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Tramonti Fantozzi MP, Ceccarelli L, Petri D, De Vita E, Agostini A, Colombatto P, Stasi C, Rossetti B, Brunetto M, Surace L, Salvati A, Calì A, Tacconi D, Bianco C, Redi D, Fabbiani M, Panza F, Luchi S, Modica S, Moneta S, Iacopini S, Nencioni C, Chigiotti S, Ottaviano G, Zignego AL, Blanc P, Pierotti P, Mariabelli E, Berni R, Silvestri C, Tavoschi L. Hepatitis C epidemiology and treatment outcomes in Italy: Impact of the DAA era and the COVID-19 pandemic. J Viral Hepat 2024. [PMID: 39072924 DOI: 10.1111/jvh.13983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 06/18/2024] [Accepted: 07/16/2024] [Indexed: 07/30/2024]
Abstract
HCV infection poses a global health threat, with significant morbidity and mortality. This study examines HCV trends in a large Italian region from 2015 to 2022, considering demographic changes, evolving clinical profiles, treatment regimens and outcomes, including the impact of the COVID-19 pandemic. This multicentre retrospective study analysed demographics, clinical histories and risk factors in 6882 HCV patients. The study spanned before and after the direct-acting antiviral (DAA) era, and the COVID-19 period, focusing on treatment outcomes (SVR12, non-SVR12 and patients lost to follow-up). Statistical methods included ANOVA, multinomial logistic regression, Kruskal-Wallis test and chi-square analysis, and were conducted adhering to the intention-to-treat (ITT) principle. The cohort, mainly Italian males (average age 58.88), showed Genotype 1 dominance (56.6%) and a high SVR12 rate (97.5%). The pandemic increased follow-up losses, yet SVR12 rates remained stable, influenced by factors like age, gender, cirrhosis and comorbidities. Despite COVID-19 challenges, the region sustained high SVR12 rates in HCV care, emphasising the importance of sustained efforts in HCV care. Continuous screening and targeted interventions in high-risk populations are crucial for achieving WHO elimination targets. The study highlights the resilience of HCV care during the pandemic and provides insights for future public health strategies.
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Affiliation(s)
| | - Luca Ceccarelli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Davide Petri
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Erica De Vita
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Antonello Agostini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | - Cristina Stasi
- CRIA-MASVE Center for Research and Innovation, Careggi University Hospital, Florence, Italy
| | | | - Maurizia Brunetto
- Hepatology Unit, Pisa University Hospital, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lidia Surace
- Hepatology Unit, Pisa University Hospital, Pisa, Italy
| | | | - Alessia Calì
- Hepatology Unit, Pisa University Hospital, Pisa, Italy
| | - Danilo Tacconi
- Division of Infectious Diseases, Arezzo Hospital, Arezzo, Italy
| | - Claudia Bianco
- Division of Infectious Diseases, Arezzo Hospital, Arezzo, Italy
| | - David Redi
- Division of Infectious Diseases, Arezzo Hospital, Arezzo, Italy
| | | | - Francesca Panza
- Infectious and Tropical Diseases Unit, Siena University Hospital, Siena, Italy
| | - Sauro Luchi
- Division of Infectious Diseases and Hepatology, San Luca Hospital, AUSL Toscana Nord Ovest, Lucca, Italy
| | - Sara Modica
- Division of Infectious Diseases and Hepatology, San Luca Hospital, AUSL Toscana Nord Ovest, Lucca, Italy
| | - Sara Moneta
- Division of Infectious Diseases and Hepatology, San Luca Hospital, AUSL Toscana Nord Ovest, Lucca, Italy
| | - Sarah Iacopini
- Division of Infectious Diseases and Hepatology, San Luca Hospital, AUSL Toscana Nord Ovest, Lucca, Italy
| | | | | | | | - Anna Linda Zignego
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Pierluigi Blanc
- Division of Infectious Diseases 1-2, AUSL Toscana Centro, Florence, Italy
| | - Piera Pierotti
- Division of Infectious Diseases 1-2, AUSL Toscana Centro, Florence, Italy
| | - Elisa Mariabelli
- Division of Infectious Diseases 1-2, AUSL Toscana Centro, Florence, Italy
| | - Roberto Berni
- Epidemiology Unit, Tuscany Regional Health Agency, Florence, Italy
| | | | - Lara Tavoschi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Ceccarelli L, Moretti G, Mazzilli S, Petri D, Corazza I, Rizzo C, Lucenteforte E, Vainieri M, Seghieri C, Tavoschi L. Evaluating hepatitis C cascade of care surveillance system in Tuscany, Italy, through a population retrospective data-linkage study, 2015-2021. BMC Infect Dis 2024; 24:362. [PMID: 38553731 PMCID: PMC10979555 DOI: 10.1186/s12879-024-09241-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 03/21/2024] [Indexed: 04/02/2024] Open
Abstract
This comprehensive retrospective data-linkage study aimed at evaluating the impact of Direct-Acting Antivirals (DAAs) on Hepatitis C Virus (HCV) testing, treatment trends, and access to care in Tuscany over six years following their introduction. Utilizing administrative healthcare records, our work reveals a substantial increase in HCV tests in 2017, attributed to the decision to provide universal access to treatment. However, despite efforts to eradicate chronic HCV through a government-led plan, the target of treating 6,221 patients annually was not met, and services contracted after 2018, exacerbated by the COVID-19 pandemic. Key findings indicate a higher prevalence of HCV screening among females in the 33-53 age group, influenced by pregnancy-related recommendations, while diagnostic tests and treatment uptake were more common among males. Problematic substance users constituted a significant proportion of those tested and treated, emphasizing their priority in HCV screening. Our paper underscores the need for decentralized HCV models and alternative testing strategies, such as point-of-care assays, especially in populations accessing harm reduction services, communities, and prisons. The study acknowledges limitations in relying solely on administrative records, advocating for improved data access and timely linkages to accurately monitor HCV care cascades and inform regional plans. Despite challenges, the paper demonstrates the value of administrative record linkages in understanding the access to care pathway for hard-to-reach populations. The findings emphasize the importance of the national HCV elimination strategy and the need for enhanced data collection to assess progress accurately, providing insights for future regional and national interventions.
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Affiliation(s)
- Luca Ceccarelli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
- Management and Healthcare Laboratory, Sant'Anna School of Advanced Studies, Pisa, Italy.
| | - Giaele Moretti
- Management and Healthcare Laboratory, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Sara Mazzilli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Scuola Normale Superiore, Pisa, Italy
| | - Davide Petri
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ilaria Corazza
- Management and Healthcare Laboratory, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Caterina Rizzo
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Ersilia Lucenteforte
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Milena Vainieri
- Management and Healthcare Laboratory, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Chiara Seghieri
- Management and Healthcare Laboratory, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Lara Tavoschi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Nevola R, Messina V, Marrone A, Coppola N, Rescigno C, Esposito V, Sangiovanni V, Claar E, Pisaturo M, Fusco FM, Rosario P, Izzi A, Pisapia R, Rosato V, Maggi P, Adinolfi LE. Epidemiology of HCV and HBV in a High Endemic Area of Southern Italy: Opportunities from the COVID-19 Pandemic-Standardized National Screening or One Tailored to Local Epidemiology? BIOLOGY 2022; 11:biology11040609. [PMID: 35453808 PMCID: PMC9028790 DOI: 10.3390/biology11040609] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 12/16/2022]
Abstract
Simple Summary Epidemiological data on viral hepatitis are essential to optimize screening programs. For HCV, the Italian Health Ministry planned a cohort screening for those born in 1969–1989. In order to update the epidemiological data of viral hepatitis in a highly endemic area of Southern Italy and assess whether the screening programs currently planned by the Italian government for those born between 1969–1989 will be effective, a retrospective multicenter study was carried out enrolling all COVID-19 hospitalized patients screened for markers of HCV and HBV infection. Indeed, the COVID-19 pandemic has resulted in access to the national health system of an unselected population similar to the general one. Among the 2126 patients evaluated, HBsAg and HCV-Ab prevalence was 1.6% and 5.1%, respectively. For HCV infection, a bimodal distribution was observed, with peaks in the birth cohorts 1930–1939 and 1960–1969 (11.6% and 5.6%, respectively). An analysis of the screening period imposed (born: 1969–1989) demonstrates that only 17% of HCV infection could be captured. Thus, an alignment of the screening period (i.e., birth cohort 1960–1984) would capture 40% of cases. Data show a high endemicity of hepatitis virus in our geographic area and the need for a tailored regional screening program. Abstract The COVID-19 pandemic led to the hospitalization of an unselected population with the possibility to evaluate the epidemiology of viral hepatitis. Thus, a retrospective multicenter study was conducted in an area of Southern Italy with the aim of assessing the prevalence of HCV and HBV markers and the ability of current screening program to capture cases. We evaluated 2126 hospitalized patients in seven COVID Centers of Naples and Caserta area in which 70% of the Campania population lives. HBsAg and HCV-Ab prevalence was 1.6% and 5.1%, respectively, with no differences between gender. Decade distribution for birth year shows a bimodal trend of HCV prevalence, with a peak (11.6%) in the decade 1930–1939 and a second peak (5.6%) for those born in 1960–1969. An analysis of the screening period imposed by the Italian government for those born between 1969 and 1989 shows that only 17% of cases of HCV infection could be captured. A small alignment of the screening period, i.e., those born from 1960 to 1984, would capture 40% of cases. The data confirm the high endemicity of our geographical area for hepatitis virus infections and underline the need for a tailored screening program according to the regional epidemiology.
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Affiliation(s)
- Riccardo Nevola
- Internal Medicine Unit, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.M.); (L.E.A.)
- Hepatology Unit, Ospedale Evangelico Betania, 80147 Naples, Italy; (E.C.); (V.R.)
- Correspondence: ; Tel.: +39-081-5664173
| | - Vincenzo Messina
- Infectious Diseases Unit, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy; (V.M.); (P.M.)
| | - Aldo Marrone
- Internal Medicine Unit, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.M.); (L.E.A.)
| | - Nicola Coppola
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (N.C.); (M.P.)
| | - Carolina Rescigno
- Infectious Diseases and Neurology Unit, Cotugno Hospital, 80131 Naples, Italy; (C.R.); (A.I.); (R.P.)
| | - Vincenzo Esposito
- IVth Division of Immunodeficiency and Gender Infectious Diseases, Cotugno Hospital, 80131 Naples, Italy; (V.E.); (P.R.)
| | - Vincenzo Sangiovanni
- IIIrd Infectious Diseases Unit, Cotugno Hospital, 80131 Naples, Italy; (V.S.); (F.M.F.)
| | - Ernesto Claar
- Hepatology Unit, Ospedale Evangelico Betania, 80147 Naples, Italy; (E.C.); (V.R.)
| | - Mariantonietta Pisaturo
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (N.C.); (M.P.)
| | - Francesco Maria Fusco
- IIIrd Infectious Diseases Unit, Cotugno Hospital, 80131 Naples, Italy; (V.S.); (F.M.F.)
| | - Pietro Rosario
- IVth Division of Immunodeficiency and Gender Infectious Diseases, Cotugno Hospital, 80131 Naples, Italy; (V.E.); (P.R.)
| | - Antonio Izzi
- Infectious Diseases and Neurology Unit, Cotugno Hospital, 80131 Naples, Italy; (C.R.); (A.I.); (R.P.)
| | - Raffaella Pisapia
- Infectious Diseases and Neurology Unit, Cotugno Hospital, 80131 Naples, Italy; (C.R.); (A.I.); (R.P.)
| | - Valerio Rosato
- Hepatology Unit, Ospedale Evangelico Betania, 80147 Naples, Italy; (E.C.); (V.R.)
| | - Paolo Maggi
- Infectious Diseases Unit, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy; (V.M.); (P.M.)
| | - Luigi Elio Adinolfi
- Internal Medicine Unit, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.M.); (L.E.A.)
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