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Galal ASGM, Dawood RM, Awady MKE, El-Dessouky YMM, Mahmoud MMAH, Alla MDAA. Recognition of 7 genes signature (Cirrhosis Risk Score) in the diagnosed non-responders to DAAs therapy by intra-PBMCs nested HCV RNA PCR. J Genet Eng Biotechnol 2023; 21:89. [PMID: 37646837 PMCID: PMC10468448 DOI: 10.1186/s43141-023-00544-3] [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: 02/01/2023] [Accepted: 08/19/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND AND AIMS Predictors of chronic HCV response to oral antiviral therapy (OAT) are related to host genetic variations. Single nucleotide polymorphisms (SNP) and alleles variations of host genes in association with hepatic fibro-cirrhotic changes have a distinct role in OAT outcomes. The current research evaluated the association of Cirrhosis-Risk-Scores (CRS) values, based on the correlation of seven genes signature-SNPs, with sonographic liver parenchymal changes in determining OAT outcomes. METHODS All study subjects (n = 54) were recruited three months after completing OAT and classified into three groups. Group I (n = 21) had negative HCV PCR, group II (n = 17) showed positive solitary intra-PBMCs HCV infection, and group III(n = 16) was serum HCV RNA PCR-positive. All study-population were subjected to examination by hepatic-ultrasound (US), FIB-4-scoring, and screening for 7 gene-signature that addressed CRS values as low, intermediate, and high depending on gene SNPs identification. RESULTS Group I showed a significant association with low CRS values compared to other groups (P < 0.001). Solitary intra- PBMCs HCV infection in group II was significantly combined with intermediate CRS values in comparison to groups I and III (P < 0.001). The high CRS values were significantly found in group III when compared to groups I and II (P < 0.01). On US imaging, low CRS values were common in normally appeared hepatic parenchyma (P < 0.001) and high CRS values were frequent in coarse-liver (P < 0.001), while bright-liver-tissues appearance was mainly detected in the intermediate CRS category (P = 0.09). On FIB-4 scoring, high CRS value were associated with hepatic fibro-cirrhosis compared to intermediate (P < 0.001) and low (P = 0.08) CRS-categories. CONCLUSION The current study concluded the association of (a) high CRS values with coarse liver in viral-RNA serologic relapse, (b) low CRS values with normal liver tissues in sustained virologic response (SVR), (c) intermediate CRS values with bright liver in solitary PBMCs relapse.
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Affiliation(s)
| | - Reham M Dawood
- Department of Microbial Biotechnology, National Research Center, Cairo, Egypt
| | - Mostafa K El Awady
- Department of Microbial Biotechnology, National Research Center, Cairo, Egypt
| | | | | | - Mohamed Darwish Ahmed Abd Alla
- Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
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Luo A, Xu P, Wang J, Li Z, Wang S, Jiang X, Ren H, Luo Q. Efficacy and safety of direct-acting antiviral therapy for chronic hepatitis C genotype 6: A meta-analysis. Medicine (Baltimore) 2019; 98:e15626. [PMID: 31096473 PMCID: PMC6531202 DOI: 10.1097/md.0000000000015626] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Because of the heterogeneity of hepatitis C virus (HCV) distribution of different genotypes, large-scale clinical trials on direct-acting antiviral (DAA) mainly included patients with genotype 1 and genotype 3 infection. Data on the efficacy of direct-acting antiviral agents in patients with chronic genotype 6 HCV infection are limited. METHODS The PubMed, Embase, and the Cochrane Libraries were searched comprehensively. All published clinical trials assessing the efficacy of DAA therapy for patients with chronic genotype 6 HCV infection were included. Sustained virological response (SVR) and rapid virological response (RVR) were pooled. Additional meta-analyses were also performed to compare the efficacy of DAA therapy in HCV-6 versus HCV-1 or HCV-3 patients. RESULTS Seventeen studies met the inclusion criteria and were included in our meta-analysis. The pooled SVR of all single arms was 95% [95% confidence interval (CI): 0.90-0.97]. The pooled RVR of all single arms was 97% (95% CI: 0.95-0.99). The SVR and RVR were both similar between HCV-6 and HCV-1 or HCV-3. Adverse events were common but rarely caused treatment interruption. CONCLUSION Based on the available data, our results indicate that DAA treatment is effective and safe for patients with genotype 6 HCV infection, and the efficacy was similar compared to patients with genotype 1 HCV or genotype 3 HCV infection.
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In-depth phylogenetic analysis of hepatitis C virus subtype 1a and occurrence of 80K and associated polymorphisms in the NS3 protease. Sci Rep 2016; 6:31780. [PMID: 27531254 PMCID: PMC4987637 DOI: 10.1038/srep31780] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/26/2016] [Indexed: 01/08/2023] Open
Abstract
HCV genetic diversity is high and impacts disease progression, treatment and drug resistance. HCV subtype 1a is divided in two clades (I and II), and the 80 K natural polymorphism in the viral NS3 protease is prevalent in clade I. Paradoxically, countries dominated by this clade have contrasting frequencies of 80 K. Over 2,000 HCV 1a NS3 sequences were retrieved from public databases representing Europe, Oceania and the Americas. Sequences were aligned with HCV reference sequences and subjected to phylogenetic analysis to investigate the relative presence of different subtype 1a clades and NS3 protease mutations. HCV-1a sequences split into clades I and II. Clade I was further structured into three subclades, IA to C. Sub-clade IA prevailed in the U.S., while subclade IC was major in Brazil. The NS3 80 K polymorphism was associated with subclade IA, but nearly absent in subclades IB and IC, a pattern similarly seen for the 91S/T compensatory mutation. Three HCV-1a-I sub-clades have been identified, with different frequencies in distinct regions. The 80 K and 91A/S mutations were associated with subclade IA, which provide an explanation for the disparities seen in simeprevir resistance profiles of countries dominated by HCV 1a-I, like the U.S. and Brazil.
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de Bruijn W, Ibáñez C, Frisk P, Bak Pedersen H, Alkan A, Vella Bonanno P, Brkičić LS, Bucsics A, Dedet G, Eriksen J, Fadare JO, Fürst J, Gallego G, Godói IP, Guerra Júnior AA, Gürsöz H, Jan S, Jones J, Joppi R, Kerman S, Laius O, Madzikwa N, Magnússon E, Maticic M, Markovic-Pekovic V, Massele A, Ogunleye O, O'Leary A, Piessnegger J, Sermet C, Simoens S, Tiroyakgosi C, Truter I, Thyberg M, Tomekova K, Wladysiuk M, Vandoros S, Vural EH, Zara C, Godman B. Introduction and Utilization of High Priced HCV Medicines across Europe; Implications for the Future. Front Pharmacol 2016; 7:197. [PMID: 27516740 PMCID: PMC4964878 DOI: 10.3389/fphar.2016.00197] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 06/21/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Infection with the Hepatitis C Virus (HCV) is a widespread transmittable disease with a diagnosed prevalence of 2.0%. Fortunately, it is now curable in most patients. Sales of medicines to treat HCV infection grew 2.7% per year between 2004 and 2011, enhanced by the launch of the protease inhibitors (PIs) boceprevir (BCV) and telaprevir (TVR) in addition to ribavirin and pegylated interferon (pegIFN). Costs will continue to rise with new treatments including sofosbuvir, which now include interferon free regimens. OBJECTIVE Assess the uptake of BCV and TVR across Europe from a health authority perspective to offer future guidance on dealing with new high cost medicines. METHODS Cross-sectional descriptive study of medicines to treat HCV (pegIFN, ribavirin, BCV and TVR) among European countries from 2008 to 2013. Utilization measured in defined daily doses (DDDs)/1000 patients/quarter (DIQs) and expenditure in Euros/DDD. Health authority activities to influence treatments categorized using the 4E methodology (Education, Engineering, Economics and Enforcement). RESULTS Similar uptake of BCV and TVR among European countries and regions, ranging from 0.5 DIQ in Denmark, Netherlands and Slovenia to 1.5 DIQ in Tayside and Catalonia in 2013. However, different utilization of the new PIs vs. ribavirin indicates differences in dual vs. triple therapy, which is down to factors including physician preference and genotypes. Reimbursed prices for BCV and TVR were comparable across countries. CONCLUSION There was reasonable consistency in the utilization of BCV and TVR among European countries in comparison with other high priced medicines. This may reflect the social demand to limit the transmission of HCV. However, the situation is changing with new curative medicines for HCV genotype 1 (GT1) with potentially an appreciable budget impact. These concerns have resulted in different prices across countries, with their impact on budgets and patient outcomes monitored in the future to provide additional guidance.
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Affiliation(s)
- Winnie de Bruijn
- Department of Pharmaceutical Sciences, Utrecht UniversityUtrecht, Netherlands
| | - Cristina Ibáñez
- Catalan Health Service - Servei Català de la SalutBarcelona, Spain
| | - Pia Frisk
- Public Health Services Committee, Stockholm County CouncilStockholm, Sweden
| | - Hanne Bak Pedersen
- Health Technologies and Pharmaceuticals, Division of Health Systems and Public Health, WHO Regional Office for EuropeCopenhagen, Denmark
| | - Ali Alkan
- Turkish Medicines and Medical Devices Agency, Ministry of HealthAnkara, Turkey
| | | | | | - Anna Bucsics
- Department of Finance, University of ViennaVienna, Austria
| | | | - Jaran Eriksen
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital HuddingeStockholm, Sweden
| | - Joseph O. Fadare
- Department of Pharmacology, Ekiti State UniversityAdo-Ekiti, Nigeria
| | - Jurij Fürst
- Health Insurance InstituteLjubljana, Slovenia
| | - Gisselle Gallego
- School of Medicine, The University of Notre Dame AustraliaDarlinghurst, NSW, Australia
- Department of Pharmacology and Clinical Neuroscience, Umea UniversityUmea, Sweden
| | - Isabella P. Godói
- School of Pharmacy, Graduate Program in Medicines and Pharmaceutical Assistance, Federal University of Minas GeraisBelo Horizonte, Brazil
- Department of Social Pharmacy, SUS Collaborating Centre – Health Technology Assessment and Excellence in Health, College of Pharmacy, Federal University of Minas GeraisBelo Horizonte, Brazil
| | - Augusto A. Guerra Júnior
- School of Pharmacy, Graduate Program in Medicines and Pharmaceutical Assistance, Federal University of Minas GeraisBelo Horizonte, Brazil
- Department of Social Pharmacy, SUS Collaborating Centre – Health Technology Assessment and Excellence in Health, College of Pharmacy, Federal University of Minas GeraisBelo Horizonte, Brazil
| | - Hakkı Gürsöz
- Turkish Medicines and Medical Devices Agency, Ministry of HealthAnkara, Turkey
| | - Saira Jan
- Clinical Pharmacy, Rutgers State University of New JerseyPiscataway, NJ, USA
- Horizon Blue Cross Blue Shield of New JerseyNewark, NJ, USA
| | - Jan Jones
- Scottish Medicines ConsortiumGlasgow, UK
| | - Roberta Joppi
- Pharmaceutical Drug Department, Azienda Sanitaria Locale of VeronaVerona, Italy
| | - Saim Kerman
- Turkish Medicines and Medical Devices Agency, Ministry of HealthAnkara, Turkey
| | - Ott Laius
- State Agency of MedicinesTartu, Estonia
| | | | - Einar Magnússon
- Department of Health Services, Ministry of HealthReykjavík, Iceland
| | - Mojca Maticic
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre LjubljanaLjubljana, Slovenia
| | - Vanda Markovic-Pekovic
- Faculty of Medicine, University of Banja LukaBanja Luka, Bosnia and Herzegovina
- Ministry of Health and Social WelfareBanja Luka, Bosnia and Herzegovina
| | - Amos Massele
- Department of Clinical Pharmacology, School of Medicine, University of BotswanaGaborone, Botswana
| | - Olayinka Ogunleye
- Clinical Pharmacology Unit, Department of Medicine, Lagos State University Teaching HospitalLagos, Nigeria
- Department of Pharmacology and Therapeutics, Lagos State University College of MedicineLagos, Nigeria
| | | | - Jutta Piessnegger
- Hauptverband der Österreichischen SozialversicherungsträgerWien, Austria
| | | | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU LeuvenLeuven, Belgium
| | | | - Ilse Truter
- Drug Utilisation Research Unit, Faculty of Health Sciences, Nelson Mandela Metropolitan UniversityPort Elizabeth, South Africa
| | - Magnus Thyberg
- Stockholms Läns Landsting, Hälso-och SjukvårdsförvaltningenStockholm, Sweden
| | | | | | - Sotiris Vandoros
- School of Management and Business, King's College LondonLondon, UK
| | - Elif H. Vural
- Turkish Medicines and Medical Devices Agency, Ministry of HealthAnkara, Turkey
| | - Corinne Zara
- Catalan Health Service - Servei Català de la SalutBarcelona, Spain
| | - Brian Godman
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital HuddingeStockholm, Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of StrathclydeGlasgow, UK
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Abdel-Ghaffar TY, Sira MM, El Naghi S. Hepatitis C genotype 4: The past, present, and future. World J Hepatol 2015; 7:2792-2810. [PMID: 26668691 PMCID: PMC4670951 DOI: 10.4254/wjh.v7.i28.2792] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 08/02/2015] [Accepted: 11/25/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) genotype (GT) 4 represents 12%-15% (15-18 million) of total global HCV infection. It is prevalent in Northern and Equatorial Africa and the Middle East, and is also present in some countries in Europe. GT-4 (and subtype 4a in particular) dominates the HCV epidemic in Egypt. In underdeveloped countries, risk factors associated with HCV infection may be due to unsafe medical practices or other factors such as familial transmission, mother’s HCV status, or illiteracy. HCV prevention and control programs should include health education, increased community awareness towards the disease, controlling infection distribution in health-care centers, proper sterilization of medical and dental instruments, and ensuring safe supply of blood and blood-products. Response rates to a 48-wk combined pegylated-interferon (PEG-IFN) and ribavirin (RBV) treatment range from 40%-69%, and HCV-GT-4 has been considered better than GT-1 but worse than GT-2 and GT-3 in treatment with PEG-IFN/RBV. However, with the introduction of the HCV-GT-1 effective protease inhibitors boceprevir and telaprevir in 2011, HCV-GT-4 became the “most difficult (GT) to treat”. Recently, the direct-acting antivirals (DAAs) with pan- genotypic activities simeprevir, sofosbuvir, and daclatasvir have been recommended in triple regimens with PEG-IFN/RBV for the treatment of HCV-GT-4. An IFN-free regimen will be available for treatment of all genotypes of HCV in the near future. To date, several DAAs have been developed and are currently being evaluated in various combinations in clinical trials. As new regimens and new agents are being approved by the Food and Drug Administration, we can expect the guidelines for HCV treatment to be changed. The availability of shorter, simpler, and more tolerable treatment regimens can reduce the morbidity and mortality associated with HCV infection. With such a large number of therapeutic agents available, we can end up with a range of choices that we can select from to treat patients.
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Nguyen NH, Nguyen MH. Current Treatment Options in Patients with Hepatitis C Virus Genotype 6. Gastroenterol Clin North Am 2015; 44:871-81. [PMID: 26600225 DOI: 10.1016/j.gtc.2015.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Approximately 3% of the world's population is chronically infected with hepatitis C virus (HCV). In some southeast Asian countries the prevalence of HCV (∼6%-7%) far exceeds that seen in the United States (1.8%). The lesser known HCV genotype 6 (HCV-6) is also common in patients from southeast Asia and the surrounding regions. Most data on direct-acting antivirals (DAAs) to date have been derived from clinical trials conducted in Western countries, where HCV-6 is rare. The standard of care for patients with HCV-6 is still pegylated interferon and ribavirin. However, data are emerging for several DAA combinations.
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Affiliation(s)
- Nghia H Nguyen
- School of Medicine, University of California, San Diego, La Jolla, CA, USA; Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Mindie H Nguyen
- Liver Transplant Program, Division of Gastroenterology and Hepatology, Stanford University Medical Center, 750 Welch Road, #210, Palo Alto, CA 94304, USA.
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Ruta S, Cernescu C. Injecting drug use: A vector for the introduction of new hepatitis C virus genotypes. World J Gastroenterol 2015; 21:10811-10823. [PMID: 26478672 PMCID: PMC4600582 DOI: 10.3748/wjg.v21.i38.10811] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 06/19/2015] [Accepted: 09/15/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) genotypes’ monitoring allows real-time insight into the dynamic changes that occur in the global epidemiological picture of HCV infection. Intravenous drug use is currently the primary driver for HCV transmission in developed and developing countries. The distribution of HCV genotypes/subtypes differs significantly between people who inject drugs (PWID) and the general population. HCV genotypes that previously exhibited a limited geographical distribution (3a, 4) are becoming more prevalent in this high-risk group. Immigration from HCV-endemic countries and the evolving networks of HCV transmission in PWID influence HCV genotypes distribution in Europe. Social vulnerabilities (e.g., unemployment, homelessness, and limited access to social and healthcare insurances systems) are important triggers for illicit drug use, which increases the associated risks of HCV infection and the frequent emergence of less prevalent genotypes. Genotype/subtype determination bears important clinical consequences in the progression of liver disease, susceptibility to antiviral therapies and the emergence of resistance-associated variants. An estimated half of the chronically HCV-infected PWID are unaware of their infection, and only one in ten of those diagnosed enter treatment. Nevertheless, PWID exhibit high response rates to new antiviral regimens, and the level of HCV reinfection is unexpectedly low. The focus of the healthcare system must be on the early detection and treatment of infection, to avoid late presentations that are associated with high levels of viremia and liver fibrosis, which may diminish the therapeutic success rate.
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Darwish SF, El-Bakly WM, El-Naga RN, Awad AS, El-Demerdash E. Antifibrotic mechanism of deferoxamine in concanavalin A induced-liver fibrosis: Impact on interferon therapy. Biochem Pharmacol 2015; 98:231-42. [PMID: 26358138 DOI: 10.1016/j.bcp.2015.09.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/02/2015] [Indexed: 02/07/2023]
Abstract
Iron-overload is a well-known factor of hepatotoxicity and liver fibrosis, which found to be a common finding among hepatitis C virus patients and related to interferon resistance. We aimed to elucidate the potential antifibrotic effect of deferoxamine; the main iron chelator, and its additional usefulness to interferon-based therapy in concanavalin A-induced immunological model of liver fibrosis. Rats were treated with deferoxamine and/or pegylated interferon-α for 6 weeks. Hepatotoxicity indices, oxidative stress, inflammatory and liver fibrosis markers were assessed. Concanavalin A induced a significant increase in hepatotoxicity indices and lipid peroxidation accompanied with a significant depletion of total antioxidant capacity, glutathione level and superoxide dismutase activity. Besides, it increased CD4(+) T-cells content and the downstream inflammatory cascades, including NF-κB, TNF-α, iNOS, COX-2, IL-6 and IFN-γ. Furthermore, α-SMA, TGF-β1 and hydroxyproline were increased markedly, which confirmed by histopathology. Treatment with either deferoxamine or pegylated interferon-α alone reduced liver fibrosis markers significantly and improved liver histology. However, some of the hepatotoxicity indices and oxidative stress markers did not improve upon pegylated interferon-α treatment alone, besides the remarkable increase in IL-6. Combination therapy of deferoxamine with pegylated interferon-α further improved all previous markers, ameliorated IL-6 elevation, as well as increased hepcidin expression. In conclusion, our study provides evidences for the potent antifibrotic effects of deferoxamine and the underlying mechanisms that involved attenuating oxidative stress and subsequent inflammatory cascade, as well as the production of profibrogenic factors. Addition of deferoxamine to interferon regimen for HCV patients may offer a promising adjuvant modality to enhance therapeutic response.
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Affiliation(s)
- Samar F Darwish
- Central Administration of Pharmaceutical Affairs, Cairo, Egypt
| | - Wesam M El-Bakly
- Pharmacology & Therapeutic Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Reem N El-Naga
- Pharmacology & Toxicology Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Azza S Awad
- Pharmacology & Toxicology Department, Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt
| | - Ebtehal El-Demerdash
- Pharmacology & Toxicology Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.
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