the UN drug conventions and many national drug laws, does not distinguish between drug use and drug abuse. A 2015 report by the UN High Commissioner for Human Rights, by contrast, found it important to emphasize that “[d]rug use is neither a medical condition nor does it necessarily lead to drug dependence.” The idea that all drug use is dangerous and evil has led to enforcement-heavy policies and has made it difficult to see potentially dangerous drugs in the same light as potentially dangerous foods, tobacco, alcohol for which the goal of social policy is to reduce potential harms.
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Affiliation(s)
| | | | - Michel Kazatchkine
- UN Special Envoy, HIV in Eastern Europe and Central Asia, Geneva, Switzerland
| | | | | | | | - Javier Cepeda
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Eric Goosby
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Carl Hart
- Columbia University, New York City, NY, USA
| | - Thomas Kerr
- University of British Columbia, Center of Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | | | | | | | | | | | | | | | | - Susan Sherman
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Nandini Vallath
- Trivandrum Institute of Palliative Sciences, Trivandrum, India
| | | | | | - Chris Beyrer
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Fraser I, Burger J, Lubbe M, Dranitsaris G, Sonderup M, Stander T. Cost-Effectiveness Modelling of Sofosbuvir-Containing Regimens for Chronic Genotype 5 Hepatitis C Virus Infection in South Africa. PHARMACOECONOMICS 2016; 34:403-417. [PMID: 26666639 DOI: 10.1007/s40273-015-0356-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND The recently launched nucleotide polymerase inhibitor sofosbuvir represents a significant turn in the treatment paradigm of chronic hepatitis C. While effective, sofosbuvir is also associated with a considerable cost. OBJECTIVE The objective of this study was to evaluate the cost effectiveness of sofosbuvir-containing regimens in treatment-naive patients with chronic hepatitis C virus (HCV) genotype 5 (HCV-G5) mono-infection in South Africa (SA). DESIGN We constructed a lifetime horizon decision-analytic Markov model of the natural history of HCV infection to evaluate the cost effectiveness of sofosbuvir-ledipasvir (SOF/LDV) monotherapy against sofosbuvir triple therapy (SOF-TT) (sofosbuvir + pegylated interferon and ribavirin [peg-INF/RBV]) and the current standard of care (SOC) (peg-INF/RBV) for patients with chronic HCV-G5 in the South African context. The model was populated with data from published literature, expert opinion and South African private sector cost data. The price modelled for sofosbuvir was the predicted South African private sector price of 82,129.32 South African rand (R) (US$7000) for 12 weeks. The analysis was conducted from a third-party payer perspective. OUTCOME MEASURES The outcome measures were discounted and undiscounted costs (in 2015 South African rand and US dollars) and quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). RESULTS Outcomes from the cost-effectiveness model show that SOF/LDV yields the most favourable future health economic outcomes compared with SOF-TT and the current SOC in SA. Findings relating to the lifetime incremental cost per QALY gained for patients infected with HCV-G5 indicate that SOF/LDV dominated both SOF-TT and SOC, i.e. SOF/LDV is less costly and more effective. CONCLUSION Outcomes from this analysis suggest that at a price of R123,190 ($US10,500) for 12 weeks of SOF/LDV might be cost effective for South African patients infected with HCV-G5.
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Affiliation(s)
- Ilanca Fraser
- Medicine Usage in South Africa (MUSA), Faculty of Health Sciences, North-West University (Potchefstroom Campus), Potchefstroom, South Africa
| | - Johanita Burger
- Medicine Usage in South Africa (MUSA), Faculty of Health Sciences, North-West University (Potchefstroom Campus), Potchefstroom, South Africa.
| | - Martie Lubbe
- Medicine Usage in South Africa (MUSA), Faculty of Health Sciences, North-West University (Potchefstroom Campus), Potchefstroom, South Africa
| | | | - Mark Sonderup
- Department of Medicine and Division of Hepatology, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
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Abdel-Ghaffar TY, Sira MM, El Naghi S. Hepatitis C genotype 4: The past, present, and future. World J Hepatol 2015; 7:2792-2810. [PMID: 26668691 PMCID: PMC4670951 DOI: 10.4254/wjh.v7.i28.2792] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 08/02/2015] [Accepted: 11/25/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) genotype (GT) 4 represents 12%-15% (15-18 million) of total global HCV infection. It is prevalent in Northern and Equatorial Africa and the Middle East, and is also present in some countries in Europe. GT-4 (and subtype 4a in particular) dominates the HCV epidemic in Egypt. In underdeveloped countries, risk factors associated with HCV infection may be due to unsafe medical practices or other factors such as familial transmission, mother’s HCV status, or illiteracy. HCV prevention and control programs should include health education, increased community awareness towards the disease, controlling infection distribution in health-care centers, proper sterilization of medical and dental instruments, and ensuring safe supply of blood and blood-products. Response rates to a 48-wk combined pegylated-interferon (PEG-IFN) and ribavirin (RBV) treatment range from 40%-69%, and HCV-GT-4 has been considered better than GT-1 but worse than GT-2 and GT-3 in treatment with PEG-IFN/RBV. However, with the introduction of the HCV-GT-1 effective protease inhibitors boceprevir and telaprevir in 2011, HCV-GT-4 became the “most difficult (GT) to treat”. Recently, the direct-acting antivirals (DAAs) with pan- genotypic activities simeprevir, sofosbuvir, and daclatasvir have been recommended in triple regimens with PEG-IFN/RBV for the treatment of HCV-GT-4. An IFN-free regimen will be available for treatment of all genotypes of HCV in the near future. To date, several DAAs have been developed and are currently being evaluated in various combinations in clinical trials. As new regimens and new agents are being approved by the Food and Drug Administration, we can expect the guidelines for HCV treatment to be changed. The availability of shorter, simpler, and more tolerable treatment regimens can reduce the morbidity and mortality associated with HCV infection. With such a large number of therapeutic agents available, we can end up with a range of choices that we can select from to treat patients.
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Lawitz E, Freilich B, Link J, German P, Mo H, Han L, Brainard DM, McNally J, Marbury T, Rodriguez-Torres M. A phase 1, randomized, dose-ranging study of GS-5816, a once-daily NS5A inhibitor, in patients with genotype 1-4 hepatitis C virus. J Viral Hepat 2015; 22:1011-9. [PMID: 26183611 DOI: 10.1111/jvh.12435] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 05/28/2015] [Indexed: 12/13/2022]
Abstract
GS-5816 is an inhibitor of the hepatitis C virus (HCV) NS5A protein that has demonstrated pan-genotypic activity and a high barrier to resistance in HCV replicon assays. The aim of this study was to evaluate the safety, antiviral activity and pharmacokinetics of once-daily doses of GS-5816 in patients with genotype 1-4 HCV infection. Patients with genotype 1-4 HCV infection were randomized to 3 days of GS-5816 at doses ranging from 5 to 150 mg or placebo. Adverse events were recorded, and plasma samples obtained for analysis of pharmacokinetics, HCV RNA and NS5A sequencing studies. GS-5816 5-150 mg for 3 days was well tolerated and resulted in rapid declines in HCV RNA that were sustained over the dosing period. In patients treated with the 150 mg dose of GS-5816, the mean maximal HCV RNA declines were 4.0, 4.0, 4.4, 3.3 and 3.5 log10 IU/mL in patients with genotype 1a, 1b, 2, 3 and 4 HCV infection, respectively. Pretreatment NS5A resistance-associated polymorphisms were detected in 31% (22/70) of patients. Genotype 1 and 3 HCV-infected patients without pretreatment NS5A resistance-associated polymorphisms had greater declines in HCV RNA than patients with resistance-associated polymorphisms. Plasma pharmacokinetics were supportive of once-daily dosing. GS-5816 demonstrated pangenotypic antiviral activity in patients with genotype 1-4 HCV infection. It will be further evaluated in combination with other pangenotypic direct-acting antivirals to achieve the goal of developing a well-tolerated, highly effective treatment for all HCV genotypes.
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Affiliation(s)
- E Lawitz
- Texas Liver Institute, University of Texas Health Sciences Center, San Antonio, TX, USA
| | - B Freilich
- Kansas City Gastroenterology and Hepatology, Kansas City, MO, USA
| | - J Link
- Gilead Sciences, Inc., Foster City, CA, USA
| | - P German
- Gilead Sciences, Inc., Foster City, CA, USA
| | - H Mo
- Gilead Sciences, Inc., Foster City, CA, USA
| | - L Han
- Gilead Sciences, Inc., Foster City, CA, USA
| | | | - J McNally
- Gilead Sciences, Inc., Foster City, CA, USA
| | - T Marbury
- Orlando Clinical Research Center, Orlando, FL, USA
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Garcia-Gonzalez P, Boultbee P, Epstein D. Novel Humanitarian Aid Program: The Glivec International Patient Assistance Program-Lessons Learned From Providing Access to Breakthrough Targeted Oncology Treatment in Low- and Middle-Income Countries. J Glob Oncol 2015; 1:37-45. [PMID: 28804770 PMCID: PMC5551649 DOI: 10.1200/jgo.2015.000570] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Imatinib was the first targeted therapy approved for the treatment of cancer. With its approval, it was immediately clear to Novartis that this breakthrough therapy would require an innovative approach to worldwide access, with special consideration of low- and middle-income countries. Lack of government reimbursement, universal health care, or health insurance coverage, few trained specialty physicians or diagnostic services, and poor health care infrastructure were, and continue to be, contributing barriers to access to treatment in low- and middle-income countries. The Glivec International Patient Assistance Program (GIPAP) is an international drug donation program established by Novartis Pharma AG and implemented in partnership with The Max Foundation, a nonprofit, nongovernmental organization. GIPAP was established in 2001, essentially in parallel with the first approval of imatinib for chronic myeloid leukemia. Since 2001, GIPAP has made imatinib accessible to all medically and financially eligible patients within 80 countries on an ongoing basis as long as their physicians prescribe it and no other means of access exists. To date, more than 49,000 patients have benefited from GIPAP, and 2.3 million monthly doses of imatinib have been approved through the program. GIPAP represents an innovative drug donation model that has set the standard for access programs for other targeted or innovative therapies. The purpose of this article is to describe the structure of GIPAP, as well as important lessons that have contributed to the success of the program. This article may assist other companies with the development of successful and far-reaching patient assistance programs in the future.
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Affiliation(s)
- Pat Garcia-Gonzalez
- , The Max Foundation; , PTB Consulting LLC, Seattle, WA; and , Novartis Pharmaceuticals, East Hanover, NJ
| | - Paula Boultbee
- , The Max Foundation; , PTB Consulting LLC, Seattle, WA; and , Novartis Pharmaceuticals, East Hanover, NJ
| | - David Epstein
- , The Max Foundation; , PTB Consulting LLC, Seattle, WA; and , Novartis Pharmaceuticals, East Hanover, NJ
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An Epidemiologic Investigation of a Case of Acute Hepatitis E. J Clin Microbiol 2015; 53:3547-52. [PMID: 26338861 DOI: 10.1128/jcm.01189-15] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 08/18/2015] [Indexed: 12/15/2022] Open
Abstract
Hepatitis E virus (HEV) is considered a zoonotic infection in developed nations. A case of acute hepatitis E in a researcher following a scalpel injury while working on a pig prompted a seroepidemiologic study to identify potential modes of transmission and determine the seroprevalence of HEV among animal handlers at the institute. Sera from personnel (n = 64) in two animal facilities and age/sex-matched blood donors (n = 63) as controls were tested for IgG anti-HEV and, if positive, for IgM anti-HEV and HEV RNA. Sera and stool from pigs aged 6 to 12 weeks from the breeding farm and older pigs from animal facilities were tested similarly. The median age of personnel was 36 years, 74% were white, 56% were male, and 74% had direct exposure to pigs. The prevalence of anti-HEV was 3.1% among personnel compared to 3.2% among blood donors; none were positive for IgM anti-HEV or HEV RNA. IgG anti-HEV was detected in sera from 10% of pigs aged 6 to 8 weeks, 80% aged 10 weeks, 100% aged 12 weeks, and 76% aged >12 weeks. HEV RNA was detected in stool but not sera from three 12-week-old pigs. Sequencing revealed HEV genotype 3 with ∼10% difference between the patient and pig sequences. Parenteral transmission is a potential mode of acute HEV infection. The low and similar seroprevalence of anti-HEV between the at-risk group and age-matched blood donors suggests low transmission risk with universal precautions among animal handlers.
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El-Mahallawy HA, Mohsen LM, Wassef M. Milestones along the road of infection prevention in Egypt. Eur J Clin Microbiol Infect Dis 2015; 34:1923-8. [PMID: 26231169 DOI: 10.1007/s10096-015-2444-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 06/19/2015] [Indexed: 11/25/2022]
Abstract
Sequela of infectious diseases include not only morbidity and mortality, but are also associated with chronic illnesses that has long constituted public health problems and huge economic burdens. This review gives a brief idea about important infectious diseases (ID) in Egypt, the main lines taken to combat them, the challenges still existing, and the possible barriers keeping IDs still forming threats to the community. Egypt has the highest prevalence rates of HCV infection worldwide. Significant evidence points towards that the HCV epidemic was initiated and propagated by the anti-schistosomal mass campaigns during the last century. Though the rates of HCV infection are declining, still the decline has not yet met the full expectations. Therefore, infection control programs are gaining more ground all over the country, especially with the growing problem of antimicrobial resistance complicating healthcare-associated infections (HAI) worldwide. Also, mass immnunization of childhood, mycobacterial tuberculosis infections, and avian influenza will be discussed.
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Affiliation(s)
- H A El-Mahallawy
- National Cancer Institute, Cairo University, Kasr el-Eini, Kornish el-Nil, Fom el-Khalig, Cairo, 11796, Egypt.
| | - L M Mohsen
- Kasr Al-Aini School of Medicine, Cairo University, Cairo, Egypt
| | - M Wassef
- Kasr Al-Aini School of Medicine, Cairo University, Cairo, Egypt
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Pho MT, Jensen DM, Meltzer DO, Kim AY, Linas BP. Clinical impact of treatment timing for chronic hepatitis C infection: a decision model. J Viral Hepat 2015; 22:630-8. [PMID: 26135026 PMCID: PMC4515086 DOI: 10.1111/jvh.12412] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 03/01/2015] [Indexed: 01/03/2023]
Abstract
Recent advances in the treatment of hepatitis C virus (HCV) infection have led to the availability of both highly efficacious interferon-containing and interferon-sparing regimens. However, the use of such therapies faces restrictions due to high costs. For patients who are medically eligible to receive interferon, the choice between the two will likely be impacted by preferences surrounding interferon, severity of disease, coverage policies and out-of-pocket costs. We developed a decision model to quantify the trade-offs between immediate, interferon-containing therapy and delayed, interferon-free therapy for patients with chronic, genotype 1 HCV infection. We projected the quality-adjusted life expectancy stratified by the presence or absence of cirrhosis for four strategies: (i) no treatment; (ii) immediate, one-time treatment with an interferon-containing regimen; (iii) immediate treatment as above with the opportunity for retreatment in patients who fail to achieve sustained virologic response with interferon-free therapy in 1 year; and (iv) delayed therapy with interferon-free therapy in 1 year. When compared to one-time immediate treatment with the interferon-containing regimen, delayed treatment with the interferon-free regimen in 1 year resulted in longer life expectancy, with a 0.2 quality-adjusted life year (QALY) increase in noncirrhotic patients, and a 1.1 QALY increase in patients with cirrhosis. This superiority in health benefits was lost when wait time for interferon-free therapy was greater than 3-3.2 years. In this modelling analysis, interferon-free therapy resulted in superior health benefits compared to immediate therapy with interferon until wait time exceeded 3-3.2 years. Such data can inform decision-making regarding treatment initiation for HCV as healthcare financing evolves.
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Affiliation(s)
- M T Pho
- Department of Medicine, Sections of Hospital Medicine and of Infectious Diseases and Global Health, University of ChicagoChicago, IL, USA
| | - D M Jensen
- Center for Liver Disease, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago MedicineChicago, IL, USA
| | - D O Meltzer
- Section of Hospital Medicine, Department of Medicine, University of ChicagoChicago, IL, USA
| | - A Y Kim
- Department of Medicine, Massachusetts General HospitalBoston, MA, USA
| | - B P Linas
- Department of Medicine, Section of Infectious Diseases, Boston Medical CenterBoston, MA, USA
- Department of Epidemiology, Boston University School of Public HealthBoston, MA, USA
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Ke R, Loverdo C, Qi H, Sun R, Lloyd-Smith JO. Rational Design and Adaptive Management of Combination Therapies for Hepatitis C Virus Infection. PLoS Comput Biol 2015; 11:e1004040. [PMID: 26125950 PMCID: PMC4488346 DOI: 10.1371/journal.pcbi.1004040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 11/13/2014] [Indexed: 12/17/2022] Open
Abstract
Recent discoveries of direct acting antivirals against Hepatitis C virus (HCV) have raised hopes of effective treatment via combination therapies. Yet rapid evolution and high diversity of HCV populations, combined with the reality of suboptimal treatment adherence, make drug resistance a clinical and public health concern. We develop a general model incorporating viral dynamics and pharmacokinetics/ pharmacodynamics to assess how suboptimal adherence affects resistance development and clinical outcomes. We derive design principles and adaptive treatment strategies, identifying a high-risk period when missing doses is particularly risky for de novo resistance, and quantifying the number of additional doses needed to compensate when doses are missed. Using data from large-scale resistance assays, we demonstrate that the risk of resistance can be reduced substantially by applying these principles to a combination therapy of daclatasvir and asunaprevir. By providing a mechanistic framework to link patient characteristics to the risk of resistance, these findings show the potential of rational treatment design.
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Affiliation(s)
- Ruian Ke
- Department of Ecology and Evolutionary Biology, University of California, Los Angeles, Los Angeles, California, United States of America
- * E-mail: (RK); (JOLS)
| | - Claude Loverdo
- Department of Ecology and Evolutionary Biology, University of California, Los Angeles, Los Angeles, California, United States of America
- CNRS/UPMC Univ Paris 06, UMR 8237, Laboratoire Jean Perrin LJP, Paris, France
| | - Hangfei Qi
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Ren Sun
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, California, United States of America
- The Molecular Biology Institute, University of California, Los Angeles, Los Angeles, California, United States of America
- Department of Infectious Diseases, Novartis Institutes for BioMedical Research, Emeryville, California, United States of America
- Zhejiang University, Hangzhou, China
| | - James O. Lloyd-Smith
- Department of Ecology and Evolutionary Biology, University of California, Los Angeles, Los Angeles, California, United States of America
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America
- * E-mail: (RK); (JOLS)
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Rao VB, Johari N, du Cros P, Messina J, Ford N, Cooke GS. Hepatitis C seroprevalence and HIV co-infection in sub-Saharan Africa: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2015; 15:819-24. [PMID: 25957078 DOI: 10.1016/s1473-3099(15)00006-7] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND An estimated 150 million people worldwide are infected with hepatitis C virus (HCV). HIV co-infection accelerates the progression of HCV and represents a major public health challenge. We aimed to determine the epidemiology of HCV and the prevalence of HIV co-infection in sub-Saharan Africa. METHODS We searched Medline and Embase (Ovid) from Jan 1, 2002, to Dec 31, 2014, for studies containing data for HCV seroprevalence in different population groups in WHO-defined regions of sub-Saharan Africa. We estimated pooled regional prevalence estimates with a DerSimonian-Laird random-effects model. Data were further stratified by risk factor and HIV status. FINDINGS We included 213 studies from 33 countries in sub-Saharan Africa, comprising 287 separate cohorts with 1 198 167 individuals. The pooled HCV seroprevalence from all cohorts was 2·98% (95% CI 2·86-3·10). The pooled HCV seroprevalence was 2·65% (95% CI 2·53-2·78) across all 185 low-risk cohorts, 3·04% (2·23-3·84) in antenatal clinic groups, 1·99% (1·86-2·12) in blood donors, but 6·9% (6·1-7·5) in other general population cohorts. The pooled seroprevalence of HCV was 11·87% (95% CI 7·05-16·70) across all high-risk groups and 9·95% (6·79-13·11) in patients with liver disease. 101 cohorts included HIV-positive samples tested for HCV (42 648 individuals), with a pooled seroprevalence of 5·73% (95% CI 4·90-6·56). INTERPRETATION We recorded a high seroprevalence of HCV across populations of sub-Saharan Africa, including in HIV-positive adults, with evidence of regional variation in the general population. Monitoring of antenatal HCV prevalence might be a helpful indicator of population trends in HCV infection; however, larger population surveys are needed to monitor these trends. Access to prevention and treatment needs to be improved for both monoinfected and co-infected individuals. FUNDING None.
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Affiliation(s)
- V Bhargavi Rao
- Manson Unit, Médecins Sans Frontières, London, UK; Division of Infectious Diseases, Imperial College London, London, UK
| | - Nur Johari
- Division of Infectious Diseases, Imperial College London, London, UK
| | | | - Janey Messina
- Spatial Epidemiology and Ecology Group, Department of Zoology, University of Oxford, Oxford, UK
| | - Nathan Ford
- Division of Infectious Diseases, Imperial College London, London, UK; Médecins Sans Frontières, Geneva, Switzerland; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Graham S Cooke
- Division of Infectious Diseases, Imperial College London, London, UK.
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Abstract
In light of new treatment regimens for hepatitis C, Amitabh Suthar and Anthony Harries outline a wider public health approach for tackling the disease.
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Affiliation(s)
- Amitabh B. Suthar
- South African Centre for Epidemiological Modelling and Analysis, University of Stellenbosch, Stellenbosch, South Africa
- * E-mail:
| | - Anthony D. Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
- Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Messina JP, Humphreys I, Flaxman A, Brown A, Cooke GS, Pybus OG, Barnes E. Global distribution and prevalence of hepatitis C virus genotypes. Hepatology 2015; 61:77-87. [PMID: 25069599 PMCID: PMC4303918 DOI: 10.1002/hep.27259] [Citation(s) in RCA: 1066] [Impact Index Per Article: 118.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 06/09/2014] [Indexed: 12/11/2022]
Abstract
UNLABELLED Hepatitis C virus (HCV) exhibits high genetic diversity, characterized by regional variations in genotype prevalence. This poses a challenge to the improved development of vaccines and pan-genotypic treatments, which require the consideration of global trends in HCV genotype prevalence. Here we provide the first comprehensive survey of these trends. To approximate national HCV genotype prevalence, studies published between 1989 and 2013 reporting HCV genotypes are reviewed and combined with overall HCV prevalence estimates from the Global Burden of Disease (GBD) project. We also generate regional and global genotype prevalence estimates, inferring data for countries lacking genotype information. We include 1,217 studies in our analysis, representing 117 countries and 90% of the global population. We calculate that HCV genotype 1 is the most prevalent worldwide, comprising 83.4 million cases (46.2% of all HCV cases), approximately one-third of which are in East Asia. Genotype 3 is the next most prevalent globally (54.3 million, 30.1%); genotypes 2, 4, and 6 are responsible for a total 22.8% of all cases; genotype 5 comprises the remaining <1%. While genotypes 1 and 3 dominate in most countries irrespective of economic status, the largest proportions of genotypes 4 and 5 are in lower-income countries. CONCLUSION Although genotype 1 is most common worldwide, nongenotype 1 HCV cases—which are less well served by advances in vaccine and drug development—still comprise over half of all HCV cases. Relative genotype proportions are needed to inform healthcare models, which must be geographically tailored to specific countries or regions in order to improve access to new treatments. Genotype surveillance data are needed from many countries to improve estimates of unmet need.
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Affiliation(s)
- Jane P Messina
- Spatial Epidemiology and Ecology Group, Department of Zoology, University of OxfordOxford, UK
| | - Isla Humphreys
- Peter Medawar Building for Pathogen Research, University of Oxford, and Oxford NHIR BRCOxford, UK
| | | | - Anthony Brown
- Peter Medawar Building for Pathogen Research, University of Oxford, and Oxford NHIR BRCOxford, UK
| | - Graham S Cooke
- Division of Infectious Diseases, St Mary's Campus, Imperial CollegeLondon, UK
| | | | - Eleanor Barnes
- Peter Medawar Building for Pathogen Research, University of Oxford, and Oxford NHIR BRCOxford, UK
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Ishida YI, Takeshita M, Kataoka H. Functional foods effective for hepatitis C: Identification of oligomeric proanthocyanidin and its action mechanism. World J Hepatol 2014; 6:870-879. [PMID: 25544874 PMCID: PMC4269906 DOI: 10.4254/wjh.v6.i12.870] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 10/03/2014] [Accepted: 10/27/2014] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) is a major cause of viral hepatitis and currently infects approximately 170 million people worldwide. An infection by HCV causes high rates of chronic hepatitis (> 75%) and progresses to liver cirrhosis and hepatocellular carcinoma ultimately. HCV can be eliminated by a combination of pegylated α-interferon and the broad-spectrum antiviral drug ribavirin; however, this treatment is still associated with poor efficacy and tolerability and is often accompanied by serious side-effects. While some novel direct-acting antivirals against HCV have been developed recently, high medical costs limit the access to the therapy in cost-sensitive countries. To search for new natural anti-HCV agents, we screened local agricultural products for their suppressive activities against HCV replication using the HCV replicon cell system in vitro. We found a potent inhibitor of HCV RNA expression in the extracts of blueberry leaves and then identified oligomeric proanthocyanidin as the active ingredient. Further investigations into the action mechanism of oligomeric proanthocyanidin suggested that it is an inhibitor of heterogeneous nuclear ribonucleoproteins (hnRNPs) such as hnRNP A2/B1. In this review, we presented an overview of functional foods and ingredients efficient for HCV infection, the chemical structural characteristics of oligomeric proanthocyanidin, and its action mechanism.
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Ford N, Swan T, Beyer P, Hirnschall G, Easterbrook P, Wiktor S. Simplification of antiviral hepatitis C virus therapy to support expanded access in resource-limited settings. J Hepatol 2014; 61:S132-8. [PMID: 25443341 DOI: 10.1016/j.jhep.2014.09.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 09/16/2014] [Accepted: 09/16/2014] [Indexed: 02/07/2023]
Abstract
Currently, access to treatment for HCV is limited, with treatment rates lowest in the more resource-limited countries, including those countries with the highest prevalence. The use of oral DAAs has the potential to provide treatment at scale by offering opportunities to simplify drug regimens, laboratory requirements, and service delivery models. Key desirable characteristics of future HCV treatment regimens include high efficacy, tolerability, pan-genotype activity, short treatment duration, oral therapy, affordability, and availability as fixed-dose combination. Using such a regimen, HCV treatment delivery could be greatly simplified. Treatment could be initiated following confirmation of the presence of viraemia, with an initial assessment of the stage of liver disease. A combination DAA therapy that is safe and effective across genotypes could remove the need for genotyping and intermediary viral load assessments for response-guided therapy and reduce the need for adverse event monitoring. Simpler, safer, shorter therapy will also facilitate simplified service delivery, including task shifting, decentralization, and integration of treatment and care. The opportunity to scale up HCV treatment using such delivery approaches will depend on efforts needed to guarantee that the new DAAs are affordable in low-income settings. This will require the engagement of all stakeholders, ranging from the companies developing these new treatments, WHO and other international organizations, including procurement and funding mechanisms, governments and civil society.
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Affiliation(s)
- Nathan Ford
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | | | - Peter Beyer
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | | | | | - Stefan Wiktor
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland.
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Evon DM, Esserman DE, Howell MA, Ruffin RA. Pegylated interferon pharmacokinetics and self-reported depressive symptoms during antiviral treatment for chronic hepatitis C. PHARMACOPSYCHIATRY 2014; 47:195-201. [PMID: 25121993 DOI: 10.1055/s-0034-1385929] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Pegylated interferon-2a (PegIFN-2a)+ribavirin treatment for chronic hepatitis C is often associated with depressive symptoms. Previous studies have failed to explore whether PegIFN-2a pharmacokinetic variability plays an etiologic role in PegIFN-2a-induced mood disorders. The objective of this investigation was to evaluate the association between trough PegIFN-2a concentration at treatment week 4 ("PegIFN-2a Cmin4") and an increase in depressive symptoms. METHODS Using data from Virahep-C, the association between PegIFN-2a Cmin4 and the following depression outcomes were evaluated using the Center for Epidemiological Studies-Depression scale (CES-D): (1) change in CES-D score from baseline to week 12; (2) greatest difference in CES-D score between baseline and weeks 4, 12, or 24; and (3) occurrence of severe depressive symptoms (CES-D greater than 23) at weeks 4, 12, or 24. One post-hoc analysis examined whether PegIFN-2a exposure during the first week of treatment was associated with change in CES-D score from baseline to week 4. RESULTS No significant associations between PegIFN-2a Cmin4 and the depression outcomes were observed (p>0.05). Exploratory analyses suggest a possible relationship between PegIFN-2a exposure during the first week of therapy and CES-D score change from baseline to week 4 (p=0.03). CONCLUSIONS PegIFN-2a concentration levels from baseline to week 4 do not predict the onset and severity of depressive symptoms during 24 weeks of antiviral therapy; however PegIFN-2a levels during the first week of treatment may predict depressive symptoms in the first 4 weeks, earlier than anticipated and warrants further exploration.
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Affiliation(s)
- D M Evon
- Division of Gastroenterology and Hepatology, UNC School of Medicine, Chapel Hill, NC, USA
| | - D E Esserman
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA
| | - M A Howell
- United Therapeutic Corporation, Research Triangle Park, NC, USA
| | - R A Ruffin
- Division of Gastroenterology and Hepatology, UNC School of Medicine, Chapel Hill, NC, USA
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Hill A, Cooke G. Medicine. Hepatitis C can be cured globally, but at what cost? Science 2014; 345:141-2. [PMID: 25013048 DOI: 10.1126/science.1257737] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Andrew Hill
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool L69 3BX, UK.
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Abstract
Hepatitis C virus (HCV) infection is a substantial health problem worldwide. Most patients infected with HCV remain chronically infected, with an increased risk of cirrhosis and hepatocellular carcinoma. Although they are associated with toxicities and low sustained viral response rates, interferon alfa and ribavirin have been the mainstay of treatment until recently. New direct acting antivirals, specifically designed to inhibit three viral proteins (the NS3/4A protease, the NS5A protein, and the NS5B RNA dependent RNA polymerase) are now becoming available. The NS3/4A inhibitor simeprevir and NS5B inhibitor sofosbuvir have recently been licensed and can reduce the length of antiviral treatment, improve response rates, and allow for interferon-free regimens for some HCV genotypes. Several other newer direct acting antivirals have shown promise in clinical studies and are likely to be licensed soon. These agents seem to facilitate the use of shortened courses of combination interferon-free therapy, which are associated with high (>95%) sustained response rates and relatively few toxicities. These regimens have also been successful in patients who were previously difficult to treat, including those with cirrhosis, HIV coinfection, and those who have undergone liver transplantation. The high cost of these agents may be the biggest challenge to their implementation worldwide.
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Affiliation(s)
- Eoin R Feeney
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, USA
| | - Raymond T Chung
- Division of Gastroenterology, Massachusetts General Hospital, Boston MA 02114, USA
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Lack of Access to Treatment as a Barrier to HCV Screening. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2014; 20:420-3. [DOI: 10.1097/phh.0b013e31829e05b8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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van Griensven J, Phirum L, Choun K, Thai S, De Weggheleire A, Lynen L. Hepatitis B and C co-infection among HIV-infected adults while on antiretroviral treatment: long-term survival, CD4 cell count recovery and antiretroviral toxicity in Cambodia. PLoS One 2014; 9:e88552. [PMID: 24533106 PMCID: PMC3922870 DOI: 10.1371/journal.pone.0088552] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 01/06/2014] [Indexed: 12/22/2022] Open
Abstract
Background Despite the high burden, there is a dearth of (long-term) outcome data of hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infected patients receiving antiretroviral treatment (ART) in a clinical setting in resource-constrained settings, particularly from Asia. Methods We conducted a retrospective cohort study including all adults initiating standard ART (non-tenofovir-based) between 03/2003 and 09/2012. HBV infection was diagnosed by HBV surface antigen detection. HCV diagnosis relied on antibody detection. The independent effect of HBV and HCV on long-term (≥5 years) ART response in terms of mortality (using Cox regression), severe livertoxicity (using logistic regression) and CD4 count increase (using mixed-effects modelling) was determined. Results A total of 3089 adults were included (median age: 35 years (interquartile range 30–41); 46% male), of whom 341 (11.0%) were co-infected with HBV and 163 (5.3%) with HCV. Over a median ART follow-up time of 4.3 years, 240 individuals died. Mortality was 1.6 higher for HBV co-infection in adjusted analysis (P = 0.010). After the first year of ART, the independent mortality risk was 3-fold increased in HCV co-infection (P = 0.002). A total of 180 (5.8%) individuals discontinued efavirenz or nevirapine due to severe livertoxicity, with an independently increased risk for HBV (hazard ratio (HR) 2.3; P<0.001) and HCV (HR 2.8; P<0.001). CD4 recovery was lower in both HBV and HCV co-infection but only statistically significant for HBV (P<0.001). Discussion HBV and HCV co-infection was associated with worse ART outcomes. The effect of early ART initiation and providing effective treatment for hepatitis co-infection should be explored.
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Affiliation(s)
- Johan van Griensven
- Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia
- Institute of Tropical Medicine, Antwerp, Belgium
- * E-mail:
| | - Lay Phirum
- Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia
| | | | - Sopheak Thai
- Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia
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Obach D, Deuffic-Burban S, Esmat G, Anwar WA, Dewedar S, Canva V, Cousien A, Doss W, Mostafa A, Pol S, Buti M, Siebert U, Fontanet A, Mohamed MK, Yazdanpanah Y. Effectiveness and cost-effectiveness of immediate versus delayed treatment of hepatitis C virus-infected patients in a country with limited resources: the case of Egypt. Clin Infect Dis 2014; 58:1064-71. [PMID: 24510934 DOI: 10.1093/cid/ciu066] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Because of logistical and economic issues, in Egypt, as in other resource-limited settings, decision makers should determine for which patients hepatitis C virus (HCV) treatment should be prioritized. We assessed the effectiveness and cost-effectiveness of different treatment initiation strategies. METHODS Using a Markov model, we simulated HCV disease in chronically infected patients in Egypt, to compare lifetime costs, quality-adjusted life expectancy (QALE), and the incremental cost-effectiveness ratio (ICER) of different treatment initiation strategies. RESULTS Immediate treatment of patients at stages F1/F2/F3 was less expensive and more effective than delaying treatment until more severe stages or not providing treatment (in patients diagnosed at F1: QALE = 18.32 years if treatment at F1 vs 18.22 if treatment at F2). Treatment of F4 patients was more effective than no treatment at all (QALE = 10.33 years vs 8.77 years) and was cost-effective (ICER = $1915/quality-adjusted life-year [QALY]). When considering that affordable triple therapies, including new direct-acting antivirals, will be available starting in 2016, delaying treatment until stage F2, then treating all patients regardless of their disease stage after 2016, was found to be cost-effective (ICER = $33/QALY). CONCLUSIONS In Egypt, immediate treatment of patients with fibrosis stage F1-F3 who present to care is less expensive and more effective than delaying treatment. However, immediate treatment at stage F1 is only slightly more effective than waiting for disease to progress to stage F2 before starting treatment and is sensitive to the forthcoming availability of new treatments. Treating patients at stage F4 is highly effective and cost-effective. In Egypt, decision makers should prioritize treatment for F4 patients and delay treatment for F1 patients who present to care.
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Affiliation(s)
- Dorothée Obach
- IAME, UMR 1137, Inserm, F-75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, F-75018 Paris, France
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Hill A, Khoo S, Fortunak J, Simmons B, Ford N. Minimum costs for producing hepatitis C direct-acting antivirals for use in large-scale treatment access programs in developing countries. Clin Infect Dis 2014; 58:928-36. [PMID: 24399087 PMCID: PMC3952605 DOI: 10.1093/cid/ciu012] [Citation(s) in RCA: 164] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Large-scale manufacture of treatment to cure hepatitis C virus (HCV) is feasible, with target prices of US$100–$250 per 12-week treatment course. These low prices could make widespread access to HCV treatment in low- and middle-income countries a realistic goal. Background. Several combinations of 2 or 3 direct-acting antivirals (DAAs) can cure hepatitis C virus (HCV) in the majority of treatment-naive patients. DAAs for HCV infection have similar mechanisms of action and chemical structures to antiretrovirals for human immunodeficiency virus (HIV) infection. Generic antiretrovirals are currently manufactured at very low prices, to treat 10 million people with HIV/AIDS in developing countries. Methods. Four HCV DAAs, currently either in phase 3 development or recent approval (daclatasvir, sofosbuvir, simeprevir, faldaprevir), and ribavirin were classified by chemical structure, molecular weight, total daily dose, and complexity of synthesis. The likely range of manufacturing costs per gram of DAA were then projected as formulated product cost, based upon treating a minimum of 1 million patients annually (to arrive at volume demand) combined with an analysis of the complexity of synthesis and a 40% margin for formulation. Projections were then compared with actual costs of antiretrovirals with similar structures. Results. Minimum manufacturing costs of antiretrovirals were US$0.2–$2.1 per gram. The complexity of chemical synthesis for HCV DAAs was ranked from lowest to highest: ribavirin, daclatasvir, sofosbuvir, faldaprevir, and simeprevir. Predicted manufacturing costs (US dollars) for 12-week courses of HCV DAAs were $21–$63 for ribavirin, $10–$30 for daclatasvir, $68–$136 for sofosbuvir, $100–$210 for faldaprevir, and $130–$270 for simeprevir. Conclusions. Within the next 15 years, large-scale manufacture of 2 or 3 drug combinations of HCV DAAs is feasible, with minimum target prices of $100–$250 per 12-week treatment course. These low prices could make widespread access to HCV treatment in low- and middle-income countries a realistic goal.
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Affiliation(s)
- Andrew Hill
- Department of Pharmacology and Therapeutics, Liverpool University, United Kingdom
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