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Qiu Q, Wang H, Liu X, Pang X, Zhang W. Comparative Immunogenicity of a High-Dose Hepatitis B Virus (HBV) Vaccine with Rapid Immunization vs. Standard Schedule in HBV Vaccine-Naïve Adults Aged 25-55 in China. Vaccines (Basel) 2024; 12:923. [PMID: 39204046 PMCID: PMC11359784 DOI: 10.3390/vaccines12080923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/15/2024] [Accepted: 08/16/2024] [Indexed: 09/03/2024] Open
Abstract
The 20 μg (0-1-6 month) hepatitis B virus (HBV) vaccination is widely recommended for HBV vaccine-naïve immune adults in China. However, suboptimal protective responses may occur due to dose-series incompletion. We aim to investigate the immunogenicity of a 60 μg HB vaccine with a 0-2 month series among HBV vaccine-naïve immune adults aged 25-55 to assess potential alternative approaches for HB immunization. A two-center randomized controlled trial was carried out. Participants were randomly allocated to either the 20 μg (0-1-6 month) or the 60 μg (0-2 month) regimen. Blood samples were collected eight weeks after the final injection to measure the antibodies. A total of 583 adults (289 in the 20 μg regimen and 294 in the 60 μg regimen) were included. The seroprotection rates (SPRs) were 97.23% and 93.54% in the 20 μg and 60 μg regimens, respectively (p = 0.0261), and the geometric mean concentrations were 600.76 mIU/mL and 265.68 mIU/mL, respectively (p < 0.0001). The immunogenicity of the 60 μg regimen decreased significantly with age, particularly in adults aged 40 and older. The 60 μg regimen may be beneficial for adults under 40, especially those with poor compliance or in urgent need of immunization.
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Affiliation(s)
| | | | | | | | - Wei Zhang
- Beijing Center for Disease Prevention and Control, Beijing 100013, China; (Q.Q.)
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2
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Yin S, Wu S, Huang J, Ren S, Xie W, Peng X. Spatial-temporal analysis of hepatitis B in Fujian Province, China in 2012-2021. INFECTIOUS MEDICINE 2024; 3:100110. [PMID: 38974348 PMCID: PMC11225665 DOI: 10.1016/j.imj.2024.100110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 12/17/2023] [Accepted: 04/02/2024] [Indexed: 07/09/2024]
Abstract
Background Fujian Province has one of the highest reported incidences of hepatitis B virus infection in China. This study aimed to provide a theoretical framework for preventing and controlling hepatitis B in Fujian Province, and to assess the trends and the spatial-temporal distribution patterns of hepatitis B in this region. Methods Data on hepatitis B cases were extracted from the National Notifiable Infectious Disease Surveillance System. Spatial autocorrelation analysis, trend surface analysis, and spatial-temporal scanning statistics were used to identify the spatial and aggregation patterns at the county level. The Joinpoint was used to assess the reported incidence trends. Results The average reported incidence of hepatitis B in Fujian from 2012 to 2021 was 14.46/10,000 population, with 583,262 notified cases. The age-adjusted reported incidence of hepatitis B decreased from 17.44/10,000 population in 2012 to 11.88/10,000 population in 2021, with an average reduction in the annual percentage change of 4.5%. There were obvious spatial-temporal aggregation characteristics in hepatitis B cases, and a high-incidence area was located in eastern Fujian. Spatio-temporal scanning statistics revealed four levels of aggregation of hepatitis B reporting rates. The first level of aggregation area included Minhou, Gulou, Jin'an, Taijiang, and nine other districts and counties. Conclusion The incidence of hepatitis B is declining in Fujian Province. Spatial clusters of hepatitis B cases in Fujian Province were identified, and high-risk areas in eastern Fujian still exist. Closely monitoring the general patterns in the occurrence of hepatitis B and implementing focused control and preventative strategies are important.
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Affiliation(s)
- Shuo Yin
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Shenggen Wu
- Fujian Provincial Center for Disease Control and Prevention, Fuzhou 350122, China
| | - Jingru Huang
- College of Integrated Chinese and Western Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350108, China
| | - Shutong Ren
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Weijiang Xie
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Xian'e Peng
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, China
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, School of Basic Medical Sciences, Fujian Medical University, Fuzhou 350108, China
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3
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Sallam M, Khalil R. Contemporary Insights into Hepatitis C Virus: A Comprehensive Review. Microorganisms 2024; 12:1035. [PMID: 38930417 PMCID: PMC11205832 DOI: 10.3390/microorganisms12061035] [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: 04/30/2024] [Revised: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
Hepatitis C virus (HCV) remains a significant global health challenge. Approximately 50 million people were living with chronic hepatitis C based on the World Health Organization as of 2024, contributing extensively to global morbidity and mortality. The advent and approval of several direct-acting antiviral (DAA) regimens significantly improved HCV treatment, offering potentially high rates of cure for chronic hepatitis C. However, the promising aim of eventual HCV eradication remains challenging. Key challenges include the variability in DAA access across different regions, slightly variable response rates to DAAs across diverse patient populations and HCV genotypes/subtypes, and the emergence of resistance-associated substitutions (RASs), potentially conferring resistance to DAAs. Therefore, periodic reassessment of current HCV knowledge is needed. An up-to-date review on HCV is also necessitated based on the observed shifts in HCV epidemiological trends, continuous development and approval of therapeutic strategies, and changes in public health policies. Thus, the current comprehensive review aimed to integrate the latest knowledge on the epidemiology, pathophysiology, diagnostic approaches, treatment options and preventive strategies for HCV, with a particular focus on the current challenges associated with RASs and ongoing efforts in vaccine development. This review sought to provide healthcare professionals, researchers, and policymakers with the necessary insights to address the HCV burden more effectively. We aimed to highlight the progress made in managing and preventing HCV infection and to highlight the persistent barriers challenging the prevention of HCV infection. The overarching goal was to align with global health objectives towards reducing the burden of chronic hepatitis, aiming for its eventual elimination as a public health threat by 2030.
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Affiliation(s)
- Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
| | - Roaa Khalil
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
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4
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Walter LA, Prados M, Lloyd A, Sontheimer S, Heimann M, Rodgers JB, Hand DT, Franco R. Birth cohort-specific consideration in an Emergency Department Hepatitis C Testing Programme: A description of age-related characteristics and outcomes. J Viral Hepat 2024; 31:233-239. [PMID: 38366787 DOI: 10.1111/jvh.13930] [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: 09/08/2023] [Revised: 01/15/2024] [Accepted: 02/10/2024] [Indexed: 02/18/2024]
Abstract
The emergency department (ED) has increasingly become an important public health partner in non-targeted hepatitis C virus (HCV) testing and referral to care efforts. HCV has traditionally been an infection associated with the Baby Boomer generation; however, recent exacerbation of the opioid epidemic has resulted in a growing number of younger cohorts, namely Millennials, also impacted by HCV. Examination of this age-related demographic shift, including subsequent linkage success and linkage barriers, from the perspective of an ED-based testing and linkage programme may have implications for future population and health systems interventions. A retrospective descriptive chart review was performed, inclusive of data from August 2015 through December 2020. We compared the quantity of positive HCV screening antibody (Ab) and confirmatory (RNA) tests and further considered linkage rates and correlative demographics (e.g. gender, race). Patient barriers to HCV care linkage (e.g. substance misuse, lack of health insurance, homelessness) were also evaluated. The data set was disaggregated by birth cohort to include Silent Generation (SG) (1928-45), Baby Boomer (BB) (1946-64), Generation X (Gen X) (1965-80), Millennial (1981-96) and Generation Z (1997-2012). Descriptive statistics and chi-square analysis were performed. Overall, 83,817 patients were tested for HCV (50.6% of eligible); 6187 (7.4%) were HCV Ab positive, and 2665 were HCV RNA positive (3.2%). RNA-positive individuals were more likely to be white (70.4%) and male (67.7%); generational distribution was similar (BB 33.3%, Gen X 32.0% and Millennials 32.7%). Amongst Ab-positive patients, white (45.5%), male (47.2%) and Millennial (49.7%) individuals were most likely to be RNA-positive. Overall, 28.1% of the RNA-positive cohort successfully linked to care; linkage to care rates were significantly higher in older generations (38.1% in BB vs. 17.8% in Millennials) (p < .00001). Over 90% were identified as having at least one linkage to care barrier. Younger generations (Gen X and Millennials) were disproportionately impacted by linkage barriers, including incarceration, lack of health insurance, history of mental health and substance use disorders, as well as history of or active injection drug use (IDU) (p < .00001). Older generations (SG and BB) were more likely to be impacted by competing medical comorbidities (p < .00001). The ED population represents a particularly vulnerable, at-risk cohort with a high prevalence of HCV and linkage to care barriers. While past HCV-specific recommendations and interventions have focused on Baby Boomers, this data suggests that younger generations, including Gen X and Millennials, are increasingly affected by HCV and face disparate social risk and social need factors which impede definitive care linkage and treatment.
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Affiliation(s)
- Lauren A Walter
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Myles Prados
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Audrey Lloyd
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sylvie Sontheimer
- Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Matthew Heimann
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Joel B Rodgers
- Division of Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Delissa T Hand
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ricardo Franco
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Lalhmangaihzuala S, Vanlaldinpuia K, Khiangte V, Laldinpuii Z, Liana T, Lalhriatpuia C, Pachuau Z. Therapeutic applications of carbohydrate-based compounds: a sweet solution for medical advancement. Mol Divers 2024:10.1007/s11030-024-10810-2. [PMID: 38554170 DOI: 10.1007/s11030-024-10810-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/10/2024] [Indexed: 04/01/2024]
Abstract
Carbohydrates, one of the most abundant biomolecules found in nature, have been seen traditionally as a dietary component of foods. Recent findings, however, have unveiled their medicinal potential in the form of carbohydrates-derived drugs. Their remarkable structural diversity, high optical purity, bioavailability, low toxicity and the presence of multiple functional groups have positioned them as a valuable scaffold and an exciting frontier in contemporary therapeutics. At present, more than 170 carbohydrates-based therapeutics have been granted approval by varying regulatory agencies such as United States Food and Drug Administration (FDA), Japan Pharmaceuticals and Medical Devices Agency (PMDA), Chinese National Medical Products Administration (NMPA), and the European Medicines Agency (EMA). This article explores an overview of the fascinating potential and impact of carbohydrate-derived compounds as pharmacological agents and drug delivery vehicles.
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Affiliation(s)
- Samson Lalhmangaihzuala
- Department of Chemistry, Pachhunga University College, Mizoram University, Aizawl, Mizoram, 796001, India
- Department of Chemistry, Mizoram University, Tanhril, Aizawl, Mizoram, 796004, India
| | - Khiangte Vanlaldinpuia
- Department of Chemistry, Pachhunga University College, Mizoram University, Aizawl, Mizoram, 796001, India.
| | - Vanlalngaihawma Khiangte
- Department of Chemistry, Pachhunga University College, Mizoram University, Aizawl, Mizoram, 796001, India
- Department of Chemistry, Mizoram University, Tanhril, Aizawl, Mizoram, 796004, India
| | - Zathang Laldinpuii
- Department of Chemistry, Pachhunga University College, Mizoram University, Aizawl, Mizoram, 796001, India
- Department of Chemistry, Mizoram University, Tanhril, Aizawl, Mizoram, 796004, India
| | - Thanhming Liana
- Department of Chemistry, Pachhunga University College, Mizoram University, Aizawl, Mizoram, 796001, India
| | - Chhakchhuak Lalhriatpuia
- Department of Chemistry, Pachhunga University College, Mizoram University, Aizawl, Mizoram, 796001, India
| | - Zodinpuia Pachuau
- Department of Chemistry, Mizoram University, Tanhril, Aizawl, Mizoram, 796004, India
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Al-Busafi SA, Alwassief A. Global Perspectives on the Hepatitis B Vaccination: Challenges, Achievements, and the Road to Elimination by 2030. Vaccines (Basel) 2024; 12:288. [PMID: 38543922 PMCID: PMC10975970 DOI: 10.3390/vaccines12030288] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 10/21/2024] Open
Abstract
Annually, more than 1.5 million preventable new hepatitis B (HBV) infections continue to occur, with an estimated global burden of 296 million individuals living with chronic hepatitis B infection. This substantial health challenge results in over 820,000 annual deaths being attributed to complications such as liver cirrhosis and hepatocellular carcinoma (HCC). The HBV vaccination remains the cornerstone of public health policy to prevent chronic hepatitis B and its related complications. It serves as a crucial element in the global effort to eliminate HBV, as established by the World Health Organization (WHO), with an ambitious 90% vaccination target by 2030. However, reports on global birth dose coverage reveal substantial variability, with an overall coverage rate of only 46%. This comprehensive review thoroughly examines global trends in HBV vaccination coverage, investigating the profound impact of vaccination on HBV prevalence and its consequences across diverse populations, including both high-risk and general demographics. Additionally, the review addresses the essential formidable challenges and facilitating factors for achieving WHO's HBV vaccination coverage objectives and elimination strategies in the coming decade and beyond.
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Affiliation(s)
- Said A. Al-Busafi
- Division of Gastroenterology and Hepatology, Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman
| | - Ahmed Alwassief
- Division of Gastroenterology and Hepatology, Department of Medicine, Sultan Qaboos University Hospital, Muscat 123, Oman
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7
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Faghihi SH, Azarbakhsh H, Piraee E. Epidemiological study of hepatitis B and hepatitis C infection in Kohgiluyeh and Boyer-Ahmad province (Iran) from 2008 to 2021: A cross-sectional study. Health Sci Rep 2024; 7:e1812. [PMID: 38328787 PMCID: PMC10848580 DOI: 10.1002/hsr2.1812] [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: 06/22/2023] [Revised: 12/19/2023] [Accepted: 12/24/2023] [Indexed: 02/09/2024] Open
Abstract
Background and Aims Viral hepatitis is one of the top five reasons people die from infections all around the world. The present study aimed to assess the epidemiological features of hepatitis B and hepatitis C infections in Kohgiluyeh and Boyer-Ahmad province. Methods The data were obtained via the census method from the registered hepatitis B and hepatitis C data in the reportable disease care system of Yasuj University of Medical Sciences. The collected data are the result of serological tests. The χ 2 test was used to evaluate the important risk factors for hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. The joinpoint regression was performed to investigate the trend of HBV and HCV in recent years. Results Here, 1270 cases of hepatitis B and C were identified and reported in Kohgiluyeh and Boyer-Ahmad province from 2008 to 2021. The median age of patients was 38 (interquartile range: 31-51), varying significantly according to the type of hepatitis. The most common hepatitis in males was hepatitis C and in females, hepatitis B. Regarding the place of residence, HBV and HCV were both more prevalent in urban areas. The age group of 25-34 years has the highest prevalence of HBV and HCV. According to the joinpoint regression analysis, there is a decrease in the 14-year trend of incidence rate due to total hepatitis B and C: the annual percent change was -5.2% (95% confidence interval [CI]: -8.4 to -1.9, p = 0.005) for hepatitis B and -0.2% (95% CI: -10.7 to 11.6, p = 0.976) for hepatitis C. Conclusion This study shows the incidence rate of hepatitis B has been decreasing during the years of study but this trend has been stable for hepatitis C. Also, the highest number of cases of hepatitis B and C were reported in the age groups of 25-34 years. Hence, preventive interventions are vital in reducing the burden of these diseases.
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Affiliation(s)
- Sayed H. Faghihi
- Department of Epidemiology, Faculty of Health, Social Determinants of Health Research CenterYasuj University of Medical SciencesYasujIran
| | - Habibollah Azarbakhsh
- Department of Epidemiology, Faculty of HealthAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Elahe Piraee
- Department of Epidemiology, Faculty of Health, Social Determinants of Health Research CenterYasuj University of Medical SciencesYasujIran
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8
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Ali MM, Gul M, Imran M, Ijaz M, Azeem S, Ullah A, Yaqub HMF. Molecular identification and genotyping of hepatitis E virus from Southern Punjab, Pakistan. Sci Rep 2024; 14:223. [PMID: 38167570 PMCID: PMC10762251 DOI: 10.1038/s41598-023-50514-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
Hepatitis E is a global health concern. Hepatitis E virus (HEV) infection is endemic in Pakistan. HEV has four genotypes: HEV-1 through HEV-4. The genotypes HEV-1 and HEV-2 are associated with infection in humans, especially in countries with poor sanitation. The genotypes HEV-3 and HEV-4 are zoonotic and human infection takes place by consuming undercooked meat or being in contact with animals. The present study was designed to ascertain the presence of HEV in the Southern Punjab region of Pakistan. First, blood samples (n = 50) were collected from patients suspected of infection with the hepatitis E virus from the Multan District. The serum was separated and the samples were initially screened using an HEV IgM-ELISA. Second, the ELISA-positive samples were subjected to PCR and were genetically characterized. For PCR, the RNA extraction and complementary DNA synthesis were done using commercial kits. The HEV ORF2 (Open Reading Frame-2, capsid protein) was amplified using nested PCR targeting a 348 bp segment. The PCR amplicons were sequenced and an evolutionary tree was constructed using MEGA X software. A protein model was built employing the SWISS Model after protein translation using ExPASy online tool. The positivity rate of anti-HEV antibodies in serum samples was found as 56% (28/50). All Pakistani HEV showed homology with genotype 1 and shared common evolutionary origin and ancestry with HEV isolates of genotype 1 of London (MH504163), France (MN401238), and Japan (LC314158). Sequence analysis of motif regions assessment and protein structure revealed that the sequences had a similarity with the reference sequence. These data suggest that genotype 1 of HEV is circulating in Pakistan. This finding could be used for the diagnosis and control of HEV in the specific geographic region focusing on its prevalent genotype.
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Affiliation(s)
- Muhammad Muddassir Ali
- Institute of Biochemistry and Biotechnology, Faculty of Biosciences, University of Veterinary and Animal Sciences, Lahore, Pakistan.
| | - Mehek Gul
- Institute of Biochemistry and Biotechnology, Faculty of Biosciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Muhammad Imran
- Institute of Biochemistry and Biotechnology, Faculty of Biosciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Muhammad Ijaz
- Department of Veterinary Medicine, Faculty of Veterinary Science, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Shahan Azeem
- Institute of Microbiology, Faculty of Veterinary Science, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Arif Ullah
- Institute of Biochemistry and Biotechnology, Faculty of Biosciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Hafiz Muhammad Farooq Yaqub
- Institute of Biochemistry and Biotechnology, Faculty of Biosciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
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9
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Liao F, Xie J, Du R, Gao W, Lan L, Wang M, Rong X, Fu Y, Wang H. Replication and Expression of the Consensus Genome of Hepatitis B Virus Genotype C from the Chinese Population. Viruses 2023; 15:2302. [PMID: 38140543 PMCID: PMC10747539 DOI: 10.3390/v15122302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/13/2023] [Accepted: 11/19/2023] [Indexed: 12/24/2023] Open
Abstract
Hepatitis B virus (HBV) genotype C is a prevalent HBV genotype in the Chinese population. Although genotype C shows higher sequence heterogeneity and more severe liver disease than other genotypes, its pathogenesis and immunological traits are not yet fully elucidated. In this study, we first established and chemically synthesized the consensus sequence based on representative 138 full-length HBV genotype C genomes from the Chinese population. The pHBV1.3C plasmid system, containing a 1.3-fold full-length HBV genotype C consensus sequence, was constructed for subsequent validation. Next, we performed functional assays to investigate the replicative competence of pHBV1.3C in vitro through the transient transfection of HepG2 and Huh7 cells and validated the in vivo function via a hydrodynamic injection to BALB/c recipient mice. The in vitro investigation revealed that the extracellular HBV DNA and intracellular replicative intermediate (i.e., pregenomic RNA, pgRNA) were apparently measurable at 48 h, and the HBsAg and HBcAg were still positive in hepatoma cells at 96 h. We also found that HBsAg and HBeAg accumulated at the extracellular and intracellular levels in a time-dependent manner. The in vivo validation demonstrated that pHBV1.3C plasmids induced HBV viremia, triggered morphological changes and HBsAg- or HBcAg- positivity of hepatocytes, and ultimately caused inflammatory infiltration and focal or piecemeal necrosis in the livers of the murine recipients. HBV protein (HBsAg) colocalized with CD8+ T cells or CD4+ T cells in the liver. F4/80+ Kupffer cells were abundantly recruited around the altered murine hepatocytes. Taken together, our results indicate that the synthetic consensus sequence of HBV genotype C is replication-competent in vitro and in vivo. This genotype C consensus genome supports the full HBV life cycle, which is conducive to studying its pathogenesis and immune response, screening novel antiviral agents, and further optimizing testing and therapeutics.
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Affiliation(s)
- Fenfang Liao
- Guangzhou Blood Center, Guangzhou 510091, China
- The Key Medical Laboratory of Guangzhou, Guangzhou 510091, China
| | - Junmou Xie
- Guangzhou Blood Center, Guangzhou 510091, China
- The Key Medical Laboratory of Guangzhou, Guangzhou 510091, China
| | - Rongsong Du
- Guangzhou Blood Center, Guangzhou 510091, China
- The Key Medical Laboratory of Guangzhou, Guangzhou 510091, China
| | - Wenbo Gao
- Guangzhou Blood Center, Guangzhou 510091, China
- The Key Medical Laboratory of Guangzhou, Guangzhou 510091, China
| | - Lanyin Lan
- Guangzhou Blood Center, Guangzhou 510091, China
- The Key Medical Laboratory of Guangzhou, Guangzhou 510091, China
| | - Min Wang
- Guangzhou Blood Center, Guangzhou 510091, China
- The Key Medical Laboratory of Guangzhou, Guangzhou 510091, China
| | - Xia Rong
- Guangzhou Blood Center, Guangzhou 510091, China
- The Key Medical Laboratory of Guangzhou, Guangzhou 510091, China
| | - Yongshui Fu
- Guangzhou Blood Center, Guangzhou 510091, China
- The Key Medical Laboratory of Guangzhou, Guangzhou 510091, China
| | - Hao Wang
- Guangzhou Blood Center, Guangzhou 510091, China
- The Key Medical Laboratory of Guangzhou, Guangzhou 510091, China
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10
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Nartey YA, Okine R, Seake-Kwawu A, Ghartey G, Asamoah YK, Siaw ADJ, Senya K, Duah A, Owusu-Ofori A, Adarkwa O, Agyeman S, Bampoh SA, Hiebert L, Njuguna H, Gupta N, Ward JW, Roberts LR, Bockarie AS, Awuku YA, Obiri-Yeboah D. Hepatitis C virus seroprevalence, testing, and treatment capacity in public health facilities in Ghana, 2016-2021; A multi-centre cross-sectional study. PLoS One 2023; 18:e0287580. [PMID: 37352242 PMCID: PMC10289322 DOI: 10.1371/journal.pone.0287580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 06/08/2023] [Indexed: 06/25/2023] Open
Abstract
The current burden of Hepatitis C virus infection and the availability of HCV-related services in Ghana are not well described. Previous estimates on HCV seroprevalence in the country are outdated. This study investigated the HCV seroprevalence and testing and treatment capacity in Ghana. A multi-centre cross-sectional study was conducted in which laboratory and blood bank registers from 17 public healthcare institutions in Ghana were reviewed. A survey on cost and availability of HCV-related testing and treatment was also performed. Crude and pooled estimates of HCV seroprevalence, frequency and median cost of available diagnostic tests and medicines were described. The crude HCV seroprevalence was 2.62% (95% CI 2.53-2.72) and the pooled estimate was 4.58% (95% CI 4.06-5.11) among 103,609 persons tested in laboratories. Age (OR 1.02 95% CI 1.01-1.02) and male sex (OR 1.26 95% CI 1.08-1.48) were predictors of a positive anti-HCV RDT test. Northern administrative regions in Ghana had the highest HCV seroprevalence ranging from 8.3-14.4%. Among 55, 458 potential blood donors, crude HCV seroprevalence was 3.57% (95% CI 3.42-3.72). Testing was through Rapid Diagnostic Test (RDT) kits in most facilities, and only 2 of 17 centres were performing HCV RNA testing. The median cost of an anti-HCV RDT test was $0.97 (0-1.61) and $3.23 (1.61-7.58) for persons with and without government health insurance respectively. The median cost of a 12-week course of the pan-genotypic direct-acting antiviral therapy sofosbuvir-daclatasvir was $887.70. In conclusion, there are significant regional differences in HCV burden across Ghana. Limited access to and cost of HCV RNA and DAA therapy hinders testing and treatment capability, and consequently HCV elimination efforts. A national HCV program supported with a sustainable financing plan is required to accelerate HCV elimination in Ghana.
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Affiliation(s)
- Yvonne Ayerki Nartey
- Department of Internal Medicine, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
- Department of Internal Medicine, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Rafiq Okine
- World Health Organisation, Country Office, Accra, Ghana
| | - Atsu Seake-Kwawu
- National Viral Hepatitis Control Program, Ghana Health Service, Accra, Ghana
| | - Georgia Ghartey
- Ghana Field Epidemiology and Laboratory Training Programme, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Yaw Karikari Asamoah
- Ghana Field Epidemiology and Laboratory Training Programme, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Ampem Darko Jnr Siaw
- Department of Internal Medicine, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Kafui Senya
- World Health Organisation, Country Office, Accra, Ghana
| | - Amoako Duah
- Department of Internal Medicine, University of Ghana Medical Centre, Accra, Ghana
| | - Alex Owusu-Ofori
- Department of Clinical Microbiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Opei Adarkwa
- Department of Obstetrics and Gynaecology, Komfo-Anokye Teaching Hospital, Kumasi, Ghana
| | - Seth Agyeman
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Accra, Ghana
| | - Sally Afua Bampoh
- Department of Internal Medicine, Greater Accra Regional Hospital, Accra, Ghana
| | - Lindsey Hiebert
- Coalition for Global Hepatitis Elimination, Task Force for Global Health, Decatur, GA, United States of America
| | - Henry Njuguna
- Coalition for Global Hepatitis Elimination, Task Force for Global Health, Decatur, GA, United States of America
| | - Neil Gupta
- Coalition for Global Hepatitis Elimination, Task Force for Global Health, Decatur, GA, United States of America
| | - John W. Ward
- Coalition for Global Hepatitis Elimination, Task Force for Global Health, Decatur, GA, United States of America
| | - Lewis Rowland Roberts
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic Rochester, Rochester, MN, United States of America
| | - Ansumana Sandy Bockarie
- Department of Internal Medicine, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Yaw Asante Awuku
- Department of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Dorcas Obiri-Yeboah
- Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, Cape Coast Ghana
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11
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Lashkarbolouk N, Khodabakhshi B, Mazandarani M. Acute Hepatitis A and Hepatitis B Coinfection in a Young Female: A Case Report and Literature Review. Case Rep Infect Dis 2023; 2023:1809020. [PMID: 37304244 PMCID: PMC10257541 DOI: 10.1155/2023/1809020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 06/13/2023] Open
Abstract
Background Hepatitis is one of the common infectious diseases that can infect patients in various forms. Based on their characteristics and clinical features, they can cause irreparable complications in patients. Coinfections and superinfections between its variant have been reported, but the coinfection of acute HAV and HBV is rarely reported. Case Presentation. In this case report, we presented a case with severe malaise, nausea, vomiting, generalized jaundice, and a history of recent tattooing and travel to the HAV endemic area. In our evaluation, she had a positive HBsAg, HBeAg, anti-HBs IgM, anti-HAV IgM, and negative result in HCV antibody, HIV antibody, and anti-HAV IgG. The coinfection of HAV/HBV was confirmed for her. Conclusion Physicians should differentiate hepatitis A and hepatitis B superinfection or coinfection, based on history and laboratory testing, to prevent complications with appropriate treatment.
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Affiliation(s)
- Narges Lashkarbolouk
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnaz Khodabakhshi
- Infectious Disease Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mahdi Mazandarani
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
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12
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Rísquez A, Echezuría L, Carrión-Nessi FS, Forero-Peña DA. A time-series analysis of morbidity and mortality of viral hepatitis in Venezuela, 1990-2016. BMC Infect Dis 2023; 23:361. [PMID: 37245003 DOI: 10.1186/s12879-023-08338-1] [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: 12/07/2022] [Accepted: 05/18/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Viral hepatitis (VH) is a leading contributor to morbidity and mortality worldwide, constituting a public health problem associated with the level of human development. In recent years, Venezuela has experienced a political, social, and economic crisis and has been impacted by natural disasters that have led to the deterioration of sanitary and health infrastructures modifying the determinants of VH. Despite epidemiological studies conducted in specific regions of the country or populations, the national epidemiological behaviour of VH remains unclear. METHODS This is a time series study involving records of morbidity and mortality by VH in Venezuela reported during the period from 1990 to 2016. The Venezuelan population was taken as the denominator of the morbidity and mortality rates, according to the Venezuelan National Institute of Statistics and the 2016 population projections from the latest census published on the website of the responsible Venezuelan agency. RESULTS During the study period, 630,502 cases and 4,679 deaths from VH in Venezuela were analysed. Most of the cases (n = 457,278; 72.6%) were classified as unspecific VH (UVH). The deaths were mainly attributed to VHB (n = 1,532; 32.7%), UVH (n = 1,287; 27.5%), and sequelae of VH (n = 977; 20.8%). The mean rates of cases and deaths from VH in the country were 95 ± 40.4 cases per 100,000 inhabitants and 0.7 ± 0.1 deaths per 100,000 inhabitants, respectively, showing a large dispersion that is evident from the calculation of the coefficients of variation. There was document a strong correlation between UVH and VHA cases (0.78, p < 0.01) morbidity rates. VHB mortality rate was very strongly correlated with sequelae of VH (-0.9, p < 0.01). CONCLUSIONS VH is a major burden of morbidity and mortality in Venezuela with an endemic-epidemic trend and an intermediate prevalence for VHA, VHB, and VHC. Epidemiological information is not published in a timely manner and diagnostic tests are insufficient in primary health services. There is an urgent need to resume epidemiological surveillance of VH and to optimise the classification system for a better understanding of UVH cases and deaths due to sequelae of VHB and VHC.
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Affiliation(s)
- Alejandro Rísquez
- "Luis Razetti" School of Medicine, Central University of Venezuela, Caracas, Venezuela.
| | - Luis Echezuría
- "Luis Razetti" School of Medicine, Central University of Venezuela, Caracas, Venezuela
| | - Fhabián S Carrión-Nessi
- "Luis Razetti" School of Medicine, Central University of Venezuela, Caracas, Venezuela
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
| | - David A Forero-Peña
- "Luis Razetti" School of Medicine, Central University of Venezuela, Caracas, Venezuela.
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela.
- Infectious Diseases Department, University Hospital of Caracas, Caracas, Venezuela.
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13
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Lin Q, Zhong Y, Wang B. Mafosfamide Boosts GMI-HBVac against HBV via Treg Depletion in HBV-Infected Mice. Vaccines (Basel) 2023; 11:1026. [PMID: 37376415 DOI: 10.3390/vaccines11061026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Chronic hepatitis B infection remains a significant worldwide health burden, placing persons at risk for hepatocellular cancer and hepatic fibrosis. Chronic hepatitis B virus (CHB) infection is characterized by elevated levels of immunosuppressive regulatory T cells (Tregs), which can inhibit the function of effector T cells and lead to an insufficient immune clearance response against HBV. Theoretically, suppression of Treg cell functionality and percentage could increase anti-HBV reactivity in CHB-infected patients, although this has not yet been explored. We attempted to enhance our previously established anti-CHB protocol utilizing the GM-CSF+IFN-α+rHBVvac regimen (GMI-HBVac) by incorporating mafosfamide (MAF), which has been utilized in anticancer therapy in the past. Intravenous administration of MAF to rAAV8-1.3HBV-infected mice resulted in a dose-dependent reduction of Tregs in the blood, rebounding to pretreatment levels 10 days later. To assess the potential benefit of adding MAF to the anti-CHB protocol, 2 μg/mL MAF was combined with the GMI-HBVac as an anti-Treg treatment in an HBV-infected animal model. When rAAV8-1.3HBV-infected mice were immunized with MAF+GMI-HBVac, peripheral blood Tregs decreased significantly, leading to dendritic cell activation, HBV-specific T cell proliferation, and the upregulation of IFN-gamma-producing CD8+T cells. In addition, MAF+GMI-HBVac vaccination stimulated T cell infiltration in HBV-infected livers. These effects may contribute to an enhanced immune response and the clearance of HBV-associated antigens, including serum HBsAg, serum HBcAg, and HBcAg+ hepatocytes. Overall, this is the first indication that MAF can act as an adjuvant with GMI-HBVac to deplete Tregs in mice with an established CHB infection. This unique therapeutic vaccine regimen produced a functional cure, as revealed by the remarkable clearance of HBsAg.
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Affiliation(s)
- Qin Lin
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), Shanghai Frontiers Science Center of Pathogenic Microorganisms and Infection, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Yiwei Zhong
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), Shanghai Frontiers Science Center of Pathogenic Microorganisms and Infection, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai 200032, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Bin Wang
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), Shanghai Frontiers Science Center of Pathogenic Microorganisms and Infection, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai 200032, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
- Children's Hospital of Fudan University, Shanghai 201102, China
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14
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Wang R, Zhu X, Zhang X, Liu H, Ji YL, Chen YH. Association of vitamin D and polymorphisms of its receptor with antiviral therapy in pregnant women with hepatitis B. World J Gastroenterol 2023; 29:3003-3012. [PMID: 37274802 PMCID: PMC10237097 DOI: 10.3748/wjg.v29.i19.3003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/28/2023] [Accepted: 04/24/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND The interruption of mother-to-child transmission (MTCT) is considered important to decrease the individual and population morbidity of hepatitis B virus (HBV) infection as well as the global burden of hepatitis B. Serum vitamin D (VD) is associated with hepatitis B.
AIM To assess whether baseline VD levels and single nucleotide polymorphisms of the VD receptor gene (VDR SNPs) are associated with the efficacy of tenofovir disoproxil fumarate (TDF) in the prevention of MTCT in pregnant women with high HBV viral loads.
METHODS Thirty-eight pregnant women who were at high risk for MTCT of HBV (those with an HBV DNA level ≥ 2 × 105 IU/mL during 12-24 wk of gestation) receiving antiviral therapy of TDF between June 1, 2019 and June 30, 2021 in Mianyang were included in this retrospective study. The women received 300 mg TDF once daily from gestational weeks 24-28 until 3 mo after delivery. To further characterize the clinical relevance of maternal serum HBV DNA levels, we stratified patients according to HBV DNA level as follows: Those with levels < 2 × 105 (full responder group) vs those levels ≥ 2 × 105 IU/mL (partial responder group) at delivery. Serum levels of 25-hydroxyvitamin D [25(OH)D], liver function markers, virological parameters, VDR SNPs and other clinical parameters were collected to analyze their association with the efficacy of TDF. The Mann-Whitney U test or t test was used to analyze the serum levels of 25(OH)D in different groups. Multiple linear regressions were utilized to analyze the determinants of the maternal HBV DNA level at delivery. Univariate and multivariate logistic regression analyses were employed to explore the association of targeted antiviral effects with various characteristics at baseline and delivery.
RESULTS A total of 38 pregnant women in Mianyang City at high risk for MTCT of HBV were enrolled in the study. The MTCT rate was 0%. No mother achieved hepatitis B e antigen or hepatitis B surface antigen (HBsAg) clearance at delivery. Twenty-three (60.5%) participants were full responders, and 15 (39.5%) participants were partial responders according to antiviral efficacy. The present study showed that a high percentage (76.3%) of pregnant women with high HBV viral loads had deficient (< 20 ng/mL) or insufficient (≥ 20 but < 31 ng/mL) VD levels. Serum 25(OH)D levels in partial responders appeared to be significantly lower than those in full responders both at baseline (25.44 ± 9.42 vs 17.66 ± 5.34 ng/mL, P = 0.006) and delivery (26.76 ± 8.59 vs 21.24 ± 6.88 ng/mL, P = 0.044). Serum 25(OH)D levels were negatively correlated with maternal HBV DNA levels [log(10) IU/mL] at delivery after TDF therapy (r = -0.345, P = 0.034). In a multiple linear regression analysis, maternal HBV DNA levels were associated with baseline maternal serum 25(OH)D levels (P < 0.0001, β = -0.446), BMI (P = 0.03, β = -0.245), baseline maternal log10 HBsAg levels (P = 0.05, β = 0.285) and cholesterol levels at delivery (P = 0.015, β = 0.341). Multivariate logistic regression analysis showed that baseline serum 25(OH)D levels (OR = 1.23, 95%CI: 1.04-1.44), maternal VDR Cdx2 TT (OR = 0.09, 95%CI: 0.01-0.88) and cholesterol levels at delivery (OR = 0.39, 95%CI: 0.17-0.87) were associated with targeted antiviral effects (maternal HBV DNA levels < 2 × 105 at delivery).
CONCLUSION Maternal VD levels and VDR SNPs may be associated with the efficacy of antiviral therapy in pregnant women with high HBV viral loads. Future studies to evaluate the therapeutic value of VD and its analogs in reducing the MTCT of HBV may be justified.
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Affiliation(s)
- Rui Wang
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xia Zhu
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xuan Zhang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Huan Liu
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yu-Lin Ji
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yong-Hua Chen
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
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15
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Aimla K, Kowalska JD, Matulionyte R, Mulabdic V, Vassilenko A, Bolokadze N, Jilich D, Antoniak S, Oprea C, Balayan T, Harxhi A, Papadopoulos A, Lakatos B, Vasylyev M, Begovac J, Yancheva N, Streinu-Cercel A, Verhaz A, Gokengin D, Dragovic G, Sojak L, Skrzat-Klapaczyńska A. Vaccination against HBV and HAV as Mode of Hepatitis Prevention among People Living with HIV-Data from ECEE Network Group. Vaccines (Basel) 2023; 11:980. [PMID: 37243084 PMCID: PMC10222000 DOI: 10.3390/vaccines11050980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/27/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: Viral hepatitis C (HCV) and viral hepatitis B (HBV) are common co-infections in people living with HIV (PLWH). All PLWH should be vaccinated against HBV and hepatitis A (HAV) and treated for HBV and HCV. We aimed to compare testing, prophylaxis and treatment of viral hepatitis in PLWH in Central and Eastern Europe (CEE) in 2019 and 2022. (2) Methods: Data was collected through two on-line surveys conducted in 2019 and 2022 among 18 countries of the Euroguidelines in CEE (ECEE) Network Group. (3) Results: In all 18 countries the standard of care was to screen all PLWH for HBV and HCV both years; screening of HAV was routine in 2019 in 54.5% and in 2022 47.4% of clinics. Vaccination of PLWH against HAV was available in 2019 in 16.7%, in 2022 in 22.2% countries. Vaccination against HBV was available routinely and free of charge in 50% of clinics both in 2019 and 2022. In HIV/HBV co-infected the choice of NRTI was tenofovir-based in 94.4% of countries in both years. All clinics that responded had access to direct-acting antivirals (DAAs) but 50% still had limitations for treatment. (4) Conclusions: Although testing for HBV and HCV was good, testing for HAV is insufficient. Vaccination against HBV and especially against HAV has room for improvement; furthermore, HCV treatment access needs to overcome restrictions.
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Affiliation(s)
- Kerstin Aimla
- Department of Infectious Diseases, Tartu University Hospital, 50406 Tartu, Estonia
| | - Justyna Dominika Kowalska
- Department of Adults’ Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Raimonda Matulionyte
- Department of Infectious Diseases and Dermatovenerology, Faculty of Medicine, Vilnius University, Vilnius University Hospital Santaros Klinikos, LT-08410 Vilnius, Lithuania
| | - Velida Mulabdic
- Clinic for Infectious Diseases, University Clinical Center Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina
| | - Anna Vassilenko
- City Clinical Hospital of Infectious Diseases, 220002 Minsk, Belarus
| | - Natalie Bolokadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, 0160 Tbilisi, Georgia
| | - David Jilich
- Department of Infectious Diseases, 1st Faculty of Medicine, Charles University in Prague and Faculty Hospital Bulovka, 18000 Prague, Czech Republic
| | - Sergii Antoniak
- Clinic of the Gromashevsky Institute of Epidemiology and Infectious Diseases, 01001 Kyiv, Ukraine
| | - Cristiana Oprea
- Victor Babes Clinical Hospital for Infectious and Tropical Diseases, 030303 Bucharest, Romania
| | | | - Arjan Harxhi
- Department of Infectious Disease, Faculty of Medicine, Medical University of Tirana, 1000 Tirana, Albania
| | - Antonios Papadopoulos
- HIV Unit, 4th Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
| | - Botond Lakatos
- National Instititue of Hematology and Infectious Diseases, National Center of HIV, 1097 Budapest, Hungary
| | - Marta Vasylyev
- Lviv Regional Public Health Center, HIV Unit, 79000 Lviv, Ukraine
| | - Josip Begovac
- University Hospital of Infectious Diseases, 10000 Zagreb, Croatia
| | - Nina Yancheva
- Department for AIDS, Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases, Medical University of Sofia, 1606 Sofia, Bulgaria
| | - Anca Streinu-Cercel
- National Institute of Infectious Diseases “Prof. Dr. Matei Balș”, 021105 Bucharest, Romania
| | - Antonija Verhaz
- Clinic for Infectious Diseases Republic of Srpska Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Deniz Gokengin
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Ege University, 35100 Izmir, Turkey
| | - Gordana Dragovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Lubomir Sojak
- Department of Infectology and Geographical Medicine, 833 05 Bratislava, Slovakia
| | - Agata Skrzat-Klapaczyńska
- Department of Adults’ Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 02-091 Warsaw, Poland
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16
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Motta-Castro ARC, Kerr L, Kendall C, Mota RS, Guimarães MDC, Leal AF, Merchan-Hamann E, Dourado I, Veras MA, de Brito AM, Pontes AK, Macena RHM, Knauth D, Lima LNGC, Cavalcante S, Díaz-Bermúdez XP, Oliveira LC, Magno L, Camillo AC, Lemos MF, Silva VCM, Compri AP, Moreira RC. Hepatitis B Prevalence among Men Who Have Sex with Men in Brazil. Trop Med Infect Dis 2023; 8:tropicalmed8040218. [PMID: 37104344 PMCID: PMC10142294 DOI: 10.3390/tropicalmed8040218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 04/28/2023] Open
Abstract
Hepatitis B virus (HBV) is a global public health problem and requires specific prevention actions, particularly focusing on the key populations, such as men who have sex with men (MSM). We aimed at assessing the prevalence of HBV infection, among MSM, in a multicity study in Brazil. In 2016, we conducted a survey using a respondent-driven sampling methodology in 12 Brazilian cities. Rapid tests (RT) were performed on 3178 samples from those MSM. Positive results were tested for HBV DNA and sequenced. If negative for HBV DNA, samples were tested for serological markers. The prevalence rate of HBV exposure and clearance was 10.1% (95% CI: 8.1-12.6), and 1.1% (95%; CI: 0.6-2.1) were confirmed to be HBsAg-positive. Of those samples tested for anti-HBs (n = 1033), only 74.4% presented a serological profile analogous to that elicited by hepatitis B vaccination. Among HBsAg-positive samples (n = 29), 72.4% were HBV DNA-positive, and from these, 18 were sequenced. HBV genotypes A, F, and G were found in 55.5%, 38.9%, and 5.6%, respectively. This study indicates high prevalence rates of MSM HBV exposure and a low positivity index for the serological marker of HBV vaccine immunity. These findings may contribute to the discussion of strategies to prevent hepatitis B and reinforce the importance of promoting HBV vaccination in this key population.
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Affiliation(s)
- Ana Rita C Motta-Castro
- Faculdade de Ciências Farmacêuticas, Alimentos e Nutrição, Universidade Federal de Mato Grosso do Sul, Campo Grande 79070-900, MS, Brazil
- Fundação Oswaldo Cruz-Mato Grosso do Sul, Campo Grande 79081-746, MS, Brazil
| | - Lígia Kerr
- Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza 60020-181, CE, Brazil
| | - Carl Kendall
- Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza 60020-181, CE, Brazil
- Global Community Health and Behavioral Sciences, Tulane University, New Orleans, LA 70112, USA
| | - Rosa S Mota
- Departamento de Estatística e Matemática Aplicada, Universidade Federal do Ceará, Fortaleza 60020-181, CE, Brazil
| | - Mark Drew C Guimarães
- Medicina Preventiva e Social, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Andréa Fachel Leal
- Departamento de Sociologia, Universidade Federal do Rio Grande do Sul, Porto Alegre 90010-150, RS, Brazil
| | - Edgar Merchan-Hamann
- Faculdade de Ciências da Saúde, Saúde Coletiva, Universidade de Brasília, Brasília 70910-900, DF, Brazil
| | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador 40170-110, BA, Brazil
| | - Maria Amélia Veras
- Departamento de Saúde Coletiva, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo 01224-001, SP, Brazil
| | - Ana Maria de Brito
- Departamento de Saúde Coletiva, Fiocruz: Instituto de Pesquisas Aggeu Magalhães, Universidade Federal de Pernambuco, Recife 50740-465, PE, Brazil
| | - Alexandre Kerr Pontes
- Instituto de Psicologia da Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-901, RJ, Brazil
| | | | - Daniela Knauth
- Departamento de Medicina Social, Universidade Federal do Rio Grande do Sul, Porto Alegre 90010-150, RS, Brazil
| | | | | | | | - Lisangela C Oliveira
- Escola de Saúde, Centro Universitário Autônomo do Brasil UNIBRASIL, Curitiba 82820-540, PR, Brazil
| | - Laio Magno
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador 41150-000, BA, Brazil
| | - Ana Cláudia Camillo
- Fundação Alfredo da Mata, Centro de Aconselhamento, Manaus 69065-040, AM, Brazil
| | - Marcílio F Lemos
- Laboratório de Hepatites, Centro de Virologia, Instituto Adolfo Lutz, São Paulo 01246-000, SP, Brazil
| | - Vanessa Cristina M Silva
- Laboratório de Hepatites, Centro de Virologia, Instituto Adolfo Lutz, São Paulo 01246-000, SP, Brazil
| | - Adriana P Compri
- Laboratório de Hepatites, Centro de Virologia, Instituto Adolfo Lutz, São Paulo 01246-000, SP, Brazil
| | - Regina Célia Moreira
- Laboratório de Hepatites, Centro de Virologia, Instituto Adolfo Lutz, São Paulo 01246-000, SP, Brazil
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17
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Impact of COVID-19 fear on Hepatitis C management. JOURNAL OF SURGERY AND MEDICINE 2023. [DOI: 10.28982/josam.7697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Background/Aim: Hepatitis C virus (HCV) infection, a major cause of cirrhosis worldwide, is the most common cause of cirrhosis and hepatocellular carcinoma in Turkey. Today, HCV infection can be treated effectively and safely using direct-acting antiviral drugs, and therefore, the World Health Organization has announced elimination targets by 2030. During the pandemic, many social and personal restrictions were applied for fear of increasing the prevalence of coronavirus disease 2019 (COVID-19) infection. Here we investigate the effects of these restrictions on managing HCV infection in internal medicine departments that deal with both infections.
Methods: Patients who applied to the internal medicine departments of our hospital and tested for anti-HCV between 11 March 2020 and 09 April 2022, which was the time interval when official restrictions were applied in Turkey during the COVID-19 pandemic, were included in the study. Patients who were not tested for anti-HCV were excluded from the study. The study was planned as a retrospective cohort study, and patients’ files tested for anti-HCV were scanned. Anti-HCV positivity, HCV RNA PCR testing, and treatment status in HCV RNA-positive patients were evaluated.
Results: During the official pandemic period when social restrictions were applied, anti-HCV positivity was revealed in 400 (1.9%) of 21,501 patients for whom anti-HCV tests were performed in internal medicine departments. HCV RNA was not tested in 64 of 400 patients with positive anti-HCV test (16%), and 83 (24.7%) of 336 patients tested for HCV RNA were found to be positive. It was determined that 17 (20.5%) of the HCV RNA-positive patients did not receive antiviral treatment.
Conclusion: In studies conducted in Turkey in the pre-pandemic period, it was determined that HCV RNA was not tested in approximately half of the anti-HCV-positive patients, while this rate was found to be only 16% during the pandemic period. This can be explained by the fact that patients infected with the COVID-19 virus were mostly followed-up by internal medicine clinics, where the awareness of viral hepatitis was high. It was determined that 20.5% of the patients with positive HCV RNA PCR tests remained untreated. This finding suggested that the social and personal restrictions applied during the pandemic led to patient follow-up and treatment disruptions.
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18
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Fadlyana E, Rusmil K, Dhamayanti M, Tarigan R, Kartasasmita CB, Sari RM, Putra MGD, Sukandar H. Comparison of Immunogenicity and Safety of Diphtheria-Tetanus-Pertussis-Hepatitis B- Haemophilus influenza B (Bio Farma) with Pentabio ® Vaccine Primed with Recombinant Hepatitis B at Birth (Using Different Source of Hepatitis B) in Indonesian Infants. Vaccines (Basel) 2023; 11:498. [PMID: 36992082 PMCID: PMC10052185 DOI: 10.3390/vaccines11030498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 02/24/2023] Open
Abstract
Satisfying the needs of the national immunization program requires maintaining diphtheria-tetanus-pertussis (DTP)-hepatitis B (HB)-Haemophilus influenza B (Hib) production. Therefore, new hepatitis B sources are needed. This study aimed to evaluate the immunogenicity of the DTP-HB-Hib vaccine (Bio Farma) that used a different source of hepatitis B. A prospective randomized, double-blind, bridging study was conducted. Subjects were divided into two groups with different batch numbers. Healthy infants 6-11 weeks of age at enrollment were immunized with three doses of the DTP-HB-Hib vaccine after a birth dose of hepatitis B vaccine. Blood samples were obtained prior to vaccination and 28 days after the third dose. Adverse events were recorded until 28 days after each dose. Of the 220 subjects, 205 (93.2%) completed the study protocol. The proportion of infants with anti-diphtheria and anti-tetanus titers ≥ 0.01 IU/mL was 100%, with anti-HBsAg titers ≥ 10 mIU/mL was 100%, and with Polyribosylribitol Phosphate-Tetanus Conjugate (PRP-TT) titers > 0.15 µg/mL was 96.1%. The pertussis response rate was 84.9%. No serious adverse events related to the study vaccine occurred. The three-dose DTP-HB-Hib vaccine (Bio Farma) is immunogenic, well tolerated, and suitable to replace licensed-equivalent vaccines.
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Affiliation(s)
- Eddy Fadlyana
- Child and Health Department, Faculty of Medicine, Padjajaran University, Hasan Sadikin Hospital West Java Indonesia, Bandung 40161, Indonesia
| | - Kusnandi Rusmil
- Child and Health Department, Faculty of Medicine, Padjajaran University, Hasan Sadikin Hospital West Java Indonesia, Bandung 40161, Indonesia
| | - Meita Dhamayanti
- Child and Health Department, Faculty of Medicine, Padjajaran University, Hasan Sadikin Hospital West Java Indonesia, Bandung 40161, Indonesia
| | - Rodman Tarigan
- Child and Health Department, Faculty of Medicine, Padjajaran University, Hasan Sadikin Hospital West Java Indonesia, Bandung 40161, Indonesia
| | - Cissy B. Kartasasmita
- Child and Health Department, Faculty of Medicine, Padjajaran University, Hasan Sadikin Hospital West Java Indonesia, Bandung 40161, Indonesia
| | - Rini Mulia Sari
- Surveillance & Clinical Research Division PT Bio Farma, Bandung 40161, Indonesia
| | - Muhammad Gilang Dwi Putra
- Child and Health Department, Faculty of Medicine, Padjajaran University, Hasan Sadikin Hospital West Java Indonesia, Bandung 40161, Indonesia
| | - Hadyana Sukandar
- Public Health Department, Faculty of Medicine, Padjajaran University, Bandung 40161, Indonesia
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Low Risk of Occult Hepatitis B Infection among Vietnamese Blood Donors. Pathogens 2022; 11:pathogens11121524. [PMID: 36558858 PMCID: PMC9786887 DOI: 10.3390/pathogens11121524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022] Open
Abstract
Occult hepatitis B infection (OBI) is characterized by the presence of low levels of hepatitis B virus (HBV) DNA and undetectable HBsAg in the blood. The prevalence of OBI in blood donors in Asia ranges from 0.013% (China) to 10.9% (Laos), with no data available from Vietnam so far. We aimed to investigate the prevalence of OBI among Vietnamese blood donors. A total of 623 (114 women and 509 men) HBsAg-negative blood donors were screened for anti-HBc and anti-HBs by ELISA assays. In addition, DNA from sera was isolated and nested PCR was performed for the HBV surface gene (S); a fragment of the S gene was then sequenced in positive samples. The results revealed that 39% (n = 242) of blood donors were positive for anti-HBc, and 70% (n = 434) were positive for anti-HBs, with 36% (n = 223) being positive for both anti-HBc and anti-HBs. In addition, 3% of blood donors (n = 19) were positive for anti-HBc only, and 34% (n = 211) had only anti-HBs as serological marker. A total of 27% (n = 170) were seronegative for any marker. Two of the blood donors (0.3%) were OBI-positive and sequencing revealed that HBV sequences belonged to HBV genotype B, which is the predominant genotype in Vietnam.
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BEHZADIFAR MEYSAM, AZARI SAMAD, SHIRKHANI SOMAYEH, GHOLAMREZAEI SHIRIN, SHAHABI SAEED, DOSHMANGIR LEILA, EHSANZADEH SEYEDJAFAR, MARTINI MARIANO, BRAGAZZI NICOLALUIGI, BEHZADIFAR MASOUD. Hepatitis B vaccination in Iran: Historical policies and programs. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E618-E624. [PMID: 36891002 PMCID: PMC9986976 DOI: 10.15167/2421-4248/jpmh2022.63.4.2731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/29/2022] [Indexed: 03/10/2023]
Abstract
Hepatitis B virus (HBV) infection is a main challenge of the health system worldwide. Health policymakers in most countries attempt to help HBV patients by implementing support programs in addition to controlling HBV in their community so that the economic burden caused by HBV do not deprive the patients of accessing health services and reducing their quality of life. There are several health interventions for the prevention and control of HBV. Providing the first dose of the HBV vaccine within 24 hours after the infant is born is the most cost-effective way to prevent and control HBV. The purpose of this study is to review the nature of HBV, its epidemiology in Iran and worldwide, and to review the various policies and programs in Iran regarding the prevention and control of HBV, especially the use of vaccination. One of the goals of Sustainable Development Goals (SDGs) is to consider hepatitis as a threat to human health. In this regard, one of the top priorities of WHO is the prevention and control of HBV. In connection with the prevention of HBV, it is claimed that vaccination is the most effective and best intervention. Thus, vaccination in the safe's program of countries is highly recommended. According to the Ministry of Health and Medical Education (MOHME) reports, Iran has the lowest prevalence of HBV among the countries in Eastern Mediterranean Region Organization (EMRO). There is a hepatitis unit in MOHME whose responsibility is to coordinate and implement the hepatitis prevention and control programs. The HBV vaccine has been officially included in the vaccination program for children in Iran since 1993, and three doses of the vaccine are given to all infants. In 2007, during a large-scale program in Iran, 17-year-olds received the HBV vaccine, followed by adolescents born in 1990 and 1991. In recent years, the health system in Iran has made significant progress in preventing and controlling HBV. Over 95% coverage of the HBV vaccination is one of the achievements that have had a great impact on reducing the trend of HBV infection. In order to achieve the 2030 goals, the Iranian government, in addition to paying more attention to HBV elimination programs, should encourage other organizations to cooperate more effectively with MOHME.
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Affiliation(s)
- MEYSAM BEHZADIFAR
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - SAMAD AZARI
- Research Center for Emergency and Disaster Resilience, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran
- Hospital Management Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - SOMAYEH SHIRKHANI
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - SHIRIN GHOLAMREZAEI
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - SAEED SHAHABI
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - LEILA DOSHMANGIR
- Tabriz Health Services Management Research Center, School of Management & Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - SEYED JAFAR EHSANZADEH
- English Language Department, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - MARIANO MARTINI
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - NICOLA LUIGI BRAGAZZI
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - MASOUD BEHZADIFAR
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
- Correspondence: Masoud Behzadifar, Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran. Lorestan University of Medical Sciences, Anooshirvan Rezaei Square, Khorramabad, Lorestan, Iran. Tel.: +98-066-33302033 - E-mail: ;
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Nartey YA, Okine R, Seake-Kwawu A, Ghartey G, Asamoah YK, Senya K, Duah A, Owusu-Ofori A, Amugsi J, Suglo D, Bampoh SA, Hiebert L, Njuguna H, Ward JW, Plymoth A, Roberts LR, Bockarie AS, Awuku YA, Obiri-Yeboah D. A nationwide cross-sectional review of in-hospital hepatitis B virus testing and disease burden estimation in Ghana, 2016 - 2021. BMC Public Health 2022; 22:2149. [PMID: 36419017 PMCID: PMC9686031 DOI: 10.1186/s12889-022-14618-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 11/14/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND AIMS Data are needed to inform hepatitis B virus (HBV) testing and treatment policies in Ghana to make progress towards achieving the 2030 WHO elimination targets. This study investigated testing patterns for HBV and described the age, sex, and region-specific prevalence of HBV infection in Ghana using hospital data. METHODS A nationwide multi-centre cross-sectional study was performed where hospital-based registers were reviewed. These included review of 139,966 laboratory, 169,048 blood bank, and 83,920 delivery register entries from 22 healthcare institutions in Ghana. Frequencies and proportions, and crude and pooled estimates reported. Chi squared test was used for tests of independence. Logistic regression was used to identify factors associated with a positive test result. RESULTS The crude HBsAg seroprevalence was 8.48% (95%CI 8.25-8.57%) with pooled estimate of 11.40% (95%CI 10.44-12.35). HBsAg seroprevalence among children under 5 years was 1.87% (95%CI 1.07-3.27) and highest age-specific seroprevalence was in those 40-49 years. The highest region-specific seroprevalences was in the Savannah (22.7%). Predictors of a positive HBsAg RDT test included female sex (OR 0.81 95% CI 0.74-0.88), and age (OR 1.005 95%CI 1.002-1.007). The proportion of parturient women receiving HBsAg testing increased between 2017 (87.2%) and 2020 (94.3%) (p < 0.001). The crude HBsAg seroprevalence in parturient women was 6.14% (95% CI 5.97-6.31). Among blood donors the crude HBsAg seroprevalence was 5.69% (95%CI 5.58-5.80). Data from 2 teaching hospitals indicated that in 2020, although 1500 HBsAg positive tests were recorded only 746 serological profile and 804 HBV DNA tests were performed. HBV e antigen seroprevalence was 6.28% (95%CI 4.73-7.84). CONCLUSION AND RECOMMENDATIONS Ghana remains a country with high HBV burden. There is an unequal distribution, with higher HBsAg seroprevalence in the north of the country. Furthermore, PCR testing is not widely available outside of large teaching hospitals, which limits diagnostic work-up. Hepatitis reporting systems and registers should be improved to facilitate data capture of indicators and standardised across the country to allow for comparability. Furthermore, where gains have been made in testing among pregnant women, there is a need for linkage to appropriate care.
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Affiliation(s)
- Yvonne Ayerki Nartey
- grid.4714.60000 0004 1937 0626Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden ,Department of Internal Medicine, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Rafiq Okine
- World Health Organisation, Country Office, Accra, Ghana
| | - Atsu Seake-Kwawu
- grid.434994.70000 0001 0582 2706National Viral Hepatitis Control Program, Ghana Health Service, Accra, Ghana
| | - Georgia Ghartey
- grid.8652.90000 0004 1937 1485Ghana Field Epidemiology and Laboratory Training Programme, School of Public Health, University of Ghana, Legon, Ghana
| | - Yaw Karikari Asamoah
- grid.8652.90000 0004 1937 1485Ghana Field Epidemiology and Laboratory Training Programme, School of Public Health, University of Ghana, Legon, Ghana
| | - Kafui Senya
- World Health Organisation, Country Office, Accra, Ghana
| | - Amoako Duah
- grid.8652.90000 0004 1937 1485Department of Internal Medicine, University of Ghana Medical Centre, Accra, Ghana
| | - Alex Owusu-Ofori
- grid.415450.10000 0004 0466 0719Clinical Microbiology Unit, Komfo-Anokye Teaching Hospital, Kumasi, Ghana
| | - James Amugsi
- Internal Medicine and Out-patient Department, Sandema District Hospital, Sandema, Ghana
| | | | - Sally Afua Bampoh
- Department of Internal Medicine, Greater Accra Regional Hospital, Accra, Ghana
| | - Lindsey Hiebert
- grid.507439.c0000 0001 0104 6164Coalition for Global Hepatitis Elimination, Task Force for Global Health, Decatur, GA USA
| | - Henry Njuguna
- grid.507439.c0000 0001 0104 6164Coalition for Global Hepatitis Elimination, Task Force for Global Health, Decatur, GA USA
| | - John W. Ward
- grid.507439.c0000 0001 0104 6164Coalition for Global Hepatitis Elimination, Task Force for Global Health, Decatur, GA USA
| | - Amelie Plymoth
- grid.4714.60000 0004 1937 0626Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Lewis Rowland Roberts
- grid.66875.3a0000 0004 0459 167XDepartment of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, MN USA
| | - Ansumana Sandy Bockarie
- grid.413081.f0000 0001 2322 8567Department of Internal Medicine, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Yaw Asante Awuku
- grid.449729.50000 0004 7707 5975Department of Medicine, University of Health and Allied Science, Ho, Ghana
| | - Dorcas Obiri-Yeboah
- grid.413081.f0000 0001 2322 8567Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
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Grandi G, Lopez LF, Burattini MN. Regional differences and temporal trend analysis of Hepatitis B in Brazil. BMC Public Health 2022; 22:1931. [PMID: 36253757 PMCID: PMC9578265 DOI: 10.1186/s12889-022-14296-1] [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] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/22/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Burden disease related to chronic HBV infection is increasing worldwide. Monitoring Hepatitis B occurrence is difficult due to intrinsic characteristics of the infection, nonetheless analyzing this information improves strategic planning towards reducing the burden related to chronic infection. In this line of thought, this study aims to analyze national and regional epidemiology of Hepatitis B and it's temporal trends based on Brazilian reported cases. METHODS Data obtained from the Brazilian National Notifiable Disease Reporting System (SINAN) from 2007 to 2018 were classified by infection status with an original classification algorithm, had their temporal trends analyzed by Joinpoint regression model and were correlated with gender, age and region. RESULTS Of the 487,180 hepatitis B cases notified to SINAN, 97.65% had it infection status correctly classified by the new algorithm. Hepatitis B detection rate, gender and age-distribution were different among Brazilian regions. Overall, detection rates remained stable from 2007 to 2018, achieving their maximal value (56.1 cases per 100,000 inhabitants) in North region. However, there were different temporal trends related to different hepatitis B status and age. Women mean age at notification were always inferior to those of men and the difference was higher in Central-West, North and Northeast regions. CONCLUSION Hepatitis B affects heterogeneously different populations throughout Brazilian territory. The differences shown in its temporal trends, regional, gender and age-related distribution helps the planning and evaluation of control measures in Brazil.
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Affiliation(s)
- Giuliano Grandi
- Infectious Diseases Division, Escola Paulista de Medicina, Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, SP Brazil
- Institute of Mathematics and Statistics, The University of São Paulo, São Paulo, SP Brazil
- Present Address: Rua Botucatu, 740–5th floor. Room 507, CEP 04023-062 São Paulo, SP Brazil
| | - Luis Fernandez Lopez
- Discipline of Medical Informatics and LIM-01 HCFMUSP, School of Medicine, The University of São Paulo, São Paulo, SP Brazil
- Center for Internet Augmented Research and Assessment - CIARA, Florida International University, Florida, USA
| | - Marcelo Nascimento Burattini
- Infectious Diseases Division, Escola Paulista de Medicina, Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, SP Brazil
- Discipline of Medical Informatics and LIM-01 HCFMUSP, School of Medicine, The University of São Paulo, São Paulo, SP Brazil
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Cao X, Du X, Jiao H, An Q, Chen R, Fang P, Wang J, Yu B. Carbohydrate-based drugs launched during 2000 -2021. Acta Pharm Sin B 2022; 12:3783-3821. [PMID: 36213536 PMCID: PMC9532563 DOI: 10.1016/j.apsb.2022.05.020] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/18/2022] [Accepted: 05/12/2022] [Indexed: 01/09/2023] Open
Abstract
Carbohydrates are fundamental molecules involved in nearly all aspects of lives, such as being involved in formating the genetic and energy materials, supporting the structure of organisms, constituting invasion and host defense systems, and forming antibiotics secondary metabolites. The naturally occurring carbohydrates and their derivatives have been extensively studied as therapeutic agents for the treatment of various diseases. During 2000 to 2021, totally 54 carbohydrate-based drugs which contain carbohydrate moities as the major structural units have been approved as drugs or diagnostic agents. Here we provide a comprehensive review on the chemical structures, activities, and clinical trial results of these carbohydrate-based drugs, which are categorized by their indications into antiviral drugs, antibacterial/antiparasitic drugs, anticancer drugs, antidiabetics drugs, cardiovascular drugs, nervous system drugs, and other agents.
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Affiliation(s)
- Xin Cao
- Zhongshan Hospital Institute of Clinical Science, Fudan University Shanghai Medical College, Shanghai 200032, China
| | - Xiaojing Du
- Zhongshan Hospital Institute of Clinical Science, Fudan University Shanghai Medical College, Shanghai 200032, China
| | - Heng Jiao
- Zhongshan Hospital Institute of Clinical Science, Fudan University Shanghai Medical College, Shanghai 200032, China
| | - Quanlin An
- Zhongshan Hospital Institute of Clinical Science, Fudan University Shanghai Medical College, Shanghai 200032, China
| | - Ruoxue Chen
- Zhongshan Hospital Institute of Clinical Science, Fudan University Shanghai Medical College, Shanghai 200032, China
| | - Pengfei Fang
- State Key Laboratory of Bio-organic and Natural Products Chemistry, Center for Excellence in Molecular Synthesis, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, Shanghai 200032, China
| | - Jing Wang
- State Key Laboratory of Bio-organic and Natural Products Chemistry, Center for Excellence in Molecular Synthesis, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, Shanghai 200032, China
| | - Biao Yu
- State Key Laboratory of Bio-organic and Natural Products Chemistry, Center for Excellence in Molecular Synthesis, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, Shanghai 200032, China
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Akbar SMF, Mahtab MA, Khan S, Yoshida O, Hiasa Y. Development of Therapeutic Vaccine for Chronic Hepatitis B: Concept, Cellular and Molecular Events, Design, Limitation, and Future Projection. Vaccines (Basel) 2022; 10:vaccines10101644. [PMID: 36298512 PMCID: PMC9612083 DOI: 10.3390/vaccines10101644] [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: 08/28/2022] [Revised: 09/20/2022] [Accepted: 09/28/2022] [Indexed: 12/02/2022] Open
Abstract
Four decades have passed since the first usage of the therapeutic vaccine in patients with chronic hepatitis B (CHB). However, there is no approved regimen of vaccine therapy for the treatment of CHB. This is mainly attributable to faulty conception, an improper understanding of the cellular and molecular mechanisms of CHB, and the impaired design of vaccine therapy for CHB. With the advent of new techniques and a better understanding of cellular and molecular mechanisms underlying the genesis of CHB, the limitations and failures of previous regimens of therapeutic vaccines have been primarily understood. Additionally, the importance of immune therapy for treating millions of CHB patients and achieving the target of "Elimination of Hepatitis by 2030" has been focused on in the international arena. This has been amplified by the apparent limitation of commercially available antiviral drugs that are infinite in duration, endowed with safety concerns, and unable to cure liver damage due to their minimal immune modulation capacities. The proposed review article comprehensively discusses each of these points and proposes evidence-based approaches for viable types of vaccine therapy for the treatment of CHB.
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Affiliation(s)
- Sheikh Mohammad Fazle Akbar
- Department of Gastroenterology and Metabology, Graduate School of Medicine, Ehime University, Ehime 791-0295, Japan
- Correspondence: ; Tel.: +81-89-960-5308; Fax: +81-89-960-5310
| | - Mamun Al Mahtab
- Interventional Hepatology Division, Department of Hepatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka 1000, Bangladesh
| | - Sakirul Khan
- Department of Microbiology, Oita University, Oita 879-5593, Japan
| | - Osamu Yoshida
- Department of Gastroenterology and Metabology, Graduate School of Medicine, Ehime University, Ehime 791-0295, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Graduate School of Medicine, Ehime University, Ehime 791-0295, Japan
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Raslan E, AbdAllah M, Soliman S. The prevalence and determinants of hepatitis B among Egyptian adults: a further analysis of a country-representative survey. EGYPTIAN LIVER JOURNAL 2022. [DOI: 10.1186/s43066-022-00207-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Hepatitis B virus (HBV) infection is a major worldwide healthcare problem with subsequent serious complications including cirrhosis and hepatocellular carcinoma (HCC). Hence, taking cognizance of HBV impact is critical for future planning of its control and prevention.
Objectives
To assess the prevalence of HBV in Egypt, analyse the demographic characteristics of HBV-infected patients and examine the common routes of its transmission.
Methods
This is a cross-sectional study of data from the Egyptian Health Issues Survey (EHIS), which employed a nationally representative sample of 16,004 individuals. The survey participants were categorized into two groups: group A, HBV positive, and group B, HBV negative. Comparative analysis was performed to identify demographic features and define possible risk factors.
Results
The total number of participants included in the study was 16,004. The mean age (± SD) was 33.5 (± 12.4) years. The prevalence of HBV was 1.52%. Demographic analysis showed that HBV was more prevalent among males, married people, people with jobs and smokers (P = 0.0011, 0.002, < 0.001 and 0.0036) respectively. Employing an adjusted multivariate logistic regression model, we observed an increased likelihood of HBV infection in married adults who received cupping without blood and who did not know if they had schistosomiasis injection therapy.
Conclusion
The application of special screening programs to highly susceptible patients and treatment optimization is recommended for the elimination of HBV. EHIS indicates the likely success of the previous Egyptian control plan for viral hepatitis through reducing several risk factors.
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Jourdain G, Panpradist N. Editorial: dying while waiting for a hepatitis B cure? Aliment Pharmacol Ther 2022; 56:550-551. [PMID: 35804475 DOI: 10.1111/apt.17081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Gonzague Jourdain
- University of Montpellier, MIVEGEC, CNRS, IRD, Montpellier, France.,Chiang Mai University Faculty of Associated Medical Sciences, Chiang Mai, Thailand
| | - Nuttada Panpradist
- Department of Bioengineering, University of Washington, Seattle, WA, USA
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Christensen KT, Pierard F, Beuselinck K, Bonsall D, Bowden R, Lagrou K, Nevens F, Schrooten Y, Simmonds P, Vandamme AM, Van Wijngaerden E, Dierckx T, Cuypers L, Van Laethem K. Full-genome next-generation sequencing of hepatitis C virus to assess the accuracy of genotyping by the commercial assay LiPA and the prevalence of resistance-associated substitutions in a Belgian cohort. J Clin Virol 2022; 155:105252. [DOI: 10.1016/j.jcv.2022.105252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/26/2022] [Accepted: 08/02/2022] [Indexed: 02/07/2023]
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28
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Alarfaj SJ, Alzahrani A, Alotaibi A, Almutairi M, Hakami M, Alhomaid N, Alharthi N, Korayem GB, Alghamdi A. The effectiveness and safety of direct-acting antivirals for hepatitis C virus treatment: A single-center experience in Saudi Arabia. Saudi Pharm J 2022; 30:1448-1453. [DOI: 10.1016/j.jsps.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 07/19/2022] [Indexed: 02/07/2023] Open
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29
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Xu J, Fan Y, Yu Y, Han Y, Kang Q, Tan N, Yang Y, Chen H, Pan J, Xu X. A Multicenter Real-World Study Evaluating the Hepatoprotective Effect of Polyene Phosphatidylcholine Against Chronic Hepatitis B. Front Med (Lausanne) 2022; 9:842098. [PMID: 35814776 PMCID: PMC9256938 DOI: 10.3389/fmed.2022.842098] [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: 12/23/2021] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Polyene phosphatidylcholine (PPC) has been widely used to treat liver diseases in China. However, there is a lack of post-marketing evidence demonstrating its liver-protective efficiency among patients infected with hepatitis B virus (HBV). This study analyzed the multicenter real-world data to compare the effectiveness of PPC with those of magnesium isoglycyrrhizinate (IsoMag) and glutathione (GSH) in patients with liver injury. Methods This study comprised the real-world data analysis of a multicenter, retrospective observational cohort. The data were retrieved from the Cooperative Registry of the Hospital Prescription in China between 1 October 2018, and 30 September 2019. A growth curve analysis was performed to compare the effects of different treatments on liver function longitudinally for up to 30 days after treatment commencement. In addition, the dose effect of the PPC treatment was investigated. Results The final cohort included 6,052 patients with approximately 8% infected with HBV (N = 471). There were 1,649, 1,750, and 2,653 patients in the PPC, GSH, and IsoMag groups, respectively, with an average age of 53.9 years. In patients with HBV infection, the PPC treatment was associated with a significant decline in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels (slopes: -3.7, 95% CI, -6.0 to -1.5 U/L/day; -2.4, 95% CI, -4.5 to -0.3 U/L/day, respectively). However, there were no significant differences in the effects among the three groups. In patients without HBV infection, the PPC treatment decreased ALT, AST, γ-glutamyl transferase (GGT), and albumin levels (-5.2, 95% CI, -5.8 to -4.5 U/L/day; -3.5, 95% CI, -4.2 to -2.7 U/L/day; -4.9, 95% CI, -6.2 to -3.7 U/L/day, -0.07, 95% CI, -0.09 to -0.04 g/L/day, respectively) and showed a stronger effect on lowering ALT levels than GSH (-2.6, 95% CI, -3.3 to -1.8 U/L/day, p < 0.05), as well as a stronger effect on lowering GGT levels than IsoMag (-1.4, 95% CI, -2.4 to -0.4 U/L/day, p < 0.05). PPC had no impact on prothrombin activity levels in patients with or without HBV infection. High-dose PPC exhibited a stronger effect on lowering ALT and AST levels than low-dose PPC. Conclusion This was the first real-world multicenter study to demonstrate that PPC efficiently lowers ALT and AST levels in patients with liver diseases regardless of the status of HBV infection. PPC treatment showed a comparable or better effect compared with GSH and IsoMag treatments. High-dose PPC resulted in a stronger effect than low-dose PPC.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Xiaoyuan Xu
- Department of Infectious Diseases, Peking University First Hospital, Beijing, China
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ORNOS ERICDAVIDBICALDO, GADDI TANTENGCO OURLADALZEUS. Decreased online hepatitis information seeking during the COVID-19 pandemic: an Infodemiology study. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E292-E297. [PMID: 35968069 PMCID: PMC9351409 DOI: 10.15167/2421-4248/jpmh2022.63.2.2556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/01/2022] [Indexed: 11/10/2022]
Abstract
Introduction Viral hepatitis remains a public health concern worldwide, mainly in developing countries. The public's awareness and interest in viral hepatitis information are essential in preventing and controlling this disease. Infodemiology has been used as a surrogate to assess the general understanding of disease and measure public awareness of health topics. However, this analysis has not been applied to viral hepatitis. Thus, this study investigated the online global search interest for viral hepatitis in the last decade, focusing on the period before and during the COVID-19 pandemic. Methods Global online search interest for hepatitis was measured using the Google Trends™ database. Spearman's rank-order correlation correlated country-specific characteristics and prevalence data with search volume index. Results There was a significant reduction in online search interest for hepatitis during the COVID-19 pandemic (2020). People searching for hepatitis are also interested in hepatitis vaccination. Search volume index is positively correlated with viral hepatitis and HIV prevalence and negatively correlated with GDP. This correlation mirrors the high burden of viral hepatitis in developing countries and their citizens' desire to be informed about this disease. Conclusions Our study found decreased global online interest in viral hepatitis during the pandemic. Moreover, higher online interest in hepatitis was observed in countries with a lower gross domestic product and high viral hepatitis and HIV prevalence. We demonstrated that global online interest toward viral hepatitis could be assessed through the infodemiologic approach using Google Trends™.
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Thompson LA, Fenton J, Charlton CL. HCV reflex testing: A single-sample, low-contamination method that improves the diagnostic efficiency of HCV testing among patients in Alberta, Canada. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2022; 7:97-107. [PMID: 36337352 PMCID: PMC9608109 DOI: 10.3138/jammi-2021-0028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) can be cured with antiviral treatments. Diagnosis normally requires two blood samples, one for serology screening and one for molecular confirmation. This multi-step process creates barriers in patient care and decreases testing for hard-to-reach populations. We used the cobas® 6800 to detect HCV RNA after antibody testing to investigate whether a single-sample reflex testing method is effective and efficient for diagnosing HCV-positive patients. METHODS HCV RNA-positive clinical samples (n = 152) were interchangeably loaded on the ARCHITECT i2000SR with negative samples (n = 152) in a checkerboard fashion, tested for HCV antibodies using fixed probes, and directly transferred to the cobas 6800 for molecular testing. Contamination rates, sensitivity, and specificity were determined by comparing Abbott m2000 and cobas 6800 viral loads. After implementing reflex testing, clinical data over a 6-month period were analyzed for diagnostic efficiency. RESULTS Contamination was present in 5 of 152 pairs (3.29%) after reflex testing. Sensitivity and specificity were 99.3% (95% CI 95.1% to 99.9%) and 100% (95% CI 97.5% to 100%), respectively, using the cobas 6800 assay after serotesting. Approximately 97% of clinical patients received a conclusive test result with the reflex-testing algorithm. For HCV-positive patients, mean diagnostic turnaround times were significantly lower using reflex testing versus the two-sample method (4 versus 39 days; p < 0.0001). CONCLUSIONS HCV reflex testing demonstrated low levels of contamination without compromising the integrity of the molecular assay. Implementation in clinical laboratories would increase the efficiency of diagnosis and decrease steps in the continuum of care for patients.
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Affiliation(s)
- L Alexa Thompson
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Jayne Fenton
- Alberta Precision Laboratories (ProvLab), University of Alberta Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Carmen L Charlton
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
- Alberta Precision Laboratories (ProvLab), University of Alberta Hospital, University of Alberta, Edmonton, Alberta, Canada
- Li Ka Shing Institute of Virology, Edmonton, Alberta, Canada
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Hanif FM, Majid Z, Luck NH, Tasneem AA, Laeeq SM, Mubarak M. Revolution in the diagnosis and management of hepatitis C virus infection in current era. World J Hepatol 2022; 14:647-669. [PMID: 35646260 PMCID: PMC9099099 DOI: 10.4254/wjh.v14.i4.647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 02/05/2022] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
Chronic hepatitis C virus (HCV) infection is a major global public health problem, particularly in developing part of the world. Significant advances have been made in the early diagnosis and treatment of the disease. Its management has been particularly revolutionized during the past two decades. In this review, we summarize the major advances in the diagnostic and management armamentarium for chronic HCV infection. The focus of the present review is on the newer directly acting anti-viral agents, which have revolutionized the management of chronic HCV infection. Management of uncomplicated chronic HCV infection and of specific complications and special at-risk populations of patients will be covered in detail. Despite the advent and approval of highly effective and well tolerable oral agents, still many challenges remain, particularly the affordability, the equitable distribution and access to later drugs. The World Health Organization aims to eliminate viral hepatitis including HCV by 2030 since its poses a major public health threat. There is an urgent need to ensure uniform and early access to diagnostic and therapeutic facilities throughout the world if the later goal has to be realized.
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Affiliation(s)
- Farina M Hanif
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation , Karachi 74200, Sindh, Pakistan
| | - Zain Majid
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation , Karachi 74200, Sindh, Pakistan
| | - Nasir Hassan Luck
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation , Karachi 74200, Sindh, Pakistan
| | - Abbas Ali Tasneem
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation , Karachi 74200, Sindh, Pakistan
| | - Syed Muddasir Laeeq
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation , Karachi 74200, Sindh, Pakistan
| | - Muhammed Mubarak
- Department of Histopathology, Sindh Institute of Urology and Transplantation , Karachi 74200, Sindh, Pakistan
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Malik GF, Zakaria N, Majeed MI, Ismail FW. Viral Hepatitis - The Road Traveled and the Journey Remaining. Hepat Med 2022; 14:13-26. [PMID: 35300491 PMCID: PMC8922334 DOI: 10.2147/hmer.s352568] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/24/2022] [Indexed: 12/16/2022] Open
Abstract
Hepatitis is defined as inflammation of the liver and is commonly due to infection with The hepatotropic viruses - hepatitis A, B, C, D and E. Hepatitis carries one of the highest disease burdens globally and has caused significant morbidity and mortality among different patient populations. Clinical presentation varies from asymptomatic or acute flu-like illness to acute liver failure or chronic liver disease, characterized by jaundice, hepatomegaly and ascites among many other signs. Eventually, this can lead to fibrosis (cirrhosis) of the liver parenchyma and carries a risk of development into hepatocellular carcinoma. Hepatitis B and C are most notorious for causing liver cirrhosis; in 2019, an estimated 296 million people worldwide had chronic hepatitis B infection and 58 million are currently estimated to have chronic hepatitis C, with 1.5 million new infections of both hepatitis B and C, occurring annually. With the help of latest serological biomarkers and viral nucleic acid amplification tests, it has become rather simple to efficiently screen, diagnose and monitor patients with hepatitis, and to commence with appropriate antiviral treatment. More importantly, the development of vaccinations against some of these viruses has greatly helped to curb the infection rates. Whilst there has been exceptional progress over the years in the management of viral hepatitis, many hurdles still remain which must be addressed in order to proceed towards a hepatitis-free world. This review will shed light on the origin and discovery of the hepatitis viruses, the global epidemiology and clinical symptoms, diagnostic modalities, currently available treatment options, the importance of prevention, and the journey needed to move forward towards the eradication of its global disease burden.
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Affiliation(s)
- Ghulam Fareed Malik
- Section of Gastroenterology, Department of Medicine, The Aga Khan University, Karachi, Pakistan
| | - Noval Zakaria
- Section of Gastroenterology, Department of Medicine, The Aga Khan University, Karachi, Pakistan
| | | | - Faisal Wasim Ismail
- Section of Gastroenterology, Department of Medicine, The Aga Khan University, Karachi, Pakistan
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Wang R, Suzuki S, Guest JD, Heller B, Almeda M, Andrianov AK, Marin A, Mariuzza RA, Keck ZY, Foung SKH, Yunus AS, Pierce BG, Toth EA, Ploss A, Fuerst TR. Induction of broadly neutralizing antibodies using a secreted form of the hepatitis C virus E1E2 heterodimer as a vaccine candidate. Proc Natl Acad Sci U S A 2022; 119:e2112008119. [PMID: 35263223 PMCID: PMC8931252 DOI: 10.1073/pnas.2112008119] [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] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 01/19/2022] [Indexed: 11/26/2022] Open
Abstract
SignificanceHepatitis C virus chronically infects approximately 1% of the world's population, making an effective vaccine for hepatitis C virus a major unmet public health need. The membrane-associated E1E2 envelope glycoprotein has been used in clinical studies as a vaccine candidate. However, limited neutralization breadth and difficulty in producing large amounts of homogeneous membrane-associated E1E2 have hampered efforts to develop an E1E2-based vaccine. Our previous work described the design and biochemical validation of a native-like soluble secreted form of E1E2 (sE1E2). Here, we describe the immunogenic characterization of the sE1E2 complex. sE1E2 elicited broadly neutralizing antibodies in immunized mice, with increased neutralization breadth relative to the membrane-associated E1E2, thereby validating this platform as a promising model system for vaccine development.
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Affiliation(s)
- Ruixue Wang
- Institute for Bioscience and Biotechnology Research, University of Maryland, Rockville, MD 20850
| | - Saori Suzuki
- Department of Molecular Biology, Princeton University, Princeton, NJ 08540
| | - Johnathan D. Guest
- Institute for Bioscience and Biotechnology Research, University of Maryland, Rockville, MD 20850
- Department of Cell Biology and Molecular Genetics, University of Maryland, College Park, MD 20742
| | - Brigitte Heller
- Department of Molecular Biology, Princeton University, Princeton, NJ 08540
| | - Maricar Almeda
- Department of Molecular Biology, Princeton University, Princeton, NJ 08540
| | - Alexander K. Andrianov
- Institute for Bioscience and Biotechnology Research, University of Maryland, Rockville, MD 20850
| | - Alexander Marin
- Institute for Bioscience and Biotechnology Research, University of Maryland, Rockville, MD 20850
| | - Roy A. Mariuzza
- Institute for Bioscience and Biotechnology Research, University of Maryland, Rockville, MD 20850
- Department of Cell Biology and Molecular Genetics, University of Maryland, College Park, MD 20742
| | - Zhen-Yong Keck
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305
| | - Steven K. H. Foung
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305
| | - Abdul S. Yunus
- Institute for Bioscience and Biotechnology Research, University of Maryland, Rockville, MD 20850
| | - Brian G. Pierce
- Institute for Bioscience and Biotechnology Research, University of Maryland, Rockville, MD 20850
- Department of Cell Biology and Molecular Genetics, University of Maryland, College Park, MD 20742
| | - Eric A. Toth
- Institute for Bioscience and Biotechnology Research, University of Maryland, Rockville, MD 20850
| | - Alexander Ploss
- Department of Molecular Biology, Princeton University, Princeton, NJ 08540
| | - Thomas R. Fuerst
- Institute for Bioscience and Biotechnology Research, University of Maryland, Rockville, MD 20850
- Department of Cell Biology and Molecular Genetics, University of Maryland, College Park, MD 20742
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Gutkind S, Starbird LE, Murphy SM, Teixeira PA, Gooden LK, Matheson T, Feaster DJ, Jain MK, Masson CL, Perlman DC, Del Rio C, Metsch LR, Schackman BR. Cost of Hepatitis C care facilitation for HIV/Hepatitis C Co-infected people who use drugs. Drug Alcohol Depend 2022; 232:109265. [PMID: 35042101 PMCID: PMC9238179 DOI: 10.1016/j.drugalcdep.2022.109265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 12/20/2021] [Accepted: 01/03/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Using data from a randomized trial, we evaluated the cost of HCV care facilitation that supports moving along the continuum of care for HIV/HCV co-infected individuals with substance use disorder. METHODS Participants were HIV patients residing in the community, initially recruited from eight US hospital sites. They received HCV care facilitation (n = 51) or treatment as usual (n = 62) for up to six months. We used micro-costing methods to evaluate costs from the healthcare sector and patient perspectives in 2017 USD. We conducted sensitivity analyses varying care facilitator caseloads and examined offsetting savings using participant self-reported healthcare utilization. RESULTS The average site start-up cost was $6320 (site range: $4320-$7000), primarily consisting of training. The mean weekly cost per participant was $20 (site range: $4-$30) for care facilitation visits and contacts, $360 (site range: $130- $700) for supervision and client outreach, and $70 (site range: $20-$180) for overhead. In sensitivity analyses applying a weekly caseload of 10 participants per care facilitator (versus 1-6 observed in the trial), the total mean weekly care facilitation cost from the healthcare sector perspective decreased to $110. Weekly participant time and travel costs averaged $7. There were no significant differences in other healthcare service costs between participants in the intervention and control arms. CONCLUSION Weekly HCV care facilitation costs were approximately $450 per participant, but approximately $110 at a real-world setting maximum caseload of 10 participants per week. No healthcare cost offsets were identified during the trial period, although future savings might result from successful HCV treatment.
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Affiliation(s)
- Sarah Gutkind
- Department of Population Health Sciences, Weill Cornell Medical College, 425 E 61st St, New York, NY 10065, USA.
| | - Laura E Starbird
- Columbia University School of Nursing, 560 West 168th St, New York, NY 10032, USA.
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, 425 E 61st St, New York, NY 10065, USA.
| | - Paul A Teixeira
- Department of Population Health Sciences, Weill Cornell Medical College, 425 E 61st St, New York, NY 10065, USA.
| | - Lauren K Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032, USA.
| | - Tim Matheson
- San Francisco Department of Health, 101 Grove St, San Francisco, CA 94102, USA.
| | - Daniel J Feaster
- Department of Epidemiology and Public Health, University of Miami School of Medicine, 1120 NW 14th St Miami, FL 33136, USA.
| | - Mamta K Jain
- Department of Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
| | - Carmen L Masson
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, USA.
| | - David C Perlman
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA.
| | - Carlos Del Rio
- Department of Global Health, Rollins School of Public Health at Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA.
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032, USA.
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, 425 E 61st St, New York, NY 10065, USA.
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Wu JY, Lau EH, Lu ML, Guo C, Guo ZM, Yuan J, Lu JH. An occupational risk of hepatitis E virus infection in the workers along the meat supply chains in Guangzhou, China. One Health 2022; 14:100376. [PMID: 35252529 PMCID: PMC8891999 DOI: 10.1016/j.onehlt.2022.100376] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/19/2022] [Accepted: 02/19/2022] [Indexed: 02/07/2023] Open
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Niquini RP, Corrêa da Mota J, Bastos LS, da Costa Moreira Barbosa D, Falcão JDS, Palmieri P, Martins P, Melo Villar L, Bastos FI. Persistently high hepatitis C rates in haemodialysis patients in Brazil [a systematic review and meta-analysis]. Sci Rep 2022; 12:330. [PMID: 35013390 PMCID: PMC8748660 DOI: 10.1038/s41598-021-03961-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 12/13/2021] [Indexed: 02/07/2023] Open
Abstract
We conducted a systematic review and meta-analysis of studies assessing HCV infection rates in haemodialysis patients in Brazil (Prospero CRD #42021275068). We included studies on patients under haemodialysis, comprising both convenience samples and exhaustive information from selected services. Patients underwent HCV serological testing with or without confirmation by HCV RNA PCR. Exclusion criteria were the following: absence of primary empirical information and studies without information on their respective settings, study year, accurate infection rates, or full specification of diagnostic tests. Studies with samples ≤ 30 and serial assessments with repeated information were also excluded. Reference databases included PubMed, LILACS, Scopus, and Web of Science for the period 1989–2019. A systematic review was carried out, followed by two independent meta-analyses: (i) studies with data on HCV prevalence and (ii) studies with a confirmatory PCR (i.e., active infection), respectively. A comprehensive set of different methods and procedures were used: forest plots and respective statistics, polynomial regression, meta-regression, subgroup influence, quality assessment, and trim-and-fill analysis. 29 studies and 11,290 individuals were assessed. The average time patients were in haemodialysis varied from 23.5 to 56.3 months. Prevalence of HCV infection was highly heterogeneous, with a pronounced decrease from 1992 to 2001, followed by a plateau and a slight decrease in recent years. The summary measure for HCV prevalence was 34% (95% CI 26–43%) for studies implemented before 2001. For studies implemented after 2001, the corresponding summary measure was 11% (95% CI 8–15%). Estimates for prevalence of active HCV infection were also highly heterogeneous. There was a marked decline from 1996 to 2001, followed by a plateau and a slight increase after 2010. The summary measure for active HCV infection was 19% (95% CI 15–25%) in studies carried out before 2001. For studies implemented after 2001, the corresponding summary measure was 9% (95% CI 6–13%). Heterogeneity was pervasive, but different analyses helped to identify its underlying sources. Besides the year each study was conducted, the findings differed markedly between geographic regions and were heavily influenced by the size of the studies and publication biases. Our systematic review and meta-analysis documented a substantial decline in HCV prevalence among Brazilian haemodialysis patients from 1992 to 2015. CKD should be targeted with specific interventions to prevent HCV infection, and if prevention fails, prompt diagnosis and treatment. Although the goal of HCV elimination by 2030 in Brazil remains elusive, it is necessary to adopt measures to achieve micro-elimination and to launch initiatives towards targeted interventions to curb the spread of HCV in people with CKD, among other high-risk groups. This is of particular concern in the context of a protracted COVID-19 pandemic and a major economic and political crisis.
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Affiliation(s)
- Roberta Pereira Niquini
- Federal Institute of Education, Science, and Technology of Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil
| | - Jurema Corrêa da Mota
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation (ICICT-FIOCRUZ), Biblioteca de Manguinhos suite 229, Av. Brasil 4365, Rio de Janeiro, 21045-900, Brazil
| | - Leonardo Soares Bastos
- Program for Scientific Computing, Oswaldo Cruz Foundation (PROCC-FIOCRUZ), Rio de Janeiro, Brazil
| | | | - Juliane da Silva Falcão
- Federal Institute of Education, Science, and Technology of Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil
| | - Paloma Palmieri
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation (ICICT-FIOCRUZ), Biblioteca de Manguinhos suite 229, Av. Brasil 4365, Rio de Janeiro, 21045-900, Brazil
| | - Patrícia Martins
- Laboratory of Viral Hepatitis, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (IOC-FIOCRUZ), Rio de Janeiro, Brazil
| | - Livia Melo Villar
- Laboratory of Viral Hepatitis, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (IOC-FIOCRUZ), Rio de Janeiro, Brazil
| | - Francisco I Bastos
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation (ICICT-FIOCRUZ), Biblioteca de Manguinhos suite 229, Av. Brasil 4365, Rio de Janeiro, 21045-900, Brazil.
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Akbar SMF, Al Mahtab M, Aguilar JC, Yoshida O, Khan S, Penton E, Gerardo GN, Hiasa Y. The Safety and Efficacy of a Therapeutic Vaccine for Chronic Hepatitis B: A Follow-Up Study of Phase III Clinical Trial. Vaccines (Basel) 2021; 10:vaccines10010045. [PMID: 35062707 PMCID: PMC8778341 DOI: 10.3390/vaccines10010045] [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] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/23/2021] [Accepted: 12/29/2021] [Indexed: 01/12/2023] Open
Abstract
The objective of the present study was to assess the safety and efficacy of a therapeutic vaccine containing both HBsAg and HBcAg (NASVAC) in patients with chronic hepatitis B (CHB) three years after the end of treatment (EOT) as a follow-up of a phase III clinical trial. NASVAC was administered ten times by the nasal route and five times by subcutaneous injection. A total of 59 patients with CHB were enrolled. Adverse events were not seen in any of the patients. Out of the 59 CHB patients, 54 patients exhibited a reduction in HBV DNA, compared with their basal levels. Although all the patients had alanine transaminase (ALT) above the upper limit of normal (>42 IU/L) before the commencement of therapy, the levels of ALT were within the ULN level in 42 patients. No patient developed cirrhosis of the liver. The present study, showing the safety and efficacy of NASVAC 3 years after the EOT, is the first to report follow-up data of an immune therapeutic agent against CHB. NASVAC represents a unique drug against CHB that is safe, of finite duration, can be administered by the nasal route, is capable of reducing HBV DNA and normalizing ALT, and contains hepatic fibrosis.
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Affiliation(s)
- Sheikh Mohammad Fazle Akbar
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon 791-0295, Japan; (O.Y.); (Y.H.)
- Correspondence: ; Tel.: +81-89-960-5308; Fax: +81-89-960-5310
| | - Mamun Al Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka 1000, Bangladesh;
| | - Julio Cesar Aguilar
- Center for Genetic Engineering and Biotechnology, Havana 10600, Cuba; (J.C.A.); (E.P.); (G.N.G.)
| | - Osamu Yoshida
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon 791-0295, Japan; (O.Y.); (Y.H.)
| | - Sakirul Khan
- Department of Microbiology, Faculty of Medicine, Oita University, Oita 879-5593, Japan;
| | - Eduardo Penton
- Center for Genetic Engineering and Biotechnology, Havana 10600, Cuba; (J.C.A.); (E.P.); (G.N.G.)
| | - Guillen Nieto Gerardo
- Center for Genetic Engineering and Biotechnology, Havana 10600, Cuba; (J.C.A.); (E.P.); (G.N.G.)
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon 791-0295, Japan; (O.Y.); (Y.H.)
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Waheed Y. Progress on global hepatitis elimination targets. World J Gastroenterol 2021; 27:8199-8200. [PMID: 35068864 PMCID: PMC8704269 DOI: 10.3748/wjg.v27.i47.8199] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/24/2021] [Accepted: 12/08/2021] [Indexed: 02/06/2023] Open
Abstract
In 2016, the World Health Assembly adopted a Global Health Sector Strategy on viral hepatitis, with targets set for the years 2020 and 2030 to achieve hepatitis elimination. The main target of hepatitis elimination strategy is to reduce the incidence of hepatitis B virus (HBV) and hepatitis C virus (HCV) by 90% and mortality by 65% in 2030. In last 5 years, the number of people receiving HCV treatment has increased from 1 million to 9.4 million; however, this number is far from the 2030 target of 40 million people receiving HCV treatment. HBV and HCV incidence rates are down from 1.4 million to 1.1 million annual deaths but this is far from the 2030 target of < 0.5 million deaths. The coronavirus disease 2019 pandemic has severely affected the efforts in the fight against hepatitis. No major donor has committed to investing in the fight against hepatitis. Time is running out. There is a need to speed up efforts in the fight against hepatitis to achieve hepatitis elimination by 2030.
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Affiliation(s)
- Yasir Waheed
- Multidisciplinary Laboratory, Foundation University Medical College, Foundation University Islamabad, Islamabad 44000, Pakistan
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Teaima MH, Al-Nuseirat A, Abouhussein D, Badary OA, El-Nabarawi MA. Pharmaceutical policies and regulations of oral antiviral drugs for treatment of hepatitis C in Egypt-case study. J Pharm Policy Pract 2021; 14:106. [PMID: 34915937 PMCID: PMC8674831 DOI: 10.1186/s40545-021-00389-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 12/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are limited studies on the role of efficient regulatory mechanisms in facilitating greater access to Hepatitis C virus (HCV) treatment. Evidence to support the importance of effective pharmaceutical policies and regulations in improving access to oral viral drugs towards the elimination of HCV is needed. This study aims to explore the adequacy of the implemented pharmaceutical policies and regulations in Egypt and their role to improve the availability and affordability of direct-acting antivirals (DAAs) to achieve universal access to the treatment of HCV. METHODS The study adopts a qualitative methodology using desk review of regulatory and legislative information, literature review, and semi-structured interviews with key experts from the concerned governmental regulatory agencies, pharmaceutical industries, academic organizations, professional associations, civil society organizations, and clinicians who are working in researching treatments for hepatitis C. FINDINGS The common DAAs available in the market are Daclatasvir, Sofosbuvir, and Sofosbuvir-based direct-acting antiviral combinations. Fast-track medicines registration pathway for marketing authorization of DAAs is used to reduce market access time frames. The pricing policies are supplemented using price negotiation to set up affordable prices that led to a reasonable price for DAAs. Using Trade-Related Aspects of Intellectual Property Rights (TRIPs) flexibility and local production of quality generics DAAs at lower prices. In addition, political will and collaboration between the government, civil society, and pharmaceutical companies improved patients' access to affordable DAAs and succeeding hepatitis C treatment in Egypt. CONCLUSIONS The study findings indicated that the implemented pharmaceutical policies and regulations have an immense role in enhancing access to medicines towards the elimination of hepatitis C in Egypt.
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Affiliation(s)
- Mahmoud H Teaima
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Adi Al-Nuseirat
- Access to Medicines and Health Technologies Unit, World Health Organization Office for the Eastern Mediterranean Region, Cairo, Egypt.
| | - Dalia Abouhussein
- Pharmaceutics Department, Egyptian Drug Authority (EDA), Cairo, Egypt
| | - Osama A Badary
- Department of Clinical Pharmacy Practice, Faculty of Pharmacy, The British University in Egypt, Cairo, Egypt
| | - Mohamed A El-Nabarawi
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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Next-generation sequencing studies on the E1-HVR1 region of hepatitis C virus (HCV) from non-high-risk HCV patients living in Punjab and Khyber Pakhtunkhwa, Pakistan. Arch Virol 2021; 166:3049-3059. [PMID: 34448937 DOI: 10.1007/s00705-021-05203-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/17/2021] [Indexed: 11/09/2022]
Abstract
The incidence rate of hepatitis C virus (HCV) infection in Pakistan is very high. In this study, we evaluated the genetic heterogeneity of HCV hypervariable region 1 (HVR1) from the HCV-infected Pakistani population and compare the isolated genotypes with representative sequences from internationally diverse geographic regions. We also investigated potential transmission events in non-high-risk HCV patients. Next-generation sequencing (NGS) data from the E1-HVR1 region from 30 HCV patients were used for phylogenetic analysis. Reference sequences were retrieved from the Los Alamos HCV and GenBank databases. NGS data were analyzed to examine HCV HVR1 sequence diversity and identify transmission links among HCV-infected individuals using Global Hepatitis Outbreak and Surveillance Technology (GHOST). Phylogenetic analysis showed the predominance of HCV genotype 3a (86.6%), followed by 1a (6.6%), 1b (3.3%), and 3b (3.3%). NGS of HVR1 displayed significant genetic heterogeneity of HCV populations within each patient. The average nucleotide sequence diversity for HVR1 was 0.055. JR781281 was found to be the most diverse (0.14) of the specimens. Phylogenetic analysis demonstrated that all HCV specimens sequenced in this study were more similar to each other and showed variations from the representative sequences. The GHOST results suggested genetic relatedness between two (6.6%) HCV cases, possibly defining an incipient outbreak in a non-high-risk population. We urge rigorous countrywide investigation of outbreaks to identify transmission clusters and their sources to incorporate preventive measures for disease control.
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Auty SG, Shafer PR, Griffith KN. Medicaid Subscription-Based Payment Models and Implications for Access to Hepatitis C Medications. JAMA HEALTH FORUM 2021; 2:e212291. [PMID: 35977192 PMCID: PMC8796990 DOI: 10.1001/jamahealthforum.2021.2291] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/28/2021] [Indexed: 01/19/2023] Open
Abstract
Question Did the use of direct-acting antiviral hepatitis C virus (HCV) medications change after implementation of subscription-based payment models for these drugs in Washington and Louisiana? Findings In this cross-sectional study, Louisiana experienced a 534.5% increase in HCV prescription fills after implementation of a subscription-based payment model, but no significant change in prescription fills was observed in Washington. Meaning In this study, subscription-based payment models in Louisiana and Washington were differentially associated with use of Medicaid-covered HCV medications, which may reflect state-level differences in implementation, historical restrictions on access to these medications, and responses to the COVID-19 pandemic. Importance Hepatitis C virus (HCV) can be cured with direct-acting antiviral medications, but state Medicaid programs often restrict access to these lifesaving medications owing to their high costs. Subscription-based payment models (SBPMs), wherein states contract with a single manufacturer to supply prescriptions at a reduced price, may offer a solution that increases access. Whether SBPMs are associated with changes in HCV medication use is unknown. Objective To estimate changes in Medicaid-covered HCV prescription fills after Louisiana and Washington implemented SBPMs on July 1, 2019. Design, Setting, and Participants This cross-sectional study examined trends in prescription fills of Medicaid-covered direct-acting antiviral HCV medications in Louisiana and Washington after implementation of SBPMs. A synthetic control approach was used to compare changes in HCV prescription fills between states that did and did not implement SBPMs. The unit of analysis was state-quarter. Outpatient direct-acting antiviral HCV prescription fills from the Medicaid State Drug Utilization Data files were obtained from all 50 US states and the District of Columbia from January 1, 2017, to June 30, 2020. Exposures Implementation of SBPMs for Medicaid-covered direct-acting antiviral HCV medications. Main Outcomes and Measures Direct-acting antiviral HCV prescriptions filled per 100 000 Medicaid enrollees. Results In the year preceding SBPM implementation, the mean (SD) rate of quarterly HCV prescription fills per 100 000 Medicaid enrollees was 43.1 (8.6) prescriptions in Louisiana and 50.1 (4.1) in Washington. After SBPM implementation, the mean (SD) rate of quarterly HCV prescription fills per 100 000 enrollees was 206.0 (51.2) prescriptions in Louisiana and 53.9 (11.0) in Washington. In synthetic control models, SBPM implementation in Louisiana was associated with an increase of 173.5 (95% CI, 74.3-265.3) quarterly prescription fills per 100 000 Medicaid enrollees during the following year, a relative increase of 534.5% (95% CI, 228.7%-1125.0%). Washington did not experience a significant change in prescription fills following SBPM implementation. Conclusions and Relevance In this cross-sectional study, Louisiana experienced substantial increases in HCV medication use among its Medicaid-enrolled population following SBPM implementation, whereas Washington did not. These differences may partially be explained by state-level variation in SBPM implementation, historical restrictions on access to HCV medications, and responses to the COVID-19 pandemic.
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Affiliation(s)
- Samantha G. Auty
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Paul R. Shafer
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Kevin N. Griffith
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
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Bousali M, Papatheodoridis G, Paraskevis D, Karamitros T. Hepatitis B Virus DNA Integration, Chronic Infections and Hepatocellular Carcinoma. Microorganisms 2021; 9:1787. [PMID: 34442866 PMCID: PMC8398950 DOI: 10.3390/microorganisms9081787] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/13/2021] [Accepted: 08/18/2021] [Indexed: 12/16/2022] Open
Abstract
Hepatitis B Virus (HBV) is an Old World virus with a high mutation rate, which puts its origins in Africa alongside the origins of Homo sapiens, and is a member of the Hepadnaviridae family that is characterized by a unique viral replication cycle. It targets human hepatocytes and can lead to chronic HBV infection either after acute infection via horizontal transmission usually during infancy or childhood or via maternal-fetal transmission. HBV has been found in ~85% of HBV-related Hepatocellular Carcinomas (HCC), and it can integrate the whole or part of its genome into the host genomic DNA. The molecular mechanisms involved in the HBV DNA integration is not yet clear; thus, multiple models have been described with respect to either the relaxed-circular DNA (rcDNA) or the double-stranded linear DNA (dslDNA) of HBV. Various genes have been found to be affected by HBV DNA integration, including cell-proliferation-related genes, oncogenes and long non-coding RNA genes (lincRNAs). The present review summarizes the advances in the research of HBV DNA integration, focusing on the evolutionary and molecular side of the integration events along with the arising clinical aspects in the light of WHO's commitment to eliminate HBV and viral hepatitis by 2030.
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Affiliation(s)
- Maria Bousali
- Bioinformatics and Applied Genomics Unit, Department of Microbiology, Hellenic Pasteur Institute, 11521 Athens, Greece;
| | - George Papatheodoridis
- Department of Gastroenterology, “Laiko” General Hospital of Athens, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Dimitrios Paraskevis
- Department of Hygiene Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 15772 Athens, Greece;
| | - Timokratis Karamitros
- Bioinformatics and Applied Genomics Unit, Department of Microbiology, Hellenic Pasteur Institute, 11521 Athens, Greece;
- Laboratory of Medical Microbiology, Department of Microbiology, Hellenic Pasteur Institute, 11521 Athens, Greece
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Torpey K, Ogyiri L, Cuylaerts V, Agyeman S, Agyei-Nkansah A, Buyze J, Commey JO, Lynen L, De Weggheleire A. Hepatitis C Prevalence and Validation of a Clinical Prediction Score for Targeted Screening among People Living with HIV in Ghana. J Int Assoc Provid AIDS Care 2021; 20:23259582211022469. [PMID: 34060369 PMCID: PMC8173997 DOI: 10.1177/23259582211022469] [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] [Indexed: 11/16/2022] Open
Abstract
WHO recommends hepatitis C (HCV) screening for all people living with HIV (PLHIV). Yet, HCV coinfection was shown to be rare in some Sub-Saharan HIV cohorts, and targeted testing was suggested more efficient for such settings. We studied HCV prevalence among Ghanaian PLHIV, and assessed the external validity of a score to guide targeted testing. This score was initially derived from a Cambodian HIV cohort, and uses as predictors: age, household member/partner with liver disease, diabetes, generalized pruritus, AST, platelets, and AST-to-platelet ratio index. We enrolled 4,023 PLHIV, most from Greater Accra and Central regions, 28.4% were male, median age was 47 years, and high-risk behavior was reported to be rare. HCV seroprevalence was 0.57%, and HCV-RNA was detectable in 0.5%. Sequencing revealed genotype 1(b) and 2(q/r) infections. The discriminatory performance of the score was suboptimal in the Ghanaian setting. The area under the curve was 0.69 (95% CI 0.59-0.79). HCV coinfection prevalence was very low in this Ghanaian PLHIV cohort with reported low-risk of onward transmission. To avoid the cost of screening all PLHIV in similar cohorts in resource-constrained settings, further research to develop better tools/scores to guide targeted HCV testing is needed.
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Affiliation(s)
- Kwasi Torpey
- 108322University of Ghana College of Health Sciences, Accra, Ghana
| | - Lily Ogyiri
- 108322University of Ghana College of Health Sciences, Accra, Ghana
| | | | | | - Adwoa Agyei-Nkansah
- 108322University of Ghana College of Health Sciences, Accra, Ghana.,285284Korle Bu Teaching Hospital, Accra, Ghana
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Stawinska-Witoszynska B, Klos J, Moryson W, Wieckowska B. Trends in the Incidence of Acute Hepatitis B in the Polish Population and Their Determinants. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:738. [PMID: 34440944 PMCID: PMC8398288 DOI: 10.3390/medicina57080738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/18/2021] [Accepted: 07/20/2021] [Indexed: 11/28/2022]
Abstract
Introduction: The World Health Assembly adopted the Global Health Strategy and aims to reduce the incidence of Hepatitis from up to 10 million cases per year to 0.9 million cases and to reduce deaths from 1.4 million to 0.5 million per year by 2030. However, given the prevalence of chronic Hepatitis B in many countries and the incidence of new cases of acute Hepatitis B, the task is not easy. This study investigates the trends and determinants of the incidence of acute Hepatitis B in Poland in 2005-2019. Materials and Methods: Data on the incidence of acute hepatitis B (AHBV) were obtained from the National Institute of Public Health. A case definition for AHBV was consistent with the EU definition. The incidence trends were determined by considering the sex, age and place of residence. Due to the exponential dependence model, the computations were based on the logarithm of the incidence rate. This allowed for the transformation to linear form and analysis could be conducted using linear models. Pearson's correlation was used to determine the linear trend of incidence in general and according to sex and place of residence. The values of incidence rates (independent proportions test) and the coefficients illustrating the trends under study were also compared among males and females as well as urban and rural residents. Results: The incidence of AHBV in the Polish population decreased with similar slopes in both sexes. The newly reported cases of AHBV were more frequent in the male population. The incidence of acute Hepatitis B in the urban population was significantly higher than in the rural population. The significant decreasing trends in incidence were observed in all age ranges, with the exception of two age ranges 0-4 and 10-14, where the total incidence during the whole study period was negligible. Conclusion: Despite the significant decrease in the incidence of AHBV in Poland and its position among the European countries with the lowest hepatitis B (HBV) incidence, the alarmingly high proportion of iatrogenic infections requires further improvement in the sanitary condition of health care facilities. It is also necessary to decrease the number of unvaccinated individuals.
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Affiliation(s)
- Barbara Stawinska-Witoszynska
- Department of Epidemiology and Hygiene, Chair of Social Medicine, Poznan University of Medical Sciences, Rokietnicka 4, 60-806 Poznan, Poland;
| | - Jan Klos
- Department of Public Health, Chair of Social Medicine, Poznan University of Medical Sciences, Rokietnicka 4, 60-806 Poznan, Poland;
| | - Waclaw Moryson
- Department of Epidemiology and Hygiene, Chair of Social Medicine, Poznan University of Medical Sciences, Rokietnicka 4, 60-806 Poznan, Poland;
| | - Barbara Wieckowska
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Rokietnicka 4, 60-806 Poznan, Poland;
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Herink MC, Geddes J, Vo K, Zaman A, Hartung DM. Effect of relaxing hepatitis C treatment restrictions on direct-acting antiviral use in a Medicaid program: an interrupted time series analysis. J Manag Care Spec Pharm 2021; 27:856-864. [PMID: 34185560 PMCID: PMC10391280 DOI: 10.18553/jmcp.2021.27.7.856] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND: Although direct-acting antivirals (DAA) have revolutionized the treatment of chronic hepatitis C virus (HCV), many state Medicaid programs have limited coverage because of their expense. In 2015, the Centers for Medicare & Medicaid Services (CMS) notified states about the legality of Medicaid coverage limitations, particularly within managed care programs. OBJECTIVES: To (1) examine how relaxation and alignment of hepatitis C policies within the Oregon Medicaid program affected DAA utilization and (2) describe changes in DAA coverage policies and patient characteristics of treated individuals over time. METHODS: We manually collected DAA Medicaid drug policies in the state of Oregon before and after the CMS notification was released. After categorizing DAA policies into 2 groups based on baseline prior authorization criteria (restrictive and permissive), we evaluated how changes in these DAA policies affected utilization over 3 time periods (pre-CMS period, post-CMS period, and fibrosis policy alignment). Immediate and gradual changes in trend were assessed using an interrupted time series regression model. Finally, we examined patient characteristics and liver disease complications over time as policy restrictions were removed and aligned with one another. RESULTS: From 2014 to 2018, Oregon's coordinated care organizations and fee-for-service drug policies relaxed liver fibrosis and substance abstinence coverage criteria leading to immediate increases in DAA use in 2016 (0.62 prescriptions per 10,000 enrollees per month; 95% CI = 0.17 to 1.08) and 2018 (1.07 prescriptions per 10,000 enrollees per month; 95% CI = 0.63 to 1.51) among more restrictive coordinated care organizations at baseline. This was followed by a decrease in trend after the 2016 and 2018 impact (-0.05; 95% CI = -0.11 to -0.001 and -0.07; 95% CI = -0.13 to -0.02, respectively). Over the 3 periods, there was a decrease in treated individuals with liver-related complications (P < 0.0001) and an increase in those with a substance use diagnosis (P = 0.0013). CONCLUSIONS: Reducing coverage limitations resulted in treatment of patients with fewer liver-related complications and more substance use disorders. Expanding access to treatment did not result in sustained increases in utilization, and additional interventions may be necessary to meet HCV elimination goals. DISCLOSURES: This study was funded in part by AbbVie Pharmaceuticals, which did not have any role in the study design, collection, analysis and interpretation of data, writing the report, or the decision to submit the report for publication. Hartung received support for his work on this study via a grant from AbbVie Pharmaceuticals. The other authors did not receive any financial support for their contributions to this study. The authors have no other financial disclosures to report. This study was presented at the Academy Health Annual Research Meeting in Washington, DC, on June 3, 2019.
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Affiliation(s)
- Megan C Herink
- Oregon State University College of Pharmacy and Oregon Health & Science University, Portland
| | - Jonah Geddes
- Oregon State University College of Pharmacy and Oregon Health & Science University, Portland
| | - Kim Vo
- College of Pharmacy, Marshall B. Ketchum University, Fullerton, CA
| | - Atif Zaman
- School of Medicine, Oregon Health & Science University, Portland
| | - Daniel M Hartung
- Oregon State University College of Pharmacy and Oregon Health & Science University, Portland
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Metsch LR, Feaster DJ, Gooden LK, Masson C, Perlman DC, Jain MK, Matheson T, Nelson CM, Jacobs P, Tross S, Haynes L, Lucas GM, Colasanti JA, Rodriguez A, Drainoni ML, Osorio G, Nijhawan AE, Jacobson JM, Sullivan M, Metzger D, Vergara-Rodriguez P, Lubelchek R, Duan R, Batycki JN, Matthews AG, Munoz F, Jelstrom E, Mandler R, Del Rio C. Care Facilitation Advances Movement Along the Hepatitis C Care Continuum for Persons With Human Immunodeficiency Virus, Hepatitis C, and Substance Use: A Randomized Clinical Trial (CTN-0064). Open Forum Infect Dis 2021; 8:ofab334. [PMID: 34377726 PMCID: PMC8339611 DOI: 10.1093/ofid/ofab334] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/24/2021] [Indexed: 12/13/2022] Open
Abstract
Background Direct-acting antivirals can cure hepatitis C virus (HCV). Persons with HCV/HIV and living with substance use are disadvantaged in benefiting from advances in HCV treatment. Methods In this randomized controlled trial, participants with HCV/HIV were randomized between February 2016 and January 2017 to either care facilitation or control. Twelve-month follow-up assessments were completed in January 2018. Care facilitation group participants received motivation and strengths-based case management addressing retrieval of HCV viral load results, engagement in HCV/HIV care, and medication adherence. Control group participants received referral to HCV evaluation and an offer of assistance in making care appointments. Primary outcome was number of steps achieved along a series of 8 clinical steps (eg, receiving HCV results, initiating treatment, sustained virologic response [SVR]) of the HCV/HIV care continuum over 12 months postrandomization. Results Three hundred eighty-one individuals were screened and 113 randomized. Median age was 51 years; 58.4% of participants were male and 72.6% were Black/African American. Median HIV-1 viral load was 27 209 copies/mL, with 69% having a detectable viral load. Mean number of steps completed was statistically significantly higher in the intervention group vs controls (2.44 vs 1.68 steps; χ 2 [1] = 7.36, P = .0067). Men in the intervention group completed a statistically significantly higher number of steps than controls. Eleven participants achieved SVR with no difference by treatment group. Conclusions The care facilitation intervention increased progress along the HCV/HIV care continuum, as observed for men and not women. Study findings also highlight continued challenges to achieve individual-patient SVR and population-level HCV elimination. Clinical Trials Registration NCT02641158.
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Affiliation(s)
- Lisa R Metsch
- Department of Sociomedical Sciences, Columbia University, New York, New York, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Lauren K Gooden
- Department of Sociomedical Sciences, Columbia University, New York, New York, USA
| | - Carmen Masson
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - David C Perlman
- Division of Infectious Diseases, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mamta K Jain
- Division of Infectious Diseases, University of Texas Southwestern Medical Center and Parkland Health & Hospital System, Dallas, Texas, USA
| | - Tim Matheson
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, California, USA
| | - C Mindy Nelson
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Petra Jacobs
- Center for Clinical Trials Network, National Institute on Drug Abuse, Rockville, Maryland, USA
| | - Susan Tross
- Department of Psychiatry, Columbia University, New York, New York, USA
| | - Louise Haynes
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Gregory M Lucas
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Allan Rodriguez
- Infectious Disease, University of Miami, Miami, Florida, USA
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Georgina Osorio
- Division of Infectious Diseases, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ank E Nijhawan
- Division of Infectious Diseases, University of Texas Southwestern Medical Center and Parkland Health & Hospital System, Dallas, Texas, USA
| | - Jeffrey M Jacobson
- Division of Infectious Diseases and HIV Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Meg Sullivan
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - David Metzger
- HIV/AIDS Prevention Research Division, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pamela Vergara-Rodriguez
- Mental Health and Substance Abuse Division, John H. Stroger, Jr Hospital of Cook County, Chicago, Illinois, USA
| | - Ronald Lubelchek
- Infectious Diseases, John H. Stroger, Jr Hospital of Cook County, Chicago, Illinois, USA
| | - Rui Duan
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Jacob N Batycki
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Abigail G Matthews
- Data Statistical Center, The Emmes Company, LLC, Rockville, Maryland, USA
| | - Felipe Munoz
- Data Statistical Center, The Emmes Company, LLC, Rockville, Maryland, USA
| | - Eve Jelstrom
- Clinical Coordinating Center, The Emmes Company, LLC, Rockville, Maryland, USA
| | - Raul Mandler
- Clinical/Medical Branch, National Institute on Drug Abuse, Rockville, Maryland, USA
| | - Carlos Del Rio
- Division of Infectious Diseases, Emory University, Atlanta, Georgia, USA
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Cheemerla S, Balakrishnan M. Global Epidemiology of Chronic Liver Disease. Clin Liver Dis (Hoboken) 2021; 17:365-370. [PMID: 34136143 PMCID: PMC8177826 DOI: 10.1002/cld.1061] [Citation(s) in RCA: 242] [Impact Index Per Article: 80.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/20/2020] [Accepted: 10/25/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
| | - Maya Balakrishnan
- Department of Internal MedicineBaylor College of MedicineHoustonTX,Section of Gastroenterology & HepatologyBaylor College of MedicineHoustonTX
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Springer SA, Del Rio C. Co-located Opioid Use Disorder and Hepatitis C Virus Treatment Is Not Only Right, But It Is Also the Smart Thing To Do as It Improves Outcomes! Clin Infect Dis 2021; 71:1723-1725. [PMID: 32011653 DOI: 10.1093/cid/ciaa111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/31/2020] [Indexed: 01/26/2023] Open
Affiliation(s)
- Sandra A Springer
- Department of Internal Medicine, Division of Infectious Disease, Yale AIDS Program, Yale School of Medicine, New Haven, Connecticut, USA
| | - Carlos Del Rio
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
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Abbas Z, Abbas M. Challenges in Formulation and Implementation of Hepatitis B Elimination Programs. Cureus 2021; 13:e14657. [PMID: 33907651 PMCID: PMC8065944 DOI: 10.7759/cureus.14657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Nearly 257 million individuals have contracted hepatitis B infection around the world. However, only 10% of them know about their illness. Mother to child transmission, nosocomial spread, and sexual transmission are the major etiological factors. Finding the missing millions is a global issue. Hepatitis B care is more difficult compared to hepatitis C as not all patients require treatment and the selection of patients is not straightforward. To eliminate hepatitis B infection, the program should screen pregnant women and start antiviral therapy from the 28th week of pregnancy if hepatitis B virus (HBV) DNA≥ 200,000 IU/mL or hepatitis B e-antigen (HBeAg) reactive. Prevention of perinatal infection, birth dose and neonatal vaccination, post-vaccination monitoring of high-risk groups, catch-up vaccination, and registration of the carriers should be an integral part of the program. Continuum of care is important when planning the elimination program from addressing the risk factors, testing, and referral for treatment. The program should integrate test and treat hepatitis services with existing local health care services. There is a need to create the right environment, raise awareness, remove stigma, and increase screening of those at risk and manage those who require treatment. A national policy should be prepared for capacity building, fund allocation, and implementation strategies. Micro-elimination strategies should boost national elimination effects. Guidelines to diagnose and treat patients with hepatitis B should be simplified. Surveillance should be done to monitor progress, and determine the impact of the elimination program on incidence and mortality, and services.
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Affiliation(s)
- Zaigham Abbas
- Gastroenterology and Hepatology, Dr. Ziauddin University Hospital, Karachi, PAK
| | - Minaam Abbas
- Medicine, School of Clinical Medicine, University of Cambridge, Cambridge, GBR
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