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Grebely J, Robaeys G, Bruggmann P, Aghemo A, Backmund M, Bruneau J, Byrne J, Dalgard O, Feld JJ, Hellard M, Hickman M, Kautz A, Litwin A, Lloyd AR, Mauss S, Prins M, Swan T, Schaefer M, Taylor LE, Dore GJ. Recommandations pour la prise en charge de l'infection par le virus de l'hépatite C chez les usagers de drogues par injection. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 111:101669. [PMID: 26847504 DOI: 10.1016/j.drugpo.2015.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
| | - Geert Robaeys
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Genk, Belgium; Department of Hepatology, UZ Leuven, Leuven, Belgium; Faculty of Medicine and Life Sciences, Limburg Clinical Research Program, Hasselt University, Hasselt, Belgium
| | | | - Alessio Aghemo
- A.M. Migliavacca Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Markus Backmund
- Ludwig-Maximilians-University, Munich, Germany; Praxiszentrum im Tal Munich, Munich, Germany
| | | | - Jude Byrne
- International Network of People who Use Drugs, Canberra, Australia
| | - Olav Dalgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
| | | | - Margaret Hellard
- Burnet Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Matthew Hickman
- School of Social & Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Achim Kautz
- European Liver Patients Association, Cologne, Germany
| | - Alain Litwin
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States
| | - Andrew R Lloyd
- Inflammation and Infection Research Centre, School of Medical Sciences, UNSW Australia, Sydney, Australia
| | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Düsseldorf, Germany
| | - Maria Prins
- Department of Research, Cluster Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands; Department of Internal Medicine, CINIMA, Academic Medical Centre, Amsterdam, The Netherlands
| | - Tracy Swan
- Treatment Action Group, New York, United States
| | - Martin Schaefer
- Department of Psychiatry, Psychotherapy and Addiction Medicine, Kliniken Essen-Mitte, Essen, Germany; Department of Psychiatry and Psychotherapy-CCM, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lynn E Taylor
- Department of Medicine, Brown University, Providence, RI, United States
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Grebely J, Robaeys G, Bruggmann P, Aghemo A, Backmund M, Bruneau J, Byrne J, Dalgard O, Feld JJ, Hellard M, Hickman M, Kautz A, Litwin A, Lloyd AR, Mauss S, Prins M, Swan T, Schaefer M, Taylor LE, Dore GJ. Empfehlungen zur Hepatitis Versorgung bei Drogenkonsumierenden. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 111:101670. [PMID: 26749563 DOI: 10.1016/j.drugpo.2015.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | - Geert Robaeys
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Genk, Belgium; Department of Hepatology, UZ Leuven, Leuven, Belgium; Faculty of Medicine and Life Sciences, Limburg Clinical Research Program, Hasselt University, Hasselt, Belgium
| | | | - Alessio Aghemo
- A.M. Migliavacca Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Markus Backmund
- Ludwig-Maximilians-University, Munich, Germany; Praxiszentrum im Tal Munich, Munich, Germany
| | | | - Jude Byrne
- International Network of People who Use Drugs, Canberra, Australia
| | - Olav Dalgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
| | | | - Margaret Hellard
- Burnet Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Matthew Hickman
- School of Social & Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Achim Kautz
- European Liver Patients Association, Cologne, Germany
| | - Alain Litwin
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States
| | - Andrew R Lloyd
- Inflammation and Infection Research Centre, School of Medical Sciences, UNSW Australia, Sydney, Australia
| | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Düsseldorf, Germany
| | - Maria Prins
- Department of Research, Cluster Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands; Department of Internal Medicine, CINIMA, Academic Medical Centre, Amsterdam, The Netherlands
| | - Tracy Swan
- Treatment Action Group, New York, United States
| | - Martin Schaefer
- Department of Psychiatry, Psychotherapy and Addiction Medicine, Kliniken Essen-Mitte, Essen, Germany; Department of Psychiatry and Psychotherapy-CCM, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lynn E Taylor
- Department of Medicine, Brown University, Providence, RI, United States
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Koustenis KR, Anagnostou O, Kranidioti H, Vasileiadi S, Antonakaki P, Koutli E, Pantsas P, Deutsch M, Manolakopoulos S. Direct-acting antiviral treatment for chronic hepatitis C in people who use drugs in a real-world setting. Ann Gastroenterol 2020; 33:195-201. [PMID: 32127741 PMCID: PMC7049240 DOI: 10.20524/aog.2020.0449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 12/09/2019] [Indexed: 12/15/2022] Open
Abstract
Background Direct-acting antivirals (DAAs) offer high cure rates in people who inject drugs (PWID) with hepatitis C virus (HCV) infection. There are concerns regarding lower response rates among PWID in real life. We evaluated the outcome of DAA therapy in PWID in a real-world setting and the factors that affect it. Methods We performed a retrospective analysis of 174 PWID with chronic hepatitis C who started DAAs in a Greek liver clinic in collaboration with an addiction program. Patients who did not return for reassessment were considered as lost to follow up (LTFU). A logistic regression model was used to assess factors associated with a sustained virological response 12 weeks after treatment completion (SVR12) and LTFU. Results Patients' mean age was 48±9.2 years and 91/174 (52.3%) were attending opioid substitution treatment programs. Overall, 144/174 (82.8%) patients completed therapy and presented for SVR12 testing, 8/174 (4.6%) did not complete treatment and 22/174 (12.6%) were LTFU. Overall SVR12 was 79.9% (139/174). For those with an available SVR12 test the response rate reached 96.5% (139/144). Regression analysis did not indicate any significant association between patient characteristics and SVR12. Age <45 years and genotype 3 were independent predictors of LTFU. Parallel use was found to have a trend towards LTFU. Conclusions HCV treatment by hepatologists and addiction specialists is feasible, effective and safe in a real-world setting. However, as 12% of patients appear to be LTFU, more emphasis should be placed on interventions guaranteeing follow up for SVR testing and general care.
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Affiliation(s)
- Kanellos Rafail Koustenis
- Gastroenterology-Liver Unit, 2 Academic Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokration General Hospital, (Kanellos Rafail Koustenis, Olga Anagnostou, Hariklia Kranidioti, Sofia Vasileiadi, Pinelopi Antonakaki, Evangelia Koutli, Paris Pantsas, Melanie Deutsch, Spilios Manolakopoulos)
| | - Olga Anagnostou
- Gastroenterology-Liver Unit, 2 Academic Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokration General Hospital, (Kanellos Rafail Koustenis, Olga Anagnostou, Hariklia Kranidioti, Sofia Vasileiadi, Pinelopi Antonakaki, Evangelia Koutli, Paris Pantsas, Melanie Deutsch, Spilios Manolakopoulos)
| | - Hariklia Kranidioti
- Gastroenterology-Liver Unit, 2 Academic Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokration General Hospital, (Kanellos Rafail Koustenis, Olga Anagnostou, Hariklia Kranidioti, Sofia Vasileiadi, Pinelopi Antonakaki, Evangelia Koutli, Paris Pantsas, Melanie Deutsch, Spilios Manolakopoulos)
| | - Sofia Vasileiadi
- Gastroenterology-Liver Unit, 2 Academic Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokration General Hospital, (Kanellos Rafail Koustenis, Olga Anagnostou, Hariklia Kranidioti, Sofia Vasileiadi, Pinelopi Antonakaki, Evangelia Koutli, Paris Pantsas, Melanie Deutsch, Spilios Manolakopoulos)
| | - Pinelopi Antonakaki
- Gastroenterology-Liver Unit, 2 Academic Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokration General Hospital, (Kanellos Rafail Koustenis, Olga Anagnostou, Hariklia Kranidioti, Sofia Vasileiadi, Pinelopi Antonakaki, Evangelia Koutli, Paris Pantsas, Melanie Deutsch, Spilios Manolakopoulos)
| | - Evangelia Koutli
- Gastroenterology-Liver Unit, 2 Academic Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokration General Hospital, (Kanellos Rafail Koustenis, Olga Anagnostou, Hariklia Kranidioti, Sofia Vasileiadi, Pinelopi Antonakaki, Evangelia Koutli, Paris Pantsas, Melanie Deutsch, Spilios Manolakopoulos)
| | - Paris Pantsas
- Gastroenterology-Liver Unit, 2 Academic Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokration General Hospital, (Kanellos Rafail Koustenis, Olga Anagnostou, Hariklia Kranidioti, Sofia Vasileiadi, Pinelopi Antonakaki, Evangelia Koutli, Paris Pantsas, Melanie Deutsch, Spilios Manolakopoulos)
| | - Melanie Deutsch
- Gastroenterology-Liver Unit, 2 Academic Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokration General Hospital, (Kanellos Rafail Koustenis, Olga Anagnostou, Hariklia Kranidioti, Sofia Vasileiadi, Pinelopi Antonakaki, Evangelia Koutli, Paris Pantsas, Melanie Deutsch, Spilios Manolakopoulos)
| | - Spilios Manolakopoulos
- Gastroenterology-Liver Unit, 2 Academic Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokration General Hospital, (Kanellos Rafail Koustenis, Olga Anagnostou, Hariklia Kranidioti, Sofia Vasileiadi, Pinelopi Antonakaki, Evangelia Koutli, Paris Pantsas, Melanie Deutsch, Spilios Manolakopoulos).,Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital (Spilios Manolakopoulos), Athens, Greece
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Papatheodoridis GV, Goulis J, Sypsa V, Lionis C, Manolakopoulos S, Elefsiniotis I, Anagnostou O, Tsoulas C, Hatzakis A, Dalekos GN. Aiming towards hepatitis C virus elimination in Greece. Ann Gastroenterol 2019; 32:321-329. [PMID: 31263353 PMCID: PMC6595935 DOI: 10.20524/aog.2019.0375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/12/2019] [Indexed: 02/06/2023] Open
Abstract
There are estimated to be 74,000-134,000 patients living with chronic hepatitis C in Greece, but only 20-30% of them are aware of their disease status. In July 2017, the Hellenic National Plan for Hepatitis C was announced in alignment with the World Health Organization goals for the eradication of hepatitis C virus (HCV) by the year 2030. This article discusses the epidemiology and current treatment of chronic hepatitis C in Greece. Additionally the authors propose actions on how to bring back to care diagnosed patients lost to follow up, optimize access to care for HCV-infected people who inject drugs, and increase HCV screening in the general population. The medical community in Greece can play a pivotal role in the implementation of the HCV National Plan and in the efforts to reach the goal of HCV elimination.
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Affiliation(s)
- George V Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital (George V. Papatheodoridis)
| | - John Goulis
- 4 Department of Internal Medicine, Αristotle University of Thessaloniki Medical School (John Goulis)
| | - Vana Sypsa
- Department of Hygiene, Medical School of National and Kapodistrian, University of Athens, Epidemiology and Medical Statistics, Athens (Vana Sypsa, Angelos Hatzakis)
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion-Crete (Christos Lionis)
| | - Spilios Manolakopoulos
- 2 Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokratio General Hospital of Athens (Spilios Manolakopoulos)
| | - Ioannis Elefsiniotis
- Academic Department of Internal Medicine-Hepatogastroenterology, "Agioi Anargyroi" General and Oncology Hospital, Athens (Ioannis Elefsiniotis)
| | - Olga Anagnostou
- Greek Organisation Against Drugs (OKANA), Athens (Olga Anagnostou)
| | - Christos Tsoulas
- Medical Department, Gilead Sciences Hellas, Athens (Christos Tsoulas)
| | - Angelos Hatzakis
- Department of Hygiene, Medical School of National and Kapodistrian, University of Athens, Epidemiology and Medical Statistics, Athens (Vana Sypsa, Angelos Hatzakis)
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, University of Thessaly Medical School, Larissa (George N. Dalekos), Greece
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5
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Cunningham EB, Amin J, Feld JJ, Bruneau J, Dalgard O, Powis J, Hellard M, Cooper C, Read P, Conway B, Dunlop AJ, Norton B, Litwin AH, Hajarizadeh B, Thurnheer MC, Dillon JF, Weltman M, Shaw D, Bruggmann P, Gane E, Fraser C, Marks P, Applegate TL, Quiene S, Siriragavan S, Matthews GV, Dore GJ, Grebely J. Adherence to sofosbuvir and velpatasvir among people with chronic HCV infection and recent injection drug use: The SIMPLIFY study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 62:14-23. [PMID: 30352330 DOI: 10.1016/j.drugpo.2018.08.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/10/2018] [Accepted: 08/10/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND This study investigated treatment adherence among people with recent injecting drug use in a study of sofosbuvir/velpatasvir therapy for HCV infection. METHODS SIMPLIFY is an international open-label, single-arm multicentre study that recruited participants with recent injecting drug use (previous six months) and chronic HCV genotype (G) 1-6 infection between March and October 2016 in seven countries (19 sites). Participants received sofosbuvir/velpatasvir once-daily for 12 weeks administered in a one-week electronic blister pack (records the time and date of each dose) for 12 weeks. We evaluated non-adherence (<90% adherent) as measured by electronic blister-pack assessed using logistic regression and generalised estimating equations (continuous) with detailed analyses of dosing dynamics. RESULTS Among 103 participants, 97% (n = 100) completed treatment. Median adherence to therapy was 94%. Overall, 32% (n = 33) were considered non-adherent (<90% adherence). Adherence significantly decreased over the course of therapy. Recent stimulant injecting (cocaine and/or amphetamines) at treatment initiation and during treatment was independently associated with non-adherence. Inconsistent dose timing (standard deviation of daily dose timing of ≥240 min) was also independently associated with non-adherence to therapy. Factors associated with inconsistent dose timing included lower levels of education and recent stimulant injecting. SVR was similar among adherent and non-adherent populations (94% vs. 94%, P = 0.944). CONCLUSION This study demonstrated high adherence to once-daily sofosbuvir/velpatasvir therapy among a population of people with recent injecting drug use. Recent stimulant injecting prior to and during DAA therapy and inconsistent dose-timing during treatment was associated with non-adherence. However, there was no impact of non-adherence on response to therapy, suggesting that adherence is not a significant barrier to successful DAA therapy in people with recent injecting drug use.
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Affiliation(s)
| | - Janaki Amin
- The Kirby Institute, UNSW Sydney, Sydney, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | | | - Julie Bruneau
- Centre Hospitalier de l'Université de Montréal, Canada
| | - Olav Dalgard
- Akershus University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jeff Powis
- South Riverdale Community Health Centre, Toronto, Canada
| | - Margaret Hellard
- The Burnet Institute, Melbourne, Australia; Department of Infectious Disease, The Alfred Hospital, Melbourne, Australia
| | | | - Phillip Read
- The Kirby Institute, UNSW Sydney, Sydney, Australia; Kirketon Road Centre, Sydney, Australia
| | - Brian Conway
- Vancouver Infectious Diseases Center, Vancouver, Canada
| | - Adrian J Dunlop
- Drug & Alcohol Clinical Services, Hunter New England Local Health District, Australia; Centre for Translational Neuroscience and Mental Health, Hunter Medical Research Institute & University of Newcastle, Australia
| | - Briana Norton
- Montefiore Medical Centre, New York, United States; Albert Einstein College of Medicine, New York, United States
| | - Alain H Litwin
- Montefiore Medical Centre, New York, United States; Albert Einstein College of Medicine, New York, United States
| | | | | | - John F Dillon
- Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | | | - David Shaw
- Royal Adelaide Hospital, Adelaide, Australia
| | | | - Edward Gane
- Auckland City Hospital, Auckland, New Zealand
| | - Chris Fraser
- Coolaid Community Health Centre, Victoria, Canada
| | | | | | | | | | - Gail V Matthews
- The Kirby Institute, UNSW Sydney, Sydney, Australia; St Vincent's Hospital, Sydney, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, Australia; St Vincent's Hospital, Sydney, Australia
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6
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Kranidioti H, Chatzievagelinou C, Protopapas A, Papatheodoridi M, Zisimopoulos K, Evangelidou E, Antonakaki P, Vlachogiannakos J, Triantos C, Elefsiniotis I, Goulis J, Mela M, Anagnostou O, Tsoulas C, Deutsch M, Papatheodoridis G, Manolakopoulos S. Clinical and epidemiological characteristics of hepatitis C virus-infected people who inject drugs: a Greek descriptive analysis. Ann Gastroenterol 2018; 31:598-603. [PMID: 30174397 PMCID: PMC6102460 DOI: 10.20524/aog.2018.0293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 06/26/2018] [Indexed: 02/07/2023] Open
Abstract
Background It is estimated that 17,000 people who inject drugs (PWID) in Greece have hepatitis C virus (HCV) viremia. The aim of our study was to explore the characteristics of the HCV-infected, direct acting antiviral (DAA)-naïve PWID. Methods This is a retrospective analysis of PWID with HCV infection. We selected data from six liver clinics during the period from 1st May 2014 to 31st May 2017 in order to record the characteristics of infected PWID. Results We included 800 PWID with HCV infection (78.5% male, mean age 42±10 years) who had not received DAAs before 1st June 2017. One third of the patients had comorbidities (diabetes mellitus, arterial hypertension and psychological disorders); 70% were smokers, 27% alcohol users, 67% unemployed, 29% married, and 34% had education >12 years; 65% were attending addiction programs; 57% were receiving methadone and 36% buprenorphine. Sporadic or systemic drug use was reported by 37% while 1.4% and 2.9% had HIV and HBV coinfection, respectively. The genotype distribution was 20.5%, 4.6%, 3.3%, 61% and 10% for genotypes 1a, 1b, 2, 3 and 4, respectively. Mean (±SD) liver stiffness was 9±7 kPa and 21% of the patients had cirrhosis. Half of the patients were in the F0-F1 stage of liver disease, defined as stiffness ≤7 kPa. Conclusions Our real-life data suggest that HCV genotype 3 remains the predominant genotype among PWID. One third of PWID had comorbidities and one-fifth cirrhosis. Half of PWID had early-stage liver disease and remained without access to DAAs according to the Greek prioritization criteria.
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Affiliation(s)
- Hariklia Kranidioti
- 2 Academic Department of Internal Medicine, Hippokration General Hospital, Athens (Hariklia Kranidioti, Pinelopi Antonakaki, Olga Anagnostou, Melanie Deutsch, Spilios Manolakopoulos), Greece
| | - Christina Chatzievagelinou
- Department of Gastroenterology, Evangelismos-Opthalmiatrion Athinon-Polykliniki Hospitals, Athens (Christina Chatzievagelinou, Maria Mela), Greece
| | - Adonis Protopapas
- 4 Academic Department of Internal Medicine, Hippokration General Hospital, Thessaloniki (Adonis Protopapas, John Goulis), Greece
| | - Margarita Papatheodoridi
- Academic Department of Gastroenterology, Laiko General Hospital, Athens (Margarita Papatheodoridi, John Vlachogiannakos, George Papatheodoridis, Spilios Manolakopoulos), Greece
| | - Konstantinos Zisimopoulos
- Department of Gastroenterology, University of Patras (Konstantinos Zisimopoulos, Christos Triantos), Greece
| | - Eftychia Evangelidou
- "Agioi Anargyroi" General and Oncology Hospital of Kifissia, Athens (Eftychia Evangelidou, Ioannis Elefsiniotis), Greece
| | - Pinelopi Antonakaki
- 2 Academic Department of Internal Medicine, Hippokration General Hospital, Athens (Hariklia Kranidioti, Pinelopi Antonakaki, Olga Anagnostou, Melanie Deutsch, Spilios Manolakopoulos), Greece
| | - John Vlachogiannakos
- Academic Department of Gastroenterology, Laiko General Hospital, Athens (Margarita Papatheodoridi, John Vlachogiannakos, George Papatheodoridis, Spilios Manolakopoulos), Greece
| | - Christos Triantos
- Department of Gastroenterology, University of Patras (Konstantinos Zisimopoulos, Christos Triantos), Greece
| | - Ioannis Elefsiniotis
- "Agioi Anargyroi" General and Oncology Hospital of Kifissia, Athens (Eftychia Evangelidou, Ioannis Elefsiniotis), Greece
| | - John Goulis
- 4 Academic Department of Internal Medicine, Hippokration General Hospital, Thessaloniki (Adonis Protopapas, John Goulis), Greece
| | - Maria Mela
- Department of Gastroenterology, Evangelismos-Opthalmiatrion Athinon-Polykliniki Hospitals, Athens (Christina Chatzievagelinou, Maria Mela), Greece
| | - Olga Anagnostou
- 2 Academic Department of Internal Medicine, Hippokration General Hospital, Athens (Hariklia Kranidioti, Pinelopi Antonakaki, Olga Anagnostou, Melanie Deutsch, Spilios Manolakopoulos), Greece
| | | | - Melanie Deutsch
- 2 Academic Department of Internal Medicine, Hippokration General Hospital, Athens (Hariklia Kranidioti, Pinelopi Antonakaki, Olga Anagnostou, Melanie Deutsch, Spilios Manolakopoulos), Greece
| | - George Papatheodoridis
- Academic Department of Gastroenterology, Laiko General Hospital, Athens (Margarita Papatheodoridi, John Vlachogiannakos, George Papatheodoridis, Spilios Manolakopoulos), Greece
| | - Spilios Manolakopoulos
- 2 Academic Department of Internal Medicine, Hippokration General Hospital, Athens (Hariklia Kranidioti, Pinelopi Antonakaki, Olga Anagnostou, Melanie Deutsch, Spilios Manolakopoulos), Greece.,Academic Department of Gastroenterology, Laiko General Hospital, Athens (Margarita Papatheodoridi, John Vlachogiannakos, George Papatheodoridis, Spilios Manolakopoulos), Greece
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The Mexican consensus on the treatment of hepatitis C. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2018. [DOI: 10.1016/j.rgmxen.2017.11.002] [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: 12/09/2022] Open
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8
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Aiza-Haddad I, Ballesteros-Amozurrutia A, Borjas-Almaguer OD, Castillo-Barradas M, Castro-Narro G, Chávez-Tapia N, Chirino-Sprung RA, Cisneros-Garza L, Dehesa-Violante M, Flores-Calderón J, Flores-Gaxiola A, García-Juárez I, González-Huezo MS, González-Moreno EI, Higuera-de la Tijera F, Kershenobich-Stalnikowitz D, López-Méndez E, Malé-Velázquez R, Marín-López E, Mata-Marín JA, Méndez-Sánchez N, Monreal-Robles R, Moreno-Alcántar R, Muñoz-Espinosa L, Navarro-Alvarez S, Pavia-Ruz N, Pérez-Ríos AM, Poo-Ramírez JL, Rizo-Robles MT, Sánchez-Ávila JF, Sandoval-Salas R, Torre A, Torres-Ibarra R, Trejo-Estrada R, Velarde-Ruiz Velasco JA, Wolpert-Barraza E, Bosques-Padilla F. The Mexican consensus on the treatment of hepatitis C. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2018; 83:275-324. [PMID: 29803325 DOI: 10.1016/j.rgmx.2017.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/17/2017] [Accepted: 11/02/2017] [Indexed: 12/12/2022]
Abstract
The aim of the Mexican Consensus on the Treatment of HepatitisC was to develop clinical practice guidelines applicable to Mexico. The expert opinion of specialists in the following areas was taken into account: gastroenterology, infectious diseases, and hepatology. A search of the medical literature was carried out on the MEDLINE, EMBASE, and CENTRAL databases through keywords related to hepatitisC treatment. The quality of evidence was subsequently evaluated using the GRADE system and the consensus statements were formulated. The statements were then voted upon, using the modified Delphi system, and reviewed and corrected by a panel of 34 voting participants. Finally, the level of agreement was classified for each statement. The present guidelines provide recommendations with an emphasis on the new direct-acting antivirals, to facilitate their use in clinical practice. Each case must be individualized according to the comorbidities involved and patient management must always be multidisciplinary.
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Affiliation(s)
| | | | - O D Borjas-Almaguer
- Hospital Universitario «Dr. José Eleuterio González», Monterrey, Nuevo León, México
| | | | - G Castro-Narro
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | | | | | - L Cisneros-Garza
- Centro de Enfermedades Hepáticas del Hospital San José, Monterrey, Nuevo León, México
| | | | - J Flores-Calderón
- Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | | | - I García-Juárez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | | | - E I González-Moreno
- Hospital Universitario «Dr. José Eleuterio González», Monterrey, Nuevo León, México
| | | | | | - E López-Méndez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - R Malé-Velázquez
- Instituto de Salud Digestiva y Hepática, Guadalajara, Jalisco, México
| | | | - J A Mata-Marín
- Hospital de Infectología del Centro Médico Nacional «La Raza», Ciudad de México, México
| | | | - R Monreal-Robles
- Hospital Universitario «Dr. José Eleuterio González», Monterrey, Nuevo León, México
| | | | - L Muñoz-Espinosa
- Hospital Universitario «Dr. José Eleuterio González», Monterrey, Nuevo León, México
| | | | - N Pavia-Ruz
- Hospital Infantil de México «Federico Gómez», Ciudad de México, México
| | - A M Pérez-Ríos
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, México
| | - J L Poo-Ramírez
- Clínica San Jerónimo de Salud Hepática y Digestiva, Ciudad de México, México
| | | | - J F Sánchez-Ávila
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | | | - A Torre
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
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Efficacy of response-guided directly observed pegylated interferon and self-administered ribavirin for people who inject drugs with hepatitis C virus genotype 2/3 infection: The ACTIVATE study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017. [DOI: 10.1016/j.drugpo.2017.05.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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10
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Cunningham EB, Hajarizadeh B, Dalgard O, Amin J, Hellard M, Foster GR, Bruggmann P, Conway B, Backmund M, Robaeys G, Swan T, Marks PS, Quiene S, Applegate TL, Weltman M, Shaw D, Dunlop A, Bruneau J, Midgard H, Bourgeois S, Thurnheer MC, Dore GJ, Grebely J. Adherence to response-guided pegylated interferon and ribavirin for people who inject drugs with hepatitis C virus genotype 2/3 infection: the ACTIVATE study. BMC Infect Dis 2017; 17:420. [PMID: 28610605 PMCID: PMC5470219 DOI: 10.1186/s12879-017-2517-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 06/01/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The aims of this analysis were to investigate treatment completion and adherence among people with ongoing injecting drug use or receiving opioid substitution therapy (OST) in a study of response-guided therapy for chronic HCV genotypes 2/3 infection. METHODS ACTIVATE was a multicenter clinical trial recruited between 2012 and 2014. Participants with genotypes 2/3 were treated with directly observed peg-interferon alfa-2b (PEG-IFN) and self-administered ribavirin for 12 (undetectable HCV RNA at week 4) or 24 weeks (detectable HCV RNA at week 4). Outcomes included treatment completion, PEG-IFN adherence, ribavirin adherence, and sustained virological response (SVR, undetectable HCV RNA >12 weeks post-treatment). RESULTS Among 93 people treated, 59% had recently injected drugs (past month), 77% were receiving OST and 56% injected drugs during therapy. Overall, 76% completed treatment. Mean on-treatment adherence to PEG-IFN and ribavirin were 98.2% and 94.6%. Overall, 6% of participants missed >1 dose of PEG-IFN and 31% took <95% of their prescribed ribavirin., Higher treatment completion was observed among those receiving 12 vs. 24 weeks of treatment (97% vs. 46%, P < 0.001) while the proportion of participants with 95% on-treatment ribavirin adherence was similar between groups (67% vs. 72%, P = 0.664). Receiving 12 weeks of therapy was independently associated with treatment completion. No factors were associated with 95% RBV adherence. Neither recent injecting drug use at baseline nor during therapy was associated with treatment completion or adherence to ribavirin. In adjusted analysis, treatment completion was associated with SVR (aOR 23.9, 95% CI 2.9-193.8). CONCLUSIONS This study demonstrated a high adherence to directly observed PEG-IFN and self-administered ribavirin among people with ongoing injecting drug use or receiving OST. These data also suggest that shortening therapy from 24 to 12 weeks can lead to improved treatment completion. Treatment completion was associated with improved response to therapy. ACTIVATE trial registration number: NCT01364090 - May 31, 2011.
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Affiliation(s)
| | | | | | - Janaki Amin
- The Kirby Institute, UNSW Sydney, Sydney, NSW Australia
| | | | | | | | - Brian Conway
- Vancouver Infectious Diseases Center, Vancouver, BC Canada
| | | | - Geert Robaeys
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Genk, Belgium
- Department of Hepatology, UZ Leuven, Leuven, Belgium
- UHasselt, Hasselt, Belgium
| | - Tracy Swan
- Treatment Action Group, New York, NY USA
| | | | - Sophie Quiene
- The Kirby Institute, UNSW Sydney, Sydney, NSW Australia
| | | | | | - David Shaw
- Royal Adelaide Hospital, Adelaide, South Australia Australia
| | - Adrian Dunlop
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW Australia
| | - Julie Bruneau
- Research Center, Centre Hospitalier de l’Universite de Montreal (CRCHUM), Montreal, Quebec, Canada
| | | | | | | | | | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW Australia
| | - on behalf of the ACTIVATE Study Group
- The Kirby Institute, UNSW Sydney, Sydney, NSW Australia
- Akershus University Hospital, Oslo, Norway
- The Liver Unit, Queen Mary University of London, London, UK
- Arud Centres for Addiction Medicine, Zurich, Switzerland
- Vancouver Infectious Diseases Center, Vancouver, BC Canada
- Ludwig Maximilians-University Munich, Munich, Germany
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Genk, Belgium
- Department of Hepatology, UZ Leuven, Leuven, Belgium
- UHasselt, Hasselt, Belgium
- Treatment Action Group, New York, NY USA
- Nepean Hospital, Sydney, NSW Australia
- Royal Adelaide Hospital, Adelaide, South Australia Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW Australia
- Burnet Institute, Melbourne, VIC Australia
- Research Center, Centre Hospitalier de l’Universite de Montreal (CRCHUM), Montreal, Quebec, Canada
- Stuivenberg ZNA, Antwerp, Belgium
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
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11
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Grebely J, Alavi M, Micallef M, Dunlop AJ, Balcomb AC, Phung N, Weltman MD, Day CA, Treloar C, Bath N, Haber PS, Dore GJ. Treatment for hepatitis C virus infection among people who inject drugs attending opioid substitution treatment and community health clinics: the ETHOS Study. Addiction 2016; 111:311-9. [PMID: 26451534 DOI: 10.1111/add.13197] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 06/02/2015] [Accepted: 09/30/2015] [Indexed: 12/12/2022]
Abstract
AIMS To estimate adherence and response to therapy for chronic hepatitis C virus (HCV) infection among people with a history of injecting drug use. A secondary aim was to identify predictors of HCV treatment response. DESIGN Prospective cohort recruited between 2009 and 2012. Participants were treated with peg-interferon alfa-2a/ribavirin for 24 (genotypes 2/3, G2/3) or 48 weeks (genotype 1, G1). SETTING Six opioid substitution treatment (OST) clinics, two community health centres and one Aboriginal community-controlled health organization providing drug treatment services in New South Wales, Australia. PARTICIPANTS Among 415 people with a history of injecting drug use and chronic HCV assessed by a nurse, 101 were assessed for treatment outcomes (21% female). MEASUREMENTS Study outcomes were treatment adherence and sustained virological response (SVR, undetectable HCV RNA >24 weeks post-treatment). FINDINGS Among 101 treated, 37% (n = 37) had recently injected drugs (past 6 months) and 62% (n = 63) were receiving OST. Adherence ≥ 80% was 86% (n = 87). SVR was 74% (75 of 101), with no difference observed by sex (males: 76%, females: 67%, P = 0.662). In adjusted analysis, age < 35 (versus ≥ 45 years) [adjusted odds ratio (aOR) = 5.06, 95% confidence interval (CI) = 1.47, 17.40] and on-treatment adherence ≥ 80% independently predicted SVR (aOR = 19.41, 95% CI = 3.61, 104.26]. Recent injecting drug use at baseline was not associated with SVR. CONCLUSIONS People with a history of injecting drug use and chronic hepatitis C virus attending opioid substitution treatment and community health clinics can achieve adherence and responses to interferon-based therapy similar to other populations, despite injecting drugs at baseline. Younger age and adherence are predictive of improved response to hepatitis C virus therapy.
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Affiliation(s)
- Jason Grebely
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | - Maryam Alavi
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | | | - Adrian J Dunlop
- University of Newcastle, Newcastle, NSW, Australia.,Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Anne C Balcomb
- Clinic 96, Kite St Community Health Centre, Orange, NSW, Australia
| | - Nghi Phung
- Drug Health Services, Western Sydney Local Health District, NSW, Australia
| | - Martin D Weltman
- Gastroenterology and Hepatology, Nepean Hospital, Kingswood, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Carolyn A Day
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Drug Health Service, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Australia, Sydney, NSW, Australia
| | | | - Paul S Haber
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
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12
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Grebely J, Robaeys G, Bruggmann P, Aghemo A, Backmund M, Bruneau J, Byrne J, Dalgard O, Feld JJ, Hellard M, Hickman M, Kautz A, Litwin A, Lloyd AR, Mauss S, Prins M, Swan T, Schaefer M, Taylor LE, Dore GJ. Recomendaciones para el manejo de la infección por el virus de la hepatitis C entre usuarios de drogas por vía parenteral. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015. [DOI: 10.1016/j.drugpo.2015.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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13
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Grebely J, Robaeys G, Bruggmann P, Aghemo A, Backmund M, Bruneau J, Byrne J, Dalgard O, Feld JJ, Hellard M, Hickman M, Kautz A, Litwin A, Lloyd AR, Mauss S, Prins M, Swan T, Schaefer M, Taylor LE, Dore GJ. Recommendations for the management of hepatitis C virus infection among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:1028-38. [PMID: 26282715 PMCID: PMC6130980 DOI: 10.1016/j.drugpo.2015.07.005] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 06/30/2015] [Accepted: 07/07/2015] [Indexed: 02/07/2023]
Abstract
In high income countries, the majority of new and existing hepatitis C virus (HCV) infections occur among people who inject drugs (PWID). In many low and middle income countries large HCV epidemics have also emerged among PWID populations. The burden of HCV-related liver disease among PWID is increasing, but treatment uptake remains extremely low. There are a number of barriers to care which should be considered and systematically addressed, but should not exclude PWID from HCV treatment. The rapid development of interferon-free direct-acting antiviral (DAA) therapy for HCV infection has brought considerable optimism to the HCV sector, with the realistic hope that therapeutic intervention will soon provide near optimal efficacy with well-tolerated, short duration, all oral regimens. Further, it has been clearly demonstrated that HCV treatment is safe and effective across a broad range of multidisciplinary healthcare settings. Given the burden of HCV-related disease among PWID, strategies to enhance HCV assessment and treatment in this group are urgently needed. These recommendations demonstrate that treatment among PWID is feasible and provide a framework for HCV assessment and care. Further research is needed to evaluate strategies to enhance testing, linkage to care, treatment, adherence, viral cure, and prevent HCV reinfection among PWID, particularly as new interferon-free DAA treatments for HCV infection become available.
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Affiliation(s)
| | - Geert Robaeys
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Genk, Belgium; Department of Hepatology, UZ Leuven, Leuven, Belgium; Faculty of Medicine and Life Sciences, Limburg Clinical Research Program, Hasselt University, Hasselt, Belgium
| | | | - Alessio Aghemo
- A.M. Migliavacca Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Markus Backmund
- Ludwig-Maximilians-University, Munich, Germany; Praxiszentrum im Tal Munich, Munich, Germany
| | | | - Jude Byrne
- International Network of People who Use Drugs, Canberra, Australia
| | - Olav Dalgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
| | | | - Margaret Hellard
- Burnet Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Matthew Hickman
- School of Social & Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Achim Kautz
- European Liver Patients Association, Cologne, Germany
| | - Alain Litwin
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States
| | - Andrew R Lloyd
- Inflammation and Infection Research Centre, School of Medical Sciences, UNSW Australia, Sydney, Australia
| | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Düsseldorf, Germany
| | - Maria Prins
- Department of Research, Cluster Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands; Department of Internal Medicine, CINIMA, Academic Medical Centre, Amsterdam, The Netherlands
| | - Tracy Swan
- Treatment Action Group, New York, United States
| | - Martin Schaefer
- Department of Psychiatry, Psychotherapy and Addiction Medicine, Kliniken Essen-Mitte, Essen, Germany; Department of Psychiatry and Psychotherapy-CCM, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lynn E Taylor
- Department of Medicine, Brown University, Providence, RI, United States
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14
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Bamvita JM, Roy E, Zang G, Jutras-Aswad D, Artenie AA, Levesque A, Bruneau J. Portraying persons who inject drugs recently infected with hepatitis C accessing antiviral treatment: a cluster analysis. HEPATITIS RESEARCH AND TREATMENT 2014; 2014:631481. [PMID: 25349730 PMCID: PMC4199115 DOI: 10.1155/2014/631481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 09/18/2014] [Accepted: 09/18/2014] [Indexed: 01/27/2023]
Abstract
Objectives. To empirically determine a categorization of people who inject drug (PWIDs) recently infected with hepatitis C virus (HCV), in order to identify profiles most likely associated with early HCV treatment uptake. Methods. The study population was composed of HIV-negative PWIDs with a documented recent HCV infection. Eligibility criteria included being 18 years old or over, and having injected drugs in the previous 6 months preceding the estimated date of HCV exposure. Participant classification was carried out using a TwoStep cluster analysis. Results. From September 2007 to December 2011, 76 participants were included in the study. 60 participants were eligible for HCV treatment. Twenty-one participants initiated HCV treatment. The cluster analysis yielded 4 classes: class 1: Lukewarm health seekers dismissing HCV treatment offer; class 2: multisubstance users willing to shake off the hell; class 3: PWIDs unlinked to health service use; class 4: health seeker PWIDs willing to reverse the fate. Conclusion. Profiles generated by our analysis suggest that prior health care utilization, a key element for treatment uptake, differs between older and younger PWIDs. Such profiles could inform the development of targeted strategies to improve health outcomes and reduce HCV infection among PWIDs.
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Affiliation(s)
- Jean-Marie Bamvita
- CRCHUM (Centre de Recherche du Centre Hospitalier de l'Université de Montréal), Tour Saint-Antoine 850, Rue St-Denis, Montréal, QC, Canada H2X 0A9
- Département de Médecine Familiale, Faculté de Médecine, Université de Montréal, Pavillon Roger-Gaudry, Bureau S-711, 2900 boul. Édouard-Montpetit, Montréal, QC, Canada H3T 1J4
| | - Elise Roy
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Campus Longueuil 1111, Rue St-Charles Ouest, Bureau 500, Longueuil, QC, Canada J4K 5G4
| | - Geng Zang
- CRCHUM (Centre de Recherche du Centre Hospitalier de l'Université de Montréal), Tour Saint-Antoine 850, Rue St-Denis, Montréal, QC, Canada H2X 0A9
| | - Didier Jutras-Aswad
- CRCHUM (Centre de Recherche du Centre Hospitalier de l'Université de Montréal), Tour Saint-Antoine 850, Rue St-Denis, Montréal, QC, Canada H2X 0A9
- Département de Médecine Familiale, Faculté de Médecine, Université de Montréal, Pavillon Roger-Gaudry, Bureau S-711, 2900 boul. Édouard-Montpetit, Montréal, QC, Canada H3T 1J4
| | - Andreea Adelina Artenie
- CRCHUM (Centre de Recherche du Centre Hospitalier de l'Université de Montréal), Tour Saint-Antoine 850, Rue St-Denis, Montréal, QC, Canada H2X 0A9
- Family Medicine Department, McGill University, 5858 Chemin de la Côte des Neiges, 3e Étage, Montréal, QC, Canada H3S 1Z1
| | - Annie Levesque
- CRCHUM (Centre de Recherche du Centre Hospitalier de l'Université de Montréal), Tour Saint-Antoine 850, Rue St-Denis, Montréal, QC, Canada H2X 0A9
- Family Medicine Department, McGill University, 5858 Chemin de la Côte des Neiges, 3e Étage, Montréal, QC, Canada H3S 1Z1
| | - Julie Bruneau
- CRCHUM (Centre de Recherche du Centre Hospitalier de l'Université de Montréal), Tour Saint-Antoine 850, Rue St-Denis, Montréal, QC, Canada H2X 0A9
- Département de Médecine Familiale, Faculté de Médecine, Université de Montréal, Pavillon Roger-Gaudry, Bureau S-711, 2900 boul. Édouard-Montpetit, Montréal, QC, Canada H3T 1J4
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15
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Arain A, Robaeys G. Eligibility of persons who inject drugs for treatment of hepatitis C virus infection. World J Gastroenterol 2014; 20:12722-12733. [PMID: 25278674 PMCID: PMC4177459 DOI: 10.3748/wjg.v20.i36.12722] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 05/19/2014] [Indexed: 02/06/2023] Open
Abstract
In this decade, an increase is expected in end-stage liver disease and hepatocellular carcinoma, most commonly caused by hepatitis C virus (HCV) infection. Although people who inject drugs (PWID) are the major source for HCV infection, they were excluded from antiviral treatments until recently. Nowadays there is incontrovertible evidence in favor of treating these patients, and substitution therapy and active substance use are no longer contraindications for antiviral treatment. The viral clearance in PWID after HCV antiviral treatment with interferon or pegylated interferon combined with ribavirin is comparable to the viral clearance in non-substance users. Furthermore, multidisciplinary approaches to delivering treatment to PWID are advised, and their treatment should be considered on an individualized basis. To prevent the spread of HCV in the PWID community, recent active PWID are eligible for treatment in combination with needle exchange programs and substitution therapy. As the rate of HCV reinfection is low after HCV antiviral treatment, there is no need to withhold HCV treatment due to concerns about reinfection alone. Despite the advances in treatment efficacies and data supporting their success, HCV assessment of PWID and initiation of antiviral treatment remains low. However, the proportion of PWID assessed and treated for HCV is increasing, which can be further enhanced by understanding the barriers to and facilitators of HCV care. Removing stigmatization and implementing peer support and group treatment strategies, in conjunction with greater involvement by nurse educators/practitioners, will promote greater treatment seeking and adherence by PWID. Moreover, screening can be facilitated by noninvasive methods for detecting HCV antibodies and assessing liver fibrosis stages. Recently, HCV clearance has become a major endpoint in the war against drugs for the Global Commission on Drug Policy. This review highlights the most recent evidence concerning HCV infection and treatment strategies in PWID.
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16
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Wiessing L, Ferri M, Grady B, Kantzanou M, Sperle I, Cullen KJ, Hatzakis A, Prins M, Vickerman P, Lazarus JV, Hope VD, Matheï C. Hepatitis C virus infection epidemiology among people who inject drugs in Europe: a systematic review of data for scaling up treatment and prevention. PLoS One 2014; 9:e103345. [PMID: 25068274 PMCID: PMC4113410 DOI: 10.1371/journal.pone.0103345] [Citation(s) in RCA: 178] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 06/29/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND People who inject drugs (PWID) are a key population affected by hepatitis C virus (HCV). Treatment options are improving and may enhance prevention; however access for PWID may be poor. The availability in the literature of information on seven main topic areas (incidence, chronicity, genotypes, HIV co-infection, diagnosis and treatment uptake, and burden of disease) to guide HCV treatment and prevention scale-up for PWID in the 27 countries of the European Union is systematically reviewed. METHODS AND FINDINGS We searched MEDLINE, EMBASE and Cochrane Library for publications between 1 January 2000 and 31 December 2012, with a search strategy of general keywords regarding viral hepatitis, substance abuse and geographic scope, as well as topic-specific keywords. Additional articles were found through structured email consultations with a large European expert network. Data availability was highly variable and important limitations existed in comparability and representativeness. Nine of 27 countries had data on HCV incidence among PWID, which was often high (2.7-66/100 person-years, median 13, Interquartile range (IQR) 8.7-28). Most common HCV genotypes were G1 and G3; however, G4 may be increasing, while the proportion of traditionally 'difficult to treat' genotypes (G1+G4) showed large variation (median 53, IQR 43-62). Twelve countries reported on HCV chronicity (median 72, IQR 64-81) and 22 on HIV prevalence in HCV-infected PWID (median 3.9%, IQR 0.2-28). Undiagnosed infection, assessed in five countries, was high (median 49%, IQR 38-64), while of those diagnosed, the proportion entering treatment was low (median 9.5%, IQR 3.5-15). Burden of disease, where assessed, was high and will rise in the next decade. CONCLUSION Key data on HCV epidemiology, care and disease burden among PWID in Europe are sparse but suggest many undiagnosed infections and poor treatment uptake. Stronger efforts are needed to improve data availability to guide an increase in HCV treatment among PWID.
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Affiliation(s)
- Lucas Wiessing
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - Marica Ferri
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - Bart Grady
- Cluster Infectious Diseases, Department of Research, Public Health Service, Amsterdam, The Netherlands
- Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, The Netherlands
| | - Maria Kantzanou
- National Reference Centre for Retroviruses, Laboratory of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Ida Sperle
- Copenhagen HIV Programme (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Katelyn J. Cullen
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
| | | | - Angelos Hatzakis
- National Reference Centre for Retroviruses, Laboratory of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Maria Prins
- Cluster Infectious Diseases, Department of Research, Public Health Service, Amsterdam, The Netherlands
- Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, The Netherlands
| | - Peter Vickerman
- London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Jeffrey V. Lazarus
- Copenhagen HIV Programme (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Vivian D. Hope
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
- London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Catharina Matheï
- Department of Public Health and Primary Care, KULeuven, Leuven, Belgium
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17
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Reimer J, Schmidt CS, Schulte B, Gansefort D, Gölz J, Gerken G, Scherbaum N, Verthein U, Backmund M. Psychoeducation improves hepatitis C virus treatment during opioid substitution therapy: a controlled, prospective multicenter trial. Clin Infect Dis 2014; 57 Suppl 2:S97-104. [PMID: 23884073 DOI: 10.1093/cid/cit307] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND People who inject drugs (PWID) have a high prevalence of hepatitis C virus (HCV) infection. However, PWID are considered "difficult to treat," requiring a specifically adapted treatment setting, including psychosocial support. METHODS In this prospective, German trial, the impact of psychoeducation (PE) on retention and sustained virologic response (SVR) during HCV therapy among PWID was evaluated. We included 198 patients in opiate substitution therapy, who fulfilled indications for antiviral treatment. All patients received pegylated interferon alfa-2a and ribavirin therapy. Patients in the intervention group (n = 82) received manualized PE sessions. RESULTS In patients with HCV genotype 1 or 4 (GT 1/4), PE was associated with increased treatment completion (76% vs 55%, P = .038), whereas PE had no such effect among GT 2/3 patients, who showed fewer dropouts and higher SVR rates. Among GT 1/4 patients, a minimum of 5 PE sessions was associated with increased SVR (71% vs 48%, P = .037). Multivariate regression analyses confirmed the impact of PE in GT 1/4 and revealed further predictors for retention and SVR, such as preexisting mental distress and adverse events. CONCLUSIONS In patients with a higher risk of dropout due to GT 1/4 or mental distress, PE was shown to improve retention and SVR. PE is an effective supportive intervention for HCV therapy among PWID.
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Affiliation(s)
- Jens Reimer
- Centre for Interdisciplinary Addiction Research, CIAR, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
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18
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Robaeys G, Grebely J, Mauss S, Bruggmann P, Moussalli J, De Gottardi A, Swan T, Arain A, Kautz A, Stöver H, Wedemeyer H, Schaefer M, Taylor L, Backmund M, Dalgard O, Prins M, Dore GJ. Recommendations for the management of hepatitis C virus infection among people who inject drugs. Clin Infect Dis 2014; 57 Suppl 2:S129-37. [PMID: 23884061 DOI: 10.1093/cid/cit302] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In the developed world, the majority of new and existing hepatitis C virus (HCV) infections occur among people who inject drugs (PWID). The burden of HCV-related liver disease in this group is increasing, but treatment uptake among PWID remains low. Among PWID, there are a number of barriers to care that should be considered and systematically addressed, but these barriers should not exclude PWID from HCV treatment. Furthermore, it has been clearly demonstrated that HCV treatment is safe and effective across a broad range of multidisciplinary healthcare settings. Given the burden of HCV-related disease among PWID, strategies to enhance HCV assessment and treatment in this group are urgently needed. These recommendations demonstrate that treatment among PWID is feasible and provides a framework for HCV assessment, management, and treatment. Further research is needed to evaluate strategies to enhance assessment, adherence, and SVR among PWID, particularly as new treatments for HCV infection become available.
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Affiliation(s)
- Geert Robaeys
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Genk, Belgium.
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EASL Clinical Practice Guidelines: management of hepatitis C virus infection. J Hepatol 2014; 60:392-420. [PMID: 24331294 DOI: 10.1016/j.jhep.2013.11.003] [Citation(s) in RCA: 646] [Impact Index Per Article: 64.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 11/05/2013] [Indexed: 02/06/2023]
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Hatzakis A, Van Damme P, Alcorn K, Gore C, Benazzouz M, Berkane S, Buti M, Carballo M, Cortes Martins H, Deuffic-Burban S, Dominguez A, Donoghoe M, Elzouki AN, Ben-Alaya Bouafif N, Esmat G, Esteban R, Fabri M, Fenton K, Goldberg D, Goulis I, Hadjichristodoulou C, Hatzigeorgiou T, Hamouda O, Hasurdjiev S, Hughes S, Kautz A, Malik M, Manolakopoulos S, Matičič M, Papatheodoridis G, Peck R, Peterle A, Potamitis G, Prati D, Roudot-Thoraval F, Reic T, Sharara A, Shennak M, Shiha G, Shouval D, Sočan M, Thomas H, Thursz M, Tosti M, Trépo C, Vince A, Vounou E, Wiessing L, Manns M, Manns M. The state of hepatitis B and C in the Mediterranean and Balkan countries: report from a summit conference. J Viral Hepat 2013; 20 Suppl 2:1-20. [PMID: 23827008 DOI: 10.1111/jvh.12120] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The burden of disease due to chronic viral hepatitis constitutes a global threat. In many Balkan and Mediterranean countries, the disease burden due to viral hepatitis remains largely unrecognized, including in high-risk groups and migrants, because of a lack of reliable epidemiological data, suggesting the need for better and targeted surveillance for public health gains. In many countries, the burden of chronic liver disease due to hepatitis B and C is increasing due to ageing of unvaccinated populations and migration, and a probable increase in drug injecting. Targeted vaccination strategies for hepatitis B virus (HBV) among risk groups and harm reduction interventions at adequate scale and coverage for injecting drug users are needed. Transmission of HBV and hepatitis C virus (HCV) in healthcare settings and a higher prevalence of HBV and HCV among recipients of blood and blood products in the Balkan and North African countries highlight the need to implement and monitor universal precautions in these settings and use voluntary, nonremunerated, repeat donors. Progress in drug discovery has improved outcomes of treatment for both HBV and HCV, although access is limited by the high costs of these drugs and resources available for health care. Egypt, with the highest burden of hepatitis C in the world, provides treatment through its National Control Strategy. Addressing the burden of viral hepatitis in the Balkan and Mediterranean regions will require national commitments in the form of strategic plans, financial and human resources, normative guidance and technical support from regional agencies and research.
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Affiliation(s)
- A Hatzakis
- National Retrovirus Reference Center, Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece.
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Frequency and predictors of no treatment in anti-hepatitis C virus-positive patients at tertiary liver centers in Greece. Eur J Gastroenterol Hepatol 2013; 25:587-93. [PMID: 23426269 DOI: 10.1097/meg.0b013e32835cb5c0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND/AIMS Despite the improving efficacy of antiviral therapy, a significant proportion of chronic hepatitis C patients never start treatment. We determined the magnitude and reasons for no treatment in anti-hepatitis C virus (HCV)-positive patients visiting tertiary liver centers in Greece. MATERIALS AND METHODS We retrospectively enrolled 1146 consecutive anti-HCV-positive patients who visited four physicians at two tertiary liver centers between 2002 and 2010. RESULTS Treatment was initiated in 628 (55%) of the 1146 patients. In particular, 309 (27%) patients were lost to follow-up before HCV RNA testing. Independent predictors of no HCV RNA testing were first visit before 2007, parenteral drug use, and the treating physician. Of the 837 patients tested for HCV RNA, 768 (92%) were eligible for antiviral therapy, had detectable serum HCV RNA, and no contraindication to treatment. Among them, 140 (18%) patients were lost to follow-up before the initiation of treatment or refused antiviral therapy. Independent predictors of no treatment were the treating physician, absence of liver biopsy or transient elastography (odds ratio: 3.5, 95% confidence interval: 2.3-5.4, P<0.001), and normal compared with elevated alanine transaminase levels (odds ratio: 1.7, 95% confidence interval: 1.1-2.8, P=0.027). CONCLUSION A significant proportion (>40%) of anti-HCV-positive patients visiting Greek tertiary liver centers do not receive antiviral therapy. Most of them are lost during the initial evaluation process, whereas the majority (>80%) of eligible patients who complete the initial evaluation eventually start antiviral therapy. The probability of treatment seems to be significantly associated with the treating physician, the alanine transaminase levels, and whether liver biopsy or transient elastography was performed.
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Deutsch M, Papadopoulos N, Hadziyannis ES, Koskinas J. Clinical characteristics, spontaneous clearance and treatment outcome of acute hepatitis C: a single tertiary center experience. Saudi J Gastroenterol 2013; 19:81-5. [PMID: 23481134 PMCID: PMC3632015 DOI: 10.4103/1319-3767.108479] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND AIMS Acute hepatitis C is rarely diagnosed due to its predominantly asymptomatic course. However, early treatment results in viral eradication in a high number of patients thus, preventing chronicity. The aim of our study was to describe our experience with patients with acute hepatitis C virus (HCV) infection who presented and followed-up in our liver unit, pointing on treatment strategy, and outcome. PATIENTS AND METHODS Retrospective, descriptive study of 30 patients with acute HCV infection (26 males and 4 females) with a mean age of 32 years. RESULTS The source of infection was mainly injection drug use in 17/30 (56.7) and medical procedures 6/30 (20%). Twenty patients (66.6%) were symptomatic. HCV-ribonucleic acid (RNA) was detectable at presentation in 26 (86.7%) patients. The genotype distribution was: 13/26 (50%) genotype 1, 3/26 (11.5%) genotype 2, 8/26 (30.8%) genotype 3 and 2/26 (7.7%) genotype 4. Totally, 9 patients (30%) experienced spontaneous viral eradication. No significant differences could be documented between patients who spontaneously cleared the virus and those who had viral persistence. Thirteen patients (44%) were treated with peginterferon-based regimen. All patients (100%) achieved non-detectable HCV-RNA and had normal serum alanine aminotransferase levels at the end of the treatment. Eleven patients achieved sustained virologic response (SVR), one relapsed and one was lost to follow-up. The overall SVR rate was 84.6%. None of the patients required dose reduction or stopped the treatment due to side effects. CONCLUSION In conclusion, early initiation of anti-viral treatment in patients with acute hepatitis C results in high-SVR rates (independently of genotype) and is well-tolerated.
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Affiliation(s)
- Melanie Deutsch
- 2nd Department of Internal Medicine, Athens University Medical School, Hippokration General Hospital of Athens, Greece
| | - Nikolaos Papadopoulos
- 2nd Department of Internal Medicine, Athens University Medical School, Hippokration General Hospital of Athens, Greece,Address for correspondence: Dr. Nikolaos Papadopoulos, 2nd Department of Internal Medicine, Athens University Medical School, Hippokration General Hospital of Athens, 114 Vas. Sophias Ave., 115 27 Athens,, Greece E-mail:
| | - Emilia S. Hadziyannis
- 2nd Department of Internal Medicine, Athens University Medical School, Hippokration General Hospital of Athens, Greece
| | - John Koskinas
- 2nd Department of Internal Medicine, Athens University Medical School, Hippokration General Hospital of Athens, Greece
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Dimova RB, Zeremski M, Jacobson IM, Hagan H, Des Jarlais DC, Talal AH. Determinants of hepatitis C virus treatment completion and efficacy in drug users assessed by meta-analysis. Clin Infect Dis 2012; 56:806-16. [PMID: 23223596 DOI: 10.1093/cid/cis1007] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV)-infected drug users (DUs) have largely been excluded from HCV care. We conducted a systematic review and meta-analysis of the literature on treatment completion and sustained virologic response (SVR) rates in DUs. We assessed the effects of different treatment approaches and services to promote HCV care among DUs as well as demographic and viral characteristics. METHODS Studies of at least 10 DUs treated with pegylated interferon/ribavirin that reported SVR were analyzed. Heterogeneity was assessed (Cochran test) and investigated (meta-regression), and pooled rates were estimated (random effects). RESULTS Thirty-six studies comprising 2866 patients were retrieved. The treatment completion rate among DUs was 83.4% (95% confidence interval [CI], 77.1%-88.9%). Among studies that included addiction-treated and untreated patients during HCV therapy, the higher the proportion of addiction-treated patients, the higher the HCV treatment completion rate (P < .0001). After adjusting for human immunodeficiency virus (HIV)/HCV coinfection, sex, and treatment of addiction, support services during antiviral therapy increased treatment completion (P < .0001). The pooled SVR rate was 55.5% (95% CI, 50.6%-60.3%). Genotype 1/4 (P = .0012) and the proportion of HIV-coinfected DUs (P = .0173) influenced the SVR rate. After adjusting for HCV genotype 1/4 and HIV/HCV coinfection, the SVR rate was positively correlated with involvement of a multidisciplinary team (P < .0001). CONCLUSIONS Treatment of addiction during HCV therapy results in higher treatment completion. Our pooled SVR rate is similar to that obtained in registration trials in the general population. Treatment of addiction during HCV therapy will likely be important for HCV-infected DUs undergoing treatment with more complex regimens including direct-acting antivirals.
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Young AM, Crosby RA, Oser CB, Leukefeld CG, Stephens DB, Havens JR. Hepatitis C viremia and genotype distribution among a sample of nonmedical prescription drug users exposed to HCV in rural Appalachia. J Med Virol 2012; 84:1376-87. [PMID: 22825816 PMCID: PMC3571688 DOI: 10.1002/jmv.23252] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Research has demonstrated that hepatitis C (HCV) genotype distribution varies geographically and demographically. This exploratory study examines HCV viremia, viral concentration, and genotype distribution among anti-HCV positive, rural Appalachian nonmedical prescription drug users. The study population was randomly selected from a pool of 200 anti-HCV positive participants in a longitudinal study. Those randomly chosen were representative of the overall pool in terms of demographics, drug use, and other risk behaviors. Participants were tested serologically for HCV RNA, viral concentration, and genotype, and interview-administered questionnaires examined behavioral and demographic characteristics. Of the 81 participants, 69% tested RNA positive, 59% of which had viral loads exceeding 800,000 IU/ml. Approximately 66% of the RNA positive sample had genotype 1a; types 2b (16%) and 3a (13%) were less common. RNA positive participants were not significantly different than RNA negative participants demographically or behaviorally. Likewise, with the exception of education, genotype 1 participants were not significantly different than those with genotype 2 or 3. The prevalence of active HCV infection highlights a need for prevention and treatment in this population. However, the predominance of genotype 1 may present challenges due to its association with decreased responsiveness to drug treatment, although the novel class of direct-acting antivirals such as telaprevir and boceprevir offer new hope in this regard. The prevalence of genotype 1 may also foreshadow heightened burden of hepatocellular carcinoma and elevated healthcare expenditures. More research is needed to characterize HCV infection and genotype in this population.
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Affiliation(s)
- April M Young
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, Georgia 30322, USA.
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Abstract
PURPOSE OF REVIEW To provide an update on new treatment approaches for patients with hepatitis C virus (HCV) infection and substance use. This issue is of extreme importance for HCV, as many patients have substance-use histories. RECENT FINDINGS Recent emergence of two new protease inhibitors, boceprevir and telaprevir, to enhance the modern treatment of HCV have boosted the sustained virologic response rate to about 80%, a 30% increase over prior standard of care with interferon and ribavirin. Unfortunately, many providers are reluctant to treat patients with substance-use histories unless they have demonstrated abstinence for at least 6 months, and there is a spoken and unspoken bias against these patients. Emerging new studies have shown that even current injection drug users can be treated successfully with results comparable to patients who are abstinent and those with no drug-use histories, especially with attention to the patient's substance use and other psychiatric problems. SUMMARY Newer treatment approaches for HCV will help many more patients than ever before to overcome the virus. Changed attitudes and innovative approaches to patients with substance-use histories are needed to bring these scientific advances to this segment of the population of patients with HCV.
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Kurelac I, Papic N, Sakoman S, Orban M, Dusek D, Coric M, Vince A. Intravenous Drug Users Can Achieve a High Sustained Virological Response Rate: experience From Croatian Reference Center for Viral Hepatitis. HEPATITIS MONTHLY 2011; 11:986-92. [PMID: 22368683 PMCID: PMC3282032 DOI: 10.5812/kowsar.1735143x.4216] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Revised: 09/02/2011] [Accepted: 09/29/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) is one of the major infectious disease agents among injecting drug users (IVDUs). However, most of the IVDUs are not still treated. OBJECTIVES To examine the treatment course, adherence, tolerability and safety profiles and SVR rates in IVDUs compared to non-IVDUs. PATIENTS AND METHODS Demographic and clinical data were collected from medical records of 345 adult patients diagnosed with chronic hepatitis C (CHC) who were treated with a PEG-IFN-α and ribavirin in Croatian Reference Center for Viral Hepatitis in Zagreb between January 2003 and January 2010. Efficacy, safety and tolerability treatment profiles were analyzed in IVDUs vs. non-IVDUs. Positive predictors for treatment outcome were evaluated by univariate and multivariate logistic regression. RESULTS A total of 106 (30.46%) IVDUs were identified. The IVDUs were mainly male (81.13% vs. 52.30%, P = 0.0001), young (mean ± SD age: 32.46 ± 5.33 y vs. 46.12 ± 11.48 y, P = 0.0001), had lower fibrosis and HAI score (measured by ISHAK) and shorter duration of infection (mean ± SD: 8.98 ± 5.87 vs. 16.79 ± 8.99 y, P = 0.0001) compared to non-IVDU group. In IVDUs, genotype 1a (24.52%) and 3a (38.68%) were predominant. There were no differences in completion rate between the two studied groups. IVDUs achieved a significantly higher rate of overall SVR (70.75% vs. 51.04%, P < 0.0009) and in genotypes 1 and 4 (65.08% vs. 48.73%, P = 0.0294) vs. non-IVDUs. Treatment discontinuation rates due to side-effects were not significantly different in IVDUs and non-IVDUs (2.83% vs. 7.11%, P = 0.1390). IVDU group had a higher rate of lost to follow-up (13.21% vs. 4.60%, P = 0.0071). There were no statistically significant differences in SVR rate between IVDUs with, or without substitution therapy (55.55% vs. 74.62%, P = 0.0866). Independent predictors of SVR were age < 40 years and genotypes 2 and 3. Type of PEG-IFN-α used was not associated with SVR. CONCLUSIONS Treatment of CHC in IVDUs should strongly be encouraged as they have positive predictors for achieving SVR such as younger age, shorter duration of infection, and consequently favorable histological stage of the disease, and good adherence to treatment. There is no difference in safety and tolerability profiles of treatment in IVDUs compared to patients with no history of drug abuse.
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Affiliation(s)
- Ivan Kurelac
- Croatian Reference Center for Viral Hepatitis, University Hospital for Infectious Diseases, Zagreb, Croatia
| | - Neven Papic
- Croatian Reference Center for Viral Hepatitis, University Hospital for Infectious Diseases, Zagreb, Croatia
- Corresponding author: Neven Papic, Department of Viral Hepatitis, University Hospital for Infectious Diseases, Mirogojska 8, 10000 Zagreb, Croatia. Tel.: +385-12826262, Fax: +385-14678235, E-mail:
| | - Slavko Sakoman
- Department of psychiatry, Ward of Addictions, Sisters of Mercy University Hospital, Zagreb, Croatia
| | - Mirjana Orban
- Department of psychiatry, Ward of Addictions, Sisters of Mercy University Hospital, Zagreb, Croatia
| | - Davorka Dusek
- Croatian Reference Center for Viral Hepatitis, University Hospital for Infectious Diseases, Zagreb, Croatia
| | - Marijana Coric
- Department of Pathology, Clinical Hospital Centre Zagreb, Zagreb, Croatia
| | - Adriana Vince
- Croatian Reference Center for Viral Hepatitis, University Hospital for Infectious Diseases, Zagreb, Croatia
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Kurelac I, Papic N, Sakoman S, Orban M, Dusek D, Coric M, Vince A. Intravenous Drug Users Can Achieve a High Sustained Virological Response Rate: experience From Croatian Reference Center for Viral Hepatitis. HEPATITIS MONTHLY 2011. [PMID: 22368683 DOI: 10.5812/kowsar.1735143x.779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) is one of the major infectious disease agents among injecting drug users (IVDUs). However, most of the IVDUs are not still treated. OBJECTIVES To examine the treatment course, adherence, tolerability and safety profiles and SVR rates in IVDUs compared to non-IVDUs. PATIENTS AND METHODS Demographic and clinical data were collected from medical records of 345 adult patients diagnosed with chronic hepatitis C (CHC) who were treated with a PEG-IFN-α and ribavirin in Croatian Reference Center for Viral Hepatitis in Zagreb between January 2003 and January 2010. Efficacy, safety and tolerability treatment profiles were analyzed in IVDUs vs. non-IVDUs. Positive predictors for treatment outcome were evaluated by univariate and multivariate logistic regression. RESULTS A total of 106 (30.46%) IVDUs were identified. The IVDUs were mainly male (81.13% vs. 52.30%, P = 0.0001), young (mean ± SD age: 32.46 ± 5.33 y vs. 46.12 ± 11.48 y, P = 0.0001), had lower fibrosis and HAI score (measured by ISHAK) and shorter duration of infection (mean ± SD: 8.98 ± 5.87 vs. 16.79 ± 8.99 y, P = 0.0001) compared to non-IVDU group. In IVDUs, genotype 1a (24.52%) and 3a (38.68%) were predominant. There were no differences in completion rate between the two studied groups. IVDUs achieved a significantly higher rate of overall SVR (70.75% vs. 51.04%, P < 0.0009) and in genotypes 1 and 4 (65.08% vs. 48.73%, P = 0.0294) vs. non-IVDUs. Treatment discontinuation rates due to side-effects were not significantly different in IVDUs and non-IVDUs (2.83% vs. 7.11%, P = 0.1390). IVDU group had a higher rate of lost to follow-up (13.21% vs. 4.60%, P = 0.0071). There were no statistically significant differences in SVR rate between IVDUs with, or without substitution therapy (55.55% vs. 74.62%, P = 0.0866). Independent predictors of SVR were age < 40 years and genotypes 2 and 3. Type of PEG-IFN-α used was not associated with SVR. CONCLUSIONS Treatment of CHC in IVDUs should strongly be encouraged as they have positive predictors for achieving SVR such as younger age, shorter duration of infection, and consequently favorable histological stage of the disease, and good adherence to treatment. There is no difference in safety and tolerability profiles of treatment in IVDUs compared to patients with no history of drug abuse.
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Affiliation(s)
- Ivan Kurelac
- Croatian Reference Center for Viral Hepatitis, University Hospital for Infectious Diseases, Zagreb, Croatia
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