1
|
Dalgard O, Litwin AH, Shibolet O, Grebely J, Nahass R, Altice FL, Conway B, Gane EJ, Luetkemeyer AF, Peng CY, Iser D, Gendrano IN, Kelly MM, Haber BA, Platt H, Puenpatom A. Health-related quality of life in people receiving opioid agonist treatment and treatment for hepatitis C virus infection. J Addict Dis 2022:1-12. [PMID: 35920743 DOI: 10.1080/10550887.2022.2088978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND In people with chronic hepatitis C virus (HCV) infection, viral eradication is associated with improved health-related quality of life (HRQOL). OBJECTIVE To assess changes in HRQOL among participants receiving opioid agonist therapy undergoing treatment for HCV infection. METHODS COSTAR (NCT02251990) was a randomized, double-blind, placebo-controlled study. Adults with HCV infection on opioid agonist therapy received elbasvir (50 mg)/grazoprevir (100 mg) or placebo for 12 weeks. HRQOL was evaluated using the Medical Outcomes Study 36-Item Short Form Health Survey version 2 (SF-36v2) Acute Form. Participants remained blinded until 4 weeks after end of treatment. RESULTS Overall, 201 participants received elbasvir/grazoprevir and 100 participants received placebo. Treatment difference mean change from baseline scores (elbasvir/grazoprevir minus placebo) indicated an improvement in HRQOL at 4 weeks after end of treatment in participants receiving elbasvir/grazoprevir versus those receiving placebo, driven by declining HRQOL in those receiving placebo and improved HRQOL in certain domains among participants receiving elbasvir/grazoprevir. Notable differences in SF-36v2 scores were evident in the general health (mean treatment difference [MTD], 6.00; 95% CI, 1.37-10.63), vitality (MTD, 6.81; 95% CI, 1.88-11.75), and mental health (MTD, 5.17; 95% CI, 0.52-9.82) domains and in the mental component summary score (mean, 2.83; 95% CI, 0.29-5.37). No notable between-treatment differences were evident at treatment weeks 4 or 12. CONCLUSION HRQOL in patients receiving medication for opioid dependence was improved following treatment for HCV infection with elbasvir/grazoprevir, suggesting that eradication of HCV infection with direct-acting antivirals is associated with improved HRQOL. TRIAL REGISTRATION NUMBER ClinicalTrials.gov, NCT02251990.
Collapse
Affiliation(s)
- Olav Dalgard
- Institute of Clinical Medicine, Akershus University, Oslo, Norway
| | - Alain H Litwin
- Prisma Health/University of South Carolina School of Medicine Greenville, Clemson University, Greenville, SC, USA
| | - Oren Shibolet
- Liver Unit, Department of Gastroenterology, Tel Aviv Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | | | - Brian Conway
- Vancouver Infectious Diseases Centre, Vancouver, BC, Canada
| | | | | | | | - David Iser
- The Alfred Hospital, Melbourne, VIC, Australia
| | | | | | | | | | | | | |
Collapse
|
2
|
He N, Feng G, Hao S, Xu M, Liu J, Kong F, Ren Z, Dou W, Yao C, Liang T, Wang J. The impact of direct-acting antivirals on quality of life in patients with hepatitis C virus infection: a meta-analysis. Ann Hepatol 2022; 27:100705. [PMID: 35398571 DOI: 10.1016/j.aohep.2022.100705] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/18/2022] [Accepted: 03/29/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES It is well known that the quality of life (QoL) of patients with chronic hepatitis C (HCV) is lower than that of the general population and that therapy with direct-acting antivirals (DAA) for HCV is safe and effective. However, data on the QoL of patients are scanty. The purpose of this study was to assess the effect of DAA drugs on patients' QoL. METHODS The literature included in this meta-analysis was due in March 2021. The random effect model of heterogeneous data and the fixed effect model of homogeneous data were used to analyze the data. QoL had to be evaluated using the Short Form Health Survey (SF-36) questionnaire with at least one measure at baseline (T0) and one measure at 12 weeks (T12) or 24 weeks (T24) after the end of therapy. The meta-analysis included eight studies, which involved 1,619 patients. RESULTS At T12, the meta-analysis showed all items of the SF-36 questionnaire improved from the pretreatment to post-treatment period and reached statistical significance (p < 0.05) except for the bodily pain (mean difference: 1.16, 95%CI -0.43-2.74) and role limitations-emotional (mean difference: 4.10, 95%CI -1.32-9.52). However, after subgroup analysis (whether ribavirin was being used or not), the bodily pain domain (mean difference: 3.34, 95%CI 1.03-5.65) became statistically significant again. At T24, the results indicated that all items of the SF-36 questionnaire improved from the pretreatment to the post-treatment period and reached statistical significance (p < 0.05) except for the role limitations-emotional domain (mean difference: 4.50, 95%CI -2.66-11.66). CONCLUSIONS There is evidence indicating that DAA therapy is accompanied by an improvement in QoL. Patients receiving DAA medication have a clinically relevant improvement in most domains of the SF-36 questionnaire at T12 or T24, except for a few aspects including role limitations-emotional.
Collapse
Affiliation(s)
- Na He
- The First Affiliated Hospital of Xi'an Medical University, Xi'an, China.
| | - Gong Feng
- Xi'an Medical University, Xi'an, China
| | - Shuai Hao
- Xi'an Medical University, Xi'an, China
| | - Meiqi Xu
- Xi'an Medical University, Xi'an, China
| | - Jing Liu
- Graduate School of Xi'an Medical University, Xi'an, China
| | - Fanjiao Kong
- Graduate School of Xi'an Medical University, Xi'an, China
| | - Zhuoxu Ren
- Graduate School of Xi'an Medical University, Xi'an, China
| | - Wenli Dou
- Graduate School of Xi'an Medical University, Xi'an, China
| | - Chengzi Yao
- Graduate School of Xi'an Medical University, Xi'an, China
| | | | - Juan Wang
- Graduate School of Xi'an Medical University, Xi'an, China
| |
Collapse
|
3
|
Younossi ZM, Racila A, Muir A, Bourliere M, Mangia A, Esteban R, Zeuzem S, Colombo M, Manns M, Papatheodoridis GV, Buti M, Chokkalingam A, Gaggar A, Nader F, Younossi I, Henry L, Stepanova M. Long-term Patient-Centered Outcomes in Cirrhotic Patients With Chronic Hepatitis C After Achieving Sustained Virologic Response. Clin Gastroenterol Hepatol 2022; 20:438-446. [PMID: 33493697 DOI: 10.1016/j.cgh.2021.01.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/04/2021] [Accepted: 01/18/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND & AIMS Achieving sustained virologic response (SVR) among patients with hepatitis C virus (HCV) leads to patient reported outcome (PRO) improvement. We aimed to assess the long-term post-SVR PRO trends in HCV patients with cirrhosis. METHODS Patients with HCV and cirrhosis treated in clinical trials with direct acting antiviral agents (DAAs) who achieved SVR-12 were prospectively enrolled in a long-term registry (clinicaltrials.gov #NCT02292706). PROs were collected every 24 weeks using the Short Form-36v2 (SF-36), CLDQ-HCV, and WPAI-HCV. RESULTS Pre-treatment baseline data were available for 854 cirrhotic patients who achieved SVR after DAAs. Of these, 730 had compensated (CC) and 124 had decompensated cirrhosis (DCC) before treatment- patients with DCC reported severe impairment in their PROs in comparison to CC patients (by mean -5% to -16% of a PRO range size; p < .05 for 16 out of 20 studied PROs]. After achieving SVR and registry enrollment, significant PRO improvements were noted from pre-treatment levels in 11/20 domains for those with DCC (+4% to +21%) and 19/20 PRO domains in patients with CC (+3% to +17%). Patients with baseline DCC had higher rates of hepatocellular carcinoma and mortality (P < .05). In patients with CC, the PRO gains persisted up to 168 weeks (3.5 years) of registry follow-up. In patients with DCC, the improvements lasted for at least 96 weeks but a declining trend after year 2. CONCLUSIONS Patients with HCV cirrhosis experience severe PRO impairment at baseline with sustainable improvement after SVR. Though those with DCC experience improvement, there is a decline after 2 years.
Collapse
Affiliation(s)
- Zobair M Younossi
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, Virginia; Inova Medicine, Inova Health System, Falls Church, Virginia; Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia.
| | - Andrei Racila
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, Virginia; Inova Medicine, Inova Health System, Falls Church, Virginia
| | - Andrew Muir
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Marc Bourliere
- Department of Hepato- Gastroenterology, Hospital Saint Joseph, Marseille, France
| | - Alessandra Mangia
- IRCCS Casa Sollievo della Sofferenza Hospital, Liver Unit, Medical Sciences, San Giovanni Rotondo, Italy
| | - Rafael Esteban
- Liver Unit, Hospital Universitari Vall d'Hebron and Ciberehd del Instituto Carlos III, Barcelona, Spain
| | - Stefan Zeuzem
- Department of Medicine I at the Goethe University Hospital, Frankfurt, Germany
| | - Massimo Colombo
- Liver Center for Translational Research, IRCCS Humanitas, Milan, Italy
| | | | | | - Maria Buti
- Liver Unit, Hospital Universitari Vall d'Hebron and Ciberehd del Instituto Carlos III, Barcelona, Spain
| | | | | | - Fatema Nader
- Center for Outcomes Research in Liver Disease, Washington, District of Columbia
| | - Issah Younossi
- Center for Outcomes Research in Liver Disease, Washington, District of Columbia
| | - Linda Henry
- Center for Outcomes Research in Liver Disease, Washington, District of Columbia
| | - Maria Stepanova
- Center for Outcomes Research in Liver Disease, Washington, District of Columbia
| |
Collapse
|
4
|
Heo J, Kim YJ, Lee JW, Kim JH, Lim YS, Han KH, Jeong SH, Cho M, Yoon KT, Bae SH, Crown ED, Fredrick LM, Alami NN, Asatryan A, Kim DH, Paik SW, Lee YJ. Efficacy and Safety of Glecaprevir/Pibrentasvir in Korean Patients with Chronic Hepatitis C: A Pooled Analysis of Five Phase II/III Trials. Gut Liver 2021; 15:895-903. [PMID: 34053916 PMCID: PMC8593501 DOI: 10.5009/gnl20321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/24/2020] [Accepted: 01/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background/Aims Glecaprevir/pibrentasvir (G/P) is the first pan-genotypic direct-acting antiviral combination therapy approved in Korea. An integrated analysis of five phase II and III trials was conducted to evaluate the efficacy and safety of G/P in Korean patients with chronic hepatitis C virus (HCV) infection. Methods The study analyzed pooled data on Korean patients with HCV infection enrolled in the ENDURANCE 1 and 2, SURVEYOR II part 4 and VOYAGE I and II trials, which evaluated the efficacy and safety of 8 or 12 weeks of G/P treatment. The patients were either treatment-naïve or had received sofosbuvir or interferon-based treatment. Efficacy was evaluated by assessing the rate of sustained virologic response at 12 weeks posttreatment (SVR12). Safety was evaluated by monitoring adverse events (AEs) and laboratory assessments. Results The analysis included 265 patients; 179 (67.5%) were HCV treatment-naïve, and most patients were either subgenotype 1B (48.7%) or 2A (44.5%). In the intention-to-treat population, 262 patients (98.9%) achieved SVR12. Three patients did not achieve SVR12 one had virologic failure and two had non-virologic failures. Most AEs were grade 1/2; eight patients (3.0%) experienced at least one grade ≥3 AE. No serious AEs related to G/P treatment were reported, and grade ≥3 hepatic laboratory abnormalities were rare (0.8%). Conclusions G/P therapy was highly efficacious and well tolerated in Korean patients with HCV infection, with most patients achieving SVR12. The safety profile was comparable to that observed in a pooled analysis of a global pan-genotypic population of patients with HCV infection who received G/P.
Collapse
Affiliation(s)
- Jeong Heo
- Department of Internal Medicine, Pusan National University College of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Yoon Jun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Woo Lee
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Ji Hoon Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Young-Suk Lim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kwang-Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sook-Hyang Jeong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Mong Cho
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Yangsan, Korea
| | - Ki Tae Yoon
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Yangsan, Korea
| | - Si Hyun Bae
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | | | | | | | | | - Seung Woon Paik
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Youn-Jae Lee
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| |
Collapse
|
5
|
Aalismail NA, Díaz-Rúa R, Ngugi DK, Cusack M, Duarte CM. Aeolian Prokaryotic Communities of the Global Dust Belt Over the Red Sea. Front Microbiol 2020; 11:538476. [PMID: 33262740 PMCID: PMC7688470 DOI: 10.3389/fmicb.2020.538476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 10/23/2020] [Indexed: 01/25/2023] Open
Abstract
Aeolian prokaryotic communities (APC) are important components of bioaerosols that are transported freely or attached to dust particles suspended in the atmosphere. Terrestrial and marine ecosystems are known to release and receive significant prokaryote loads into and from the surrounded atmospheric air. However, compared to terrestrial systems, there is a lack of microbial characterization of atmospheric dust over marine systems, such as the Red Sea, which receives significant terrestrial dust loads and is centrally located within the Global Dust Belt. Prokaryotic communities are likely to be particularly important in the Global Dust Belt, the area between the west coast of North Africa and Central Asia that supports the highest dust fluxes on the planet. Here we characterize the diversity and richness of the APC over the Red Sea ecosystem, the only sea fully contained within the Global Dust Belt. MiSeq sequencing was used to target 16S ribosomal DNA of two hundred and forty aeolian dust samples. These samples were collected at ∼7.5 m high above the sea level at coastal and offshore sampling sites over a 2-year period (2015–2017). The sequencing outcomes revealed that the APC in the atmospheric dust is dominated by Proteobacteria (42.69%), Firmicutes (41.11%), Actinobacteria, (7.69%), and Bacteroidetes (3.49%). The dust-associated prokaryotes were transported from different geographical sources and found to be more diverse than prokaryotic communities of the Red Sea surface water. Marine and soil originated prokaryotes were detected in APC. Hence, depending on the season, these groups may have traveled from other distant sources during storm events in the Red Sea region, where the APC structure is influenced by the origin and the concentration of aeolian dust particles. Accordingly, further studies of the impact of atmospheric organic aerosols on the recipient environments are required.
Collapse
Affiliation(s)
- Nojood A Aalismail
- Red Sea Research Center and Computational Bioscience Research Center, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia
| | - Rubén Díaz-Rúa
- Red Sea Research Center and Computational Bioscience Research Center, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia
| | - David K Ngugi
- Leibniz Institute DSMZ - German Collection of Microorganisms and Cell Cultures GmbH, Braunschweig, Germany
| | - Michael Cusack
- Red Sea Research Center and Computational Bioscience Research Center, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia
| | - Carlos M Duarte
- Red Sea Research Center and Computational Bioscience Research Center, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia
| |
Collapse
|
6
|
Watanabe S, Morimoto N, Miura K, Murohisa T, Tahara T, Sato T, Tano S, Fukaya Y, Kurata H, Okamura Y, Numao N, Uehara K, Murayama K, Nakazawa K, Sugaya H, Yoshizumi H, Iijima M, Tsukui M, Hirosawa T, Takaoka Y, Nomoto H, Maeda H, Goka R, Isoda N, Yamamoto H. Efficacy and safety of glecaprevir and pibrentasvir combination therapy in old-aged patients with chronic hepatitis C virus infection. J Rural Med 2020; 15:139-145. [PMID: 33033533 PMCID: PMC7530586 DOI: 10.2185/jrm.2020-004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/23/2020] [Indexed: 12/11/2022] Open
Abstract
Objective: Combination therapy with glecaprevir and pibrentasvir (G/P) has
been shown to provide a sustained virologic response (SVR) rate of >97% in patients
with chronic hepatitis C virus (HCV) infection in the first published real-world Japanese
data. However, a recently published study showed that the treatment was often discontinued
in patients ≥75 years old, resulting in low SVR in intention-to-treat (ITT) analysis.
Thus, our aim was to evaluate real-world data for G/P therapy in patients ≥75 years of
age, the population density of which is high in “rural” regions. Patients and Methods: We conducted a multicenter study to assess the
efficacy and safety of G/P therapy for chronic HCV infection, in the North Kanto area in
Japan. Results: Of the 308 patients enrolled, 294 (95.5%) completed the treatment
according to the protocol. In ITT and per-protocol analyses, the overall SVR12 rate was
97.1% and 99.7%, respectively. The old-aged patients group consisted of 59 participants,
56 of whom (94.9%) completed the scheduled protocol. Although old-aged patients tended to
have non-SVR factors such as liver cirrhosis, history of HCC, and prior DAA therapies, the
SVR12 rates in old-aged patients were 98.3% and 100% in the ITT and PP analyses,
respectively. Of 308 patients enrolled, adverse events were observed in 74 patients
(24.0%), with grade ≥3 events in 8 patients (2.6%). There was no significant difference in
any grade and grade ≥3 adverse events between the old-aged group and the rest of the study
participants. Only one patient discontinued the treatment because of adverse events. Conclusion: G/P therapy is effective and safe for old-aged patients.
Collapse
Affiliation(s)
- Shunji Watanabe
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Japan
| | - Naoki Morimoto
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Japan
| | - Kouichi Miura
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Japan
| | | | - Toshiyuki Tahara
- Department of Gastroenterology, Saiseikai Utsunomiya Hospital, Japan
| | - Takashi Sato
- Department of Gastroenterology, Nasu Red Cross Hospital, Japan
| | - Shigeo Tano
- Department of Gastroenterology, Shin-Oyama City Hospital, Japan
| | - Yukimura Fukaya
- Department of Internal Medicine, Nasu Minami Hospital, Japan
| | - Hidekazu Kurata
- Department of Gastroenterology, Tochigi Medical Center Shimotsuga, Japan
| | | | - Norikatsu Numao
- Department of Gastroenterology, Haga Red Cross Hospital, Japan
| | - Keita Uehara
- Department of Gastroenterology, Tochigi Medical Center, Japan
| | - Kozue Murayama
- Department of Gastroenterology, Koga Red Cross Hospital, Japan
| | | | - Hitoshi Sugaya
- Department of Internal Medicine, Utsunomiya Higashi Hospital, Japan.,Department of Gastroenterology, Ashikaga Red Cross Hospital, Japan
| | | | - Makoto Iijima
- Department of Gastroenterology, Dokkyo Medical University, Japan.,Department of Gastroenterology, Yuai Memorial Hospital, Japan
| | - Mamiko Tsukui
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Japan
| | - Takuya Hirosawa
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Japan
| | - Yoshinari Takaoka
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Japan
| | - Hiroaki Nomoto
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Japan
| | - Hiroshi Maeda
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Japan
| | - Rie Goka
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Japan
| | - Norio Isoda
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Japan
| | - Hironori Yamamoto
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Japan
| |
Collapse
|
7
|
Mücke MM, Maasoumy B, Dietz J, Mücke VT, Simon CO, Canchola JA, Cornberg M, Marins EG, Manns MP, Zeuzem S, Wedemeyer H, Sarrazin C, Vermehren J. Utility of the new cobas HCV test for viral load monitoring during direct-acting antiviral therapy. PLoS One 2019; 14:e0224751. [PMID: 31738773 PMCID: PMC6860929 DOI: 10.1371/journal.pone.0224751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/21/2019] [Indexed: 11/23/2022] Open
Abstract
Background The COBAS AmpliPrep/COBAS TaqMan assay HCV (CAP/CTM) is widely used in clinical routine for HCV testing. Recently, the new cobas HCV test was established for high throughput testing with minimal operator intervention. As different assays may yield different quantitative/qualitative results that possibly impact treatment decisions, the aim of this study was to externally evaluate the cobas HCV test performance in comparison to CAP/CTM in a clinically relevant setting. Methods Serum samples were obtained from 270 patients who received direct acting antiviral therapy with different treatment regimens at two study sites (Hannover and Frankfurt) in 2016. Overall, 1545 samples (baseline, on-treatment and follow-up) were tested in parallel by both assays. Results The mean difference between cobas HCV and CAP/CTM for the quantification of HCV RNA was 0.008 log10 IU/ml HCV RNA (95% limits of agreement: -0.02–0.036) showing excellent agreement of both assays. With respect to clinical cut offs (HCV RNA detectable vs. target not detected and HCV RNA above the lower limit of quantification (LLOQ) vs. <LLOQ), discordant results were obtained in 9.5% and 4.6%, respectively; the greatest differences were observed during early stages of antiviral therapy (week 1, week 2 and week 4), but none were statistically significant. Overall percent agreement for SVR between cobas HCV and CAP/CTM at the 15 IU/ml cutoff was 99.2% (95%CI 92.7%-100%). Conclusion The performance of the new cobas HCV test was comparable to CAP/CTM in a clinical setting representing a large patient population with HCV GT 1 and 3 treated with DAAs.
Collapse
Affiliation(s)
- Marcus M. Mücke
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Benjamin Maasoumy
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Julia Dietz
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Victoria T. Mücke
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | | | - Marcus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Ed G. Marins
- Roche Molecular Systems, Pleasanton, CA, United States of America
| | - Michael P. Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Stefan Zeuzem
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Christoph Sarrazin
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
- Department of Gastroenterology, St. Josefs-Hospital, Wiesbaden, Germany
| | - Johannes Vermehren
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
- * E-mail:
| |
Collapse
|
8
|
Younossi ZM, Stepanova M, Anstee QM, Lawitz EJ, Wai-Sun Wong V, Romero-Gomez M, Kersey K, Li G, Subramanian GM, Myers RP, Djedjos CS, Okanoue T, Trauner M, Goodman Z, Harrison SA. Reduced Patient-Reported Outcome Scores Associate With Level of Fibrosis in Patients With Nonalcoholic Steatohepatitis. Clin Gastroenterol Hepatol 2019; 17:2552-2560.e10. [PMID: 30779990 DOI: 10.1016/j.cgh.2019.02.024] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patient-reported outcomes (PROs) are used to measure patients' experience with their disease. However, there are few PRO data from patients with NASH. We collected data from the STELLAR clinical trials to assess PROs for NASH and advanced fibrosis. METHODS We analyzed data from 1667 patients (58 ± 9 years, 40% male, 52% with cirrhosis, 74% with diabetes) with NASH and bridging fibrosis or compensated cirrhosis (metavir scores, F3 or F4) enrolled in the phase 3 STELLAR trials of selonsertib (NCT03053050 and NCT03053063) who completed PRO questionnaires (SF-36, CLDQ-NASH, EQ-5D, or WPAI:SHP) before treatment initiation. RESULTS Compared with patients with F3 fibrosis, higher proportions of patients with F4 fibrosis were female, were white, had more hematologic and gastrointestinal comorbidities, and had type 2 diabetes (P ≤ .01). Mean physical health-related PRO scores were significantly lower than those of the general population: patients with F4 fibrosis had score reductions of 4.4% to 12.9% in 6/8 SF-36 domains and patients with F3 fibrosis had score reductions of 3.9% to 11.7% in 4/8 domains (P < .01). Compared to patients with F3 fibrosis, those with F4 fibrosis had lower scores in all but 1 domains of CLDQ-NASH, Role Physical, Bodily Pain, and Social Functioning domains of the SF-36, and EQ-5D (P ≤ 01). In multivariate regression analysis, factors independently associated with lower PRO scores included having cirrhosis, female sex, higher body mass index, history of smoking, and diabetes or other comorbidities (P < .01). CONCLUSIONS PROs are significantly lower in patients with NASH with advanced fibrosis who participated in the STELLAR clinical trials. Treatment of patients with NASH should focus on improving not only clinical outcomes but also quantifiable symptom burden and health-related quality of life.
Collapse
Affiliation(s)
- Zobair M Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia; Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, Virginia.
| | - Maria Stepanova
- Center for Outcomes Research in Liver Disease (COR-LD), Washington, District of Columbia
| | - Quentin M Anstee
- Institute of Cellular Medicine, The Medical School, Newcastle University, Newcastle-upon-Tyne, and Newcastle NIHR Biomedical Research Centre, Newcastle-upon-Tyne, United Kingdom
| | - Eric J Lawitz
- Texas Liver Institute, University of Texas Health San Antonio, San Antonio, Texas
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong
| | | | | | - Georgia Li
- Gilead Sciences, Inc, Foster City, California
| | | | | | | | | | - Michael Trauner
- Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Zachary Goodman
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia; Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, Virginia
| | - Stephen A Harrison
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
9
|
Mücke MM, Herrmann E, Mücke VT, Graf C, Zeuzem S, Vermehren J. Efficacy and safety of direct-acting antivirals for hepatitis C in the elderly: A systematic review and meta-analysis. Liver Int 2019; 39:1652-1660. [PMID: 31033122 DOI: 10.1111/liv.14126] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/19/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND&AIMS Since the introduction of direct-acting antivirals (DAAs) several studies have reported high efficacy and safety in Hepatitis C infected patients, even in those earlier considered difficult-to-treat. We aimed to assess the efficacy and safety of DAA therapy in elderly patients. METHODS The PubMed MEDLINE, Embase and Cochrane databases were searched through July 2018. Two independent researchers extracted data and assessed the quality and risk of bias. Risk ratios (RRs) were pooled using random effects models. The primary outcome was efficacy of DAA therapy assessed by the RR for non-sustained virologic response (SVR) among patients aged <65 vs ≥65 years. RESULTS Overall, we identified 63 studies including 34 082 patients treated with different DAAs. Risk for non-SVR was comparable in patients <65 and ≥65 years of age (RR 1.00, 95% CI 0.86-1.15; P = 0.979) and even lower in a subgroup analysis of cirrhotic patients ≥65 years of age (RR 0.59, 95% CI 0.35-0.99, P = 0.044). Risk for non-SVR was similar between age groups in all other subgroup analyses. Elderly patients had a significantly increased risk of adverse events (AEs) (RR 1.30, 95% CI 1.11-1.52, P = 0.001), but not for serious adverse events (P = 0.43) or treatment discontinuation (P = 0.15). Risk for anaemia if treated with additional ribavirin was 2.84 (95% CI 1.73-4.66, P < 0.001) in elderly patients compared to patients <65 years. CONCLUSION Our results show that DAAs are highly effective and safe in elderly patients. Ribavirin should be avoided in the elderly as more AEs and particularly anaemia is observed. Further cost-effectiveness analyses are needed to evaluate the socio-economic benefit of treating elderly people without advanced liver disease.
Collapse
Affiliation(s)
- Marcus M Mücke
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Eva Herrmann
- Institute of Biostatistics and Mathematical Modeling, Goethe University, Frankfurt am Main, Germany
| | - Victoria T Mücke
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christiana Graf
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Stefan Zeuzem
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Johannes Vermehren
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| |
Collapse
|
10
|
Xie Q, Xuan JW, Tang H, Ye XG, Xu P, Lee IH, Hu SL. Hepatitis C virus cure with direct acting antivirals: Clinical, economic, societal and patient value for China. World J Hepatol 2019; 11:421-441. [PMID: 31183003 PMCID: PMC6547290 DOI: 10.4254/wjh.v11.i5.421] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/05/2019] [Accepted: 04/19/2019] [Indexed: 02/06/2023] Open
Abstract
About 10 million people in China are infected with hepatitis C virus (HCV), with the seroprevalence of anti-HCV in the general population estimated at 0.6%. Delaying effective treatment of chronic hepatitis C (CHC) is associated with liver disease progression, cirrhosis, hepatocellular carcinoma, and liver-related mortality. The extrahepatic manifestations of CHC further add to the disease burden of patients. Managing CHC-related advanced liver diseases and systemic manifestations are costly for both the healthcare system and society. Loss of work productivity due to reduced well-being and quality of life in CHC patients further compounds the economic burden of the disease. Traditionally, pegylated-interferon plus ribavirin (PR) was the standard of care. However, a substantial number of patients are ineligible for PR treatment, and only 40%-75% achieved sustained virologic response. Furthermore, PR is associated with impairment of patient-reported outcomes (PROs), high rates of adverse events, and poor adherence. With the advent of direct acting antivirals (DAAs), the treatment of CHC patients has been revolutionized. DAAs have broader eligible patient populations, higher efficacy, better PRO profiles, fewer adverse events, and better adherence rates, thereby making it possible to cure a large proportion of all CHC patients. This article aims to provide a comprehensive evaluation on the value of effective, curative hepatitis C treatment from the clinical, economic, societal, and patient experience perspectives, with a focus on recent data from China, supplemented with other Asian and international experiences where China data are not available.
Collapse
Affiliation(s)
- Qing Xie
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Jian-Wei Xuan
- Health Economic Research Institute, School of Pharmacy, Sun Yat-Sen University, Guangzhou 510006, Guangdong Province, China
| | - Hong Tang
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xiao-Guang Ye
- Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, Guangdong Province, China
| | - Peng Xu
- Gilead Sciences Inc, Shanghai 200122, China
| | - I-Heng Lee
- Gilead Sciences Inc, Foster City, CA 94404, United States
| | - Shan-Lian Hu
- School of Public Health, Fudan University, Shanghai 200032, China
- Shanghai Health Development Research Center, Shanghai 200032, China.
| |
Collapse
|
11
|
Viganò M, Andreoni M, Perno CF, Craxì A, Aghemo A, Alberti A, Andreone P, Babudieri S, Bonora S, Brunetto MR, Bruno R, Bruno S, Calvaruso V, Caporaso N, Cartabellotta F, Ceccherini-Silberstein F, Cento V, Ciancio A, Colombatto P, Coppola N, Di Marco V, Di Perri G, Fagiuoli S, Gaeta GB, Gasbarrini A, Lampertico P, Pellicelli A, Prestileo T, Puoti M, Raimondo G, Rizzardini G, Taliani G, Zignego AL. Real life experiences in HCV management in 2018. Expert Rev Anti Infect Ther 2019; 17:117-128. [PMID: 30582384 DOI: 10.1080/14787210.2019.1563755] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Hepatitis C virus (HCV) infection is a major cause of chronic liver disease, with approximately 71 million chronically infected individuals worldwide. Treatment of chronic hepatitis C has considerably improved in the last few years thanks to the introduction of direct-acting antivirals able to achieve sustained virological response in more than 95% of patients. Successful anti-HCV treatment can halt liver disease progression and solve the HCV-related extra-hepatic manifestations, eventually reducing liver-related and overall mortality. Areas covered: With the aim to respond to unmet needs in patient's identification, universal access to antiviral therapy and treatment optimization in specific setting of HCV-infected patients, a group of Italian experts met in Stresa in May 2018. The summary of the considerations arising from this meeting and the final statements are reported in this paper. Expert commentary: All the advances on HCV cure may have a real clinical impact not only in individual patients but also at the social health level if they are applied to all infected patients, independently from the stage of liver disease. Further improvements are needed in order to attain HCV elimination, such as the development of an enhanced screening program working in parallel to the present treatment options.
Collapse
Affiliation(s)
- Mauro Viganò
- a Hepatology Unit, Ospedale San Giuseppe , University of Milan , Milan , Italy
| | - Massimo Andreoni
- b Department Medicine of Systems , University Tor Vergata , Rome , Italy
| | - Carlo Federico Perno
- c Department of Laboratory Medicine, Niguarda Hospital , University of Milan , Milan , Italy
| | - Antonio Craxì
- d Department of Gastroenterology, DiBiMIS , University of Palermo , Palermo , Italy
| | - Alessio Aghemo
- e UO Medicina Interna ed Epatologia , Humanitas University and Research Hospital , Milano , Italy
| | - Alfredo Alberti
- f Department of Molecular Medicine , University of Padua , Padua , Italy
| | - Pietro Andreone
- g Centro per lo Studio e Ricerche delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche , Università di Bologna , Bologna , Italy
| | - Sergio Babudieri
- h Infectious Diseases Department, AOU Sassari , University of Sassari , Sassari , Italy
| | - Stefano Bonora
- i Unit of Infectious Diseases, Department of Medical Sciences , University of Turin , Turin , Italy
| | - Maurizia Rossana Brunetto
- j Dipartimento di Medicina Clinica e Sperimentale Università di Pisa , UO Epatologia Azienda Ospedaliero-Universitaria Pisana , Pisa , Italy
| | - Raffaele Bruno
- k Division of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo , University of Pavia , Pavia , Italy
| | - Savino Bruno
- l Department of Internal Medicine , Humanitas University Medicine , Rozzano , Italy
| | - Vincenza Calvaruso
- d Department of Gastroenterology, DiBiMIS , University of Palermo , Palermo , Italy
| | - Nicola Caporaso
- m Department of Clinical Medicine and Surgery, Gastroenterology Unit , University of Naples "Federico II" , Naples , Italy
| | - Fabio Cartabellotta
- n Department of Internal Medicine , Buccheri La Ferla Hospital Fatebenefratelli , Palermo , Italy
| | | | - Valeria Cento
- c Department of Laboratory Medicine, Niguarda Hospital , University of Milan , Milan , Italy
| | - Alessia Ciancio
- p Dipartimento di Scienze Mediche , Università di Torino , Torino , Italy
| | - Piero Colombatto
- j Dipartimento di Medicina Clinica e Sperimentale Università di Pisa , UO Epatologia Azienda Ospedaliero-Universitaria Pisana , Pisa , Italy
| | - Nicola Coppola
- q Infectious Diseases Unit, AORN Caserta , University of Campania , Caserta , Italy
| | - Vito Di Marco
- d Department of Gastroenterology, DiBiMIS , University of Palermo , Palermo , Italy
| | - Giovanni Di Perri
- i Unit of Infectious Diseases, Department of Medical Sciences , University of Turin , Turin , Italy
| | - Stefano Fagiuoli
- r USC Gastroenterologia Epatologia e Trapiantologia, Dipartimento di Medicina Specialistica e dei Trapianti , ASST Papa Giovanni XXIII , Bergamo , Italy
| | | | - Antonio Gasbarrini
- t Fondazione Policlinico Gemelli IRCCS , Universita' Cattolica del Sacro Cuore , Roma , Italy
| | - Pietro Lampertico
- u Gastroenterology and Hepatology Division, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Università di Milano , Milano , Italy
| | - Adriano Pellicelli
- v UOC Malattie del Fegato Dipartimento Interaziendale Trapianti Azienda Ospedaliera San Camillo Forlanini , Rome , Italy
| | - Tullio Prestileo
- w Infectious Diseases Unit and Centre for Migration and Health ARNAS , Civico-Benfratelli Hospital , Palermo , Italy
| | - Massimo Puoti
- x SC Malattie Infettive, Department of Infectious Diseases , ASST Grande Ospedale Metropolitano Niguarda , Milano , Italy
| | - Giovanni Raimondo
- y Division of Clinical and Molecular Hepatology, Department of Internal Medicine , University Hospital of Messina , Messina , Italy
| | - Giuliano Rizzardini
- z Infectious Diseases Department ASST Fatebenefratelli Sacco, School of Clinical Medicine, Faculty of Health Science , University of the Witwatersrand , Johannesburg , South Africa
| | - Gloria Taliani
- aa Infectious Diseases Unit and School of Tropical Medicine , Sapienza of Rome University , Rome , Italy
| | - Anna Linda Zignego
- ab Department of Experimental and Clinical Medicine and Department of Oncology, Interdepartmental Hepatology Center MASVE , Azienda Ospedaliero-Universitaria Careggi (AOUC) , Florence , Italy
| |
Collapse
|
12
|
Younossi ZM, Stepanova M, Henry L, Han KH, Ahn SH, Lim YS, Chuang WL, Kao JH, Nguyen KV, Lai CL, Chan HLY, Wei L. Sofosbuvir and ledipasvir are associated with high sustained virologic response and improvement of health-related quality of life in East Asian patients with hepatitis C virus infection. J Viral Hepat 2018; 25:1429-1437. [PMID: 29974665 DOI: 10.1111/jvh.12965] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 05/22/2018] [Accepted: 06/11/2018] [Indexed: 12/17/2022]
Abstract
Although HCV infection is highly prevalent in East Asia, these patients have been underrepresented in HRQL studies. Here, we assess HRQL in East Asian HCV patients treated with different anti-HCV regimens. Patients completed Short Form-36 (SF-36) before, during and after treatment. A total of 989 HCV patients were enrolled in two phase 3 clinical trials [China: 60.2%, South Korea: 22.4%, Taiwan: 17.4%; genotype 1: 55.3%, treatment-naïve: 57.5%; cirrhosis: 14.0%]. Patients received pegylated interferon, sofosbuvir and ribavirin (Peg-IFN + SOF + RBV; n = 130, genotypes 1, 6) or SOF + RBV (n = 475, all genotypes) or SOF and ledipasvir (LDV/SOF; n = 384, genotype 1). The SVR-12 rates were 94.6%, 96.2% and 99.2%, respectively (P = 0.005). During treatment, Peg-IFN + SOF + RBV-treated group experienced significant declines in most HRQL scores (by the end of treatment, mean decline up to -12.0 points, all P < 0.05). Patients on SOF + RBV had milder HRQL impairment (up to -5.8 points, P < 0.05 for 5 of 8 HRQL domains). In contrast, patients receiving IFN- and RBV-free regimen with LDV/SOF had their HRQL scores improve (mean up to +4.3 points, P < 0.0001 for 3 of 8 scales). In multivariate analysis, receiving Peg-IFN + SOF + RBV was consistently independently associated with HRQL impairment during treatment (β: -10.3 to -16.4) and after achieving SVR-12 (β: -4.4 to -9.1) (all P < 0.01). The results were reproduced in a subgroup of patients enrolled in China. We conclude that in East Asian patients with HCV, HRQL improved from baseline after treatment with LDV/SOF but not with Peg-IFN + RBV-containing or Peg-IFN-free RBV-containing regimens. The HRQL impairment associated with the use of Peg-IFN persists even after achieving sustained virologic clearance.
Collapse
Affiliation(s)
- Zobair M Younossi
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, Virginia.,Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia
| | - Maria Stepanova
- Center for Outcomes Research in Liver Disease, Washington, District of Columbia
| | - Linda Henry
- Center for Outcomes Research in Liver Disease, Washington, District of Columbia
| | | | | | - Young-Suk Lim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wan-Long Chuang
- Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jia-Horng Kao
- National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Kinh V Nguyen
- National Hospital of Tropical Diseases, Hanoi, Vietnam
| | - Ching Lung Lai
- Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Henry Lik-Yuen Chan
- Institute of Digestive Disease, the Chinese University of Hong Kong, Hong Kong, China
| | - Lai Wei
- Peking University People's Hospital, Beijing, China
| |
Collapse
|
13
|
Younossi Z, Papatheodoridis G, Cacoub P, Negro F, Wedemeyer H, Henry L, Hatzakis A. The comprehensive outcomes of hepatitis C virus infection: A multi-faceted chronic disease. J Viral Hepat 2018; 25 Suppl 3:6-14. [PMID: 30398294 DOI: 10.1111/jvh.13005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 08/16/2018] [Indexed: 02/06/2023]
Abstract
Treatment of hepatitis C virus (HCV) infection has been revolutionized with the introduction of pangenotypic, interferon- and ribavirin-free regimens associated with high cure rates and a low side effect profile. Additionally, there is evidence that HCV cure reduces HCV complications, improves patient-reported outcomes and is cost-saving in most western countries in the long term. This is a review of the comprehensive burden of HCV and the value of eliminating HCV infection. With the introduction of the interferon-free all-oral, once a day pill treatment regimen for the cure of HCV, the potential to eliminate HCV by 2030 has become a possibility for some regions of the world. Nevertheless, there are barriers to screening, linkage to care, and treatment in many countries that must be overcome in order to reach this goal. In conclusion, globally, work must continue to ensure national policies are in place to support screening, linkage to care and affordable treatment in order to eliminate HCV.
Collapse
Affiliation(s)
- Zobair Younossi
- Department of Medicine, Inova Fairfax Hospital, Falls Church, Virginia.,Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia
| | - Georgios Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens Laiko, Athens, Greece
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, AP HP Hôpital La Pitié-Salpêtrière, Paris, France.,CNRS UMR 7087, INSERM UMR S-959, DHU I2B, Sorbonne Université, Paris, France
| | | | | | - Linda Henry
- Center for Outcomes Research in Liver Disease, Washington D.C
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School of National and Kapodistrian University of Athens, Athens, Greece.,Hepatitis B and C Public Policy Association, L-2453 , Luxembourg
| |
Collapse
|