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Brothers S, DiDomizio E, Nichols L, Brooks R, Villanueva M. Perceptions Towards HCV Treatment with Direct Acting Antivirals (DAAs): A Qualitative Analysis with Persons with HIV/HCV Co-infection Who Delay or Refuse Treatment. AIDS Behav 2023; 27:119-133. [PMID: 35776253 PMCID: PMC9663279 DOI: 10.1007/s10461-022-03749-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 01/24/2023]
Abstract
In the United States, approximately 25% of people with HIV (PWH) are co-infected with hepatitis C (HCV). Since 2014, highly effective and well-tolerated direct-acting antivirals (DAAs) have revolutionized HCV treatment. Uptake of DAAs by people with HIV/HCV co-infection has improved but remains suboptimal due to system, provider, and patient-level barriers. To explore patient-level issues by better understanding their attitudes towards DAA treatment, we conducted qualitative interviews with 21 persons with HIV/HCV co-infection who did not consent to DAA treatment or delayed treatment for at least 1 year after diagnosis. We found PWH perceived DAA treatment barriers and facilitators on multiple levels of the social-ecological environment: the individual (HCV disease and treatment literacy), interpersonal (peer influence), institutional (media and healthcare provider relationship), and structural levels (treatment cost and adherence support). Recommendations to improve DAA treatment uptake include HCV-treatment adherence support, HCV disease and treatment literacy training (particularly for substance use and DAA treatment interactions), and encouraging PWH who have successfully completed DAA treatment to speak with their peers.
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Affiliation(s)
- Sarah Brothers
- Department of Sociology, Pennsylvania State University, 316 Oswald Tower, University Park, PA, 16802, USA.
- HIV/AIDS Program, Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA.
| | - Elizabeth DiDomizio
- HIV/AIDS Program, Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Lisa Nichols
- HIV/AIDS Program, Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Ralph Brooks
- HIV/AIDS Program, Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Merceditas Villanueva
- HIV/AIDS Program, Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
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2
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Fernandes SA, Tovo CV, da Silva ALM, Pinto LP, Carteri RB, Mattos AA. Relationship between phase angle, steatosis, and liver fibrosis in patients coinfected with human immunodeficiency virus/hepatitis C virus. World J Hepatol 2022; 14:1173-1181. [PMID: 35978664 PMCID: PMC9258259 DOI: 10.4254/wjh.v14.i6.1173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 04/16/2022] [Accepted: 05/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Malnutrition, lipodystrophy, and dyslipidemia are prevalent characteristics in patients with human immunodeficiency virus (HIV) infection with or without previous treatment. Such a clinical condition can lead to the hypothesis of the presence of hepatic steatosis with possible progression to fibrosis and the risk of hepatocellular carcinoma. Notably, a low phase angle (PA), evaluated by bioelectrical impedance analysis (BIA), is an independent prognostic marker of clinical progression and survival in HIV-infected patients.
AIM To evaluate the relationship between PA and body composition with steatosis and hepatic fibrosis in HIV/hepatitis C virus (HCV)-coinfected patients.
METHODS A retrospective observational study by convenience sampling of coinfected HIV/HCV patients, in which all patients underwent transient elastography (Fibroscan) and BIA evaluation. Student’s t test was used for group comparisons, and Spearman’s or Pearson’s correlation test was used when appropriate. The significance level was set at 5%, and analyses were performed using SPSS version 21.0.
RESULTS Forty-three patients who received antiretroviral therapy met the inclusion criteria, and 23 (53.5%) were under treatment with protease inhibitors (PIs). There was no difference in PA between those who used PIs and those who did not (P = 0.635). There was no correlation between fibrosis grade and PA (P = 0.355) or lean mass (P = 0.378). There was a significant inverse correlation between the controlled attenuation parameter (CAP) and lean mass (P = 0.378), positive correlation between PA and lean mass (P = 0.378), and negative correlation between PA and fatty mass (P = 0.378), although the CAP and PA were not correlated. When evaluated by sex, no significant correlations were found.
CONCLUSION PA determines the muscle function of HIV/HCV-coinfected patients, and the CAP values reinforce the association with lean mass, suggesting that patients require early nutritional interventions.
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Affiliation(s)
- Sabrina Alves Fernandes
- Postgraduate Program in Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
| | - Cristiane Valle Tovo
- Postgraduate Program in Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
| | | | - Letícia Pereira Pinto
- Postgraduate Program in Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
| | - Randhall B Carteri
- Department of Nutrition, Centro Universitário Metodista-IPA, Porto Alegre 90420-060, Brazil
- Department of Nutrition, Centro Universitário CESUCA, Cachoeirinha 94935-630, Brazil
| | - Angelo A Mattos
- Postgraduate Program in Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
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Dzinamarira T, Murewanhema G, Chitungo I, Ngara B, Nkambule SJ, Madziva R, Herrera H, Mukwenha S, Cuadros DF, Iradukunda PG, Mashora M, Tungwarara N, Rwibasira GN, Musuka G. Risk of mortality in HIV-infected COVID-19 patients: A systematic review and meta-analysis. J Infect Public Health 2022; 15:654-661. [PMID: 35617829 PMCID: PMC9110010 DOI: 10.1016/j.jiph.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/27/2022] [Accepted: 05/10/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The relationship between HIV infection and COVID-19 clinical outcomes remains a significant public health research problem. We aimed to determine the association of HIV comorbidity with COVID-19 mortality. METHODS We searched PubMed, Google Scholar and World Health Organization library databases for relevant studies. All searches were conducted from 1st to 7th December 2021. Title, abstract and full text screening was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The relative risk of mortality in HIV-infected COVID-19 patients was computed using a random-effects model. All analyses were performed using Meta and Metasens statistical packages available in R version 4.2.1 software package. The quality of included studies was assessed using the GRADE approach, Egger's test was employed to determine the risk of bias. RESULTS A total of 16 studies were included in this review. Among the COVID-19 patients with HIV infection, the mortality rate due to COVID-19 was 7.97% (4 287/53,801), and among the COVID-19 patients without HIV infection, the mortality rate due to COVID-19 was 0.69% (127, 961/18, 513, 747). In the random effects model, we found no statistically significant relative risk of mortality in HIV-infected COVID-19 patients (RR 1.07, 95% CI 0.86-1.32). The between-studies heterogeneity was substantial (I2 = 91%, P < 0.01), while the risk of publication bias was not significant. CONCLUSION Findings did not link HIV infection with an increased risk of COVID-19 mortality. Our results add to the conflicting data on the relationship between COVID-19 and HIV infection.
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Affiliation(s)
- Tafadzwa Dzinamarira
- School of Health Systems & Public Health, University of Pretoria, Pretoria 0002, South Africa; ICAP at Columbia University, Harare, Zimbabwe.
| | - Grant Murewanhema
- Unit of Obstetrics and Gynaecology, Department of Primary Health Care Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Zimbabwe
| | - Itai Chitungo
- Faculty of Medicine, College of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Bernard Ngara
- Faculty of Medicine, College of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Sphamandla Josias Nkambule
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4001, South Africa
| | | | | | | | | | | | | | - Nigel Tungwarara
- Department of Health Studies, University of South Africa, South Africa
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Zhao Y, Kong LX, Feng FS, Yang J, Wei G. A simple CD4+ T cells to FIB-4 ratio for evaluating prognosis of BCLC-B hepatocellular carcinoma: a retrospective cohort study. BMC Cancer 2022; 22:311. [PMID: 35321670 PMCID: PMC8941753 DOI: 10.1186/s12885-022-09433-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/21/2022] [Indexed: 02/08/2023] Open
Abstract
Introduction Immunotherapy has become a new therapy for advanced hepatocellular carcinoma (HCC); however, its treatment results are considerably different. CD4+ T cells (CD4+) are the key to immunotherapy, but patients with HCC that have low CD4+ are rarely observed for clinical evidence. Hepatitis B virus-related HCC is often accompanied by cirrhosis and portal hypertension; therefore, CD4+ tend to be relatively low in number. TACE is the standard treatment for Barcelona Clinic Liver Cancer (BCLC)-B HCC, which may further reduce the number of CD4 + . Methods This retrospective cohort study further reduced CD4+ by including patients with human immunodeficiency virus (HIV) to observe the relationship between CD4+ and Chronic hepatitis B virus (CHB) induced HCC. A total of 170 BCLC-B HCC patients (42 HIV+) were included. Univariate and multivariate analyses, and artificial neural networks (ANNs) were used to evaluate the independent risk factors for the two-year survival. Results The statistical analysis of the two-year survival rate showed that the main factors influencing survival were liver function and immune indices, including CD4+, platelet, alanine aminotransferase, aspartate aminotransferase, aspartate aminotransferase-to-platelet ratio index, and fibrosis-4 (FIB-4) (P < 0.05). Compared with that in other indices, in logistic and ANN multivariate analysis, CD4 + -to-FIB-4 ratio (CD4+/FIB-4) had the highest importance with 0.716 C-statistic and 145.93 cut-off value. In terms of overall survival rate, HIV infection was not a risk factor (P = 0.589); however, CD4+/FIB-4 ≤ 145.93 significantly affected patient prognosis (P = 0.002). Conclusion HIV infection does not affect the prognosis of BCLC-B HCC, but CD4+ have a significant predictive value. CD4+ played a vital role in HCC and this deserves the attention from physicians. Further, the CD4+/FIB-4 is a clinically valuable effective prognostic indicator for these patients.
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Affiliation(s)
- Yong Zhao
- Department of General Surgery, Chengdu Public Health Clinical Medical Center, Sichuan Province, Chengdu, China
| | - Ling Xiang Kong
- Department of Liver Surgery and Liver transplantation Laboratory, West China Hospital of Sichuan University, Sichuan Province, Chengdu, China
| | - Feng Shi Feng
- Department of General Surgery, Chengdu Public Health Clinical Medical Center, Sichuan Province, Chengdu, China
| | - Jiayin Yang
- Department of Liver Surgery and Liver transplantation Laboratory, West China Hospital of Sichuan University, Sichuan Province, Chengdu, China.
| | - Guo Wei
- Department of General Surgery, Chengdu Public Health Clinical Medical Center, Sichuan Province, Chengdu, China.
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5
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Kong L, Wei G, Lv T, Jiang L, Yang J, Zhao Y, Yang J. Outcome of TACE treatment in HIV infected patients with hepatocellular carcinoma. Sci Rep 2021; 11:696. [PMID: 33436856 PMCID: PMC7804028 DOI: 10.1038/s41598-020-80311-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 12/17/2020] [Indexed: 02/05/2023] Open
Abstract
The surgical treatment and transcatheter arterial chemoembolization (TACE) rate of human immunodeficiency virus (HIV)-infected hepatocellular carcinoma (HCC) patients is relatively low in West China. For various reasons, most patients do not receive timely surgical treatment. Upon transfer to an infectious disease centralized hospital, they were already classified in the Barcelona Clinic Liver Cancer (BCLC)-B stage. A total of 2249 BCLC-B HCC patients were analyzed. The eligible population was divided into three groups for analysis of survival and prognostic factors; These were 21 HIV infected (HIV+) HCC patients treated with TACE (TACE+), 1293 non-HIV-infected (HIV−) HCC patients treated with TACE, and 150 HIV− HCC patients who only receive medication (TACE−) as a second control group. After 1:2 matching, 1- and 2-year survival of HIV+ TACE+ and HIV− TACE+ groups was 64.3% and 76.5% (P = 0.453) and 45.5% vs. 50.0% (P = 0.790) respectively. We also compared one and two-year survival between HIV+ TACE+ and HIV− TACE−. One-year overall survival was 64.3% vs. 45.7% (P = 0.097) and 2-year survival was 45.5% vs. 7.1% (P = 0.004). Multivariate analysis showed that the most important prognostic factors for survival were serum alpha-fetoprotein (AFP) and Child–Pugh score and tumor size, while HIV status had no significant effect on prognosis statistically. CD4 levels below 200 may increase the risk of opportunistic infection after surgery, but after anti-infection and systematic supportive therapy, it has no effect on survival. HIV+ patients should have the same treatment opportunities as HIV− patients. If the patient's immune status permits, we suggest that early TACE treatment should be administered to BCLC-B HCC patients, regardless of HIV infection.
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Affiliation(s)
- Lingxiang Kong
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Guo Wei
- Department of General Surgery, Chengdu Public Health Clinical Medical Center, Chengdu, Sichuan Province, China.
| | - Tao Lv
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Li Jiang
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Jian Yang
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Yong Zhao
- Department of General Surgery, Chengdu Public Health Clinical Medical Center, Chengdu, Sichuan Province, China
| | - Jiayin Yang
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
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6
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Siza C, Bixler D, Davidson S. Proportion and Characterization of Co-infections of HIV and Hepatitis C or Hepatitis B among People with HIV in Alabama, 2007-2016. South Med J 2020; 113:298-304. [PMID: 32483640 DOI: 10.14423/smj.0000000000001104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES People living with human immunodeficiency virus (HIV) have an increased risk of other infections, including viral hepatitis, which can complicate the treatment and progression of the disease. We sought to characterize Alabama cases of HIV co-infected with hepatitis C virus or hepatitis B virus. METHODS Using surveillance data, we defined co-infection as a person identified as having hepatitis C or hepatitis B and HIV during 2007-2016. We compared demographics, outcomes, and risk factors for co-infected versus monoinfected individuals with HIV. We mapped co-infected individuals' distribution. RESULTS Of 5824 people with HIV, 259 (4.4%) were co-infected with hepatitis C (antibody or RNA positive) and 145 (2.5%) with hepatitis B (surface antigen, e antigen, or DNA positive) during 2007-2016. Individuals with HIV and hepatitis C had a greater odds of injection drug use (adjusted odds ratio 9.7; 95% confidence interval 6.0-15.5). Individuals with HIV and hepatitis B had a greater odds of male-to-male sexual contact (adjusted odds ratio 1.7; 95% confidence interval 1.1-2.6). Co-infection was greater in urban public health districts. CONCLUSIONS We identified risk behaviors among Alabama populations associated with increased odds for HIV and viral hepatitis co-infection. Outreach, prevention, testing, and treatment resources can be targeted to these populations.
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Affiliation(s)
- Charlene Siza
- From the Centers for Disease Control and Prevention, Atlanta, Georgia, and the Alabama Department of Public Health, Montgomery
| | - Danae Bixler
- From the Centers for Disease Control and Prevention, Atlanta, Georgia, and the Alabama Department of Public Health, Montgomery
| | - Sherri Davidson
- From the Centers for Disease Control and Prevention, Atlanta, Georgia, and the Alabama Department of Public Health, Montgomery
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Hall T, Jenkins CA, Hulgan T, Furukawa S, Turner M, Pratap S, Sterling TR, Tabatabai M, Berthaud V. Hepatitis C Coinfection and Mortality in People Living with HIV in Middle Tennessee. AIDS Res Hum Retroviruses 2020; 36:193-199. [PMID: 31789047 PMCID: PMC7071089 DOI: 10.1089/aid.2019.0113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
HIV and hepatitis C virus (HCV) coinfection is associated with poor health outcomes. This study was designed to assess risk factors for and mortality with coinfection before direct-acting antiviral treatment availability in a state with an evolving opioid epidemic. HCV infection was determined from review of the medical record at two clinics serving the majority of people living with HIV (PLWH) in care in Middle Tennessee from 2004 to 2013. Association of potential risk factors with HCV-positivity was assessed using logistic regression. Association of HCV-positivity with mortality was assessed with a Cox proportional hazards model, adjusting for selected covariates. A total of 3,501 patients were included: 24% female; 51% men who have sex with men; 47% white; 44% African American/black; median age of 38 at their first visit; median most recent CD4 count 502 cells/μL (301-716); and HIV viral load 47 copies/mL (39-605); followed for a median of 3.0 (1-5) years. Prevalence of HCV was 13%. Those with a history of injection drug use (IDU) demonstrated the highest odds of HCV-positivity [odds ratio 12.94; 95% confidence interval (CI) 9.39-17.83]. There were 305 deaths; median age at death was 47 years (40-53). HCV coinfection was associated with greater mortality (hazard ratio 1.61; 95% CI 1.20-2.17; p < .001). Among PLWH, HCV coinfection was associated with IDU and an independent predictor of mortality. These results affirm the importance of HCV coinfection and inform interventions targeting the continuum of HCV care, uptake of HCV treatment, and the impact of drug use in this population.
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Affiliation(s)
- Toni Hall
- Department of Medicine, Meharry Medical College, Nashville, Tennessee
| | - Cathy A Jenkins
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Todd Hulgan
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sally Furukawa
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Megan Turner
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Siddharth Pratap
- Department of Bioinformatics, Meharry Medical College, Nashville, Tennessee
| | - Timothy R Sterling
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mohammad Tabatabai
- Department of Biostatistics, Meharry Medical College, Nashville, Tennessee
| | - Vladimir Berthaud
- Department of Medicine, Meharry Medical College, Nashville, Tennessee
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Alessio L, Onorato L, Sangiovanni V, Borrelli F, Manzillo E, Esposito V, Simeone F, Martini S, Capoluongo N, Leone S, Di Filippo G, D'Abbraccio M, Aprea L, Megna AS, Milano E, Rizzo V, Saracino A, Coppola N. DAA-based treatment for HIV-HCV-coinfected patients: analysis of factors of sustained virological response in a real-life study. Antivir Ther 2020; 25:193-201. [PMID: 32314978 DOI: 10.3851/imp3353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The aim of the present study was to evaluate in HIV-infected patients treated with a direct-acting antiviral agent (DAA)-based regimen the variables associated with sustained virological response (SVR) and the trend in biochemical parameters and clinical events during and after DAA regimen. METHODS We performed a multicentre retrospective cohort study, enrolling all 243 HIV-HCV-coinfected adult patients treated with DAAs between January 2015 and December 2018 in one of the nine participating Infectious Disease Centers in southern Italy, eight in Campania and one in Apulia. RESULTS Of the 243 patients enrolled, 233 (95.9%) obtained an SVR at 12 weeks (SVR12). Of the 10 patients with non-SVR, 7 were tested for NS3, NS5A and NS5B resistance-associated substitutions (RASs) by sequencing analysis and 6 showed at least 1 major RAS in 1 HCV region (all in NS5A, 2 in NS5B and 1 in NS3). Comparing the 233 patients achieving SVR and the 10 non-achievers, no variable was independently associated with non-SVR. During and after DAA regimen, no modification in the biochemical parameters and clinical events was observed; however, the serum cholesterol and low-density lipoprotein (LDL) levels showed an increase (from 159 ±41.3 mg/dl at baseline to 174 ±44.5 mg/dl at week 12 after stopping treatment, P<0.001, and from 92 ±34.6 mg/dl to 109.4 ±73.7 mg/dl, P=0.002, respectively). CONCLUSIONS The treatment with DAAs led to a high SVR12 rate in HIV-HCV-coinfected subjects, irrespective of epidemiological, clinical or virological characteristics. However, the DAA regimen was associated with an increase in total- and LDL-cholesterol, to be taken into account in the management of HIV infection.
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Affiliation(s)
- Loredana Alessio
- Infectious Diseases Unit, AORN Sant'Anna e San Sebastiano, Caserta, Italy
| | - Lorenzo Onorato
- Infectious Diseases Unit, AORN Sant'Anna e San Sebastiano, Caserta, Italy.,Department of Mental Health and Preventive Medicine, Section of Infectious Diseases, University of Campania "L. Vanvitelli", Naples, Italy
| | | | | | - Elio Manzillo
- VIII Infectious Diseases Unit, AORN dei Colli, P.O. Cotugno, Naples, Italy
| | - Vincenzo Esposito
- Immunodeficiency and Gender Related Infectious Diseases Unit, Department of Infectious Disease and Infectious Emergencies, AORN dei Colli, P.O. Cotugno, Naples, Italy
| | - Filomena Simeone
- Infectious Diseases Unit, AORN Sant'Anna e San Sebastiano, Caserta, Italy
| | - Salvatore Martini
- Department of Mental Health and Preventive Medicine, Section of Infectious Diseases, University of Campania "L. Vanvitelli", Naples, Italy
| | - Nicolina Capoluongo
- Department of Mental Health and Preventive Medicine, Section of Infectious Diseases, University of Campania "L. Vanvitelli", Naples, Italy
| | | | | | - Maurizio D'Abbraccio
- Immunodeficiency and Gender Related Infectious Diseases Unit, Department of Infectious Disease and Infectious Emergencies, AORN dei Colli, P.O. Cotugno, Naples, Italy
| | - Lucia Aprea
- VIII Infectious Diseases Unit, AORN dei Colli, P.O. Cotugno, Naples, Italy
| | | | - Eugenio Milano
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | - Viviana Rizzo
- Immunodeficiency and Gender Related Infectious Diseases Unit, Department of Infectious Disease and Infectious Emergencies, AORN dei Colli, P.O. Cotugno, Naples, Italy
| | - Annalisa Saracino
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | - Nicola Coppola
- Infectious Diseases Unit, AORN Sant'Anna e San Sebastiano, Caserta, Italy.,Department of Mental Health and Preventive Medicine, Section of Infectious Diseases, University of Campania "L. Vanvitelli", Naples, Italy
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Liver stiffness and fibrosis-4 alone better predict liver events compared with aspartate aminotransferase to platelet ratio index in a cohort of human immunodeficiency virus and hepatitis C virus co-infected patients from ANRS CO13 HEPAVIH cohort. Eur J Gastroenterol Hepatol 2019; 31:1387-1396. [PMID: 31033848 DOI: 10.1097/meg.0000000000001408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES HIV/hepatitis C virus (HCV) co-infection leads to major complications, and noninvasive markers developed to stage liver fibrosis could be used as prognostic markers. We aimed to compare the performances of liver stiffness (LS), fibrosis-4 (FIB-4), and aspartate aminotransferase to platelet ratio index (APRI) to predict liver-related events in HIV/HCV co-infected patients. PATIENTS AND METHODS HIV/HCV co-infected patients from the ANRS CO13 HEPAVIH cohort were included if they had LS, FIB-4, and APRI measurements done in a window of 3 months. Primary outcome was the time between inclusion and occurrence of a liver-related event. Univariable and multivariable Fine and Gray models were performed. Predictive performances were compared by the area under the receiver operating characteristic (AUROC) differences after correction of optimistic by bootstrap samples. Best cutoffs to predict liver-related events were estimated by sensitivity and specificity maximization. RESULTS A total of 998 patients were included. Overall, 70.7% were men. Their median age was 46.8 years. According to LS value, 204 (20.4%) patients had cirrhosis. Overall, 39 patients experienced at least one liver-related event. In univariable analysis, LS AUROC curve was significantly superior to FIB-4 and APRI AUROC curves, being 87.9, 78.2, and 75.0%, respectively. After adjustment on age, CD4 levels, and insulin resistance, no differences were observed. The best cutoffs to identify patients at low or high risk of liver-related events were below 8.5, 1.00, and 0.35 and above 16.5, 4.00, and 1.75 for LS, FIB-4, and APRI, respectively. CONCLUSION To predict HCV-related events, APRI had lower performance than LS and FIB-4. FIB-4 is as good as LS to predict HCV-related events, suggesting that it can be used for the management of HIV/HCV co-infected patients and replace LS.
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Dold L, Schwarze-Zander C, Boesecke C, Mohr R, Langhans B, Wasmuth JC, Strassburg CP, Rockstroh JK, Spengler U. Survival of HIV/HCV co-infected patients before introduction of HCV direct acting antivirals (DAA). Sci Rep 2019; 9:12502. [PMID: 31467319 PMCID: PMC6715635 DOI: 10.1038/s41598-019-48756-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 07/25/2019] [Indexed: 12/02/2022] Open
Abstract
HIV/HCV infection is supposed to substantially reduce survival as compared to HIV mono-infection. Here, we compared longtime-survival and causes of death in a cohort of HIV- and HIV/HCV-co-infected patients on combined antiretroviral therapy (cART), before introduction of HCV direct acting antivirals (DAA). 322 Caucasian patients with HIV (n = 176) and HIV/HCV-infection (n = 146) were enrolled into this study. All patients were recruited between 2003 and 2004 and followed until 01.01.2014. We compared overall survival between the two groups by the Kaplan-Meyer method and identified independent factors associated with long-time survival by conditional Cox regression analysis. In total 46 (14.3%) patients died during the observation period (HIV infection: n = 23 (13.1%), HIV/HCV infection: n = 23 (15.8%) but overall-survival did not differ significantly between HIV/HCV-infected and HIV mono-infected patients (p = 0.619). Survival was substantially better in patients with complete suppression of HIV replication below the level of detection than in those with residual viremia (p = 0.001). Age (p = 0.008), γ-glutamyltranspeptidase (p < 0.0001) and bilirubin (p = 0.008) were significant predictors of survival irrespective from HCV co-infection. Complete repression of HIV replication on cART is the key factor determining survival both in HIV- and HIV/HCV-co-infected patients, while HCV co-infection and therapy without DAAs seem to affect survival to a lesser extent. Thus, patients with HIV/HCV co-infection require particularly intensive cART.
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Affiliation(s)
- L Dold
- Department of Internal Medicine I, Rheinische Friedrich-Wilhelms University Bonn, Bonn, Germany. .,German Center for Infection Research (DZIF), partner site Cologne-Bonn, Bonn, Germany.
| | - C Schwarze-Zander
- Department of Internal Medicine I, Rheinische Friedrich-Wilhelms University Bonn, Bonn, Germany.,German Center for Infection Research (DZIF), partner site Cologne-Bonn, Bonn, Germany
| | - C Boesecke
- Department of Internal Medicine I, Rheinische Friedrich-Wilhelms University Bonn, Bonn, Germany.,German Center for Infection Research (DZIF), partner site Cologne-Bonn, Bonn, Germany
| | - R Mohr
- Department of Internal Medicine I, Rheinische Friedrich-Wilhelms University Bonn, Bonn, Germany.,German Center for Infection Research (DZIF), partner site Cologne-Bonn, Bonn, Germany
| | - B Langhans
- Department of Internal Medicine I, Rheinische Friedrich-Wilhelms University Bonn, Bonn, Germany.,German Center for Infection Research (DZIF), partner site Cologne-Bonn, Bonn, Germany
| | - J-C Wasmuth
- Department of Internal Medicine I, Rheinische Friedrich-Wilhelms University Bonn, Bonn, Germany.,German Center for Infection Research (DZIF), partner site Cologne-Bonn, Bonn, Germany
| | - C P Strassburg
- Department of Internal Medicine I, Rheinische Friedrich-Wilhelms University Bonn, Bonn, Germany.,German Center for Infection Research (DZIF), partner site Cologne-Bonn, Bonn, Germany
| | - J K Rockstroh
- Department of Internal Medicine I, Rheinische Friedrich-Wilhelms University Bonn, Bonn, Germany.,German Center for Infection Research (DZIF), partner site Cologne-Bonn, Bonn, Germany
| | - U Spengler
- Department of Internal Medicine I, Rheinische Friedrich-Wilhelms University Bonn, Bonn, Germany.,German Center for Infection Research (DZIF), partner site Cologne-Bonn, Bonn, Germany
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11
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Leone S, Lorenzini P, Cozzi-Lepri A, Orofino G, Bernacchia D, Castagna A, Menozzi M, Guaraldi G, Madeddu G, Di Biagio A, Puoti M, Gori A, d'Arminio Monforte A. Impact of diabetes on the risk of serious liver events and liver-related deaths in people living with HIV and hepatitis C co-infection: data from the ICONA Foundation Cohort Study. Eur J Clin Microbiol Infect Dis 2019; 38:1857-1865. [PMID: 31230205 DOI: 10.1007/s10096-019-03618-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 06/14/2019] [Indexed: 12/29/2022]
Abstract
To investigate the association between diabetes and HCV infection in persons living with HIV and to determine the impact of diabetes on the occurrence of serious liver events (SLEs) and liver-related deaths (LRDs) among HIV/HCV-co-infected patients. Patients were included if they had at least one follow-up visit. In a cross-sectional analysis among all HIV patients, we have investigated the association between diabetes and HCV infection. A further longitudinal analysis was performed in the population of HIV/HCV-co-infected free from SLE with FIB-4 index < 3.25 at baseline, using the following endpoints: (A) first event between SLE and LRD; (B) liver fibrosis progression defined as the first of two consecutive FIB-4 > 3.25; (C) first event between SLE, LRD, and liver fibrosis progression. Data from 15,571 HIV patients were analyzed: 2944 (18.9%) were HCV-Ab positive, and 739 (4.7%) presented a diagnosis of diabetes at their last follow-up. Among HIV/HCV-co-infected population, 107 patients had a diagnosis of diabetes. Viremic HCV-co-infected patients had 3-fold risk of diabetes onset than HCV-uninfected patients. On HIV/HCV-co-infected population, 85 SLEs/LRDs occurred over 20,410 person-years of follow-up (PYFU), for an incidence rate of 4.2/1000 PYFU (95%CI 3.4-5.2). Diabetic patients had 3-fold risk of pooled SLE and LRD than patients without diabetes. Furthermore, viremic HCV infection was independently associated with a higher risk of SLE/LRD (aIRR 3.35 [95%CI 1.14-9.83]). In HIV-infected patients, viremic HCV co-infection is a strong predictor of diabetes. Among HIV/HCV-co-infected population, diabetic patients showed an increased risk of SLE/LRD compared with those without diabetes.
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Affiliation(s)
- Sebastiano Leone
- Division of Infectious Diseases, Department of Internal Medicine, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100, Avellino, Italy.
| | | | | | | | - Dario Bernacchia
- Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, DIBIC 'L. Sacco', University of Milan, Milan, Italy
| | - Antonella Castagna
- Infectious Diseases Department, IRCCS San Raffaele Scientific Institute & Vita-Salute University, Milan, Italy
| | - Marianna Menozzi
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Guaraldi
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Giordano Madeddu
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Antonio Di Biagio
- Infectious Diseases Unit, Policlinico San Martino Hospital, Genoa, Italy
| | - Massimo Puoti
- Infectious Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Gori
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, School of Medicine and Surgery, University of Milan, Milan, Italy
| | - Antonella d'Arminio Monforte
- Clinic of Infectious and Tropical Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
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12
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Rossi C, Young J, Martel-Laferrière V, Walmsley S, Cooper C, Wong A, Gill MJ, Klein MB. Direct-Acting Antiviral Treatment Failure Among Hepatitis C and HIV-Coinfected Patients in Clinical Care. Open Forum Infect Dis 2019; 6:ofz055. [PMID: 30882016 PMCID: PMC6411211 DOI: 10.1093/ofid/ofz055] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/24/2019] [Accepted: 02/12/2019] [Indexed: 12/27/2022] Open
Abstract
Background There are limited data on the real-world effectiveness of direct-acting antiviral (DAA) treatment in patients coinfected with hepatitis C virus (HCV) and HIV—a population with complex challenges including ongoing substance use, cirrhosis, and other comorbidities. We assessed how patient characteristics and the appropriateness of HCV regimen selection according to guidelines affect treatment outcomes in coinfected patients. Methods We included all patients who initiated DAA treatment between November 2013 and July 2017 in the Canadian Co-Infection Cohort. Sustained virologic response (SVR) was defined as an undetectable HCV RNA measured between 10 and 18 weeks post-treatment. We defined treatment failure as virologic failure, relapse, or death without achieving SVR. Bayesian logistic regression was used to estimate the posterior odds ratios (ORs) associated with patient demographic, clinical, and treatment-related risk factors for treatment failure. Results Two hundred ninety-five patients initiated DAAs; 31% were treatment-experienced, 29% cirrhotic, and 80% HCV genotype 1. Overall, 92% achieved SVR (263 of 286, 9 unknown), with the highest rates in females (97%) and lowest in cirrhotics (88%) and high-frequency injection drug users (89%). Many patients (38%) were prescribed regimens that were outside current clinical guidelines. This did not appreciably increase the risk of treatment failure—particularly in patients with genotype 1 (prior odds ratio [OR], 1.5; 95% credible interval [CrI], 0.38–6.0; posterior OR, 1.0; 95% CrI, 0.40–2.5). Conclusions DAAs were more effective than anticipated in a diverse, real-world coinfected cohort, despite the use of off-label, less efficacious regimens. High-frequency injection drug use and cirrhosis were associated with an increased risk of failure.
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Affiliation(s)
- Carmine Rossi
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, Glen Site, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jim Young
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, Glen Site, McGill University Health Centre, Montreal, Quebec, Canada.,Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Valérie Martel-Laferrière
- Department of Microbiology and Infectious Diseases, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Sharon Walmsley
- University Health Network, University of Toronto, Toronto, Canada.,CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - Curtis Cooper
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Alexander Wong
- Regina Qu'Appelle Health Region, Regina, Saskatchewan, Canada
| | - M John Gill
- Southern Alberta HIV Clinic, Calgary, Alberta, Canada
| | - Marina B Klein
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, Glen Site, McGill University Health Centre, Montreal, Quebec, Canada.,CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
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13
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Infection by HTLV-1 Is Associated With High Levels of Proinflammatory Cytokines in HIV-HCV-Coinfected Patients. J Acquir Immune Defic Syndr 2018; 77:230-234. [PMID: 29084047 DOI: 10.1097/qai.0000000000001576] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES HIV, hepatitis C virus (HCV), and human T-cell lymphotropic virus type 1 (HTLV-1) share the same routes of infection, making coinfection by these viruses a frequent finding in endemic areas. However, there is scarce information on the clinical/immunological consequences of triple infection. Coinfection by HTLV-1 is able to modulate cytokine's production in patients with HIV, but there are no data on the immune response of HIV-HCV-HTLV-1-infected patients. METHODS We compared the plasma levels of 25 different cytokines in patients with HIV-HCV, according to their serostatus to HTLV-1 infection. Eligible patients should be on stable highly active antiretroviral therapy and have undetectable HIV-1 plasma viral load for, at least, 12 months. Cytokines levels were also evaluated by CD4 cells count, rates of sustained virological response (SVR) to previous HCV treatment, frequency of spontaneous HCV clearance, and HCV/IFN-λ3 genotypes. RESULTS Twenty-five patients (15 coinfected by HIV and HCV, 10 coinfected by HIV, HCV, and HTLV-1) were evaluated. Among the triply infected group, 3 had undetectable HCV viremia (spontaneous clearance). All but one remaining patients were previously treated for HCV, with similar SVR rates (∼29%). Cytokines levels did not differ per HCV/IFN-λ3 genotypes, mean CD4 cells count, age, sex, or SVR. However, patients coinfected by HTLV-1 showed significantly higher levels of IL-1b, IL-2, TNF-α, IFN-γ, MIP-1α, RANTES, and interferon-induced protein 10 (IP-10) than HIV-HCV-coinfected ones. Patients presenting HCV spontaneous clearance had the highest levels of cytokines. CONCLUSIONS Coinfection by HTLV-1 increases the plasma levels of proinflammatory cytokines of patients with HIV-HCV and can influence the outcomes of coinfected patients.
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15
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Stellbrink HJ. [Treatment of HIV-infected patients: metabolism, bone, cardiovascular - what is part of routine care?]. MMW Fortschr Med 2018; 159:14-23. [PMID: 28597280 DOI: 10.1007/s15006-017-9047-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Hans-Jürgen Stellbrink
- Infektionsmedizinisches Centrum Hamburg (ICH), Grindelallee 35, D-20146, Hamburg, Deutschland.
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16
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Salazar-Vizcaya L, Wandeler G, Fehr J, Braun D, Cavassini M, Stoeckle M, Bernasconi E, Hoffmann M, Rougemont M, Béguelin C, Rauch A. Impact of Direct-Acting Antivirals on the Burden of HCV Infection Among Persons Who Inject Drugs and Men Who Have Sex With Men in the Swiss HIV Cohort Study. Open Forum Infect Dis 2018; 5:ofy154. [PMID: 30027103 PMCID: PMC6047421 DOI: 10.1093/ofid/ofy154] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 06/25/2018] [Indexed: 12/11/2022] Open
Abstract
In the Swiss HIV Cohort Study, the number of people who inject drugs with replicating hepatitis C virus (HCV) infection decreased substantially after the introduction of direct-acting antivirals (DAAs). Among men who have sex with men, the increase in DAA uptake and efficacy was counterbalanced by frequent incident HCV infections.
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Affiliation(s)
- Luisa Salazar-Vizcaya
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Jan Fehr
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Department of Public Health, Epidemiology, Biostatistic and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Dominique Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland.,Division of Infectious Diseases, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Matthias Cavassini
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland.,Division of Infectious Diseases, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Marcel Stoeckle
- Department of Infectious Diseases and Hospital Hygiene, University Hospital Basel, Basel, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland
| | - Matthias Hoffmann
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Mathieu Rougemont
- Division of Infectious Diseases, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | - Charles Béguelin
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andri Rauch
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
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da Rocha MC, Marinho RT, Rodrigues T. Mortality Associated with Hepatobiliary Disease in Portugal between 2006 and 2012. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2018; 25:123-131. [PMID: 29761148 PMCID: PMC5939859 DOI: 10.1159/000484868] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/24/2017] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Hepatobiliary disease is becoming a major public health problem, and recent data suggest that the burden of liver disease is higher than previously thought. Our aim was to quantify the mortality from hepatobiliary disease in Portugal and to compare this with the mortality related o other causes over a 7-year period (2006-2012). MATERIALS AND METHODS A statistical analysis of mortality data according to cause, sex, age, and region from the National Statistics Institute in Portugal was carried out. The data related to 14 causes of death, the most frequent of which were alcoholic liver disease (ALD) (International Classification of Diseases code K70), unspecified cirrhosis of liver (UCL) (K74.6), hepatocellular carcinoma (HCC) (C22.0), unspecified malignant neoplasm of liver (C22.9), and cholangiocarcinoma (C22.1). RESULTS Between 2006 and 2012, 18,279 deaths (24.5/100,000) from hepatobiliary disease were registered in Portugal, constituting the 8th leading cause of death. The main causes of death from hepatobiliary disease were ALD (7.1/100,000), UCL (5.5/100,000), and HCC (4.3/100,000), with a male predominance (72%). ALD was the main aetiology in younger age groups (40-65 years), while primary neoplasms of the liver and the intrahepatic bile ducts were predominant in the elderly (>80 years). The mortality related to HCC increased by 66% between 2006 and 2012. CONCLUSION These data outline the burden of hepatobiliary disease in Portugal (8th cause of death) and highlight a potential impact on economic productivity.
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Affiliation(s)
- Manuel Coelho da Rocha
- Department of Gastroenterology and Hepatology, Hospital de Santa Maria - Centro Hospitalar Lisboa Norte, Lisbon, Portugal
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18
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Béguelin C, Suter A, Bernasconi E, Fehr J, Kovari H, Bucher HC, Stoeckle M, Cavassini M, Rougemont M, Schmid P, Wandeler G, Rauch A. Trends in HCV treatment uptake, efficacy and impact on liver fibrosis in the Swiss HIV Cohort Study. Liver Int 2018; 38:424-431. [PMID: 28741901 DOI: 10.1111/liv.13528] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 07/20/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Hepatitis C virus (HCV) therapies with interferon-free second-generation direct-acting antivirals (DAAs) are highly effective and well tolerated. They have the potential to increase treatment eligibility and efficacy in HIV-infected patients. We assessed the impact of DAAs on treatment uptake and efficacy, as well as its impact on the burden of liver disease in the Swiss HIV Cohort Study (SHCS). METHODS We describe clinical and virological characteristics of patients treated with second-generation DAAs. We compared treatment incidence, sustained virological response (SVR)12 and liver fibrosis stages between three time periods: period 1, 01/2009-08/2011 (prior to the availability of DAAs); period 2, 09/2011-03/2014 (first generation DAAs); period 3, 04/2014-12/2015 (second generation DAAs). RESULTS At the beginning of the third period, 876 SHCS participants had a chronic HCV infection of whom 180 (20%) started treatment with a second-generation DAA. Three-quarters of them had advanced liver fibrosis (Metavir ≥ F3) of whom 80% were cirrhotics. SVR12 was achieved in 173/180 (96%) patients, three patients died and four experienced a virological failure. Over the three time periods, treatment uptake (4.5/100 py, 5.7/100 py, 22.4/100 py) and efficacy (54%, 70%, 96% SVR12) continuously increased. The proportion of cirrhotic patients with replicating HCV infection in the SHCS declined from 25% at the beginning to 12% at the end of the last period. CONCLUSIONS After the introduction of second-generation DAAs, we observed an increase in treatment uptake and efficacy which resulted in a significant reduction in the number of cirrhotic patients with a replicating HCV infection in the SHCS.
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Affiliation(s)
- Charles Béguelin
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Annatina Suter
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland
| | - Jan Fehr
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Helen Kovari
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology & Biostatistics, University Hospital Basel and University of Basel, Basel, Switzerland.,Department of Infectious Diseases & Hospital Hygiene, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Marcel Stoeckle
- Department of Infectious Diseases & Hospital Hygiene, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Mathias Cavassini
- Division of Infectious Diseases, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Mathieu Rougemont
- Division of Infectious Diseases, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | - Patrick Schmid
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Andri Rauch
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland
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Marcon PDS, Tovo CV, Kliemann DA, Fisch P, Mattos AAD. Incidence of hepatocellular carcinoma in patients with chronic liver disease due to hepatitis B or C and coinfected with the human immunodeficiency virus: A retrospective cohort study. World J Gastroenterol 2018; 24:613-622. [PMID: 29434450 PMCID: PMC5799862 DOI: 10.3748/wjg.v24.i5.613] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 12/26/2017] [Accepted: 01/15/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the incidence of hepatocellular carcinoma (HCC) in chronic liver disease due to hepatitis B virus (HBV) or hepatitis C virus (HCV) coinfected with human immunodeficiency virus (HIV).
METHODS A retrospective cohort study was performed, including patients with chronic liver disease due to HBV or HCV, with and without HIV coinfection. Patients were selected in the largest tertiary public hospital complex in southern Brazil between January 2007 and June 2014. We assessed demographic and clinical data, including lifestyle habits such as illicit drug use or alcohol abuse, in addition to frequency and reasons for hospital admissions via medical records review.
RESULTS Of 804 patients were included (399 with HIV coinfection and 405 monoinfected with HBV or HCV). Coinfected patients were younger (36.7 ± 10 vs 46.3 ± 12.5, P < 0.001). Liver cirrhosis was observed in 31.3% of HIV-negative patients and in 16.5% of coinfected (P < 0.001). HCC was diagnosed in 36 patients (10 HIV coinfected and 26 monoinfected). The incidence density of HCC in coinfected and monoinfected patients was 0.25 and 0.72 cases per 100 patient-years (95%CI: 0.12-0.46 vs 0.47-1.05) (long-rank P = 0.002), respectively. The ratio for the HCC incidence rate was 2.98 for HIV-negative. However, when adjusting for age or when only cirrhotic are analyzed, the absence of HIV lost statistical significance for the development of HCC.
CONCLUSION In this study, the presence of HIV coinfection in chronic liver disease due to HBV or HCV showed no relation to the increase of HCC incidence.
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Affiliation(s)
- Patrícia dos Santos Marcon
- Hepatology Post-Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90020-090, RS, Brazil
| | - Cristiane Valle Tovo
- Hepatology Post-Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90020-090, RS, Brazil
| | - Dimas Alexandre Kliemann
- Infectology Department at Hospital Nossa Senhora da Conceição, Porto Alegre 91350-200, RS, Brazil
| | - Patrícia Fisch
- Epidemiology Department at Hospital Nossa Senhora da Conceição, Porto Alegre 91350-200, RS, Brazil
| | - Angelo Alves de Mattos
- Hepatology Post-Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90020-090, RS, Brazil
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20
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Ruiz-Mateos E, Tarancon-Diez L, Alvarez-Rios AI, Dominguez-Molina B, Genebat M, Pulido I, Abad MA, Muñoz-Fernandez MA, Leal M. Association of heterozygous CCR5Δ32 deletion with survival in HIV-infection: A cohort study. Antiviral Res 2017; 150:15-19. [PMID: 29221798 DOI: 10.1016/j.antiviral.2017.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/02/2017] [Accepted: 12/04/2017] [Indexed: 11/15/2022]
Abstract
The role of a 32 base pair deletion in the CCR5 gene (CCR5Δ32) in HIV-disease progression and response to combined antiretroviral therapy (cART) is well established. However, the impact of CCR5Δ32 in the long-term survival pre-cART and after cART introduction in a large cohort of HIV-infected patients is unknown. We analyzed the association of CCR5Δ32 deletion in the long-term survival of HIV-infected patients recruited between June 1981 and October 2016 (n = 1006). Clinical and epidemiological variables were recorded and CCR5Δ32 deletion was assessed by PCR and electrophoretic analysis. The association of CCR5Δ32 deletion with the time to death was analyzed by Log-Rank tests and Cox Regression models. The CCR5 WT/Δ32 prevalence was 13.4% (n = 135). We did not find any homozygous subject for CCR5Δ32 deletion. AIDS (n = 85, 41.5%) and non-AIDS (n = 87, 42.4%) events were the main causes of 205 deaths. CCR5Δ32 deletion was independently associated with survival (p = 0.022; hazard ratio (HR): 0.572, confidence interval (CI) [0.354-0.923]), after adjusting by HIV diagnosis before 1997, age at diagnosis, being on cART, risk of transmission, nadir CD4+ T-cell counts and CDC stage C. This result was reproduced when the analysis was restricted to patients on cART (p = 0.045; HR: 0.530 [0.286-0.985]). These results confirm the protective role of CCR5Δ32, and extend it to the long-term survival in a large cohort of HIV-infected patients. Beyond its antiviral effect, CCR5Δ32 enhanced the long-term survival of patients on cART.
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Affiliation(s)
- Ezequiel Ruiz-Mateos
- Laboratory of Immunovirology, Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain.
| | - Laura Tarancon-Diez
- Laboratory of Immunovirology, Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | - Ana I Alvarez-Rios
- Department of Clinical Biochemistry, Virgen del Rocio University Hospital (IBiS/CSIC/SAS/University of Seville), Seville, Spain
| | - Beatriz Dominguez-Molina
- Laboratory of Immunovirology, Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | - Miguel Genebat
- Laboratory of Immunovirology, Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | - Ildefonso Pulido
- Laboratory of Immunovirology, Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | - Maria Antonia Abad
- Laboratory of Immunovirology, Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | - Maria Angeles Muñoz-Fernandez
- Molecular Immunobiology Laboratory, General Universitary Hospital Gregorio Marañon, Health Research Institute Gregorio Marañon, Spanish HIV HGM BioBank, Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Manuel Leal
- Laboratory of Immunovirology, Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain.
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Abstract
PURPOSE OF REVIEW Availability of direct acting antivirals (DAAs) that demonstrate remarkable clinical efficacy and safety has revolutionized the ability to treat chronic infection with hepatitis C virus (HCV). An equal measure of clinical success has now been achieved in persons coinfected with HCV and the HIV, a historically harder to cure cohort with interferon-based therapy. Global goals include identifying all HIV-HCV-infected persons, gaining access to DAA therapy, preventing de novo and reinfection, and managing the sequelae of chronic infection. This review will discuss advances in the field of HIV-HCV coinfection reported during the last 18 months, and will suggest areas for future investigation. RECENT FINDINGS An expanding body of literature has enhanced our understanding of the clinical and epidemiologic issues surrounding HIV-HCV coinfection. DAA therapy for HCV is highly efficacious in HIV-HCV-coinfected persons if drug-drug interactions are appropriately considered. SUMMARY Eradicating HCV infection in persons with HIV coinfection can be achieved safely and effectively with available DAAs. Economic and social approaches to enable access and delivery of curative HCV therapy to HIV-infected persons require continued research and resource allocation.
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Maponga TG, Matteau Matsha R, Morin S, Scheibe A, Swan T, Andrieux-Meyer I, Spearman CW, Klein MB, Rockstroh JK. Highlights from the 3rd international HIV/viral hepatitis Co-infection meeting - HIV/viral hepatitis: improving diagnosis, antiviral therapy and access. HEPATOLOGY, MEDICINE AND POLICY 2017; 2:8. [PMID: 30288321 PMCID: PMC6171003 DOI: 10.1186/s41124-017-0025-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 03/29/2017] [Indexed: 02/08/2023]
Abstract
The International AIDS Society convened the 3rd International HIV/Viral Hepatitis Co-Infection Meeting on 17 July 2016 as part of the pre-conference program preceding the 21st International AIDS Conference held in Durban, South Africa. The meeting brought together a diversity of scientific, technical and community interests to discuss opportunities and challenges for increased prevention, diagnosis and treatment of viral hepatitis in people living with HIV, particularly in low- and middle-income settings. The objectives of the meeting were:i.To review the latest therapeutic developments in viral hepatitis;ii.To identify challenges such as high cost of medications for hepatitis C virus (HCV) and risk of developing viral resistance, and successes, such as the provision of HCV treatment in community-based settings, movements to reduce drug costs and increasing access, in relation to scaling up diagnosis, screening, antiviral treatment and prevention of viral hepatitis;iii.To advance the agenda for elimination of viral hepatitis as a public health problem. Discussions centred around the six key interventions outlined by the World Health Organization Global Health Sector Strategy on Viral Hepatitis 2016-2021: hepatitis B virus (HBV) vaccination (including birth dose); safe injection practices plus safe blood; harm reduction among people who inject drugs; safer sex practices; hepatitis B treatment; and hepatitis C cure. This article summarizes the main issues and findings discussed during the pre-conference meeting. One of the recommendations from the meeting delegates is universal implementation of birth dose vaccination for HBV without further delay to prevent mother-to-child transmission of infection. There is also the need to implement screening and treatment of hepatitis among pregnant women. A call was made for concerted efforts to be put together by all stakeholders towards addressing some of the structural barriers, including criminalization of drug use, discrimination and stigma that people living with viral hepatitis face. Finally, the need for greater advocacy was highlighted to enable access to therapy of viral hepatitis at lower cost than currently prevails. Implementation of these resolutions will help in achieving the target of eliminating viral hepatitis as a public health threat.
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Affiliation(s)
- Tongai G Maponga
- 1Division of Medical Virology, University of Stellenbosch, Faculty of Medicine and Health Sciences, Stellenbosch, South Africa
| | | | - Sébastien Morin
- 3HIV Programmes and Advocacy, International AIDS Society, Geneva, Switzerland
| | - Andrew Scheibe
- TB/HIV Care Association and Desmond Tutu HIV Centre, Cape Town, South Africa
| | | | | | - C Wendy Spearman
- 7Division of Hepatology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Marina B Klein
- 8Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
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