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Laguno M, Martínez-Rebollar M, Casanova M, de Lazzari E, González-Cordón A, Torres B, Inciarte A, Mora LDL, Ugarte A, Ambrosioni J, Blanco JL, Martínez E, Mallolas J. Long-term evolution in liver fibrosis and immune profile after direct-acting antivirals therapy in hepatitis C virus-human immunodeficiency virus co-infected patients. Clin Microbiol Infect 2021; 28:610.e1-610.e7. [PMID: 34464735 DOI: 10.1016/j.cmi.2021.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Hepatitis C virus (HCV) therapy with direct-acting antivirals (DAA) achieves high rates of sustained virological response in people living with human immunodeficiency virus (HIV) (PLWH). Information on its long-term clinical impact is scarce. The aim of this study was to analyse liver fibrosis and immune response evolution after DAA treatment. METHODS Retrospective, single centre cohort study of HIV-HCV co-infected patients treated with DAA between June 2013 and June 2018. We analysed the changes during follow up in liver fibrosis (assessed by transient elastography (TE), aspartate aminotransferase to platelet ratio index (APRI) and FIB-4 scores) and immunity (CD4 and CD8 cells counts and CD4/CD8 ratio). RESULTS We included 410 patients; 75% (308/407) men with a mean age of 50 years (SD 8); 78% (318/410) had long chronic HCV infection (median 21 years, interquartile range (IQR) 6-27 years) and 27% (107/393) had liver cirrhosis. Liver fibrosis improvement based on the decrease in TE value compared with the baseline occurred in 43% (131/302) of patients and 31% of patients based on biological scores (APRI: 124/398; FIB-4: 104/398) (p < 0.0001), being more frequent in those with advanced baseline fibrosis (83/144). The higher decrease was observed at 6 months after DAA therapy (-0.23; 95% CI -0.29 to -0.18), but a continuum in fibrosis regression of at least 30% from baseline value of TE was observed along the follow up (32% of patients at month 6, 51% at month 24 and 55% at month 48). Regarding the immunological profile, there was a significant decrease in CD8 counts at month 48 (-62.38; 95% CI -106.77 to -17.99; p 0.0001) and a progressive rise in the CD4/CD8 ratio after 24 months of follow up reaching an increment of +0.07 (95% CI 0.03-0.10, p 0.0001) at month 48. CONCLUSIONS HCV treatment with DAA in PLWH is associated with significant progressive improvement in liver fibrosis and recovery of the immune system with an increase in the CD4/CD8 ratio in long-term follow up.
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Affiliation(s)
| | | | | | | | | | - Berta Torres
- HIV Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alexy Inciarte
- HIV Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Ainoa Ugarte
- HIV Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | | | | | - Josep Mallolas
- HIV Unit, Hospital Clínic de Barcelona, Barcelona, Spain
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2
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Soares J, Ferreira A, Silva-Pinto A, Almeida F, Piñeiro C, Serrão R, Sarmento A. The Influence of Antiretroviral Therapy on Hepatitis C Virus Viral Load and Liver Fibrosis in Human Immunodeficiency Virus-Coinfected Patients: An Observational Study. Intervirology 2019; 62:182-190. [PMID: 31775148 DOI: 10.1159/000503631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 09/21/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The role of antiretroviral therapy (ART) for Hepatitis C viral load (HCV-VL) and liver fibrosis is poorly understood. This study aimed at evaluating the influence of ART on HCV-VL and liver fibrosis in human immunodeficiency virus (HIV)/HCV-coinfected patients. METHODS We conducted a retrospective cohort study of HIV/HCV-coinfected patients followed at a tertiary university hospital. RESULTS In total, 143 patients were included. In 61 patients, ART initiation was accompanied by an increase in HCV-VL and a decrease in HIV viral load (HIV-VL), whereas ART suspension led to a decrease in HCV-VL and an increase in HIV-VL. Among the 55 HIV-suppressed patients who switched to a raltegravir (RAL)-containing regimen, median HCV-VL levels decreased significantly, while switching to a rilpivirine-containing regimen did not yield a significant reduction. DISCUSSION If the -treatment of chronic hepatitis starts before ART, ART initiation should be delayed as much as possible. If ART has been started, it is advisable to wait 1 year before initiating chronic hepatitis treatment. RAL as the third agent in an ART regimen could be beneficial in HIV/HCV-coinfected patients, in comparison to other antiretroviral drugs. CONCLUSION The start and the suspension of ART significantly interferes with HCV-VL in HIV/HCV-coinfected patients.
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Affiliation(s)
- Jorge Soares
- Infectious Diseases Department, Centro Hospitalar São João, Porto, Portugal
| | - António Ferreira
- Medicine Department, Hospital de Viana do Castelo, Viana do Castelo, Portugal
| | - André Silva-Pinto
- Infectious Diseases Department, Centro Hospitalar São João, Porto, Portugal,
| | - Francisco Almeida
- Infectious Diseases Department, Centro Hospitalar São João, Porto, Portugal
| | - Carmela Piñeiro
- Infectious Diseases Department, Centro Hospitalar São João, Porto, Portugal
| | - Rosário Serrão
- Infectious Diseases Department, Centro Hospitalar São João, Porto, Portugal
| | - António Sarmento
- Infectious Diseases Department, Centro Hospitalar São João, Porto, Portugal
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3
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Londoño MC, Riveiro-Barciela M, Ahumada A, Muñoz-Gómez R, Roget M, Devesa-Medina MJ, Serra MÁ, Navascués CA, Baliellas C, Aldamiz-Echevarría T, Gutiérrez ML, Polo-Lorduy B, Carmona I, Benlloch S, Bonet L, García-Samaniego J, Jiménez-Pérez M, Morán-Sánchez S, Castro Á, Delgado M, Gea-Rodríguez F, Martín-Granizo I, Montes ML, Morano L, Castaño MA, de los Santos I, Laguno M, Losa JE, Montero-Alonso M, Rivero A, de Álvaro C, Manzanares A, Mallolas J, Barril G, González-Parra E, García-Buey L. Effectiveness, safety/tolerability of OBV/PTV/r ± DSV in patients with HCV genotype 1 or 4 with/without HIV-1 co-infection, chronic kidney disease (CKD) stage IIIb-V and dialysis in Spanish clinical practice - Vie-KinD study. PLoS One 2019; 14:e0221567. [PMID: 31550267 PMCID: PMC6759177 DOI: 10.1371/journal.pone.0221567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 08/11/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND AIMS Limited data are available on the effectiveness and tolerability of direct-acting antivirals (DAAs) therapies in the real world for HCV-infected patients with comorbidities. This study aimed to describe the effectiveness of OBV/PTV/r ± DSV (3D/2D regimen) with or without ribavirin (RBV) in HCV or HCV/HIV co-infected patients with GT1/GT4 and CKD (IIIb-V stages), including those under hemodialysis and peritoneal dialysis in routine clinical practice in Spain in 2015. MATERIAL AND METHODS Non-interventional, retrospective, multicenter data collection study in 31 Spanish sites. Socio-demographic, clinical variables, study treatment characteristics, effectiveness and tolerability data were collected from medical records. RESULTS Data from 135 patients with a mean age (SD) of 58.3 (11.4) years were analyzed: 92.6% GT1 (81.6% GT1b and 17.6% GT1a) and 7.4% GT4, 14 (10.4%) HIV/HCV co-infected, 19.0% with fibrosis F3 and 28.1% F4 by FibroScan®, 52.6% were previously treated with pegIFN and RBV. 11.1%, 14.8% and 74.1% of patients had CKD stage IIIb, IV and V respectively. 68.9% of patients were on hemodialysis; 8.9% on peritoneal dialysis and 38.5% had history of renal transplant. A total of 125 (96.2%) of 135 patients were treated with 3D, 10 (7.4%) with 2D and 30.4% received RBV. The overall intention-to-treat (ITT) sustained virologic response at week 12 (SVR12) was 92.6% (125/135) and the overall modified-ITT (mITT) SVR12 was 99.2% (125/126). The SVR12 rates (ITT) per sub-groups were: HCV mono-infected (91.7%), HCV/HIV co-infected (100%), GT1 (92.0%), GT4 (100%), CKD stage IIIb (86.7%), stage IV (95%) and stage V (93%). Among the 10 non-SVR there was only 1 virologic failure (0.7%); 4 patients had missing data due lost to follow up (3.0%) and 5 patients discontinued 3D/2D regimen (3.7%): 4 due to severe adverse events (including 3 deaths) and 1 patient´s decision. CONCLUSIONS These results have shown that 3D/2D regimens are effective and tolerable in patients with advanced CKD including those in dialysis with GT 1 or 4 chronic HCV mono-infection and HIV/HCV coinfection in a real-life cohort. The overall SVR12 rates were 92.6% (ITT) and 99.2% (mITT) without clinically relevant changes in eGFR until 12 weeks post-treatment. These results are consistent with those reported in clinical trials.
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Affiliation(s)
- María-Carlota Londoño
- Liver Unit, Hospital Clínic/IDIBAPS, Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERhed), Instituto de Salud Carlos III, Madrid, Madrid, Spain
| | - Mar Riveiro-Barciela
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERhed), Instituto de Salud Carlos III, Madrid, Madrid, Spain
- Liver Unit, Internal Medicine Department, Hospital Vall d'Hebron, Barcelona, Barcelona, Spain
| | - Adriana Ahumada
- Department of Gastroenterology, Hospital General Universitario Gregorio Marañón, Madrid, Madrid, Spain
| | - Raquel Muñoz-Gómez
- Department of Gastroenterology, Hospital General Universitario 12 de Octubre, Madrid, Madrid, Spain
| | - Mercé Roget
- Liver Unit, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain
| | - María J. Devesa-Medina
- Department of Gastroenterology, Hospital Universitario Clínico San Carlos, Madrid, Madrid, Spain
| | - Miguel Ángel Serra
- Digestive Medicine Service, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Carmen A. Navascués
- Department of Gastroenterology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Carme Baliellas
- Liver Unit, Hospital de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Teresa Aldamiz-Echevarría
- Infectious Diseases-HIV Hospital General Universitario Gregorio Marañón (IiSGM), Madrid, Madrid, Spain
| | - María L. Gutiérrez
- Department of Gastroenterology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Benjamín Polo-Lorduy
- Digestive Diseases Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Madrid, Spain
| | - Isabel Carmona
- Digestive Disease Unit, Hospital Universitario Virgen Macarena, Sevilla, Sevilla, Spain
| | - Salvador Benlloch
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERhed), Instituto de Salud Carlos III, Madrid, Madrid, Spain
- Department of Hepatology, Hospital Universitario y Politécnico La Fe, Valencia, Valencia, Spain
| | - Lucía Bonet
- Department of Gastroenterology, Hospital Universitario Son Espases, Palma de Mallorca, Mallorca, Spain
| | - Javier García-Samaniego
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERhed), Instituto de Salud Carlos III, Madrid, Madrid, Spain
- Liver Unit, Hospital Universitario La Paz/IdiPaz, Madrid, Madrid, Spain
| | | | | | - Ángeles Castro
- Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Manuel Delgado
- Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Francisco Gea-Rodríguez
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERhed), Instituto de Salud Carlos III, Madrid, Madrid, Spain
- Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Madrid, Madrid, Spain
| | - Ignacio Martín-Granizo
- Department of Gastroenterology, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | | | - Luís Morano
- Infectious Disease Unit, Internal Medicine Department, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | | | - Ignacio de los Santos
- Department of Internal Medicine, Hospital Universitario La Princesa, Madrid, Madrid, Spain
| | - Montserrat Laguno
- HIV Unit, Infectious Diseases Service, Hospital Clínic/IDIBAPS, Barcelona, Barcelona, Spain
| | - Juan Emilio Losa
- Infectious Diseases Unit, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Marta Montero-Alonso
- Infectious Diseases Unit, Hospital Universitario y Politécnico La Fe, Valencia, Valencia, Spain
| | - Antonio Rivero
- Infectious Diseases Unit, Hospital Universitario Reina Sofía de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain
| | | | - Amanda Manzanares
- Medical Department & Quality Assurance, ABBVIE, Madrid, Madrid, Spain
| | - Josep Mallolas
- HIV Unit, Infectious Diseases Service, Hospital Clínic/IDIBAPS, Barcelona, Barcelona, Spain
| | - Guillermina Barril
- Nephrology Unit, Hospital Universitario La Princesa, Madrid, Madrid, Spain
| | - Emilio González-Parra
- Nephrology Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Madrid, Spain
| | - Luisa García-Buey
- Liver Unit, Hospital Universitario La Princesa, Madrid, Madrid, Spain
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Mattingly TJ, Pandit NS, Onukwugha E. Burden of Co-Infection: A Cost Analysis of Human Immunodeficiency Virus in a Commercially Insured Hepatitis C Virus Population. Infect Dis Ther 2019; 8:219-228. [PMID: 30825134 PMCID: PMC6522558 DOI: 10.1007/s40121-019-0240-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Indexed: 12/16/2022] Open
Abstract
Introduction In patients with hepatitis C virus (HCV), human immunodeficiency virus (HIV) represents a major cause of morbidity and economic burden. Economic evaluations in HIV-HCV typically focus on government-sponsored insurance plans rather than a commercially insured cohort. This study evaluated the clinical and economic burden of HIV-HCV co-infection compared with HCV alone in commercially insured patients throughout the United States. Methods Commercial medical and pharmacy claims from 2007 to 2015 from a 10% random sample of enrollees within the IQVIA PharMetrics Plus™ administrative claims database were analyzed. Patients were included based on the presence of a claim with a HCV diagnosis across three separate cross-sectional periods which were created from the full dataset (2007–2009, 2010–2012, and 2013–2015). Costs incurred were categorized as emergency department, inpatient, outpatient medical, outpatient pharmacy, and other, based on the claim place of service. Descriptive statistics and proportion of total costs in each group have been reported for all cost categories. Results The samples included 22,329 from 2007 to 2009, 23,186 from 2010 to 2012, and 27,288 from 2013 to 2015. In all three cross-sections, HIV-HCV individuals were more likely to be male and carriers of hepatitis B virus. Pharmacy costs were $29,368 in the HCV-only group, compared to $73,547 in the HIV-HCV group (p < 0.0001). Pharmacy costs increased as a proportion of total costs for both groups, increasing after 2012 from 41% to 55% for HIV-HCV and from 19% to 34% for HCV-only. Conclusion The present study describes the total direct health care costs in HIV-HCV co-infected individuals and HCV-only patients in commercially insured health plans. Spending on pharmacy increased as a proportion of total health care costs in both groups. Further clinical and economic evaluations in HCV and/or HIV populations in the US should consider system-level factors related to insurance type when applying to the entire population.
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Affiliation(s)
- T Joseph Mattingly
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA.
| | - Neha S Pandit
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Eberechukwu Onukwugha
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
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5
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Wu J, Huang P, Fan H, Tian T, Xia X, Fu Z, Wang Y, Ye X, Yue M, Zhang Y. Effectiveness of ombitasvir/paritaprevir/ritonavir, dasabuvir for HCV in HIV/HCV coinfected subjects: a comprehensive analysis. Virol J 2019; 16:11. [PMID: PMID: 30654809 PMCID: PMC6337763 DOI: 10.1186/s12985-018-1114-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 12/27/2018] [Indexed: 11/17/2022] Open
Abstract
Background Data on the treatment of patients with hepatitis C virus (HCV)/human immunodeficiency virus (HIV) coinfection remains limited. A comprehensive analysis was performed to evaluate the efficacy and safety of ombitasvir (OBV)/paritaprevir (PTV)/ritonavir(r) ± dasabuvir (DSV) ± ribavirin (RBV) for treatment in HCV/HIV coinfected patients. Methods We systematically searched and included studies that enrolled patients with HIV/HCV coinfection using the OBV/PTV/r ± DSV ± RBV regimens and reported sustained virological response after 12 weeks (SVR12) end-of-treatment. Heterogeneity of results was assessed and pooled SVR rates were computed with 95% confidence intervals (95%CI). Subgroup analysis and assessment of publication bias through Egger’s test were further performed. Results Ten studies containing 1358 coinfected patients were included in this study. The pooled estimate of SVR12 was 96.3% (95%CI: 95.1–97.4). Subgroup analysis showed that pooled SVR12 rate was 96.2% (95% CI: 94.8–97.4) for patients with genotype (GT) 1 and 98.8% (95% CI: 95.1–100.0) for those with GT4. The SVR12 rates for the treatment-naïve (TN) and treatment-experienced (TE) patients were 96.8% (95% CI, 94.8–98.5) and 98.9% (95% CI, 96.4–100.0), respectively. Pooled SVR12 rate was 97.8(95%CI: 94.6–99.8) for patients with cirrhosis and 96.7% (95%CI: 95.3–97.8) without cirrhosis. The pooled incidence of any adverse events (AEs) and serious adverse events (SAEs) was 73.9% (95%CI: 38.1–97.6) and 2.7% (95%CI: 0.0–9.5). Publication bias did not exist in this study. Conclusions The comprehensive analysis showed high efficacy for the OBV/PTV/r ± DSV ± RBV regimen in patients coinfected with HIV and HCV, regardless of genotypes, history of treatment and the presence or absence of cirrhosis. Electronic supplementary material The online version of this article (10.1186/s12985-018-1114-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jingjing Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Peng Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.,Key Laboratory of Infectious Diseases, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.,Institute of Epidemiology and Microbiology, Huadong Research Institute for Medicine and Biotechnics, Nanjing, 210002, China
| | - Haozhi Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Ting Tian
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Xueshan Xia
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Yunnan, 650550, China
| | - Zuqiang Fu
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Yan Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Xiangyu Ye
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Ming Yue
- Department of Infectious Diseases, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
| | - Yun Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, 211166, China. .,Key Laboratory of Infectious Diseases, School of Public Health, Nanjing Medical University, Nanjing, 211166, China. .,Institute of Epidemiology and Microbiology, Huadong Research Institute for Medicine and Biotechnics, Nanjing, 210002, China.
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6
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Ison MG, Heldman M. Bacterial Infections. HEPATIC CRITICAL CARE 2018. [PMCID: PMC7120903 DOI: 10.1007/978-3-319-66432-3_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Bacterial infections are the most significant infectious source of morbidity and mortality in cirrhotic patients. Bacteria infections result is both acute decompensation in chronic liver disease and mortality in patients with decompensated cirrhosis. Spontaneous bacterial peritonitis (SBP), bacteremia, pneumonia, urinary tract infections (UTI) and skin and soft tissue infection (SSTI) are the most significant sources of infection in cirrhosis. Bacterial infections can precipitate renal failure and worsening hepatic encephalopathy, and patients with sepsis and liver disease have higher rates of acute respiratory distress syndrome (ARDS) and coagulopathy.
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Phylogenetic Diversity in Core Region of Hepatitis C Virus Genotype 1a as a Factor Associated with Fibrosis Severity in HIV-1-Coinfected Patients. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1728456. [PMID: 29259976 PMCID: PMC5702417 DOI: 10.1155/2017/1728456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 10/19/2017] [Indexed: 02/06/2023]
Abstract
High hepatitis C virus (HCV) genetic diversity impacts infectivity/pathogenicity, influencing chronic liver disease progression associated with fibrosis degrees and hepatocellular carcinoma. HCV core protein is crucial in cell-growth regulation and host-gene expression. Liver fibrosis is accelerated by unknown mechanisms in human immunodeficiency virus-1- (HIV-1-) coinfected individuals. We aimed to study whether well-defined HCV-1a core polymorphisms and genetic heterogeneity are related to fibrosis in a highly homogeneous group of interferon-treated HIV-HCV-coinfected patients. Genetic heterogeneity was weighed by Faith's phylogenetic diversity (PD), which has been little studied in HCV. Eighteen HCV/HIV-coinfected patients presenting different liver fibrosis stages before anti-HCV treatment-initiation were recruited. Sampling at baseline and during and after treatment was performed up to 72 weeks. At inter/intrahost level, HCV-1a populations were studied using molecular cloning and Sanger sequencing. Over 400 complete HCV-1a core sequences encompassing 573 positions of C were obtained. Amino acid substitutions found previously at positions 70 and 91 of HCV-1b core region were not observed. However, HCV genetic heterogeneity was higher in mild than in severe fibrosis cases. These results suggest a potential utility of PD as a virus-related factor associated with chronic hepatitis C progression. These observations should be reassessed in larger cohorts to corroborate our findings and assess other potential covariates.
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8
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Zanolla AF, Buss C, Kliemann DA, Pinto GS, Vasques VS, Tovo CV. Relative validity of a food frequency questionnaire in patients coinfected with hepatitis C virus and human immunodeficiency virus. Rev Soc Bras Med Trop 2017; 50:117-120. [PMID: 28327813 DOI: 10.1590/0037-8682-0027-2016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 09/23/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION: Validation of food frequency questionnaires (FFQs) is recommended for accurate measurement of habitual food consumption. We assessed the relative validity of a FFQ in patients coinfected with hepatitis C virus and human immunodeficiency virus. METHODS: Each patient responded to a FFQ and three 24-hour food recalls. Pearson's correlation and weighted Kappa index analyses were performed to identify the FFQ relative validity and concordance. RESULTS: De-attenuated correlation coefficients ranged from 0.35 (vitamin B1) to 0.81 (selenium). The concordance index ranged from 0.07 (vitamin C) to 0.51 (calcium). CONCLUSIONS: The FFQ showed satisfactory relative validity for most nutrients.
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Affiliation(s)
- Anelise Fernanda Zanolla
- Programa de Pós-Graduação Stricto Sensu em Medicina: Hepatologia, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil
| | - Caroline Buss
- Programa de Pós-Graduação Stricto Sensu em Medicina: Hepatologia, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil.,Departamento de Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil
| | - Dimas Alexandre Kliemann
- Programa de Pós-Graduação Stricto Sensu em Medicina: Hepatologia, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil.,Ambulatório de Infectologia, Hospital Nossa Senhora da Conceição, Porto Alegre, RS, Brasil
| | - Giselle Souza Pinto
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil
| | | | - Cristiane Valle Tovo
- Programa de Pós-Graduação Stricto Sensu em Medicina: Hepatologia, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil.,Departamento de Medicina: Gastroenterologia, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil.,Serviço de Gastroenterologia, Hospital Nossa Senhora da Conceição, Porto Alegre, RS, Brasil
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Sande JA, Verjee S, Vinayak S, Amersi F, Ghesani M. Ultrasound shear wave elastography and liver fibrosis: A Prospective Multicenter Study. World J Hepatol 2017; 9:38-47. [PMID: 28105257 PMCID: PMC5220270 DOI: 10.4254/wjh.v9.i1.38] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/24/2016] [Accepted: 08/08/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the accuracy of shear wave elastography (SWE) alone and in combination with aminotransferase platelet ratio index (APRI) score in the staging of liver fibrosis.
METHODS A multicenter prospective study was conducted to assess the accuracy of SWE (medians) and APRI to predict biopsy results. The analysis focused on distinguishing the different stages of liver disease, namely, F0 from F1-4, F0-1 from F2-4, F0-2 from F3-4 and F0-3 from F4; F0-F1 from F2-F4 being of primary interest. The area under the receiver operating characteristic (AUROC) curve was computed using logistic regression model. The role of age, gender and steatosis was also assessed.
RESULTS SWE alone accurately distinguished F0-1 from F2-4 with a high probability. The AUROC using SWE alone was 0.91 compared to 0.78 for using the APRI score alone. The APRI score, when used in conjunction with SWE, did not make a significant contribution to the AUROC. SWE and steatosis were the only significant predictors that differentiated F0-1 from F2-4 with an AUROC of 0.944.
CONCLUSION Our study validates the use of SWE in the diagnosis and staging of liver fibrosis. Furthermore, the probability of a correct diagnosis is significantly enhanced with the addition of steatosis as a prognostic factor.
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Budzko L, Marcinkowska-Swojak M, Jackowiak P, Kozlowski P, Figlerowicz M. Copy number variation of genes involved in the hepatitis C virus-human interactome. Sci Rep 2016; 6:31340. [PMID: 27510840 PMCID: PMC4980658 DOI: 10.1038/srep31340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 07/18/2016] [Indexed: 02/06/2023] Open
Abstract
Copy number variation (CNV) is a newly discovered form of intra-species genetic polymorphism that is defined as deletions or duplications of genome segments ranging from 1 kbp to several Mbp. CNV accounts for the majority of the genetic variation observed in humans (CNV regions cover more than 10% of the human genome); therefore, it may significantly influence both the phenotype and susceptibility to various diseases. Unfortunately, the impact of CNV on a number of diseases, including hepatitis C virus (HCV) infection, remains largely unexplored. Here, we analyzed 421 human genes encoding proteins that have been shown to interact with HCV proteins or genomic RNA (proteins from the HCV-human interactome). We found that 19 of the 421 candidate genes are located in putative CNV regions. For all of these genes, copy numbers were determined for European, Asiatic and African populations using the multiplex ligation-dependent amplification (MLPA) method. As a result, we identified 4 genes, IGLL1, MLLT4, PDPK1, PPP1R13L, for which the CN-genotype ranged from 1 to 6. All of these genes are involved in host-virus interaction; thus, their polymorphism has a potential impact on the development of HCV infection and/or therapy outcome.
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Affiliation(s)
- Lucyna Budzko
- Institute of Bioorganic Chemistry, Polish Academy of Sciences, Poznan, Poland
| | | | - Paulina Jackowiak
- Institute of Bioorganic Chemistry, Polish Academy of Sciences, Poznan, Poland
- Institute of Chemical Technology and Engineering, Poznan University of Technology, Poznan, Poland
| | - Piotr Kozlowski
- Institute of Bioorganic Chemistry, Polish Academy of Sciences, Poznan, Poland
- Institute of Chemical Technology and Engineering, Poznan University of Technology, Poznan, Poland
| | - Marek Figlerowicz
- Institute of Bioorganic Chemistry, Polish Academy of Sciences, Poznan, Poland
- Institute of Computing Science, Poznan University of Technology, Poznan, Poland
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11
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Saab S, Virabhak S, Parisé H, Johnson S, Wang A, Misurski D, Gonzalez YS, Juday T. Cost-Effectiveness of Genotype 1 Chronic Hepatitis C Virus Treatments in Patients Coinfected with Human Immunodeficiency Virus in the United States. Adv Ther 2016; 33:1316-30. [PMID: 27342742 DOI: 10.1007/s12325-016-0362-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Indexed: 12/15/2022]
Abstract
INTRODUCTION New treatments for chronic hepatitis C virus (HCV) are highly effective in patients coinfected with human immunodeficiency virus (HIV). This study estimated the cost-effectiveness of treatments for genotype 1 (GT1) HCV in HIV-coinfected patients. METHODS A Markov model based on HCV natural history was used. The base-case analysis included both treatment-naïve and -experienced patients. Alternatives were ombitasvir/paritaprevir/ritonavir, dasabuvir with or without ribavirin (3D ± R) for 12 or 24 weeks, sofosbuvir plus peginterferon and R (SOF + PR) for 12 weeks, SOF + R for 24 weeks, and no treatment (NT). A subgroup analysis restricted to treatment-naïve, non-cirrhotic patients compared 3D ± R for 12 weeks to SOF plus ledipasvir (LDV) for 12 weeks and NT. Transition probabilities, utilities, and costs were obtained from the published literature. Outcomes were measured over a lifetime horizon and included rates of compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma and liver-related death, total costs, life-years, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER). RESULTS In the base-case, SOF + R was dominated by both SOF + PR and 3D ± R. Compared to SOF + PR, 3D ± R had an ICER of $45,581. The lifetime rates of liver morbidity and mortality were lower among those treated with 3D ± R compared to SOF + PR, SOF + R, or NT. In the subgroup analysis, 3D ± R was cost-effective compared to NT at a threshold of $50,000 per QALY (ICER $27,496). SOF/LDV had an ICER of $104,489 per QALY gained compared to 3D ± R. CONCLUSION In the GT1 HCV population coinfected with HIV, 3D ± R was cost-effective compared to NT, SOF + R, and SOF + PR. In the treatment-naïve sub-population, 3D ± R was cost-effective compared to NT and SOF/LDV.
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Affiliation(s)
- Sammy Saab
- Pfleger Liver Institute, UCLA, Los Angeles, CA, USA
| | | | | | | | - Alice Wang
- Health Economics and Outcomes Research, AbbVie, Inc., Mettawa, IL, USA.
| | - Derek Misurski
- Health Economics and Outcomes Research, AbbVie, Inc., Mettawa, IL, USA
| | | | - Timothy Juday
- Health Economics and Outcomes Research, AbbVie, Inc., Mettawa, IL, USA
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12
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Prasetyo AA, Dharmawan R, Raharjo I, Hudiyono. Human Leukocyte Antigen-E Alleles are Associated with Hepatitis C Virus, Torque Teno Virus, and Toxoplasma Co-infections but are not Associated with Hepatitis B Virus, Hepatitis D Virus, and GB Virus C Co-infections in Human Immunodeficiency Virus Patients. J Glob Infect Dis 2016; 8:75-81. [PMID: 27293362 PMCID: PMC4879794 DOI: 10.4103/0974-777x.182121] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Context: Data regarding the distribution of Human Leukocyte Antigen (HLA)-E alleles and their association with blood-borne pathogen infections/co-infections are limited for many populations, including Indonesia. Aims: The aim of this study was to analyze the association between HLA-E allelic variants and infection with blood-borne pathogens such as hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), torque teno virus (TTV), GB virus C (GBV-C), and Toxoplasma gondii (T. gondii) in Indonesian Javanese human immunodeficiency virus (HIV) patients. Settings and Design: A total of 320 anti-HIV-positive blood samples were analyzed for HBV, HCV, HDV, TTV, GBV-C, and T. gondii infection status and its association with HLA-E allelic variants. Materials and Methods: Nucleic acid was extracted from plasma samples and used for the molecular detection of HBV DNA, HCV RNA, HDV RNA, TTV DNA, and GBV-C RNA, whereas hepatitis B surface antigen, anti-HCV, immunoglobulin M and G (IgM and IgG) anti-T. gondii were detected through serological testing. The blood samples were genotyped for HLA-E loci using a sequence-specific primer-polymerase chain reaction. Statistical Analysis Used: Either the Chi-square or Fisher's exact test was performed to analyze the frequency of HLA-E alleles and blood-borne pathogen infections in the population. Odds ratios (ORs) were calculated to measure the association between the antibodies found and the participants’ possible risk behaviors. A logistic regression analysis was used to assess the associations. Results: HLA-E*101/0101 was associated with HCV/TTV co-infection (adjusted OR [aOR]: 3.5; 95% confidence interval [CI]: 1.156-10.734; P = 0.027) and IgM/IgG anti-Toxo positivity (aOR: 27.0; 95% CI: 3.626-200.472; P = 0.001). HLA-E*103/0103 was associated with TTV co-infection (aOR: 2.7; 95% CI: 1.509-4.796; P = 0.001). Conclusions: HLA-E alleles in Indonesian Javanese HIV patients were found to be associated with HCV, TTV, and toxoplasma co-infections.
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Affiliation(s)
- Afiono Agung Prasetyo
- A-IGIC (A-Infection, Genomic, Immunology & Cancer) Research Group, Sutami 36A, Surakarta, Indonesia; Department of Microbiology, Faculty of Medicine, Sutami 36A, Surakarta, Indonesia; Center of Biotechnology and Biodiversity Research and Development, Sebelas Maret University, Jl. Ir. Sutami 36A, Surakarta, Indonesia
| | - Ruben Dharmawan
- A-IGIC (A-Infection, Genomic, Immunology & Cancer) Research Group, Sutami 36A, Surakarta, Indonesia; Department of Parasitology, Faculty of Medicine, Surakarta, Indonesia
| | - Irvan Raharjo
- A-IGIC (A-Infection, Genomic, Immunology & Cancer) Research Group, Sutami 36A, Surakarta, Indonesia
| | - Hudiyono
- A-IGIC (A-Infection, Genomic, Immunology & Cancer) Research Group, Sutami 36A, Surakarta, Indonesia; Department of Microbiology, Faculty of Medicine, Sutami 36A, Surakarta, Indonesia; Center of Biotechnology and Biodiversity Research and Development, Sebelas Maret University, Jl. Ir. Sutami 36A, Surakarta, Indonesia
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13
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Afzali H, Momen-Heravi M, Farokhzad A. Epidemiological Distribution and Genotype Characterization of the Hepatitis C Virus Among HIV Patients in Kashan, Iran. HEPATITIS MONTHLY 2016; 16:e30459. [PMID: 27642343 PMCID: PMC5018303 DOI: 10.5812/hepatmon.30459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 04/12/2016] [Accepted: 05/28/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Parenteral transmission is a common route of transmission for both human immunodeficiency virus (HIV) and hepatitis C virus (HCV); therefore, hepatitis C viral infection is highly prevalent among people infected with HIV. OBJECTIVES This study was designed to examine the epidemiology and describe the clinical manifestation as well as the HCV genotypes in patients from the city of Kashan, Iran, who are coinfected with HIV and HCV. PATIENTS AND METHODS This descriptive study was conducted in 2014 in the city of Kashan. The population consisted of all the HIV-infected patients who were referred to the behavioral counseling center and jail in Kashan. Demographic information and HCV- and HIV-related risk behaviors were obtained through the use of an interviewer-assisted questionnaire. After the participants gave written informed consent to participate, 10 cc venous blood samples were collected. The serum samples were screened for HCV infection using an enzyme-linked immunosorbent assay (ELISA). In the event of a positive test for HCV, the RNA was then amplified by polymerase chain reaction (PCR) amplification. The HCV subtypes were determined via the direct sequencing of the amplicons. All data analysis was performed using SPSS version 16.0 for the descriptive statistics, and then the chi-square test and Pearson coefficient were performed for additional analysis. RESULTS The results of the analysis indicated that 54 (85%) of the 63 HIV-infected patients were males who were also HCV positive and who had less than a high school level education. There was a significant association between HCV infection and both occupation (P < 0.0001) and level of education (P < 0.05). All the HIV/HCV coinfected cases had a history of illicit drug use, while 92.6% had a history of imprisonment and 40.7% had high risk sexual contacts. Overall, genotype 1 was found in 75.9% of HCV patients, while genotype 3 was found in 24.1%. Some 94.4% of HCV patients had subtype A. There were no clinical symptoms of chronic hepatitis C. CONCLUSIONS The majority of HIV-infected persons in the city of Kashan were also HCV positive. Genotype 1 was the predominant type, alongside subtype A. Considering the high prevalence of HCV among the HIV-infected persons, as well as the impact of occupation, education, illicit drug use, and imprisonment on the incidence of both infections, health policy makers must introduce health programs and plans to reduce the prevalence of these infections.
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Affiliation(s)
- Hasan Afzali
- Associate Professor, Department of Infectious Disease, School of Medicine, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Mansooreh Momen-Heravi
- Associate Professor, Department of Infectious Disease, Social Determinants of Health (SDH) Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding Author: Mansooreh Momen-Heravi, Associate Professor, Department of Infectious Disease, Social Determinants of Health (SDH) Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-9133611017, E-mail:
| | - Asefeh Farokhzad
- Infectious Disease Specialist, Department of Infectious Disease, School of Medicine, Kashan University of Medical Sciences, Kashan, IR Iran
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14
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Sede M, Parra M, Manrique JM, Laufer N, Jones LR, Quarleri J. Evolution of hepatitis C virus in HIV coinfected patients under antiretroviral therapy. INFECTION GENETICS AND EVOLUTION 2016; 43:186-96. [PMID: 27234841 DOI: 10.1016/j.meegid.2016.05.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/13/2016] [Accepted: 05/23/2016] [Indexed: 02/07/2023]
Abstract
Five patients (P) were followed-up for an average of 7.73years after highly active antiretroviral therapy (HAART) initiation. Patients' immune and virological status were determined by periodical CD4+T-cell counts and HIV and HCV viral load. HCV populations were studied using longitudinal high throughput sequence data obtained in parallel by virological and immunological parameters. Two patients (P7, P28) with sub-optimal responses to HAART presented HCV viral loads significantly higher than those recorded for two patients (P1, P18) that achieved good responses to HAART. Interestingly, HCV populations from P7 and P28 displayed a stable phylogenetic structure, whereas HCV populations from P1 and P18showeda significant increase in their phylogenetic structure, followed by a decrease after achieving acceptable CD4+T-cell counts (>500 cell/μl). The fifth patient (P25) presented high HCV viral loads, preserved CD4+T-cell counts from baseline and all along the follow-up, and displayed a constant viral phylogenetic structure. These results strongly suggest that HAART-induced immune recovery induces a decrease in HCV viral load and an increase in the HCV population phylogenetic structure likely reflecting the virus diversification in response to the afresh immune response. The relatively low HCV viral load observed in the HAART responder patients suggests that once HCV is adapted it reaches a maximum number of haplotypes higher than that achieved during the initial stages of the immune response as inferred from the two recovering patients. Future studies using larger number of patients are needed to corroborate these hypotheses.
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Affiliation(s)
- Mariano Sede
- Consejo Nacional de Investigaciones Científicas y Técnicas, Av. Rivadavia 1917, C1083ACA Buenos Aires, Argentina; Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS), Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155-Piso 11, C1121ABG Buenos Aires, Argentina
| | - Micaela Parra
- Consejo Nacional de Investigaciones Científicas y Técnicas, Av. Rivadavia 1917, C1083ACA Buenos Aires, Argentina; Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS), Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155-Piso 11, C1121ABG Buenos Aires, Argentina
| | - Julieta M Manrique
- Consejo Nacional de Investigaciones Científicas y Técnicas, Av. Rivadavia 1917, C1083ACA Buenos Aires, Argentina; Laboratorio de Virología y Genética Molecular, Facultad de Ciencias Naturales sede Trelew, Universidad Nacional de la Patagonia San Juan Bosco, 9 de Julio y Belgrano S/N, 9100 Trelew, Chubut, Argentina
| | - Natalia Laufer
- Consejo Nacional de Investigaciones Científicas y Técnicas, Av. Rivadavia 1917, C1083ACA Buenos Aires, Argentina; Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS), Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155-Piso 11, C1121ABG Buenos Aires, Argentina
| | - Leandro R Jones
- Consejo Nacional de Investigaciones Científicas y Técnicas, Av. Rivadavia 1917, C1083ACA Buenos Aires, Argentina; Laboratorio de Virología y Genética Molecular, Facultad de Ciencias Naturales sede Trelew, Universidad Nacional de la Patagonia San Juan Bosco, 9 de Julio y Belgrano S/N, 9100 Trelew, Chubut, Argentina.
| | - Jorge Quarleri
- Consejo Nacional de Investigaciones Científicas y Técnicas, Av. Rivadavia 1917, C1083ACA Buenos Aires, Argentina; Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS), Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155-Piso 11, C1121ABG Buenos Aires, Argentina.
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15
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Hartling HJ, Birch C, Gaardbo JC, Hove M, Trøseid M, Clausen MR, Gerstoft J, Ullum H, Nielsen SD. T-cell homeostasis in chronic HCV-infected patients treated with interferon and ribavirin or an interferon-free regimen. APMIS 2015; 123:903-11. [PMID: 26279289 DOI: 10.1111/apm.12429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 07/07/2015] [Indexed: 01/04/2023]
Abstract
Direct-acting antiviral has replaced pegylated interferon-α and ribavirin-based treatment in the treatment of chronic hepatitis C virus (HCV) infection. While interferon-α is immune modulating and causes lymphopenia, interferon-free regimens seem to be well-tolerated. This study aimed to compare T-cell homeostasis before, during, and after HCV treatment with or without interferon-α in patients with chronic HCV infection. A total of 20 patients with chronic HCV infection were treated with pegylated interferon-α and ribavirin, and six patients were treated with an interferon-free regimen. All patients were treated for a minimum of 12 weeks. Interferon-α treatment caused an increase in the density of the receptor for IL-7 (IL-7Rα) during treatment, while interferon-free regimens caused a decrease in IL-7Rα density. After a sustained viral response, proportions of IL-7Rα+ T cells and IL-7Rα density decreased compared to prior treatment values. Finally, a proportion of CD8+ effector memory was lower while proportion of apoptotic T cells was higher after sustained virologic response compared to prior treatment. Despite lymphopenia during interferon, alterations in T-cell homeostasis during treatment were relatively similar in patients receiving interferon-based treatment and in patients receiving interferon-free treatment, and alterations during and after treatment seem to illustrate a reduced need for high levels of T cells aimed at controlling infection.
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Affiliation(s)
- Hans Jakob Hartling
- Viro-Immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Carsten Birch
- Viro-Immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Julie C Gaardbo
- Viro-Immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Malene Hove
- Viro-Immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marius Trøseid
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Mette Rye Clausen
- Department of Hepatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jan Gerstoft
- Viro-Immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henrik Ullum
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Viro-Immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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16
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Brugnaro P, Morelli E, Cattelan F, Petrucci A, Panese S, Eseme F, Cavinato F, Barelli A, Raise E. Non-acquired immunodeficiency syndrome definings malignancies among human immunodeficiency virus-positive subjects: Epidemiology and outcome after two decades of HAART era. World J Virol 2015; 4:209-218. [PMID: 26279983 PMCID: PMC4534813 DOI: 10.5501/wjv.v4.i3.209] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 03/02/2015] [Accepted: 05/28/2015] [Indexed: 02/05/2023] Open
Abstract
Highly active antiretroviral therapy (HAART) for human immunodeficiency virus (HIV) infection has been widely available in industrialized countries since 1996; its widespread use determined a dramatic decline in acquired immunodeficiency syndrome (AIDS)-related mortality, and consequently, a significant decrease of AIDS-defining cancers. However the increased mean age of HIV-infected patients, prolonged exposure to environmental and lifestyle cancer risk factors, and coinfection with oncogenic viruses contributed to the emergence of other malignancies that are considered non-AIDS-defining cancers (NADCs) as a relevant fraction of morbidity and mortality among HIV-infected people twenty years after HAART introduction. The role of immunosuppression in the pathogenesis of NADCs is not well defined, and future researches should investigate the etiology of NADCs. In the last years there is a growing evidence that intensive chemotherapy regimens and radiotherapy could be safely administrated to HIV-positive patients while continuing HAART. This requires a multidisciplinary approach and a close co-operation of oncologists and HIV-physicians in order to best manage compliance of patients to treatment and to face drug-related side effects. Here we review the main epidemiological features, risk factors and clinical behavior of the more common NADCs, such as lung cancer, hepatocellular carcinoma, colorectal cancer and anal cancer, Hodgkin’s lymphoma and some cutaneous malignancies, focusing also on the current therapeutic approaches and preventive screening strategies.
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Abstract
Coinfections of sexually transmitted infections are frequent due to the same transmission routes which may facilitate the transmission of other sexually transmitted infections. Sexually transmitted coinfections are associated with atypical and generally more severe clinical features, more complications, resistency to treatment, unfavourable outcome, and worse prognosis. Sexually transmitted infections may increase the likelihood of acquiring and transmission of HIV infection. The authors summarize the most important characteristics of sexually transmitted infections (such as HIV and hepatitis B virus, HIV and hepatitis C virus, HIV and syphilis, HIV and gonorrhoeae, HIV and chlamydia coinfections). These infections are more frequent in HIV infected patients than in the normal population. The shared transmission routes, impairment of the immune response, elevated cytokine levels and the associated inflammatory milieu produce local tissue damage, breaches in mucosal epithelium, which increases the risk of human immunodeficiency virus infection. Regular screening for sexually transmitted infections, use of more sensitive diagnostic methods, improved reporting and avoidance of unsafe sexual behaviour among certain subpopulations as well as education are essential in the prevention of sexually transmitted coinfections.
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Affiliation(s)
- Márta Marschalkó
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
| | - Katinka Pónyai
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
| | - Sarolta Kárpáti
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
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18
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Moqueet N, Infante-Rivard C, Platt RW, Young J, Cooper C, Hull M, Walmsley S, Klein MB. Favourable IFNL3 genotypes are associated with spontaneous clearance and are differentially distributed in Aboriginals in Canadian HIV-hepatitis C co-infected individuals. Int J Mol Sci 2015; 16:6496-512. [PMID: 25803108 PMCID: PMC4394544 DOI: 10.3390/ijms16036496] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/13/2015] [Accepted: 03/13/2015] [Indexed: 12/13/2022] Open
Abstract
Canadian Aboriginals are reported to clear Hepatitis C (HCV) more frequently. We tested the association of spontaneous clearance and three single nucleotide polymorphisms (SNPs) near the Interferon-lambda 3 (IFNL3) gene (rs12979860, rs8099917, functional variant rs8103142) and compared the SNP frequencies between HIV-HCV co-infected whites and Aboriginals from the Canadian Co-infection Cohort. HCV treatment-naïve individuals with at least two HCV RNA tests were included (n = 538). A spontaneous clearance case was defined as someone with two consecutive HCV RNA-negative tests, at least six months apart. Data were analyzed using Cox proportional hazards adjusted for sex and ethnicity. Advantageous variants and haplotypes were more common in Aboriginals than Caucasians: 57% vs. 46% had the rs12979860 CC genotype, respectively; 58% vs. 48%, rs8103142 TT; 74% vs. 67%, the rs12979860 C allele; and 67% vs. 64% the TCT haplotype with three favourable alleles. The adjusted Hazard Ratios (95% CI) for spontaneous clearance were: rs12979860: 3.80 (2.20, 6.54); rs8099917: 5.14 (2.46, 10.72); and rs8103142: 4.36 (2.49, 7.62). Even after adjusting for rs12979860, Aboriginals and females cleared HCV more often, HR (95% CI) = 1.53 (0.89, 2.61) and 1.42 (0.79, 2.53), respectively. Our results suggest that favourable IFNL3 genotypes are more common among Aboriginals than Caucasians, and may partly explain the higher HCV clearance rates seen among Aboriginals.
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Affiliation(s)
- Nasheed Moqueet
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC H3A 1A2, Canada.
| | - Claire Infante-Rivard
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC H3A 1A2, Canada.
| | - Robert W Platt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC H3A 1A2, Canada.
| | - Jim Young
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel 4031, Switzerland.
- Department of Medicine, Division of Infectious Diseases/Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, 3650 Saint-Urbain Street, Montreal, QC H2X 2P4, Canada.
| | - Curtis Cooper
- The Ottawa Hospital-Research Institute, Ottawa, ON K1Y 4E9, Canada.
| | - Mark Hull
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada.
| | - Sharon Walmsley
- Toronto General Research Institute, University Health Network, University of Toronto, Toronto, ON M5G 2M9, Canada.
| | - Marina B Klein
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC H3A 1A2, Canada.
- Department of Medicine, Division of Infectious Diseases/Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, 3650 Saint-Urbain Street, Montreal, QC H2X 2P4, Canada.
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