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Dinh DA, Tan Y, Saeed S. Disengagement from Care Among People Co-Infected with HIV and HCV: A Scoping Review. AIDS Behav 2024:10.1007/s10461-024-04436-6. [PMID: 38992228 DOI: 10.1007/s10461-024-04436-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2024] [Indexed: 07/13/2024]
Abstract
Disengagement from care among people with HIV (PWH) and hepatitis C (HCV) increases the risks of adverse health outcomes and poses significant barriers to achieving global HIV and HCV elimination goals. In accordance with the Joanna Briggs Institute framework, a scoping review was conducted to synthesize and highlight existing gaps in the literature on (dis)engagement in care among PWH and HCV. We searched for original studies on (dis)engagement in care among PWH and HCV in high-income countries using eight electronic databases from inception to May 2023. Our search yielded 4462 non-duplicated records, which were scoped to 27 studies. Definitions of (dis)engagement in care were diverse, with considerable heterogeneity in how retention was operationalized and temporally measured. Studies identified predictors of (dis)engagement to be related to drug and substance use (n = 5 articles), clinical factors (n = 5), social and welfare (n = 4), and demographic characteristics (n = 2). When engagement in care was treated as an exposure, it was associated with HCV treatment initiation (n = 3), achieving sustained virological response (n = 2), and maintaining HIV viral suppression (n = 1). Interventions to improve care engagement among PWH and HCV were limited to five studies using cash incentives (n = 1) and individual case management (n = 4). (Dis)engagement in care is a dynamic process influenced by shifting priorities that may 'tip the balance' towards or away from regularly interacting with healthcare professionals. However, inconsistent definitions render cross-study comparisons and meta-analyses virtually impossible. Further research needs to establish a standardized definition to identify patients at high risk of disengagement and develop interventions that leverage the nested HIV/HCV care cascades to retain and recover patients lost from care.
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Affiliation(s)
- Duy A Dinh
- Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Yvonne Tan
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Sahar Saeed
- Department of Public Health Sciences, Queen's University, 203 Carruthers Hall 62 Fifth Field Company Lane, Kingston, ON, K7L 3N6, Canada.
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Basoulis D, Mastrogianni E, Eliadi I, Papadopoulou M, Psichogiou M. HCV-HIV co-infection in people who inject drugs: Barriers to treatment and cure of HCV infection in the era of DAAs, a prospective study in Athens, Greece. HIV Med 2024. [PMID: 39031579 DOI: 10.1111/hiv.13681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 05/29/2024] [Indexed: 07/22/2024]
Abstract
OBJECTIVES HIV/hepatitis C virus (HCV) co-infection among people who inject drugs (PWID) remains a global health problem. The goal of our study was to evaluate, in a real-world setting, success rates of sustained virological response (SVR) using direct-acting antivirals (DAAs) to treat a population of PWID living with HCV/HIV. METHODS This was a prospective single-center observational study. We collected demographic, socioeconomic, and clinical data pertaining to HIV and HCV infection in PWID with several barriers to care. We identified risk factors for SVR failure. RESULTS Among 130 individuals retained to HIV care, we planned HCV treatment in 119/130 (91.5%); 106/119 (89.1%) started treatment with DAAs and 100/106 (94.3%) completed treatment. People not starting treatment were more often in active opioid drug use (odds ratio [OR] 0.25; 95% confidence interval [CI] 0.07-0.97, p = 0.045) and benzodiazepine abuse (OR 0.25; 95% CI 0.07-0.95, p = 0.042). Only 86/100 (86%) were tested for SVR at 12 weeks (SVR12) and 72/86 (83.7%) achieved SVR. PWID in opioid substitution programmes tended to return for SVR12 testing more often (54.7% vs. 30%, p = 0.081). Individuals in active opioid drug use (OR 0.226; 95% CI 0.064-0.793, p = 0.02) or with poor adherence (OR 0.187; 95% CI 0.043-0.814, p = 0.025) were less likely to achieve SVR. At the end of our study period, 113/119 (95%) treatment-eligible patients remained alive. HCV infection was cured in 68/113 (61.1%) people. CONCLUSIONS Our findings underscore the importance of prioritizing combatting substance use to achieve HCV elimination goals. A systematic approach with effort to overcome barriers to receiving and completing treatment and encourage to enrol in opioid substitution programmes if not possible to completely abstain from use, can help increase chances of HCV cure.
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Affiliation(s)
- Dimitris Basoulis
- 1st Department of Internal Medicine, Laiko General Hospital, Athens, Greece
| | | | - Irene Eliadi
- 1st Department of Internal Medicine, Laiko General Hospital, Athens, Greece
| | | | - Mina Psichogiou
- 1st Department of Internal Medicine, Laiko General Hospital, Athens, Greece
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Thomadakis C, Basoulis D, Tsachouridou O, Protopapas K, Paparizos V, Astriti M, Chini M, Chrysos G, Marangos M, Panagopoulos P, Kofteridis D, Sambatakou H, Mastrogianni E, Panatzis N, Pechlivanidou E, Psichοgiou M, Touloumi G. HCV Cascade of Care in HIV/HCV Co-Infected Individuals: Missed Opportunities for Micro-Elimination. Viruses 2024; 16:885. [PMID: 38932178 PMCID: PMC11209384 DOI: 10.3390/v16060885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/17/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
People living with HIV-HCV co-infection comprise a target group for HCV-micro-elimination. We conducted an HCV cascade of care (CoC) for HIV-HCV co-infected individuals living in Greece and investigated factors associated with different HCV-CoC stages. We analyzed data from 1213 participants from the Athens Multicenter AIDS Cohort Study. A seven-stage CoC, overall and by subgroup (people who inject drugs (PWID), men having sex with men (MSM), men having sex with women (MSW), and migrants], was constructed, spanning from HCV diagnosis to sustained virologic response (SVR). Logistic/Cox regression models were employed to identify factors associated with passing through each CoC step. Among 1213 anti-HCV-positive individuals, 9.2% died before direct-acting antiviral (DAA) availability. PWID exhibited higher mortality rates than MSM. Of 1101 survivors, 72.2% remained in care and underwent HCV-RNA testing. Migrants and PWID showed the lowest retention rates. HCV-RNA was available for 79.2% of those in care, with 77.8% diagnosed with chronic HCV. Subsequently, 71% initiated DAAs, with individuals with very low CD4 counts (<100 cells/μL) exhibiting lower odds of DAA initiation. SVR testing was available for 203 individuals, with 85.7% achieving SVR. The SVR rates did not differ across risk groups. In 2023, significant gaps and between-group differences persisted in HCV-CoC among HIV-HCV co-infected individuals in Greece.
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Affiliation(s)
- Christos Thomadakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (C.T.); (N.P.); (E.P.)
| | - Dimitrios Basoulis
- 1st Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (D.B.); (E.M.); (M.P.)
| | - Olga Tsachouridou
- Infectious Diseases Unit, 1st Internal Medicine Department, AHEPA University Hospital, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece;
| | - Konstantinos Protopapas
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, 124 62 Athens, Greece;
| | - Vasilios Paparizos
- AIDS Unit, Clinic of Venereologic & Dermatologic Diseases, Medical School, Syngros Hospital, National and Kapodistrian University of Athens, 161 21 Athens, Greece;
| | - Myrto Astriti
- 1st Department of Internal Medicine and Infectious Diseases Unit, General Hospital of Athens G. Gennimatas, 115 27 Athens, Greece;
| | - Maria Chini
- 3rd Department of Internal Medicine Infectious Diseases Unit, Red Cross General Hospital, 115 26 Athens, Greece;
| | - Georgios Chrysos
- Infectious Diseases Unit, Tzaneion General Hospital of Piraeus, 185 36 Athens, Greece;
| | - Markos Marangos
- Department of Internal Medicine & Infectious Diseases, Patras University General Hospital, 265 04 Patras, Greece;
| | - Periklis Panagopoulos
- Infectious Diseases Unit, 2nd University Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, 681 00 Alexandroupolis, Greece;
| | - Diamantis Kofteridis
- Department of Internal Medicine, University Hospital of Heraklion, 715 00 Heraklion, Greece;
| | - Helen Sambatakou
- HIV Unit, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Hippokration University General Hospital, 115 27 Athens, Greece;
| | - Elpida Mastrogianni
- 1st Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (D.B.); (E.M.); (M.P.)
| | - Nikos Panatzis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (C.T.); (N.P.); (E.P.)
| | - Evmorfia Pechlivanidou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (C.T.); (N.P.); (E.P.)
| | - Mina Psichοgiou
- 1st Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (D.B.); (E.M.); (M.P.)
| | - Giota Touloumi
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (C.T.); (N.P.); (E.P.)
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Wegener M, Brooks R, Speers S, Nichols L, Villanueva M. Implementing a Surveillance-Based Approach to Create a Statewide Viral Clearance Cascade for Hepatitis C Among People With HIV and HCV Coinfection in Connecticut. Public Health Rep 2024; 139:208-217. [PMID: 37232422 PMCID: PMC10851907 DOI: 10.1177/00333549231172173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES Highly effective direct-acting antiviral medications have made it feasible to achieve elimination of hepatis C virus (HCV), including for people with HIV and HCV coinfection. The Centers for Disease Control and Prevention offers guidance for a laboratory surveillance-based HCV viral clearance cascade, which allows public health departments to track the outcomes of people with HCV based on the following steps: ever infected, virally tested, initial infection, and cured or cleared. We examined the feasibility of this approach among people with HIV and HCV coinfection in Connecticut. METHODS We matched an HIV surveillance database, which included cases from the enhanced HIV/AIDS Reporting System as of December 31, 2019, and the HCV surveillance database, the Connecticut Electronic Disease Surveillance System, to define a cohort of coinfected people. We used HCV laboratory results obtained from January 1, 2016, through August 3, 2020, to determine HCV status. RESULTS Of 1361 people who were ever infected with HCV as of December 31, 2019, 1256 (92.3%) received HCV viral testing, 865 of 1256 people tested (68.9%) were HCV infected, and 336 of 865 infected people (38.8%) were cleared or cured. People who had undetectable HIV viral loads at most recent HIV test (<200 copies/mL) were more likely than those with detectable HIV viral loads to achieve HCV cure (P = .02). CONCLUSIONS A surveillance-based approach that includes data based on the Centers for Disease Control and Prevention HCV viral clearance cascade is feasible to implement, can help track population-level outcomes longitudinally, and can help identify gaps to inform HCV elimination strategies.
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Affiliation(s)
| | - Ralph Brooks
- School of Medicine, Yale University, New Haven, CT, USA
| | - Suzanne Speers
- Connecticut Department of Public Health, Hartford, CT, USA
| | - Lisa Nichols
- School of Medicine, Yale University, New Haven, CT, USA
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Baumann L, Braun DL, Cavassini M, Stoeckle M, Bernasconi E, Schmid P, Calmy A, Haerry D, Béguelin C, Fux CA, Wandeler G, Surial B, Rauch A. Long-term trends in hepatitis C prevalence, treatment uptake and liver-related events in the Swiss HIV Cohort Study. Liver Int 2024; 44:169-179. [PMID: 37850685 DOI: 10.1111/liv.15754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND AND AIMS Treatment for chronic hepatitis C virus (HCV) infections changed dramatically in the last decade. We assessed changes in the prevalence of replicating HCV infection, treatment uptake and liver-related morbidity and mortality in persons with HIV (PWH) and hepatitis C in the Swiss HIV cohort study. METHODS We included all cohort participants between 2002 and 2021. We assessed yearly prevalence of replicating HCV infection, overall and liver-related mortality, as well as the yearly incidence of liver-related events in persons with at least one documented positive HCV-RNA. RESULTS Of 14 652 participants under follow-up, 2294 had at least one positive HCV-RNA measurement. Of those, 1316 (57%) ever received an HCV treatment. Treatment uptake increased from 8.1% in 2002 to a maximum of 32.6% in 2016. Overall, prevalence of replicating HCV infection declined from 16.5% in 2004 to 1.3% in 2021. HCV prevalence declined from 63.2% to 7.1% in persons who inject drugs, and from 4.1% to 0.6% in men who have sex with men. Among the 2294 persons with replicating HCV infection, overall mortality declined from a maximum of 3.3 per 100 patient-years (PY) to 1.1 per 100 PY, and incidence of liver-related events decreased from 1.4/100 PY to 0.2/100 PY. CONCLUSIONS The introduction of DAA therapy was associated with a more than 10-fold reduction in prevalence of replicating HCV infection in PWH, approaching the estimates in the general population. Overall mortality and liver-related events declined substantially in persons living with HIV and hepatitis C.
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Affiliation(s)
- Lukas Baumann
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dominique L Braun
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Matthias Cavassini
- Division of Infectious Diseases, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Marcel Stoeckle
- Division of Infectious Diseases and Hospital Epidemiology, University of Basel, Basel, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Ente Ospedaliero Cantonale, Lugano, University of Geneva and University of Southern Switzerland, Lugano, Switzerland
| | - Patrick Schmid
- Division of Infectious Diseases, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Alexandra Calmy
- HIV/AIDS Unit, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | | | - Charles Béguelin
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Division of Infectious Diseases, Regional Hospital Biel, Biel, Switzerland
| | - Christoph A Fux
- Division of Infectious Diseases and Infection Prevention, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Gilles Wandeler
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bernard Surial
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andri Rauch
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Fursa O, Reekie J, Kuzin I, Hetman L, Kryshchuk A, Starychenko O, Hrytsaiuk N, Khodus I, Nyzhnyk A, Rakhuba V, Kovalevska M, Maistat T, Pryhoda I, Ahieieva M, Varvarovska O, Valdenmaiier O, Lundgren J, Peters L. Cross-sectional HIV and HCV cascades of care across the regions of Ukraine between 2019 and 2020: findings from the CARE cohort. J Int AIDS Soc 2023; 26:e26166. [PMID: 37705358 PMCID: PMC10500257 DOI: 10.1002/jia2.26166] [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: 12/12/2022] [Accepted: 08/23/2023] [Indexed: 09/15/2023] Open
Abstract
INTRODUCTION Eastern Europe is facing major HIV and hepatitis C (HCV) epidemics, with many people living with HIV (PLHIV) and HIV/HCV coinfection living in Ukraine. Despite the previous progress towards care quality improvement, the ongoing war in Ukraine is disrupting HIV and HCV care. METHODS We described an HIV cascade of care (CoC) in PLHIV from two clinical sites and an HCV CoC for anti-HCV-positive PLHIV from six sites in Ukraine, enrolled in the CARE cohort between 1 January 2019 and 1 June 2020. The cross-sectional HIV CoC and HCV CoC are described at study enrolment. RESULTS Of 1028 PLHIV, 1014 (98.6%, 95% confidence interval [CI] 97.7-99.3) were on antiretroviral therapy (ART), and 876 (86.4% of those on ART, 95% CI 84.1-88.4) were virologically suppressed. Of 894 participants on ART >6 months, 90.8% (95% CI 88.7-92.6) were virologically suppressed (HIV-RNA <200 copies/ml). Of 2040 anti-HCV-positive PLHIV, 417 (20.4%, 95% CI 18.7-22.3) were ever tested for HCV-RNA prior to enrolment, ranging from 4.9% to 54.4% across sites, and 13.5% were currently HCV-RNA positive. One hundred and eighteen persons (7.3% of ever chronically infected) had received HCV treatment, and 25 persons (1.6% of ever chronically infected) were cured, with variations across sites (0%-7.5%). The site diagnosing 54.4% of people with chronic HCV was the only one providing free RNA testing for all anti-HCV-positive persons, while the intra-country differences in treatment coverage were driven by the number of available direct-acting antiviral (DAA) courses. CONCLUSIONS Over 98% of PLHIV in care in both CARE sites in Ukraine were receiving ART, and the target of 90% virally suppressed was achieved in persons >6 months on ART. Only one of six HIV/HCV study sites tested over 50% anti-HCV-positive PLHIV for HCV-RNA and treated over 25% of eligible persons. While free HCV-RNA testing and DAA treatment are paramount to achieving HCV elimination targets, they remained a challenge in Ukraine in 2019-2020. The extent of the HIV and HCV care disruption during the war will be further assessed in the CARE cohort and compared with the pre-war findings.
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Affiliation(s)
- Olga Fursa
- Centre of Excellence for Health, Immunity and InfectionsRigshospitaletCopenhagenDenmark
| | - Joanne Reekie
- Centre of Excellence for Health, Immunity and InfectionsRigshospitaletCopenhagenDenmark
| | - Ihor Kuzin
- Public Health Center of the Ministry of Health of UkraineKyivUkraine
| | - Larysa Hetman
- Public Health Center of the Ministry of Health of UkraineKyivUkraine
| | - Alina Kryshchuk
- Public Health Center of the Ministry of Health of UkraineKyivUkraine
| | - Olena Starychenko
- Kyiv City AIDS Prevention and Control Center (Kyiv City Clinical Hospital №5)KyivUkraine
| | - Nana Hrytsaiuk
- Kyiv City AIDS Prevention and Control Center (Kyiv City Clinical Hospital №5)KyivUkraine
| | - Inna Khodus
- Kyiv Regional Center for Public HealthKyivUkraine
| | - Alla Nyzhnyk
- Kyiv Regional Center for Public HealthKyivUkraine
| | | | | | - Tetiana Maistat
- Regional Clinical Center for AIDS Prevention and Control of Kharkiv Regional CouncilKharkivUkraine
| | - Iryna Pryhoda
- Mariupol City Hospital №4 named after I.K. MatsukaMariupolUkraine
| | | | - Olena Varvarovska
- Regional Medical Specialized Center of Zhytomyr Regional CouncilZhytomyrUkraine
| | - Olena Valdenmaiier
- Centre of Excellence for Health, Immunity and InfectionsRigshospitaletCopenhagenDenmark
| | - Jens Lundgren
- Centre of Excellence for Health, Immunity and InfectionsRigshospitaletCopenhagenDenmark
| | - Lars Peters
- Centre of Excellence for Health, Immunity and InfectionsRigshospitaletCopenhagenDenmark
| | - the CARE study group
- Centre of Excellence for Health, Immunity and InfectionsRigshospitaletCopenhagenDenmark
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Requena MB, Grabar S, Lanoy E, Pialoux G, Billaud E, Duvivier C, Merle P, Piroth L, Tattevin P, Salmon D, Weiss L, Costagliola D, Lacombe K. Mortality in hepatitis C virus-cured vs. hepatitis C virus-uninfected people with HIV. AIDS 2023; 37:1297-1306. [PMID: 37070541 DOI: 10.1097/qad.0000000000003569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVE It is unknown whether hepatitis C virus (HCV)-cured people with HIV (PWH) without cirrhosis reached the same mortality risk as HCV-uninfected PWH. We aimed to compare mortality in PWH cured of HCV by direct-acting antivirals (DAAs) to mortality in individuals with HIV monoinfection. DESIGN Nationwide hospital cohort. METHODS HIV-controlled participants without cirrhosis and HCV-cured by DAAs started between September 2013 and September 2020, were matched on age (±5 years), sex, HIV transmission group, AIDS status, and body mass index (BMI) (±1 kg/m 2 ) to up to 10 participants with a virally suppressed HIV monoinfection followed at the time of HCV cure ±6 months. Poisson regression models with robust variance estimates were used to compare mortality in both groups after adjusting for confounders. RESULTS The analysis included 3961 HCV-cured PWH (G1) and 33 872 HCV-uninfected PWH (G2). Median follow-up was 3.7 years in G1 [interquartile range (IQR): 2.0-4.6], and 3.3 years (IQR: 1.7-4.4) in G2. Median age was 52.0 years (IQR: 47.0-56.0), and 29 116 (77.0%) were men. There were 150 deaths in G1 [adjusted incidence rate (aIR): 12.2/1000 person-years] and 509 (aIR: 6.3/1000 person-years) in G2, with an incidence rate ratio (IRR): 1.9 [95% confidence interval (CI), 1.4-2.7]. The risk remained elevated 12 months post HCV cure (IRR: 2.4 [95% CI, 1.6-3.5]). Non-AIDS/non-liver-related malignancy was the most common cause of death in G1 (28 deaths). CONCLUSIONS Despite HCV cure and HIV viral suppression, after controlling on factors related to mortality, DAA-cured PWH without cirrhosis remain at higher risk of all-cause mortality than people with HIV monoinfection. A better understanding of the determinants of mortality is needed in this population.
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Affiliation(s)
- Maria-Bernarda Requena
- Sorbonne Université, INSERM, Pierre Louis Institute of Epidemiology and Public Health, IPLESP
| | - Sophie Grabar
- Sorbonne Université, INSERM, Pierre Louis Institute of Epidemiology and Public Health, IPLESP
- AP-HP, Public Health Unit, Saint-Antoine Hospital
| | - Emilie Lanoy
- Sorbonne Université, INSERM, Pierre Louis Institute of Epidemiology and Public Health, IPLESP
| | - Gilles Pialoux
- Sorbonne Université, AP-HP, Department of Infectious Diseases, Tenon Hospital, Paris
| | - Eric Billaud
- Université de Nantes, INSERM UIC 1413, Department of Infectious Diseases, CHU Hôtel Dieu, Nantes
| | - Claudine Duvivier
- Université de Paris Cité, AP-HP, Necker Hospital, Department of Infectious Diseases, INSERM, U1016, Institut Cochin, CNRS, UMR8104, Necker-Pasteur Infectiology Center, IHU Imagine, Institut Pasteur, Necker-Pasteur Infectiology Center, Paris
| | - Philippe Merle
- Université Lyon 1, Department of Hepatology, de la Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon
| | - Lionel Piroth
- University of Bourgogne-Franche-Comté, INSERM, Clinical Epidemiology unit CIC1432, Department of Infectious Diseases, Dijon University Hospital, Dijon
| | - Pierre Tattevin
- Department of Infectious Diseases and Intensive Care Medicine, CHU de Rennes, Rennes
| | - Dominique Salmon
- Université Paris Cité, Department of Immunology and Infectious Diseases, AP-HP Hôtel-Dieu
| | - Laurence Weiss
- Université Paris Cité, Department of Immunology and Infectious Diseases, AP-HP Hôtel-Dieu
| | - Dominique Costagliola
- Sorbonne Université, INSERM, Pierre Louis Institute of Epidemiology and Public Health, IPLESP
| | - Karine Lacombe
- Sorbonne Université, INSERM, Pierre Louis Institute of Epidemiology and Public Health, IPLESP
- AP-HP, Department of Infectious Diseases, Saint-Antoine Hospital, Paris, France
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8
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Ross J, Rupasinghe D, Avihingsanon A, Lee MP, Pujari S, Sharp G, Kumarasamy N, Khusuwan S, Khol V, Agus Somia IK, Pham TN, Kiertiburanakul S, Choi JY, Duy Do C, Sohn AH, Jiamsakul A. Trends in hepatitis C virus coinfection and its cascade of care among adults living with HIV in Asia between 2010 and 2020. PLoS One 2023; 18:e0287909. [PMID: 37379314 PMCID: PMC10306215 DOI: 10.1371/journal.pone.0287909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/14/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Chronic hepatitis C virus (HCV) infection contributes to substantial morbidity and mortality among adults living with HIV. Cascades of HCV care support monitoring of program performance, but data from Asia are limited. We assessed regional HCV coinfection and cascade outcomes among adults living with HIV in care from 2010-2020. METHODS Patients ≥18 years old with confirmed HIV infection on antiretroviral therapy (ART) at 11 clinical sites in Cambodia, China, India, Indonesia, South Korea, Thailand and Vietnam were included. HCV- and HIV-related treatment and laboratory data were collected from those with a positive HCV antibody (anti-HCV) test after January 2010. An HCV cascade was evaluated, including proportions positive for anti-HCV, tested for HCV RNA or HCV core antigen (HCVcAg), initiated on HCV treatment, and achieved sustained virologic response (SVR). Factors associated with screening uptake, treatment initiation, and treatment response were analyzed using Fine and Gray's competing risk regression model. RESULTS Of 24,421 patients, 9169 (38%) had an anti-HCV test, and 971 (11%) had a positive result. The proportion with positive anti-HCV was 12.1% in 2010-2014, 3.9% in 2015-2017, and 3.8% in 2018-2020. From 2010 to 2014, 34% with positive anti-HCV had subsequent HCV RNA or HCVcAg testing, 66% initiated HCV treatment, and 83% achieved SVR. From 2015 to 2017, 69% with positive anti-HCV had subsequent HCV RNA or HCVcAg testing, 59% initiated HCV treatment, and 88% achieved SVR. From 2018 to 2020, 80% had subsequent HCV RNA or HCVcAg testing, 61% initiated HCV treatment, and 96% achieved SVR. Having chronic HCV in later calendar years and in high-income countries were associated with increased screening, treatment initiation or achieving SVR. Older age, injecting drug use HIV exposure, lower CD4 and higher HIV RNA were associated with reduced HCV screening or treatment initiation. CONCLUSIONS Our analysis identified persistent gaps in the HCV cascade of care, highlighting the need for focused efforts to strengthen chronic HCV screening, treatment initiation, and monitoring among adult PLHIV in the Asia region.
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Affiliation(s)
- Jeremy Ross
- TREAT Asia, amfAR, The Foundation for AIDS Research, Bangkok, Thailand
| | | | - Anchalee Avihingsanon
- HIV-NAT/ Thai Red Cross AIDS Research Centre and Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Man Po Lee
- Queen Elizabeth Hospital, Hong Kong SAR, China
| | | | - Gerald Sharp
- National Institute of Allergy and Infectious Diseases (NIAID), Bethesda, Maryland, United States of America
| | | | | | - Vohith Khol
- National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia
| | - I. Ketut Agus Somia
- Faculty of Medicine, Prof. Dr. I.G.N.G. Ngoerah Hospital, Udayana University, Bali, Indonesia
| | | | | | - Jun Yong Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Annette H. Sohn
- TREAT Asia, amfAR, The Foundation for AIDS Research, Bangkok, Thailand
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Parczewski M, Jabłonowska E, Wójcik-Cichy K, Zhyvytsia D, Witak-Jędra M, Leszczyszyn-Pynka M, Aksak-Wąs B, Siwak E, Cielniak I, Olczak A, Szymczak A, Szetela B, Bociąga-Jasik M, Kalinowska-Nowak A, Mularska E, Witor A, Jakubowski P, Hlebowicz M, Rozpłochowski B, Łojewski W, Scheibe K, Serwin K. Clinical Perspective on Human Immunodeficiency Virus Care of Ukrainian War Refugees in Poland. Clin Infect Dis 2023; 76:1708-1715. [PMID: 36888680 DOI: 10.1093/cid/ciad116] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/23/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND The Russian invasion of Ukraine forced migration for safety, protection, and assistance. Poland is the primary sheltering country for Ukrainian refugees, providing support including medical care, which resulted in the rapid ∼15% increase in the number of followed-up people with human immunodeficiency virus (HIV) (PWH) in the country. Here, we present the national experience on HIV care provided for refugees from Ukraine. METHODS Clinical, antiretroviral, immunological, and virologic data from 955 Ukrainian PWH entering care in Poland since February 2022 were analyzed. The dataset included both antiretroviral-treated (n = 851) and newly diagnosed (n = 104) patients. In 76 cases, protease/reverse transcriptase/integrase sequencing was performed to identify drug resistance and subtype. RESULTS Most (70.05%) of the patients were female, with a predominance of heterosexual (70.3%) transmissions. Anti-hepatitis C antibody and hepatitis B antigen were present in 28.7% and 2.9% of the patients, respectively. A history of tuberculosis was reported in 10.1% of cases. Among previously treated patients, the viral suppression rate was 89.6%; 77.3% of newly HIV diagnosed cases were diagnosed late (with lymphocyte CD4 count <350 cells/μL or AIDS). The A6 variant was observed in 89.0% of sequences. Transmitted mutations in the reverse transcriptase were found in 15.4% treatment-naive cases. Two patients with treatment failure exhibited multiclass drug resistance. CONCLUSIONS Migration from Ukraine influences the characteristics of HIV epidemics in Europe, with an increase in the proportion of women and hepatitis C coinfected patients. Antiretroviral treatment efficacy among previously treated refugees was high, with new HIV cases frequently diagnosed late. The A6 subtype was the most common variant.
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Affiliation(s)
- Miłosz Parczewski
- Department of Infectious, Tropical Diseases, and Immune Deficiency, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Elżbieta Jabłonowska
- Department of Infectious Diseases and Hepatology, Medical University of Lódz, Lódz, Poland
| | - Kamila Wójcik-Cichy
- Department of Infectious Diseases and Hepatology, Medical University of Lódz, Lódz, Poland
| | - Dmytro Zhyvytsia
- Infectious, Tropical Diseases, and Immune Deficiency, Regional Hospital, Szczecin, Poland
| | - Magdalena Witak-Jędra
- Infectious, Tropical Diseases, and Immune Deficiency, Regional Hospital, Szczecin, Poland
| | | | - Bogusz Aksak-Wąs
- Department of Infectious, Tropical Diseases, and Immune Deficiency, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Ewa Siwak
- Department of Infection, Tropical Diseases, and Hepatology, Medical University in Warsaw, Warsaw, Poland
| | - Iwona Cielniak
- Department of Infection, Tropical Diseases, and Hepatology, Medical University in Warsaw, Warsaw, Poland
| | - Anita Olczak
- Department of Adult Infection Diseases, Medical University in Warsaw, Warsaw, Poland
| | - Aleksandra Szymczak
- Department of Infectious Diseases and Hepatology, Faculty of Medicine, Nicolaus Copernicus University Ludwik Rydygier Collegium, Bydgoszcz, Poland
| | - Bartosz Szetela
- Department of Infectious Diseases and Hepatology, Faculty of Medicine, Nicolaus Copernicus University Ludwik Rydygier Collegium, Bydgoszcz, Poland
| | - Monika Bociąga-Jasik
- Department of Infectious Diseases, Liver Disease, and Acquired Immune Deficiencies, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Kalinowska-Nowak
- Department of Infectious Diseases, Liver Disease, and Acquired Immune Deficiencies, Wroclaw Medical University, Wroclaw, Poland
| | - Elżbieta Mularska
- Department of Infectious Diseases, Regional Hospital Chorzów, Chorzów, Poland
| | - Adam Witor
- Department of Infectious Diseases, Regional Hospital Chorzów, Chorzów, Poland
| | - Paweł Jakubowski
- Department of Infectious and Tropical Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Maria Hlebowicz
- Infectious Diseases Clinical Ward, University of Warma and Mazury, Olsztyn, Poland
| | - Błażej Rozpłochowski
- Department of Infectious Diseases, Hepatology, and Acquired Immunodeficiencies, Karol Marcinkowski University of Medical Sciences, Poznan, Poland
| | - Władysław Łojewski
- Department of Infectious Diseases, Regional Hospital in Zielona Gora, Zielona Góra, Poland
| | - Kaja Scheibe
- Department of Infectious, Tropical Diseases, and Immune Deficiency, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Karol Serwin
- Department of Infectious, Tropical Diseases, and Immune Deficiency, Pomeranian Medical University in Szczecin, Szczecin, Poland
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Corona-Mata D, Rivero-Juárez A, Camacho Á, Ruiz-Torres L, Ruiz-Cáceres I, de la Fuente Darder B, Cáceres-Anillo D, de Guía Castro-Granados M, Lizaur-Barbudo M, Victoria Cabrera-Gisbert M, Redondo-Écija J, Aparicio-Aparicio A, Manchado-López L, Cobos L, Pérez-Valero I, Rivero A. Efficacy of a comprehensive strategy for the detection and treatment of hepatitis C infection in a population attending addiction centers. Front Public Health 2023; 11:1092960. [PMID: 36817894 PMCID: PMC9932806 DOI: 10.3389/fpubh.2023.1092960] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Background and aims The burden hepatitis C infection in people with history or current drug use suppose a high risk of hepatic complications and transmission infectious disease. This population is poor linked to heath system and is difficult to achieve them and support treatment because they have high rates of lost follow-up. Our aim was to evaluate an intervention for the diagnosis and treatment of chronic hepatitis C and HIV in this population. Methods Six-hundred and eighty-three people attended in Drugs and Addictions Centers (DAC) were asked to participate in health counseling and provide blood sample for test HCV, HIV, and syphilis from April 2019 to June 2020. Totally 556 subjects were surveyed and tested. All of them were assigned to a patient navigation program to improve health education and linking to the sanitary system. Hepatitis C infection patients were evaluated in an ampliated medical consult to evaluate hepatic stage with transient liver elastography and initiated Direct Acting Antivirals to achieve Sustained Viral Response. Results Of the 556 patients who agreed to participate in the study, 33 (5.9%) had active HCV infection. Of the 33 patients infected with HCV, three were lost to follow-up once the diagnosis of HCV infection was made. Twenty-eight patients (93.3%) completed treatment and 26 achieved Sustained Viral Response (78.8%). Of the 30 patients, seven (23.3%) had advanced fibrosis, and of these, four (16.6%) had liver cirrhosis. One of the cirrhotic patients had hepatic space-occupying lesions at the baseline evaluation and was diagnosed with hepatocarcinoma. Conclusions Our study suggests that the implementation of strategies based on personalized intervention models can contribute to the control of HCV infection in DAC users.
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Affiliation(s)
- Diana Corona-Mata
- Infectious Diseases Department, Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Reina Sofía University Hospital of Córdoba, University of Córdoba, Córdoba, Spain
| | - Antonio Rivero-Juárez
- Infectious Diseases Department, Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Reina Sofía University Hospital of Córdoba, University of Córdoba, Córdoba, Spain,CIBERINFEC, ISCIII – CIBER of Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain,*Correspondence: Antonio Rivero-Juárez ✉
| | - Ángela Camacho
- Infectious Diseases Department, Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Reina Sofía University Hospital of Córdoba, University of Córdoba, Córdoba, Spain,CIBERINFEC, ISCIII – CIBER of Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - Laura Ruiz-Torres
- Infectious Diseases Department, Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Reina Sofía University Hospital of Córdoba, University of Córdoba, Córdoba, Spain
| | - Inmaculada Ruiz-Cáceres
- Infectious Diseases Department, Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Reina Sofía University Hospital of Córdoba, University of Córdoba, Córdoba, Spain
| | - Bartolomé de la Fuente Darder
- Unidad de Drogas y Adicciones-CPD (UDA-CPD), Instituto Provincial Bienestar Social, Diputación Córdoba, Córdoba, Spain
| | | | - María de Guía Castro-Granados
- Unidad de Drogas y Adicciones-CPD (UDA-CPD), Instituto Provincial Bienestar Social, Diputación Córdoba, Córdoba, Spain
| | - María Lizaur-Barbudo
- Unidad de Drogas y Adicciones-CPD (UDA-CPD), Instituto Provincial Bienestar Social, Diputación Córdoba, Córdoba, Spain
| | | | - Justa Redondo-Écija
- Unidad de Drogas y Adicciones-CPD (UDA-CPD), Instituto Provincial Bienestar Social, Diputación Córdoba, Córdoba, Spain
| | - Ana Aparicio-Aparicio
- Unidad de Drogas y Adicciones-CPD (UDA-CPD), Instituto Provincial Bienestar Social, Diputación Córdoba, Córdoba, Spain
| | - Leticia Manchado-López
- Unidad de Drogas y Adicciones-CPD (UDA-CPD), Instituto Provincial Bienestar Social, Diputación Córdoba, Córdoba, Spain
| | - Luciano Cobos
- Unidad de Drogas y Adicciones-CPD (UDA-CPD), Instituto Provincial Bienestar Social, Diputación Córdoba, Córdoba, Spain
| | - Ignacio Pérez-Valero
- Infectious Diseases Department, Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Reina Sofía University Hospital of Córdoba, University of Córdoba, Córdoba, Spain,CIBERINFEC, ISCIII – CIBER of Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Rivero
- Infectious Diseases Department, Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Reina Sofía University Hospital of Córdoba, University of Córdoba, Córdoba, Spain,CIBERINFEC, ISCIII – CIBER of Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
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Elrashdy F, Hagag S, Mohamed R, Abdel Alem S, Meshaal S, Cordie A, Elsharkawy A, Esmat G. Incidence of hepatitis C virus infection among people living with HIV: An Egyptian cohort study. South Afr J HIV Med 2022; 23:1442. [PMID: 36479422 PMCID: PMC9724027 DOI: 10.4102/sajhivmed.v23i1.1442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/16/2022] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Egypt used to have one of the highest hepatitis C virus (HCV) infection prevalence rates worldwide, with an estimated HCV prevalence of around 4.5% to 6.7%. OBJECTIVES To determine the HCV infection incidence rate amid Egyptian patients living with HIV. METHOD A total of 460 HIV-positive patients were recruited in a retrospective cohort study from Imbaba Fever Hospital, Cairo, between January 2016 and March 2019. The patients had a negative baseline and at least one other HCV antibody test. Hepatitis C virus antibody testing was done by antibody sandwich third-generation enzyme-linked immunosorbent assay. The hepatitis C virus infection incidence rate among HIV-infected patients was calculated using the person-time incidence rate. RESULTS Two hundred and eighteen patients were finally included: 146 (31.7%) patients were excluded for having a positive baseline HCV Ab result and 96 patients were excluded for not having a follow-up HCV Ab test. Eighteen patients had HCV seroconversion (8.3%), achieving an incidence rate of 4.06 cases per 100 person-years (95% confidence interval: 3.87-4.24). Injection drug use (IDU) was the commonest risk factor among seroconverters, with an HCV incidence rate of 7.08 cases per 100 person-years. Injection drug use history was reported in 83.3% of the seroconverters and in only 47.2% of non-seroconverters; P = 0.005. CONCLUSION Egyptian HIV-infected patients show a high incidence rate of HCV infection especially among those who have a history of IDU. Accordingly, attention should be paid for prevention, screening and timely treatment of HCV in patients infected with HIV. WHAT THIS STUDY ADDS The demonstration of a high HCV infection incidence rate among HIV-infected patients and shows the need for screening and prevention in this population.
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Affiliation(s)
- Fatma Elrashdy
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Suzan Hagag
- Department of Public Health and Community Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rahma Mohamed
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
- Kasr Al-Aini HIV and Viral Hepatitis Fighting Group, Cairo University Hospitals, Cairo University, Cairo, Egypt
| | - Shereen Abdel Alem
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Safa Meshaal
- Department of Clinical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Cordie
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
- Kasr Al-Aini HIV and Viral Hepatitis Fighting Group, Cairo University Hospitals, Cairo University, Cairo, Egypt
| | - Aisha Elsharkawy
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Gamal Esmat
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
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