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Ugarte A, De La Mora L, De Lazzari E, Chivite I, Fernández E, Inciarte A, Laguno M, Ambrosioni J, Solbes E, Berrocal L, González-Cordón A, Martínez-Rebollar M, Foncillas A, Calvo J, Blanco JL, Martínez E, Mallolas J, Torres B. Rapid initiation of bictegravir/emtricitabine/tenofovir alafenamide as first-line therapy in HIV infection. A prospective study. J Antimicrob Chemother 2024; 79:2343-2353. [PMID: 39045754 DOI: 10.1093/jac/dkae235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/22/2024] [Indexed: 07/25/2024] Open
Abstract
INTRODUCTION Rapid initiation of ART after HIV diagnosis is recommended for individual and public health benefits. However, certain clinical and ART-related considerations hinder immediate initiation of therapy. METHODS An open-label, single-arm, single-centre 48-week prospective clinical trial involving ART-naïve HIV-diagnosed adults who started bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) within a week from the first hospital visit, before the availability of baseline laboratory and genotype results. The primary aim was to determine the proportion of people with at least one condition that would hinder immediate initiation of any recommended ART regimen other than BIC/FTC/TAF. Clinicaltrials.gov: NCT04416906. RESULTS We included 100 participants: 79% men, 64% from Latin America, median age 32 years. According to European AIDS Clinical Society (EACS) and US Department of Health and Human Services 2023 guidelines, 11% (95%CI 6; 19) of participants had at least one condition that made any ART different from BIC/FTC/TAF less appropriate for a rapid ART strategy. Seventy-nine percent of the people started BIC/FTC/TAF within the first 48 hours of their first hospital visit. There were 16 early discontinuations (11 lost to follow-up). By week 48, 92% (95%CI 86; 98) of the participants of the ITT population with observed data achieved viral suppression. Eight grade 3-4 adverse events (AEs), five serious AEs and six ART-related AEs were identified. Adherence remained high. CONCLUSIONS BIC/FTC/TAF is an optimal treatment for rapid initiation of ART. However, additional strategies to improve retention in care must be implemented.
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Affiliation(s)
- Ainoa Ugarte
- HIV Unit, Infectious Diseases Service, Hospital Clinic of Barcelona, Villarroel Street 170, Barcelona 08036, Spain
- University of Barcelona, Barcelona, Spain
| | - Lorena De La Mora
- HIV Unit, Infectious Diseases Service, Hospital Clinic of Barcelona, Villarroel Street 170, Barcelona 08036, Spain
- University of Barcelona, Barcelona, Spain
| | - Elisa De Lazzari
- HIV Unit, Infectious Diseases Service, Hospital Clinic of Barcelona, Villarroel Street 170, Barcelona 08036, Spain
- University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Carlos III, Madrid, Spain
| | - Iván Chivite
- HIV Unit, Infectious Diseases Service, Hospital Clinic of Barcelona, Villarroel Street 170, Barcelona 08036, Spain
- University of Barcelona, Barcelona, Spain
| | - Emma Fernández
- HIV Unit, Infectious Diseases Service, Hospital Clinic of Barcelona, Villarroel Street 170, Barcelona 08036, Spain
| | - Alexy Inciarte
- HIV Unit, Infectious Diseases Service, Hospital Clinic of Barcelona, Villarroel Street 170, Barcelona 08036, Spain
- University of Barcelona, Barcelona, Spain
| | - Montserrat Laguno
- HIV Unit, Infectious Diseases Service, Hospital Clinic of Barcelona, Villarroel Street 170, Barcelona 08036, Spain
- University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Carlos III, Madrid, Spain
| | - Juan Ambrosioni
- HIV Unit, Infectious Diseases Service, Hospital Clinic of Barcelona, Villarroel Street 170, Barcelona 08036, Spain
- University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Carlos III, Madrid, Spain
| | - Estela Solbes
- HIV Unit, Infectious Diseases Service, Hospital Clinic of Barcelona, Villarroel Street 170, Barcelona 08036, Spain
| | - Leire Berrocal
- HIV Unit, Infectious Diseases Service, Hospital Clinic of Barcelona, Villarroel Street 170, Barcelona 08036, Spain
| | - Ana González-Cordón
- HIV Unit, Infectious Diseases Service, Hospital Clinic of Barcelona, Villarroel Street 170, Barcelona 08036, Spain
- University of Barcelona, Barcelona, Spain
| | - María Martínez-Rebollar
- HIV Unit, Infectious Diseases Service, Hospital Clinic of Barcelona, Villarroel Street 170, Barcelona 08036, Spain
- University of Barcelona, Barcelona, Spain
| | - Alberto Foncillas
- HIV Unit, Infectious Diseases Service, Hospital Clinic of Barcelona, Villarroel Street 170, Barcelona 08036, Spain
- University of Barcelona, Barcelona, Spain
| | - Júlia Calvo
- HIV Unit, Infectious Diseases Service, Hospital Clinic of Barcelona, Villarroel Street 170, Barcelona 08036, Spain
| | - José Luis Blanco
- HIV Unit, Infectious Diseases Service, Hospital Clinic of Barcelona, Villarroel Street 170, Barcelona 08036, Spain
- University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Carlos III, Madrid, Spain
| | - Esteban Martínez
- HIV Unit, Infectious Diseases Service, Hospital Clinic of Barcelona, Villarroel Street 170, Barcelona 08036, Spain
- University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Carlos III, Madrid, Spain
| | - Josep Mallolas
- HIV Unit, Infectious Diseases Service, Hospital Clinic of Barcelona, Villarroel Street 170, Barcelona 08036, Spain
- University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Carlos III, Madrid, Spain
| | - Berta Torres
- HIV Unit, Infectious Diseases Service, Hospital Clinic of Barcelona, Villarroel Street 170, Barcelona 08036, Spain
- University of Barcelona, Barcelona, Spain
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Olivas P, Perez-Campuzano V, Orts L, Montironi C, Magaz M, Ruiz P, Shalaby S, Ojeda A, Rosich P, Baiges A, Turon F, Lens S, García Pagán JC, Hernández-Gea V. Porto-sinusoidal vascular disorder in chronic HBV: A significant coexistence not to be overlooked. JHEP Rep 2024; 6:100996. [PMID: 38384671 PMCID: PMC10879788 DOI: 10.1016/j.jhepr.2023.100996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/16/2023] [Accepted: 12/17/2023] [Indexed: 02/23/2024] Open
Abstract
Background & Aims Porto-sinusoidal vascular disorder (PSVD) encompasses a group of liver diseases with vascular abnormalities that can cause portal hypertension in the absence of cirrhosis. The new diagnostic criteria allow for coexistence with other liver diseases, however its relationship with chronic hepatitis B (CHB) remains unclear. This study aimed to assess HBV prevalence in a PSVD cohort and evaluate its clinical impact. Methods This retrospective study was conducted on patients with PSVD at Hospital Clínic Barcelona. HBV serology was evaluated, and patients were categorized into HBV chronic infection, past infection, or no HBV exposure. Clinical characteristics and outcomes were compared. Results We included 155 patients with PSVD. Prevalence of CHB and past HBV infection in patients with PSVD was higher than in the general population (5.8% vs. 0.5%, p <0.0001 and 20% vs. 9.1%, p <0.0001, respectively). Patients with CHB had a significant delay in PSVD diagnosis compared to those without CHB (11 [5-25] vs. 1 [0-3] years, p = 0.002) and had a more advanced disease (MELD score 12 [9-17] vs. 9 [7-11], p = 0.012) at the time of PSVD diagnosis. The clinical evolution of PSVD in patients with CHB was marked by a significantly higher transplantation rate at the last follow-up (33% vs. 4.1%, p = 0.001). Conclusions Recognizing the coexistence of PSVD and CHB is important for timely diagnosis and optimal management, highlighting the potential benefits of specialized care for potentially improved outcomes. Impact and implications The new diagnostic criteria for porto-sinusoidal vascular disorder (PSVD) allow for coexistence with other liver diseases. The results of the present study highlight, for the first time, a non-negligible prevalence of chronic hepatitis B in the PSVD population that was previously unknown. Coexistence may challenge and delay the PSVD diagnosis and is associated with a more unfavorable clinical course. Our findings will increase awareness of this coexistence and improve PSVD diagnosis and management. Furthermore, the data will encourage new studies to determine the prevalence and clinical behavior of other chronic liver diseases that coexist with PSVD.
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Affiliation(s)
- Pol Olivas
- Liver Unit, Hospital Clínic, Fundació Recerca Clínic Barcelona- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Departament de Medicina i Ciències de la Salut. Universitat de Barcelona. Centro de Investigación biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
- Barcelona Hepatic Hemodynamic Laboratory, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN RARE-Liver), AGAUR 2021 SGR 01115, Barcelona, Spain
| | - Valeria Perez-Campuzano
- Liver Unit, Hospital Clínic, Fundació Recerca Clínic Barcelona- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Departament de Medicina i Ciències de la Salut. Universitat de Barcelona. Centro de Investigación biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
- Barcelona Hepatic Hemodynamic Laboratory, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN RARE-Liver), AGAUR 2021 SGR 01115, Barcelona, Spain
| | - Lara Orts
- Liver Unit, Hospital Clínic, Fundació Recerca Clínic Barcelona- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Departament de Medicina i Ciències de la Salut. Universitat de Barcelona. Centro de Investigación biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
- Barcelona Hepatic Hemodynamic Laboratory, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN RARE-Liver), AGAUR 2021 SGR 01115, Barcelona, Spain
| | - Carla Montironi
- Department of Pathology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Marta Magaz
- Liver Unit, Hospital Clínic, Fundació Recerca Clínic Barcelona- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Departament de Medicina i Ciències de la Salut. Universitat de Barcelona. Centro de Investigación biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
- Barcelona Hepatic Hemodynamic Laboratory, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN RARE-Liver), AGAUR 2021 SGR 01115, Barcelona, Spain
| | - Pablo Ruiz
- Liver Unit, Hospital Clínic, Fundació Recerca Clínic Barcelona- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Departament de Medicina i Ciències de la Salut. Universitat de Barcelona. Centro de Investigación biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Sarah Shalaby
- Liver Unit, Hospital Clínic, Fundació Recerca Clínic Barcelona- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Departament de Medicina i Ciències de la Salut. Universitat de Barcelona. Centro de Investigación biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
- Barcelona Hepatic Hemodynamic Laboratory, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN RARE-Liver), AGAUR 2021 SGR 01115, Barcelona, Spain
| | - Asunción Ojeda
- Liver Unit, Hospital Clínic, Fundació Recerca Clínic Barcelona- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Departament de Medicina i Ciències de la Salut. Universitat de Barcelona. Centro de Investigación biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
- Barcelona Hepatic Hemodynamic Laboratory, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN RARE-Liver), AGAUR 2021 SGR 01115, Barcelona, Spain
| | - Pau Rosich
- Liver Unit, Hospital Clínic, Fundació Recerca Clínic Barcelona- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Departament de Medicina i Ciències de la Salut. Universitat de Barcelona. Centro de Investigación biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
- Barcelona Hepatic Hemodynamic Laboratory, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN RARE-Liver), AGAUR 2021 SGR 01115, Barcelona, Spain
| | - Anna Baiges
- Liver Unit, Hospital Clínic, Fundació Recerca Clínic Barcelona- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Departament de Medicina i Ciències de la Salut. Universitat de Barcelona. Centro de Investigación biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
- Barcelona Hepatic Hemodynamic Laboratory, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN RARE-Liver), AGAUR 2021 SGR 01115, Barcelona, Spain
| | - Fanny Turon
- Liver Unit, Hospital Clínic, Fundació Recerca Clínic Barcelona- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Departament de Medicina i Ciències de la Salut. Universitat de Barcelona. Centro de Investigación biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
- Barcelona Hepatic Hemodynamic Laboratory, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN RARE-Liver), AGAUR 2021 SGR 01115, Barcelona, Spain
| | - Sabela Lens
- Liver Unit, Hospital Clínic, Fundació Recerca Clínic Barcelona- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Departament de Medicina i Ciències de la Salut. Universitat de Barcelona. Centro de Investigación biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Juan Carlos García Pagán
- Liver Unit, Hospital Clínic, Fundació Recerca Clínic Barcelona- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Departament de Medicina i Ciències de la Salut. Universitat de Barcelona. Centro de Investigación biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
- Barcelona Hepatic Hemodynamic Laboratory, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN RARE-Liver), AGAUR 2021 SGR 01115, Barcelona, Spain
| | - Virginia Hernández-Gea
- Liver Unit, Hospital Clínic, Fundació Recerca Clínic Barcelona- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Departament de Medicina i Ciències de la Salut. Universitat de Barcelona. Centro de Investigación biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
- Barcelona Hepatic Hemodynamic Laboratory, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN RARE-Liver), AGAUR 2021 SGR 01115, Barcelona, Spain
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Rocabert A, Borjabad B, Berrocal L, Blanch J, Inciarte A, Chivite I, Gonzalez-Cordon A, Torres B, Ambrosioni J, Martinez-Rebollar M, Laguno M, De La Mora L, Foncillas A, Sempere A, Rodriguez A, Solbes E, Llobet R, Miro JM, Mallolas J, Blanco JL, De Lazzari E, Martinez E. Tolerability of bictegravir/tenofovir alafenamide/emtricitabine versus dolutegravir/lamivudine as maintenance therapy in a real-life setting. J Antimicrob Chemother 2023; 78:2961-2967. [PMID: 37875023 DOI: 10.1093/jac/dkad338] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/11/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND While both the burden of therapy and the individual drugs in bictegravir/tenofovir alafenamide/emtricitabine (BIC/TAF/FTC) and dolutegravir/lamivudine differ, it is unclear whether their real-life tolerability may be also different. METHODS Single-centre, clinical cohort analysis of all virologically suppressed persons with HIV (PWH) who were first prescribed bictegravir as BIC/TAF/FTC or dolutegravir as dolutegravir/lamivudine and had taken ≥1 dose of study medication. Major outcomes were discontinuations either for any reason or due to toxicity. Incidence was calculated as number of episodes per 100 person-years adjusted through propensity score analysis. RESULTS Relative to persons treated with BIC/TAF/FTC (n = 1231), persons treated with dolutegravir/lamivudine (n = 821) were older and had more AIDS-defining conditions although better HIV control. After a median follow-up of 52 weeks, adjusted incidence rates for discontinuation were 6.68 (95% CI 5.18-8.19) and 8.44 (95% CI 6.29-10.60) episodes per 100 person-years for BIC/TAF/FTC and dolutegravir/lamivudine, respectively; adjusted incidence rate ratio for dolutegravir/lamivudine was 1.26 (95% CI 0.89-1.78) relative to BIC/TAF/FTC (P = 0.1847). Adjusted incidence rates for discontinuation due to toxicity were 3.88 (95% CI 2.70-5.06) and 4.62 (95% CI 3.05-6.19) episodes per 100 person-years for BIC/TAF/FTC and dolutegravir/lamivudine, respectively; adjusted incidence rate ratio for dolutegravir/lamivudine was 1.19 (95% CI 0.75-1.90) relative to BIC/TAF/FTC (P = 0. 4620). Adverse events leading to discontinuation were neuropsychiatric (n = 42; 2%), followed by gastrointestinal (n = 23; 1%), dermatological (n = 15; 1%) and weight increase (n = 15; 1%), without differences between regimens. CONCLUSIONS Switching to BIC/TAF/FTC or dolutegravir/lamivudine showed no difference in the risks of overall or toxicity-related discontinuations or in the profile of adverse events leading to discontinuation.
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Affiliation(s)
- Alba Rocabert
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Beatriz Borjabad
- Service of Internal Medicine, Hospital Moises Broggi, Sant Joan Despí, Spain
| | - Leire Berrocal
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Jordi Blanch
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Alexy Inciarte
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Ivan Chivite
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | - Berta Torres
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Juan Ambrosioni
- Hospital Clínic, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Maria Martinez-Rebollar
- Hospital Clínic, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Montserrat Laguno
- Hospital Clínic, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Abiu Sempere
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Ana Rodriguez
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Estela Solbes
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Roger Llobet
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Jose M Miro
- Hospital Clínic, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Mallolas
- Hospital Clínic, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Jose L Blanco
- Hospital Clínic, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Elisa De Lazzari
- Hospital Clínic, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Esteban Martinez
- Hospital Clínic, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Crespo J, Cabezas J, Aguilera A, Berenguer M, Buti M, Forns X, García F, García-Samaniego J, Hernández-Guerra M, Jorquera F, Lazarus JV, Lens S, Martró E, Pineda JA, Prieto M, Rodríguez-Frías F, Rodríguez M, Serra MÁ, Turnes J, Domínguez-Hernández R, Casado MÁ, Calleja JL. Recommendations for the integral diagnosis of chronic viral hepatitis in a single analytical extraction. GASTROENTEROLOGIA Y HEPATOLOGIA 2023; 46:150-162. [PMID: 36257502 DOI: 10.1016/j.gastrohep.2022.09.009] [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: 07/29/2022] [Revised: 09/08/2022] [Accepted: 09/28/2022] [Indexed: 11/11/2022]
Abstract
The Spanish Society of Digestive Pathology (SEPD), the Spanish Association for the Study of the Liver (AEEH), the Spanish Society of Infections and Clinical Microbiology (SEIMC) and its Viral Hepatitis Study Group (GEHEP), and with the endorsement of the Alliance for the Elimination of Viral Hepatitis in Spain (AEHVE), have agreed on a document to carry out a comprehensive diagnosis of viral hepatitis (B, C and D), from a single blood sample; that is, a comprehensive diagnosis, in the hospital and/or at the point of care of the patient. We propose an algorithm, so that the positive result in a viral hepatitis serology (B, C and D), as well as human immunodeficiency virus (HIV), would trigger the analysis of the rest of the virus, including the viral load when necessary, in the same blood draw. In addition, we make two additional recommendations. First, the need to rule out a previous hepatitis A virus (VHA) infection, to proceed with its vaccination in cases where IgG-type studies against this virus are negative and the vaccine is indicated. Second, the determination of the HIV serology. Finally, in case of a positive result for any of the viruses analyzed, there must be an automated alerts and initiate epidemiological monitoring.
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Affiliation(s)
- Javier Crespo
- Servicio de Gastroenterología y Hepatología, Grupo de Investigación Clínica y Traslacional en Enfermedades Digestivas, Instituto de Investigación Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, España.
| | - Joaquín Cabezas
- Servicio de Gastroenterología y Hepatología, Grupo de Investigación Clínica y Traslacional en Enfermedades Digestivas, Instituto de Investigación Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Antonio Aguilera
- Servicio de Microbiología, Hospital Clínico Universitario de Santiago de Compostela, Departamento de Microbioloxía y Parasitoloxía, Universidade de Santiago de Compostela, A Coruña, España
| | - Marina Berenguer
- Unidad de Hepatología y Trasplante Hepático y CIBEREHD, Hospital Universitario y Politécnico La Fe; IIS La Fe y Universidad de Valencia, Valencia, España
| | - María Buti
- Servicio de Hepatología, Hospital Universitario Valle Hebrón y CIBEREHD del Instituto Carlos III, Barcelona, España
| | - Xavier Forns
- Servicio de Hepatología, Hospital Clínic, Universidad de Barcelona, IDIBAPS, CIBEREHD, Barcelona, España
| | - Federico García
- Servicio de Microbiología, Hospital Universitario Clínico San Cecilio, Instituto de Investigación IBS, Ciber de Enfermedades Infecciosas (CIBERINFEC), Granada, España
| | | | - Manuel Hernández-Guerra
- Servicio de Aparato Digestivo, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, España
| | - Francisco Jorquera
- Servicio de Aparato Digestivo, Complejo Asistencial Universitario de León, IBIOMED y CIBEREHD, León, España
| | - Jeffrey V Lazarus
- Instituto de Salud Global de Barcelona (ISGlobal), Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - Sabela Lens
- Servicio de Hepatología, Hospital Clínic de Barcelona, IDIBAPS, CIBEREHD, Universidad de Barcelona, Barcelona, España
| | - Elisa Martró
- Servicio de Microbiología, Laboratori Clínic Metropolitana Nord (LCMN), Hospital Universitario Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona (Barcelona), España, Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, España
| | - Juan Antonio Pineda
- Departamento de Medicina, Universidad de Sevilla, Hospital Universitario de Valme, Ciber de Enfermedades Infecciosas (CIBERINFEC), Sevilla, España
| | - Martín Prieto
- Unidad de Hepatología y Trasplante Hepático, Hospital Universitario y Politécnico La Fe, Valencia, CIBEREHD, Instituto de Salud Carlos III, Madrid, España
| | - Francisco Rodríguez-Frías
- Servicios de Microbiología y Bioquímica, Laboratorios Clínicos Hospital Universitario Vall d'Hebron, CIBEREHD, Instituto de investigación Vall d'Hebron (VHIR), Barcelona, España
| | - Manuel Rodríguez
- Sección de Hepatología, Servicio de Digestivo, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Universidad de Oviedo, Oviedo, España
| | - Miguel Ángel Serra
- Catedrático Jubilado de Medicina, Universidad de Valencia, Valencia, España
| | - Juan Turnes
- Servicio de Digestivo, Hospital Universitario de Pontevedra, Pontevedra, España
| | | | | | - José Luis Calleja
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Puerta de Hierro, Instituto de Investigación Puerta de Hierro Majadahonda (IDIPHIM), Universidad Autónoma de Madrid, Madrid, España
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Santos M, Corma-Gómez A, Fernandez-Fuertes M, González-Serna A, Rincón P, Real LM, Pineda JA, Macías J. Burden of significant liver damage in people living with HIV after microelimination of the hepatitis C virus. J Infect 2023; 86:41-46. [PMID: 36410455 DOI: 10.1016/j.jinf.2022.11.004] [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: 03/17/2022] [Revised: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Once HIV/HCV-coinfection microelimination has been virtually achieved in some countries, there is no information about the burden of liver disease among people living with HIV (PLWH). The aim of this study was to define the current prevalence and causes of significant liver damage (SLD) in PLWH. METHODS Cross-sectional study including 619 PLWH. SLD was defined as liver stiffness (LS) ≥ 7.2 kPa measured by transient elastography. Nonviral liver damage (NVLD) was considered if there was no evidence injury due to chronic hepatitis C virus (HCV) infection, active hepatitis B (HBV) or E virus infections. RESULTS One hundred and twelve of 619 (18.2%) PLWH showed SLD, including 34/112 (5.5%) with LS ≥14 kPa. 72/112 (64.3%) had cured HCV infection, 4/112 (3.6%) active HBV infection, and 2/112 HBV/prior HCV coinfection. Thus, 40 (35.7%) showed NVLD. Metabolic associated steatohepatitis (MASH) was present in 29/40 (72.5%) of patients with NVLD, alcoholic liver damage in 2/40 (2.5%) and mixed steatohepatitis in 5/40 (12.5%). CONCLUSIONS After HIV/HCV microelimination the burden of liver damage is high among PLWH. Persistent injury after HCV is a very frequent cause of SLD. However, NVLD, mainly due to MASH, is also a common condition in this population.
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Affiliation(s)
- M Santos
- Unidad de Enfermedades Infecciosas y Microbiología. Hospital Universitario Virgen de Valme. Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Spain; CIBERINFEC. Spain
| | - A Corma-Gómez
- Unidad de Enfermedades Infecciosas y Microbiología. Hospital Universitario Virgen de Valme. Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Spain; CIBERINFEC. Spain
| | - M Fernandez-Fuertes
- Unidad de Enfermedades Infecciosas y Microbiología. Hospital Universitario Virgen de Valme. Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Spain; CIBERINFEC. Spain
| | - A González-Serna
- Unidad de Enfermedades Infecciosas y Microbiología. Hospital Universitario Virgen de Valme. Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Spain; CIBERINFEC. Spain; Department of Physiology, University of Sevilla. Sevilla, Spain
| | - P Rincón
- Unidad de Enfermedades Infecciosas y Microbiología. Hospital Universitario Virgen de Valme. Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Spain; CIBERINFEC. Spain
| | - L M Real
- Unidad de Enfermedades Infecciosas y Microbiología. Hospital Universitario Virgen de Valme. Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Spain; CIBERINFEC. Spain; Department of Surgical Specialties, Biochemistry and Immunology. University of Málaga, Málaga, Spain
| | - J A Pineda
- Unidad de Enfermedades Infecciosas y Microbiología. Hospital Universitario Virgen de Valme. Sevilla, Spain; CIBERINFEC. Spain; Department of Medicine. University of Sevilla. Sevilla, Spain.
| | - J Macías
- Unidad de Enfermedades Infecciosas y Microbiología. Hospital Universitario Virgen de Valme. Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Spain; CIBERINFEC. Spain; Department of Medicine. University of Sevilla. Sevilla, Spain
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