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D'Ambrosio R, Anolli MP, Pugliese N, Masetti C, Aghemo A, Lampertico P. Prevalence of HCV infection in Europe in the DAA era: Review. Liver Int 2024; 44:1548-1563. [PMID: 38804727 DOI: 10.1111/liv.15981] [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: 04/13/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024]
Abstract
In 2016, the Global Health Sector Strategy, ratified by the 69th World Health Assembly, set the ambitious goal of eliminating hepatitis C virus (HCV) and hepatitis B virus infections by 2030, emphasizing the importance of national screening programmes. Achieving this goal depends on each country's ability to identify and treat 80% of chronic hepatitis C cases, a critical threshold set by the World Health Organization. Traditionally, estimates of HCV prevalence have been based on interferon era studies that focused on high-risk subgroups rather than the general population. In addition, the incomplete data available from national registries also limited the understanding of HCV prevalence. The 2016 report from the European Centre for Disease Prevention and Control highlighted that HCV rates varied across European counties, ranging from .1% to 5.9%. However, data were only available for 13 countries, making the overall picture less clear. Additionally, the epidemiological data may have underestimated the true burden of HCV due to lack of awareness among those with chronic infection. The main objective of this review is to provide a comprehensive summary of HCV epidemiology in Europe in the current era of direct-acting antivirals (DAAs). The data included in the analysis range from the end of 2013 to December 2023 and have been categorised according to the United Nations Geoscheme. The resulting synthesis underscores the noteworthy impact of DAA treatment on the epidemiological situation.
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Affiliation(s)
- Roberta D'Ambrosio
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria P Anolli
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Pugliese
- Division of Internal Medicine and Hepatology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Science, Humanitas University, Milan, Italy
| | - Chiara Masetti
- Division of Internal Medicine and Hepatology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Alessio Aghemo
- Division of Internal Medicine and Hepatology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Science, Humanitas University, Milan, Italy
| | - Pietro Lampertico
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, CRC "A. M. and A. Migliavacca" Centre for Liver Disease, University of Milan, Milan, Italy
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2
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Christensen PB, Debrabant B, Cowan S, Debrabant K, Øvrehus A, Duberg AS. Hepatitis C time trends in reported cases and estimates of the hidden population born before 1965, Denmark and Sweden, 1990 to 2020. Euro Surveill 2022; 27:2200243. [PMID: 36695470 PMCID: PMC9808318 DOI: 10.2807/1560-7917.es.2022.27.50.2200243] [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] [Indexed: 12/23/2022] Open
Abstract
BackgroundAccording to the World Health Organization, hepatitis C virus (HCV) infection should be under control by 2030.AimOur aim was to describe the size and temporal changes in reported cases of chronic HCV infection in Denmark and Sweden and to estimate the size of the hidden (undiagnosed) population born before 1965.MethodsWe extracted all HCV infections reported to national surveillance systems in Denmark and Sweden from 1990 to 2020. Prediction of the size of the hidden HCV-infected population was restricted to the cohort born before 1965 and cases reported up to 2017. We applied a model based on removal sampling from binomial distributions, estimated the yearly probability of diagnosis, and deducted the original HCV-infected population size.ResultsDenmark (clinician-based) reported 10 times fewer hepatitis C cases annually than Sweden (laboratory and clinician-based), peaking in 2007 (n = 425) and 1992 (n = 4,537), respectively. In Denmark, the birth year distribution was monophasic with little change over time. In recent years, Sweden has had a bimodal birth year distribution, suggesting ongoing infection in the young population. In 2017, the total HCV-infected population born before 1965 was estimated at 10,737 living persons (95% confidence interval (CI): 9,744-11,806), including 5,054 undiagnosed, in Denmark and 16,124 (95% CI: 13,639-18,978), including 10,580 undiagnosed, in Sweden.ConclusionsThe reporting of HCV cases in Denmark and Sweden was different. For Denmark, the estimated hidden population was larger than the current national estimate, whereas in Sweden the estimate was in line with the latest published numbers.
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Affiliation(s)
- Peer Brehm Christensen
- Department of Infectious Diseases Q, Odense University Hospital, Denmark,Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Birgit Debrabant
- Department of Mathematics and Computer Science, University of Southern Denmark, Odense, Denmark,Department of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Susan Cowan
- Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Kristian Debrabant
- Department of Mathematics and Computer Science, University of Southern Denmark, Odense, Denmark
| | - Anne Øvrehus
- Department of Infectious Diseases Q, Odense University Hospital, Denmark,Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Ann-Sofi Duberg
- Department of Infectious Diseases, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Sweden
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3
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Colombe S, Axelsson M, Aleman S, Duberg AS, Lundberg Ederth J, Dahl V. Monitoring the progress towards the elimination of hepatitis B and C in Sweden: estimation of core indicators for 2015 and 2018. BMC Infect Dis 2022; 22:885. [PMCID: PMC9700967 DOI: 10.1186/s12879-022-07886-2] [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: 02/14/2022] [Accepted: 11/18/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction To monitor Sweden’s progress towards the WHO goal of eliminating viral hepatitis, we estimated the prevalence, notification rate, and liver-related morbidity and mortality for diagnosed hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in 2015 and 2018. Methods We identified cases of hepatitis B and C within the National System for Notifiable Diseases and obtained data on treatment and whether the case was deceased or not. We calculated prevalence, notification rates per 100,000, and proportion of newly diagnosed cases of hepatitis with liver disease at the time of diagnosis, and proportion of all deceased cases who died from liver disease. We calculated Poisson 95% confidence intervals (CIs) around the notification rates and Wilson 95% CIs around prevalence and mortality estimates. Results In 2015 and 2018, the prevalence of diagnosed HBV infections was 0.20% [95% CI: 0.19–0.20] and 0.21% [0.20–0.21]. Notification rates per 100,000 for HBV infections were 13.02 [12.32–13.76] and 7.71 [7.18–8.27]. HBV liver-related morbidity was 2.65% [1.90–3.68] and 2.16% [1.35–3.43]. HBV liver-related mortality was 20.00% [14.81–26.44] and 17.95% [13.20–23.94]. In 2015 and 2018, the prevalence of diagnosed HCV-infections was 0.24% [0.24–0.25] and 0.18% [0.18–0.19]. Notification rates per 100,000 for HCV infections were 15.92 [15.14–16.73] and 13.05 [12.36–13.77]. HCV liver–related morbidity was 8.14% [6.89–9.60] and 3.90% [2.99–5.08]. HCV liver–related mortality was 27.08% [24.54–29.77] and 26.90% [24.12–29.88]. Conclusions All indicators decreased or remained stable between 2015 and 2018, indicating progress in the elimination of viral hepatitis, especially for HCV infection.
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Affiliation(s)
- Soledad Colombe
- grid.419734.c0000 0000 9580 3113Public Health Agency of Sweden, Solna, Sweden ,grid.418914.10000 0004 1791 8889European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden ,grid.11505.300000 0001 2153 5088Outbreak Research Team, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Maria Axelsson
- grid.419734.c0000 0000 9580 3113Public Health Agency of Sweden, Solna, Sweden
| | - Soo Aleman
- grid.24381.3c0000 0000 9241 5705Department of Infectious Diseases, Karolinska University Hospital/Karolinska Institutet, Stockholm, Sweden
| | - Ann-Sofi Duberg
- grid.15895.300000 0001 0738 8966Department of Infectious Diseases, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Viktor Dahl
- grid.419734.c0000 0000 9580 3113Public Health Agency of Sweden, Solna, Sweden
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4
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Blach S, Blomé M, Duberg A, Jerkeman A, Kåberg M, Klasa P, Lagging M, Razavi‐Shearer D, Razavi H, Aleman S. Hepatitis C elimination in Sweden: Progress, challenges and opportunities for growth in the time of COVID-19. Liver Int 2021; 41:2024-2031. [PMID: 34051065 PMCID: PMC8242794 DOI: 10.1111/liv.14978] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/20/2021] [Accepted: 05/23/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND & AIMS In 2014, the burden of hepatitis C virus (HCV) in Sweden was evaluated, to establish a baseline and inform public health interventions. Considering the changing landscape of HCV treatment, prevention, and care, and in light of the COVID-19 pandemic, this analysis seeks to evaluate Sweden's progress towards the World Health Organization (WHO) elimination targets and identify remaining barriers. METHODS The data used for modelling HCV transmission and disease burden in Sweden were obtained through literature review, unpublished sources and expert input. A dynamic Markov model was employed to forecast population sizes and incidence of HCV through 2030. Two scenarios ('2019 Base' and 'WHO Targets') were developed to evaluate Sweden's progress towards HCV elimination. RESULTS At the beginning of 2019, there were 29 700 (95% uncertainty interval: 19 300-33 700) viremic infections in Sweden. Under the base scenario, Sweden would achieve and exceed the WHO targets for diagnosis, treatment and liver-related death. However, new infections would decrease by less than 10%, relative to 2015. Achieving all WHO targets by 2030 would require (i) expanding harm reduction programmes to reach more than 90% of people who inject drugs (PWID) and (ii) treating 90% of HCV + PWID engaged in harm reduction programmes and ≥7% of PWID not involved in harm reduction programmes, annually by 2025. CONCLUSIONS It is of utmost importance that Sweden, and all countries, find sustainability in HCV programmes by broadening the setting and base of providers to provide stability and continuity of care during turbulent times.
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Affiliation(s)
- Sarah Blach
- Department of EpidemiologyCenter for Disease Analysis FoundationLafayetteCOUSA
| | - Marianne Blomé
- Faculty of MedicineDepartment of Translational MedicineClinical Infection MedicineLund UniversityMalmöSweden
| | - Ann‐Sofi Duberg
- Faculty of Medicine and HealthDepartment of Infectious DiseasesÖrebro UniversityÖrebroSweden
| | - Anna Jerkeman
- Faculty of MedicineDepartment of Translational MedicineClinical Infection MedicineLund UniversityMalmöSweden
| | - Martin Kåberg
- Stockholm Needle ExchangeStockholm Centre for Dependency DisordersStockholmSweden,Division of Infection and DermatologyDepartment of Medicine HuddingeKarolinska InstituteKarolinska University Hospital HuddingeStockholmSweden
| | | | - Martin Lagging
- Department of Infectious Diseases/VirologyInstitute of BiomedicineSahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of Clinical MicrobiologyRegion Västra GötalandSahlgrenska University HospitalGothenburgSweden
| | | | - Homie Razavi
- Department of EpidemiologyCenter for Disease Analysis FoundationLafayetteCOUSA
| | - Soo Aleman
- Department of Medicine HuddingeKarolinska InstituteStockholmSweden,Department of Infectious DiseasesKarolinska University HospitalStockholmSweden
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5
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Safreed-Harmon K, Blach S, Aleman S, Bollerup S, Cooke G, Dalgard O, Dillon JF, Dore GJ, Duberg AS, Grebely J, Boe Kielland K, Midgard H, Porter K, Razavi H, Tyndall M, Weis N, Lazarus JV. The Consensus Hepatitis C Cascade of Care: Standardized Reporting to Monitor Progress Toward Elimination. Clin Infect Dis 2020; 69:2218-2227. [PMID: 31352481 DOI: 10.1093/cid/ciz714] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 07/26/2019] [Indexed: 01/10/2023] Open
Abstract
Cascade-of-care (CoC) monitoring is an important component of the response to the global hepatitis C virus (HCV) epidemic. CoC metrics can be used to communicate, in simple terms, the extent to which national and subnational governments are advancing on key targets, and CoC findings can inform strategic decision-making regarding how to maximize the progression of individuals with HCV to diagnosis, treatment, and cure. The value of reporting would be enhanced if a standardized approach were used for generating CoCs. We have described the Consensus HCV CoC that we developed to address this need and have presented findings from Denmark, Norway, and Sweden, where it was piloted. We encourage the uptake of the Consensus HCV CoC as a global instrument for facilitating clear and consistent reporting via the World Health Organization (WHO) viral hepatitis monitoring platform and for ensuring accurate monitoring of progress toward WHO's 2030 hepatitis C elimination targets.
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Affiliation(s)
- Kelly Safreed-Harmon
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Sarah Blach
- Center for Disease Analysis Foundation, Lafayette, Colorado, USA
| | - Soo Aleman
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Signe Bollerup
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark
| | - Graham Cooke
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | - Olav Dalgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - John F Dillon
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | | | - Ann-Sofi Duberg
- Department of Infectious Diseases, School of Medical Sciences, Örebro University, Örebro, Sweden
| | | | - Knut Boe Kielland
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | - Håvard Midgard
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Kholoud Porter
- Institute for Global Health, University College London, London, United Kingdom
| | - Homie Razavi
- Center for Disease Analysis Foundation, Lafayette, Colorado, USA
| | - Mark Tyndall
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.,CHIP, World Health Organization Collaborating Centre on HIV and Viral Hepatitis, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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6
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Büsch K, Hansson F, Holton M, Lagging M, Westin J, Kövamees J, Sällberg M, Söderholm J. Sick leave and disability pension in patients with chronic hepatitis C compared with a matched general population: a nationwide register study. BMJ Open 2020; 10:e035996. [PMID: 32878754 PMCID: PMC7470645 DOI: 10.1136/bmjopen-2019-035996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate sick leave and disability pension in patients with chronic hepatitis C virus (HCV) infection as compared with a matched general population cohort. DESIGN Retrospective register study. SETTING Nationwide in Sweden. PARTICIPANTS This register-based study used the Swedish National Patient Register to identify working-age patients with HCV in 2012 (n=32 021) who were diagnosed between 1999 and 2007 (n=19 362). Sick leave and disability pension data were retrieved from Statistics Sweden (1994-2012), with up to five matched individuals from the general population. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was workdays lost due to sick leave episodes (>14 days) and disability pension overall. The secondary outcome was workdays lost per subgroup of patients with chronic HCV. RESULTS In 2012, 14% of the HCV patients had ≥1 registered sick leave episode compared with 10% in the matched comparator cohort. For disability pension benefits, results were 30% versus 8%, respectively. Overall, in 2012, 57% of patients with HCV did not have any registered workdays lost, whereas 30% were absent ≥360 days compared with 83% and 9% in the matched cohort, respectively. The mean total number of annual workdays lost in 2012 was 126 days in the HCV patient cohort compared with 40 days in the matched general population comparator cohort. Annual days lost increased from a mean of 86 days 5 years before diagnosis to 136 days during the year of diagnosis. CONCLUSIONS These results show that Swedish HCV patients used more sick days and have a higher frequency of disability pension compared with a comparator cohort from the general Swedish population. Whether earlier diagnosis of HCV and treatment might impact work absence in Sweden warrants further investigation.
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Affiliation(s)
- Katharina Büsch
- Health economics and outcomes research, AbbVie AB, Stockholm, Sweden
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Michelle Holton
- Health Research, Lorimer Enterprises Inc, Red Deer, Alberta, Canada
| | - Martin Lagging
- Department of Infectious Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Westin
- Department of Infectious Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Matti Sällberg
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Söderholm
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Medical Affairs, AbbVie AB, Stockholm, Sweden
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7
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Aleman S, Söderholm J, Büsch K, Kövamees J, Duberg AS. Frequent loss to follow-up after diagnosis of hepatitis C virus infection: A barrier towards the elimination of hepatitis C virus. Liver Int 2020; 40:1832-1840. [PMID: 32294288 DOI: 10.1111/liv.14469] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 02/07/2020] [Accepted: 04/02/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Previous studies on hepatitis C cascade of care have been mainly focused on diagnosis and treatment rate, while less attention has been given to patients lost to follow-up (LTFU) after diagnosis. Analyses of this latter issue on population level are missing. AIMS In this nationwide study of people with HCV, we aimed to estimate the proportion LTFU after HCV diagnosis, characterize them, and analyze their other healthcare contacts. METHODS Patients diagnosed with chronic HCV in the Swedish National Patient Register during 2001-2011 and still alive December 31, 2013, were included. The number of cured patients without need of follow-up was estimated. Visits to HCV specialist care during 2012-2013 were analysed. For those LTFU, other specialist care contacts were studied. RESULTS In total 29 217 patients were included, with 24 733 with need of HCV care. 61% (n = 15 007) of them were LTFU from HCV care in 2012-2013 and 58% did not attend HCV care during the second year after HCV diagnosis. The departments of surgery/orthopaedic or psychiatry/dependency were the most common other non-primary healthcare contacts. Predictors for LTFU were young age, male sex, low education, presence of psychiatric/dependency diagnosis, unmarried and longer duration since diagnosis of HCV. CONCLUSIONS This study showed that almost two-thirds of patients were LTFU after HCV diagnosis, with frequent occurrence early after diagnosis. Efforts to link patients back to HCV care, in combination with early and easy access to HCV treatment and harm reduction, are necessary to reach the HCV elimination goal.
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Affiliation(s)
- Soo Aleman
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Söderholm
- AbbVie AB, Stockholm, Sweden.,Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Katharina Büsch
- AbbVie AB, Stockholm, Sweden.,Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden
| | | | - Ann-Sofi Duberg
- Department of Infectious Diseases, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Björkström K, Franzén S, Eliasson B, Miftaraj M, Gudbjörnsdottir S, Trolle-Lagerros Y, Svensson AM, Hagström H. Risk Factors for Severe Liver Disease in Patients With Type 2 Diabetes. Clin Gastroenterol Hepatol 2019; 17:2769-2775.e4. [PMID: 31009793 DOI: 10.1016/j.cgh.2019.04.038] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/21/2019] [Accepted: 04/13/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Type 2 diabetes is a risk factor for development of cirrhosis and hepatocellular carcinoma. However, risk factors that identify persons with the highest risk for these outcomes are missing from unselected, population-based cohorts. METHODS The National Diabetes Register contains data on about 90% of persons in Sweden with type 2 diabetes. In this cohort study, persons with type 2 diabetes listed in the National Diabetes Register were compared with 5 individuals from the general population (controls), matched for age, sex, and county. In total, 406 770 persons with type 2 diabetes and 2 033 850 controls were included and followed for 21 596 934 person-years. We used population-based registers to determine the incidence of severe liver disease, defined as a diagnosis of hepatocellular carcinoma, cirrhosis, decompensation, liver failure and/or death due to liver disease during follow up. Cox regression was performed to estimate the risk of severe liver disease and to examine risk factors in persons with type 2 diabetes. RESULTS Risk for severe liver disease was increased in patients with type 2 diabetes compared to controls (hazard ratio, 2.28; 95% CI, 2.21-2.36). Risk factors associated with severe liver disease in persons with type 2 diabetes were higher age, male sex, hypertension, higher body mass index, lower glomerular filtration rate, microalbuminuria, and smoking. Statins were associated with a decreased risk of severe liver disease. CONCLUSIONS Persons with type 2 diabetes have an increased risk for severe liver disease. Knowledge of risk factors can be helpful in identifying persons with type 2 diabetes who have a high risk for severe liver disease.
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Affiliation(s)
- Karl Björkström
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Stefan Franzén
- Swedish National Diabetes Register, Centre of Registers in Region, Sweden
| | - Björn Eliasson
- Swedish National Diabetes Register, Centre of Registers in Region, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Mervete Miftaraj
- Swedish National Diabetes Register, Centre of Registers in Region, Sweden
| | - Soffia Gudbjörnsdottir
- Swedish National Diabetes Register, Centre of Registers in Region, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Ylva Trolle-Lagerros
- Unit of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ann-Marie Svensson
- Swedish National Diabetes Register, Centre of Registers in Region, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Hannes Hagström
- Unit of Clinical Epidemiology, Department of Medicine Solna, Karolinska University Hospital, Stockholm, Sweden; Unit of Hepatology, Department of Upper Gastrointestinal Diseases, Karolinska University Hospital, Stockholm, Sweden.
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9
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Batyrbekova N, Aleman S, Lybeck C, Montgomery S, Duberg AS. Hepatitis C Virus Infection and the Temporal Trends in the Risk of Liver Cancer: A National Register-Based Cohort Study in Sweden. Cancer Epidemiol Biomarkers Prev 2019; 29:63-70. [PMID: 31719064 DOI: 10.1158/1055-9965.epi-19-0769] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 09/10/2019] [Accepted: 11/04/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In many countries, including Sweden, the birth cohorts with the highest prevalence of hepatitis C virus (HCV) infection have now reached the ages with high risk of primary liver cancer (PLC). The aims of this study were to investigate the temporal trends in PLC incidence and the relative risks of PLC among people diagnosed with HCV infection between 1990 and 2015. METHODS The HCV cohort (n = 52,853) was compared with a matched non-HCV comparison cohort (n = 523,649). Both the national Cancer Register (CR) and Cause of Death Register (DR) were used for follow-up. The crude and age-standardized PLC incidence rates were calculated. The relative risk was estimated as standardized incidence ratios (SIR) and as HRs using stratified Cox hazards regression. RESULTS There were 1,609 with PLC diagnosis in the HCV cohort; the annual number increased continuously with the crude incidence rate reaching 4.56 per 1,000 person-years in 2013 while remaining low and stable in the comparison cohort. In the HCV cohort, the age-standardized PLC incidence rates per 1,000 person-years remained relatively constant at 2.64 [95% confidence interval (CI), 1.54-3.75] in 2000 and 3.31 (2.51-4.12) in 2014. The highest SIR was 73 (65.9-79.5) among those infected for 35 to 40 years; and the highest HR was 65.9 (55.9-77.6) for men and 62.2 (31.9-121.1) for women. CONCLUSIONS There was a considerable increase in PLC incidence over time and an extremely high relative risk in the population with HCV infection for more than 35 years. IMPACT The national HCV-associated PLC incidence should be monitored in future studies to evaluate the effect of direct-acting antiviral (DAA) treatment.
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Affiliation(s)
| | - Soo Aleman
- Department of Infectious Diseases, Karolinska Institutet/Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Lybeck
- Department of Infectious Diseases, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden.,Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Ann-Sofi Duberg
- Department of Infectious Diseases, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden.
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10
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Joob B, Wiwanitkit V. Required Treatment Expenditures for Hepatitis C Virus Infection and Advantage in the Reduction of Hepatocellular Carcinoma Incidence: Analysis of Possible Options in an Endemic Area. Indian J Med Paediatr Oncol 2019. [DOI: 10.4103/ijmpo.ijmpo_101_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Background: Hepatitis C virus (HCV) infection is a known underlying factor contributing to hepatocellular carcinogenesis. The use of direct-acting antiviral (DAA) medication is a form of clinical management for controlling HCV infection and reducing the hepatocellular carcinoma incidence. This medication is introduced to several endemic areas. The big concern is on the treatment expenditures. Several alternative options are proposed and it is required to assess the effect of each alternative option. Objective: Here, the authors assessed and estimated the required treatment expenditures for HCV infection and advantage in the reduction of hepatocellular carcinoma incidence based on the analysis of possible options in an endemic area. Methods: A medical economics analysis was done. Results: According to the cost–utility analysis, the best alternative option that is hereby recommended is DAA medication coverage for all cases. Conclusion: DAA medication coverage for all cases is recommended.
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Affiliation(s)
- Beuy Joob
- Sanitation 1 Medical Academic Center, Bangkok, Thailand
| | - Viroj Wiwanitkit
- Department of Community Medicine, Dr. DY Patil University, Pune, Maharashtra, India
- Department of Tropicla Medicine, Hainan Medical University, Haikou, China
- Department of Medical Science, Faculty of Medicine, University of Nis, Niš, Serbia
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11
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Kjellin M, Kileng H, Akaberi D, Palanisamy N, Duberg AS, Danielsson A, Kristiansen MG, Nöjd J, Aleman S, Gutteberg T, Goll R, Lannergård A, Lennerstrand J. Effect of the baseline Y93H resistance-associated substitution in HCV genotype 3 for direct-acting antiviral treatment: real-life experience from a multicenter study in Sweden and Norway. Scand J Gastroenterol 2019; 54:1042-1050. [PMID: 31424972 DOI: 10.1080/00365521.2019.1652846] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: The NS5A resistance-associated substitution (RAS) Y93H is found quite frequently (5-10%) at baseline in direct-acting antiviral agents (DAA) treatment-naïve genotype (GT) 3a patients when studied by the population-sequencing method (cut-off 20%). This RAS may impair HCV DAA treatment response, since it possesses a high fold in vitro resistance to daclatasvir (DCV) and velpatasvir (VEL) in GT 3. We investigated the effect of baseline Y93H in patients with GT 3a infection on treatment outcome, with or without resistance-based DAA-treatment during 2014-2017. Patients/Methods: Treatment in the intervention group (n = 130) was tailored to baseline resistance-findings by population-sequencing method. Detection of baseline Y93H above 20% prompted a prolonged treatment duration of NS5A-inhibitor and sofosbuvir (SOF) and/or addition of ribavirin (RBV). Patients without baseline Y93H in the intervention group and all patients in the control group (n = 78) received recommended standard DAA-treatment. Results: A higher sustained virologic response rate (SVR) in the intervention group was shown compared to the control group at 95.4% (124/130) and 88.5% (69/78), respectively (p = .06). All five patients with baseline Y93H in the intervention group achieved SVR with personalised treatment based on results from resistance testing; either with the addition of RBV or prolonged treatment duration (24w). In the control group, 2/4 patients with Y93H at baseline treated with ledipasvir/SOF/RBV or DCV/SOF without RBV, failed treatment. Conclusion: The results from this real-life study are in accordance with the findings of the randomised controlled trials in 2015 and the EASL-guidelines of 2016, thus, baseline Y93H impacts on DCV and VEL treatment outcome.
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Affiliation(s)
- Midori Kjellin
- Department of Medical Sciences, Section of Clinical Microbiology, Uppsala University , Uppsala , Sweden
| | - Hege Kileng
- Gastroenterology and Nutrition Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway , Tromsø , Norway.,Department of Medicine, University Hospital of North Norway , Tromsø , Norway
| | - Dario Akaberi
- Department of Medical Sciences, Section of Clinical Microbiology, Uppsala University , Uppsala , Sweden
| | - Navaneethan Palanisamy
- HBIGS, University of Heidelberg , Heidelberg , Germany.,Institute of Biology II, University of Freiburg , Freiburg , Germany
| | - Ann-Sofi Duberg
- Department of Infectious Diseases, School of Medical Sciences, Faculty of Medicine and Health, Örebro University , Örebro , Sweden
| | | | - Magnhild Gangsøy Kristiansen
- Nordlandssykehuset Bodø, Department of Clinical Medicine (IKM), UiT the Artic University of Tromsø , Tromsø , Norway
| | - Johan Nöjd
- Nordlandssykehuset Bodø, Department of Clinical Medicine (IKM), UiT the Artic University of Tromsø , Tromsø , Norway
| | - Soo Aleman
- Department of Infectious Diseases, Karolinska University Hospital/Karolinska Institutet , Stockholm , Sweden
| | - Tore Gutteberg
- Research Group for Host-Microbe Interactions, Department of Medical Biology, UiT the Arctic University of Norway , Tromsø , Norway.,Department of Microbiology and Infection Control, University Hospital of North Norway , Tromsø , Norway
| | - Rasmus Goll
- Gastroenterology and Nutrition Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway , Tromsø , Norway.,Department of Medicine, University Hospital of North Norway , Tromsø , Norway
| | - Anders Lannergård
- Department of Medical Sciences, Section of Infectious Diseases, Uppsala University Hospital , Uppsala , Sweden
| | - Johan Lennerstrand
- Department of Medical Sciences, Section of Clinical Microbiology, Uppsala University , Uppsala , Sweden
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12
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Shumway M, Luetkemeyer AF, Peters MG, Johnson MO, Napoles TM, Riley ED. Direct-acting antiviral treatment for HIV/HCV patients in safety net settings: patient and provider preferences. AIDS Care 2019; 31:1340-1347. [PMID: 30829533 DOI: 10.1080/09540121.2019.1587353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
HIV/HCV coinfected patients are a priority for direct acting antiretroviral (DAA) treatment, yet barriers to treating vulnerable patients persist. This study surveyed safety net clinic patients and providers to quantify their preferences for DAA treatment and prioritize modifiable barriers. Preferences were assessed using best-worst scaling. General linear mixed models were used to determine whether attributes differed in importance and whether patients and providers valued attributes differently. 158 HIV/HCV coinfected patients and 49 providers participated. Patients and providers had strong preferences for treatment within the medical homes where patients receive HIV care. Support such as reminders and advice numbers were also important, but were more important to providers than patients. Providers identified lack of insurance coverage for DAA as the most significant barrier. Providers rated HIV primary care providers as best suited to deliver DAA to HIV+ patients. Addressing structural barriers is essential for increasing DAA treatment in safety net settings.
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Affiliation(s)
- Martha Shumway
- Department of Psychiatry, Weill Institute for Neurosciences, University of California , San Francisco , CA , USA.,Department of Psychiatry, Zuckerberg San Francisco General Hospital and Trauma Center , San Francisco , CA , USA
| | - Anne F Luetkemeyer
- Department of Medicine, University of California , San Francisco , CA , USA.,Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center , San Francisco , CA , USA
| | - Marion G Peters
- Department of Medicine, University of California , San Francisco , CA , USA
| | - Mallory O Johnson
- Department of Medicine, University of California , San Francisco , CA , USA
| | - Tessa M Napoles
- Department of Medicine, University of California , San Francisco , CA , USA.,Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center , San Francisco , CA , USA.,Department of Social and Behavioral Sciences, University of California , San Francisco , CA , USA
| | - Elise D Riley
- Department of Medicine, University of California , San Francisco , CA , USA.,Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center , San Francisco , CA , USA
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13
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Isakov V, Chulanov V, Abdurakhmanov D, Burnevich E, Nurmukhametova E, Kozhevnikova G, Gankina N, Zhuravel S, Romanova S, Hyland RH, Lu S, Svarovskaia ES, McNally J, Brainard DM, Ivashkin V, Morozov V, Bakulin I, Lagging M, Zhdanov K, Weiland O. Sofosbuvir/velpatasvir for the treatment of HCV: excellent results from a phase-3, open-label study in Russia and Sweden. Infect Dis (Lond) 2018; 51:131-139. [PMID: 30499360 DOI: 10.1080/23744235.2018.1535186] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In both Russia and Sweden, the dominant hepatitis C virus (HCV) is genotype 1, but around one-third of patients have genotype 3 infection. For such countries, HCV genotype testing is recommended prior to therapy. An effective pangenotypic therapy may potentially eliminate the need for genotyping. In this study, we evaluated the efficacy and safety of sofosbuvir/velpatasvir for 12 weeks in patients from Russia and Sweden. METHODS In an open-label, single-arm phase-3 study, patients could have HCV genotype 1-6 infection and were treatment-naïve or interferon treatment-experienced. All patients received sofosbuvir/velpatasvir, once daily for 12 weeks. The primary endpoint was sustained virologic response 12 weeks post-treatment (SVR12). RESULTS Of 122 patients screened, 119 were enrolled and treated. Overall, half (50%) were male, 18% had cirrhosis, and 24% had failed prior interferon-based therapy. In total, 66% of patients were infected with HCV genotype 1 (59% 1b and 7% 1a), 6% with genotype 2, and 29% with genotype 3. The overall SVR12 rate was 99% (118/119, 95% confidence interval 95-100%). One treatment-experienced patient infected with HCV genotype 3 experienced virologic relapse after completing treatment. The most common adverse events were headache (16%) and fatigue (7%). Serious adverse events were observed in four patients, but none were related to treatment. No patients discontinued treatment due to adverse events. CONCLUSION Sofosbuvir/velpatasvir as a pangenotypic treatment for 12 weeks was highly effective in patients from Russia and Sweden infected with HCV genotypes 1, 2, or 3. Sofosbuvir/velpatasvir was safe and well-tolerated. Clinical trial number: ClinicalTrials.gov NCT02722837.
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Affiliation(s)
- Vasily Isakov
- a 1 Department of Gastroenterology and Hepatology , Institute of Nutrition , Moscow , Russia
| | - Vladimir Chulanov
- b 2 Central Research Institute of Epidemiology , Moscow , Russia.,c 3 Hepatology Unit, Sechenov First State Medical University , Moscow , Russia
| | | | - Eduard Burnevich
- c 3 Hepatology Unit, Sechenov First State Medical University , Moscow , Russia.,d 4 City Clinical Hospital #24 of Moscow Healthcare Department , Moscow , Russia
| | | | - Galina Kozhevnikova
- f 6 Central Scientific and Research Institute of Epidemiology , Moscow , Russia
| | - Natalya Gankina
- g 7 Krasnoyarsk Regional Center of AIDS Prevention , Krasnoyarsk , Russia
| | - Sergey Zhuravel
- h 8 Sklifosovsky Scientific Research Institution of Emergency Care of Moscow Healthcare Department , Moscow , Russia
| | - Svetlana Romanova
- i 9 Center for Prevention and Control AIDS and Infectious Diseases , Saint Petersburg , Russia
| | | | - Sophia Lu
- j 10 Gilead Sciences , Foster City , CA, USA
| | | | | | | | - Vladimir Ivashkin
- c 3 Hepatology Unit, Sechenov First State Medical University , Moscow , Russia
| | | | - Igor Bakulin
- l 12 Propedeutics of Internal Diseases, Gastroenterology and Dietology, I.I. Mechnikov North-West State Medical University , Saint Petersburg , Russia
| | - Martin Lagging
- m 13 Department of Infectious Diseases/Virology , Institute of Biomedicine Sahlgrenska Academy University of Gothenburg , Gothenburg , Sweden
| | | | - Ola Weiland
- o 15 Department of Internaö Medicine Division of Infectious Diseases , Karolinska Institutet, Karolinska University Hospital Huddinge , Stockholm , Sweden
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14
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Matsumoto K, Wu Y, Kitazawa T, Fujita S, Seto K, Hasegawa T. Cost of illness of hepatocellular carcinoma in Japan: A time trend and future projections. PLoS One 2018; 13:e0199188. [PMID: 29920556 PMCID: PMC6007925 DOI: 10.1371/journal.pone.0199188] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 06/01/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the fifth leading cause of death in Japan. The aim of this study was to calculate the social burden of HCC using the cost of illness (COI) method, and to identify the key factors driving changes in the economic burden of HCC. METHODS Utilizing government-based statistical nationwide data, the cost of illness (COI) method was used to estimate the COI for 1996, 1999, 2002, 2005, 2008, and 2014 to make predictions for 2017, 2020, 2023, 2026, and 2029. The COI comprised direct and indirect costs (morbidity and mortality costs) of HCC. RESULTS From 1996 to 2014, COI trended downward. In 2014, COI (579.2 billion JPY) was 0.71 times greater than that in 1996 (816.2 billion JPY). Mortality costs accounted for more than 70% of total COI and were a major contributing factor to the decrease in COI. It was predicted that COI would continue a downward trend until 2029, and that the rate of decline would be similar. CONCLUSIONS COI of HCC has been decreasing since 1996. Treatment of patients infected with hepatitis C virus using newly introduced technologies has high therapeutic effectiveness, and will affect the future prevalence of HCC. These policies and technologies may accelerate the downward tendency of COI, and the relative economic burden of HCC is likely to continue to decrease.
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Affiliation(s)
- Kunichika Matsumoto
- Department of Social Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Yinghui Wu
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Takefumi Kitazawa
- Department of Social Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Shigeru Fujita
- Department of Social Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Kanako Seto
- Department of Social Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Tomonori Hasegawa
- Department of Social Medicine, Toho University School of Medicine, Tokyo, Japan
- * E-mail:
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15
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Nasser SC, Mansour H, Abi Nader T, Metni M. Cost-effectiveness of novel treatment of hepatitis C virus in Lebanese patients. Int J Clin Pharm 2018; 40:693-699. [PMID: 29611014 DOI: 10.1007/s11096-018-0628-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/23/2018] [Indexed: 01/01/2023]
Abstract
Background Limited data is available on Hepatitis C disease prevalence, treatment initiation and its cost-effectiveness in Lebanon and the whole Middle East. Objective The aim of the study is to assess whether initiation of novel Direct Acting Antiviral agents (DAAs) at early stage of hepatitis C is cost-effective in Lebanese patients. Setting Lebanon. Methods This modeling study was conducted from the perspective of Lebanese third party payers, where existing practice is based on international guidelines for the diagnosis and treatment of diseases. The model assessed cost-effectiveness of early versus delayed DAAs treatment in a standard patient upon HCV diagnosis. Medical costs were valued using in-house database. Main outcome measures Incremental Cost-Effectiveness Ratio (ICER) per QALY and per life-year extended. Results Treatment at early HCV disease stage has led to an ICER of 587 euro per QALY gained throughout the course of the disease. Outcomes of early treatment with DAAs upon HCV diagnosis led to an incremental cost of 27,268 euro per QALY gained at first year of treatment, and of 1527 euro per additional life-year extended. Sensitivity analysis showed that a 25% decrease in the cost of dual drug option resulted in a decrease of incremental cost to 16,982 euro per QALY gained at first year of treatment with DAAs upon early HCV diagnosis. Conclusion Decision makers are encouraged to reinforce the need to screen for HCV and initiate novel treatment at early disease stage in the Lebanese healthcare system.
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Affiliation(s)
- Soumana C Nasser
- School of Pharmacy, Lebanese American University, Byblos, Lebanon.
| | - Hanine Mansour
- School of Pharmacy, Lebanese American University, Byblos, Lebanon
| | | | - Mirna Metni
- Medical Control Department, Lebanese National Security Social Fund, Beirut, Lebanon
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16
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Ponziani FR, Miele L, Tortora A, Furnari M, Bodini G, Pompili M, Gasbarrini A, Giannini EG. Treatment of early stage chronic hepatitis C virus infection. Expert Rev Clin Pharmacol 2018; 11:519-524. [PMID: 29498556 DOI: 10.1080/17512433.2018.1447923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Treatment of Hepatitis C Virus (HCV) with direct acting antivirals (DAAs) is able to achieve the cure of infection in almost the totality of patients, independently of the characteristics of the individual and the virus, using short treatment schedules, and without the need of ribavirin. The high cost of DAAs is the main limiting factor for universal treatment of HCV. However, there is a strong evidence that treatment of infection at the early stage of disease may be the most rewarding approach. Areas covered: This review evaluates the aspects underlying the benefit of treating chronic HCV infection at the early stage of disease. It outlines the considerations that have to be taken into account when planning treatment in patients with HCV and minimal liver disease, assessing the positive reflex of viral eradication on several HCV-associated extra-hepatic conditions such as the risk of lymphoma, insulin-resistance and glycaemic control, and renal function. Lastly, it also covers the improvement of patients' quality of life and the pharmaco-economic aspects associated with early treatment. Expert commentary: Treatment of patients with HCV and minimal liver disease is associated with a beneficial, pleiotropic effect of viral eradication that goes beyond the simplistic consideration of the improvement in liver disease-related outcomes.
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Affiliation(s)
- Francesca Romana Ponziani
- a Internal Medicine, Gastroenterology and Hepatology Unit, Fondazione Policlinico "A. Gemelli" , Catholic University of Rome , Rome , Italy
| | - Luca Miele
- a Internal Medicine, Gastroenterology and Hepatology Unit, Fondazione Policlinico "A. Gemelli" , Catholic University of Rome , Rome , Italy
| | - Annalisa Tortora
- a Internal Medicine, Gastroenterology and Hepatology Unit, Fondazione Policlinico "A. Gemelli" , Catholic University of Rome , Rome , Italy
| | - Manuele Furnari
- b Gastroenterology Unit, Department of Internal Medicine , University of Genoa, IRCCS Ospedale Policlinico San Martino , Genoa , Italy
| | - Giorgia Bodini
- b Gastroenterology Unit, Department of Internal Medicine , University of Genoa, IRCCS Ospedale Policlinico San Martino , Genoa , Italy
| | - Maurizio Pompili
- a Internal Medicine, Gastroenterology and Hepatology Unit, Fondazione Policlinico "A. Gemelli" , Catholic University of Rome , Rome , Italy
| | - Antonio Gasbarrini
- a Internal Medicine, Gastroenterology and Hepatology Unit, Fondazione Policlinico "A. Gemelli" , Catholic University of Rome , Rome , Italy
| | - Edoardo Giovanni Giannini
- b Gastroenterology Unit, Department of Internal Medicine , University of Genoa, IRCCS Ospedale Policlinico San Martino , Genoa , Italy
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17
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Kjellin M, Wesslén T, Löfblad E, Lennerstrand J, Lannergård A. The effect of the first-generation HCV-protease inhibitors boceprevir and telaprevir and the relation to baseline NS3 resistance mutations in genotype 1: experience from a small Swedish cohort. Ups J Med Sci 2018; 123. [PMID: 29536805 PMCID: PMC5901468 DOI: 10.1080/03009734.2018.1441928] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The clinical experience with protease-inhibitor (PI) triple regimen appears disappointing regarding effect, side effects, high work load, and costs. This real-world study evaluates baseline and emerging resistance-associated substitutions (RASs) and their significance for treatment outcome. METHOD Thirty-six genotype 1a/b patients treated according to Swedish recommendations during 2011-2013 with triple therapy including pegylated interferon and ribavirin in combination with a protease-inhibitor, either boceprevir (BOC) or telaprevir (TVR), were retrospectively evaluated. Frozen serum samples from the patients were tested for resistance with pan-genotypic population sequencing. RESULTS Overall, 56% (20/36) of the patients achieved sustained viral response (SVR). The SVR was comparable between BOC (64%; 9/14) and TVR (50%; 11/22) (p = 0.07), and the IL28B type non-CC (48%; 12/25) and CC (46%; 6/13) (p = 0.77). The SVR was higher in patients without cirrhosis (89.5%; 17/19) (p < 0.0005), in treatment-naïve patients (70%; 14/20) (p = 0.02), and those with low viral load (<800,000 IU/mL) (66.7%; 8/12) (p < 0.0002), compared to those with cirrhosis (17.6%; 3/17), treatment-experienced (37.5%; 6/16), and high viral load (>800,000 IU/mL) (50%; 12/24). CONCLUSION PI triple regimes were highly effective in treatment-naïve patients without cirrhosis, but in this real-world cohort an inferior effect was evident in cirrhotic and treatment-experienced patients. Although tested on a limited sample, the baseline resistance testing seems to have no impact on prediction of therapy outcome. The reason could be that the baseline RASs T54S and V55A have relatively low resistance towards BOC and TVR. Emerging RASs, mainly R155K, with known high resistance to BOC and TVR were frequently found in non-responders.
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Affiliation(s)
- Midori Kjellin
- Section of Clinical Microbiology, Department of Medical Sciences, Uppsala University Hospital, Sweden
| | - Terése Wesslén
- Section of Infectious Diseases, Department of Medical Sciences, Uppsala University Hospital, Sweden
| | - Erik Löfblad
- Section of Infectious Diseases, Department of Medical Sciences, Uppsala University Hospital, Sweden
| | - Johan Lennerstrand
- Section of Clinical Microbiology, Department of Medical Sciences, Uppsala University Hospital, Sweden
| | - Anders Lannergård
- Section of Infectious Diseases, Department of Medical Sciences, Uppsala University Hospital, Sweden
- CONTACT Anders Lannergård Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, S 751 85 Uppsala, Sweden
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18
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Fraser H, Martin NK, Brummer-Korvenkontio H, Carrieri P, Dalgard O, Dillon J, Goldberg D, Hutchinson S, Jauffret-Roustide M, Kåberg M, Matser AA, Matičič M, Midgard H, Mravcik V, Øvrehus A, Prins M, Reimer J, Robaeys G, Schulte B, van Santen DK, Zimmermann R, Vickerman P, Hickman M. Model projections on the impact of HCV treatment in the prevention of HCV transmission among people who inject drugs in Europe. J Hepatol 2018; 68:402-411. [PMID: 29080808 PMCID: PMC5841161 DOI: 10.1016/j.jhep.2017.10.010] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 10/02/2017] [Accepted: 10/08/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND & AIMS Prevention of hepatitis C virus (HCV) transmission among people who inject drugs (PWID) is critical for eliminating HCV in Europe. We estimated the impact of current and scaled-up HCV treatment with and without scaling up opioid substitution therapy (OST) and needle and syringe programmes (NSPs) across Europe over the next 10 years. METHODS We collected data on PWID HCV treatment rates, PWID prevalence, HCV prevalence, OST, and NSP coverage from 11 European settings. We parameterised an HCV transmission model to setting-specific data that project chronic HCV prevalence and incidence among PWID. RESULTS At baseline, chronic HCV prevalence varied from <25% (Slovenia/Czech Republic) to >55% (Finland/Sweden), and <2% (Amsterdam/Hamburg/Norway/Denmark/Sweden) to 5% (Slovenia/Czech Republic) of chronically infected PWID were treated annually. The current treatment rates using new direct-acting antivirals (DAAs) may achieve observable reductions in chronic prevalence (38-63%) in 10 years in Czech Republic, Slovenia, and Amsterdam. Doubling the HCV treatment rates will reduce prevalence in other sites (12-24%; Belgium/Denmark/Hamburg/Norway/Scotland), but is unlikely to reduce prevalence in Sweden and Finland. Scaling-up OST and NSP to 80% coverage with current treatment rates using DAAs could achieve observable reductions in HCV prevalence (18-79%) in all sites. Using DAAs, Slovenia and Amsterdam are projected to reduce incidence to 2 per 100 person years or less in 10 years. Moderate to substantial increases in the current treatment rates are required to achieve the same impact elsewhere, from 1.4 to 3 times (Czech Republic and France), 5-17 times (France, Scotland, Hamburg, Norway, Denmark, Belgium, and Sweden), to 200 times (Finland). Scaling-up OST and NSP coverage to 80% in all sites reduces treatment scale-up needed by 20-80%. CONCLUSIONS The scale-up of HCV treatment and other interventions is needed in most settings to minimise HCV transmission among PWID in Europe. LAY SUMMARY Measuring the amount of HCV in the population of PWID is uncertain. To reduce HCV infection to minimal levels in Europe will require scale-up of both HCV treatment and other interventions that reduce injecting risk (especially OST and provision of sterile injecting equipment).
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Affiliation(s)
- Hannah Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Natasha K Martin
- Division of Global Public Health, University of California, San Diego, San Diego, CA, USA; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Patrizia Carrieri
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France; ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Olav Dalgard
- University of Oslo, Oslo, Norway; Akershus University Hospital, Lørenskog, Norway
| | | | | | - Sharon Hutchinson
- Glasgow Caledonian University, Glasgow, Scotland, UK; Health Protection Scotland, Glasgow, Scotland, UK
| | - Marie Jauffret-Roustide
- French Institute for Public Health Surveillance, St. Maurice, France; CERMES3 (Inserm U988/UMR CNRS 8211/EHESS/Paris Descartes University), Paris, France
| | - Martin Kåberg
- Department of Medicine, Huddinge, Division of Infectious Diseases, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Amy A Matser
- Public Health Service of Amsterdam, Amsterdam, The Netherlands; University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mojca Matičič
- University of Ljubljana, Ljubljana, Slovenia; University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Viktor Mravcik
- National Monitoring Centre for Drugs and Drug Addiction, Prague, Czech Republic; Charles University and General University Hospital in Prague, Prague, Czech Republic; National Institute of Mental Health, Klecany, Czech Republic
| | | | - Maria Prins
- Public Health Service of Amsterdam, Amsterdam, The Netherlands; Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Jens Reimer
- HealthNorth, Bremen, Germany; University of Hamburg, Hamburg, Germany
| | - Geert Robaeys
- Ziekenhuis Oost-Limburg, Genk, Belgium; Hasselt University, Diepenbeek, Belgium; University Hospital Leuven, Leuven, Belgium
| | | | | | | | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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19
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Safreed-Harmon K, Hetherington KL, Aleman S, Alho H, Dalgard O, Frisch T, Gottfredsson M, Weis N, Lazarus JV. Policy responses to hepatitis C in the Nordic countries: Gaps and discrepant reporting in the Hep-Nordic study. PLoS One 2018; 13:e0190146. [PMID: 29381697 PMCID: PMC5790214 DOI: 10.1371/journal.pone.0190146] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 12/09/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND AIMS In the Nordic countries (Denmark, Finland, Iceland, Norway, Sweden), the prevalence of chronic hepatitis C virus (HCV) infection is relatively low in the general population, but is much higher among people who inject drugs (PWID). We conducted an exploratory study to investigate the extent to which these countries have policies supporting key elements of the public health response that is necessary to achieve the global goal of eliminating HCV as a public health threat. METHODS Fourteen stakeholders representing government agencies, medical societies, and civil society organisations (CSOs) in the Nordic countries completed a cross-sectional online survey that included 21 policy questions related to national coordination, prevention, testing, linkage to care, and treatment. We summarised the findings in a descriptive analysis, and noted discrepant responses from stakeholders within the same country. RESULTS Stakeholders reported that three of the five study countries have national viral hepatitis strategies, while only Iceland has a national HCV elimination goal. The availability of harm reduction services varies, with opioid substitution therapy provided for the general population throughout all countries, but not needle and syringe programmes. No country has access to anonymous HCV testing in all parts of the country. National HCV treatment guidelines are available in all countries except Finland, and all countries provide publicly funded direct-acting antiviral treatment. Disagreement regarding policies was observed across countries, and CSOs were the stakeholder group that most frequently answered survey questions incorrectly. CONCLUSION The Nordic region as a whole has not consistently expressed its commitment to tackling HCV, despite the existence of large HCV epidemics among PWID in these countries. Stakeholder alignment and an established elimination goal with an accompanying strategy and implementation plan should be recognised as the basis for coordinated national public health efforts to achieve HCV elimination in the Nordic region and elsewhere.
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Affiliation(s)
- Kelly Safreed-Harmon
- CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Kristina L. Hetherington
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Soo Aleman
- Department of Infectious Diseases, Karolinska Institutet/Karolinska University Hospital, Stockholm, Sweden
| | - Hannu Alho
- Abdominal Center, Helsinki University Hospital, Helsinki, Finland
| | - Olav Dalgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
| | | | - Magnus Gottfredsson
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Internal Medicine, Division of Infectious Diseases, Landspitali University Hospital, Reykjavik, Iceland
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jeffrey V. Lazarus
- CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
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20
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Are we ready to treat hepatitis C virus in individuals with opioid use disorder: assessment of readiness in European countries on the basis of an expert-generated model. Eur J Gastroenterol Hepatol 2017; 29:1206-1214. [PMID: 28914697 DOI: 10.1097/meg.0000000000000962] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Individuals with a history of injecting drugs have a high prevalence of chronic hepatitis C (HCV) infection. Many have a history of opioid use disorder (OUD). Despite novel treatments with improved efficacy and tolerability, treatment is limited in the group. A faculty of experts shared insights from clinical practice to develop an HCV care-readiness model. Evidence and expert knowledge was collected. Ten experts developed a model of three factors (with measures): 'healthcare engagement', 'guidance' and 'place'. Overall, 40-90% of individuals with OUD engage with drug treatment services. Ten of 12 HCV guidelines provided specific advice for the OUD population. Ten of 12 OUD care guidelines provided useful HCV care advice. In 11 of 12 cases, location of HCV/drug treatment care was in different places. This readiness assessment shows that there are important limitations to successful HCV care in OUD. Specific actions should be taken: maintain/increase access to OUD treatment services/opioid agonist therapy, updating HCV guidance, locate care in the same place and allow wider prescribing of anti HCV medicines.
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21
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Bennett H, Gordon J, Jones B, Ward T, Webster S, Kalsekar A, Yuan Y, Brenner M, McEwan P. Hepatitis C disease transmission and treatment uptake: impact on the cost-effectiveness of new direct-acting antiviral therapies. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2017; 18:1001-1011. [PMID: 27803989 DOI: 10.1007/s10198-016-0844-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 10/18/2016] [Indexed: 05/23/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) treatment can reduce the incidence of future infections through removing opportunities for onward transmission. This benefit is not captured in conventional cost-effectiveness evaluations of treatment and is particularly relevant in patient groups with a high risk of transmission, such as those people who inject drugs (PWID), where the treatment rates have been historically low. This study aimed to quantify how reduced HCV transmission changes the cost-effectiveness of new direct-acting antiviral (DAA) regimens as a function of treatment uptake rates. METHODS An established model of HCV disease transmission and progression was used to quantify the impact of treatment uptake (10-100%), within the PWID population, on the cost-effectiveness of a DAA regimen versus pre-DAA standard of care, conducted using daclatasvir plus sofosbuvir in the UK setting as an illustrative example. RESULTS The consequences of reduced disease transmission due to treatment were associated with additional net monetary benefit of £24,304-£90,559 per patient treated at £20,000/QALY, when 10-100% of eligible patients receive treatment with 100% efficacy. Dependent on patient genotype, the cost-effectiveness of HCV treatment using daclatasvir plus sofosbuvir improved by 36-79% versus conventional analysis, at 10-100% treatment uptake in the PWID population. CONCLUSIONS The estimated cost-effectiveness of HCV treatment was shown to improve as more patients are treated, suggesting that the value of DAA regimens to the NHS could be enhanced by improved treatment uptake rates among PWID. However, the challenge for the future will lie in achieving increased rates of treatment uptake, particularly in the PWID population.
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Affiliation(s)
- Hayley Bennett
- HEOR, Health Economics and Outcomes Research Ltd, 9 Oak Tree Court, Mulberry Drive, Cardiff Gate Business Park, Cardiff, CF23 8RS, UK.
| | - Jason Gordon
- HEOR, Health Economics and Outcomes Research Ltd, 9 Oak Tree Court, Mulberry Drive, Cardiff Gate Business Park, Cardiff, CF23 8RS, UK
- Department of Public Health, University of Adelaide, Adelaide, Australia
| | - Beverley Jones
- HEOR, Health Economics and Outcomes Research Ltd, 9 Oak Tree Court, Mulberry Drive, Cardiff Gate Business Park, Cardiff, CF23 8RS, UK
| | - Thomas Ward
- HEOR, Health Economics and Outcomes Research Ltd, 9 Oak Tree Court, Mulberry Drive, Cardiff Gate Business Park, Cardiff, CF23 8RS, UK
| | - Samantha Webster
- HEOR, Health Economics and Outcomes Research Ltd, 9 Oak Tree Court, Mulberry Drive, Cardiff Gate Business Park, Cardiff, CF23 8RS, UK
| | - Anupama Kalsekar
- World Wide Health Economics and Outcomes Research, Bristol-Myers Squibb Pharmaceuticals Ltd, Princeton, USA
| | - Yong Yuan
- World Wide Health Economics and Outcomes Research, Bristol-Myers Squibb Pharmaceuticals Ltd, Princeton, USA
| | - Michael Brenner
- UK HEOR, Bristol-Myers Squibb Pharmaceuticals Ltd, Uxbridge, UK
| | - Phil McEwan
- HEOR, Health Economics and Outcomes Research Ltd, 9 Oak Tree Court, Mulberry Drive, Cardiff Gate Business Park, Cardiff, CF23 8RS, UK
- School of Human and Health Sciences, Swansea University, Swansea, UK
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22
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Kileng H, Bernfort L, Gutteberg T, Moen OS, Kristiansen MG, Paulssen EJ, Berg LK, Florholmen J, Goll R. Future complications of chronic hepatitis C in a low-risk area: projections from the hepatitis c study in Northern Norway. BMC Infect Dis 2017; 17:624. [PMID: 28915795 PMCID: PMC5602833 DOI: 10.1186/s12879-017-2722-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 09/08/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hepatitis C (HCV) infection causes an asymptomatic chronic hepatitis in most affected individuals, which often remains undetected until cirrhosis and cirrhosis-related complications occur. Screening of high-risk subjects in Northern Norway has revealed a relatively low prevalence in the general population (0.24%). Despite this, late complications of HCV infection are increasing. Our object was to estimate the future prevalence and complications of chronic HCV infection in the period 2013-2050 in a low-risk area. METHODS We have entered available data into a prognostic Markov model to project future complications to HCV infection. RESULTS The model extrapolates the prevalence in the present cohort of HCV-infected individuals, and assumes a stable low incidence in the projection period. We predict an almost three-fold increase in the incidence of cirrhosis (68 per 100,000), of decompensated cirrhosis (21 per 100,000) and of hepatocellular carcinoma (4 per 100,000) by 2050, as well as a six-fold increase in the cumulated number of deaths from HCV-related liver disease (170 per 100,000 inhabitants). All estimates are made assuming an unchanged treatment coverage of approximately 15%. The estimated numbers can be reduced by approximately 50% for cirrhosis, and by approximately one third for the other endpoints if treatment coverage is raised to 50%. CONCLUSION These projections from a low-prevalence area indicate a substantial rise in HCV-related morbidity and mortality in the coming years. The global HCV epidemic is of great concern and increased treatment coverage is necessary to reduce the burden of the disease.
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Affiliation(s)
- H Kileng
- Gastroenterology and Nutrition Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
- Department of Internal Medicine, Section of Gastroenterology, University Hospital of North Norway, Tromsø, Norway.
| | - L Bernfort
- Department of Medical and Health Sciences, University of Linköping, Linköping, Sweden
| | - T Gutteberg
- Research Group for Host-Microbe Interactions, Department of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Microbiology, University Hospital of North Norway, Tromsø, Norway
| | - O S Moen
- Gastroenterology and Nutrition Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | | | - E J Paulssen
- Gastroenterology and Nutrition Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Internal Medicine, Section of Gastroenterology, University Hospital of North Norway, Tromsø, Norway
| | - L K Berg
- Department of Medicine, Helgeland Hospital, Mo i Rana, Norway
| | - J Florholmen
- Gastroenterology and Nutrition Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Internal Medicine, Section of Gastroenterology, University Hospital of North Norway, Tromsø, Norway
| | - R Goll
- Gastroenterology and Nutrition Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Internal Medicine, Section of Gastroenterology, University Hospital of North Norway, Tromsø, Norway
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23
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Kåberg M, Hammarberg A, Lidman C, Weiland O. Prevalence of hepatitis C and pre-testing awareness of hepatitis C status in 1500 consecutive PWID participants at the Stockholm needle exchange program. Infect Dis (Lond) 2017; 49:728-736. [PMID: 28574295 DOI: 10.1080/23744235.2017.1334263] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND People who inject drugs (PWID) are the driving force of the hepatitis C virus (HCV) epidemic. Still, treatment is scarcely offered and the awareness of HCV status in PWID is poor. Prevention includes clean needles, syringes and other paraphernalia. HCV awareness was investigated in 1500 PWID in a needle exchange program (NEP) in Stockholm, Sweden, together with HCV prevalence, and time to HCV infection after start of injection drug use. METHODS 1500 PWID in the Stockholm NEP were consecutively enrolled. At baseline, awareness of the individual pre-test HCV status was measured followed with tests for anti-HCV and HCV RNA if anti-HCV was positive. RESULTS Mean age of participants was 39 years and the mean time of injection drug use 18 (0-51) years. The overall anti-HCV prevalence was 82% whereof 76% were HCV RNA positive. Within 4 years after start of injection drug use 50% of the participants were anti-HCV positive. Self-awareness of HCV status was low. Hence, 32% who believed that they never have encountered HCV were anti-HCV positive, and 24% were HCV RNA positive. For those who reported not being aware of their HCV status 62% were anti-HCV positive, and 47% were HCV RNA positive. CONCLUSION The very high prevalence of chronic HCV in PWID in Stockholm indicates that both measures for prevention with increased awareness of HCV, and a higher antiviral treatment utilisation in combination need to be implemented in order to reduce the HCV prevalence and combat the HCV epidemic.
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Affiliation(s)
- Martin Kåberg
- a Department of Medicine Huddinge, Division of Infectious Diseases , Karolinska Institutet, Karolinska University Hospital Huddinge , Stockholm , Sweden.,b Capio Maria, Addiction Centre , Stockholm , Sweden
| | - Anders Hammarberg
- c Centre for Psychiatry Research, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden.,d Stockholm Health Care Services, Stockholm County Council , Stockholm , Sweden
| | - Christer Lidman
- a Department of Medicine Huddinge, Division of Infectious Diseases , Karolinska Institutet, Karolinska University Hospital Huddinge , Stockholm , Sweden
| | - Ola Weiland
- a Department of Medicine Huddinge, Division of Infectious Diseases , Karolinska Institutet, Karolinska University Hospital Huddinge , Stockholm , Sweden
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24
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Yu ML, Huang CF, Yeh ML, Tsai PC, Huang CI, Hsieh MH, Hsieh MY, Lin ZY, Chen SC, Huang JF, Dai CY, Chuang WL. Time-Degenerative Factors and the Risk of Hepatocellular Carcinoma after Antiviral Therapy among Hepatitis C Virus Patients: A Model for Prioritization of Treatment. Clin Cancer Res 2017; 23:1690-1697. [PMID: 27733478 DOI: 10.1158/1078-0432.ccr-16-0921] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/10/2016] [Accepted: 09/17/2016] [Indexed: 12/11/2022]
Abstract
Purpose: Age and hepatic fibrosis are the factors that increase the risk of hepatocellular carcinoma over time. We aimed to explore their impact at the initiation of antiviral therapy on hepatocellular carcinoma among chronic hepatitis C (CHC) patients.Experimental Design: A total of 1,281 biopsy-proven CHC patients receiving IFN-based therapy were followed for a mean period of 5.5 years.Results: The 5-year cumulative incidence of hepatocellular carcinoma did not differ between non-sustained virological response (SVR) and SVR patients who were <40 years old (7.7% vs. 0.5%, P = 0.1) but was significantly higher in non-SVR patients between 40 and 55 years old (18.0% vs. 1.3%, P < 0.001) and >55 years old (15.1% vs. 7.9%, P = 0.03). Compared with SVR, non-SVR was independently predictive of hepatocellular carcinoma in patients 40 to 55 years old [HR/95% confidence intervals (CI), 10.92/3.78-31.56; P < 0.001] and >55 years old (HR/CI, 1.96/1.06-3.63; P = 0.03) but not in patients <40 years old (HR/CI, 2.76/0.41-18.84; P = 0.3). The 5-year cumulative incidence of hepatocellular carcinoma did not differ between non-SVR and SVR patients whose fibrosis stage was F0-1 (4.6% vs. 1.9%, P = 0.25) but was higher in non-SVR patients with F2-3 (21.4% vs. 4.3%, P < 0.001) or F4 (33.5% vs. 8.4%, P = 0.002). Compared with SVR, non-SVR was independently predictive of hepatocellular carcinoma in patients with F2-3 (HR/CI, 4.36/2.10-9.03; P < 0.001) and F4 (HR/CI, 3.84/1.59-9.30; P = 0.03) but not in those with F0-1 (HR/CI, 1.53/0.49-4.74; P = 0.47).Conclusions: Delayed hepatitis C virus clearance for patients with CHC >40 years old or with a fibrosis stage >2 increases the risk of hepatocellular carcinoma over time. Clin Cancer Res; 23(7); 1690-7. ©2016 AACR.
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Affiliation(s)
- Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Faculty of Internal Medicine, College of Medicine, and Center for Infectious Disease and Cancer Research, and Lipid Science and Aging Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
- Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Chung-Feng Huang
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Faculty of Internal Medicine, College of Medicine, and Center for Infectious Disease and Cancer Research, and Lipid Science and Aging Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Lun Yeh
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Faculty of Internal Medicine, College of Medicine, and Center for Infectious Disease and Cancer Research, and Lipid Science and Aging Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Chien Tsai
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ching-I Huang
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Meng-Hsuan Hsieh
- Department of Preventive Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ming-Yen Hsieh
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Zu-Yau Lin
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Faculty of Internal Medicine, College of Medicine, and Center for Infectious Disease and Cancer Research, and Lipid Science and Aging Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shinn-Cherng Chen
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Faculty of Internal Medicine, College of Medicine, and Center for Infectious Disease and Cancer Research, and Lipid Science and Aging Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jee-Fu Huang
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Faculty of Internal Medicine, College of Medicine, and Center for Infectious Disease and Cancer Research, and Lipid Science and Aging Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Yen Dai
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
- Faculty of Internal Medicine, College of Medicine, and Center for Infectious Disease and Cancer Research, and Lipid Science and Aging Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Preventive Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wan-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
- Faculty of Internal Medicine, College of Medicine, and Center for Infectious Disease and Cancer Research, and Lipid Science and Aging Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
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25
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Buti M, Calleja JL, García-Samaniego J, Serra MÁ, Crespo J, Romero M, Simón MÁ, Turnes J, Blasco AJ, Lázaro P, Robbins S, Razavi H. Elimination of hepatitis C in Spain: Adaptation of a mathematical model based on the public health strategic plan for addressing hepatitis C in the National Health System. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.medcle.2017.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Törner A, Stokkeland K, Svensson Å, Dickman PW, Hultcrantz R, Montgomery S, Duberg AS. The underreporting of hepatocellular carcinoma to the cancer register and a log-linear model to estimate a more correct incidence. Hepatology 2017; 65:885-892. [PMID: 27533761 DOI: 10.1002/hep.28775] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 07/19/2016] [Indexed: 01/15/2023]
Abstract
UNLABELLED The Cancer Register (CR) in Sweden has reported that the incidence of primary liver cancer (PLC) has slowly declined over the last decades. Even though all cancers, irrespective of diagnostic method, should be reported to the CR, the PLC incidence may not reflect the true rate. Improved diagnostic tools have enabled diagnosis of hepatocellular carcinoma based on noninvasive methods without histological verification, possibly associated with missed cancer reports or misclassification in the CR. Our objective was to study the completeness and assess the underreporting of PLC to the CR and to produce a more accurate estimate based on three registers. The CR, the Cause of Death Register, and the Patient Register were investigated. Differences and overlap were examined, the incidence was estimated by merging data from the registers, and the number reported to none of the registers was estimated using a log-linear capture-recapture model. The results show that 98% of the PLCs reported to the CR were histologically verified; 80% were hepatocellular carcinoma and 20% were intrahepatic cholangiocarcinoma. Unspecified liver cancer decreased over time and constituted <10% of all reported liver cancers. The CR may underestimate the liver cancer incidence by 37%-45%, primarily due to missed cancer reports. The estimated annual number of liver cancers increased over time, but the standardized incidence was stable around 11 per 100,000. Hepatitis C-associated liver cancer increased and constituted 20% in 2010. CONCLUSION There was an underreporting of PLC diagnosed by noninvasive methods; the incidence was considerably higher than estimated by the CR, with a stable incidence over time; reporting needs to improve and combining registers is recommended when studying incidence. (Hepatology 2017;65:885-892).
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Affiliation(s)
- Anna Törner
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Knut Stokkeland
- Department of Medicine, Visby Hospital, Visby, Sweden.,Department of Medicine, Gastroenterology and Hepatology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Åke Svensson
- Department of Mathematics, Stockholm University, Stockholm, Sweden
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Rolf Hultcrantz
- Department of Medicine, Gastroenterology and Hepatology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.,Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology and Public Health, University College London, UK
| | - Ann-Sofi Duberg
- Department of Infectious Diseases, School of Medical Sciences, Örebro University, Örebro, Sweden
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27
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Gountas I, Sypsa V, Papatheodoridis G, Souliotis G, Razavi H, Hatzakis A. Is elimination of HCV possible in a country with low diagnostic rate and moderate HCV prevalence?: The case of Greece. J Gastroenterol Hepatol 2017; 32:466-472. [PMID: 27403912 DOI: 10.1111/jgh.13485] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM The treatment of hepatitis C (HCV) with interferon (IFN)-free direct-acting antivirals (DAAs) is anticipated to change the future burden of disease. The aim of this study is to quantify the impact of IFN-free DAAs on HCV-related morbidity and mortality in Greece under different scenarios concerning treatment coverage and primary prevention, including the proposed by World Health Organization Global Hepatitis Strategy. METHODS A previously described model was used to project the future disease burden up to 2030 under scenarios, which includes treatment based on the combination of pegylated-IFN with ribavirin (base case) and scenarios using DAAs therapies. RESULTS Under the base case scenario, an increase in HCV-related morbidity and mortality is predicted in Greece (mortality in 2030: +23.6% compared with 2015). If DAAs are used with the same treatment coverage, the number of hepatocellular carcinoma cases and of liver related deaths are predicted to be lower by 4-7% compared with 2015. Under increased treatment coverage (from 2000 treated/year to approximately 5000/year in 2015-2020 and 2500/year subsequently), morbidity and mortality will decrease by 43-53% in 2030 compared with 2015. To achieve the WHO Global Hepatitis Strategy goals, a total number of 86 500 chronic hepatitis C patients will have to be treated during 2015-2030. CONCLUSIONS Elimination of HCV in Greece by 2030 necessitates great improvements in primary prevention, implementation of large screening programs and high treatment coverage.
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Affiliation(s)
- Ilias Gountas
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Papatheodoridis
- Department of Gastroenterology, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - George Souliotis
- Faculty of Social and Political Sciences, University of Peloponnese, Korinthos, Greece
| | - Homie Razavi
- Center for Disease Analysis, Lafayette, Colorado, USA
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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28
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Elimination of hepatitis C in Spain: Adaptation of a mathematical model based on the public health strategic plan for addressing hepatitis C in the National Health System. Med Clin (Barc) 2017; 148:277-282. [PMID: 28159349 DOI: 10.1016/j.medcli.2016.12.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/22/2016] [Accepted: 12/27/2016] [Indexed: 11/22/2022]
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29
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Büsch K, Waldenström J, Lagging M, Aleman S, Weiland O, Kövamees J, Duberg AS, Söderholm J. Prevalence and comorbidities of chronic hepatitis C: a nationwide population-based register study in Sweden. Scand J Gastroenterol 2017; 52:61-68. [PMID: 27598393 DOI: 10.1080/00365521.2016.1228119] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study was to estimate the prevalence of physician-diagnosed and registered chronic hepatitis C (CHC), and to estimate the reported frequencies of Charlson comorbidities compared with matched comparators from the general population. MATERIALS AND METHODS Patients were identified according to ICD codes for CHC in the Swedish National Patient Register (1997-2013). Prevalence was estimated according to different patient identification algorithms and for different subgroups. Charlson comorbidities were ascertained from the same register and compared with age/sex/county of residence matched general population comparators. RESULTS A total of 34,633 individuals with physician-diagnosed CHC were alive in Sweden in 2013 (mean age, 49 years; 64% men), corresponding to a physician-diagnosed prevalence of 0.36%. The prevalence varied by case definition (0.22%-0.36%). The estimate dropped to 0.14% for monitored CHC disease (defined as ≥1 CHC-related visit in 2013). Overall, 41.3% of the CHC patients had ≥1 physician-registered Charlson comorbidity; the most common was liver diseases (22.1%). Compared with matched comparators from the general population (n = 171,338), patients with CHC had more physician-diagnosed and registered diseases such as chronic pulmonary disease (10.2% vs. 4.0%), diabetes (10.6% vs. 5.5%) and liver-related cancer (1.3% vs. 0.2%; all p < .01). No information on behavioural factors, such as smoking, alcohol consumption or on-going illicit drug use, was available. CONCLUSION The physician-diagnosed prevalence of CHC was slightly lower than previously reported estimates, and varied by case definition. The additional comorbidities observed in the CHC group should be taken into consideration, as these comorbidities add to the disease burden.
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Affiliation(s)
- Katharina Büsch
- a AbbVie AB , Stockholm , Sweden.,b Department of Medicine , Karolinska Institutet , Stockholm , Sweden.,h Department of Laboratory Medicine, Division of Clinical Microbiology , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
| | - Jesper Waldenström
- c Department of Infectious Medicine , Institute of Biomedicine, Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden
| | - Martin Lagging
- c Department of Infectious Medicine , Institute of Biomedicine, Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden
| | - Soo Aleman
- d Department of Infectious Diseases , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden.,e Department of Gastroenterology and Hepatology , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
| | - Ola Weiland
- f Department of Medicine Huddinge, Division of Infectious Diseases , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
| | | | - Ann-Sofi Duberg
- g Department of Infectious Diseases, Faculty of Medicine and Health , Örebro University , Örebro , Sweden
| | - Jonas Söderholm
- a AbbVie AB , Stockholm , Sweden.,h Department of Laboratory Medicine, Division of Clinical Microbiology , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
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30
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Scavone C, Sportiello L, Rafaniello C, Mascolo A, Sessa M, Rossi F, Capuano A. New era in treatment options of chronic hepatitis C: focus on safety of new direct-acting antivirals (DAAs). Expert Opin Drug Saf 2016; 15:85-100. [DOI: 10.1080/14740338.2016.1221396] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Cristina Scavone
- Department of Experimental Medicine, Section of Pharmacology, Second University of Naples, Naples, Italy
| | - Liberata Sportiello
- Department of Experimental Medicine, Section of Pharmacology, Second University of Naples, Naples, Italy
| | - Concetta Rafaniello
- Department of Experimental Medicine, Section of Pharmacology, Second University of Naples, Naples, Italy
| | - Annamaria Mascolo
- Department of Experimental Medicine, Section of Pharmacology, Second University of Naples, Naples, Italy
| | - Maurizio Sessa
- Department of Experimental Medicine, Section of Pharmacology, Second University of Naples, Naples, Italy
| | - Francesco Rossi
- Department of Experimental Medicine, Section of Pharmacology, Second University of Naples, Naples, Italy
| | - Annalisa Capuano
- Department of Experimental Medicine, Section of Pharmacology, Second University of Naples, Naples, Italy
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Hepatitis C-related cirrhosis. Current status. Med Clin (Barc) 2016; 148:78-85. [PMID: 27855947 DOI: 10.1016/j.medcli.2016.09.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 12/15/2022]
Abstract
Chronic hepatitis C virus (HCV) infection affects around 150 million people. It is a leading cause of liver related morbidity and mortality through its predisposition to liver fibrosis, cirrhosis and end-stage liver complications. New treatments based on direct-acting antivirals have opened a new era in the management of HCV cirrhosis. They allow for HCV eradication without substantial side effects in almost all cirrhotic patients, reducing the risk of hepatocellular carcinoma, liver decompensation and mortality. This review provides an update on HCV cirrhosis. The paper focuses on the disease burden and major progresses in the diagnosis, follow-up and treatment of this patient subgroup.
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Dillon JF, Lazarus JV, Razavi HA. Urgent action to fight hepatitis C in people who inject drugs in Europe. HEPATOLOGY, MEDICINE AND POLICY 2016; 1:2. [PMID: 30288305 PMCID: PMC5918492 DOI: 10.1186/s41124-016-0011-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 06/20/2016] [Indexed: 12/19/2022]
Abstract
Hepatitis C virus (HCV) infection is a leading cause of liver cirrhosis and liver cancer, is curable in most people. Injecting drug use currently accounts for 80 % of new HCV infections with a known transmission route in the European Union (EU). HCV has generally received little attention from the public or policymakers in the EU, with major gaps in national-level strategies, action plans, guidelines and the evidence base. Specifically, people who inject drugs (PWID) are often excluded from treatment owing to various patient, healthcare provider and health system factors. All policymakers responsible for health services in EU countries should ensure that prevention, treatment, care and support interventions addressing HCV in PWID are developed and implemented. According to current best practice, PWID should have access to comprehensive, evidence-based multiprofessional harm reduction (especially opioid substitution therapy and clean needles and syringes) and support/care services based in the community and modified with community involvement to accommodate this hard-to-reach population. Other recommended components of care include vaccination against hepatitis B and other infections; peer support interventions; HIV testing, prevention and treatment; drug and alcohol services; psychological care as needed; and social support services. HCV testing should be performed regularly in PWID to identify infected persons and engage them in care. HCV-infected PWID should be considered for antiviral treatment (based on an individualised assessment and delivered within multidisciplinary care/support programmes) both to cure infected individuals and prevent onward transmission. Modelling data suggest that the HCV disease burden can only be cut substantially if antiviral treatment is scaled up together with prevention programmes. Measures should be taken to reduce stigma and discrimination against PWID at the provider and institutional levels. In conclusion, strategic action at the policy level is urgently needed to increase access to HCV prevention, testing and treatment among PWID, the group at highest risk of HCV infection. Such action has the potential to substantially reduce the number of infected persons, along with the disease burden and related care costs.
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Affiliation(s)
- John F Dillon
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, UK
| | - Jeffrey V Lazarus
- 2Centre for Health and Infectious Disease Research (CHIP) and WHO Collaborating Centre on HIV and Viral Hepatitis, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Ederth J, Jern C, Norder H, Magnius L, Alm E, Rognsvåg BK, Sundin CG, Brytting M, Esbjörnsson J, Mild M. Molecular characterization of HCV in a Swedish county over 8 years (2002-2009) reveals distinct transmission patterns. Infect Ecol Epidemiol 2016; 6:30670. [PMID: 26854010 PMCID: PMC4744866 DOI: 10.3402/iee.v6.30670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 01/13/2016] [Accepted: 01/13/2016] [Indexed: 02/06/2023] Open
Abstract
Background Hepatitis C virus (HCV) is a major public health concern and data on its molecular epidemiology in Sweden is scarce. We carried out an 8-year population-based study of newly diagnosed HCV cases in one of Sweden's centrally situated counties, Södermanland (D-county). The aim was to characterize the HCV strains circulating, analyze their genetic relatedness to detect networks, and in combination with demographic data learn more about transmission. Methods Molecular analyses of serum samples from 91% (N=557) of all newly notified cases in D-county, 2002–2009, were performed. Phylogenetic analysis (NS5B gene, 300 bp) was linked to demographic data from the national surveillance database, SmiNet, to characterize D-county transmission clusters. The linear-by-linear association test (LBL) was used to analyze trends over time. Results The most prevalent subtypes were 1a (38%) and 3a (34%). Subtype 1a was most prevalent among cases transmitted via sexual contact, via contaminated blood, or blood products, while subtype 3a was most prevalent among people who inject drugs (PWIDs). Phylogenetic analysis revealed that the subtype 3a sequences formed more and larger transmission clusters (50% of the sequences clustered), while the 1a sequences formed smaller clusters (19% of the sequences clustered), possibly suggesting different epidemics. Conclusion We found different transmission patterns in D-county which may, from a public health perspective, have implications for how to control virus infections by targeted interventions.
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Affiliation(s)
- Josefine Ederth
- Department of Microbiology, Public Health Agency of Sweden, Solna, Sweden;
| | - Camilla Jern
- Stockholm South General Hospital, Stockholm, Sweden
| | - Helené Norder
- Department of Infectious Medicine, Institute of Biomedicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Magnius
- Department of Infectious Medicine, Institute of Biomedicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erik Alm
- Department of Microbiology, Public Health Agency of Sweden, Solna, Sweden
| | | | | | - Mia Brytting
- Department of Microbiology, Public Health Agency of Sweden, Solna, Sweden
| | - Joakim Esbjörnsson
- Department of Microbiology Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden.,Nuffield Department Medicine, University of Oxford, Oxford, United Kingdom
| | - Mattias Mild
- Department of Microbiology, Public Health Agency of Sweden, Solna, Sweden
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