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Mamdouh Farghaly H, Shams MY, Abd El-Hafeez T. Hepatitis C Virus prediction based on machine learning framework: a real-world case study in Egypt. Knowl Inf Syst 2023. [DOI: 10.1007/s10115-023-01851-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
AbstractPrediction and classification of diseases are essential in medical science, as it attempts to immune the spread of the disease and discover the infected regions from the early stages. Machine learning (ML) approaches are commonly used for predicting and classifying diseases that are precisely utilized as an efficient tool for doctors and specialists. This paper proposes a prediction framework based on ML approaches to predict Hepatitis C Virus among healthcare workers in Egypt. We utilized real-world data from the National Liver Institute, founded at Menoufiya University (Menoufiya, Egypt). The collected dataset consists of 859 patients with 12 different features. To ensure the robustness and reliability of the proposed framework, we performed two scenarios: the first without feature selection and the second after the features are selected based on sequential forward selection (SFS). Furthermore, the feature subset selected based on the generated features from SFS is evaluated. Naïve Bayes, random forest (RF), K-nearest neighbor, and logistic regression are utilized as induction algorithms and classifiers for model evaluation. Then, the effect of parameter tuning on learning techniques is measured. The experimental results indicated that the proposed framework achieved higher accuracies after SFS selection than without feature selection. Moreover, the RF classifier achieved 94.06% accuracy with a minimum learning elapsed time of 0.54 s. Finally, after adjusting the hyperparameter values of the RF classifier, the classification accuracy is improved to 94.88% using only four features.
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Sakr AA, Ahmed AE, Abd El-Maksoud MDE, Gamal A, El-Garem H, Ahmed OM. Interferon lambda 4 gene polymorphisms as a predicting tool of response to hepatitis C virus genotype 4 patients treated with Sofosbuvir and Ribavirin. INFECTION GENETICS AND EVOLUTION 2020; 86:104606. [PMID: 33127459 DOI: 10.1016/j.meegid.2020.104606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 10/07/2020] [Accepted: 10/20/2020] [Indexed: 01/04/2023]
Abstract
The relation between interferon lambda 4 gene (IFNL4) and direct acting antiviral (DAA) regimens in hepatitis C virus (HCV) infected patients is not clear. So, a single nucleotide polymorphisms (SNP) of IFNL4 gene genotypes and its relationship with Sofosbuvir (SOF) and Ribavirin (RBV) treatment response is under consideration. This study aims to investigate the relation between IFNL4 polymorphisms and clearance of HCV genotype 4 for HCV patients. Hence, the appropriate drug can be chosen for each patient. SNP genotyping assay for IFNL4 which formerly known as IL28B (rs368234815) was examined for genomic DNA. The DNA was extracted from whole blood of one hundred patients who documented to have infection with chronic HCV genotype 4 (positive PCR) and treated with SOF and RBV. Patients were diagnosed, previously, as HCV genotype 4 and classified according to drug response into two groups (responders, non-responders). All samples were compared with 50 of non-infected (negative PCR) people (control group). The TT/TT homozygous represents 48% of patients and 66% of non-infected people while the homozygous ∆G/∆G is 21% and 12%, respectively. There is significance to IFNL4 genotypes for the treatment response with the probability value p < 0.001. The percentages of the appearance of genotypes TT/TT, TT/∆G and ∆G/∆G for responders were 60%, 28% and 12%, respectively. There is no significance for gender, age, ALT and PLC to treatment response to SOF and RBV, while INR has.
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Affiliation(s)
- Amany A Sakr
- Department of Biotechnology, Faculty of Postgraduate Studies for Advanced Sciences, Beni-Suef University, Egypt.
| | - Amr E Ahmed
- Department of Biotechnology, Faculty of Postgraduate Studies for Advanced Sciences, Beni-Suef University, Egypt
| | - Mohamed D E Abd El-Maksoud
- Department of Biochemistry, Genetic Engineering and Biotechnology Research Division, National Research Centre, Dokki, Giza, Egypt
| | - Amany Gamal
- National Hepatology and Tropical Medicine Research Institute (NHTMRI), Cairo, Egypt
| | - Hasan El-Garem
- Department of Gastroenterology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Osama M Ahmed
- Department of Zoology, Physiology Division, Faculty of Science, Beni-Suef University, Egypt
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McCabe L, White IR, Chau NVV, Barnes E, Pett SL, Cooke GS, Walker AS. The design and statistical aspects of VIETNARMS: a strategic post-licensing trial of multiple oral direct-acting antiviral hepatitis C treatment strategies in Vietnam. Trials 2020; 21:413. [PMID: 32423467 PMCID: PMC7236096 DOI: 10.1186/s13063-020-04350-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 04/25/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Eliminating hepatitis C is hampered by the costs of direct-acting antiviral treatment and the need to treat hard-to-reach populations. Access could be widened by shortening or simplifying treatment, but limited research means it is unclear which approaches could achieve sufficiently high cure rates to be acceptable. We present the statistical aspects of a multi-arm trial designed to test multiple strategies simultaneously and a monitoring mechanism to detect and stop individual randomly assigned groups with unacceptably low cure rates quickly. METHODS The VIETNARMS trial will factorially randomly assign patients to two drug regimens, three treatment-shortening strategies or control, and adjunctive ribavirin or no adjunctive ribavirin with shortening strategies (14 randomly assigned groups). We will use Bayesian monitoring at interim analyses to detect and stop recruitment into unsuccessful strategies, defined by more than 0.95 posterior probability that the true cure rate is less than 90% for the individual randomly assigned group (non-comparative). Final comparisons will be non-inferiority for regimens (margin 5%) and strategies (margin 10%) and superiority for adjunctive ribavirin. Here, we tested the operating characteristics of the stopping guideline for individual randomly assigned groups, planned interim analysis timings and explored power at the final analysis. RESULTS A beta (4.5, 0.5) prior for the true cure rate produces less than 0.05 probability of incorrectly stopping an individual randomly assigned group with a true cure rate of more than 90%. Groups with very low cure rates (<60%) are very likely (>0.9 probability) to stop after about 25% of patients are recruited. Groups with moderately low cure rates (80%) are likely to stop (0.7 probability) before overall recruitment finishes. Interim analyses 7, 10, 13 and 18 months after recruitment commences provide good probabilities of stopping inferior individual randomly assigned groups. For an overall true cure rate of 95%, power is more than 90% to confirm non-inferiority in the regimen and strategy comparisons, regardless of the control cure rate, and to detect a 5% absolute difference in the ribavirin comparison. CONCLUSIONS The operating characteristics of the stopping guideline are appropriate, and interim analyses can be timed to detect individual randomly assigned groups that are highly likely to have suboptimal performance at various stages. Therefore, our design is suitable for evaluating treatment-shortening or -simplifying strategies. TRIAL REGISTRATION ISRCTN registry: ISRCTN61522291. Registered on 4 October 2019.
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Affiliation(s)
- Leanne McCabe
- Medical Research Council Clinical Trials Unit at University College London, 90 High Holborn, WC1V 6LJ London, UK
| | - Ian R. White
- Medical Research Council Clinical Trials Unit at University College London, 90 High Holborn, WC1V 6LJ London, UK
| | | | | | - Sarah L. Pett
- Medical Research Council Clinical Trials Unit at University College London, 90 High Holborn, WC1V 6LJ London, UK
| | | | - A. Sarah Walker
- Medical Research Council Clinical Trials Unit at University College London, 90 High Holborn, WC1V 6LJ London, UK
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Fan Z, Liu J, Wang F, Liu J, Ding X, Liu S. HCV core antigen is a useful predictor during pegylated-interferon/ribavirin therapy in patients with hepatitis C virus genotype 1b. Medicine (Baltimore) 2019; 98:e14795. [PMID: 30855495 PMCID: PMC6417632 DOI: 10.1097/md.0000000000014795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Enzyme immunoassays for quantifying hepatitis C virus (HCV) core antigen (Ag) have been proposed as an alternative to HCV RNA detection. The present study aimed to investigate the early kinetics of serum HCVcAg and its usefulness in predicting virological responses.The clinical data of 135 patients with chronic hepatitis C treated with pegylated interferon alpha (PEG-IFN-α) and ribavirin was retrospectively collected. The patients were grouped according to their treatment outcomes as follows: sustained virological response (SVR), nonsustained virological response (N-SVR), and relapse.Higher HCVcAg and HCV RNA levels were observed in patients in the N-SVR group than in the other groups at baseline. HCVcAg better predicted rapid virological response (RVR) compared with HCV RNA and had a predictive value similar to that of HCV RNA for SVR and early virological response. In the relapse group, HCV RNA decreased to 0 after 48 weeks, whereas HCVcAg was still detectable, indicating that HCVcAg more sensitively predicted relapse in antiviral therapy than HCV RNA.For patients treated with PEG-INF-α and ribavirin, HCVcAg may more sensitively predict relapse than HCV RNA.
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Affiliation(s)
- Zhijuan Fan
- Clinical Laboratory of Tianjin Third Central Hospital
- Tianjin Key Laboratory of Artificial Cell
- Artificial Cell Engineering Technology Research Center of Public Health Ministry, Hedong District
| | - Junfeng Liu
- Department of Clinical Laboratory, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Science and Beijing Union Medical College
| | - Fengmei Wang
- Tianjin Key Laboratory of Artificial Cell
- Artificial Cell Engineering Technology Research Center of Public Health Ministry, Hedong District
- Tianjin Institute of Hepatobiliary Disease, Hedong District
| | - Jingmin Liu
- Department of Obstetrics, Tianjin TEDA Hospital, Tianjin, China
| | - Xian Ding
- Clinical Laboratory of Tianjin Third Central Hospital
- Tianjin Key Laboratory of Artificial Cell
- Artificial Cell Engineering Technology Research Center of Public Health Ministry, Hedong District
| | - Shuye Liu
- Clinical Laboratory of Tianjin Third Central Hospital
- Tianjin Key Laboratory of Artificial Cell
- Artificial Cell Engineering Technology Research Center of Public Health Ministry, Hedong District
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Risk factors for acquiring HCV at a healthcare center in Hidalgo, Mexico. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2019. [DOI: 10.1016/j.rgmxen.2018.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Assih M, Ouattara AK, Diarra B, Yonli AT, Compaore TR, Obiri-Yeboah D, Djigma FW, Karou S, Simpore J. Genetic diversity of hepatitis viruses in West-African countries from 1996 to 2018. World J Hepatol 2018; 10:807-821. [PMID: 30533182 PMCID: PMC6280160 DOI: 10.4254/wjh.v10.i11.807] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/10/2018] [Accepted: 10/23/2018] [Indexed: 02/06/2023] Open
Abstract
The severity of hepatic pathology and the response to treatment depend on the hepatitis virus genotype in the infected host. The objective of this review was to determine the distribution of hepatitis virus genotypes in West African countries. A systematic review of the literature in PubMed, Google Scholar and Science Direct was performed to identify 52 relevant articles reporting hepatitis A, B, C, D, E and G viruses genotypes. Hepatitis B virus (HBV) genotype E with a prevalence of 90.6% (95%CI: 0.891-0.920) found in this review, is characterized by low genetic diversity. Hepatitis C virus (HCV) genotypes 1 and 2 represented 96.4% of HCV infections in West African countries, while hepatitis delta virus, hepatitis A virus, hepatitis G virus genotypes 1 and HEV genotype 3 were reported in some studies in Ghana and Nigeria. HBV genotype E is characterized by high prevalence, low genetic diversity and wide geographical distribution. Further studies on the clinical implications of HBV genotype E and HCV genotypes 1 and 2 are needed for the development of an effective treatment against this viral hepatitis in West African countries. Surveillance of the distribution of different genotypes is also needed to reduce recombination rates and prevent the emergence of more virulent viral strains.
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Affiliation(s)
- Maléki Assih
- Biochemistry-Microbiology, CERBA/LABIOGENE, Ouagadougou 02006, Burkina Faso
- Laboratory of Molecular Biology and Molecular Genetics (LABIOGENE) UFR/SVT, University Ouaga I Prof Joseph KI-ZERBO, Ouagadougou 00226, Burkina Faso
| | - Abdoul Karim Ouattara
- Biochemistry-Microbiology, CERBA/LABIOGENE, Ouagadougou 02006, Burkina Faso
- Laboratory of Molecular Biology and Molecular Genetics (LABIOGENE) UFR/SVT, University Ouaga I Prof Joseph KI-ZERBO, Ouagadougou 00226, Burkina Faso
| | - Birama Diarra
- Biochemistry-Microbiology, CERBA/LABIOGENE, Ouagadougou 02006, Burkina Faso
- Laboratory of Molecular Biology and Molecular Genetics (LABIOGENE) UFR/SVT, University Ouaga I Prof Joseph KI-ZERBO, Ouagadougou 00226, Burkina Faso
| | - Albert Theophane Yonli
- Biochemistry-Microbiology, CERBA/LABIOGENE, Ouagadougou 02006, Burkina Faso
- Laboratory of Molecular Biology and Molecular Genetics (LABIOGENE) UFR/SVT, University Ouaga I Prof Joseph KI-ZERBO, Ouagadougou 00226, Burkina Faso
| | - Tegwindé Rebeca Compaore
- Biochemistry-Microbiology, CERBA/LABIOGENE, Ouagadougou 02006, Burkina Faso
- Laboratory of Molecular Biology and Molecular Genetics (LABIOGENE) UFR/SVT, University Ouaga I Prof Joseph KI-ZERBO, Ouagadougou 00226, Burkina Faso
| | - Dorcas Obiri-Yeboah
- Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, Cape Coast 00233, Ghana
| | - Florencia Wendkuuni Djigma
- Biochemistry-Microbiology, CERBA/LABIOGENE, Ouagadougou 02006, Burkina Faso
- Laboratory of Molecular Biology and Molecular Genetics (LABIOGENE) UFR/SVT, University Ouaga I Prof Joseph KI-ZERBO, Ouagadougou 00226, Burkina Faso
| | - Simplice Karou
- Ecole Supérieure des Techniques Biologiques et Alimentaires (ESTBA-UL), Universite de Lome, Lome 00229, Togo
| | - Jacques Simpore
- Biochemistry-Microbiology, CERBA/LABIOGENE, Ouagadougou 02006, Burkina Faso
- Laboratory of Molecular Biology and Molecular Genetics (LABIOGENE) UFR/SVT, University Ouaga I Prof Joseph KI-ZERBO, Ouagadougou 00226, Burkina Faso
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Di Biagio A, Taramasso L, Cenderello G. Treatment of hepatitis C virus genotype 4 in the DAA era. Virol J 2018; 15:180. [PMID: 30466446 PMCID: PMC6251143 DOI: 10.1186/s12985-018-1094-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 11/13/2018] [Indexed: 02/07/2023] Open
Abstract
The recently approved interferon-free DAA (direct antiviral agents) regimens have shown not only to be effective in terms of sustained virological response (SVR) rates (> 90%) but also well tolerated in most hepatitis C virus (HCV) infected patients. Nevertheless HCV genotypes are different and only a small percentage of trials consider genotype 4 (GT4), which was associated with lower rates of SVR compared with other genotypes before the arrival of the DAA's. In this review, we discuss the efficacy of DAA therapy in GT4 HCV infection with specific reference to more recent studies, including those conducted in a 'field-practice' scenario. Overall, DAA-based regimens appear more effective also in the poorly-explored setting of patients with HCV GT4 infection. Despite an overall limited number of patients was evaluated, favorable results are being derived from studies on ombitasvir/paritaprevir/ritonavir, sofosbuvir and velpatasvir, whether or not in association with voxilaprevir, and with the new combined therapy glecaprevir + pibentasvir.
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Affiliation(s)
- Antonio Di Biagio
- Infectious Diseases Clinic, Policlinico Hospital San Martino, L.go R. Benzi n 10, 16132 Genoa, Italy
| | - Lucia Taramasso
- Department of Health Sciences (DISSAL), University of Genova and Infectious Disease Clinic, Via Pastore n 1, 16136 Genoa, Italy
- Infectious Diseases Unit, Department of Internal Medicine, ‘Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Milan, Italy
| | - Giovanni Cenderello
- Infectious Disease Unit, EO Ospedali Galliera, via Mura delle Cappuccine n 14, 16128 Genoa, Italy
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Minosse C, Selleri M, Giombini E, Bartolini B, Capobianchi MR, Cerilli S, Loiacono L, Taibi C, D'Offizi G, McPhee F, Garbuglia A. Clinical and virological properties of hepatitis C virus genotype 4 infection in patients treated with different direct-acting antiviral agents. Infect Drug Resist 2018; 11:2117-2127. [PMID: 30464554 PMCID: PMC6223400 DOI: 10.2147/idr.s179158] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background The efficacy of direct-acting antivirals (DAAs) depends on the hepatitis C virus (HCV) genotype 4 (GT4) subtype which are used in the treatment of HCV. We aimed to retrospectively investigate the baseline prevalence of HCV NS5A and NS5B polymorphisms and their impact on virological outcome in GT4-infected patients treated with various DAA regimens. Patients and methods Available plasma samples from HCV GT4-infected patients treated with different DAA regimens were analyzed at baseline and after treatment failure, where applicable. Sanger sequencing of patient-derived NS5A and NS5B regions was performed on all available samples, while ultradeep pyrosequencing (UDPS) of NS5A and NS5B regions was performed only on samples from treatment failures at different time points. Results Sustained virological response (SVR) was achieved by 96% (48/50) of patients. Of 16 patients with baseline NS5A sequence, polymorphisms at amino acid positions associated with drug resistance were detected only at position 58: P58 (69.2%) and T58 (30.8%). Of 21 patients with baseline NS5B sequence, N142S was detected only in the two treatment failures, both with GT4d were treated with sofosbuvir (SOF)-based regimens, suggesting a potential involvement in SOF efficacy. Two patients (patient 1 [Pt1] and patient 2 [Pt2]) relapsed. In Pt1, NS5A-T56I and NS5A-Y93H/S emerged. In Pt2, NS5A-L28F emerged and a novel NS5B resistance-associated substitution (RAS), L204F, representing 1.5% of the viral population at baseline, enriched to 71% and 91.6% during and after treatment failure, respectively. UDPS of NS5B from Pt2 indicated a mixed infection of approximately 1:5, GT1a:GT4d, at baseline and GT4d during failure. Phylogenetic analysis of NS5A sequences indicated no clustering of HCV strains from patients achieving SVR vs patients who relapsed. The mean genetic distance in NS5A sequences was 5.8%, while a lower genetic distance (3.1%) was observed in NS5B sequences. Conclusion Results from these analyses confirm the importance of UDPS in the analysis of viral quasispecies variability and the identification of novel RASs potentially associated with DAA treatment failure in HCV GT4-infected patients.
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Affiliation(s)
- Claudia Minosse
- Department of Pre-clinical Research Epidemiology and Advanced Diagnostics, Laboratory of Virology, National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Marina Selleri
- Department of Pre-clinical Research Epidemiology and Advanced Diagnostics, Laboratory of Virology, National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Emanuela Giombini
- Department of Pre-clinical Research Epidemiology and Advanced Diagnostics, Laboratory of Virology, National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Barbara Bartolini
- Department of Pre-clinical Research Epidemiology and Advanced Diagnostics, Laboratory of Virology, National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Maria Rosaria Capobianchi
- Department of Pre-clinical Research Epidemiology and Advanced Diagnostics, Laboratory of Virology, National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Stefano Cerilli
- Clinical Department, Infectious Disease-Hepatology Unit, National Institute for Infectious Diseases, "Lazzaro Spallanzani" - IRCCS, Rome, Italy,
| | - Laura Loiacono
- Clinical Department, Infectious Disease-Hepatology Unit, National Institute for Infectious Diseases, "Lazzaro Spallanzani" - IRCCS, Rome, Italy,
| | - Chiara Taibi
- Clinical Department, Infectious Disease-Hepatology Unit, National Institute for Infectious Diseases, "Lazzaro Spallanzani" - IRCCS, Rome, Italy,
| | - Gianpiero D'Offizi
- Clinical Department, Infectious Disease-Hepatology Unit, National Institute for Infectious Diseases, "Lazzaro Spallanzani" - IRCCS, Rome, Italy,
| | - Fiona McPhee
- Bristol-Myers Squibb Research and Development, Wallingford, CT, USA
| | - AnnaRosa Garbuglia
- Department of Pre-clinical Research Epidemiology and Advanced Diagnostics, Laboratory of Virology, National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
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Luxenburger H, Graß F, Baermann J, Boettler T, Marget M, Emmerich F, Panning M, Thimme R, Nitschke K, Neumann-Haefelin C. Differential virus-specific CD8 + T-cell epitope repertoire in hepatitis C virus genotype 1 versus 4. J Viral Hepat 2018; 25:779-790. [PMID: 29397015 DOI: 10.1111/jvh.12874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 01/05/2018] [Indexed: 01/06/2023]
Abstract
Virus-specific CD8+ T-cell responses play an important role in the outcome of hepatitis C virus (HCV) infection. To date, most HCV-specific CD8+ T-cell epitopes have been defined in HCV genotype 1 infection. In contrast, the HCV genotype 4-specific CD8+ T-cell response is poorly defined. Here, we analysed whether known HCV-specific CD8+ T-cell epitopes are also recognized in HCV genotype 4-infected patients and set out to identify the first HCV genotype 4-specific CD8+ T-cell epitopes. We studied patients chronically infected with HCV genotype 1 (n = 20) or 4 (n = 21) using 91 well-described HCV-specific epitope peptides. In addition, we analysed 24 genotype 4-infected patients using 40 epitope candidates predicted using an in silico approach. HCV-specific CD8+ T-cell responses targeting previously described epitopes were detectable in the majority of genotype 1-infected patients (11 of 20). In contrast, patients infected with HCV genotype 4 rarely targeted these epitopes (4 of 21; P = .0247). Importantly, we were able to identify eight novel HCV genotype 4-specific CD8+ T-cell epitopes. Only one of these epitopes was shared between genotype 1 and genotype 4. These results indicate that there is little overlap between CD8+ T-cell repertoires targeting HCV genotype 1 and 4. Prophylactic vaccination studies based on HCV genotype 1 are currently underway. However, in countries with the highest prevalence of HCV infection, such as Egypt, most patients are infected with HCV genotype 4. Thus, prophylactic vaccination strategies need to be adapted to HCV genotype 4 before their application to regions where HCV genotype 4 is endemic.
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Affiliation(s)
- Hendrik Luxenburger
- Faculty of Medicine, Department of Medicine II, University Hospital Freiburg, University of Freiburg, Freiburg, Germany
| | - Franziska Graß
- Faculty of Medicine, Department of Medicine II, University Hospital Freiburg, University of Freiburg, Freiburg, Germany
| | - Janina Baermann
- Faculty of Medicine, Department of Medicine II, University Hospital Freiburg, University of Freiburg, Freiburg, Germany
| | - Tobias Boettler
- Faculty of Medicine, Department of Medicine II, University Hospital Freiburg, University of Freiburg, Freiburg, Germany
| | - Matthias Marget
- Institute of Transfusion Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Emmerich
- Faculty of Medicine, Institute for Cell and Gene Therapy, University Hospital Freiburg, University of Freiburg, Freiburg, Germany
| | - Marcus Panning
- Faculty of Medicine, Institute of Virology, University Hospital Freiburg, University of Freiburg, Freiburg, Germany
| | - Robert Thimme
- Faculty of Medicine, Department of Medicine II, University Hospital Freiburg, University of Freiburg, Freiburg, Germany
| | - Katja Nitschke
- Faculty of Medicine, Department of Medicine II, University Hospital Freiburg, University of Freiburg, Freiburg, Germany
| | - Christoph Neumann-Haefelin
- Faculty of Medicine, Department of Medicine II, University Hospital Freiburg, University of Freiburg, Freiburg, Germany
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Contreras-Omaña R, García-Lemus FJ, García-Camacho A. Risk factors for acquiring HCV at a healthcare center in Hidalgo, Mexico. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2018; 84:36-43. [PMID: 29895448 DOI: 10.1016/j.rgmx.2018.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 02/11/2018] [Accepted: 02/22/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION AND AIMS The approach to HCV infection begins with the directed search for risk factors linked to its acquisition. Therefore, our primary aim was to identify the prevalence of risk factors associated with HCV infections in insured individuals seen at the Hidalgo delegation of the IMSS. MATERIALS AND METHODS An observational, descriptive, cross-sectional study was conducted through validated surveys that identified major and minor risk factors. In cases of major risk factors, the Advanced Quality™ RAPID-ANTI-HCV TEST Accutrack® tests were applied to detect anti-HCV. Patients with positive tests were referred to the Hepatology service for the diagnostic-therapeutic approach. Statistical analysis was performed through measures of central tendency and percentages. RESULTS A total of 528 insured individuals were surveyed (95%CI with a 5% margin of error). Two hundred eighty-two rapid tests were performed. Five of them were positive (0.94%) and belonged to the patients in the dialysis/hemodialysis group. A total of 71.2% persons had positive risk factors. The association of 2 or more factors varied from 2 to 8 factors present at the same time. Of the entire study population, 6.25% presented with 4 risk factors and 4.35% presented with 5 risk factors at the same time. CONCLUSIONS Nearly three quarters of the individuals surveyed were exposed to HCV acquisition. The association of 2 or more risk factors in patients demonstrated their collective potentiality for acquiring HCV. We identified persons receiving treatment with dialysis/hemodialysis and those with high-risk sexual practices as vulnerable groups for HCV infection and suggest that they receive promotion and prevention activities, as well as public policy management.
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Affiliation(s)
- R Contreras-Omaña
- Centro de Investigación en Enfermedades Hepáticas y Gastroenterología, Hidalgo, México.
| | - F J García-Lemus
- Centro de Investigación en Enfermedades Hepáticas y Gastroenterología, Hidalgo, México; Universidad Autónoma del Estado de Hidalgo, México
| | - A García-Camacho
- Centro de Investigación en Enfermedades Hepáticas y Gastroenterología, Hidalgo, México; Universidad Autónoma del Estado de Hidalgo, México
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El-Raziky M, Khairy M, Fouad A, Salama A, Elsharkawy A, Tantawy O. Effect of Direct-Acting Agents on Fibrosis Regression in Chronic Hepatitis C Virus Patients' Treatment Compared with Interferon-Containing Regimens. J Interferon Cytokine Res 2018; 38:129-136. [PMID: 29565743 DOI: 10.1089/jir.2017.0137] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Hepatitis C virus (HCV) treatment is aiming to cure and prevent the development, progression of fibrosis, and related complications. Interferon-based therapy was claimed to reduce or even reverse fibrosis. Although direct-acting agents have a better cure rate, we still lack the knowledge of their effect on fibrosis regression. We aim to assess fibrosis regression in direct-acting agents compared with interferon-based treatment regimens in the treatment of chronic HCV patients. The 204 chronic HCV patients were divided into 3 groups; group 1(N = 68) received Peg-IFN and ribavirin, group 2 (N = 69) received sofosbuvir and ribavirin, and group 3 (N = 67) received Peg-IFN, ribavirin, and sofosbuvir. Fibrosis assessment was performed by transient elastography (TE), APRI and FIB 4, in the pretreatment and at least 3 months after end of treatment. Of these, 66.2% of the patients did not show significant fibrosis changes, 6.4% fibrosis progressed, and 27.5% of fibrosis regressed (P < 0.0001) by TE. Similar results were detected in the different treatment regimens with no statistically significant difference between the regimens. Fibrosis regression was detected in 43.3% of cirrhotic patients who achieved sustained virological response (SVR) and only in 27.4% with significant fibrosis. Significant improvement of posttreatment aspartate transaminase, alanine transaminase, and alpha fetoprotein as well as APRI and FIB 4 scores were detected. Fibrosis regression (TE, APRI and FIB 4) was detected with direct-acting agents and interferon-based therapy. Treated patients with significant fibrosis will benefit of fibrosis regression irrespective to their treatment response, whereas fibrosis regression was associated with SVR in cirrhotic patients.
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Affiliation(s)
- Maissa El-Raziky
- Endemic Medicine Department and Hepatology Unit, Faculty of Medicine, Cairo University , Cairo, Egypt
| | - Marwa Khairy
- Endemic Medicine Department and Hepatology Unit, Faculty of Medicine, Cairo University , Cairo, Egypt
| | - Ahmed Fouad
- Endemic Medicine Department and Hepatology Unit, Faculty of Medicine, Cairo University , Cairo, Egypt
| | - Ahmed Salama
- Endemic Medicine Department and Hepatology Unit, Faculty of Medicine, Cairo University , Cairo, Egypt
| | - Aisha Elsharkawy
- Endemic Medicine Department and Hepatology Unit, Faculty of Medicine, Cairo University , Cairo, Egypt
| | - Omnia Tantawy
- Endemic Medicine Department and Hepatology Unit, Faculty of Medicine, Cairo University , Cairo, Egypt
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12
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Efficacy of daclatasvir-based quadruple therapy in nonresponder patients infected by hepatitis C virus genotype 4: the ANRS HC32 QUATTRO study. Eur J Gastroenterol Hepatol 2018; 30:302-309. [PMID: 29271782 DOI: 10.1097/meg.0000000000001035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND A few direct antiviral agents have been studied in difficult-to-treat patients infected by hepatitis C virus (HCV) genotype 4 (GT4). The efficacy of daclatasvir (DCV), asunaprevir (ASV), pegylated interferon and ribavirin (Peg-IFN/RBV) association was investigated in these patients. PATIENTS AND METHODS This open-label, single-arm, phase 2 study was conducted in HCV GT4 patients who were null or partial responders to Peg-IFN/RBV. Patients received 24 weeks of DCV (60 mg, once daily), ASV (100 mg, twice daily) and Peg-IFN/RBV. The primary endpoint was sustained virologic response at post-treatment week 12 [sustained virologic response (SVR)12]. RESULTS Sixty patients were included; 45 (75%) were previous null responders and 27 (45%) had cirrhosis. The most frequent subtypes were GT4a (48%) and GT4d (27%) with 25% of the patients being infected with other subtypes such as 4c, 4r, 4f, 4k, 4j and 4q. The global SVR12 was 95% (90% confidence interval: 90.4-99.6) and 96.3% (90% confidence interval: 87.5-99.5) in cirrhotic patients. All patients achieving SVR12 also achieved SVR24. Previous Peg-IFN/RBV response, IL28b genotype, cirrhosis status or GT4 subtypes did not influence SVR12 rates. Serious adverse events occurred in 13% of the patients, four being cirrhotic and four noncirrhotic. Three (5%) patients stopped HCV therapy prematurely: one because of virologic breakthrough and two because of serious adverse events. Grade 3/4 laboratory abnormalities included leukopenia (33%), neutropenia (27%), thrombocytopenia (4%) and transaminases increase (2%). CONCLUSION Association of DCV plus ASV and peg-IFN/RBV for 24 weeks demonstrated a high rate of SVR12 in HCV GT4-infected prior nonresponders, independently of the cirrhotic status or the GT4 subtype. The safety profile was acceptable, even in cirrhotic patients.
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13
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Tsukiyama-Kohara K, Kohara M. Hepatitis C Virus: Viral Quasispecies and Genotypes. Int J Mol Sci 2017; 19:ijms19010023. [PMID: 29271914 PMCID: PMC5795974 DOI: 10.3390/ijms19010023] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 12/16/2017] [Accepted: 12/18/2017] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) mainly replicates in the cytoplasm, where it easily establishes persistent infection, resulting in chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma. Due to its high rate of mutation, HCV forms viral quasispecies, categorized based on the highly variable regions in the envelope protein and nonstructural 5A protein. HCV possesses seven major genotypes, among which genotype 1 is the most prevalent globally. The distribution of HCV genotypes varies based on geography, and each genotype has a different sensitivity to interferon treatment. Recently-developed direct-acting antivirals (DAAs), which target viral proteases or polymerases, mediate drastically better antiviral effects than previous therapeutics. Although treatment with DAAs has led to the development of drug-resistant HCV mutants, the most recently approved DAAs show improved pan-genomic activity, with a higher barrier to viral resistance.
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Affiliation(s)
- Kyoko Tsukiyama-Kohara
- Joint Faculty of Veterinary Meedicine, Kagoshima University, 1-21-24 Korimoto Kagoshima-city, Kgoshima 890-0065, Japan.
| | - Michinori Kohara
- Department of Microbiology and Cell Biology, Tokyo Metropolitan Institute, 2-1-6 Kamikitazawa, Setagaya-Ku 156-8506, Japan.
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Trapani S, Rizzato L, Masiero L, Ricci A, Morabito V, Peritore D, Fiaschetti P, Del Sordo E, Cacciotti AR, Montemurro A, Nanni Costa A. Hepatitis C Virus Positive Patients on the Waiting List for Liver Transplantation: Turnover and Characteristics of the Population on the Eve of the Therapeutic Revolution With Direct-Acting Antivirals. Transplant Proc 2017; 49:658-666. [PMID: 28457366 DOI: 10.1016/j.transproceed.2017.02.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Antivirals direct acting (DAA) for hepatitis C virus (HCV) have brought a revolution in the field of transplantation. It is likely to think that in the future patients on the waiting list for liver transplantation (LT) will no longer be registered for HCV-related cirrhosis but for liver disease from other causes. On the eve of this change, we show a snapshot of the Italian waiting list for LT. METHODS From October 1, 2012 to September 30, 2013, we estimated the total number of patients on the liver waiting list as intention to treat (ITT), the number of incident cases, and the delistings, particularly in the HCV positive (HCV+) population. Gender, median age, etiology and prognosis of liver disease, presence of hepatocellular carcinoma (HCC), reason for delisting, mean waiting time for LT, and rate of death on waiting list were evaluated. RESULTS In the time period, there were 517 new patients who were HCV+ (median age, 53 years): 255 (49.3%) mono-infected with HCV, 236 (45.7%) co-infected with HCV and hepatitis B virus (HBV), 11 (2.1%) co-infected with HCV and human immunodeficiency virus (HIV), and 15 (2.9%) co-infected with HCV, HBV, and HIV. The median model for end-stage liver disease (MELD) score at listing was 17 and HCC was present in 206 (39.8%) cases. HCV+ patients delisted were 442 (61.9%), 355 (80.3%) for LT. The mean waiting time to transplantation was 1.9 months; the percentage of death was 7.6%. CONCLUSIONS This snapshot of the waiting list for LT in the year before the advent of DAA drugs will allow us to assess whether and how they will change the waiting list for LT when we start to look at the impact of new therapies on the waiting list.
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Affiliation(s)
- S Trapani
- Italian National Transplant Center, Rome, Italy.
| | - L Rizzato
- Italian National Transplant Center, Rome, Italy
| | - L Masiero
- Italian National Transplant Center, Rome, Italy
| | - A Ricci
- Italian National Transplant Center, Rome, Italy
| | - V Morabito
- Italian National Transplant Center, Rome, Italy
| | - D Peritore
- Italian National Transplant Center, Rome, Italy
| | | | - E Del Sordo
- Italian National Transplant Center, Rome, Italy
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Bawazir A, AlGusheri F, Jradi H, AlBalwi M, Abdel-Gader AG. Hepatitis C virus genotypes in Saudi Arabia: a future prediction and laboratory profile. Virol J 2017; 14:208. [PMID: 29096662 PMCID: PMC5667522 DOI: 10.1186/s12985-017-0873-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/18/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) genotypes and subtypes are considered an important tool for epidemiological and clinical studies and valuable markers for disease progression and response to antiviral therapy. The aim of this study was to identify the prevalence of HCV genotypes and their relation to socio-demographic factors particularly age and sex, various biochemical profiles and viral load. METHODS The records (630) of Saudi patients positive for HCV (2007-2011) reported in the system of the Molecular Pathology Laboratory at a tertiary reference hospital in Riyadh, Saudi Arabia were analyzed. Socio-demographic characteristics, liver biochemical profile, viral load and co-infection with HBV and HIV were retrieved from the hospital database. The associations of continuous and categorical variables with genotypes were analyzed. RESULT The overall mean age of the surveyed patients was 59 years ±0.5 years (21% were <50 years (p = 0.02). The rate of infection is lower in males than in females (47.6% vs. 52.4%). HCV genotype 4 was the most prevalent (60.7%), followed by genotype 1 (24.8%). However, genotype 1 and 3 were found more in males (29.7% vs. 20.3% and 6% vs. 2.1%, respectively, p = 0.001), while genotype 2 and 4 were more among females (4.8% vs. 2% and 68.5% vs. 52.3%, respectively). In addition, genotype 1 was found dominant in younger males (33.8%). Biochemical parameters across gender showed significant variation in particular for the ALT (p = 0.007). The mean viral load was significantly higher in genotype 1 than genotype 4 (4,757,532 vs. 1,435,012, p = <001). There is a very low overall percentage of co-infection of HBV or HIV in this study (around 2% for each). CONCLUSION Although HCV genotype 4 shows an overall high prevalence in this study, a clear decline in the rate of this genotype was also demonstrated in particular among the younger age group who displayed increasing trends toward the global trend of genotype 1, rather than genotype 4. This finding would be of clinical interest in relation to future planning of the therapy for HCV infected patient.
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Affiliation(s)
- Amen Bawazir
- The King Abdullah International Medical Research Center (KAIMRC), Community and environmental Health,College of Public Health & Health Informatics. King Saud Bin Abdulaziz University for Health Sciences, Riyadh, 11481 Saudi Arabia
| | - Fahad AlGusheri
- Division of Molecular Pathology and Genetics, Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Hoda Jradi
- The King Abdullah International Medical Research Center (KAIMRC), Community and environmental Health,College of Public Health & Health Informatics. King Saud Bin Abdulaziz University for Health Sciences, Riyadh, 11481 Saudi Arabia
| | - Mohammed AlBalwi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, 3660, Riyadh, 11481 Saudi Arabia
| | - Abdel-Galil Abdel-Gader
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Shehata RH, Abdelmoneim SS, Osman OA, Hasanain AF, Osama A, Abdelmoneim SS, Toraih EA. Deregulation of miR-34a and Its Chaperon Hsp70 in Hepatitis C virus-Induced Liver Cirrhosis and Hepatocellular Carcinoma Patients. Asian Pac J Cancer Prev 2017; 18:2395-2401. [PMID: 28950684 PMCID: PMC5720642 DOI: 10.22034/apjcp.2017.18.9.2395] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: MicroRNA deregulation may occur during hepatocellular carcinoma (HCC) genesis and progression
stages. MicroRNA-34a (miR-34a) functions as a tumor suppressor and is down-regulated or silenced in a variety of
human cancers, while heat shock proteins (Hsps) play important roles in assisting protein folding and preventing
both protein aggregation and transport across membranes. The present study aimed to evaluating serum expression of
miR-34a and its target Hsp70 for early detection of HCC in patients with liver cirrhosis (LC), focusing on correlations
with clinicopathological features. Methods: A total of 180 patients were included: 120 with HCC on top of LC (60 with
either early or late HCC) and 60 patients with HCV-related LC. In addition, 60 healthy individuals were considered as
controls. Real-time polymerase chain reactions were performed for expression profiling of serum miR-34a and Hsp70
and for allelic discrimination of the promotor variant (rs2763979, C/T). In addition, in silico analysis was carried out.
Results: All participants were heterozygote for the promotor polymorphism. miR-34a serum levels were significantly
under-expressed in LC and especially HCC patients as compared to controls. Associations with a high Child-Turcotte-
Pugh (CTP) score, advanced cancer stage, and number of masses were noted. In contrast the target Hsp70 was significantly
overexpressed in cancer patients but not in LC group and inversely correlated with miR-34a levels. Conclusion: Utility
of circulating miRNAs as biomarkers for early detection of HCC was raised. Future large-scale studies are warranted
to confirm the current findings.
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Affiliation(s)
- Rasha H Shehata
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt. ,
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Influence of the IL6 − 147C/G polymorphism on clinical characteristics of chronic hepatitis C in Brazilian patients. GENE REPORTS 2017. [DOI: 10.1016/j.genrep.2017.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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Nosotti L, Petrelli A, Genovese D, Catone S, Argentini C, Vella S, Rossi A, Costanzo G, Fortino A, Chessa L, Miglioresi L, Mirisola C. Distribution of IL28B Polymorphism in a Cohort of Italians and Immigrants with HCV Infection: Association with Viraemia, Stage of Fibrosis and Response to Treatment. J Immigr Minor Health 2017; 19:876-882. [PMID: 27271956 DOI: 10.1007/s10903-016-0444-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Aims of the study are to investigate, in a cohort of patients affected by HCV chronic hepatitis with genotypes 1 and 4, the prevalence of interleukin 28B (IL28B) genotypes, the possible association between IL28B polymorphism and severity of liver damage, the role of IL28B CC as a predictor of outcome. 365 patients with HCV infection were observed between 2013 and 2014. Demographic, virological, biochemical, and genetic characteristics of each patient were investigated. Liver fibrosis was assessed by transient elastometry. Mean age of the patients (72.9 % males, 27.1 % females) is 50 years. 91.5 % % of patients are Caucasian, 8.5 % African. In the patients with HCV1 and HCV4 a higher frequency of IL28B CT is observed with a prevalence of 52.1 and 61.8 % respectively. As regards ethnic group, African people have a prevalence of 35.5 % for CC, while Caucasians have a prevalence of 23.8 % for CC. In our cohort, IL28B polymorphism does not show significant differences among ethnic groups and in HCV1 and HCV4 genotypes. As described in literature, IL28B CC genotype is confirmed as predictor of sustained virological response in both Caucasians and Africans. A significant correlation between liver fibrosis and IL28B polymorphism emerges.
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Affiliation(s)
- L Nosotti
- National Institute for Health, Migration and Poverty (NIHMP), Via San Gallicano 25/a, 00153, Rome, Italy.
| | - A Petrelli
- National Institute for Health, Migration and Poverty (NIHMP), Via San Gallicano 25/a, 00153, Rome, Italy
| | - D Genovese
- National Institute for Health (NIH), Rome, Italy
| | - S Catone
- National Institute for Health (NIH), Rome, Italy
| | - C Argentini
- National Institute for Health (NIH), Rome, Italy
| | - S Vella
- National Institute for Health (NIH), Rome, Italy
| | - A Rossi
- National Institute for Health, Migration and Poverty (NIHMP), Via San Gallicano 25/a, 00153, Rome, Italy
| | - G Costanzo
- National Institute for Health, Migration and Poverty (NIHMP), Via San Gallicano 25/a, 00153, Rome, Italy
| | - A Fortino
- National Institute for Health, Migration and Poverty (NIHMP), Via San Gallicano 25/a, 00153, Rome, Italy
| | - L Chessa
- Center for the Study of Liver Diseases, University of Cagliari, Cagliari, Italy
| | - L Miglioresi
- National Institute for Health, Migration and Poverty (NIHMP), Via San Gallicano 25/a, 00153, Rome, Italy
| | - C Mirisola
- National Institute for Health, Migration and Poverty (NIHMP), Via San Gallicano 25/a, 00153, Rome, Italy
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Molina-Cuadrado E, Mateo-Carrrasco H, Collado A, Casado Martín M. Anaemia predictors in patients with chronic hepatitis C treated with ribavirin and direct-acting antiviral agents. Eur J Hosp Pharm 2017; 25:132-137. [PMID: 31157007 DOI: 10.1136/ejhpharm-2017-001277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 04/21/2017] [Accepted: 04/25/2017] [Indexed: 01/28/2023] Open
Abstract
Objectives Anaemia is the most common side effect associated with ribavirin (RBV). This study intended to assess its incidence and determine its predictive factors in patients with hepatitis C virus on RBV plus direct-acting antiviral agents (DAAs). Methods A retrospective study of patients receiving RBV+DAA was conducted. Serum haemoglobin (Hb) was determined at baseline and monitored 4 weekly. Anaemia was defined as a single occurrence of Hb <10 g/dL. Bivariate and multivariate logistic regression analyses were conducted to assess the relationship between the occurrence of anaemia and the following factors: age, gender, FibroScan score, viral load, cirrhotic status (yes/no), RBV dose, glomerular filtration rate (GFR), alanine amino transferase, albumin, treatment duration (12 vs ≥12 weeks), baseline Hb, and Hb% drop (weeks 0-2). Results 152 patients were included, of which 15.1% experienced anaemia. The analysis revealed that estimated GFR (eGFR), baseline Hb, 12-week treatment duration and Hb% drop (weeks 0-2) were significantly associated with the likelihood of developing anaemia (p<0.05). Two mathematical models were subsequently developed to predict patients at risk of anaemia: a pretreatment model (positive predictive value 86.6%) which included eGFR, baseline Hb and 12-week treatment duration and an intratreatment model (positive predictive value of 90.48%) which in addition included the Hb% drop (weeks 0-2). Conclusion Anaemia was found to be less significant in this cohort compared with studies on RBV plus pegylated interferon, telaprevir or boceprevir combinations, but higher than those on newer DAAs. Baseline Hb, eGFR, 12-week treatment duration and Hb% drop (weeks 0-2) significantly predicted the risk of anaemia and were used to construct two predictive models.
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Affiliation(s)
| | | | - Antonio Collado
- Infectious Disease Department, Torrecárdenas University Hospital, Almería, Spain
| | - Marta Casado Martín
- Gastroenterology Department, Torrecárdenas University Hospital, Almería, Spain
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Berto A, Day J, Van Vinh Chau N, Thwaites GE, My NN, Baker S, Darton TC. Current challenges and possible solutions to improve access to care and treatment for hepatitis C infection in Vietnam: a systematic review. BMC Infect Dis 2017; 17:260. [PMID: 28399806 PMCID: PMC5387342 DOI: 10.1186/s12879-017-2360-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/29/2017] [Indexed: 12/24/2022] Open
Abstract
Background Hepatitis C infection is a major public health concern in low- and middle-income countries where an estimated 71.1 million individuals are living with chronic infection. The World Health Organization (WHO) has recently released new guidance for hepatitis C virus (HCV) treatment programs, which include improving the access to new direct-acting antiviral agents. In Vietnam, a highly populated middle-income country, the seroprevalence of HCV infection is approximately 4% and multiple genotypes co-circulate in the general population. Here we review what is currently known regarding the epidemiology of HCV in Vietnam and outline options for reducing the significant burden of morbidity and mortality in our setting. Methods We performed a systematic review of the currently available literature to evaluate what has been achieved to date with efforts to control HCV infection in Vietnam. Results This search retrieved few publications specific to Vietnam indicating a significant gap in baseline epidemiological and public health data. Key knowledge gaps identified included an understanding of the prevalence in specific high-risk groups, characterization of circulating HCV genotypes in the population and likely response to treatment, and the extent to which HCV treatment is available, accessed and utilized. Conclusions We conclude that there is an urgent need to perform up to date assessments of HCV disease burden in Vietnam, especially in high-risk groups, in whom incidence is high and cross infection with multiple genotypes is likely to be frequent. Coordinating renewed surveillance measures with forthcoming HCV treatment studies should initiate the traction required to achieve the WHO goal of eliminating HCV as a public health threat by 2030, at least in this region.
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Affiliation(s)
- Alessandra Berto
- Oxford University Clinical Research Unit, Vietnam Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
| | - Jeremy Day
- Oxford University Clinical Research Unit, Vietnam Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | | | - Guy E Thwaites
- Oxford University Clinical Research Unit, Vietnam Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Ngoc Nghiem My
- Oxford University Clinical Research Unit, Vietnam Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
| | - Stephen Baker
- Oxford University Clinical Research Unit, Vietnam Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,The London School of Hygiene and Tropical Medicine, London, UK
| | - Thomas C Darton
- Oxford University Clinical Research Unit, Vietnam Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
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Ahmad YK, Tawfeek S, Sharaf-Eldin M, Elbatea HE, Kobtan A, El-Kalla F, Badawi R, Abd-Elsalam S. Anti-Nuclear Cytoplasmic Antibody-Associated Vasculitis: A Probable Adverse Effect of Sofosbuvir Treatment in Chronic Hepatitis C Patients. Hosp Pharm 2017; 52:294-301. [PMID: 28515509 PMCID: PMC5424834 DOI: 10.1310/hpj5204-294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background: Egypt has the largest hepatitis C virus (HCV) epidemic worldwide. Sofosbuvir is an antiviral drug acting by inhibition of the HCV NS5B polymerase. It has shown high efficacy in combination with several other drugs and has a low reported rate of side effects. Objective: The aim of this prospective cohort study was to assess the safety of sofosbuvir-based treatment regimens used to treat chronic hepatitis C infections and to detect any side effects of sofosbuvir not previously reported. Methods: We studied treatment side effects in 3,000 patients with chronic HCV infection treated with sofosbuvir and ribavirin for 24 weeks or treated by pegylated interferon, sofosbuvir, and ribavirin triple therapy for 12 weeks. The endpoint of the study was the end of treatment. Results: Hyperbilirubinemia occurred frequently during treatment in both groups. Treatment was discontinued in 72 cases due to hepatic decompensation and drug complications; 8 of the cases had deep vein thrombosis (DVT) and 7 had cerebral ischemia. Surprisingly, 177/3,000 (5.9%) patients presented with abnormal bleeding, 85 of whom had a vasculitic skin rash. Conclusion: We report the occurrence of previously nonrecorded side effects with sofosbuvir, namely DVT and bleeding disorders associated with anti-nuclear cytoplasmic antibody (ANCA)-associated vasculitis (AAV).We believe this to be the first report of sofosbuvir-induced AAV skin lesions and bleeding disorders.
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Ahmad YK, Tawfeek S, Sharaf-Eldin M, Elbatea HE, Kobtan A, El-Kalla F, Badawi R, Abd-Elsalam S. Anti-Nuclear Cytoplasmic Antibody-Associated Vasculitis: A Probable Adverse Effect of Sofosbuvir Treatment in Chronic Hepatitis C Patients. Hosp Pharm 2017; 52:294-301. [DOI: 10.1310/hpx5204-294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
| | - Salwa Tawfeek
- National Research Center, Department of Internal Medicine
| | - Mohamed Sharaf-Eldin
- Tanta University, Department of Tropical Medicine and Infectious Diseases, Tanta, Egypt
| | - Hassan E. Elbatea
- Kafr El-Sheikh University, Department of Tropical Medicine and Infectious Diseases
| | - Abdelrahman Kobtan
- Tanta University, Department of Tropical Medicine and Infectious Diseases, Tanta, Egypt
| | - Ferial El-Kalla
- Tanta University, Department of Tropical Medicine and Infectious Diseases, Tanta, Egypt
| | - Rehab Badawi
- Tanta University, Department of Tropical Medicine and Infectious Diseases, Tanta, Egypt
| | - Sherief Abd-Elsalam
- Tanta University, Department of Tropical Medicine and Infectious Diseases, Tanta, Egypt
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Sood A, Midha V, Mahajan R, Narang V, Mehta V, Wander P, Sharma S, Kaur K, Singh D. Results of sofosbuvir-based combination therapy for chronic hepatitis C cohort of Indian patients in real-life clinical practice. J Gastroenterol Hepatol 2017; 32:894-900. [PMID: 27787910 DOI: 10.1111/jgh.13628] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/29/2016] [Accepted: 10/10/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIM The introduction of sofosbuvir has revolutionized the treatment of chronic hepatitis C. This study was planned to observe whether the efficacy and tolerability of sofosbuvir-based regimens demonstrated in phase 3 clinical trial results translate into real-life clinical practice. METHODS This prospective, non-randomized observational study conducted in Dayanand Medical College and Hospital, Punjab, included all consecutive treatment-naïve patients with chronic hepatitis C (genotypes 1-5) who were treated with sofosbuvir-based regimens. Response to therapy was assessed at week 4 (rapid virological response), week 12 or 24 (end of treatment response), and 12 weeks after cessation of therapy (sustained virological response [SVR]). RESULTS Of 947 patients diagnosed with chronic hepatitis C virus and considered for treatment with direct-acting antivirals, 736 patients (77.1%) opted for treatment (age 45.1 ± 10.1 years, 64% men, genotype 3 [80%], genotype 1 [14.7%], and genotype 4 [4.9%]). Viral load was high (>600 000 IU/mL) in 361/736 (49%); 330 patients (44.8%) had cirrhosis (80 [14.3%] were decompensated). Patients with genotypes 1, 4, and 5 (n = 135) were treated with triple drug regime (pegylated interferon, ribavirin, and sofosbuvir) for 12 weeks. Patients with genotype 3 (n = 589) were treated either with dual therapy (sofosbuvir and ribavirin) for 24 weeks (n = 405) or triple therapy for 12 weeks (n = 184). SVR was achieved in 453/473 (95.8%). SVR rates did not differ among different genotypes but were higher in non-cirrhotics. CONCLUSION Sofosbuvir-based treatment regimens achieve high SVR rates in real-life cohort of Indian patients with chronic hepatitis C infection (including those with cirrhosis).
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Affiliation(s)
- Ajit Sood
- Department of Gastroenterology, Dayanand Medical College, Ludhiana, Punjab, India
| | - Vandana Midha
- Department of Internal Medicine, Dayanand Medical College, Ludhiana, Punjab, India
| | - Ramit Mahajan
- Department of Gastroenterology, Dayanand Medical College, Ludhiana, Punjab, India
| | - Vikram Narang
- Department of Pathology, Dayanand Medical College, Ludhiana, Punjab, India
| | - Varun Mehta
- Department of Gastroenterology, Dayanand Medical College, Ludhiana, Punjab, India
| | | | - Suresh Sharma
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Gupta N, Kabahizi J, Mukabatsinda C, Walker TD, Musabeyezu E, Kiromera A, Van Nuil JI, Steiner K, Mukherjee J, Nsanzimana S, Mbituyumuremyi A. "Waiting for DAAs": A retrospective chart review of patients with untreated hepatitis C in Rwanda. PLoS One 2017; 12:e0174148. [PMID: 28323868 PMCID: PMC5360324 DOI: 10.1371/journal.pone.0174148] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 03/03/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Access to treatment for hepatitis C virus (HCV) in sub-Saharan Africa is extremely limited. With the advent of direct acting antivirals (DAAs), highly effective and easy-to-deliver oral regimens are now available on the global market. This study was conducted to understand the background and characteristics of a national cohort of patients with HCV infection enrolled in care and awaiting therapy with DAAs. METHODS AND FINDINGS We conducted a retrospective chart review of all adult patients with confirmed HCV infection who were currently enrolled in care and treatment at the four existing hepatitis referral centers in Rwanda. Patient charts at these centers were reviewed, and routinely collected data were recorded and analyzed. Overall, 253 patients were identified; median age was 56 years (IQR: 43, 65), and 149 (58.9%) were female. Median viral load was 688,736 IU/ml and 96.7% were HCV genotype 4. As classified by FIB-4 score, 64.8% of the patients had moderate to severe fibrosis. Fibrosis stage was associated with age (OR 1.12, CI 1.09-1.17), but not with time since diagnosis, gender, treatment center, or type of insurance. There was a low frequency of documented co-morbid conditions, including hypertension, diabetes, HIV, and hepatitis B virus. CONCLUSIONS Compared to an estimated 55,000 patients eligible for HCV treatment in Rwanda, this study identified only 253 patients currently diagnosed and engaged in care, highlighting an immense treatment gap in HCV, likely due to the lack of accessible and affordable screening, diagnostic, and treatment modalities. The patients that were enrolled in care had a disproportionately advanced fibrosis stage, possibly indicating late presentation to care or lack of treatment options. In the context of newly available and effective treatment options, this study supports the overall need to accelerate access to HCV screening, diagnostics, and care and treatment services in resource-limited settings in sub-Saharan Africa.
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Affiliation(s)
- Neil Gupta
- Division of Global Health Equity, Brigham & Women’s Hospital, Boston, Massachusetts, United States of America
- Partners In Health / Inshuti Mu Buzima, Rwinkwavu, Rwanda
| | | | | | | | | | | | | | - Kevin Steiner
- Division of Global Health Equity, Brigham & Women’s Hospital, Boston, Massachusetts, United States of America
| | - Joia Mukherjee
- Division of Global Health Equity, Brigham & Women’s Hospital, Boston, Massachusetts, United States of America
- Partners In Health / Inshuti Mu Buzima, Rwinkwavu, Rwanda
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Burstow NJ, Mohamed Z, Gomaa AI, Sonderup MW, Cook NA, Waked I, Spearman CW, Taylor-Robinson SD. Hepatitis C treatment: where are we now? Int J Gen Med 2017; 10:39-52. [PMID: 28255252 PMCID: PMC5322849 DOI: 10.2147/ijgm.s127689] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Chronic hepatitis C infection affects millions of people worldwide and confers significant morbidity and mortality. Effective treatment is needed to prevent disease progression and associated complications. Previous treatment options were limited to interferon and ribavirin (RBV) regimens, which gave low cure rates and were associated with unpleasant side effects. The era of direct-acting antiviral (DAA) therapies began with the development of first-generation NS3/4A protease inhibitors in 2011. They vastly improved outcomes for patients, particularly those with genotype 1 infection, the most prevalent genotype globally. Since then, a multitude of DAAs have been licensed for use, and outcomes for patients have improved further, with fewer side effects and cure rates approaching 100%. Recent regimens are interferon-free, and in many cases, RBV-free, and involve a combination of DAA agents. This review summarizes the treatment options currently available and discusses potential barriers that may delay the global eradication of hepatitis C.
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Affiliation(s)
- Nicholas J Burstow
- Liver Unit, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Zameer Mohamed
- Liver Unit, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Asmaa I Gomaa
- National Liver Institute, Menoufiya University, Shbeen El Kom, Egypt
| | - Mark W Sonderup
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, Republic of South Africa
| | - Nicola A Cook
- Liver Unit, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Imam Waked
- National Liver Institute, Menoufiya University, Shbeen El Kom, Egypt
| | - C Wendy Spearman
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, Republic of South Africa
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Young J, Weis N, Hofer H, Irving W, Weiland O, Giostra E, Pascasio JM, Castells L, Prieto M, Postema R, Lefevre C, Evans D, Bucher HC, Calleja JL. The effectiveness of daclatasvir based therapy in European patients with chronic hepatitis C and advanced liver disease. BMC Infect Dis 2017; 17:45. [PMID: 28061762 PMCID: PMC5219681 DOI: 10.1186/s12879-016-2106-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 12/10/2016] [Indexed: 12/13/2022] Open
Abstract
Background There is limited evidence for the effectiveness of daclatasvir in patients whose hepatitis C threatens their life expectancy. The Named Patient Program in Europe included patients with advanced chronic hepatitis C, a life expectancy of less than 12 months and no other treatment options. Methods A retrospective multi-country cohort of patients with chronic hepatitis C who received daclatasvir as part of the Named Patient Program in Austria, Denmark, Spain, Sweden, Switzerland and the United Kingdom. Treatment response was defined as a sustained virologic response (unquantifiable hepatitis C RNA) at 12 weeks post treatment. We summarised the characteristics of the patients in this cohort and estimated the rate of sustained virologic response for patients receiving daclatasvir and sofosbuvir with or without ribavirin using hierarchical Bayesian modelling. Results The 249 patients included had a median age of 56 years; most were male (78%), hepatitis C genotype 1 (75%), treatment experienced (65%) and with decompensated cirrhosis (59%). Many had had a liver transplant before receiving daclatasvir (40%). Of the 249 patients, 242 patients received daclatasvir and sofosbuvir and either reached 12 weeks post treatment or died during (n = 9) or after treatment (n = 4) or were lost to follow up during treatment (n = 1). The estimated rate of sustained virologic response at 12 weeks post treatment was 87% (95% credible interval 75 to 94%) for previously treated genotype 1 patients with decompensated cirrhosis. Conclusions Daclatasvir with sofosbuvir is an effective treatment in clinical practice for hepatitis C genotype 1 patients with decompensated cirrhosis. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-2106-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jim Young
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Spitalstrasse 12, CH-4031, Basel, Switzerland.
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - Harald Hofer
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - William Irving
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, University of Nottingham, Nottingham, UK
| | - Ola Weiland
- Division of Infectious Diseases, Department of Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Emiliano Giostra
- Service de Gastroentérologie et Hépatologie, Hôpitaux universitaires de Genève, Geneva, Switzerland
| | | | - Lluis Castells
- Liver Unit, Internal Medicine Department, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - Martin Prieto
- Hepatology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Roelien Postema
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb, Uxbridge, United Kingdom
| | - Cinira Lefevre
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb, Rueil-Malmaison, France
| | - David Evans
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb, Rueil-Malmaison, France
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Spitalstrasse 12, CH-4031, Basel, Switzerland
| | - Jose Luis Calleja
- Liver Unit, Hospital Universitario Puerta de Hierro, Universidad Autonoma de Madrid, Madrid, Spain
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Asselah T, Moreno C, Sarrazin C, Gschwantler M, Foster GR, Craxí A, Buggisch P, Sanai F, Bicer C, Lenz O, Van Dooren G, Nalpas C, Lonjon-Domanec I, Schlag M, Buti M. Efficacy of a 12-Week Simeprevir Plus Peginterferon/Ribavirin (PR) Regimen in Treatment-Naïve Patients with Hepatitis C Virus (HCV) Genotype 4 (GT4) Infection and Mild-To-Moderate Fibrosis Displaying Early On-Treatment Virologic Response. PLoS One 2017; 12:e0168713. [PMID: 28056030 PMCID: PMC5215882 DOI: 10.1371/journal.pone.0168713] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/25/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND HCV GT4 accounts for up to 20% of HCV infections worldwide. Simeprevir, given for 12 weeks as part of a 24- or 48-week combination regimen with PR is approved for the treatment of chronic HCV GT4 infection. Primary study objectives were assessment of efficacy and safety of simeprevir plus PR in treatment-naïve patients with HCV GT4 treated for 12 weeks. Primary efficacy outcome was sustained virologic response 12 weeks post-treatment (SVR12). Additional objectives included investigation of potential associations of rapid virologic response and baseline factors with SVR12. METHODS This multicentre, open-label, single-arm study (NCT01846832) evaluated efficacy and safety of simeprevir plus PR in 67 patients with HCV GT4 infection. Patients were treatment-naïve, aged 18-70 years with METAVIR F0-F2 fibrosis. Patients with early virologic response (HCV RNA <25 IU/mL [detectable/undetectable in IL28B CC patients or undetectable in IL28B CT/TT patients] at Week 2 and undetectable at Weeks 4 and 8) were eligible to stop all treatment at the end of Week 12, otherwise PR therapy was continued to Week 24. RESULTS Of 67 patients treated, 34 (51%) qualified for 12-week treatment including all but one patient with IL28B CC genotype (14/15). All patients in the 12-week group had undetectable HCV RNA at end of treatment, and 97% (33/34) achieved SVR12. No new safety signals with simeprevir plus PR were identified. The proportion of patients experiencing Grade 3-4 adverse events was lower in the 12-week group than in the 24-week group. CONCLUSIONS Our findings on simeprevir plus PR therapy shortened to 12 weeks in patients with HCV GT4 infection with favourable baseline characteristics and displaying early on-treatment virologic response are encouraging. No new safety signals were associated with simeprevir plus PR in this study. TRIAL REGISTRATION NCT01846832.
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Affiliation(s)
- Tarik Asselah
- Hepatology Department, Beaujon Hospital, University of Paris, Paris, France
| | - Christophe Moreno
- CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Christoph Sarrazin
- Johann Wolfgang Goethe University Hospital, Medizinische Klinik 1, Frankfurt am Main, Germany
| | | | - Graham R. Foster
- Queen Mary Hospital, University of London, Barts Health, London, United Kingdom
| | - Antonio Craxí
- Sezione di Gastroenterologia & Epatologia, Di.Bi.M.I.S., University of Palermo, Palermo, Italy
| | - Peter Buggisch
- Institute for Interdisciplinary Medicine at the Asklepios Klinik St. Georg, Hamburg, Germany
| | - Faisal Sanai
- Division of Gastroenterology, Department of Medicine, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Ceyhun Bicer
- Janssen Infectious Diseases BVBA, Beerse, Belgium
| | - Oliver Lenz
- Janssen Infectious Diseases BVBA, Beerse, Belgium
| | | | | | | | | | - Maria Buti
- Liver Unit, Hospital Valle Hebron and Ciberehd del Institut Carlos III, Barcelona, Spain
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Gheith O, Halim MA, Othman N, Al-Otaibi T, Nair P, Nampoory N. Hepatitis C Virus in the Renal Transplant Population: An Update With Focus on the New Era of Antiviral Regimens. EXP CLIN TRANSPLANT 2016; 15:10-20. [PMID: 27915966 DOI: 10.6002/ect.2015.0341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Chronic hepatitis C virus infection is a global health problem, especially among renal transplant recipients. Herein, we present an overview of hepatitis C virus among renal transplant patients, with a focus on some updated aspects concerning types of viral genotypes, methods of diagnosis, the effects of renal transplant on hepatitis C virus infection, and summary of hepatitis C virus-related complications after renal transplant. We also discuss patient and graft survival rates and the present and future therapeutic options with special focus on new antiviral and possible interactions with immunosuppressive medications.
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Affiliation(s)
- Osama Gheith
- From the Urology and Nephrology Center, Mansoura University, Mansoura, Egypt; and the Hamed Al-Essa Organ Transplant Center, Kuwait
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Hashem MB, Elbaz T, El-kassas M, Esmat G. Management of Hepatitis C Virus—Genotypes 4, 5, and 6 Using Direct Antiviral Agents: Review of Current Status. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2016. [DOI: 10.1007/s40506-016-0094-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Shah SR, Rao PN, Sarin SK, Chowdhury A, Bhatia S, Dharamsi R, Goswami BD, Kapoor D, Luaia R, Mehta R, Mukewar S, Prasad VGM, Rai RR, Saigal S, Singh D, Trehanpati N, Chen S, Gaggar A, Knox SJ, Subramanian GM, Singh SP, Sood A, Varghese J, Venugopal RV. Chronic hepatitis C virus infection in India: Regional demographics and distribution of viral genotypes. Indian J Gastroenterol 2016; 35:469-477. [PMID: 27844277 DOI: 10.1007/s12664-016-0709-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 10/11/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Although chronic hepatitis C virus (HCV) infection affects millions of people in India, few studies have assessed host, viral, and disease characteristics of chronically infected patients at national and regional levels. Such information is critical to support large scale screening and treatment initiatives for chronic HCV infection in India. METHODS Patients with known chronic HCV infection making routine or for-cause visits to the participating study centers were enrolled in this observational study. Patients attended a single outpatient visit during which demographics and medical history were collected, a physical examination was performed, and blood and urine samples were collected for laboratory assessments. Samples were analyzed to determine HCV genotypes and subtypes, and genotypes of interferon lambda 3 (IFNL3) single nucleotide polymorphism. No therapeutic interventions were administered. RESULTS We enrolled 500 patients at 19 centers, categorized into four geographic regions (North, South, East, and West). All patients self-identified as Indian, and most (66 %) were male. Genotype 3 was the most common genotype overall (54 %); however, its prevalence varied greatly by region, ranging from 34 % in the South to 69 % in the East. Genotypes 1 (24 %) and 4 (6 %) were the next most common, and HCV genotype could not be determined for 16 % of patients. CONCLUSIONS This prospective survey suggests that demographics, viral, and host factors in patients with chronic HCV infection are highly variable in India and pose significant challenges for the implementation of broad-scale screening and treatment initiatives.
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Affiliation(s)
- Samir R Shah
- Global Hospitals, 35, Dr. E Borges Road, Parel, Mumbai, 400 012, India.
| | - P N Rao
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India
| | - Shiv K Sarin
- Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, Delhi, 110 070, India
| | - Abhijit Chowdhury
- Institute of Post Graduate Medical Education and Research, 244 A.J.C Bose Road, Kolkata, 700 020, India
| | - Shobna Bhatia
- Seth GS Medical College and KEM Hospital, Acharya Donde Marg, Parel, Mumbai, 400 012, India
| | - Rajesh Dharamsi
- Dharamsi Hospital, Chandni Chowk, South Shivaji Nagar, Nishant Colony, Sangli, 416 416, India
| | - B D Goswami
- Institute of Digestive and Liver Disease, Guwahati, Assam, India
| | | | - Rosang Luaia
- Civil Hospital, Dawrpui, Aizawl, Mizoram, 796 001, India
| | - Rajiv Mehta
- Liver Clinic, U-9 Jolly Plaza, Athwagate, Surat, 395 001, India
| | - Shrikant Mukewar
- Midas Institute of Gastroenterology, Midas Heights, Central Bazar Road, Ramdas Peth, Ramdaspeth, Nagpur, 440 012, India
| | - V G Mohan Prasad
- VGM Hospital, 2100, Trichy Road, Singanallur, Coimbatore, 641 005, India
| | - Ramesh Roop Rai
- Rai Speciality Care Centre, H-6, Janpath, Shyam Nagar, Ajmer Road, Sodala, Jaipur, 302 019, India
| | - Sanjiv Saigal
- Medanta-The Medicity, Sector 38, Gurgaon, Delhi (NCR), 122 018, India
| | | | - Nirupama Trehanpati
- Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, Delhi, 110 070, India
| | - Sandra Chen
- Gilead Sciences, 333 Lakeside Dr, Foster City, CA, 94404, USA
| | - Anuj Gaggar
- Gilead Sciences, 333 Lakeside Dr, Foster City, CA, 94404, USA
| | - Steven J Knox
- Gilead Sciences, 333 Lakeside Dr, Foster City, CA, 94404, USA
| | | | - Shivaram Prasad Singh
- Department of Gastroenterology, S.C.B. Medical College, Manglabag, Cuttack, 753 007, India
| | - Ajit Sood
- Dayanand Medical College and Hospital, Tagore Nagar, Civil Lines, Ludhiana, 141 001, India
| | - Joy Varghese
- Global Hospitals and Health City, 439, Cheran Nagar, Perumbakkam, Chennai, 600 100, India
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Abergel A, Metivier S, Samuel D, Jiang D, Kersey K, Pang PS, Svarovskaia E, Knox SJ, Loustaud-Ratti V, Asselah T. Ledipasvir plus sofosbuvir for 12 weeks in patients with hepatitis C genotype 4 infection. Hepatology 2016; 64:1049-56. [PMID: 27351341 DOI: 10.1002/hep.28706] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 06/13/2016] [Accepted: 06/15/2016] [Indexed: 12/15/2022]
Abstract
UNLABELLED Genotype 4 hepatitis C virus (HCV) was considered difficult to treat in the era of pegylated interferon-alpha (Peg-IFN-α) and ribavirin regimens. We evaluated the efficacy and safety of therapy with the nonstructural (NS) 5A inhibitor, ledipasvir, combined with the NS5B polymerase inhibitor, sofosbuvir, in patients with HCV genotype 4. In this phase 2, open-label study, 44 patients (22 treatment naïve and 22 treatment experienced) received a fixed-dose combination tablet of 90 mg of ledipasvir and 400 mg of sofosbuvir orally once-daily for 12 weeks. The primary endpoint was the percentage of patients with HCV RNA <15 IU/mL 12 weeks after stopping therapy (SVR12). Among study participants, HCV genotype 4 subtypes were well represented (4a, n = 25; 4d, n = 10; other subtypes, n = 9). Ten patients (23%) had compensated cirrhosis. Of the 22 treatment-experienced patients, 21 (95%) had a non-CC IL-28B genotype. All 44 patients completed the full 12 weeks of dosing. The SVR12 rate was 93% (41 of 44; 95% confidence interval, 81-99). SVR12 rates were similar between treatment-naïve (95%; 21 of 22) and treatment-experienced (91%; 20 of 22) patients. All 3 patients who did not achieve SVR12 had virological relapse within 4 weeks of the end of treatment; all 3 had baseline HCV RNA ≥800,000 IU/mL, a non-CC IL-28B genotype, and pretreatment NS5A resistance-associated variants. None of the patients who relapsed had cirrhosis. The most common adverse events were asthenia, headache, and fatigue. No patients experienced a serious adverse event. CONCLUSION The all-oral regimen of ledipasvir and sofosbuvir is an effective and safe treatment for a wide range of HCV 4 subtypes in both treatment-naïve and -experienced patients, including those with compensated cirrhosis. (EudraCT number: 2013-003978-27; Clinicaltrials.gov NCT02081079) (Hepatology 2016;64:1049-1056).
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Affiliation(s)
- Armand Abergel
- Department of Hepatology and Gastroenterology, Centre Hospitalier Universitaire Estaing, Université d'Auvergne, UMR CNRS 6284, Clermont-Ferrand, France.
| | - Sophie Metivier
- Department of Hepatology and Gastroenterology, Centre Hospitalier Universitaire Purpan, Toulouse, France
| | - Didier Samuel
- Centre Hépato-Biliaire, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, UMR-S 1193, Université Paris-Sud, INSERM U785, Villejuif, France
| | | | | | | | | | | | - Veronique Loustaud-Ratti
- Department of Hepatology and Gastroenterology, Centre Hospitalier Universitaire Limoges, U850 INSERM, Université de Limoges, Limoges, France
| | - Tarik Asselah
- Department of Hepatology, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université Paris-Diderot and INSERM UMR1149, Clichy, France
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Arends J, Kracht P, Hoepelman A. Performance of hepatitis C virus (HCV) direct-acting antivirals in clinical trials and daily practice. Clin Microbiol Infect 2016; 22:846-852. [DOI: 10.1016/j.cmi.2016.05.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/12/2016] [Accepted: 05/28/2016] [Indexed: 02/06/2023]
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Dey D, Banerjee M. Inhibitor-Based Therapeutics for Treatment of Viral Hepatitis. J Clin Transl Hepatol 2016; 4:248-257. [PMID: 27777893 PMCID: PMC5075008 DOI: 10.14218/jcth.2016.00025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/14/2016] [Accepted: 09/14/2016] [Indexed: 12/12/2022] Open
Abstract
Viral hepatitis remains a significant worldwide threat, in spite of the availability of several successful therapeutic and vaccination strategies. Complications associated with acute and chronic infections, such as liver failure, cirrhosis and hepatocellular carcinoma, are the cause of considerable morbidity and mortality. Given the significant burden on the healthcare system caused by viral hepatitis, it is essential that novel, more effective therapeutics be developed. The present review attempts to summarize the current treatments against viral hepatitis, and provides an outline for upcoming, promising new therapeutics. Development of novel therapeutics requires an understanding of the viral life cycles and viral effectors in molecular detail. As such, this review also discusses virally-encoded effectors, found to be essential for virus survival and replication in the host milieu, which may be utilized as potential candidates for development of alternative therapies in the future.
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Affiliation(s)
- Debajit Dey
- Kusuma School of Biological Sciences, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, India
| | - Manidipa Banerjee
- Kusuma School of Biological Sciences, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, India
- *Correspondence to: Dr. Manidipa Banerjee, Kusuma School of Biological Sciences, Indian Institute of Technology Delhi, Block 1A, Hauz Khas, New Delhi 110016, India. Tel: +91-11-26597538, Fax: +91-11-26597530, E-mail:
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Ezzikouri S, Jadid FZ, Hamdi S, Wakrim L, Tsukiyama-Kohara K, Benjelloun S. Supplementing Conventional Treatment with Pycnogenol® May Improve Hepatitis C Virus-Associated Type 2 Diabetes: A Mini Review. J Clin Transl Hepatol 2016; 4:228-233. [PMID: 27777890 PMCID: PMC5075005 DOI: 10.14218/jcth.2016.00021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 06/20/2016] [Accepted: 07/07/2016] [Indexed: 12/20/2022] Open
Abstract
Hepatitis C virus (HCV) infection and type 2 diabetes mellitus (T2DM) present a significant health burden, with increasing complications and mortality rates worldwide. Pycnogenol® (PYC), a natural product, possesses antidiabetic and antiviral properties that may improve HCV-associated T2DM. In this review, we present previously published data on the effectiveness of PYC against HCV replication and T2DM. We believe that supplementing conventional treatment with PYC may improve the current HCV therapy, attenuate HCV-associated T2DM, and reduce the risk of complications such as cirrhosis or hepatocellular carcinoma and cardiovascular disease.
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Affiliation(s)
- Sayeh Ezzikouri
- Virology Unit, Viral Hepatitis Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco
- *Correspondence to: Sayeh Ezzikouri, Viral Hepatitis Laboratory, Institut Pasteur du Maroc, 1 Place Louis Pasteur, Casablanca 20360, Morocco. Tel: +212-5-27016076, +212-5-22434450, Fax: +212-5-22260957, E-mail:
| | - Fatima Zahra Jadid
- Virology Unit, Viral Hepatitis Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Salsabil Hamdi
- Virology Unit, Viral Hepatitis Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Lahcen Wakrim
- Virology Unit, Immunovirology Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Kyoko Tsukiyama-Kohara
- Laboratory of Animal Hygiene, Joint Faculty of Veterinary Medicine, Kagoshima University, Kagoshima, Japan
- Transboundary Animal Diseases Centre, Joint Faculty of Veterinary Medicine, Kagoshima University, Kagoshima, Japan
| | - Soumaya Benjelloun
- Virology Unit, Viral Hepatitis Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco
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Changing Epidemiology of Hepatitis C Virus Genotype among Patients with Human Immunodeficiency Virus/Hepatitis C Virus Co-Infection in China. PLoS One 2016; 11:e0161844. [PMID: 27603929 PMCID: PMC5014309 DOI: 10.1371/journal.pone.0161844] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 08/12/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Co-infection with hepatitis C virus (HCV) has become the most common cause of death in human immunodeficiency virus (HIV) infected patients on antiretroviral therapy. The distribution of HCV genotypes varies with geographical regions and time, and limited studies have focused on the HCV genotype in HIV/HCV co-infection. METHODS The distribution of HCV genotypes was evaluated in 414 patients with HIV/HCV co-infection in three regions (South, Central and Northwest) of China from 2008 to 2010. The NS5B region of HCV was characterized using nested reverse transcription polymerase chain reaction. Nucleotide sequences obtained were subjected to phylogenetic analysis, and genotypes were assigned using published reference genotypes. RESULTS Genotype 3 was the most prevalent HCV strain (36.2%), followed by genotype 6 (30.0%), genotype 1 (28.5%), genotype 2 (5.1%), and genotype 5 (0.2%). The distribution varied geographically. Genotype 6 (37.6%) was the predominant strain while genotype 1 (20.2%) was less common in the South compared to the Central and Northwest regions (all P < 0.001). The distribution also varied temporally. There was no significant difference in genotype distribution in Guangdong (a province in the South region), between patient cohorts from 2005-2008 and 2009-2010. However, outside Guangdong, genotypes 3 and 6a became significantly more prevalent (22.4% vs.42.2%, P< 0.001; 8.0% vs. 19.8%, P = 0.004), and genotype 1 less prevalent (54.4% vs.26.6%, P< 0.001) over time. CONCLUSION The most dramatic shift in genotypic distribution was the movement of HCV genotypes 3 and 6a outside of Guangdong in HIV/HCV co-infected patients. This movement appeared closely associated with transmission via injected drug use.
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3D-QSAR study and design of 4-hydroxyamino α-pyranone carboxamide analogues as potential anti-HCV agents. Chem Phys Lett 2016. [DOI: 10.1016/j.cplett.2016.08.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Win NN, Kanda T, Nakamoto S, Yokosuka O, Shirasawa H. Hepatitis C virus genotypes in Myanmar. World J Gastroenterol 2016; 22:6095-6099. [PMID: 27468202 PMCID: PMC4945971 DOI: 10.3748/wjg.v22.i27.6095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 05/23/2016] [Accepted: 06/13/2016] [Indexed: 02/06/2023] Open
Abstract
Myanmar is adjacent to India, Bangladesh, Thailand, Laos and China. In Myanmar, the prevalence of hepatitis C virus (HCV) infection is 2%, and HCV infection accounts for 25% of hepatocellular carcinoma. In this study, we reviewed the prevalence of HCV genotypes in Myanmar. HCV genotypes 1, 3 and 6 were observed in volunteer blood donors in and around the Myanmar city of Yangon. Although there are several reports of HCV genotype 6 and its variants in Myanmar, the distribution of the HCV genotypes has not been well documented in areas other than Yangon. Previous studies showed that treatment with peginterferon and a weight-based dose of ribavirin for 24 or 48 wk could lead to an 80%-100% sustained virological response (SVR) rates in Myanmar. Current interferon-free treatments could lead to higher SVR rates (90%-95%) in patients infected with almost all HCV genotypes other than HCV genotype 3. In an era of heavy reliance on direct-acting antivirals against HCV, there is an increasing need to measure HCV genotypes, and this need will also increase specifically in Myanmar. Current available information of HCV genotypes were mostly from Yangon and other countries than Myanmar. The prevalence of HCV genotypes in Myanmar should be determined.
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Hepatitis C Virus Genotype 1 to 6 Protease Inhibitor Escape Variants: In Vitro Selection, Fitness, and Resistance Patterns in the Context of the Infectious Viral Life Cycle. Antimicrob Agents Chemother 2016; 60:3563-78. [PMID: 27021330 DOI: 10.1128/aac.02929-15] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 03/21/2016] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) NS3 protease inhibitors (PIs) are important components of novel HCV therapy regimens. Studies of PI resistance initially focused on genotype 1. Therefore, knowledge about the determinants of PI resistance for the highly prevalent genotypes 2 to 6 remains limited. Using Huh7.5 cell culture-infectious HCV recombinants with genotype 1 to 6 NS3 protease, we identified protease positions 54, 155, and 156 as hot spots for the selection of resistance substitutions under treatment with the first licensed PIs, telaprevir and boceprevir. Treatment of a genotype 2 isolate with the newer PIs vaniprevir, faldaprevir, simeprevir, grazoprevir, paritaprevir, and deldeprevir identified positions 156 and 168 as hot spots for resistance; the Y56H substitution emerged for three newer PIs. Substitution selection also depended on the specific recombinant. The substitutions identified conferred cross-resistance to several PIs; however, most substitutions selected under telaprevir or boceprevir treatment conferred less resistance to certain newer PIs. In a single-cycle production assay, across genotypes, PI treatment primarily decreased viral replication, which was rescued by PI resistance substitutions. The substitutions identified resulted in differential effects on viral fitness, depending on the original recombinant and the substitution. Across genotypes, fitness impairment induced by resistance substitutions was due primarily to decreased replication. Most combinations of substitutions that were identified increased resistance or fitness. Combinations of resistance substitutions with fitness-compensating substitutions either rescued replication or compensated for decreased replication by increasing assembly. This comprehensive study provides insight into the selection patterns and effects of PI resistance substitutions for HCV genotypes 1 to 6 in the context of the infectious viral life cycle, which is of interest for clinical and virological HCV research.
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Souii A, Elargoubi A, Fallecker C, Mastouri M, Drouet E. Hepatitis C Genotype Prevalence in Monastir Region, Tunisia: Correlation between 5' Untranslated Region (5'UTR), Non-structural 5B (NS5B), and Core Sequences in HCV Subtyping. Curr Microbiol 2016; 73:324-334. [PMID: 27189386 DOI: 10.1007/s00284-016-1064-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 05/07/2016] [Indexed: 12/23/2022]
Abstract
Hepatitis C virus (HCV) is a causative agent of chronic liver disease, cirrhosis, and hepatocellular carcinoma. It constitutes a major public health around the world. There is no vaccine available against HCV, and current therapies are effective in only small percentage of patients. HCV has wide population-specific genotype variability. Genotype knowledge and viral load assessment are equally important for designing therapeutic strategies. Taking into account that the molecular epidemiology of HCV variants circulating in Tunisia is not yet well elucidated, and that, at present, little is known about the distribution pattern of HCV in Monastir region (Tunisia), we aimed, herein, to evaluate the prevalence of HCV genotypes in Monastir and to identify risk-related factors. For this purpose, 50 anti-HCV antibody-positive cases were diagnosed and subjected to viral RNA extraction, amplification, genotyping, and viral load quantification. Molecular epidemiology was studied by 5' untranslated region (5' UTR) sequencing as compared with the non-structural 5B (NS5B) and core region sequences. Overall concordance between 5' UTR, core, and NS5B sequencing was 100 %. The highest prevalent genotype was 1b (50 %) followed by genotypes 1a (16 %), 4a (12 %), 2a (10 %), 2c (8 %), and 3a (4 %). Interestingly, the subtype 1b had a statistically significant higher viral load than the other genotypes followed by subtype 1a. Based on these data, this study revealed a high prevalence of HCV genotype 1 (subtypes 1b and 1a) compared to other genotypes. A continued monitoring of HCV and knowledge of circulating genotypes could impact on future vaccine formulations.
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Affiliation(s)
- Amira Souii
- Department of Biotechnology, Higher Institute of Applied Biological Sciences of Tunis, University of Tunis El Manar, 09 Sreet Zouhair Essafi, 1006, Tunis, Tunisia.
| | - Aida Elargoubi
- Laboratory of Microbiology of the University Hospital Center Fattouma Bourguiba of Monastir, Avenue Farhat HACHED, 5000, Monastir, Tunisia
| | - Catherine Fallecker
- Institute of Structural Biology (Ibs), University Grenoble Alpes, CEA, CNRS, 38044 Grenoble, Street of Martyrs, 38042, Grenoble, France
| | - Maha Mastouri
- Laboratory of Microbiology of the University Hospital Center Fattouma Bourguiba of Monastir, Avenue Farhat HACHED, 5000, Monastir, Tunisia.,Laboratory of Contagious Diseases and Biologically Active Substances, LR99 - ES27, Faculty of Pharmacy, University of Monastir, Avicenne Street, 5000, Monastir, Tunisia
| | - Emmanuel Drouet
- Institute of Structural Biology (Ibs), University Grenoble Alpes, CEA, CNRS, 38044 Grenoble, Street of Martyrs, 38042, Grenoble, France
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Wu D, Fu X, Wen Y, Liu B, Deng Z, Dai L, Tan D. High-resolution melting combines with Bayes discriminant analysis: a novel hepatitis C virus genotyping method. Clin Exp Med 2016; 17:325-332. [PMID: 27178340 DOI: 10.1007/s10238-016-0424-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/30/2016] [Indexed: 01/06/2023]
Abstract
Current hepatitis C virus (HCV) genotyping techniques are often highly technical, costly, or need improvements in sensitivity and specificity. These limitations indicate the need of novel methods for HCV genotyping. The present study aimed to develop a novel genotyping method combining high-resolution melting (HRM) analysis with Bayes discriminant analysis (BDA). Target gene fragment including 5'-untranslated and core region was selected. Four or five inner amplicons for every serum were amplified using nested PCR, HRM was used to determine the melting temperature of the amplicons, and HCV genotypes were then analyzed utilizing BDA. In initial genotyping (HCV genotypes were classified into 1b, 2a, 3a, 3b, and 6a), both the overall accuracy rate and the cross-validation accuracy rate were 92.6 %, external validation accuracy rate was 95.0 %. To enhance the accuracy rate of genotyping, HCV genotypes were firstly classified into 1b, 3a, 3b, and 2a-6a, followed by a supplementary genotyping for 2a-6a. Both the overall accuracy rate and the cross-validation accuracy rate reached 97.5 %, and external validation accuracy rate was 100 %. Comparing adjusted HRM genotyping with type-specific probe technique, the difference in accuracy rates was not significant. However, the limit of detection and cost were lower for HRM. Comparing with sequencing, the limit detection of HRM was the same as the former, but the cost of HRM was lower. Hence, HRM combined with BDA was a novel method that equipped with superior accuracy, high sensitivity, and lower cost and therefore could be a better technique for HCV genotyping.
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Affiliation(s)
- Daxian Wu
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Key Laboratory of Viral Hepatitis of Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan Province, China.,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University, Hangzhou, 310002, China
| | - Xiaoyu Fu
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Key Laboratory of Viral Hepatitis of Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
| | - Ya Wen
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Key Laboratory of Viral Hepatitis of Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
| | - Bingjie Liu
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Key Laboratory of Viral Hepatitis of Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan Province, China
| | - Zhongping Deng
- Sansure Biotechnology Corporation, Changsha, Hunan, 410205, China
| | - Lizhong Dai
- Sansure Biotechnology Corporation, Changsha, Hunan, 410205, China
| | - Deming Tan
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Key Laboratory of Viral Hepatitis of Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan Province, China.
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Zopf S, Kremer AE, Neurath MF, Siebler J. Advances in hepatitis C therapy: What is the current state - what come's next? World J Hepatol 2016; 8:139-47. [PMID: 26839638 PMCID: PMC4724577 DOI: 10.4254/wjh.v8.i3.139] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 12/15/2015] [Accepted: 01/05/2016] [Indexed: 02/06/2023] Open
Abstract
Chronic hepatitis C virus (HCV) infection affects 80-160 million people worldwide and is one of the leading causes of chronic liver disease. It is only a few years ago that standard treatment regimes were based on pegylated interferon alpha and ribavirin. However, treatment of HCV has undergone a revolutionary change in recent years. The admission of the nucleotide polymerase inhibitor Sofosbuvir enabled an interferon-free regimen with direct antiviral agents (DAA). Meanwhile seven DAAs are available and can be applied in several combinations for 8 to 24 wk depending on HCV genotype and patient characteristics such as cirrhosis and chronic renal failure. High rates of sustained virological response (SVR) rates can be achieved with these novel drugs. Even in difficult to treat populations such as patients with liver cirrhosis, HCV-human immunodeficiency virus co-infections, after liver transplantion, or with chronic kidney disease comparable high rates of SVR can be achieved. The anticipated 2(nd) generation DAAs are strikingly effective in patients so far classified as difficult to treat including decompensated liver cirrhosis or post-transplant patients. These 2(nd) generations DAAs will have higher resistance barriers, higher antiviral effects and a pan-genotypic spectrum. This review highlights the current state of the art of antiviral treatment in hepatitis C and gives an outlook for upcoming therapies.
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Affiliation(s)
- Steffen Zopf
- Steffen Zopf, Andreas E Kremer, Markus F Neurath, Juergen Siebler, Medical Department 1, University of Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Andreas E Kremer
- Steffen Zopf, Andreas E Kremer, Markus F Neurath, Juergen Siebler, Medical Department 1, University of Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Markus F Neurath
- Steffen Zopf, Andreas E Kremer, Markus F Neurath, Juergen Siebler, Medical Department 1, University of Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Juergen Siebler
- Steffen Zopf, Andreas E Kremer, Markus F Neurath, Juergen Siebler, Medical Department 1, University of Erlangen-Nuremberg, 91054 Erlangen, Germany
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Knobler H, Malnick S. Hepatitis C and insulin action: An intimate relationship. World J Hepatol 2016; 8:131-138. [PMID: 26807209 PMCID: PMC4716529 DOI: 10.4254/wjh.v8.i2.131] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 10/02/2015] [Accepted: 01/04/2016] [Indexed: 02/06/2023] Open
Abstract
Chronic hepatitis C virus (HCV) infection has been shown to be linked to a higher prevalence of type 2 diabetes compared with the general population or with patients with chronic hepatitis B infection and diabetes is the most common extra-hepatic manifestation of HCV. The HCV-diabetes association is due to insulin resistance (IR) that occurs early in the course of the disease even in patients without or with minimal fibrosis. The mechanisms for HCV-induced IR are only partly understood and include a direct inhibitory effect of HCV on insulin signaling pathway. IR in chronic HCV results in an increased progression rate of hepatic fibrosis, cirrhosis and hepatocellular carcinoma. Some but not all studies found that IR reduces the response rate to interferon/ribavirin therapy. Whether IR affects the response to the new direct-acting antiviral treatments is still unknown.
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Altindis M, Dal T, Akyar I, Karatuna O, Gokahmetoglu S, Ulger ST, Kulah C, Uzun B, Şener AG, Ozdemir M, Aydogan S, Kuskucu MA, Midilli K, Otlu B, Celen MK, Buruk K, Guducuoglu H. Six-year distribution pattern of hepatitis C virus in Turkey: a multicentre study. BIOTECHNOL BIOTEC EQ 2015. [DOI: 10.1080/13102818.2015.1093430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Lasfar A, Zloza A, Cohen-Solal KA. IFN-lambda therapy: current status and future perspectives. Drug Discov Today 2015; 21:167-171. [PMID: 26552337 DOI: 10.1016/j.drudis.2015.10.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/02/2015] [Accepted: 10/30/2015] [Indexed: 12/12/2022]
Abstract
Interferon-lambda (IFN-λ), the most recently described type III IFN, plays a crucial part by acting on specific cell types, controlling viral infections and establishing robust innate immunity against cancer. In contrast to IFN-α or IFN-γ, IFN-λ has a restricted cell response pattern, which could make this new IFN a better choice for disease targeting and reducing adverse events. Although IFN-λ is considered to have pivotal roles in cancer, viral infections and autoimmune diseases, clinical trials have only been conducted for treatment of chronic hepatitis C virus infection. In this review, we discuss the current and the potential clinical applications of IFN-λ in the context of current IFN therapy.
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Affiliation(s)
- Ahmed Lasfar
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers, State University of New Jersey, Piscataway, NJ, USA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
| | - Andrew Zloza
- Section of Surgical Oncology Research, Rutgers Cancer Institute of New Jersey, Department of Surgery, Rutgers Robert Wood Johnson Medical School, Rutgers, State University of New Jersey, New Brunswick, NJ, USA
| | - Karine A Cohen-Solal
- Rutgers Cancer Institute of New Jersey, Department of Medicine, Division of Medical Oncology, Rutgers, State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Substitutions at NS3 Residue 155, 156, or 168 of Hepatitis C Virus Genotypes 2 to 6 Induce Complex Patterns of Protease Inhibitor Resistance. Antimicrob Agents Chemother 2015; 59:7426-36. [PMID: 26392503 DOI: 10.1128/aac.01953-15] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 09/10/2015] [Indexed: 01/14/2023] Open
Abstract
Various protease inhibitors (PIs) currently are becoming available for treatment of hepatitis C virus (HCV). For genotype 1, substitutions at NS3 protease positions 155, 156, and 168 are the main determinants of PI resistance. For other genotypes, similar substitutions were selected during PI treatment but were not characterized systematically. To elucidate the impact of key PI resistance substitutions on genotypes 2 to 6, we engineered the substitutions R155A/E/G/H/K/Q/T, A156G/S/T/V, and D/Q168A/E/G/H/N/V into HCV recombinants expressing genotype 2 to 6 proteases. We evaluated viral fitness and sensitivity to nine PIs (telaprevir, boceprevir, simeprevir, asunaprevir, vaniprevir, faldaprevir, paritaprevir, deldeprevir, and grazoprevir) in Huh7.5 cells. We found that most variants showed decreased fitness compared to that of the original viruses. Overall, R155K, A156G/S, and D/Q168A/E/H/N/V variants showed the highest fitness; however, genotype 4 position 168 variants showed strong fitness impairment. Most variants tested were resistant to several PIs. Resistance levels varied significantly depending on the specific substitution, genotype, and PI. For telaprevir and boceprevir, specific 155 and 156, but not 168, variants proved resistant. For the remaining PIs, most genotype 2, 4, 5, and 6, but not genotype 3, variants showed various resistance levels. Overall, grazoprevir (MK-5172) had the highest efficacy against original viruses and variants. This is the first comprehensive study revealing the impact of described key PI resistance substitutions on fitness and PI resistance of HCV genotypes 2 to 6. In conclusion, the studied substitutions induced resistance to a panel of clinically relevant PIs, including the newer PIs paritaprevir, deldeprevir, and grazoprevir. We discovered complex patterns of resistance, with the impact of substitutions varying from increased sensitivity to high resistance.
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Doss W, Shiha G, Hassany M, Soliman R, Fouad R, Khairy M, Samir W, Hammad R, Kersey K, Jiang D, Doehle B, Knox SJ, Massetto B, McHutchison JG, Esmat G. Sofosbuvir plus ribavirin for treating Egyptian patients with hepatitis C genotype 4. J Hepatol 2015; 63:581-5. [PMID: 25937436 DOI: 10.1016/j.jhep.2015.04.023] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 04/09/2015] [Accepted: 04/21/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS Egypt has the highest prevalence of chronic hepatitis C virus (HCV) infection in the world, and more than 90% of patients are infected with genotype 4 virus. We evaluated the efficacy and safety of the HCV polymerase inhibitor sofosbuvir in combination with ribavirin in HCV genotype 4 patients in Egypt. METHODS Treatment-naïve or treatment-experienced patients with genotype 4 HCV infection (n=103) were randomly assigned to receive either 12 or 24 weeks of sofosbuvir 400 mg and ribavirin 1000-1200 mg daily. Randomization was stratified by prior treatment experience and by presence or absence of cirrhosis. The primary endpoint was the percentage of patients with HCV RNA <25 IU/ml 12 weeks after therapy (SVR12). RESULTS Among all patients, 52% had received prior HCV treatment and 17% had cirrhosis at baseline. SVR12 rates were 90% (46/51) with 24 weeks and 77% (40/52) with 12 weeks of sofosbuvir and ribavirin therapy. Patients with cirrhosis at baseline had lower rates of SVR12 (63% 12 weeks, 78% 24 weeks) than those without cirrhosis (80% 12 weeks, 93% 24 weeks). The most common adverse events were fatigue, headache, insomnia, and anemia. Two patients experienced serious adverse events (cerebral ischemia, dyspnea). No adverse events resulted in treatment discontinuation. CONCLUSION Sofosbuvir plus ribavirin for 12 or 24 weeks is effective in treating both treatment-naïve and treatment-experienced Egyptian patients with genotype 4 HCV.
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Affiliation(s)
- Wahid Doss
- National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Gamal Shiha
- Egyptian Liver Research Institute and Hospital (ELRIAH), Mansoura, Egypt.
| | - Mohamed Hassany
- National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Reham Soliman
- Egyptian Liver Research Institute and Hospital (ELRIAH), Mansoura, Egypt
| | | | | | - Waleed Samir
- Egyptian Liver Research Institute and Hospital (ELRIAH), Mansoura, Egypt
| | - Radi Hammad
- National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | | | - Deyuan Jiang
- Gilead Sciences, Inc., Foster City, CA, United States
| | - Brian Doehle
- Gilead Sciences, Inc., Foster City, CA, United States
| | - Steven J Knox
- Gilead Sciences, Inc., Foster City, CA, United States
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Kamal SM, Kassim S, El Gohary E, Fouad A, Nabegh L, Hafez T, Bahnasy K, Hassan H, Ghoraba D. The accuracy and cost-effectiveness of hepatitis C core antigen assay in the monitoring of anti-viral therapy in patients with chronic hepatitis C genotype 4. Aliment Pharmacol Ther 2015; 42:307-18. [PMID: 26018116 DOI: 10.1111/apt.13261] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 02/24/2015] [Accepted: 05/09/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Quantitative hepatitis C (HCV) polymerase chain reaction (qtHCV-PCR), the gold standard for monitoring HCV therapy, is an expensive, time-consuming procedure that requires equipped laboratories and trained personnel. AIMS To assess the accuracy and cost-effectiveness of the automated Abbott ARCHITECT HCV Ag assay (Wiesbaden, Germany) in monitoring response to pagylated interferon (PEG-IFN) and ribavirin therapy for chronic HCV genotype 4 (G4). METHODS This longitudinal, non-inferiority study compared the efficacy and cost benefit of an All-HCV core antigen assay protocol and a hybrid qtHCV RNA PCR and HCV core Ag assay protocol to the standard All-qtHCV-PCR protocol in chronic HCV G4 patients treated with pegylated interferon (PEG IFN) and ribavirin. RESULTS Four hundred and ten patients with chronic hepatitis C genotype 4 met inclusion criteria and were enrolled in the study. The sustained virological response rate (SVR) was 66.34%. The All-HCV core antigen and hybrid monitoring assays resulted in the significant cost savings without compromising performance. A good correlation existed between HCV viral load and HCV core antigen levels (r = 0.944; P < 0.0001). Baseline HCV RNA values <600 IU/mL, baseline HCV core Ag levels <2000 fmol/L, rapid virological response, rapid decline in HCV core antigen were strong predictors of SVR. CONCLUSION Hepatitis C core Ag assay is a point-of-care, reproducible, reliable, cost-effective monitoring tool with rapid turnaround time that, which can effectively replace or adjunct to qRT-PCR in monitoring interferon based or interferon-free anti-viral therapy in chronic hepatitis genotype 4 patients in resource-limited countries with a high burden of hepatitis C.
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Affiliation(s)
- S M Kamal
- Department of Gastroenterolgy, Hepatology and Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - S Kassim
- Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - E El Gohary
- Department of Molecular Biology and Biochemistry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - A Fouad
- Department of Gastroenterolgy, Hepatology and Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - L Nabegh
- Department of Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - T Hafez
- Department of Molecular Biology, American University, Cairo, Egypt
| | - K Bahnasy
- Department of Bioinformatics, Faculty of Computer Science, Ain Shams University, Cairo, Egypt
| | - H Hassan
- Department of Clinical Pathology, Cairo University, Cairo, Egypt.,Department of Clinical Pathology, Salman Bin Abdul Aziz University, Riyadh, Saudi Arabia
| | - D Ghoraba
- Department of Gastroenterolgy, Hepatology and Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Fathy MM, Abo Taleb ME, El Hawary MS, Nabih MI, Aref WM, Makhlouf MM. Assessment of interleukin 28B genotype as a predictor of response to combined therapy with pegylated interferon plus ribavirin in HCV infected Egyptian patients. Cytokine 2015; 74:268-72. [PMID: 26003758 DOI: 10.1016/j.cyto.2015.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 04/24/2015] [Accepted: 05/03/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIM Single nucleotide polymorphisms (SNPs) of interleukin 28B (IL28B) gene is associated with spontaneous clearance and variable response to combined therapy with pegylated interferon (PEG-IFN) and ribavirin (RBV) in chronic hepatitis C virus (HCV) infected patients. This study aimed at assessing the value of IL28B rs8099917 gene polymorphism in predicting sustained virological response (SVR) among HCV infected Egyptian patients treated with PEG-IFN and RBV. METHODS Our study was conducted on 153 chronic HCV infected patients treated with PEG-IFN and RBV. Genotyping of rs8099917 near the IL-28B gene was performed by Real Time PCR using Taq-Man probe assay. RESULTS The overall SVR was achieved in 49.6% of patients. Patients with TT genotype showed significantly higher SVR rate than minor allele (TG/GG) carriers (74% vs. 26%, P=0.004). Logistic regression analysis revealed that TT carriers had 2.8 higher chance for SVR achievement than G allele carriers TG/GG (OR=2.8, 95% CI=1.4-5.6, P=0.004). Younger age, male sex and low activity grading were significant predictors of SVR (P=0.003, P=<0.001 and P<0.001 respectively). High pretreatment AST levels and advanced liver fibrosis were negative predictors of SVR (P=0.04 and P<0.001 respectively). CONCLUSION IL28B genotype is a significant pre-treatment predictor of response to PEG-IFN/RBV in HCV infected Egyptian patients.
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Affiliation(s)
- Mona M Fathy
- Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Mohamed E Abo Taleb
- Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed S El Hawary
- Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mona I Nabih
- Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Wael M Aref
- Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Manal M Makhlouf
- Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Mathew S, Fatima K, Fatmi MQ, Archunan G, Ilyas M, Begum N, Azhar E, Damanhouri G, Qadri I. Computational Docking Study of p7 Ion Channel from HCV Genotype 3 and Genotype 4 and Its Interaction with Natural Compounds. PLoS One 2015; 10:e0126510. [PMID: 26030803 PMCID: PMC4451521 DOI: 10.1371/journal.pone.0126510] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 04/02/2015] [Indexed: 12/15/2022] Open
Abstract
Background The current standard care therapy for hepatitis C virus (HCV) infection consists of two regimes, namely interferon-based and interferon-free treatments. The treatment through the combination of ribavirin and pegylated interferon is expensive, only mildly effective, and is associated with severe side effects. In 2011, two direct-acting antiviral (DAA) drugs, boceprevir and telaprevir, were licensed that have shown enhanced sustained virologic response (SVR) in phase III clinical trial, however, these interferon-free treatments are more sensitive to HCV genotype 1 infection. The variable nature of HCV, and the limited number of inhibitors developed thus aim in expanding the repertoire of available drug targets, resulting in targeting the virus assembly therapeutically. Aim We conducted this study to predict the 3D structure of the p7 protein from the HCV genotypes 3 and 4. Approximately 63 amino acid residues encoded in HCV render this channel sensitive to inhibitors, making p7 a promising target for novel therapies. HCV p7 protein forms a small membrane known as viroporin, and is essential for effective self-assembly of large channels that conduct cation assembly and discharge infectious virion particles. Method In this study, we screened drugs and flavonoids known to disrupt translation and production of HCV proteins, targeted against the active site of p7 residues of HCV genotype 3 (GT3) (isolatek3a) and HCV genotype 4a (GT4) (isolateED43). Furthermore, we conducted a quantitative structure–activity relationship and docking interaction study. Results The drug NB-DNJ formed the highest number of hydrogen bond interactions with both modeled p7 proteins with high interaction energy, followed by BIT225. A flavonoid screen demonstrated that Epigallocatechin gallate (EGCG), nobiletin, and quercetin, have more binding modes in GT3 than in GT4. Thus, the predicted p7 protein molecule of HCV from GT3 and GT4 provides a general avenue to target structure-based antiviral compounds. Conclusions We hypothesize that the inhibitors of viral p7 identified in this screen may be a new class of potent agents, but further confirmation in vitro and in vivo is essential. This structure-guided drug design for both GT3 and GT4 can lead to the identification of drug-like natural compounds, confirming p7 as a new target in the rapidly increasing era of HCV.
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Affiliation(s)
- Shilu Mathew
- Department of Biotechnology, Jamal Mohamed College, Tiruchirappalli, India
- Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Animal Science, Bharathidasan University, Tiruchirappalli, India
| | - Kaneez Fatima
- IQ Institute of Infection and Immunity, Lahore, Punjab, Pakistan
| | - M. Qaiser Fatmi
- Department of Biosciences, COMSATS Institute of Information Technology, Park Road, Chak Shahzad, Islamabad, Pakistan
| | | | - Muhammad Ilyas
- Department of Botany, Jamal Mohamed College, Tiruchirappalli, Tamil Nadu, India
| | - Nargis Begum
- Department of Biotechnology, Jamal Mohamed College, Tiruchirappalli, India
| | - Esam Azhar
- King Fahd Medical Research Center, King Abdul Aziz University, Jeddah, Saudi Arabia
| | - Ghazi Damanhouri
- King Fahd Medical Research Center, King Abdul Aziz University, Jeddah, Saudi Arabia
| | - Ishtiaq Qadri
- King Fahd Medical Research Center, King Abdul Aziz University, Jeddah, Saudi Arabia
- * E-mail:
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