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Bal T, Dirican E. A potential new way to facilitate HCV elimination: The prediction of viremia in anti-HCV seropositive patients using machine learning algorithms. Arab J Gastroenterol 2024; 25:223-229. [PMID: 38705815 DOI: 10.1016/j.ajg.2024.03.003] [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] [Received: 12/25/2022] [Revised: 01/19/2024] [Accepted: 03/20/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND AND STUDY AIMS The present study was undertaken to design a new machine learning (ML) model that can predict the presence of viremia in hepatitis C virus (HCV) antibody (anti-HCV) seropositive cases. PATIENTS AND METHODS This retrospective study was conducted between January 2012-January 2022 with 812 patients who were referred for anti-HCV positivity and were examined for HCV ribonucleic acid (HCV RNA). Models were constructed with 11 features with a predictor (presence and absence of viremia) to predict HCV viremia. To build an optimal model, this current study also examined and compared the three classifier data mining approaches: RF, SVM and XGBoost. RESULTS The highest performance was achieved with XGBoost (90%), which was followed by RF (89%), SVM Linear (85%) and SVM Radial (83%) algorithms, respectively. The four most important key features contributing to the models were: alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (ALB) and anti-HCV levels, respectively, while "ALB" was replaced by the "AGE" only in the XGBoost model. CONCLUSION This study has shown that XGBoost and RF based ML models, incorporating anti-HCV levels and routine laboratory tests (ALT, AST, ALB), and age are capable of providing HCV viremia diagnosis with 90% and 89% accuracy, respectively. These findings highlight the potential of ML models in the early diagnosis of HCV viremia, which may be helpful in optimizing HCV elimination programs.
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Affiliation(s)
- Tayibe Bal
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey.
| | - Emre Dirican
- Department of Biostatistics, Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
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Martino SD, Petri GL, De Rosa M. Hepatitis C: The Story of a Long Journey through First, Second, and Third Generation NS3/4A Peptidomimetic Inhibitors. What Did We Learn? J Med Chem 2024; 67:885-921. [PMID: 38179950 DOI: 10.1021/acs.jmedchem.3c01971] [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: 01/06/2024]
Abstract
Hepatitis C viral (HCV) infection is the leading cause of liver failure and still represents a global health burden. Over the past decade, great advancements made HCV curable, and sustained viral remission significantly improved to more than 98%. Historical treatment with pegylated interferon alpha and ribavirin has been displaced by combinations of direct-acting antivirals. These regimens include drugs targeting different stages of the HCV life cycle. However, the emergence of viral resistance remains a big concern. The design of peptidomimetic inhibitors (PIs) able to fit and fill the conserved substrate envelope region within the active site helped avoid contact with the vulnerable sites of the most common resistance-associated substitutions Arg155, Ala156, and Asp168. Herein, we give an overview of HCV NS3 PIs discovered during the past decade, and we deeply discuss the rationale behind the structural optimization efforts essential to achieve pangenotypic activity.
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Affiliation(s)
- Simona Di Martino
- Drug Discovery Unit, Medicinal Chemistry Group, Ri.MED Foundation, Palermo 90133, Italy
| | - Giovanna Li Petri
- Drug Discovery Unit, Medicinal Chemistry Group, Ri.MED Foundation, Palermo 90133, Italy
| | - Maria De Rosa
- Drug Discovery Unit, Medicinal Chemistry Group, Ri.MED Foundation, Palermo 90133, Italy
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Kondili LA, Andreoni M, Aghemo A, Mastroianni CM, Merolla R, Gallinaro V, D'Offizi G, Craxì A. Forecasting the long-term impact of COVID-19 on hepatitis C elimination plans in Italy: A mathematical modelling approach. Liver Int 2023; 43:2615-2624. [PMID: 37735959 DOI: 10.1111/liv.15712] [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: 04/04/2023] [Revised: 07/21/2023] [Accepted: 08/13/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Italy has a high HCV prevalence, and despite the approval of a dedicated fund for 'Experimental screening' for 2 years, screening has not been fully implemented. We aimed to evaluate the long-term impact of the persisting delay in HCV elimination after the Coronavirus disease 2019 (COVID-19) pandemic in Italy. METHODS We used a mathematical, probabilistic modelling approach evaluating three hypothetical 'Inefficient', 'Efficient experimental' and 'WHO Target' screening scenarios differing by treatment rates over time. A Markov chain for liver disease progression evaluated the number of active infections, decompensated cirrhosis (DC), hepatocellular carcinoma (HCC) and HCV liver-related deaths up to the years 2030 and 2050. RESULTS The 'WHO Target' scenario estimated 3900 patients with DC and 600 with HCC versus 4400 and 600 cases, respectively, similar for both 'Inefficient' and 'Efficient experimental' screening up to 2030. A sharp (10-fold) decrease in DC and HCC was estimated by the 'WHO Target' scenario compared with the other two scenarios in 2050; the forecasted number of DC was 420 cases versus 4200 and 3800 and of HCC <10 versus 600 and 400 HCC cases by 'WHO Target,' 'Inefficient' and 'Efficient experimental' scenarios, respectively. A significant decrease of the cumulative estimated number of liver-related deaths was observed up to 2050 by the 'WHO Target' scenario (52000) versus 'Inefficient' or 'Efficient experimental' scenarios (79 000 and 74 000 liver-related deaths, respectively). CONCLUSIONS Our estimates highlight the need to extensively and efficiently address HCV screening and cure of HCV infection in order to avoid the forecasted long-term HCV adverse outcomes in Italy.
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Affiliation(s)
- Loreta A Kondili
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
- Dentistry and Dental Prosthetics, UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | - Massimo Andreoni
- Infectious Diseases Unit, University of Tor Vergata, Rome, Italy
| | - Alessio Aghemo
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | | | | | | | - Gianpiero D'Offizi
- Dentistry and Dental Prosthetics, UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
- UOC Malattie Infettive-Epatologia Dipartimento POIT INMI Lazzaro Spallanzani, Rome, Italy
| | - Antonio Craxì
- PROMISE, School of Medicine, University of Palermo, Palermo, Italy
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Nevola R, Rosato V, Conturso V, Perillo P, Le Pera T, Del Vecchio F, Mastrocinque D, Pappalardo A, Imbriani S, Delle Femine A, Piacevole A, Claar E. Can Telemedicine Optimize the HCV Care Cascade in People Who Use Drugs? Features of an Innovative Decentralization Model and Comparison with Other Micro-Elimination Strategies. BIOLOGY 2022; 11:biology11060805. [PMID: 35741326 PMCID: PMC9219847 DOI: 10.3390/biology11060805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/21/2022] [Accepted: 05/21/2022] [Indexed: 11/25/2022]
Abstract
Simple Summary The global fight against the hepatitis C virus (HCV) involves the processes of micro-elimination of populations at risk. People who use drugs (PWUDs) represent a viral reservoir, due to the historical challenge in treating this population. In particular, the difficulties in the linkage to care of these patients, as well as low adherence to therapies and follow-up and the risk of re-infection make PWUDs a “difficult-to-treat” population. In view of this, the testing of effective management and treatment models for chronic HCV infection in PWUDs is crucial for promoting its elimination. Telemedicine could be a successful solution in the integration and decentralization of care services. Abstract People who use drugs (PWUDs) are a crucial population in the global fight against viral hepatitis. The difficulties in linkage to care, the low adherence to therapy, the frequent loss to follow-up and the high risk of re-infection make the eradication process of the hepatitis C virus (HCV) really hard in this viral reservoir. Several management and treatment models have been tested with the aim of optimizing the HCV care cascade in PWUDs. Models of decentralization of the care process and integration of services seem to provide the highest success rates. Giving this, telemedicine could favor the decentralization of diagnostic-therapeutic management, key for the implementation of linkage to care, reduction of waiting times, optimization of adherence and results and reduction of the costs. The purpose of this literature review is to examine the role and possible impact of telemedicine in optimizing the HCV care cascade, comparing the different care models that have shown to improve the linkage to care and therapeutic adherence in this special population.
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Affiliation(s)
- Riccardo Nevola
- Hepatology Unit, Ospedale Evangelico Betania, 80147 Naples, Italy; (V.R.); (P.P.); (D.M.); (A.P.); (E.C.)
- Internal Medicine Unit, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (S.I.); (A.D.F.); (A.P.)
- Correspondence: ; Tel.: +39-081-566-4173
| | - Valerio Rosato
- Hepatology Unit, Ospedale Evangelico Betania, 80147 Naples, Italy; (V.R.); (P.P.); (D.M.); (A.P.); (E.C.)
| | - Vincenza Conturso
- Service for Addiction, DS32, ASL Napoli 1, 80147 Naples, Italy; (V.C.); (T.L.P.); (F.D.V.)
| | - Pasquale Perillo
- Hepatology Unit, Ospedale Evangelico Betania, 80147 Naples, Italy; (V.R.); (P.P.); (D.M.); (A.P.); (E.C.)
| | - Teresa Le Pera
- Service for Addiction, DS32, ASL Napoli 1, 80147 Naples, Italy; (V.C.); (T.L.P.); (F.D.V.)
| | - Ferdinando Del Vecchio
- Service for Addiction, DS32, ASL Napoli 1, 80147 Naples, Italy; (V.C.); (T.L.P.); (F.D.V.)
| | - Davide Mastrocinque
- Hepatology Unit, Ospedale Evangelico Betania, 80147 Naples, Italy; (V.R.); (P.P.); (D.M.); (A.P.); (E.C.)
| | - Annalisa Pappalardo
- Hepatology Unit, Ospedale Evangelico Betania, 80147 Naples, Italy; (V.R.); (P.P.); (D.M.); (A.P.); (E.C.)
| | - Simona Imbriani
- Internal Medicine Unit, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (S.I.); (A.D.F.); (A.P.)
| | - Augusto Delle Femine
- Internal Medicine Unit, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (S.I.); (A.D.F.); (A.P.)
| | - Alessia Piacevole
- Internal Medicine Unit, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (S.I.); (A.D.F.); (A.P.)
| | - Ernesto Claar
- Hepatology Unit, Ospedale Evangelico Betania, 80147 Naples, Italy; (V.R.); (P.P.); (D.M.); (A.P.); (E.C.)
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Rosato V, Kondili LA, Nevola R, Perillo P, Mastrocinque D, Aghemo A, Claar E. Elimination of Hepatitis C in Southern Italy: A Model of HCV Screening and Linkage to Care among Hospitalized Patients at Different Hospital Divisions. Viruses 2022; 14:v14051096. [PMID: 35632837 PMCID: PMC9143022 DOI: 10.3390/v14051096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/08/2022] [Accepted: 05/15/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Free-of-charge HCV screening in some key populations and in 1969–1989 birth cohorts has been funded in Italy as the first step to diagnosing individuals who are infected but asymptomatic. The aim of this study is to evaluate the feasibility of an opportunistic HCV screening and its linkage to care. Methods: A hospital-based HCV screening was conducted as a routine test for in-patients admitted to the Evangelical Hospital Betania of Naples from January 2020 to May 2021. All consecutive in-patients were screened for the HCV antibody (HCV-Ab) at the time of their admission to the hospital, and those born prior to year 2000 were included in the study. HCV-RNA testing was required for those not previously treated and without antiviral treatment contraindications. For in-patients with an active infection, treatment started soon after hospital admission. Results: Among 12,665 inpatients consecutively screened, 510 (4%) were HCV-Ab positive. The HCV-Ab positivity rate increased with age, reaching the highest prevalence (9.49%) in those born before 1947. Among patients positive for HCV, 118 (23.1%) had been previously treated, 172 (33.9%) had been discharged before being tested for HCV-RNA, and 26 (5.1%) had not been tested for short life expectancy. Of 194 (38% of HCV-Ab+) patients who were tested for HCV-RNA, 91 (46.2%) were HCV-RNA positive. Of patients with active infection, 33 (36%) were admitted to the liver unit with signs of liver damage either not previously diagnosed or diagnosed but unlinked to care for HCV infection. Of the patients positive for HCV-RNA, 87 (95.6%) started treatment; all achieved sustained virological response. Conclusion: HCV active infection has been frequently found in patients with comorbidities admitted in the hospital in Southern Italy. To achieve HCV elimination in Italy, broader screening strategies are required. In addition to screening of the 1969–1989 birth cohort of individuals unaware of their infection status, diagnosis and linkage to care of patients with known liver damage is strictly required. Hospital screening is feasible, but prompt reflex testing for identifying HCV-active infections is necessary to increase diagnosis and subsequent linkage to care.
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Affiliation(s)
- Valerio Rosato
- Liver Unit, Ospedale Evangelico Betania, 80147 Naples, Italy; (V.R.); (R.N.); (P.P.); (D.M.)
| | - Loreta A. Kondili
- Center for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy;
| | - Riccardo Nevola
- Liver Unit, Ospedale Evangelico Betania, 80147 Naples, Italy; (V.R.); (R.N.); (P.P.); (D.M.)
| | - Pasquale Perillo
- Liver Unit, Ospedale Evangelico Betania, 80147 Naples, Italy; (V.R.); (R.N.); (P.P.); (D.M.)
| | - Davide Mastrocinque
- Liver Unit, Ospedale Evangelico Betania, 80147 Naples, Italy; (V.R.); (R.N.); (P.P.); (D.M.)
| | - Alessio Aghemo
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Italy;
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, 20089 Rozzano, Italy
| | - Ernesto Claar
- Liver Unit, Ospedale Evangelico Betania, 80147 Naples, Italy; (V.R.); (R.N.); (P.P.); (D.M.)
- Correspondence:
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Kondili LA, Craxì L, Andreoni M, Mennini FS, Razavi H. Opportunistic co-screening for HCV and COVID-19-related services: A creative response with a need for thoughtful reflection. Liver Int 2022; 42:960-962. [PMID: 35447008 PMCID: PMC9115188 DOI: 10.1111/liv.15243] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | - Lucia Craxì
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.)University of PalermoPalermoItaly
| | - Massimo Andreoni
- Infectious Disease Unit, Department of System MedicineTor Vergata University and HospitalRomeItaly
| | - Francesco S. Mennini
- Economic Evaluation and HTA (EEHTA), CEIS, Faculty of EconomicsUniversity of Rome "Tor Vergata" and Institute of Leadership and Management in Health, Kingston Business School, Kingston UniversityLondonUK
| | - Homie Razavi
- Center for Disease Analysis FoundationLafayetteColoradoUSA
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Nevola R, Messina V, Marrone A, Coppola N, Rescigno C, Esposito V, Sangiovanni V, Claar E, Pisaturo M, Fusco FM, Rosario P, Izzi A, Pisapia R, Rosato V, Maggi P, Adinolfi LE. Epidemiology of HCV and HBV in a High Endemic Area of Southern Italy: Opportunities from the COVID-19 Pandemic-Standardized National Screening or One Tailored to Local Epidemiology? BIOLOGY 2022; 11:biology11040609. [PMID: 35453808 PMCID: PMC9028790 DOI: 10.3390/biology11040609] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 12/16/2022]
Abstract
Simple Summary Epidemiological data on viral hepatitis are essential to optimize screening programs. For HCV, the Italian Health Ministry planned a cohort screening for those born in 1969–1989. In order to update the epidemiological data of viral hepatitis in a highly endemic area of Southern Italy and assess whether the screening programs currently planned by the Italian government for those born between 1969–1989 will be effective, a retrospective multicenter study was carried out enrolling all COVID-19 hospitalized patients screened for markers of HCV and HBV infection. Indeed, the COVID-19 pandemic has resulted in access to the national health system of an unselected population similar to the general one. Among the 2126 patients evaluated, HBsAg and HCV-Ab prevalence was 1.6% and 5.1%, respectively. For HCV infection, a bimodal distribution was observed, with peaks in the birth cohorts 1930–1939 and 1960–1969 (11.6% and 5.6%, respectively). An analysis of the screening period imposed (born: 1969–1989) demonstrates that only 17% of HCV infection could be captured. Thus, an alignment of the screening period (i.e., birth cohort 1960–1984) would capture 40% of cases. Data show a high endemicity of hepatitis virus in our geographic area and the need for a tailored regional screening program. Abstract The COVID-19 pandemic led to the hospitalization of an unselected population with the possibility to evaluate the epidemiology of viral hepatitis. Thus, a retrospective multicenter study was conducted in an area of Southern Italy with the aim of assessing the prevalence of HCV and HBV markers and the ability of current screening program to capture cases. We evaluated 2126 hospitalized patients in seven COVID Centers of Naples and Caserta area in which 70% of the Campania population lives. HBsAg and HCV-Ab prevalence was 1.6% and 5.1%, respectively, with no differences between gender. Decade distribution for birth year shows a bimodal trend of HCV prevalence, with a peak (11.6%) in the decade 1930–1939 and a second peak (5.6%) for those born in 1960–1969. An analysis of the screening period imposed by the Italian government for those born between 1969 and 1989 shows that only 17% of cases of HCV infection could be captured. A small alignment of the screening period, i.e., those born from 1960 to 1984, would capture 40% of cases. The data confirm the high endemicity of our geographical area for hepatitis virus infections and underline the need for a tailored screening program according to the regional epidemiology.
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Affiliation(s)
- Riccardo Nevola
- Internal Medicine Unit, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.M.); (L.E.A.)
- Hepatology Unit, Ospedale Evangelico Betania, 80147 Naples, Italy; (E.C.); (V.R.)
- Correspondence: ; Tel.: +39-081-5664173
| | - Vincenzo Messina
- Infectious Diseases Unit, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy; (V.M.); (P.M.)
| | - Aldo Marrone
- Internal Medicine Unit, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.M.); (L.E.A.)
| | - Nicola Coppola
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (N.C.); (M.P.)
| | - Carolina Rescigno
- Infectious Diseases and Neurology Unit, Cotugno Hospital, 80131 Naples, Italy; (C.R.); (A.I.); (R.P.)
| | - Vincenzo Esposito
- IVth Division of Immunodeficiency and Gender Infectious Diseases, Cotugno Hospital, 80131 Naples, Italy; (V.E.); (P.R.)
| | - Vincenzo Sangiovanni
- IIIrd Infectious Diseases Unit, Cotugno Hospital, 80131 Naples, Italy; (V.S.); (F.M.F.)
| | - Ernesto Claar
- Hepatology Unit, Ospedale Evangelico Betania, 80147 Naples, Italy; (E.C.); (V.R.)
| | - Mariantonietta Pisaturo
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (N.C.); (M.P.)
| | - Francesco Maria Fusco
- IIIrd Infectious Diseases Unit, Cotugno Hospital, 80131 Naples, Italy; (V.S.); (F.M.F.)
| | - Pietro Rosario
- IVth Division of Immunodeficiency and Gender Infectious Diseases, Cotugno Hospital, 80131 Naples, Italy; (V.E.); (P.R.)
| | - Antonio Izzi
- Infectious Diseases and Neurology Unit, Cotugno Hospital, 80131 Naples, Italy; (C.R.); (A.I.); (R.P.)
| | - Raffaella Pisapia
- Infectious Diseases and Neurology Unit, Cotugno Hospital, 80131 Naples, Italy; (C.R.); (A.I.); (R.P.)
| | - Valerio Rosato
- Hepatology Unit, Ospedale Evangelico Betania, 80147 Naples, Italy; (E.C.); (V.R.)
| | - Paolo Maggi
- Infectious Diseases Unit, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy; (V.M.); (P.M.)
| | - Luigi Elio Adinolfi
- Internal Medicine Unit, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.M.); (L.E.A.)
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Di Marco L, La Mantia C, Di Marco V. Hepatitis C: Standard of Treatment and What to Do for Global Elimination. Viruses 2022; 14:v14030505. [PMID: 35336911 PMCID: PMC8954407 DOI: 10.3390/v14030505] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/09/2022] [Accepted: 02/21/2022] [Indexed: 12/04/2022] Open
Abstract
Hepatitis C virus infection has a substantial effect on morbidity and mortality worldwide because it is a cause of cirrhosis, hepatocellular carcinoma, liver transplantation, and liver-related death. Direct acting antiviral drugs available today have high efficacy and excellent safety and can be used in all patients with clinically evident chronic liver disease and in groups that demonstrate risk behaviors to reduce the spread of infection. The Global Health Strategy of WHO to eliminate hepatitis infection by 2030 assumes “a 90% reduction in new cases of chronic hepatitis C, a 65% reduction in hepatitis C deaths, and treatment of 80% of eligible people with HCV infections”. In this review effective models and strategies for achieving the global elimination of HCV infection are analyzed. The screening strategies must be simple and equally effective in high-risk groups and in the general population; fast and effective models for appropriate diagnosis of liver disease are needed; strategies for direct acting antiviral drug selection must be cost-effective; linkage to care models in populations at risk and in marginalized social classes must be specifically designed and applied; strategies for obtaining an effective vaccine against HCV infection have yet to be developed.
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Affiliation(s)
- Lorenza Di Marco
- Gastroenterology Unit, Department of Medical Specialties, University of Modena & Reggio Emilia, 41100 Modena, Italy;
- Clinical and Experimental Medicine PhD Program, University of Modena & Reggio Emilia, 41100 Modena, Italy
| | - Claudia La Mantia
- Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | - Vito Di Marco
- Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
- Correspondence: ; Tel.: +39-0916552106
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Romagnoli D. Elimination of hepatitis C virus infection in Europe: targeting the obstacles. EXPLORATION OF MEDICINE 2022. [DOI: 10.37349/emed.2022.00075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Dante Romagnoli
- Gastroenterology Unit, Polyclinic, Azienda Ospedaliero-Universitaria di Modena, 41124 Modena, Italy
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Milestones to reach Hepatitis C Virus (HCV) elimination in Italy: From free-of-charge screening to regional roadmaps for an HCV-free nation. Dig Liver Dis 2022; 54:237-242. [PMID: 33926816 DOI: 10.1016/j.dld.2021.03.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 12/11/2022]
Abstract
Although Italy has been on track for Hepatitis C Virus (HCV) elimination since 2019, it fell off track due to the decrease in the number of treated patients. HCV elimination in Italy will be possible if immediate action is taken. A health policy was implemented beginning in 2021, consisting of screening among key populations and birth cohorts (1969-1989), estimated to have a high prevalence of undiagnosed individuals. The active screening requires regional governance that manages the processes' complexity integrating a well-organized network between territory assistance and hospital to achieve an effective HCV care cascade. This document aims to support the regional decision-making process by defining paths for screening and linkage-to-care. Implementing active screening strategies beyond a risk-based approach is required as a General Practitioners' task. Simplified paths must be drawn for the key populations screening. The infrastructure built for COVID-19 vaccination could be used also for HCV screening. According to a multidisciplinary care delivery, screening should be supplemented with rapid linkage-to-care and treatment of newly diagnosed patients. The realization of the proactive screening during the first two years is vital because it will define the tracks for the whole HCV cost-effective screening of 1948-1988 birth cohorts in Italy.
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Marcellusi A, Mennini FS, Ruf M, Galli C, Aghemo A, Brunetto MR, Babudieri S, Craxi A, Andreoni M, Kondili LA. Optimizing diagnostic algorithms to advance Hepatitis C elimination in Italy: A cost effectiveness evaluation. Liver Int 2022; 42:26-37. [PMID: 34582627 PMCID: PMC9292516 DOI: 10.1111/liv.15070] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Optimized diagnostic algorithms to detect active infections are crucial to achieving HCV elimination. We evaluated the cost effectiveness and sustainability of different algorithms for HCV active infection diagnosis, in a context of a high endemic country for HCV infection. METHODS A Markov disease progression model, simulating six diagnostic algorithms in the birth cohort 1969-1989 over a 10-year horizon from a healthcare perspective was used. Conventionally diagnosis of active HCV infection is through detection of antibodies (HCV-Ab) detection followed by HCV-RNA or HCV core antigen (HCV-Ag) confirmatory testing either on a second sample or by same sample reflex testing. The undiagnosed and unconfirmed rates were evaluated by assays false negative estimates and each algorithm patients' drop-off. Age, liver disease stages distribution, liver disease stage costs, treatment effectiveness and costs were used to evaluate the quality-adjusted life-years (QALYs) and the incremental cost-effectiveness ratios (ICER). RESULTS The reference option was Rapid HCV-Ab followed by second sample HCV-Ag testing which produced the lowest QALYs (866,835 QALYs). The highest gains in health (QALYs=974,458) was obtained by HCV-RNA reflex testing which produced a high cost-effective ICER (€891/QALY). Reflex testing (same sample-single visit) vs two patients' visits algorithms, yielded the highest QALYs and high cost-effective ICERs (€566 and €635/QALY for HCV-Ag and HCV-RNA, respectively), confirmed in 99.9% of the 5,000 probabilistic simulations. CONCLUSIONS Our data confirm, by a cost effectiveness point of view, the EASL and WHO clinical practice guidelines recommending HCV reflex testing as most cost effective diagnostic option vs other diagnostic pathways.
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Affiliation(s)
- Andrea Marcellusi
- Economic Evaluation and HTA (EEHTA)CEISFaculty of EconomicsUniversity of Rome “Tor Vergata”RomeItaly
- Institute of Leadership and Management in HealthKingston Business SchoolKingston UniversityLondonUK
| | - Francesco Saverio Mennini
- Economic Evaluation and HTA (EEHTA)CEISFaculty of EconomicsUniversity of Rome “Tor Vergata”RomeItaly
- Institute of Leadership and Management in HealthKingston Business SchoolKingston UniversityLondonUK
| | - Murad Ruf
- Public Health, Medical AffairsGilead ScienceLondonUK
| | - Claudio Galli
- Global Medical and Scientific AffairsCore Laboratory, AbbottRomeItaly
| | - Alessio Aghemo
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleItaly
- Division of Internal Medicine and HepatologyHumanitas Research Hospital IRCCSRozzanoItaly
| | - Maurizia R. Brunetto
- Internal MedicineDepartment of Clinical and Experimental MedicineUniversity of PisaPisaItaly
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis VirusesUniversity Hospital of PisaPisaItaly
| | - Sergio Babudieri
- Infectious and Tropical Disease UnitDepartment of MedicalSurgical and Experimental SciencesUniversity of SassariSassariItaly
| | - Antonio Craxi
- Gastroenterology and Hepatology UnitDepartment of Internal Medicine and Medical Specialties “PROMISE”University of PalermoPalermoItaly
| | - Massimo Andreoni
- Department of Systems MedicineUniversity of Rome “Tor Vergata”RomeItaly
- Infectious Diseases ClinicUniversity Hospital “Tor Vergata”RomeItaly
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12
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Ponziani FR, Aghemo A, Cabibbo G, Masarone M, Montagnese S, Petta S, Russo FP, Lai Q. Management of liver disease in Italy after one year of the SARS-CoV-2 pandemic: A web-based survey. Liver Int 2021; 41:2228-2232. [PMID: 34219343 DOI: 10.1111/liv.14998] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/05/2021] [Accepted: 06/12/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Francesca Romana Ponziani
- Internal Medicine and Gastroenterology - Hepatology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessio Aghemo
- Division of Internal Medicine and Hepatology, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Giuseppe Cabibbo
- Section of Gastroenterology & Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy
| | - Mario Masarone
- Internal Medicine and Hepatology Division, Department of Medicine, Surgery and Odontostomatology, "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | | | - Salvatore Petta
- Section of Gastroenterology and Hepatology, PROMISE, University of Palermo, Palermo, Italy
| | - Francesco Paolo Russo
- Department of Surgery, Oncology and Gastroenterology, University Hospital Padua, Padua, Italy
| | - Quirino Lai
- General Surgery and Organ Transplantation Unit, Sapienza University of Rome, Rome, Italy
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13
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Mohamed R, Cordie A, Lazarus JV, Esmat G. Micro-elimination of hepatitis C among people living with HIV in Egypt. Liver Int 2021; 41:1445-1447. [PMID: 34139062 DOI: 10.1111/liv.14974] [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: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 02/13/2023]
Affiliation(s)
- Rahma Mohamed
- Endemic Medicine Department, Cairo University Hospitals, Cairo, Egypt.,Kasr Al-Aini HIV and Viral Hepatitis Fighting Group, Cairo University Hospitals, Cairo, Egypt
| | - Ahmed Cordie
- Endemic Medicine Department, Cairo University Hospitals, Cairo, Egypt.,Kasr Al-Aini HIV and Viral Hepatitis Fighting Group, Cairo University Hospitals, Cairo, Egypt
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Gamal Esmat
- Endemic Medicine Department, Cairo University Hospitals, Cairo, Egypt
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