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Jorquera F, Ledesma F, Ahumada A, Manzano ML, Castiella A, Lorente S, Miquel M, Mariño Z, Castellote J, Sanz E, Uriz J. Clinical profile of Spanish hepatitisC virus-infected treatment-naïve patients with compensated cirrhosis in the CREST study. GASTROENTEROLOGIA Y HEPATOLOGIA 2024; 47:605-611. [PMID: 38355095 DOI: 10.1016/j.gastrohep.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 01/30/2024] [Accepted: 02/06/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND AND AIM OF THE STUDY There are still patients with hepatitisC in Spain who have yet to be diagnosed, but their clinical profile is unclear. In 2021, 21.93% of patients diagnosed had cirrhosis and were mostly treatment-naïve. METHODS This sub-analysis describes the clinical profile of the 60Spanish treatment-naïve patients with compensated cirrhosis who were included in the CREST study. MAJOR RESULTS Sixty percent of patients were male, median age 56years, and 33% had a history of drug use. Almost three-quarters (71.3%) had more than one comorbidity and 78.3% took concomitant medication. At treatment initiation, median platelet count was 139×103/μL and FibroScan® 17kPa. No virological failure was observed and no patient discontinued treatment due to adverse events. No clinically significant changes were noted during or after treatment in the median platelet, albumin, bilirubin, and transaminase levels. CONCLUSIONS Treatment with glecaprevir/pibrentasvir for 8weeks in this cohort of treatment-naïve patients with compensated cirrhosis in Spain was safe and effective. This information reinforces the use of this short antiviral regimen even when there is compensated cirrhosis, simplifying the approach to hepatitisC among those patients still to be diagnosed and treated in Spain.
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Affiliation(s)
- Francisco Jorquera
- Complejo Asistencial Universitario de León, IBIOMED y CIBERehd, León, España.
| | | | - Adriana Ahumada
- Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | | | - Sara Lorente
- Hospital Clínico Universitario Lozano Blesa, Universidad de Zaragoza, IIS Aragón, Zaragoza, España
| | - Mireia Miquel
- Hospital Universitario Parc Taulí, Institut d'Investigació i Innovació I3PT, Universidad Autónoma de Barcelona, Sabadell, Barcelona, España; Universitat de Vic - Universitat Central de Catalunya (UVic-UCC), Vic, Barcelona, España; CIBERehd, Instituto Carlos III, Madrid, España
| | - Zoe Mariño
- Hospital Clínic, IDIBAPS, CIBERehd, Universitat de Barcelona, Barcelona, España
| | - José Castellote
- Hospital Universitario de Bellvitge, IDIBELL, Universidad de Barcelona, Hospitalet de Llobregat, Barcelona, España
| | | | - Juan Uriz
- Hospital Universitario de Navarra, IdiSNA, Pamplona, España
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Brouard C, Schwager M, Expert A, Drewniak N, Laporal S, de Lagasnerie G, Lot F. Impact of Public Policy and COVID-19 Pandemic on Hepatitis C Testing and Treatment in France, 2014-2021. Viruses 2024; 16:792. [PMID: 38793673 PMCID: PMC11125660 DOI: 10.3390/v16050792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Given the World Health Organization's target to eliminate the hepatitis C virus (HCV) by 2030, we assessed the impact of French public policies and the COVID-19 pandemic on HCV testing and initiation of direct-antiviral agents (DAAs). Using the French National Health Data System, we identified individuals living in metropolitan France with at least one reimbursement for an anti-HCV test and those with a first delivery of DAAs between 1 January 2014 and 31 December 2021. During this period, the annual number of people tested increased each year between 3.3 (in 2015) and 9.3% (in 2021), except in 2020, with a drop of 8.3%, particularly marked in April (-55.0% compared to February 2020). A return to pre-pandemic testing levels was observed in 2021. The quarterly number of patients initiating DAAs presented an upward trend from Q1-2014 until mid-2017, with greater increases in Q1-2015, and Q1- and Q2-2017, concomitant with DAA access policies and availability of new therapies. Then, quarterly numbers decreased. A 65.5% drop occurred in April compared to February 2020. The declining DAA initiations since mid-2017, despite new measures improving access and screening efforts, could be due to the shrinking pool of patients requiring treatment and a need to increase awareness among undiagnosed infected people. Further action is needed to eliminate HCV in France.
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Affiliation(s)
- Cécile Brouard
- Santé Publique France, The National Public Health Agency, 94415 Saint-Maurice, France; (N.D.); (S.L.); (F.L.)
| | - Manon Schwager
- Caisse Nationale de l’Assurance Maladie, 75986 Paris, France; (M.S.); (A.E.); (G.d.L.)
| | - Aude Expert
- Caisse Nationale de l’Assurance Maladie, 75986 Paris, France; (M.S.); (A.E.); (G.d.L.)
| | - Nicolas Drewniak
- Santé Publique France, The National Public Health Agency, 94415 Saint-Maurice, France; (N.D.); (S.L.); (F.L.)
| | - Stella Laporal
- Santé Publique France, The National Public Health Agency, 94415 Saint-Maurice, France; (N.D.); (S.L.); (F.L.)
| | | | - Florence Lot
- Santé Publique France, The National Public Health Agency, 94415 Saint-Maurice, France; (N.D.); (S.L.); (F.L.)
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Zou Y, Yue M, Ye X, Wang Y, Ma X, Zhang A, Xia X, Chen H, Yu R, Yang S, Huang P. Epidemiology of acute hepatitis C and hepatitis C virus-related cirrhosis in reproductive-age women, 1990-2019: An analysis of the Global Burden of Disease study. J Glob Health 2024; 14:04077. [PMID: 38638097 PMCID: PMC11026988 DOI: 10.7189/jogh.14.04077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Abstract
Background The current study uniquely focuses on the global incidence and temporal trends of acute hepatitis C (AHC) and hepatitis C virus (HCV)-related cirrhosis among women of reproductive age (15-49 years) from 1990-2019. The risk of vertical transmission and adverse perinatal outcomes associated with HCV infection underscores the importance of prioritising these women in HCV prevention efforts. Methods Leveraging the Global Burden of Disease 2019 data, we calculated age-standardised incidence rates (ASIR) and assessed temporal trends via the average annual percent change from joinpoint regression. The age-period-cohort model was employed to understand further the effects of age, period, and birth cohort. Results Over the 30 years, global incidences of AHC and HCV-related cirrhosis in reproductive-age women increased by 46.45 and 72.74%, respectively. The ASIR of AHC was highest in low sociodemographic index regions but showed a declining trend. Conversely, the ASIR of HCV-related cirrhosis displayed unfavourable trends in low, low-middle, and high sociodemographic index regions. Special attention is necessary for sub-Saharan Africa, high-income North America, Eastern Europe, and Central Asia due to their high incidence rates or increasing trends of AHC and HCV-related cirrhosis. Notably, the age-period-cohort model suggests a recent resurgence in AHC and HCV-related cirrhosis risk. Conclusions The current study is the first to thoroughly evaluate the trends of AHC and HCV-related cirrhosis among reproductive-age women, shedding light on previously unexplored aspects of HCV epidemiology. Our findings identify critical areas where health care systems must adapt to the changing dynamics of HCV infection. The detailed stratification by region and nation further enables the development of localised prevention and treatment strategies.
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Affiliation(s)
- Yanzheng Zou
- Department of Epidemiology, National Vaccine Innovation Platform, Centre for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Ming Yue
- Department of Infectious Diseases, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiangyu Ye
- Department of Epidemiology, National Vaccine Innovation Platform, Centre for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yifan Wang
- Department of Infectious Disease, Jurong Hospital Affiliated to Jiangsu University, Jurong, China
| | - Xinyan Ma
- Department of Epidemiology, National Vaccine Innovation Platform, Centre for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Amei Zhang
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China
| | - Xueshan Xia
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China
- Kunming Medical University, Kunming, China
| | - Hongbo Chen
- Department of Infectious Disease, Jurong Hospital Affiliated to Jiangsu University, Jurong, China
| | - Rongbin Yu
- Department of Epidemiology, National Vaccine Innovation Platform, Centre for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Sheng Yang
- Department of Biostatistics, National Vaccine Innovation Platform, Centre for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Peng Huang
- Department of Epidemiology, National Vaccine Innovation Platform, Centre for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
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Gonzalez Corro LA, Zook K, Landry M, Rosecrans A, Harris R, Gaskin D, Falade-Nwulia O, Page KR, Lucas GM. An Analysis of Social Determinants of Health and Their Implications for Hepatitis C Virus Treatment in People Who Inject Drugs: The Case of Baltimore. Open Forum Infect Dis 2024; 11:ofae107. [PMID: 38567197 PMCID: PMC10986855 DOI: 10.1093/ofid/ofae107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/21/2024] [Indexed: 04/04/2024] Open
Abstract
Background Sixty-eight percent of the nearly 3.5 million people living with hepatitis C virus (HCV) in the United States are people who inject drugs (PWID). Despite effective treatments, uptake remains low in PWID. We examined the social determinants of health (SDoH) that affect the HCV care cascade. Methods We conducted a secondary analysis of data from 720 PWID in a cluster-randomized trial. We recruited PWID from 12 drug-affected areas in Baltimore. Inclusion criteria were injection in the prior month or needle sharing in the past 6 months. Intake data consisted of a survey and HCV testing. Focusing on SDoH, we analyzed self-report of (1) awareness of HCV infection (in those with active or previously cured HCV) and (2) prior HCV treatment (in the aware subgroup). We used descriptive statistics and logistic regression for statistical analyses. Results The 342 participants were majority male and Black with a median age of 52 years. Women were more likely to be aware of their status but less likely to be treated. Having a primary care provider and HIV-positive status were associated with increased awareness and treatment. Unhoused people had 51% lower odds of HCV treatment. People who reported that other PWID had shared their HCV status with them had 2.3-fold higher odds of awareness of their own status. Conclusions Further study of gender disparities in HCV treatment access is needed. Increased social support was associated with higher odds of HCV treatment, suggesting an area for future interventions. Strategies to identify and address SDoH are needed to end HCV.
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Affiliation(s)
| | - Katie Zook
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Miles Landry
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Amanda Rosecrans
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Baltimore City Health Department, Baltimore, Maryland, USA
| | - Robert Harris
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Baltimore City Health Department, Baltimore, Maryland, USA
| | - Darrell Gaskin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Tian F, Forouzannia F, Feng Z, Biondi MJ, Mendlowitz AB, Feld JJ, Sander B, Wong WWL. Feasibility of hepatitis C elimination by screening and treatment alone in high-income countries. Hepatology 2024:01515467-990000000-00748. [PMID: 38478751 DOI: 10.1097/hep.0000000000000779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/27/2023] [Indexed: 03/23/2024]
Abstract
BACKGROUND AND AIMS Despite the availability of highly effective direct-acting antiviral therapy, chronic hepatitis C (CHC) continues to cause a major public health burden. In many high-income countries, treatment rates have been declining, which was exacerbated by the impact of the COVID-19 pandemic, threatening the ability to meet the World Health Organization (WHO)'s targets for eliminating HCV as a public health threat by 2030. We sought to model the impact of CHC in Canada, a resource-rich country with ongoing immigration from HCV-endemic regions; which relies exclusively on risk-based screening for case identification. APPROACH AND RESULTS We developed an agent-based model to characterize the HCV epidemic in a high-income country with ongoing immigration. Combinations of prevention such as harm reduction, screening, and treatment strategies were considered. Model parameters were estimated from the literature and calibrated against historical HCV data. Sensitivity analyses were performed to assess uncertainty. Under the current status quo of risk-based screening, we predict the incidence of CHC-induced decompensated cirrhosis, HCC, and liver-related deaths would decrease by 79.4%, 76.1%, and 62.1%, respectively, between 2015 and 2030, but CHC incidence would only decrease by 11.1%. The results were sensitive to HCV transmission rate and an annual number of people initiating treatment. CONCLUSIONS Current risk-based screening, and subsequent treatment, will be inadequate to achieve WHO goals. With extensive scale-up in screening, and treatment, the mortality target may be achievable, but the target for preventing new CHC cases is unlikely reachable, highlighting the importance of developing enhanced harm-reduction strategies for HCV elimination.
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Affiliation(s)
- Feng Tian
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
| | | | - Zeny Feng
- Department of Mathematics and Statistics, University of Guelph, Guelph, Ontario, Canada
| | - Mia J Biondi
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
- School of Nursing, York University, Toronto, Ontario, Canada
| | - Andrew B Mendlowitz
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, Ontario, Canada
| | - Jordan J Feld
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - Beate Sander
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
| | - William W L Wong
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
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Rhodes T, Lancaster K, Adams S. In search of a 'good number': knowledge controversy and population estimates in the endgame of hepatitis C elimination. BMJ Glob Health 2024; 9:e014659. [PMID: 38413104 PMCID: PMC10900359 DOI: 10.1136/bmjgh-2023-014659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/19/2024] [Indexed: 02/29/2024] Open
Abstract
We explore the contentious life of a metric used to assess a country's progress in relation to global disease elimination targets. Our topic is hepatitis C elimination, and our context is Australia. A fundamental metric in the calculation of progress toward hepatitis C elimination targets, as set by the WHO, is the population prevalence of people living with hepatitis C. In Australia, this modelled estimate has generated some controversy, largely through its repeated downsizing as an effect of calculus. The 2015 baseline population estimate in Australia, from which measures of current elimination progress are assessed, has reduced, over time, by around 30%. Informed by a social study of science approach, we used qualitative interviews with 32 experts to explore the knowledge controversy. The controversy is narrated through the core concerns of 'scale' and 'care', with narratives aligning differently to imaginaries of 'science' and 'community'. We trace how constitutions of 'estimate' and 'number' circulate in relation to 'population' and 'people', and as affective values. We show how enactments of estimates and numbers materialise hepatitis elimination in different ways, with policy implications. The event of the knowledge controversy opens up the social and political life of enumerations-for science and community-inviting deliberation on how to make 'good numbers' in the race to eliminate hepatitis C.
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Affiliation(s)
- Tim Rhodes
- London School of Hygiene & Tropical Medicine, London, UK
- University of New South Wales, Sydney, New South Wales, Australia
| | - Kari Lancaster
- Goldsmiths University of London, London, UK
- University of New South Wales, Sydney, New South Wales, Australia
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O'Sullivan M, Jones AM, Mourad A, Haddadin Y, Verma S. Excellent hepatitis C virus cure rates despite increasing complexity of people who use drugs: Integrated-Test-stage Treat study final outcomes. J Viral Hepat 2024; 31:66-77. [PMID: 38018328 DOI: 10.1111/jvh.13897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/27/2023] [Accepted: 10/31/2023] [Indexed: 11/30/2023]
Abstract
Achieving hepatitic C virus (HCV) elimination requires linking people who use drugs (PWUD) into care. We report final direct-acting antivirals (DAAs)-based outcomes from the Integrated-Test-stage -Treat (ITTREAT) study. Project ITTREAT (2013-2021), based at an addiction centre, was a 'one-stop' service with innovative linkage to care strategies. Primary outcome was sustained virological response (SVR12) (intention to treat ITT) including whether individuals were recruited in first (period 1) versus last four (period 2 included the COVID-19 pandemic) years of the study. Number recruited were n = 765, mean age 40.9 ± 10.1 years, 78% males, history of current/past injecting drug use (IDU) and alcohol use being 77% and 90%, respectively. Prevalence of a positive HCV PCR was 84% with 19% having cirrhosis. Comparing those recruited in period 2 versus period 1, there was increasing prevalence of IDU, 90% versus 72% (p < .001); homelessness, 67% versus 50% (p < .001); psychiatric diagnosis, 84% versus 50% (p < .001); overdose history 71% versus 31% (p < .001), receiving opioid agonist treatment (OAT) 75% versus 52% (p < .001) and comorbidity 44% versus 25% (p < .001). Of those treated with DAAs (n = 272), ITT SVR rates were 86% (95% CI: 81%-90%), being similar in period 2 versus period 1. Predictors of non-SVR were receiving OAT (OR 0.33, 95% CI: 0.12-0.87, p = .025) and ≥80% adherence (OR 0.01, 95% CI: 0.003-0.041, p < .001). Reinfection rates period 2 versus period 1 (per 100 person-years) were 1.84 versus 1.70, respectively. In the treated cohort, mortality was 15%, being mostly drug-related. Despite increasing complexity of PWUD, high SVR12 rates are achievable with use of OAT and good adherence.
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Affiliation(s)
- Margaret O'Sullivan
- University Hospitals Sussex NHS Foundation Trust Brighton and Sussex University, Brighton, UK
| | | | - Adele Mourad
- University Hospitals Sussex NHS Foundation Trust Brighton and Sussex University, Brighton, UK
- Brighton & Sussex Medical School, Brighton, UK
| | - Yazan Haddadin
- University Hospitals Sussex NHS Foundation Trust Brighton and Sussex University, Brighton, UK
- Brighton & Sussex Medical School, Brighton, UK
| | - Sumita Verma
- University Hospitals Sussex NHS Foundation Trust Brighton and Sussex University, Brighton, UK
- Brighton & Sussex Medical School, Brighton, UK
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Marcellusi A, Mennini FS, Andreoni M, Kondili LA. Screening strategy to advance HCV elimination in Italy: a cost-consequence analysis. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024:10.1007/s10198-023-01652-0. [PMID: 38280068 DOI: 10.1007/s10198-023-01652-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 11/21/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND AND AIMS Italy has the greatest burden of hepatitis C virus (HCV) infection in Western Europe. The screening strategy represents a crucial prevention tool to achieve HCV elimination in Italy. We evaluated the cost-consequences of different screening strategies for the diagnosis of HCV active infection in the birth cohort 1948-1968 to achieve the HCV elimination goal. METHODS We designed a probabilistic model to estimate the clinical, and economic outcomes of different screening coverage uptakes, considering the direct costs of HCV management according to each liver fibrosis stage, in the Italian context. A decision probabilistic tree simulates 4 years of HCV testing of the 1948-1968 general population birth cohort, (15,485,565 individuals to be tested) considering different coverage rates. A No-screening scenario was compared with two alternative screening scenarios that represented different coverage rates each year: (1) Incremental approach (coverage rates equal to 5%, 10%, 30%, and 50% at years 1, 2, 3, and 4, respectively) and (2) Fast approach (50% coverage rate at years 1, 2, 3 and 4). Overall 106,200 cases were previously estimated to have an HCV active infection. A liver disease progression Markov model was considered for an additional 6 years (horizon-time 10 years). RESULTS The highest increased number of deaths and clinical events are reported for the No-screening scenario (21,719 cumulative deaths at the end of ten years; 10,148 cases with HCC and/or 7618 cases with Decompensated Cirrhosis). Following the Fast-screening scenario, the reductions in clinical outcomes and deaths were higher compared with No-screening and Incremental-screening. At ten years time horizon, less than 5696 liver deaths (PSA CI95%: - 3873 to 7519), 3,549 HCC (PSA CI95%: - 2413 to 4684) and less than 3005 liver decompensations (PSA CI 95%: - 2104 to 3907) were estimated compared with the Incremental-scenario. The overall costs of the Fast-screening, including the costs of the DAA and liver disease management of the infected patients for 10 years, are estimated to be € 43,107,543 more than no-investment in screening and € 62,289,549 less compared with the overall costs estimated by the Incremental-scenario. CONCLUSION It is necessary to guarantee dedicated funds and efficiency of the system for the cost-efficacious screening of the 1948-1968 birth cohort in Italy. A delay in HCV diagnosis and treatment in the general population, yet not addressed for the HCV free-of-charge screening, will have important clinical and economic consequences in Italy.
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Affiliation(s)
- Andrea Marcellusi
- Faculty of Economics, CEIS, Economic Evaluation and HTA (EEHTA), University of Rome "Tor Vergata", Rome, Italy
| | - Francesco Saverio Mennini
- Faculty of Economics, CEIS, Economic Evaluation and HTA (EEHTA), University of Rome "Tor Vergata", Rome, Italy
- Institute for Leadership and Management in Health, Kingston University London, London, UK
| | - Massimo Andreoni
- Policlinico Tor Vergata, University of Rome "Tor Vergata", Rome, Italy
| | - Loreta A Kondili
- Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.
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Buti M, Vaz-Pinto I, Magno Pereira V, Casado M, Llaneras J, Barreira A, Esteves C, Guimarães M, Gorgulho A, Mourão T, Xavier E, Jasmins L, Reis AP, Faria N, Freitas B, Andrade G, Camelo-Castillo A, Rodríguez-Maresca MÁ, Carrodeguas A, Medina D, Esteban R. Emergency department contribution to HCV elimination in the Iberian Peninsula. Int J Emerg Med 2024; 17:5. [PMID: 38178000 PMCID: PMC10768527 DOI: 10.1186/s12245-023-00570-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/01/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Undiagnosed cases of hepatitis C virus (HCV) infection result in significant morbidity and mortality, further transmission, and increased public health costs. Testing in emergency departments (EDs) is an opportunity to expand HCV screening. The goal of this project was to increase the proportion of eligible patients screened for HCV in urban areas. METHODS An opportunistic automated HCV screening program was implemented in the EDs of 4 public hospitals in Spain and Portugal at different periods between 2018 and 2023. HCV prevalence was prospectively evaluated, and single-step or reflex testing was used for confirmation in the same sample. RESULTS More than 90% of the population eligible for testing were screened in the participating centers. We found HCV antibody seroprevalence rates ranging from 0.6 to 3.9%, with between 19 and 53% of viremic individuals. CONCLUSIONS Opportunistic HCV screening in EDs is feasible, does not disrupt ED activities, is highly effective in increasing diagnosis, and contributes to WHO's HCV elimination goals.
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Affiliation(s)
- Maria Buti
- Hospital Universitari Vall d'Hebron and CIBEREHD del Instituto Carlos III, 119, 08035, Barcelona, Spain.
| | | | | | - Marta Casado
- Hospital Universitario Torrecárdenas, Almería, Spain
| | | | - Ana Barreira
- Hospital Universitari Vall d'Hebron and CIBEREHD del Instituto Carlos III, 119, 08035, Barcelona, Spain
| | | | | | | | | | | | | | | | - Nancy Faria
- Hospital Dr. Nélio Mendonça, Madeira, Portugal
| | | | | | | | | | | | | | - Rafael Esteban
- Hospital Universitari Vall d'Hebron and CIBEREHD del Instituto Carlos III, 119, 08035, Barcelona, Spain
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10
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Rennert L, Howard KA, Kickham CM, Gezer F, Coleman A, Roth P, Boswell K, Gimbel RW, Litwin AH. Implementation of a mobile health clinic framework for Hepatitis C virus screening and treatment: a descriptive study. LANCET REGIONAL HEALTH. AMERICAS 2024; 29:100648. [PMID: 38124995 PMCID: PMC10733089 DOI: 10.1016/j.lana.2023.100648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
Background Although treatment for Hepatitis C Virus (HCV) is effective, individuals face access barriers. The utility of mobile health clinics (MHC), effective mechanisms for providing healthcare to underserved populations, is understudied for HCV-related interventions. We aimed to describe implementation of, and factors associated with, screening and treatment via MHCs. Methods Clemson Rural Health implemented a novel MHC program to reach and treat populations at-risk for HCV with a focus on care for uninsured individuals. We examined HCV screening and treatment initiation/completion indicators between May 2021 and January 2023. Findings Among 607 individuals screened across 31 locations, 94 (15.5%) tested positive via antibody and viral load testing. Treatment initiation and completion rates were 49.6% and 86.0%, respectively. Among those screened, the majority were male (57.5%), White (61.3%; Black/Hispanic: 28.2%/7.7%), and without personal vehicle as primary transportation mode (54.4%). Injection drug use (IDU) was 27.2% and uninsured rate was 42.8%. Compared to HCV-negative, those infected included more individuals aged 30-44 (52.1% vs. 36.4%, p = 0.023), male (70.2% vs. 55.2%, p = 0.009), White (78.5% vs. 60.2%, p < 0.0001), without personal vehicle (58.5% vs. 43.5%, p = 0.028), IDU (83.7% vs. 21.0%, p < 0.0001), and uninsured (61.2% vs. 48.8%, p = 0.050). Uninsured rates were higher among those initiating compared to not initiating treatment (74.5% vs. 45.3%, p = 0.004). Interpretation The MHC framework successfully reaching its target population: at-risk individuals with access barriers to healthcare. The high HCV screening and treatment initiation/completion rates demonstrate the utility of MHCs as effective and acceptable intervention settings among historically difficult-to-treat populations. Funding Gilead Sciences, Inc., and SC Center for Rural and Primary Healthcare.
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Affiliation(s)
- Lior Rennert
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
- Center for Public Health Modeling and Response, Clemson University, Clemson, SC, USA
| | - Kerry A. Howard
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
- Center for Public Health Modeling and Response, Clemson University, Clemson, SC, USA
| | | | - Fatih Gezer
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
- Center for Public Health Modeling and Response, Clemson University, Clemson, SC, USA
| | | | - Prerana Roth
- Prisma Health-Upstate, Greenville, SC, USA
- Clemson University School of Health Research, Clemson University, Clemson, SC, USA
- University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | | | - Ronald W. Gimbel
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
- Clemson Rural Health, Clemson University, Clemson, SC, USA
| | - Alain H. Litwin
- Prisma Health-Upstate, Greenville, SC, USA
- Clemson University School of Health Research, Clemson University, Clemson, SC, USA
- University of South Carolina School of Medicine Greenville, Greenville, SC, USA
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11
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Liu CH, Lin HC, Kao JH. Toward the hepatitis C virus elimination in Asia: The policy forum from the 2023 Asian Pacific Association of the Study of the Liver (APASL). J Formos Med Assoc 2023; 122:1234-1237. [PMID: 37821301 DOI: 10.1016/j.jfma.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023] Open
Affiliation(s)
- Chen-Hua Liu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan
| | - Han-Chieh Lin
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jia-Horng Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.
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12
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Ganguin AA, Skorup I, Streb S, Othman A, Luciani P. Formation and Investigation of Cell-Derived Nanovesicles as Potential Therapeutics against Chronic Liver Disease. Adv Healthc Mater 2023; 12:e2300811. [PMID: 37669775 DOI: 10.1002/adhm.202300811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/04/2023] [Indexed: 09/07/2023]
Abstract
A new therapeutic approach using cell-derived nanovesicles (cdNVs) is offered here to overcome the lack of effective treatments for liver fibrosis, a reversible chronic liver disease. To achieve this goal the formation and purification of cdNVs from untreated, quiescent-like, or activated LX-2 cells, an immortalized human hepatic stellate cell (HSC) line with key features of transdifferentiated HSCs are established. Analysis of the genotype and phenotype of naïve and transdifferentiated LX-2 cells activated through transforming growth factor beta 1, following treatment with cdNVs, reveals a concentration-dependent fibrosis regression. The beneficial fibrosis-resolving effects of cdNVs are linked to their biomolecular corona. Liposomes generated using lipids extracted from cdNVs exhibit a reduced antifibrotic response in perpetuated LX-2 cells and show a reduced cellular uptake. However, incubation with soluble factors collected during purification results in a new corona, thereby restoring fibrosis regression activity. Overall, cdNVs display encouraging therapeutic properties, making them a promising candidate for the development of liver fibrosis resolving therapeutics.
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Affiliation(s)
- Aymar Abel Ganguin
- Department of Chemistry, Biochemistry and Pharmaceutical Sciences, University of Bern, Bern, 3012, Switzerland
| | - Ivo Skorup
- Department of Chemistry, Biochemistry and Pharmaceutical Sciences, University of Bern, Bern, 3012, Switzerland
| | - Sebastian Streb
- Functional Genomics Center Zurich (FGCZ), University of Zurich/ETH Zurich, Zurich, 8057, Switzerland
| | - Alaa Othman
- Functional Genomics Center Zurich (FGCZ), University of Zurich/ETH Zurich, Zurich, 8057, Switzerland
| | - Paola Luciani
- Department of Chemistry, Biochemistry and Pharmaceutical Sciences, University of Bern, Bern, 3012, Switzerland
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13
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Martín-Carbonero L, Gutierrez Á, Bisbal O, Vergas J, González-Baeza A, Rodríguez Martín C, Vivancos MJ, Sanz J, Álvarez B, Palomar M, de Los Santos I, Sepúlveda-Crespo D, Resino S, Berenguer J, Cano-Smith J, González-García J, Ryan P. Recently acquired hepatitis C: Epidemiological characteristics and treatment response in a large cohort of MSM living with HIV in Madrid. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023:S2529-993X(23)00258-7. [PMID: 37945463 DOI: 10.1016/j.eimce.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/30/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION We analyzed epidemiological, clinical characteristics, and the response to treatment in people living with HIV (PLHIV) who recently acquired hepatitis C (RAHC) in a multicentre study in Madrid (Spain). METHODS Multicenter, ambispective, observational study of RAHC in men who have sex with men (MSM) infected with HIV. Clinical, epidemiological, and RAHC evolution were recorded prospectively in 2019 and 2020 and retrospectively in 2017 and 2018. In patients who received HCV treatment, sustained virological response (SVR) was provided 12 weeks after the end of treatment in an intention to treat analysis (ITT): all treated patients were included; and in analysis per-protocol (PP): missing patients were excluded. RESULTS Overall, 133 patients were included. Median (IQR) age was 40 (34.3-46.1) years, 90.9% had at least one previous sexual transmission disease (STD), and 33.6% had previously hepatitis C. More than half of the prospective sample included patients using chemsex related drugs (57.3%), 45.7% of them intravenously. The most prevalent genotype was G1a (66.2%), followed by G4 (11.3%). Ten of 90 patients evaluated for spontaneous cure (11%) cured the infection spontaneously, and 119 had treatment after a median time of 1.8 (0.7-4.6) months: sustained virological response (SVR) was achieved in 90.7% in the ITT and 94.7% in the PP analysis, with no differences regarding the direct-acting antiviral agents (DAA) combination used. CONCLUSIONS MSM infected by HIV with a RAHC were exposed to high-risk sexual behavior. Spontaneous cure rate was low, while SVR after treatment was achieved by more than 90%.
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Affiliation(s)
- Luz Martín-Carbonero
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Idipaz, Madrid, Spain.
| | - Ángela Gutierrez
- Servicio de Medicina Interna-Infecciosas, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, Spain
| | - Otilia Bisbal
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario 12 de Octubre - Imas 12, Madrid, Spain; CIBERINFECC, Spain
| | - Jorge Vergas
- Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Alicia González-Baeza
- Departamento Psicología Biológica y de la Salud, Facultad de Psicología, Universidad Autónoma de Madrid, Spain
| | - Carmen Rodríguez Martín
- Hospital Clínico San Carlos, IdISSC, Madrid, Spain; Centro Sanitario Sandoval, Madrid, Spain
| | - María Jesús Vivancos
- Departamento de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal - IRYCIS, Madrid, Spain
| | - José Sanz
- Unidad de Enfermedades Infecciosas, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | - Beatriz Álvarez
- Unidad de Enfermedades Infecciosas, Fundacion Jimenez Diaz, Madrid, Spain
| | - Marina Palomar
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Idipaz, Madrid, Spain
| | - Ignacio de Los Santos
- Servicio de Medicina Interna-Infecciosas, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, Spain; CIBERINFECC, Spain
| | - Daniel Sepúlveda-Crespo
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Salvador Resino
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Juan Berenguer
- Servicio de Enfermedades Infecciosas, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Joanna Cano-Smith
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Idipaz, Madrid, Spain
| | - Juan González-García
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Idipaz, Madrid, Spain; CIBERINFECC, Spain
| | - Pablo Ryan
- Servicio de Medicina Interna, Hospital Universitario Infanta Leonor, Madrid, Spain
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14
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Crespo J, Cabezas J, Calleja JL, Buti M, Lazarus JV. The path to successful hepatitis C elimination in Spain. Nat Rev Gastroenterol Hepatol 2023; 20:689-690. [PMID: 37500899 DOI: 10.1038/s41575-023-00813-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Affiliation(s)
- Javier Crespo
- Gastroenterology and Hepatology Department, Marqués de Valdecilla University Hospital, Santander, Spain.
- Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, Santander, Spain.
- School of Medicine, University of Cantabria, Santander, Spain.
| | - Joaquín Cabezas
- Gastroenterology and Hepatology Department, Marqués de Valdecilla University Hospital, Santander, Spain
- Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, Santander, Spain
| | - José Luis Calleja
- Gastroenterology and Hepatology Department, Puerta de Hierro University Hospital, Madrid, Spain
- Puerta de Hierro Majadahonda Research Institute (IDIPHIM), Madrid, Spain
- Autonomous University of Madrid, Madrid, Spain
| | - María Buti
- Liver Unit, Hospital Universitario Valle Hebrón, Barcelona, Spain
- CIBER del Instituto Carlos III, Barcelona, Spain
| | - Jeffrey V Lazarus
- CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, NY, USA.
- Barcelona Institute of Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.
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15
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Hamilton F, Arnold D, Lilford R. Bad research is not all bad. Trials 2023; 24:680. [PMID: 37864198 PMCID: PMC10588138 DOI: 10.1186/s13063-023-07706-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 10/04/2023] [Indexed: 10/22/2023] Open
Abstract
In this commentary, we discuss a recent article in Trials that raised concerns about the number of poorly performed randomised trials in the medical literature and discuss the trials literature more widely. Although we all aim for higher methodological standards in trials, we argue that (i) the idea that 'most randomised trials are bad', which the recent article concludes is an overly simplistic representation of the situation, and (ii) the suggestion that an increased focus on methodological review during trial development (e.g. ethical boards performing some assessment of the methodologists on a trial), while well meaning, may have negative unintended consequences. We therefore propose that (a) trials should be assessed on their merits and weaknesses, including an assessment of risk of bias but placing that in a wider context; (b) we should recognise that although the methodological conduct of trials is of utmost importance, interventions that aim to improve this could have unintended consequences-such as bureaucracy-that have an overall negative effect; and (c) we should therefore generate an evidence base for policy interventions to improve conduct of trials rather than applying arbitrary rules.
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Affiliation(s)
- Fergus Hamilton
- Infection Science, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK.
- MRC Integrative Epidemiology Unit, Oakfield House, University of Bristol, Bristol, BS10 5NB, UK.
| | - David Arnold
- MRC Integrative Epidemiology Unit, Oakfield House, University of Bristol, Bristol, BS10 5NB, UK
- Academic Respiratory Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK
| | - Richard Lilford
- NIHR ARC West Midlands, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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16
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Lazarus JV, Picchio CA, Colombo M. Hepatocellular Carcinoma Prevention in the Era of Hepatitis C Elimination. Int J Mol Sci 2023; 24:14404. [PMID: 37762706 PMCID: PMC10531569 DOI: 10.3390/ijms241814404] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/13/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
The hepatitis C virus (HCV), a single-stranded RNA virus belonging to the Flaviviridae family, is a major cause of hepatocellular carcinoma (HCC) worldwide. Tumors caused by HCC have an increased mortality rate globally, which is more accentuated in Western countries. The carcinogenic potential of this virus is mediated through a wide range of mechanisms, spanning from the induction of chronic inflammation to oxidative stress and deregulation of cellular pathways by viral proteins. As the number of new infections continues unabated, HCC-related mortality should be prioritized through early detection, continued prevention of HCV transmission, and treatment of HCV with safe and efficacious direct antiviral agents (DAAs). People who inject drugs (PWID) are a significant reservoir of new HCV infections globally, and in order to eliminate hepatitis C as a global health threat, as set out by the World Health Organization, an integrated approach based on the optimization of care delivery and increased access to harm reduction and treatment for PWID is needed. Thanks to the development of safe and effective antiviral agents, eradication of the infection is now possible in almost all treated patients, leading to a significant reduction but not the elimination of the risk for HCC in cured patients. This is particularly relevant among aged populations who have cofactors of morbidity known to accelerate HCC progression, such as diabetes, obesity, and excessive alcohol consumption. Given the restless accumulation of individuals with cured HCV infection, the implementation of risk-stratified surveillance programs becomes impellent from a cost-effectiveness perspective, whereas the availability of a performant biomarker to predict HCC in cured patients remains an unmet clinical need.
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Affiliation(s)
- Jeffrey V. Lazarus
- HPAM, CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, NY 10027, USA;
- Faculty of Medicine and Health Sciences, University of Barcelona, 08036 Barcelona, Spain
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain;
| | - Camila A. Picchio
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain;
| | - Massimo Colombo
- EASL International Liver Foundation, 1203 Geneva, Switzerland
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17
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Kondili LA, Craxì L, Nava F, Babudieri S, D'Ambrosio R, Marcellusi A, Mennini FS, Valle S, Russo P, Olimpieri PP, Andreoni M, Aghemo A. From Prioritization to Universal Treatment: Successes and Challenges of Hepatitis C Virus Elimination in Italy. J Infect Dis 2023; 228:S211-S220. [PMID: 37703346 DOI: 10.1093/infdis/jiad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
Italy has had the highest prevalence of hepatitis C virus (HCV) infection and mortality from HCV-related liver cancer in Europe. Although direct-acting antivirals (DAA) were initially restricted to persons with advanced fibrosis, their use has since been extended to all infected individuals; more than 244 000 persons have been treated to date. HCV liver-related mortality is expected to decline by 75% by 2030, achieving the World Health Organization target for mortality. However, Italy risks failing to meet the overall goal of eliminating HCV infection by 2030. In this light, €71.5 million have been allocated for screening initially specific target populations (persons who inject drugs, prison inmates, and the 1969-1989 birth cohort). Herein, we outline the challenges and recommendations for how to move Italy toward HCV elimination, including expanding screening programs in other populations, increasing awareness through strategic communication, sustaining DAA access, and tailoring care models to meet the needs of key populations.
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Affiliation(s)
- Loreta A Kondili
- Center for Global Health, Istituto Superiore di Sanita, Rome, Italy
- Degree Course in Dentistry and Dental Prosthetics, UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | - Lucia Craxì
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Felice Nava
- Health Care and Drug Abuse Unit in Prison, Public Health Agency, Padua, Italy
- Federazione Italiana degli Operatori dei Dipartimenti e dei Servizi delle Dipendenze, Milan, Italy
| | - Sergio Babudieri
- Infectious and Tropical Disease Unit, University Hospital of Sassari, Sassari, Italy
- Italian Society of Penitentiary Health Medicine, Viterbo, Italy
| | - Roberta D'Ambrosio
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Marcellusi
- Economic Evaluation and Health Technology Assessment, Centre for Economic and International Studies, Faculty of Economics, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Saverio Mennini
- Economic Evaluation and Health Technology Assessment, Centre for Economic and International Studies, Faculty of Economics, University of Rome Tor Vergata, Rome, Italy
- Institute of Leadership and Management in Health, Kingston Business School, Kingston University, London, United Kingdom
- Italian Society of Health Technology Assessment, Rome, Italy
| | - Sabrina Valle
- General Directorate for Health Prevention, Prevention of Communicable Diseases and International Prophylaxis, Italian Ministry of Health, Rome, Italy
| | - Pierluigi Russo
- Health Economic Evaluations Office, Italian Medicines Agency, Rome, Italy
- Monitoring Registers Office, Italian Medicines Agency, Rome, Italy
| | | | - Massimo Andreoni
- Infectious Diseases Clinic, University Hospital Tor Vergata, Rome, Italy
- Italian Society of Infectious and Tropical Diseases, Prato, Italy
| | - Alessio Aghemo
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Isituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, 20089, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Italian Association for the Study of the Liver, Rome, Italy
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18
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Pawlotsky JM. Burden of hepatitis B and C in Europe calls for political impetus to accelerate elimination efforts. Lancet Public Health 2023; 8:e666-e667. [PMID: 37633674 DOI: 10.1016/s2468-2667(23)00179-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/02/2023] [Indexed: 08/28/2023]
Affiliation(s)
- Jean-Michel Pawlotsky
- National Reference Center for Viral Hepatitis B, C and D, Department of Virology, Hôpital Henri Mondor (AP-HP), Université Paris-Est, 94010 Créteil, France; Team "Viruses, Hepatology, Cancer", Institut Mondor de Recherche Biomédicale, INSERM U955, Université Paris-Est, Créteil, France.
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19
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Hamill V, Wong S, Benselin J, Krajden M, Hayes PC, Mutimer D, Yu A, Dillon JF, Gelson W, Velásquez García HA, Yeung A, Johnson P, Barclay ST, Alvarez M, Toyoda H, Agarwal K, Fraser A, Bartlett S, Aldersley M, Bathgate A, Binka M, Richardson P, Morling JR, Ryder SD, MacDonald D, Hutchinson S, Barnes E, Guha IN, Irving WL, Janjua NZ, Innes H. Mortality rates among patients successfully treated for hepatitis C in the era of interferon-free antivirals: population based cohort study. BMJ 2023; 382:e074001. [PMID: 37532284 PMCID: PMC10394680 DOI: 10.1136/bmj-2022-074001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVES To quantify mortality rates for patients successfully treated for hepatitis C in the era of interferon-free, direct acting antivirals and compare these rates with those of the general population. DESIGN Population based cohort study. SETTING British Columbia, Scotland, and England (England cohort consists of patients with cirrhosis only). PARTICIPANTS 21 790 people who were successfully treated for hepatitis C in the era of interferon-free antivirals (2014-19). Participants were divided into three liver disease severity groups: people without cirrhosis (pre-cirrhosis), those with compensated cirrhosis, and those with end stage liver disease. Follow-up started 12 weeks after antiviral treatment completion and ended on date of death or 31 December 2019. MAIN OUTCOME MEASURES Crude and age-sex standardised mortality rates, and standardised mortality ratio comparing the number of deaths with that of the general population, adjusting for age, sex, and year. Poisson regression was used to identify factors associated with all cause mortality rates. RESULTS 1572 (7%) participants died during follow-up. The leading causes of death were drug related mortality (n=383, 24%), liver failure (n=286, 18%), and liver cancer (n=250, 16%). Crude all cause mortality rates (deaths per 1000 person years) were 31.4 (95% confidence interval 29.3 to 33.7), 22.7 (20.7 to 25.0), and 39.6 (35.4 to 44.3) for cohorts from British Columbia, Scotland, and England, respectively. All cause mortality was considerably higher than the rate for the general population across all disease severity groups and settings; for example, all cause mortality was three times higher among people without cirrhosis in British Columbia (standardised mortality ratio 2.96, 95% confidence interval 2.71 to 3.23; P<0.001) and more than 10 times higher for patients with end stage liver disease in British Columbia (13.61, 11.94 to 15.49; P<0.001). In regression analyses, older age, recent substance misuse, alcohol misuse, and comorbidities were associated with higher mortality rates. CONCLUSION Mortality rates among people successfully treated for hepatitis C in the era of interferon-free, direct acting antivirals are high compared with the general population. Drug and liver related causes of death were the main drivers of excess mortality. These findings highlight the need for continued support and follow-up after successful treatment for hepatitis C to maximise the impact of direct acting antivirals.
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Affiliation(s)
- Victoria Hamill
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Public Health Scotland, Glasgow, UK
- Joint first authors
| | - Stanley Wong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Joint first authors
| | - Jennifer Benselin
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, UK
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - David Mutimer
- Liver and Hepatology Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - John F Dillon
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, UK
| | - William Gelson
- Cambridge Liver Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Hector A Velásquez García
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alan Yeung
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Public Health Scotland, Glasgow, UK
| | - Philip Johnson
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | | | - Maria Alvarez
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Hidenori Toyoda
- Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Kosh Agarwal
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - Andrew Fraser
- Aberdeen Royal Infirmary, Aberdeen, UK
- Queen Elizabeth University Hospital, Glasgow, UK
| | - Sofia Bartlett
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Aldersley
- Leeds Liver Unit, St James's University Hospital, Leeds, UK
| | | | - Mawuena Binka
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Paul Richardson
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Joanne R Morling
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, UK
- Lifespan and Population Health, University of Nottingham, Nottingham, UK
| | - Stephen D Ryder
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Douglas MacDonald
- Gastroenterology and Hepatology, Royal Free London NHS Foundation Trust, London, UK
| | - Sharon Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Public Health Scotland, Glasgow, UK
| | - Eleanor Barnes
- Nuffield Department of Medicine and the Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Indra Neil Guha
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, UK
| | - William L Irving
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, UK
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital Vancouver, British Columbia, Canada
| | - Hamish Innes
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Public Health Scotland, Glasgow, UK
- Lifespan and Population Health, University of Nottingham, Nottingham, UK
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20
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Kaze E, Henrion J. Clinical characteristics of hepatocellular carcinoma in patients with cirrhosis: a comparative cohort study. Acta Gastroenterol Belg 2023; 86:412-416. [PMID: 37814557 DOI: 10.51821/86.3.11867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Background and study aims The epidemiology of cirrhosis has changed over the last two decades. We aimed to assess whether the epidemiology and clinical presentation of hepatocellular carcinoma (HCC) occurring in cirrhosis has changed. Patients and methods The patients were recruited from the Cirrhosis Registry. This database included patients with cirrhosis who had attended the outpatient' liver clinic at the Centre Hospitalier Jolimont in La Louvière, Belgium, since January 1995. We extracted data on two cohorts of patients with cirrhosis collected over an identical time period and followed up for the same duration. Results Cohort 1 included 504 patients enrolled from 1995 to 2005; among them, 89 patients developed HCC during the defined follow-up period (group 1). Cohort 2 included 566 patients enrolled from 2006 to 2016, among whom 73 patients developed HCC during the defined follow-up period (group 2). When patients with HCC in both groups were compared, no differences were found in the age at HCC diagnosis, the test that alerted on the presence of HCC, the extension, and the stage of the lesion at diagnosis. In the group 1, hepatitis C virus-related HCC occurred in 53% of the cases compared with 18% in the group 2 (P<0.001). Alcohol-related HCC occurred in 27% in the group 1 compared with 60% in the group 2 (P<0.001). The prevalence of metabolic dysfunction-associated steatotic liver disease-related HCC accounted for 10% in all groups. Conclusion The general epidemiology of HCC has not changed; however the etiology of underlying cirrhosis has changed.
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Affiliation(s)
- E Kaze
- Department of gastroenterology and hepatology, Centre Hospitalier Jolimont, Haine-Saint-Paul, Belgium
- Department of gastroenterology and hepatology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - J Henrion
- Department of gastroenterology and hepatology, Centre Hospitalier Jolimont, Haine-Saint-Paul, Belgium
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21
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Heo J, Kim YJ, Lee SW, Lee YJ, Yoon KT, Byun KS, Jung YJ, Tak WY, Jeong SH, Kwon KM, Suri V, Wu P, Jang BK, Lee BS, Cho JY, Jang JW, Yang SH, Paik SW, Kim HJ, Kwon JH, Park NH, Kim JH, Kim IH, Ahn SH, Lim YS. Efficacy and safety of sofosbuvir-velpatasvir and sofosbuvir-velpatasvir-voxilaprevir for hepatitis C in Korea: a Phase 3b study. Korean J Intern Med 2023; 38:504-513. [PMID: 37424500 DOI: 10.3904/kjim.2022.252] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 04/15/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND/AIMS Despite the availability of direct-acting antivirals (DAAs) for chronic hepatitis C virus (HCV) infection in Korea, need remains for pangenotypic regimens that can be used in the presence of hepatic impairment, comorbidities, or prior treatment failure. We investigated the efficacy and safety of sofosbuvir-velpatasvir and sofosbuvir-velpatasvir-voxilaprevir for 12 weeks in HCV-infected Korean adults. METHODS This Phase 3b, multicenter, open-label study included 2 cohorts. In Cohort 1, participants with HCV genotype 1 or 2 and who were treatment-naive or treatment-experienced with interferon-based treatments, received sofosbuvir-velpatasvir 400/100 mg/day. In Cohort 2, HCV genotype 1 infected individuals who previously received an NS5A inhibitor-containing regimen ≥ 4 weeks received sofosbuvir-velpatasvir-voxilaprevir 400/100/100 mg/day. Decompensated cirrhosis was an exclusion criterion. The primary endpoint was SVR12, defined as HCV RNA < 15 IU/mL 12 weeks following treatment. RESULTS Of 53 participants receiving sofosbuvir-velpatasvir, 52 (98.1%) achieved SVR12. The single participant who did not achieve SVR12 experienced an asymptomatic Grade 3 ASL/ALT elevation on day 15 and discontinued treatment. The event resolved without intervention. All 33 participants (100%) treated with sofosbuvir-velpatasvir-voxilaprevir achieved SVR 12. Overall, sofosbuvir-velpatasvir and sofosbuvir-velpatasvir-voxilaprevir were safe and well tolerated. Three participants (5.6%) in Cohort 1 and 1 participant (3.0%) in Cohort 2 had serious adverse events, but none were considered treatment-related. No deaths or grade 4 laboratory abnormalities were reported. CONCLUSION Treatment with sofosbuvir-velpatasvir or sofosbuvir-velpatasvir-voxilaprevir was safe and resulted in high SVR12 rates in Korean HCV patients.
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Affiliation(s)
- Jeong Heo
- Department of Internal Medicine, College of Medicine, Pusan National University and Biomedical 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
| | - Sung Wook Lee
- Department of Internal Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Youn-Jae Lee
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ki Tae Yoon
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Kwan Soo Byun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yong Jin Jung
- Division of Gastroenterology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Won Young Tak
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sook-Hyang Jeong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | | | | | - Peiwen Wu
- Gilead Sciences, Inc., Foster City, CA, USA
| | - Byoung Kuk Jang
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Byung Seok Lee
- Department of Internal Medicine, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Ju-Yeon Cho
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Korea
| | - Jeong Won Jang
- Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo Hyun Yang
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Seung Woon Paik
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Joon Kim
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jung Hyun Kwon
- Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Neung Hwa Park
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Ju Hyun Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - In Hee Kim
- Department of Internal Medicine, Jeonbuk National University Hospital, Jeonju, Korea
| | - Sang Hoon Ahn
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Suk Lim
- Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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22
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Snell G, Marshall AD, van Gennip J, Bonn M, Butler-McPhee J, Cooper CL, Kronfli N, Williams S, Bruneau J, Feld JJ, Janjua NZ, Klein M, Cunningham N, Grebely J, Bartlett SR. Public reimbursement policies in Canada for direct-acting antiviral treatment of hepatitis C virus infection: A descriptive study. CANADIAN LIVER JOURNAL 2023; 6:190-200. [PMID: 37503523 PMCID: PMC10370724 DOI: 10.3138/canlivj-2022-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/28/2023] [Indexed: 07/29/2023]
Abstract
Background Direct-acting antiviral (DAA) therapies have simplified HCV treatment, and publicly funded Canadian drug plans have eliminated disease-stage restrictions for reimbursement of DAA therapies. However other policies which complicate, delay, or prevent treatment initiation still persist. We aim to describe these plans' existing reimbursement criteria and appraise whether they hinder treatment access. Methods We reviewed DAA reimbursement policies of 16 publicly funded drug plans published online and provided by contacts with in-depth knowledge of prescribing criteria. Data were collected from May to July 2022. Primary outcomes were: (1) if plans have arranged to accept point-of-care HCV RNA testing for diagnosis; testing requirements for (2) HCV genotype, (3) fibrosis stage, and (4) chronic infection; (5) time taken and method used to approve reimbursement requests; (6) providers eligible to prescribe DAAs; and (7) restrictions on re-treatment. Results Fifteen (94%) plans have at least one policy in place which limits simplified HCV treatment. Many plans continue to require results of genotype or fibrosis staging, limit eligible prescribers, and take longer than 1 day to approve coverage requests. One plan discourages treatment for re-infection. Conclusion Reimbursement criteria set by publicly funded Canadian drug plans continue to limit timely, equitable access to HCV treatment. Eliminating clinically irrelevant pre-authorization testing, expanding eligible prescribers, expediting claims processing, and broadening coverage of treatment for reinfection will improve access to DAAs. The federal government could further enhance efforts by introducing a federal HCV elimination strategy or federal high-cost drug PharmaCare program.
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Affiliation(s)
- Gaelen Snell
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alison D Marshall
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- The Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | | | - Matthew Bonn
- Canadian Association of People Who Use Drugs, Dartmouth, Nova Scotia, Canada
| | | | - Curtis L Cooper
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Nadine Kronfli
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, Montréal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada
| | - Sarah Williams
- Calgary Liver Unit, Alberta Health Services, Calgary, Alberta, Canada
| | - Julie Bruneau
- Centre Hospitalier de l’Université de Montréal Research Center, Quebec, Canada
| | - Jordan J Feld
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marina Klein
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, Montréal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada
| | - Nance Cunningham
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Jason Grebely
- The Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sofia R Bartlett
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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23
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Devan P, Tiong KLA, Neo JE, Mohan BP, Wijarnpreecha K, Tam YCS, Coppola N, Preda CM, Wong YJ. Treatment Outcomes of Sofosbuvir/Velpatasvir/Voxilaprevir in Direct-Acting Antiviral-Experienced Hepatitis C Virus Patients: A Systematic Review and Meta-Analysis. Viruses 2023; 15:1489. [PMID: 37515176 PMCID: PMC10384139 DOI: 10.3390/v15071489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
About 5% of chronic hepatitis C (CHC) patients experienced treatment failure with direct-acting antiviral (DAA) treatment. The global data on the practice and treatment outcomes of Sofosbuvir/Velpatasvir/Voxilaprevir (SOF/VEL/VOX) in DAA-experienced CHC patients remains sparse. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of SOF/VEL/VOX as a salvage treatment in DAA-experienced CHC patients. We searched five electronic databases from inception to 31 January 2023. The study outcomes were SVR12 and treatment-related adverse effects, with subgroup analysis performed based on genotype, cirrhosis, HCC, prior SOF/VEL exposure, and region. We identified and analyzed data from 24 studies (2877 DAA-experienced CHC patients); 17.2% had prior SOF/VEL exposure, 25% received ribavirin with SOF/VEL/VOX, and 42% had pre-treatment resistance-associated substitution (RAS) testing performed. Eastern Mediterranean had a higher pooled SVR12 than the America and Europe regions (p < 0.05). Predictors of SOF/VEL/VOX failure were genotype 3, active HCC, baseline cirrhosis, and prior SOF/VEL. Baseline RAS mutation and ribavirin supplementation were not associated with higher SVR12. Treatment discontinuation because of drug-related adverse events was uncommon (10 studies, 0.2%). In summary, SOF/VEL/VOX is efficacious and safe for retreatment in DAA-experienced CHC patients, even with RAS mutation. Our findings support SOF/VEL/VOX as a first-line rescue treatment for DAA-experienced CHC patients.
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Affiliation(s)
- Pooja Devan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Kai Le Ashley Tiong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Jean Ee Neo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Babu P Mohan
- Division of Gastroenterology & Hepatology, University of Utah Health, Salt Lake City, UT 84112, USA
| | - Karn Wijarnpreecha
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona College of Medicine, Phoenix, AZ 85004, USA
| | - Yew Chong Steve Tam
- Education Resource Centre, Medical Board, Singapore General Hospital, Singapore 169608, Singapore
| | - Nicola Coppola
- Department of Mental Health and Preventive Medicine, University of Campania "L. Vanvitelli", 81100 Napoli, Italy
| | - Carmen Monica Preda
- Clinical Institute of Fundeni, Gastroenterology and Hepatology, 022328 Bucharest, Romania
| | - Yu Jun Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
- Department of Gastroenterology & Hepatology, Changi General Hospital, Singapore 529889, Singapore
- Duke-NUS Academic Medicine Programme, SingHealth, Singapore 169608, Singapore
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24
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Meyer ED, Dudareva S, Kollan C, Mauss S, Wedemeyer H, Schmidt D, Zimmermann R. Additional challenges in reaching hepatitis C elimination goals in Germany due to the COVID-19 pandemic - descriptive analysis of drug prescription data from January 2018 to June 2021. Front Public Health 2023; 11:1149694. [PMID: 37325322 PMCID: PMC10267983 DOI: 10.3389/fpubh.2023.1149694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 05/12/2023] [Indexed: 06/17/2023] Open
Abstract
Effectively treating hepatitis C viral (HCV) infections prevents sequelae and onward transmission. In Germany, HCV drug prescriptions have declined since 2015. During the COVID-19 pandemic, lockdowns impacted the access to HCV care services and HCV treatment. We assessed if the COVID-19 pandemic further decreased treatment prescriptions in Germany. We built log-linear models with monthly HCV drug prescription data from pharmacies from January 2018 - February 2020 (pre-pandemic) to calculate expected prescriptions for March 2020-June 2021 and different pandemic phases. We calculated monthly prescription trends per pandemic phase using log-linear models. Further, we scanned all data for breakpoints. We stratified all data by geographic region and clinical settings. The number of DAA prescriptions in 2020 (n = 16,496, -21%) fell below those of 2019 (n = 20,864) and 2018 (n = 24,947), continuing the declining trend from previous years. The drop in prescriptions was stronger from 2019 to 2020 (-21%) than from 2018 to 2020 (-16%). Observed prescriptions met predictions from March 2020 to June 2021, but not during the first COVID-19 wave (March 2020-May 2020). Prescriptions increased during summer 2020 (June 2020-September 2020) and fell below the pre-pandemic numbers during the following pandemic waves (October 2020 - February 2021 and March 2021 - June 2021). Breakpoints during the first wave indicate that prescriptions plummeted overall, in all clinical settings and in four of six geographic regions. Both, outpatient clinics and private practices prescribed overall as predicted. However, outpatient hospital clinics prescribed 17-39% less than predicted during the first pandemic wave. HCV treatment prescriptions declined but stayed within the lower realms of predicted counts. The strongest decline during the first pandemic wave indicates a temporary HCV treatment gap. Later, prescriptions matched predictions despite of pronounced decreases during the second and third waves. In future pandemics, clinics and private practices need to adapt more rapidly to maintain a continuous access to care. In addition, political strategies should focus more on continuously providing essential medical care during periods of restricted access due to infectious disease outbreaks. The observed decrease in HCV treatment may challenge reaching the HCV elimination goals in Germany by 2030.
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Affiliation(s)
- Emily D. Meyer
- Department of Infectious Disease Epidemiology, Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Sandra Dudareva
- Department of Infectious Disease Epidemiology, Unit of HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Christian Kollan
- Department of Infectious Disease Epidemiology, Unit of HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Düsseldorf, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hanover, Germany
| | - Daniel Schmidt
- Department of Infectious Disease Epidemiology, Unit of HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Ruth Zimmermann
- Department of Infectious Disease Epidemiology, Unit of HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
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25
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Su WW, Yang CC, Chang RWJ, Yeh YH, Yen HH, Yang CC, Lee YL, Liu CE, Liang SY, Sung ML, Ko SY, Kuo CY, Chen SLS, Yeh YP, Hu TH. A new collaborative care approach toward hepatitis C elimination in marginalized populations. J Infect Public Health 2023; 16:1201-1208. [PMID: 37271101 DOI: 10.1016/j.jiph.2023.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Treating marginalized populations with HCV infection for elimination is faced with the challenge for the integration of HCV screening service offered for patients often moving across multiple settings. We envisaged a novel collaborative care approach to identify to what extent HCV patients overlapped between and within these multiple institutions and reported the findings of treatment coverage of these marginalized populations after HCV care cascades. METHODS We enrolled 7765 patients residing in the Changhua County, Taiwan offered with HCV screening from correctional institutions, HIV clinics, methadone clinics, and the existing HIV surveillance program (four subgroups including police-arrested people, probationers, non-injection drug user, and high-risk behavior people) between 2019 and 2020. The collaborative care and information were integrated through a teamwork of gastroenterologists, psychologists, infectious disease specialists, and nursing coordinators under the auspices of local health authority. RESULTS The overall participation rate in HCV screening was 92.65% (7194/7765). The prevalence rate was the highest in methadone clinics (90.17%) followed by correctional institutions (37.67%), HIV clinics (34.60%), and the surveillance program (18.14%). We found 25.41% (77/303) of methadone clinic patients, 17.65% (129/731) of HIV clinic patients, and various proportions for 44.09% (41/93) of deferred prosecuted or probationers under surveillance program were also recruited into other settings. Individuals' patient flow within setting was more frequent than that between setting. After calibrating the overlap of patient flow, a total of 1700 anti-HCV positives out of 4074 after screening were traced with available follow-up information to complete 92.52% treatment coverage of 1177 RNA-positives (77.23%) diagnosed from 1524 undergoing RNA testing with similar findings across multiple settings. CONCLUSION A new collaborative integrated care was adopted for elucidating patient flow between and within multiple settings in order to calibrate the accurate demand for HCV care cascades and enhance HCV treatment coverage in marginalized populations.
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Affiliation(s)
- Wei-Wen Su
- Changhua Christian Hospital, Changhua, Taiwan
| | - Chih-Chao Yang
- Changhua Hospital, Ministry of Health and Welfare, Changhua, Taiwan
| | - Rene Wei-Jung Chang
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | | | | | | | - Yu-Lin Lee
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | | | - Sun-Yuan Liang
- Changhua Hospital, Ministry of Health and Welfare, Changhua, Taiwan
| | - Man-Li Sung
- Changhua Public Health Bureau, Changhua, Taiwan
| | - Shu-Yu Ko
- Changhua Public Health Bureau, Changhua, Taiwan
| | | | - Sam Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yen-Po Yeh
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan; Changhua Public Health Bureau, Changhua, Taiwan.
| | - Tsung-Hui Hu
- Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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26
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Debette-Gratien M, François S, Chevalier C, Alain S, Carrier P, Rigaud C, Abraham B, Burgevin AL, Courat L, Debenes B, Koffi J, Caux-Nussbaum E, Zattoni-Leroy J, Feuillet-Sow G, Dumont Q, Nubukpo P, Loustaud-Ratti V. Towards hepatitis C elimination in France: Scanvir, an effective model to test and treat drug users on dedicated days. J Viral Hepat 2023; 30:355-361. [PMID: 36597183 DOI: 10.1111/jvh.13798] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/22/2022] [Accepted: 12/28/2022] [Indexed: 01/05/2023]
Abstract
According to the French recommendations, the elimination of the hepatitis C virus by 2025 could be a realistic public health goal. Screening policies are being intensified, and access to treatment is promoted for patients who escape the usual care pathway. The 'Scanvir' program is an original strategy based on dedicated screening days, as part of the 'test, treat and cure HCV' event in addiction care centers in a French region, during which innovative screening technologies (RDTs, FibroScan® and point-of-care HCV RNA testing) are brought on site and access to a multidisciplinary team is offered. A total of 392 patients attended the 67 regional Scanvir sessions: 31.6% were HCV Ab-positive and 66% of them were HCV RNA-positive. Treatment was initiated in 79.3% of the patients. RDTs were accepted by 62% of the PWIDs (including those who already knew their status) and FibroScan® by 99.5% of the patients. 80% of the viremic patients started their treatment on site and are now cured or still under treatment. Advanced fibrosis evaluated by FibroScan® (LSM > 8 KPa) was suspected in 13.4% and 14.1% of the global and the HCV population, respectively. Scanvir is an efficient strategy for HCV elimination based on dedicated days aimed at increasing cost-effectiveness and offering a multidisciplinary service while saving human care resources. It is an exportable strategy that also offers comprehensive screening of associated chronic liver diseases via the elastometry device and interviews.
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Affiliation(s)
| | - Sandrine François
- Hepato-Gastroenterology Department, University Hospital Center, Limoges, France
| | | | - Sophie Alain
- Virology Department, University Hospital Center, Limoges, France
| | - Paul Carrier
- Hepato-Gastroenterology Department, University Hospital Center, Limoges, France
| | - Céline Rigaud
- Hepato-Gastroenterology Department, University Hospital Center, Limoges, France
| | - Bruno Abraham
- Infectiology Department, Hospital Center, Brive, France
| | | | - Laurent Courat
- Addictology Department, Vauclaire Hospital, Périgueux, France.,Committee for Study and Information on Drugs and Addictions (CEID), Périgueux, France
| | - Bernard Debenes
- Hepatogastroenterology Department, Hospital Center, Périgueux, France
| | - Joseph Koffi
- Infectiology Department, Hospital Center, Périgueux, France
| | | | - Juliette Zattoni-Leroy
- Addictology Department (CSAPA), Hospital Center Esquirol, Limoges, France.,Addictology Department (CSAPA), Guéret, France
| | | | | | - Philippe Nubukpo
- Addictology Department (CSAPA), Hospital Center Esquirol, Limoges, France
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27
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Young J, Wang S, Lanièce Delaunay C, Cooper CL, Cox J, Gill MJ, Hull M, Walmsley S, Wong A, Klein MB. The rate of hepatitis C reinfection in Canadians coinfected with HIV and its implications for national elimination. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 114:103981. [PMID: 36893502 DOI: 10.1016/j.drugpo.2023.103981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND The World Health Organisation (WHO) has set targets for the rate of new infections as a way to measure progress towards the elimination of hepatitis C virus (HCV) as a public health threat. As more people are successfully treated for HCV, a higher proportion of new infections will be reinfections. We consider whether the reinfection rate has changed since the interferon era and what we can infer about national elimination efforts from the current reinfection rate. METHODS The Canadian Coinfection Cohort is representative of HIV HCV coinfected people in clinical care. We selected cohort participants successfully treated for a primary HCV infection either in the interferon era or in the era of direct acting antivirals (DAAs). Selected participants were followed from 12 weeks after completing a successful treatment until the end of 2019 or until their last measured HCV RNA. We estimated the reinfection rate in each treatment era, overall and in participant subgroups, using proportional hazard models appropriate for interval censored data. RESULTS Among 814 successfully treated participants with additional HCV RNA measurements, there were 62 reinfections. The overall reinfection rate was 2.6 (95% confidence interval, CI, 1.2-4.1) /100 person years (PY) in the interferon era and 3.4 (95% CI 2.5-4.4) /100 PY in the DAA era. The rate in those reporting injection drug use (IDU) was much higher: 4.7 (95% CI 1.4-7.9) /100 PY and 7.6 (95% CI 5.3-10) /100 PY in the interferon and DAA eras respectively. CONCLUSION The overall reinfection rate in our cohort is now above the WHO target set for new infections in people who inject drugs. The reinfection rate in those reporting IDU has increased since the interferon era. This suggests Canada is not on track to achieve HCV elimination by 2030.
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Affiliation(s)
- Jim Young
- Research Institute of the McGill University Health Centre, 5252 Boulevard de Maisonneuve Ouest, Montreal, Quebec H4A3S5, Canada; Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, 2001 McGill College Suite 1200, Montreal, Quebec H3A1G1, Canada.
| | - Shouao Wang
- Research Institute of the McGill University Health Centre, 5252 Boulevard de Maisonneuve Ouest, Montreal, Quebec H4A3S5, Canada
| | - Charlotte Lanièce Delaunay
- Research Institute of the McGill University Health Centre, 5252 Boulevard de Maisonneuve Ouest, Montreal, Quebec H4A3S5, Canada; Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, 2001 McGill College Suite 1200, Montreal, Quebec H3A1G1, Canada
| | - Curtis L Cooper
- Division of Infectious Diseases, Department of Medicine, Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa K1Y4E9, Canada
| | - Joseph Cox
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, 2001 McGill College Suite 1200, Montreal, Quebec H3A1G1, Canada; Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, 1001 Boulevard Décarie, Montreal, Quebec H4A3J1, Canada
| | - M John Gill
- Department of Medicine, University of Calgary, 2500 University Drive, Calgary, Alberta T2N1N4, Canada
| | - Mark Hull
- BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Colombia V6Z1Y6, Canada
| | - Sharon Walmsley
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of Toronto, 6 Queen's Park Crescent West, Toronto. Ontario M5S3H2, Canada
| | - Alexander Wong
- Division of Infectious Diseases, Department of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, Saskatchewan S7N5E5, Canada
| | - Marina B Klein
- Research Institute of the McGill University Health Centre, 5252 Boulevard de Maisonneuve Ouest, Montreal, Quebec H4A3S5, Canada; Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, 2001 McGill College Suite 1200, Montreal, Quebec H3A1G1, Canada; Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, 1001 Boulevard Décarie, Montreal, Quebec H4A3J1, Canada; CIHR Canadian HIV Trials Network, 608-1081 Burrard Street, Vancouver, British Columbia V6Z1Y6, Canada
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Yousafzai MT, Alavi M, Valerio H, Hajarizadeh B, Grebely J, Dore GJ. Hepatitis C care cascade before and during the direct-acting antiviral eras in New South Wales, Australia: A population-based linkage study. J Viral Hepat 2023; 30:250-261. [PMID: 36537024 DOI: 10.1111/jvh.13791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/15/2022] [Accepted: 12/10/2022] [Indexed: 01/12/2023]
Abstract
The hepatitis C virus (HCV) care cascade characterization is important for monitoring progress towards HCV elimination. This study evaluated HCV care cascade and factors associated with treatment during pre-DAA (2011-2012 and 2013-2015) and DAA (2016-2018) eras in New South Wales (NSW), Australia. We conducted a cohort study of people with an HCV notification (1993 to 2017) through end 2018, linked to administrative datasets, including HCV treatment and non-hospital services. Those aged <18 years, died within first 6 months of study period or notification, and who had successful HCV treatment in period before were excluded. Sex-specific spontaneous viral clearance was incorporated to estimate treatment-eligible population. The study population in each period were cumulative and brought forward from one period to the next. Among 115,667 people with HCV notification, 87,063 fulfilled eligibility criteria. During 2011 to 2012, 2013 to 2015, and 2016 to 2018, cumulative HCV notifications were 71,677, 77,969, and 80,017; 52,016, 56,793, and 57,467 were eligible for treatment; 29%, 48%, and 64% confirmed HCV RNA positive; and 0.6%, 5%, and 38% initiated HCV treatment, respectively. Birth cohort 1945 to 1964 (vs. ≥1965), males, non-Aboriginal ethnicity, regional/rural area of residence, and HCV/HIV co-infection were associated with higher treatment uptake. Incarceration and drug dependence were associated with higher treatment uptake during the DAA era. In Australia, many marginalized populations including those incarcerated and those with drug dependence have equitable treatment uptake in the DAA era. Targeted strategies are required to enhance treatment uptake for females and Aboriginal populations.
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Affiliation(s)
| | - Maryam Alavi
- The Kirby Institute, UNSW Sydney, Sydney, Australia
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Jiang N, Bruneau J, Makarenko I, Minoyan N, Zang G, Høj SB, Larney S, Martel-Laferrière V. HCV treatment initiation in the era of universal direct acting antiviral coverage - Improvements in access and persistent barriers. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 113:103954. [PMID: 36758334 DOI: 10.1016/j.drugpo.2023.103954] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Barriers to HCV treatment initiation persisted after the introduction of direct-acting antivirals (DAAs) in Canada among people who inject drugs (PWID); whether DAA universal coverage lifted these barriers remain unknown. We assessed the evolution of HCV treatment initiation and associated factors among PWID in Montreal, Canada, comparing eras of IFN-based regimens (2011-2013), of DAA restricted access (2014-02/2018), and universal coverage (03/2018-03/2020). METHODS We included chronically HCV-infected participants followed in a community-based PWID cohort in Montreal, Canada between 2011 and 03/2020 and collected data at 3-month intervals. Time-updated Cox regressions were conducted to examine 9 variables of interest associated with treatment initiation overall and for each of the three eras. RESULTS Of 276 participants, 126 initiated treatment during follow-up. Yearly initiation increased from 3% in 2011 to 19% in 2016, and 54% in 2018. PWID aged >40 (vs. ≤40) were twice as likely to initiate treatment in 2014-02/2018 (HR: 2.02 95%CI: [1.24-3.28]) but not in other periods (2011-2013: 0.55 [0.25-1.22]; 03/2018-03/2020: 1.14 [0.59-2.22])). Odds of initiation were lower for men than women in all periods, with women three times more likely to be treated under universal coverage (0.30 [0.11-0.77] vs 2011-2013: 0.67 [0.25-1.78] and 2014-02/2018: 0.75 [0.42-1.35]). Recent incarceration was negatively associated with initiation throughout all periods (2011-2013: 0.57 [0.13-2.43]; 2014-03/2018: 0.39 [0.17-0.91]; 03/2018-03/2020: 0.25 [0.07-0.83]). Barriers associated with high injection frequency appear to have diminished since DAA introduction (2014-02/2018: 0.71 [0.42-1.20]; 03/2018-03/2020: 1.05 [0.52-2.11] vs. 2011-2013: 0.26 [0.08-0.88]). Contact with a primary care physician and engagement in opioid agonist therapy were positively associated with treatment initiation, though estimates were attenuated under universal coverage relative to previous eras. CONCLUSION Treatment initiation rates have increased since the introduction of universal DAA coverage, though barriers such as incarceration persist.
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Affiliation(s)
- Nathalie Jiang
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2×0A9, Canada
| | - Julie Bruneau
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2×0A9, Canada; Département de Médecine Familiale et Médecine d'Urgence, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, Québec, H3C 3J7, Canada
| | - Iuliia Makarenko
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2×0A9, Canada; Department of Family Medicine, McGill University, 845 rue Sherbrooke Ouest, Montreal, Quebec, H3A 0G4, Canada
| | - Nanor Minoyan
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2×0A9, Canada; École de Santé Publique de l'Université de Montréal, 7101 Avenue du Parc, Montréal, Québec, H3N 1×9, Canada
| | - Geng Zang
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2×0A9, Canada
| | - Stine Bordier Høj
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2×0A9, Canada
| | - Sarah Larney
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2×0A9, Canada
| | - Valérie Martel-Laferrière
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2×0A9, Canada; Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, Québec, H3C 3J7, Canada.
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Crespo J, Calleja JL, Cabezas J, García F, Aguilera A, Jorquera F, Lazarus JV. A call for the comprehensive diagnosis of viral hepatitis as a key step towards its elimination. Liver Int 2023; 43:1145-1147. [PMID: 36700337 DOI: 10.1111/liv.15529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/12/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023]
Affiliation(s)
- Javier Crespo
- Gastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, Santander, Spain
| | - José Luis Calleja
- Gastroenterology and Hepatology Department, Puerta de Hierro University Hospital, Puerta de Hierro Majadahonda Research Institute (IDIPHIM), Autonomous University of Madrid, Madrid, Spain
| | - Joaquín Cabezas
- Gastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, Santander, Spain
| | - Federico García
- Microbiology Department, San Cecilio Clinic University Hospital, Biosanitary Research Institute of Granada (IBIS), Granada, Spain.,CIBER infectious Diseases (CIBERINFEC), Madrid, Spain
| | - Antonio Aguilera
- Microbiology Department, Santiago de Compostela Clinic University Hospital, Microbiology and Parasitology Department, Santiago de Compostela University, A Coruña, Spain
| | - Francisco Jorquera
- Gastroenterology and Hepatology Department, University Hospital of Leon, IBIOMED and CIBERehd, León, Spain
| | - Jeffrey V Lazarus
- Barcelona Institute of Global Health (ISGlobal), Hospital Clínic, Barcelona, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, New York, USA
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Bryce K, Smith C, Rodger A, Macdonald D. Falling treatment uptake in the hepatitis C care cascade is a growing threat to achieving elimination. J Viral Hepat 2023; 30:46-55. [PMID: 36197840 PMCID: PMC10091771 DOI: 10.1111/jvh.13757] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 09/07/2022] [Accepted: 09/10/2022] [Indexed: 12/13/2022]
Abstract
Most high-income countries are not on track to achieve the World Health Organization hepatitis C elimination targets. As elimination programmes assess growing proportions of patients in community-based pathways, rates of treatment uptake may fall. We aimed to identify factors associated with DAA treatment uptake and measure changes in their prevalence over time. We performed a time-to-treatment analysis on 2728 patients approved for hepatitis C Direct-Acting Antiviral treatment in the North Central London region between January 2016 and October 2019. We investigated the association between treatment uptake and factors including assessment/treatment setting (hospital, drug service or prison), patient age, gender, injection drug use, harmful alcohol use, cirrhosis status and previous treatment. The likelihood of treatment uptake was reduced by three independent risk factors. These included assessment setting: prison-based or drug-service pathways (aHR 0.29 or 0.81 vs. hospital outpatient pathway, 95% CI 0.21-0.40 and 0.70-0.94 respectively, p < .001); being UK-born (aHR 0.89 vs. non-UK born, 0.82-0.98, p = .01); and history of harmful alcohol use (aHR 0.84 vs. no history, 0.72-0.99, p = .04). The average number of these risk factors for not starting treatment per patient increased over time (R2 = 0.66 p < .001). Independent of these, there was an additional 5% reduction in rate of treatment initiation in each successive year of the programme (aHR 0.95, 0.91-0.99, p = .02). In conclusion, disengagement from care before treatment uptake was found to be a growing threat to elimination. Despite provision of community-based test-to-cure pathways, there are persistent barriers to treatment uptake and these are increasing over time.
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Affiliation(s)
- Kathleen Bryce
- Institute for Global HealthUniversity College LondonLondonUK
- Royal Free London NHS Foundation TrustLondonUK
| | - Colette Smith
- Institute for Global HealthUniversity College LondonLondonUK
| | - Alison Rodger
- Institute for Global HealthUniversity College LondonLondonUK
- Royal Free London NHS Foundation TrustLondonUK
| | - Douglas Macdonald
- Royal Free London NHS Foundation TrustLondonUK
- Institute for Liver and Digestive HealthUniversity College LondonLondonUK
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Krekulová L, Damajka T, Krumphanslová Z, Řehák V. Pilot Outreach Program in Remedis-The Promising Step toward HCV Elimination among People Who Inject Drugs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:501. [PMID: 36612821 PMCID: PMC9819867 DOI: 10.3390/ijerph20010501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
The global effort to eliminate HCV infection requires new approaches to accessing and testing the affected population in a setting with as low of a threshold as possible. The focus should be on socially marginalized people who inject drugs (PWIDs) and who are not willing or able to visit standard medical services. With this vision, we established an outreach service-a testing point in an ambulance in the park in front of the Main Railway Station of the capital city of Prague-to provide bloodborne disease testing and treatment. The service was available every week on Wednesday afternoon. Over the initial two years of our experience, 168 unique people were tested. Of them, 82 (49%) were diagnosed with chronic HCV infection and were eligible for treatment with antivirals. Of these, 24 (29%) initiated antiviral treatment over the study period, and 17 (71%) of these individuals achieved a documented sustained virological response. Offering medical services in PWIDs' neighborhoods helps overcome barriers and increase the chances that they will become patients and begin HCV treatment. The described outcomes appear promising for reaching the vision of linkage to the care of such a hard-to-reach population and can serve as a feasible model of care for further expansion.
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Affiliation(s)
- Laura Krekulová
- Remedis, s.r.o., Vladimírova 10, 140 00 Prague 4, Czech Republic
- 4th Department of Internal Medicine, First Faculty of Medicine, Charles University in Prague, Kateřinská 32, 128 00 Prague 2, Czech Republic
| | - Tomáš Damajka
- Remedis, s.r.o., Vladimírova 10, 140 00 Prague 4, Czech Republic
| | | | - Vratislav Řehák
- Remedis, s.r.o., Vladimírova 10, 140 00 Prague 4, Czech Republic
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Wallace J, Richmond J, Howell J, Hajarizadeh B, Power J, Treloar C, Revill PA, Cowie B, Wang S, Stoové M, Pedrana A, Hellard M. Exploring the Public Health and Social Implications of Future Curative Hepatitis B Interventions. Viruses 2022; 14:v14112542. [PMID: 36423153 PMCID: PMC9693003 DOI: 10.3390/v14112542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/11/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
Abstract
Hepatitis B is a significant global health issue where the 296 million people estimated to live with the infection risk liver disease or cancer without clinical intervention. The World Health Organization has committed to eliminating viral hepatitis as a public health threat by 2030, with future curative hepatitis B interventions potentially revolutionizing public health responses to hepatitis B, and being essential for viral hepatitis elimination. Understanding the social and public health implications of any cure is imperative for its successful implementation. This exploratory research, using semi-structured qualitative interviews with a broad range of professional stakeholders identifies the public health elements needed to ensure that a hepatitis B cure can be accessed by all people with hepatitis B. Issues highlighted by the experience of hepatitis C cure access include preparatory work to reorientate policy settings, develop resourcing options, and the appropriateness of health service delivery models. While the form and complexity of curative hepatitis B interventions are to be determined, addressing current disparities in cascade of care figures is imperative with implementation models needing to respond to the cultural contexts, social implications, and health needs of people with hepatitis B, with cure endpoints and discourse being contested.
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Affiliation(s)
- Jack Wallace
- Burnet Institute, Melbourne, VIC 3004, Australia
- Australian Research Centre in Sex, Health and Society, Latrobe University, Bundoora, VIC 3083, Australia
- Centre for Social Research in Health, UNSW, Sydney, NSW 2052, Australia
- Correspondence: ; Tel.: +61-432850708
| | | | - Jessica Howell
- Burnet Institute, Melbourne, VIC 3004, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
| | | | - Jennifer Power
- Australian Research Centre in Sex, Health and Society, Latrobe University, Bundoora, VIC 3083, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW, Sydney, NSW 2052, Australia
| | - Peter A. Revill
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC 3010, Australia
- Department of Microbiology and Immunology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Benjamin Cowie
- WHO Collaborating Centre for Viral Hepatitis, Peter Doherty Institute for Infection and Immunity, Parkville, VIC 3010, Australia
| | - Su Wang
- Center for Asian Health, Saint Barnabas Medical Center, RWJBarnabas-Rutgers Medical Group, Florham Park, NJ 07039, USA
| | - Mark Stoové
- Burnet Institute, Melbourne, VIC 3004, Australia
| | | | - Margaret Hellard
- Burnet Institute, Melbourne, VIC 3004, Australia
- Department of Infectious Diseases, Alfred Health & Monash University, Melbourne, VIC 3004, Australia
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Fiore V, De Vito A, Colpani A, Manca V, Maida I, Madeddu G, Babudieri S. Viral Hepatitis C New Microelimination Pathways Objective: Psychiatric Communities HCV Free. LIFE (BASEL, SWITZERLAND) 2022; 12:life12111873. [PMID: 36431008 PMCID: PMC9697639 DOI: 10.3390/life12111873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND People with psychiatric disorders have a high prevalence of HCV. For this reason, tailored interventions should be developed to reach this population. METHODS We performed a retrospective study on patients treated for HCV infection in psychiatric nursing homes, approached with a quick diagnosis, staging and treatment. RESULTS We included data on 586 people screened for HCV with quick tests. High HCV seroprevalence was found in this population (231; 39.4%). Among people who tested positive, there were high rates of active infection (220; 95.2%). Out of the 220 patients with active infection, 95.9% were male, 85.5% were Italian, median age was 43 (IQR = 35-52) years old. In the majority of cases (162; 73.6%), the risk factor was unknown. The most common genotype was 3a (98; 44.5%), and patients mostly had a low fibrosis, according with FIB-4 value (142; 64.5%). Of them, one (0.45%) categorically refused the treatment, and one (0.45%) had liver cirrhosis and advanced hepatocellular carcinoma. Overall, 218 patients underwent eligibility for DAAs. The most prescribed treatment was glecaprevir/pibrentasvir (GLE/PIB (172; 78.2%)). The others practiced sofosbuvir/velpatasvir (SOF/VEL). All patients reached the end of treatment. One (0.45%) was lost to follow up, and all the others reached the SVR12. CONCLUSIONS The point-of-care testing and pangenotypic DAAs' availability represent one of the most important steps for a fast diagnostic and therapeutical option. Tailored microelimination pathways for every difficult-to-reach/to-treat populations are needed. This would allow us to move more easily towards HCV elimination.
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Burgui C, San Miguel R, Goñi-Esarte S, Juanbeltz R, Úriz-Otano JI, Reparaz J, Sarobe M, Zozaya JM, Castilla J. Effectiveness of hepatitis C antiviral treatment and feasibility of hepatitis C elimination goal. Postgrad Med 2022; 135:352-360. [PMID: 36305320 DOI: 10.1080/00325481.2022.2141499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Second-generation direct-acting antivirals (DAAs) have shown high efficacy in the treatment of chronic hepatitis C virus (HCV) infections in clinical trials. This study aimed to estimate the effectiveness in real-life conditions and their capacity to eliminate HCV infection in the general population. METHODS In this observational cohort study, patients with active HCV infection who commenced DAA treatment between 2015 and 2020 in Navarre, Spain, were studied. Sustained virological response (SVR), defined as an undetectable viral load 12 weeks after the end of treatment, was evaluated until the end of 2021. RESULTS Of a total 1366 HCV-infected patients that commenced treatment, 19.3% (n = 263) were HIV-coinfected. After the first DAA treatment, SVR was achieved in 96.6% (n = 1320/1366) of patients and in 97.7% (95% confidence interval [CI] 96.6%-98.3%) of those who completed treatment (per-protocol analysis; n = 1320/1351). SVR was achieved in 97.9% (n = 1066/1089) and 96.9% (n = 254/262) of mono-infected and HIV-coinfected patients, respectively. Thirty-one patients had virological failure due to non-response (n = 19), poor compliance (n = 9), and with adverse events (n = 3). Of 27 patients that received a second treatment, 24 attained SVR (one after a third treatment), two died, and one that did not achieve SVR declined a third treatment. Three patients were re-infected, re-treated, and achieved SVR. At the end of the study, 1344 patients (98.4%, 95% CI 97.6%-98.9%) had achieved SVR, and only 1.8% needed more than one course of treatment. All patients who completed the treatment and were followed-up achieved SVR. CONCLUSION With DAAs, SVR was achieved in all patients with active HCV infection who completed follow-up, and a second course of treatment was only necessary in a small proportion of patients. Adherence to treatment is essential for HCV infection elimination.
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Affiliation(s)
- Cristina Burgui
- Instituto de Salud Pública de Navarra, Pamplona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Ramón San Miguel
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Servicio de Farmacia Hospitalaria, Hospital Universitario de Navarra, Pamplona, Spain
| | - Silvia Goñi-Esarte
- Servicio de Digestivo, Hospital Universitario de Navarra, Pamplona, Spain
| | - Regina Juanbeltz
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Servicio de Farmacia Hospitalaria, Hospital Universitario de Navarra, Pamplona, Spain
| | - Juan Isidro Úriz-Otano
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Servicio de Digestivo, Hospital Universitario de Navarra, Pamplona, Spain
| | - Jesús Reparaz
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Servicio de Medicina Interna, Hospital Universitario de Navarra, Pamplona, Spain
| | - Maite Sarobe
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Servicio de Farmacia Hospitalaria, Hospital Universitario de Navarra, Pamplona, Spain
| | - José Manuel Zozaya
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Servicio de Digestivo, Hospital Universitario de Navarra, Pamplona, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra, Pamplona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
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Takehara T, Izumi N, Mochida S, Genda T, Fujiyama S, Notsumata K, Tamori A, Suzuki F, Suri V, Mercier RC, Matsuda T, Matsuda K, Kato N, Chayama K, Kumada H. Sofosbuvir-velpatasvir in adults with hepatitis C virus infection and compensated cirrhosis in Japan. Hepatol Res 2022; 52:833-840. [PMID: 35802063 DOI: 10.1111/hepr.13810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/28/2022] [Accepted: 07/06/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND & PURPOSE Protease-free regimens for chronic hepatitis C virus (HCV) infection are safe and effective for persons with either compensated or decompensated cirrhosis. We examined the efficacy and safety of sofosbuvir-velpatasvir in participants with HCV and compensated cirrhosis in Japan. METHODS This was a Phase 3, multi-center, open-label study. At 20 sites, 37 individuals with chronic HCV infection of any genotype and compensated cirrhosis received sofosbuvir-velpatasvir (400 mg/100 mg) daily for 12 weeks. Participants were treatment-naïve or treatment-experienced with interferon-based treatments with or without HCV NS3/4A protease inhibitors. Prior exposure with HCV NS5A or NS5B inhibitors was prohibited. The primary study endpoint was sustained virologic response 12 weeks after treatment (SVR12). RESULTS Among participants, 62% had HCV genotype 1 infection, and 38% had HCV genotype 2. More than three quarters (29/37, 78%) were HCV treatment naïve. All participants (37/37, 100%) achieved SVR12. Seventeen participants (46%) and three participants (8%) had pretreatment resistance-associated substitutions to HCV NS5A and NS5B nucleoside inhibitors respectively, yet no on-treatment breakthrough or relapse occurred. Sofosbuvir-velpatasvir for 12 weeks treatment was safe and well tolerated. The most commonly reported adverse events were headache (8%, 3/37) and diarrhea (5%, 2/37). One serious adverse event, patella fracture, occurred and was considered not treatment related. No participants discontinued study treatment due to an adverse event. Three participants (8%) had a Grade 3 laboratory abnormality; all were hyperglycemia. CONCLUSION Sofosbuvir-velpatasvir resulted in high SVR rates and was well tolerated among Japanese patients with HCV and compensated cirrhosis. This single-tablet regimen offers a highly effective, protease-inhibitor free regimen for treating HCV. CLINICALTRIALS gov Identifier: NCT04112303.
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Affiliation(s)
- Tetsuo Takehara
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Namiki Izumi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Satoshi Mochida
- Department of Gastroenterology and Hepatology, Saitama Medical University, Saitama, Japan
| | - Takuya Genda
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Shigetoshi Fujiyama
- Department of Gastroenterology and Hepatology, Kumamoto Shinto General Hospital, Kumamoto, Japan
| | - Kazuo Notsumata
- Department of Internal Medicine, Fukui-ken Saiseikai Hospital, Fukui, Japan
| | - Akihiro Tamori
- Department of Hepatology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Fumitaka Suzuki
- Department of Hepatology, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Vithika Suri
- Gilead Sciences, Inc, Foster City, California, USA
| | | | | | | | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuaki Chayama
- Collaborative Research Laboratory of Medical Innovation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Patient journey of individuals tested for HCV in Spain: LiverTAI, a retrospective analysis of EHRs through natural language processing. GASTROENTEROLOGÍA Y HEPATOLOGÍA 2022:S0210-5705(22)00253-9. [DOI: 10.1016/j.gastrohep.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/14/2022] [Accepted: 10/16/2022] [Indexed: 11/27/2022]
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Cornberg M, Stoehr A, Naumann U, Teuber G, Klinker H, Lutz T, Möller H, Hidde D, Lohmann K, Simon KG. Real-World Safety, Effectiveness, and Patient-Reported Outcomes in Patients with Chronic Hepatitis C Virus Infection Treated with Glecaprevir/Pibrentasvir: Updated Data from the German Hepatitis C-Registry (DHC-R). Viruses 2022; 14:v14071541. [PMID: 35891520 PMCID: PMC9318383 DOI: 10.3390/v14071541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/29/2022] [Accepted: 07/09/2022] [Indexed: 11/29/2022] Open
Abstract
Using data from the German Hepatitis C-Registry (Deutsche Hepatitis C-Register, DHC-R), we report the real-world safety and effectiveness of glecaprevir/pibrentasvir (GLE/PIB) treatment and its impact on patient-reported outcomes (PROs) in underserved populations who are not typically included in clinical trials, yet who will be crucial for achieving hepatitis C virus (HCV) elimination. The DHC-R is an ongoing, non-interventional, multicenter, prospective, observational cohort study on patients treated for chronic HCV infection in Germany. The data cutoff was 17 January 2021. The primary effectiveness endpoint was sustained virologic response at post-treatment Week 12 (SVR12). Safety outcomes were assessed in all patients receiving GLE/PIB. PROs were assessed using the SF-36 survey. Of 2354 patients, 1964 had valid SVR12 data (intention-to-treat analysis). Of these, 1905 (97.0%) achieved SVR12 with rates similar across the comorbidities analyzed, except for people who actively use drugs (PWUD (active)) (86.4%). Excluding those who discontinued treatment and did not achieve SVR12, or were reinfected with HCV, the rate was 99.3%, with similar results regardless of comorbidity. PWUD (active) and those with psychiatric disorders had the most meaningful improvements in PROs. Adverse events (AEs) occurred in 631/2354 patients (26.8%), and serious AEs in 44 patients (1.9%). GLE/PIB was highly effective and well tolerated in this real-world study of patient groups key to HCV elimination.
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Affiliation(s)
- Markus Cornberg
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Hannover Medizinische Hochschule, 30625 Hannover, Germany
- Correspondence: ; Tel.: +49-51-1532-6821
| | | | | | - Gerlinde Teuber
- Practice PD Dr. med. G. Teuber, 60594 Frankfurt am Main, Germany;
| | - Hartwig Klinker
- Department of Internal Medicine, University Hospital Würzburg, 97080 Würzburg, Germany;
| | | | | | - Dennis Hidde
- AbbVie Germany GmbH & Co., KG, 65189 Wiesbaden, Germany; (D.H.); (K.L.)
| | - Kristina Lohmann
- AbbVie Germany GmbH & Co., KG, 65189 Wiesbaden, Germany; (D.H.); (K.L.)
| | - Karl-Georg Simon
- MVZ Dres Eisenbach/Simon/ Schwarz/GbR, 51375 Leverkusen, Germany; k.-
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Kondili LA, Buti M, Riveiro-Barciela M, Maticic M, Negro F, Berg T, Craxì A. Impact of the COVID-19 pandemic on hepatitis B and C elimination: an EASL survey. JHEP Rep 2022; 4:100531. [PMID: 35967191 PMCID: PMC9364666 DOI: 10.1016/j.jhepr.2022.100531] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/08/2022] [Accepted: 06/11/2022] [Indexed: 02/09/2023] Open
Abstract
Background & Aims The World Health Organization (WHO) HBV and HCV elimination targets, set in 2016 and based on projections to 2030, were unable to consider the impact of intervening factors. To evaluate the impact of the COVID-19 pandemic on viral hepatitis elimination programs, the European Association for the Study of the Liver (EASL) conducted a survey in liver centers worldwide in 2021. Methods A web-based questionnaire was distributed (May-July 2021) to all EASL members representing clinical units providing HBV and HCV hepatitis care. Results are expressed as absolute numbers and reduction rates for each care activity. Results Data were collected from 32 European and 12 non-European clinical centers. Between January 2019 (pre-pandemic) and December 2020 (during the pandemic), chronic HBV consultations decreased by 32% and 26%, new referrals by 38% and 39%, HBV testing rates by 39% and 21% (for HBsAg detection) and 30% and 22% (for HBV DNA detection), and new HBV treatments by 20% and 44% (p = 0.328) in European and non-European centers, respectively. With regard to HCV during the same time frame, the overall reductions were 39% and 50% for consultations, 49% and 49% for new referrals, 11% and 38% for HCV RNA detection, and 51% and 54% for new HCV antiviral treatments for European and non-European Centers, respectively (p = 0.071). Conclusions All steps in the viral hepatitis care cascade have been hampered by the COVID-19 pandemic, with a comparable impact across different centers. These data reaffirm the pandemic’s major effect on global viral hepatitis elimination programs and suggest that actions to achieve the WHO 2030 targets should be reconsidered and revised to account for each country's progress relative to pre-pandemic values. Lay summary The EASL multinational survey conclusively shows that viral hepatitis elimination programs, expected to provide control of hepatitis B and hepatitis C worldwide by 2030, have been held back by the COVID-19 pandemic in clinical centers from several European and non-European countries, with a comparable impact across centers. Limitations in the cascade of care for both HBV and HCV were linked to limited access to screening, consultations, specific testing, and actual treatment. As restrictions for COVID-19 begin to lift, efforts to diagnose and provide treatment for viral hepatitis should remain high on the list of priorities for public health officials to maintain the WHO elimination efforts. Measures that have been put in place to control the COVID-19 pandemic could be transferred to increasing the diagnosis and linkage to care of people with hepatitis. Viral hepatitis elimination programs have been hampered by the COVID-19 pandemic. A survey performed in several clinical centers shows the impact of COVID-19 on all steps of the viral hepatitis care cascade. Measures used to control COVID-19 could be used to increase the diagnosis and linkage to care of people living with hepatitis B and C.
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Tergast TL, Blach S, Tacke F, Berg T, Cornberg M, Kautz A, Manns M, Razavi H, Sarrazin C, Serfert Y, van Thiel I, Zeuzem S, Wedemeyer H. Updated epidemiology of hepatitis C virus infections and implications for hepatitis C virus elimination in Germany. J Viral Hepat 2022; 29:536-542. [PMID: 35357770 DOI: 10.1111/jvh.13680] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/24/2022] [Accepted: 03/08/2022] [Indexed: 12/09/2022]
Abstract
In 2014, an analysis was conducted to evaluate the hepatitis C virus (HCV) epidemiology and disease burden in Germany. Since then, there have been considerable developments in HCV management such as the implementation of direct acting antivirals. The aim of this analysis was to assess the recent data available for Germany, establish an updated 2020 HCV prevalence and cascade of care and evaluate the impact of what-if scenarios on the future burden of disease using modelling analysis. A dynamic Markov model was used to forecast the HCV disease burden in Germany. Model inputs were retrieved through literature review, unpublished sources and expert input. Next, three "what-if" scenarios were developed to evaluate the status quo, COVID-19 pandemic, and steps needed to achieve the WHO targets for elimination. At the beginning of 2020, there were 189,000 (95% UI: 76,700-295,000) viremic infections in Germany, a decline of more than 85,000 viremic infections since 2012. Annual treatment starts went down since 2015. Compared with 2019, the COVID-19 pandemic resulted in a further 11% decline in 2020. If this continues for two years, it could result in 110 excess HCC cases and 200 excess liver related deaths by 2030. To achieve the WHO targets, 81,200 people need to be diagnosed, with 118,600 initiated on treatment by 2030. This could also avert 1,020 deaths and 720 HCC cases between 2021 and 2030. Germany has made strides towards HCV elimination, but more efforts are needed to achieve the WHO targets by 2030.
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Affiliation(s)
- Tammo L Tergast
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | | | - Frank Tacke
- Department of Hepatology & Gastroenterology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,Leberstiftungs-GmbH Deutschland, Hannover, Germany
| | | | - Michael Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,Leberstiftungs-GmbH Deutschland, Hannover, Germany
| | | | - Christoph Sarrazin
- Department of Internal Medicine and Liver Center, St. Josefs-Hospital Wiesbaden, Wiesbaden, Germany.,Viral Hepatitis Research Group, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| | | | | | - Stefan Zeuzem
- Department of Medicine, University Hospital, Frankfurt, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,Leberstiftungs-GmbH Deutschland, Hannover, Germany
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Mackesy-Amiti ME, Falk J, Latkin C, Kaufmann M, Williams L, Boodram B. Egocentric network characteristics of people who inject drugs in the Chicago metro area and associations with hepatitis C virus and injection risk behavior. Harm Reduct J 2022; 19:58. [PMID: 35655222 PMCID: PMC9161656 DOI: 10.1186/s12954-022-00642-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hepatitis C (HCV) infection has been rising in the suburban and rural USA, mainly via injection-based transmission. Injection and sexual networks are recognized as an important element in fostering and preventing risky behavior; however, the role of social support networks has received somewhat less attention. METHODS Using baseline data from an ongoing longitudinal study, we examined the composition and structure of injection drug use (IDU), sex, and social support networks of young people who inject drugs (aged 18-30) and their injection network members. Lasso logistic regression was used to select a subset of network characteristics that were potentially important predictors of injection risk behaviors and HCV exposure. RESULTS Several measures of IDU, sexual, and support network structure and composition were found to be associated with HCV exposure, receptive syringe sharing (RSS), and ancillary equipment sharing. Gender and sexual relationships were important factors for all risk behaviors. Support network characteristics were also important, notably including a protective effect of majority Hispanic support networks for RSS and HCV exposure. Both IDU network residence heterogeneity and support network geography were associated with injection equipment sharing. CONCLUSIONS The associations of IDU and support network geography with equipment sharing highlight the need to extend harm reduction efforts beyond urban areas. Greater understanding of support network influences on risk behavior may provide important insights to strengthen the benefits of harm reduction. In considering the probability of HCV transmission, it is important to consider setting and network structures that promote propagation of risk.
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Affiliation(s)
- Mary Ellen Mackesy-Amiti
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St, Chicago, IL, 60612, USA.
| | - Joshua Falk
- Advanced Cyberinfrastructure for Education and Research (ACER), Office of the Vice Chancellor of Innovation, University of Illinois at Chicago, 728 W. Roosevelt Rd., 215A RRB, Chicago, IL, 60607, USA
| | - Carl Latkin
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Maggie Kaufmann
- Community Outreach Intervention Projects, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St, Chicago, IL, 60612, USA
| | - Leslie Williams
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St, Chicago, IL, 60612, USA
| | - Basmattee Boodram
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St, Chicago, IL, 60612, USA
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Brennan PN, Byrne CJ, Dillon JF. Decentralisation of hepatitis C virus care into community settings: A key approach on the path to elimination. Liver Int 2022; 42:1222-1224. [PMID: 35678037 DOI: 10.1111/liv.15229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/15/2021] [Indexed: 02/13/2023]
Affiliation(s)
- Paul N Brennan
- University of Edinburgh, Edinburgh, UK.,Division of Molecular and Clinical Medicine, Ninewells Hospital, University of Dundee School of Medicine, Dundee, UK.,Department of Gastroenterology, NHS Tayside, Ninewells Hospital & Medical School, Dundee, UK
| | - Christopher J Byrne
- Division of Molecular and Clinical Medicine, Ninewells Hospital, University of Dundee School of Medicine, Dundee, UK.,Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - John F Dillon
- Division of Molecular and Clinical Medicine, Ninewells Hospital, University of Dundee School of Medicine, Dundee, UK.,Department of Gastroenterology, NHS Tayside, Ninewells Hospital & Medical School, Dundee, UK
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Lazarus JV, Picchio CA, Byrne CJ, Crespo J, Colombo M, Cooke GS, Dore GJ, Grebely J, Ward JW, Dillon JF. A Global Systematic Review of Hepatitis C Elimination Efforts through Micro-Elimination. Semin Liver Dis 2022; 42:159-172. [PMID: 35189667 DOI: 10.1055/a-1777-6112] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Microelimination targets specific subpopulations and/or geographic settings for hepatitis C virus (HCV) elimination. This review reports on global HCV microelimination literature published from 2013 to 2020. Data were extracted from publications to report a score based on the four key components defining microelimination. Sustained virologic response (SVR) and treatment initiation proportions were calculated for each manuscript and grouped means of these estimates were compared depending on microelimination score and care setting. A total of 83% of the studies were from high-income settings and mainly included people who use drugs or those incarcerated. Among manuscripts, 18 had "low" microelimination scores, 11 had "high" scores, and the differences in mean proportion who initiated treatment and achieved SVR between low and high score groups were statistically significant. Microelimination can be a useful complementary strategy for driving engagement in HCV treatment and cure. Our analysis suggests that adhering to more of the core microelimination components can improve outcomes. This study is registered with Prospero, registration identification: CRD42020175211.
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Affiliation(s)
- Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic de Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Camila A Picchio
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic de Barcelona, Spain
| | - Christopher J Byrne
- Division of Molecular and Clinical Medicine, University of Dundee School of Medicine, Ninewells Hospital, Dundee, United Kingdom
| | - Javier Crespo
- Department of Gastroenterology and Hepatology, University Hospital Marques de Valdecilla. Research Institute Valdecilla-IDIVAL, Santander, Spain
| | - Massimo Colombo
- General Medicine & Liver Center, San Raffaele Hospital, Milan, Italy
| | - Graham S Cooke
- Division of Infectious Diseases, Faculty of Medicine, Imperial College London, United Kingdom
| | | | | | - John W Ward
- Coalition for Global Hepatitis Elimination, The Task Force for Global Health, Atlanta, United States
| | - John F Dillon
- Division of Molecular and Clinical Medicine, University of Dundee School of Medicine, Ninewells Hospital, Dundee, United Kingdom
- Department of Gastroenterology, Ninewells Hospital & Medical School, Dundee, United Kingdom
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Johannesson JM, Fridriksdottir RH, Löve TJ, Runarsdottir V, Hansdóttir I, Löve A, Thordardottir M, Hernandez UB, Olafsson S, Gottfredsson M. HIGH RATE OF HCV REINFECTION AMONG RECENTLY INJECTING DRUG USERS: RESULTS FROM THE TRAP HEP C PROGRAM - A PROSPECTIVE NATIONWIDE, POPULATION-BASED STUDY. Clin Infect Dis 2022; 75:1732-1739. [PMID: 35438144 DOI: 10.1093/cid/ciac272] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Treatment as Prevention for Hepatitis C program started in 2016 in Iceland, offering treatment with direct-acting antivirals to hepatitis C virus (HCV)-infected individuals. Reinfections through injection drug use (IDU) can hamper elimination efforts. We determined reinfection rates (RIR) of HCV among patients in the program. METHODS Clinical data were gathered prospectively. The study cohort consisted of HCV-cured patients with an estimated sustained virologic response between February 1st 2016 and November 20th 2018, with follow-up until November 20th 2019. The observation period and time until reinfection was estimated using a single random point imputation method coupled with Monte Carlo simulation. The RIR was expressed as reinfections/100 person-years (PYs). RESULTS 640 treatments of 614 patients (417 males, mean age 44.3 years) resulted in cure, with 52 reinfections subsequently confirmed in 50 patients (37 males). Follow-up was 672.1 PYs with median time to reinfection of 231.7 days. History of IDU was reported by 523 patients (84.8%) and recent IDU with 220 (34.4%) treatments. Stimulants were the preferred injected drug in 85.5% of patients with history of IDU. The RIR was 7.7/100 PYs. Using multivariate Cox proportional hazards models for interval-censored data, age (HR 0.96, 95% CI 0.94-0.99) and recent IDU (HR 2.91, 95% CI 1.48-5.76) were significantly associated with reinfection risk. CONCLUSIONS The RIR is high in a setting of widespread stimulant use, particularly in young people with recent IDU. Regular follow up is important among high-risk populations to diagnose reinfections early and reduce transmission.
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Affiliation(s)
- Jon M Johannesson
- Department of Internal Medicine, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Ragnheidur H Fridriksdottir
- Department of Gastroenterology and Hepatology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Thorvardur J Löve
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Department of Science, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | | | | | - Arthur Löve
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Department of Clinical Microbiology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Marianna Thordardottir
- Center for Health Security and Communicable Disease Control, Directorate of Health, Reykjavik, Iceland
| | - Ubaldo B Hernandez
- Department of Science, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Sigurdur Olafsson
- Department of Gastroenterology and Hepatology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Magnus Gottfredsson
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Department of Science, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.,Department of Infectious Diseases, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
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Vento S, Cainelli F. Chronic liver diseases must be reduced worldwide: it is time to act. THE LANCET GLOBAL HEALTH 2022; 10:e471-e472. [PMID: 35303449 DOI: 10.1016/s2214-109x(22)00047-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 01/28/2022] [Indexed: 12/15/2022] Open
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Solomon SS, Wagner-Cardoso S, Smeaton L, Sowah LA, Wimbish C, Robbins G, Brates I, Scello C, Son A, Avihingsanon A, Linas B, Anthony D, Nunes EP, Kliemann DA, Supparatpinyo K, Kityo C, Tebas P, Bennet JA, Santana-Bagur J, Benson CA, Van Schalkwyk M, Cheinquer N, Naggie S, Wyles D, Sulkowski M. A minimal monitoring approach for the treatment of hepatitis C virus infection (ACTG A5360 [MINMON]): a phase 4, open-label, single-arm trial. Lancet Gastroenterol Hepatol 2022; 7:307-317. [PMID: 35026142 PMCID: PMC8920770 DOI: 10.1016/s2468-1253(21)00397-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Despite widespread availability of direct-acting antivirals including generic formulations, limited progress has been made in the global adoption of hepatitis C virus (HCV) treatment. Barriers to treatment scale-up include availability and access to diagnostic and monitoring tests, health-care infrastructure, and requirement for frequent visits during treatment. METHODS ACTG A5360 was a phase 4, open-label, single-arm trial across 38 sites in Brazil, South Africa, Thailand, Uganda, and the USA. Key inclusion criteria were age of 18 years or older, evidence of active HCV infection (HCV RNA >1000 IU/mL) and HCV treatment-naive; patients with compensated cirrhosis and HIV/HCV co-infection were included but their enrolment was capped. All participants received a fixed dose combination of oral sofosbuvir (400 mg) and velpatasvir (100 mg) once daily for 12 weeks. The minimal monitoring (MINMON) approach consisted of four components: (1) there was no pre-treatment genotyping; (2) the entire treatment course (84 tablets) was dispensed at entry; (3) there were no scheduled visits or laboratory monitoring; and (4) there were two points of remote contact, at week 4 for adherence and week 22, to schedule outcome assessment at week 24 (-2 weeks to +4 weeks). Participants who missed the week 24 window could return for a visit to assess treatment response any time before week 72. Unplanned visits for any reason were permissible before the week 24 visit. The primary efficacy outcome was sustained virological response (SVR), defined as HCV RNA less than the lower limit of quantification measured at least 22 weeks post-treatment initiation; the primary safety outcome was serious adverse events. The primary efficacy analysis included all participants who initiated treatment, using a missing=failure approach. The primary safety analysis included all participants who initiated treatment and had at least one post-treatment assessment. This trial is registered at ClinicalTrials.gov, NCT03512210. FINDINGS Between Oct 22, 2018, and July 19, 2019, 400 participants were enrolled across all 38 sites; 399 initiated treatment. At the SVR assessment visit, 355 (89%) of 397 participants reported taking 100% of the trial medication during the 12-week treatment period; two patients did not have any follow-up visits after the entry visit and were excluded from the safety analyses. Overall, 379 of the 399 who initiated treatment had an SVR (95·0%, 95% CI 92·4-96·7). 14 (4%) of 397 participants reported serious adverse events between treatment initiation and week 28; none were treatment related or led to treatment discontinuation or death. 15 (4%) of 399 participants had unplanned visits; none were related to treatment. INTERPRETATION In this diverse global population of people with HCV, the MINMON approach with sofosbuvir-velpatasvir treatment was safe and achieved SVR comparable to standard monitoring observed in real-world data. Coupled with innovative case finding strategies, this strategy could be crucial to the global HCV elimination agenda. FUNDING US National Institutes of Health and Gilead Sciences.
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Affiliation(s)
- Sunil S Solomon
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | | | - Laura Smeaton
- Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | | | | | - Irena Brates
- Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Christine Scello
- Frontier Science & Technology Research Foundation, Inc, Amherst, NY, USA
| | - Annie Son
- Gilead Sciences, Foster City, CA, USA
| | - Anchalee Avihingsanon
- HIV-NAT, Thai Red Cross AIDS Research Centre and TB RU, Chulalongkorn University, Bangkok, Thailand
| | | | | | | | | | | | - Cissy Kityo
- Joint Clinical Research Centre, Kampala, Uganda
| | - Pablo Tebas
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jaclyn Ann Bennet
- Clinical HIV Research Unit, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | | | - Constance A Benson
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Marije Van Schalkwyk
- Family Centre for Research with Ubuntu, Stellenbosch University, Cape Town, South Africa
| | | | | | - David Wyles
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Mark Sulkowski
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Four Weeks Treatment with Glecaprevir/Pibrentasvir + Ribavirin-A Randomized Controlled Clinical Trial. Viruses 2022; 14:v14030614. [PMID: 35337021 PMCID: PMC8948928 DOI: 10.3390/v14030614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/14/2022] [Indexed: 01/25/2023] Open
Abstract
Enhancing treatment uptake for hepatitis C to achieve the elimination goals set by the World Health Organization could be achieved by reducing the treatment duration. The aim of this study was to compare the sustained virological response at week 12 (SVR12) after four weeks of glecaprevir/pibrentasvir (GLE/PIB) + ribavirin compared to eight weeks of GLE/PIB and to estimate predictors for SVR12 with four weeks of treatment through a multicenter open label randomized controlled trial. Patients were randomized 2:1 (4 weeks:8 weeks) and stratified by genotype 3 and were treatment naïve of all genotypes and without significant liver fibrosis. A total of 27 patients were analyzed for predictors for SVR12, including 15 from the first pilot phase of the study. In the ‘modified intention to treat’ group, 100% (7/7) achieved cure after eight weeks and for patients treated for four weeks the SVR12 was 58.3% (7/12). However, patients with a baseline viral load <2 mill IU/mL had 93% SVR12. The study closed prematurely due to the low number of included patients due to the COVID-19 pandemic. Our results suggest that viral load should be taken into account when considering trials of short course treatment.
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Harney BL, Whitton B, Paige E, Brereton R, Weiss R, Membrey D, Wade AJ, Iser D, Kemp W, Roberts SK, Spelman T, Sacks-Davis R, Hellard ME, Doyle JS. A multi-site, nurse-coordinated hepatitis C model of care in primary care and community services in Melbourne, Australia. Liver Int 2022; 42:522-531. [PMID: 34821021 DOI: 10.1111/liv.15107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/10/2021] [Accepted: 11/18/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) treatment through primary care and community-based services will be a critical component of HCV elimination. We evaluated a nurse-coordinated programme providing care across eight sites and analysed progression through the HCV care cascade. METHODS People-accessing services from six primary care clinics, a homeless crisis accommodation provider and a mental health service were directly referred to nurses or engaged by nurses during regular clinic visits. Nurses supported HCV testing, treatment and follow-up. The prescription was provided by affiliated clinicians. Logistic regression was used to examine factors associated with treatment commencement and sustained virological response (SVR) testing. RESULTS Of 640 people referred to and/or engaged by the nurses from January 2017 to July 2019, 518 had an HCV RNA test of whom 381 (74%) were HCV RNA positive. Treatment was commenced by 281 (74%) people of whom 161 had an SVR test, 157 (97.5%) were cured. Opioid agonist therapy was associated with treatment commencement (aOR 2.68, 95% CI 1.48-4.88). People who were homeless/unstably housed were less likely to commence treatment (aOR 0.45, 95% CI 0.23-0.87). Treatment prescription from a specialist (aOR 2.39, 95% CI 1.20-4.74) and recent injection drug use (<6 months) (aOR 2.15, 95% CI 1.07-4.31) was associated with SVR testing. CONCLUSION A nurse-coordinated model of care led to high levels of HCV treatment uptake and cure amongst people attending primary care and community services. More tailored models of care may be beneficial for people who are homeless or have unstable housing. These results support primary care and community-based hepatitis C treatment.
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Affiliation(s)
- Brendan L Harney
- Department of Infectious Diseases, Alfred Health & Monash University, Melbourne, Australia.,Disease Elimination Program, Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Bradley Whitton
- Department of Infectious Diseases, Alfred Health & Monash University, Melbourne, Australia
| | - Emma Paige
- Department of Infectious Diseases, Alfred Health & Monash University, Melbourne, Australia
| | - Rebecca Brereton
- St Kilda Road Clinic & South City Clinic, Alfred Community Mental & Addiction Health, Melbourne, Australia
| | | | | | - Amanda J Wade
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,Department of Infectious Diseases, Barwon Health, Geelong, Australia
| | - David Iser
- Department of Infectious Diseases, Alfred Health & Monash University, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - William Kemp
- Department of Gastroenterology, Alfred Health, Melbourne, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, Alfred Health, Melbourne, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Tim Spelman
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Margaret E Hellard
- Department of Infectious Diseases, Alfred Health & Monash University, Melbourne, Australia.,Disease Elimination Program, Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Doherty Institute and School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Joseph S Doyle
- Department of Infectious Diseases, Alfred Health & Monash University, Melbourne, Australia.,Disease Elimination Program, Burnet Institute, Melbourne, Australia
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Dröse S, Øvrehus ALH, Holm DK, Madsen LW, Mössner BK, Søholm J, Hansen JF, Røge BT, Christensen PB. A multi-level intervention to eliminate hepatitis C from the Region of Southern Denmark: the C-Free-South project. BMC Infect Dis 2022; 22:202. [PMID: 35232372 PMCID: PMC8889755 DOI: 10.1186/s12879-022-07196-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 02/22/2022] [Indexed: 11/16/2022] Open
Abstract
Denmark has signed the WHO strategy to eliminate hepatitis C virus (HCV). In the absence of a national strategy for elimination, a local action plan was developed in the Region of Southern Denmark (RSD). The aim of the strategy is to diagnose 90% of HCV-infected persons and treat 80% of those diagnosed by 2025. The strategy was developed by reviewing Danish data on HCV epidemiology and drug use to identify key populations for screening, linkage to care, and treatment. Based on available published data from 2016, an estimated 3028 persons in the RSD were HCV-RNA positive (population prevalence 0.21%). Of these, 1002 were attending clinical care, 1299 were diagnosed but not in clinical care, and 727 were undiagnosed. Three different interventions targeting the HCV-infected population and two interventions for HCV surveillance are planned to achieve elimination. The “C-Free-South” strategy aims to eliminate HCV in our region by identifying (90%) and treating (80%) of infected persons by the end of 2025, 5 years earlier than the WHO elimination target date.
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Affiliation(s)
- Sandra Dröse
- Department of Infectious Diseases, Odense University Hospital, J. B. Winsloews Vej 4, Indgang 18 Penthouse 2. sal, 5000, Odense C, Denmark. .,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3. sal, 5000, Odense, Denmark.
| | - Anne Lindebo Holm Øvrehus
- Department of Infectious Diseases, Odense University Hospital, J. B. Winsloews Vej 4, Indgang 18 Penthouse 2. sal, 5000, Odense C, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3. sal, 5000, Odense, Denmark
| | - Dorte Kinggaard Holm
- Department of Clinical Immunology, Odense University Hospital, 29 J. B. Winsloews Vej 4, Indgang 8, Odense C, 5000, Odense, Denmark
| | - Lone Wulff Madsen
- Department of Infectious Diseases, Odense University Hospital, J. B. Winsloews Vej 4, Indgang 18 Penthouse 2. sal, 5000, Odense C, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3. sal, 5000, Odense, Denmark
| | - Belinda Klemmensen Mössner
- Department of Infectious Diseases, Odense University Hospital, J. B. Winsloews Vej 4, Indgang 18 Penthouse 2. sal, 5000, Odense C, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3. sal, 5000, Odense, Denmark
| | - Jacob Søholm
- Department of Infectious Diseases, Odense University Hospital, J. B. Winsloews Vej 4, Indgang 18 Penthouse 2. sal, 5000, Odense C, Denmark
| | - Janne Fuglsang Hansen
- Department of Infectious Diseases, Odense University Hospital, J. B. Winsloews Vej 4, Indgang 18 Penthouse 2. sal, 5000, Odense C, Denmark
| | - Birgit Thorup Røge
- Department of Medicine, Lillebaelt Hospital, Sygehusvej 24, 6000, Kolding, Denmark
| | - Peer Brehm Christensen
- Department of Infectious Diseases, Odense University Hospital, J. B. Winsloews Vej 4, Indgang 18 Penthouse 2. sal, 5000, Odense C, Denmark. .,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3. sal, 5000, Odense, Denmark.
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