1
|
Pol S, Thompson AJ, Collins M, Venier E, Cotte L, Laguno Centeno M, Mera J, Reiberger T, Burroughs M, Semizarov DG, Iacob AM, Welhaven A, Fredrick LM, Doyle JS. Effectiveness and safety of glecaprevir/pibrentasvir for 8 weeks in the treatment of patients with acute hepatitis C: A single-arm retrospective study. Hepatology 2024:01515467-990000000-00885. [PMID: 38768260 DOI: 10.1097/hep.0000000000000923] [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: 12/07/2023] [Accepted: 04/24/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND AND AIMS No direct-acting antiviral is currently approved for acute HCV infection, delaying treatment. We investigated the effectiveness and safety of 8-week glecaprevir/pibrentasvir (G/P) in patients with acute HCV infection. APPROACH AND RESULTS This noninterventional, single-arm, retrospective chart review was designed to enroll adults/adolescents with acute HCV infection. Analyses were conducted on a full analysis set (FAS; all enrolled) and modified FAS (FAS excluding nonvirologic failures). The primary end point (modified FAS) was sustained virologic response at posttreatment week 12 (SVR12) with superiority to 92.6% threshold determined by historic chronic HCV G/P SVR12 rates. Secondary end points (FAS) included SVR12, on-treatment virologic failure, posttreatment relapse, and reinfection. Adverse events and safety laboratory values were assessed.Overall, 202 adults were enrolled; in the modified FAS, 150/151 (99.3%; 95% CI: 96.3-99.9) achieved SVR12, demonstrating superiority to efficacy threshold. In the FAS, the SVR12 rate was 74.3% and the on-treatment virologic failure rate was 0%. Relapse and reinfection rates after the final treatment visit (FAS) were 0.5% and 3%, respectively; 39 patients had missing SVR12 data. No on-treatment alanine aminotransferase elevations > 3 × upper limit of normal with total bilirubin > 2 × upper limit of normal were reported. All 53 patients with alanine aminotransferase Grade ≥ 2 at baseline improved to Grade 0/1 on treatment. No adverse eventss of hepatic decompensation/failure or leading to G/P discontinuation occurred. Two patients had serious adverse events unrelated to G/P. CONCLUSIONS Eight-week G/P therapy was effective and well-tolerated in patients with acute HCV infection. Data support further investigation of G/P in acute HCV to shorten care cascades, reduce transmission, and support HCV elimination.
Collapse
Affiliation(s)
- Stanislas Pol
- Department of Hepatology/Addictology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
- Université de Paris Cité, Paris, France
| | - Alexander J Thompson
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
- Medicine, Dentistry and Health Services, University of Melbourne, Melbourne, Victoria, Australia
| | - Michelle Collins
- Global Medical Affairs, AbbVie Inc., North Chicago, Illinois, USA
| | - Elisa Venier
- Addiction Medical Services, Toronto, Ontario, Canada
| | - Laurent Cotte
- Maladies Infectieuses, Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Lyon, France
| | | | - Jorge Mera
- Department of Infectious Diseases, Cherokee Nation Health Services, Tahlequah, Oklahoma, United States
| | - Thomas Reiberger
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | | | | | | | - Anne Welhaven
- Global Pharmaceutical R&D, AbbVie Inc., North Chicago, Illinois, USA
| | - Linda M Fredrick
- Global Pharmaceutical R&D, AbbVie Inc., North Chicago, Illinois, USA
| | - Joseph S Doyle
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| |
Collapse
|
2
|
Gleriano JS, Krein C, Chaves LDP. Aspects that facilitate access to care for viral hepatitis: An evaluative research. SAO PAULO MED J 2024; 142:e2023078. [PMID: 38477774 DOI: 10.1590/1516-3180.2023.0078.r1.29112023] [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: 03/26/2023] [Accepted: 11/29/2023] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Viral hepatitis is a major public health concern worldwide. OBJECTIVES This study aimed to analyze the factors that facilitate access to care for viral hepatitis. DESIGN AND SETTING Using a sequential mixed method, this evaluation research was conducted in the state of Mato Grosso, Brazil. METHODS Mapping of references and selection of regions were made based on the quantity and heterogeneity of services. The stakeholders, including the managers of the State Department of Health and professionals from reference services, were identified. Nine semi-structured interviews were conducted using content analysis and discussions guided by the dimensions of the analysis model of universal access to health services. RESULTS In the political dimension, decentralizing services and adhering to the Intermunicipal Health Consortium are highly encouraged. In the economic-social dimension, a commitment exists to allocate public funds for the expansion of referral services and subsidies to support users in their travel for appointments, medications, and examinations. In the organizational dimension, the availability of inputs for testing, definition of user flow, ease of scheduling appointments, coordination by primary care in testing, collaboration following the guidelines and protocols, and engagement in extramural activities are guaranteed. In the technical dimension, professionals actively commit to the service and offer different opening hours, guarantee the presence of an infectious physician, expand training opportunities, and establish intersectoral partnerships. In the symbolic dimension, professionals actively listen to the experiences of users throughout their care trajectory and demonstrate empathy. CONCLUSIONS The results are crucial for improving comprehensiveness, but necessitate managerial efforts to enhance regional governance.
Collapse
Affiliation(s)
- Josué Souza Gleriano
- PhD. Nurse, Adjunct Professor, Department of Nursing, Faculty of Agricultural, Biological, Engineering and Health Sciences, Universidade do Estado de Mato Grosso (UNEMAT), Tangará da Serra (MT), Brazil
| | - Carlise Krein
- Msc. Nurse, Department of General and Specialized Nursing, Ribeirão Preto School of Nursing, Universidade de São Paulo (USP), Ribeirão Preto (SP), Brazil
| | - Lucieli Dias Pedreschi Chaves
- PhD. Nurse, Associate Professor, Department of General and Specialized Nursing, Ribeirão Preto School of Nursing, Universidade de São Paulo (USP), Ribeirão Preto (SP), Brazil
| |
Collapse
|
3
|
Pinazo-Bandera JM, Aranda J, García-García AM, Alcántara R, Ortega-Alonso A, Del Campo-Herrera E, Clavijo E, García-Escaño MD, Ruiz Ruiz JJ, Morales-Herrera M, Valle-López V, Martín-Alarcón R, Viciana I, Jiménez JB, Fernández-García F, Toro-Ortiz JP, Sánchez-Yáñez E, Álvarez-Álvarez I, Andrade RJ, Robles-Díaz M, García-Cortés M. Hepatitis C virus point-of-care microelimination approach in a vulnerable population in the South of Spain. Gastroenterol Rep (Oxf) 2024; 12:goad077. [PMID: 38264764 PMCID: PMC10805342 DOI: 10.1093/gastro/goad077] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 12/05/2023] [Accepted: 12/19/2023] [Indexed: 01/25/2024] Open
Abstract
Background Since the introduction of direct-acting antivirals, thousands of chronic hepatitis C patients have been successfully treated. However, vulnerable populations have a higher prevalence of hepatitis C virus (HCV) infection and face barriers that impede their access to antivirals. We carried out an HCV microelimination program focused on vulnerable population groups in Malaga. Methods People in drug addiction treatment centers and homeless shelters in Malaga who participated in the program between October 2020 and October 2021 were included. After providing participants with educational information on HCV, a dry drop test (DDT) was used to collect blood for subsequent screening for HCV infection. The participants who were diagnosed with HCV infection were scheduled for comprehensive healthcare assessments, including blood tests, ultrasonography, elastography, and the prescription of antivirals, all conducted in a single hospital visit. Sustained viral response (SVR) was analysed 12 weeks after end of treatment. Results Of the 417 persons invited to participate, 271 (65%) agreed to participate in the program. These participants were screened for HCV infection and 28 of them were diagnosed with HCV infection (10%). These hepatitis C-infected patients had a mean age of 53 ± 9 years; 86% were males and 93% were or had been drug users. Among 23 patients with HCV infection, HCV genotype 1a predominated (74%). Medical exams showed that 19% (4/21) had advanced fibrosis (F3-4), and 5% (1/21) had portal hypertension. Finally, 23 infected patients received treatment with glecaprevir/pibrentasvir or sofosbuvir/velpatasvir and SVR was confirmed in 22 patients (96%). Conclusions Drug users and homeless people have a higher prevalence of HCV infection than the general population. The microelimination program with educational activity and screening tools achieved a high participation rate, easy healthcare access, and a high rate of SVR despite the SARS-CoV-2 pandemic.
Collapse
Affiliation(s)
- José María Pinazo-Bandera
- Gastroenterology Department, Málaga Biomedicine Research Institute-IBIMA BIONAND Platform, Virgen de la Victoria University Hospital, University of Málaga, Málaga, Spain
- Biomedic Research Network in Hepatic and Digestive Diseases (CIBERehd), Madrid, Spain
| | - Jesús Aranda
- Gastroenterology Department, Málaga Biomedicine Research Institute-IBIMA BIONAND Platform, Virgen de la Victoria University Hospital, University of Málaga, Málaga, Spain
| | - Alberto Manuel García-García
- Gastroenterology Department, Málaga Biomedicine Research Institute-IBIMA BIONAND Platform, Virgen de la Victoria University Hospital, University of Málaga, Málaga, Spain
| | - Ramiro Alcántara
- Gastroenterology Department, Málaga Biomedicine Research Institute-IBIMA BIONAND Platform, Virgen de la Victoria University Hospital, University of Málaga, Málaga, Spain
| | - Aida Ortega-Alonso
- Gastroenterology Department, Málaga Biomedicine Research Institute-IBIMA BIONAND Platform, Virgen de la Victoria University Hospital, University of Málaga, Málaga, Spain
- Biomedic Research Network in Hepatic and Digestive Diseases (CIBERehd), Madrid, Spain
| | - Enrique Del Campo-Herrera
- Gastroenterology Department, Málaga Biomedicine Research Institute-IBIMA BIONAND Platform, Virgen de la Victoria University Hospital, University of Málaga, Málaga, Spain
| | - Encarnación Clavijo
- Microbiology Department, Málaga Biomedicine Research Institute-IBIMA BIONAND Platform, Virgen de la Victoria University Hospital, University of Málaga, Málaga, Spain
| | - M Dolores García-Escaño
- Gastroenterology Department, Málaga Biomedicine Research Institute-IBIMA BIONAND Platform, Virgen de la Victoria University Hospital, University of Málaga, Málaga, Spain
| | - Juan Jesús Ruiz Ruiz
- Provincial Center for Drug Addiction, Provincial Council of Málaga, Málaga, Spain
| | | | | | | | - Isabel Viciana
- Microbiology Department, Málaga Biomedicine Research Institute-IBIMA BIONAND Platform, Virgen de la Victoria University Hospital, University of Málaga, Málaga, Spain
| | | | - Felix Fernández-García
- Gastroenterology Department, Málaga Biomedicine Research Institute-IBIMA BIONAND Platform, Virgen de la Victoria University Hospital, University of Málaga, Málaga, Spain
| | - Juan Pedro Toro-Ortiz
- Gastroenterology Department, Málaga Biomedicine Research Institute-IBIMA BIONAND Platform, Virgen de la Victoria University Hospital, University of Málaga, Málaga, Spain
| | - Elena Sánchez-Yáñez
- Farmacy Department, Virgen de la Victoria University Hospital, Málaga, Spain
| | - Ismael Álvarez-Álvarez
- Gastroenterology Department, Málaga Biomedicine Research Institute-IBIMA BIONAND Platform, Virgen de la Victoria University Hospital, University of Málaga, Málaga, Spain
- Biomedic Research Network in Hepatic and Digestive Diseases (CIBERehd), Madrid, Spain
| | - Raúl J Andrade
- Gastroenterology Department, Málaga Biomedicine Research Institute-IBIMA BIONAND Platform, Virgen de la Victoria University Hospital, University of Málaga, Málaga, Spain
- Biomedic Research Network in Hepatic and Digestive Diseases (CIBERehd), Madrid, Spain
| | - Mercedes Robles-Díaz
- Gastroenterology Department, Málaga Biomedicine Research Institute-IBIMA BIONAND Platform, Virgen de la Victoria University Hospital, University of Málaga, Málaga, Spain
- Biomedic Research Network in Hepatic and Digestive Diseases (CIBERehd), Madrid, Spain
| | - Miren García-Cortés
- Gastroenterology Department, Málaga Biomedicine Research Institute-IBIMA BIONAND Platform, Virgen de la Victoria University Hospital, University of Málaga, Málaga, Spain
- Biomedic Research Network in Hepatic and Digestive Diseases (CIBERehd), Madrid, Spain
| |
Collapse
|
4
|
HepCare Plus: Enhancing Primary Care Identification and Treatment of Hepatitis C Virus in High-Risk Individuals. Pathogens 2022; 11:pathogens11121428. [PMID: 36558762 PMCID: PMC9781392 DOI: 10.3390/pathogens11121428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022] Open
Abstract
Hepatitis C Virus (HCV) disproportionately affects people who inject drugs, migrants, prisoners and the homeless. An integrated, peer-led model of care involving primary and secondary care is required to enhance the identification and treatment of HCV in these marginalised groups. HepCare Plus builds on the network and achievements of HepCare Europe (a co-funded Third Health Programme of the European Union/Health Service Executive project). It further identifies those not accessing care and facilitates prompt assessment and treatment of those diagnosed with HCV, with the aid of a peer support worker (PSW) and a community HCV nurse specialist. Of 109 individuals identified and assessed for HCV treatment, 100 commenced HCV treatment. Despite interruptions to treatment (COVID-19 pandemic and national health service cyberattack) there was a high-level of treatment completion with PSW engagement (98%, n = 98). Eighty (73%) individuals were previously aware of a positive HCV status, highlighting the ongoing need to address barriers preventing marginalised groups from engaging with care. HepCare Plus reiterates the defining role of peer-led community interventions in HCV treatment engagement and the need for continuous open-ended HCV care. It provides a sustainable framework to meaningfully combat HCV and achieve the United Nations Sustainable Development Goal of HCV elimination by 2030.
Collapse
|
5
|
Hashim A, Bremner S, Grove JI, Astbury S, Mengozzi M, O'Sullivan M, Macken L, Worthley T, Katarey D, Aithal GP, Verma S. Chronic liver disease in homeless individuals and performance of non-invasive liver fibrosis and injury markers: VALID study. Liver Int 2022; 42:628-639. [PMID: 34846794 DOI: 10.1111/liv.15122] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/22/2021] [Accepted: 11/25/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS Community-based assessment and management of chronic liver disease (CLD) in people who are homeless (PWAH) remain poorly described. We aimed to determine prevalence/predictors of CLD in PWAH and assess the performance of non-invasive liver fibrosis and injury markers. METHODS The Vulnerable Adult LIver Disease (VALID) study provided a "one-stop" liver service based at homeless hostels. Our primary outcome was the prevalence of clinically significant hepatic fibrosis (CSHF; liver stiffness measurement (LSM) ≥8 kPa). RESULTS Total individuals recruited were 127, mean ± SD age 47 ± 9.4 years, 50% (95% CI 41%-59%) and 39% (95% CI 31%-48%) having alcohol dependence and a positive HCV RNA respectively. CSHF was detected in 26% (95% CI 17%-35%), independent predictors being total alcohol unit/week (OR 1.01, 95% CI 1.00-1.02, P = .002) and HCV RNA positivity (OR 2.93, 95% CI 1.12-7.66, P = .029). There was moderate agreement between LSM and Enhanced Liver Fibrosis (ELF) score (kappa 0.536, P < .001) for CSHF as assessed by LSM ≥8 kPa. Those with CSHF had significantly higher levels of IFN-γ (P = .002), IL-6 (P = .001), MMP-2 (P = .006), ccCK-18 (P < .001) and ELF biomarkers (P < .001), compared to those without CSHF. Service uptake was ≥95%. Direct acting antiviral (DAA) treatment completion was 93% (95% CI 77%-99%), sustained virological response (SVR) being 83% (95% CI 64%-94%). CONCLUSION There is a significant liver disease burden from HCV and alcohol in PWAH. Non-invasive liver fibrosis and injury markers can help in identifying such individuals in the community. Despite a challenging cohort, excellent service uptake and high DAA-based SVRs can be achieved.
Collapse
Affiliation(s)
- Ahmed Hashim
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK.,Department of Gastroenterology and Hepatology, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Stephen Bremner
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Jane I Grove
- NIHR Nottingham Biomedical Research Centre, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK.,Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Stuart Astbury
- NIHR Nottingham Biomedical Research Centre, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK.,Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Manuela Mengozzi
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - Margaret O'Sullivan
- Department of Gastroenterology and Hepatology, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Lucia Macken
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK.,Department of Gastroenterology and Hepatology, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | - Dev Katarey
- Department of Hepatology, Royal Free Hospital, London, UK
| | - Guruprasad P Aithal
- NIHR Nottingham Biomedical Research Centre, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK.,Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Sumita Verma
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK.,Department of Gastroenterology and Hepatology, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| |
Collapse
|
6
|
Martel-Laferrière V, Brissette S, Wartelle-Bladou C, Juteau LC, Popa M, Goyer MÈ, Bruneau J. Impact of an Accelerated Pretreatment Evaluation on Linkage-to-Care for Hepatitis C-infected Persons Who Inject Drugs. Subst Abuse 2022; 16:11782218221119068. [PMID: 35990750 PMCID: PMC9382068 DOI: 10.1177/11782218221119068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/25/2022] [Indexed: 11/15/2022]
Abstract
Background: Historically, hepatitis C virus (HCV) pretreatment evaluation has required multiple visits, frequently resulting in loss to follow-up and a delayed initiation of treatment. New technologies can accelerate this process. We investigated the feasibility of a single-day evaluation program and its impact on evaluation completion, treatment eligibility awareness, and treatment initiation among people who inject drugs (PWIDs). Methods: HCV-infected PWID who were unaware if they were eligible for treatment were recruited in a prospective evaluation of an accelerated model of care between 2017 and 2019 and compared to a historical cohort. The patients underwent a medical evaluation, rapid HCV viral load testing, and transient elastography during a single visit, at the end of which they were informed whether they were eligible for treatment. A historical cohort of patients fulfilling the same inclusion criteria and evaluated with the usual standard of care spanning several visits who were examined at the addiction medicine clinic from 2014 to 2016 served as the comparison group. Results: The accelerated and historical cohorts included 99 and 76 patients, respectively. The cohorts did not differ significantly by age and gender, but more patients in the historical cohort were undergoing opioid agonist therapy, while more patients in the accelerated cohort injected drugs in the last month. An accelerated evaluation resulted in a higher rate of evaluation completion (100% vs 67.1%; P < .001). Among those eligible for treatment, the proportion of those initiating treatment was similar between the groups (51/64 (79.7%) vs. 26/37 (70.3%); P = .28). The delay in the initiation of treatment was shorter in the accelerated cohort than in the historical cohort (69 (IQR: 49-106) days vs. 219 (IQR: 141-416) days; P < .001). Conclusions: Accelerated evaluation enhanced the awareness of eligibility and reduced the time to initiation among eligible patients. Trial Registration: This study is registered on www.clinicaltrials.gov (NCT02755402).
Collapse
Affiliation(s)
- Valérie Martel-Laferrière
- Université de Montréal, Montreal, QC, Canada
- Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Suzanne Brissette
- Université de Montréal, Montreal, QC, Canada
- Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Claire Wartelle-Bladou
- Université de Montréal, Montreal, QC, Canada
- Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Louis-Christophe Juteau
- Université de Montréal, Montreal, QC, Canada
- Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Maria Popa
- Université de Montréal, Montreal, QC, Canada
| | - Marie-Ève Goyer
- Université de Montréal, Montreal, QC, Canada
- CIUSSS du Centre-Sud de Montréal, Montreal, QC, Canada
| | - Julie Bruneau
- Université de Montréal, Montreal, QC, Canada
- Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
| |
Collapse
|