1
|
Adane T, Getawa S. The prevalence and associated factors of hepatitis B and C virus in hemodialysis patients in Africa: A systematic review and meta-analysis. PLoS One 2021; 16:e0251570. [PMID: 34157037 PMCID: PMC8219139 DOI: 10.1371/journal.pone.0251570] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/28/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Due to its invasive procedure patients on hemodialysis (HD) are at high risk of infections. Infections acquired in dialysis units can prolong hospitalization date and/or prolong illness in patients, and increase treatment cost. There are no adequate data on the prevalence of Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections in HD patients. Therefore, this study aimed to estimate the pooled prevalence and associated factors of HBV and HCV infections among HD patients in Africa. METHOD The databases PubMed, Medline, EMBASE, Cochrane library, web of science, African Journals Online, Science Direct, and Google Scholar were searched to identify relevant studies. The review was performed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were extracted independently by two authors and analyzed using STATA 11. A random-effect model was fitted to estimate the pooled prevalence with their 95% confidence interval. To detect publication bias funnel plots analysis and Egger weighted regression tests were done. RESULTS The overall pooled prevalence of HBV and HCV infection among HD patients in Africa was 9.88% (95% CI: 7.20-12.56) I2 = 97.9% and 23.04% (95% CI: 18.51-2757) I2 = 99.6%, respectively. In addition, the pooled prevalence of HBV and HCV co-infection was 7.18% (95% CI: 3.15-11.20) I2 = 99.6%. Duration of dialysis was found to be the contributing factor for the occurrence of HBV and HCV among HD patients (OR = 1.44; 95% CI: 1.04, 2.01). CONCLUSION This study showed that there is high prevalence of HBV and HCV infections in HD patients in Africa. Therefore, strict adherence to precautions of infection control measures, isolation of seropositive patients, improvement in infrastructures, adequate screening of HBV and HCV for the donated blood, and decentralized HD services is needed to minimize the risk of HBV and HCV infections in HD facilities.
Collapse
Affiliation(s)
- Tiruneh Adane
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Solomon Getawa
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
2
|
HCV eradication in chronic kidney disease: ready for prime time? Lancet Gastroenterol Hepatol 2020; 5:880-882. [PMID: 32531258 DOI: 10.1016/s2468-1253(20)30015-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 11/20/2022]
|
3
|
Seo HY, Seo MS, Yoon SY, Choi JW, Ko SY. Full-dose sofosbuvir plus low-dose ribavirin for hepatitis C virus genotype 2-infected patients on hemodialysis. Korean J Intern Med 2020; 35:559-565. [PMID: 31064176 PMCID: PMC7214360 DOI: 10.3904/kjim.2018.338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 10/08/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND/AIMS New direct-acting antivirals have shown surprising success in the treatment of hepatitis C, not only in the general population, but also in difficult-to-treat cohorts. However, there is still limited data regarding direct-acting antivirals, including sofosbuvir (SOF), in the context of hemodialysis. The aim of this study was to investigate the safety and outcome of administering full-dose SOF (400 mg/day) plus low-dose ribavirin (RBV, 100 to 200 mg/day) in hemodialysis patients with hepatitis C virus (HCV) genotype 2 (GT2) infection. METHODS Patients with chronic HCV GT2 infection and end-stage renal disease on maintenance hemodialysis treated with full-dose SOF plus low-dose RBV were retrospectively identified from a database of patients with HCV GT2 who were treated in Konkuk University Chungju Hospital between February 2017 and February 2018. Medical records were reviewed for demographics, medical history, laboratory data, and radiologic and electrocardiographic findings. RESULTS All nine patients completed a full course of 12 weeks of treatment with a full-dose SOF plus low-dose RBV regimen. Two had compensated cirrhosis. Seven patients were treatment-naïve, and two had a relapse following previous interferon-based therapy. All patients had a sustained viral response at 12 weeks post-treatment. There was no discontinuation of treatment because of side effects. CONCLUSION In hemodialysis patients with HCV GT2 infection, the full-dose SOF plus low-dose RBV regimen appears to be safe and well tolerated, and yields high rates of sustained virologic response.
Collapse
Affiliation(s)
- Hee Yeon Seo
- Department of Internal Medicine, Konkuk University School of Medicine, Chungju, Korea
| | - Myeong-Sook Seo
- Department of Internal Medicine, Konkuk University School of Medicine, Chungju, Korea
| | - Sun-Young Yoon
- Department of Internal Medicine, Konkuk University School of Medicine, Chungju, Korea
| | - Jong Wook Choi
- Department of Internal Medicine, Konkuk University School of Medicine, Chungju, Korea
| | - Soon Young Ko
- Department of Internal Medicine, Konkuk University School of Medicine, Chungju, Korea
- Correspondence to Soon Young Ko, M.D. Department of Internal Medicine, Konkuk University School of Medicine, 268 Chungwon-daero, Chungju 27478, Korea Tel: +82-43-840-8207 Fax: +82-43-840-8973 E-mail:
| |
Collapse
|
4
|
Kansay S, Sekhon J, Rana S. Seroprevalence of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus among hemodialysis patients in a Tertiary Care Teaching Hospital in a developing country. Indian J Sex Transm Dis AIDS 2019; 40:120-125. [PMID: 31922101 PMCID: PMC6896388 DOI: 10.4103/ijstd.ijstd_53_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) prevalence in hemodialysis patients varies geographically, both within and between countries. High prevalence of these infections in dialysis patients reflects the increased presence of common risk factors for their acquisition, including transfusion, transplantation, history of drug abuse, plus susceptibility to nosocomial transmission during dialysis. OBJECTIVE The aim of this study is to investigate the seroprevalence and clinical profile of HIV, HBV, and HCV patient's on hemodialysis. MATERIALS AND METHODS Clinical and epidemiological data of patients undergoing maintenance hemodialysis in the dialysis unit of a teaching institution were obtained and analyzed over a 5 years' period. RESULTS A total of 127 males and 69 females were studied. Their mean age was 50.45 years. Out of the total 196 dialysis-dependent patients, 2 (1.02%) were seropositive for HIV antibodies, 6 (3.06%) were hepatitis B surface antigen positive, and 30 (15.30%) were anti-HCV antibody positive. There was no coexistence of HIV, HBV, and HCV markers. The major primary renal diseases in hemodialysis patients included diabetes mellitus (42%), hypertension (22%), chronic nephritis (15%), urologic diseases (6%), cystic renal diseases (4%), and others (11%). CONCLUSION Prevalence of transfusion-transmissible viral infections was higher among hemodialysis patients, especially HCV infection which was an alarming situation and therefore strict adherence to infection control strategies, barrier precautions, and preventive measures, including routine hepatitis B vaccination and regular virological follow-up were recommended along with regular education and training programs of technical and nursing personnel's involved with dialysis patients.
Collapse
Affiliation(s)
- Sonam Kansay
- Department of Transfusion Medicine, Gian Sagar Medical College and Hospital, Patiala, Punjab, India
| | - Jannat Sekhon
- Department of General Medicine, Gian Sagar Medical College and Hospital, Patiala, Punjab, India
| | - Saifi Rana
- Department of General Medicine, Gian Sagar Medical College and Hospital, Patiala, Punjab, India
| |
Collapse
|
5
|
Armando C, Evangelista S, Massimiliano C, Silvia A, Gaia P, Paola I, Maria C, Gianluca M, Nicola C, Concetta Anna D, Massimo C, Caterina S. Eradication of HCV Infection with the Direct-Acting Antiviral Therapy in Renal Allograft Recipients. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4674560. [PMID: 31179323 PMCID: PMC6507153 DOI: 10.1155/2019/4674560] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 01/14/2019] [Accepted: 03/26/2019] [Indexed: 02/07/2023]
Abstract
Hepatitis C virus (HCV) infection unfavorably affects the survival of both renal patients undergoing hemodialysis and renal transplant recipients. In this subset of patients, the effectiveness and safety of different combinations of interferon-free direct-acting antiviral agents (DAAs) have been analyzed in several small studies. Despite fragmentary, the available data demonstrate that DAA treatment is safe and effective in eradicating HCV infection, with a sustained virologic response (SVR) rates nearly 95% and without an increased risk of allograft rejection. This review article analyzes the results of most published studies on this topic to favor more in-depth knowledge of the readers on the subject. We suggest, however, perseverating in this update as the optimal DAA regimen may not be proposed yet, because of the expected arrival of newer DAAs and of the lack of data from large multicenter randomized controlled trials.
Collapse
Affiliation(s)
- Calogero Armando
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Sagnelli Evangelista
- Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Creta Massimiliano
- Department of Neurosciences, Human Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Angeletti Silvia
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Peluso Gaia
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Incollingo Paola
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Candida Maria
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Minieri Gianluca
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Carlomagno Nicola
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Dodaro Concetta Anna
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Ciccozzi Massimo
- Unit of Medical Statistic and Molecular Epidemiology, University Campus Bio-Medico, Rome, Italy
| | - Sagnelli Caterina
- Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| |
Collapse
|
6
|
Eisenberger U, Friebus-Kardash J, Guberina H, Kribben A, Witzke O, Willuweit K, Gerken G, Herzer K. Treatment With Grazoprevir/Elbasvir for Renal Transplant Recipients With Chronic Hepatitis C Virus Infection and Impaired Allograft Function. Transplant Direct 2019; 5:e419. [PMID: 30656217 PMCID: PMC6324915 DOI: 10.1097/txd.0000000000000860] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/26/2018] [Accepted: 11/14/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Direct-acing antiviral agents are highly efficient treatment options for chronic hepatitis C virus (HCV) infection after renal allograft transplantation. Treatment options for patients with impaired graft function remain limited. Therefore, we assessed the effectiveness and safety of grazoprevir/elbasvir therapy for patients with chronic HCV infection and impaired renal allograft function. METHODS Eleven renal allograft recipients with therapy-naïve HCV genotype (GT) 1a, 1b, or 4 were treated with the fixed-dose combination of elbasvir/grazoprevir without ribavirin for 12 weeks. All recipients exhibited impaired graft function with an average glomerular filtration rate lower than 30 mL/min per 1.73 m2. Clinical data were retrospectively reviewed for renal and liver function parameters. Patients were closely monitored for trough levels of immunosuppressive agents, viral load, laboratory values, and potential adverse effects. RESULTS Seven (64%) patients exhibited a rapid virologic response within 4 weeks (HCV GT1a, n = 2; HCV GT1b, n = 5). The other 4 patients exhibited a virologic response within 8 weeks (HCV GT1b, n = 3; HCV GT 4, n = 1). All patients exhibited a sustained virologic response at week 12 after the end of treatment. Clinical measures of liver function improved substantially for all patients. Few adverse effects were reported. Impaired renal allograft function and proteinuria remained stable. For most patients, only moderate adjustments to the tacrolimus dosage were necessary for maintaining sufficient trough levels. CONCLUSIONS This treatment appears to be safe and effective for renal transplant recipients with impaired allograft function and is a promising treatment option for eradicating HCV infection in this patient population.
Collapse
Affiliation(s)
- Ute Eisenberger
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Justa Friebus-Kardash
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Hana Guberina
- Department of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Katharina Willuweit
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Guido Gerken
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Kerstin Herzer
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
| |
Collapse
|
7
|
Bruchfeld A, Lindahl K. Direct acting anti-viral medications for hepatitis C: Clinical trials in patients with advanced chronic kidney disease. Semin Dial 2018; 32:135-140. [PMID: 30475421 DOI: 10.1111/sdi.12762] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Hepatitis C is a global health concern, with important implications in chronic kidney disease (CKD) due to its increased prevalence in this population. Patients with advanced CKD have until recently been excluded from the pivotal direct acting anti-viral (DAA) trials, which have demonstrated high virological cure numbers. Sofosbuvir-free DAAs dasabuvir, ombitasvir/paritaprevir/ritonavir with or without ribavirin, and elbasvir/grazoprevir are well-tolerated in patients with genotype 1 and 4 CHC with CKD 4 or 5 (including HD), with virologic cure rates of above 90%, in both single-arm and placebo-controlled studies. More recently a pangenotypic approach using glecaprevir and pibrentasvir has also been shown to be highly effective in CKD 4-5. With increasingly successful treatment options with minimal side-effects most hepatitis C virus (HCV)-infected patients with CKD and ESRD can be cured. Outstanding issues to be considered is how to raise the awareness of the availability of safe DAAs and excellent outcomes in CKD, and moreover to define optimal timing of treatment and address the question of HCV eradication in all stages of CKD including the dialysis population.
Collapse
Affiliation(s)
- Annette Bruchfeld
- Department of Renal Medicine, CLINTEC, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
| | - Karin Lindahl
- Department of Medicine, Division of Infectious Diseases, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
8
|
Morikawa K, Nakamura A, Shimazaki T, Sakamoto N. Safety and efficacy of elbasvir/grazoprevir for the treatment of chronic hepatitis C: current evidence. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:2749-2756. [PMID: 30233138 PMCID: PMC6132225 DOI: 10.2147/dddt.s133697] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Treatments for hepatitis C virus (HCV) have advanced greatly, becoming more efficacious with fewer adverse events, due to the availability of direct-acting antiviral agents, which target specific steps in the HCV life cycle. Recently, a combination regimen consisting of the HCV nonstructural protein 5A inhibitor elbasvir (EBR) and the HCV NS3/4A protease inhibitor grazoprevir (GZR) was approved for the treatment of patients with chronic HCV and genotypes (Gts) 1 and 4 in various countries. In Phase III trials, the combination of EBR/GZR (fixed-dose combination table or single agent) for 12 or 16 weeks of treatment with or without ribavirin resulted in a high sustained virological response at 12 weeks in treatment-naïve and treatment-experienced patients with HCV Gt 1a, 1b, 4, or 6, including special populations, such as individuals with advanced chronic kidney disease, HCV-HIV coinfection, and compensated cirrhosis. In this review, we focus on the mode of action, pharmacokinetics, clinical applications, efficacy, and safety profile of EBR/GZR, including special populations who have been considered refractory from the extensive evidence of clinical trials.
Collapse
Affiliation(s)
- Kenichi Morikawa
- Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan,
| | - Akihisa Nakamura
- Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan,
| | - Tomoe Shimazaki
- Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan,
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan,
| |
Collapse
|
9
|
Wigneswaran J, Van Wyck D, Pegues D, Gholam P, Nissenson AR. Hepatitis C virus infection in patients with end-stage renal disease. Hemodial Int 2018; 22:297-307. [DOI: 10.1111/hdi.12672] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 03/27/2018] [Indexed: 12/22/2022]
Affiliation(s)
| | | | - David Pegues
- Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - Pierre Gholam
- Liver Center of Excellence; University Hospitals of Cleveland; Cleveland Ohio USA
| | - Allen R. Nissenson
- DaVita, Inc.; Denver Colorado USA
- David Geffen School of Medicine; University of California; Los Angeles California USA
| |
Collapse
|
10
|
Higher risk of renal disease in chronic hepatitis C patients: Antiviral therapy survival benefit in patients on hemodialysis. J Hepatol 2018; 68:904-911. [PMID: 29233630 DOI: 10.1016/j.jhep.2017.12.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 11/08/2017] [Accepted: 12/01/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND & AIMS Several studies have shown that chronic hepatitis C (CHC) infection has a negative impact on kidney function, as well as survival, in patients with chronic kidney disease (CKD) or on hemodialysis. The aim of this nationwide registry study was to describe renal disease in Swedish patients with CHC. METHODS In the present study, patients were identified for CHC (B18.2) and CKD (N18) according to the International Classification of Diseases (ICD)-10 in the nationwide Swedish inpatient care day surgery (1997-2013) and non-primary outpatient care (2001-2013) patient registries. Hemodialysis was defined using the procedure code in the non-primary outpatient care. For each patient, up to five non-CHC diagnosed age/sex/place of residency-matched comparators were drawn from the general population at the time of diagnosis. Follow-up started at the date of CHC diagnosis and patients accrued person-time until, whichever came first, death, emigration or December 31st, 2013. RESULTS Between 2001 and 2013, 42,522 patients received a CHC diagnosis. Of these patients, 2.5% (1,077/45,222) were diagnosed with CKD during 280,123 person-years, compared with 0.7% (1,454/202,694) in the matched general population comparators (1,504,765 person-years), resulting in a standardized incidence ratio (SIR) of 4.0. There was a 3.3-7.0-fold risk of patients with CHC requiring hemodialysis. Overall, 17% of patients with CHC receiving hemodialysis were treated for CHC; 24% in the treated cohort died compared with 56% of the untreated cohort (p <0.0001), with antiviral treatment improving survival with an odds ratio of 3.901 (p = 0.001). CONCLUSIONS The results from this nationwide registry study showed that patients with CHC are at a higher risk of developing CKD. Furthermore, hepatitis C treatment seemed to improve survival for patients with CHC on hemodialysis compared with untreated patients. LAY SUMMARY Hepatitis C is an infectious disease that mainly infects the liver, but has also been shown to have negative effects on other organs. This nationwide study demonstrates an increased risk of hepatitis C patients developing reduced kidney function and the need for dialysis. The study also showed improved survival in dialysis patients who received antiviral treatment.
Collapse
|
11
|
Al-Rabadi L, Box T, Singhania G, Al-Marji C, Agarwal A, Hall I, Gordon CE, Tran H. Rationale for treatment of hepatitis C virus infection in end-stage renal disease patients who are not kidney transplant candidates. Hemodial Int 2018; 22 Suppl 1:S45-S52. [DOI: 10.1111/hdi.12656] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Laith Al-Rabadi
- Renal Section, Department of Medicine; University of Utah Hospital; Salt Lake City Utah USA
| | - Terry Box
- Gastroenterology Section, Department of Medicine; University of Utah Hospital; Salt Lake City Utah USA
| | - Girish Singhania
- Renal Section, Department of Medicine; University of Utah Hospital; Salt Lake City Utah USA
| | - Catreena Al-Marji
- Renal Section, Department of Medicine; University of Utah Hospital; Salt Lake City Utah USA
| | - Adhish Agarwal
- Renal Section, Department of Medicine; University of Utah Hospital; Salt Lake City Utah USA
| | - Isaac Hall
- Renal Section, Department of Medicine; University of Utah Hospital; Salt Lake City Utah USA
| | - Craig E. Gordon
- Renal Section, Department of Medicine; Boston Medical Center; Boston Massachusetts USA
| | - Huy Tran
- Gastroenterology Section, Department of Medicine; University of Iowa Hospital and Clinics; Iowa City Iowa USA
| |
Collapse
|
12
|
Uojima H, Kobayashi S, Hidaka H, Matsumoto S, Ohtake T, Kinbara T, Oka M, Yamanouchi Y, Kunieda T, Yamanoue H, Kanemaru T, Tsutsumi K, Fujikawa T, Sung JH, Kako M. Virological response to daclatasvir and asunaprevir combination therapy for chronic hepatitis C virus genotype 1b infection in dialysis patients: a prospective, multicenter study. RENAL REPLACEMENT THERAPY 2017. [DOI: 10.1186/s41100-016-0091-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
13
|
Alves da Silva R, de Souza Todão J, Kamitani FL, Silva AEB, de Carvalho-Filho RJ, Ferraz MLCG, de Carvalho IMVG. Molecular characterization of hepatitis C virus in end-stage renal disease patients under hemodialysis. J Med Virol 2017; 90:537-544. [PMID: 29064576 DOI: 10.1002/jmv.24976] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 10/12/2017] [Indexed: 12/09/2022]
Abstract
New direct-acting antiviral (DAA) agents are in development or already approved for the treatment of chronic hepatitis C virus (HCV) infection. The effectiveness of these drugs is related to the previous existence of resistant variants. Certain clinical conditions can allow changes in immunological characteristics of the host and even modify genetic features of viral populations. The aim of this study was to perform HCV molecular characterization from samples of end-stage renal disease patients on hemodialysis (ESRD-HD). Nested PCR and Sanger sequencing were used to obtain genetic information from the NS5B partial region of a cohort composed by 86 treatment-naïve patients. Genomic sequences from the Los Alamos databank were employed for comparative analysis. Bioinformatics methodologies such as phylogenetic reconstructions, informational entropy, and mutation analysis were used to analyze datasets separated by geographical location, HCV genotype, and renal function status. ESRD-HD patients presented HCV genotypes 1a (n = 18), 1b (n = 16), 2a (n = 2), 2b (n = 2), and 3a (n = 4). Control subjects were infected with genotypes 1a (n = 11), 1b (n = 21), 2b (n = 4), and 3a (n = 8). Dataset phylogenetic reconstruction separated HCV subtype 1a into two distinct clades. The entropy analysis from the ESRD-HD group revealed two amino acid positions related to an epitope for cytotoxic T lymphocytes and T helper cells. Genotype 1a was found to be more diverse than subtype 1b. Also, genotype 1a ERSD-HD patients had a higher mean of amino acids changes in comparison to control group patients. The identification of specific mutations on epitopes and high genetic diversity within the NS5B HCV partial protein in hemodialysis patients can relate to host immunological features and geographical distribution patterns. This genetic diversity can affect directly the new DAA's resistance mechanisms.
Collapse
Affiliation(s)
- Rafael Alves da Silva
- Laboratório de Hepatologia Molecular Aplicada (LHeMA), Departamento de Gastroenterologia, Unidade de Hepatologia, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil.,Instituto Butantan, Laboratório de Parasitologia, São Paulo, Brazil
| | - Jardelina de Souza Todão
- Laboratório de Hepatologia Molecular Aplicada (LHeMA), Departamento de Gastroenterologia, Unidade de Hepatologia, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil
| | | | - Antonio Eduardo Benedito Silva
- Laboratório de Hepatologia Molecular Aplicada (LHeMA), Departamento de Gastroenterologia, Unidade de Hepatologia, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil.,Departamento de Gastroenterologia, Unidade de Hepatologia, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil
| | - Roberto José de Carvalho-Filho
- Laboratório de Hepatologia Molecular Aplicada (LHeMA), Departamento de Gastroenterologia, Unidade de Hepatologia, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil.,Departamento de Gastroenterologia, Unidade de Hepatologia, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil
| | - Maria Lucia Cardoso Gomes Ferraz
- Laboratório de Hepatologia Molecular Aplicada (LHeMA), Departamento de Gastroenterologia, Unidade de Hepatologia, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil.,Departamento de Gastroenterologia, Unidade de Hepatologia, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil
| | - Isabel Maria Vicente Guedes de Carvalho
- Laboratório de Hepatologia Molecular Aplicada (LHeMA), Departamento de Gastroenterologia, Unidade de Hepatologia, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil.,Instituto Butantan, Laboratório de Parasitologia, São Paulo, Brazil
| |
Collapse
|
14
|
Eisenberger U, Guberina H, Willuweit K, Bienholz A, Kribben A, Gerken G, Witzke O, Herzer K. Successful Treatment of Chronic Hepatitis C Virus Infection With Sofosbuvir and Ledipasvir in Renal Transplant Recipients. Transplantation 2017; 101:980-986. [PMID: 27495770 DOI: 10.1097/tp.0000000000001414] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Treatment of chronic hepatitis C virus (HCV) infection after renal allograft transplantation has been an obstacle because of contraindications associated with IFN-based therapies. Direct-acting antiviral agents are highly efficient treatment options that do not require IFN and may not require ribavirin. Therefore, we assessed the efficacy and safety of sofosbuvir and ledipasvir in renal transplant patients with chronic HCV infection. METHODS Fifteen renal allograft recipients with therapy-naive HCV genotype (GT) 1a, 1b, or 4 were treated with the combination of sofosbuvir and ledipasvir without ribavirin for 8 or 12 weeks. Clinical data were retrospectively analyzed for viral kinetics and for renal and liver function parameters. Patients were closely monitored for trough levels of immunosuppressive agents, laboratory values, and potential adverse effects. RESULTS Ten patients (66%) exhibited a rapid virologic response within 4 weeks (HCV GT1a, n = 4; HCV GT1b, n = 6). The other 5 patients exhibited a virologic response within 8 (HCV GT 1b, n = 4) or 12 weeks (HCV GT4, n = 1). One hundred percent of patients exhibited sustained virologic response at week 12 after the end of treatment. Clinical measures of liver function improved substantially for all patients. Adverse events were scarce; renal transplant function and proteinuria remained stable. Importantly, dose adjustments for tacrolimus were necessary for maintaining sufficient trough levels. CONCLUSIONS The described regimen appears to be safe and effective for patients after renal transplant and is a promising treatment regimen for eradicating HCV in this patient population.
Collapse
Affiliation(s)
- Ute Eisenberger
- 1 Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Germany. 2 Department of Gastroenterology and Hepatology, University Hospital Essen, University Duisburg-Essen, Germany. 3 Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Germany. 4 Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University Duisburg-Essen, Germany
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Luma HN, Halle MP, Eloumou SAFB, Azingala F, Kamdem F, Donfack-Sontsa O, Ashuntantang G. Seroprevalence of human immunodeficiency virus, hepatitis B and C viruses among haemodialysis patients in two newly opened centres in Cameroon. Pan Afr Med J 2017; 27:235. [PMID: 28979637 PMCID: PMC5622837 DOI: 10.11604/pamj.2017.27.235.13121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 07/16/2017] [Indexed: 12/16/2022] Open
Abstract
Introduction Haemodialysis (HD) patients are potentially susceptible to infection with blood borne viral agents especially; Human Immunodeficiency Virus (HIV), hepatitis B (HBV) and hepatitis C Viruses (HCV), compared to the general population. We described their epidemiology in two newly created haemodialysis units in Cameroon: the Buea and Bamenda haemodialysis centres. Methods A cross sectional study: included were patients who had spent at least three months in haemodialysis. HBV, HCV and HIV serologies were determined and patients' characteristics extracted from patient's records. Results We included 104 participants (44 in Buea and 60 in Bamenda). Mean age was 48 years and 65.4% were men. Median duration in dialysis was 14 months. One of the three viral markers was present in 40.1% of patients. The hepatitis B surface antigen, anti-HCV and anti-HIV antibody prevalence were respectively 10.6%, 19.2%, 13.5%. A history of sexually transmitted infection was the only variable associated with anti-HIV antibody positivity Conclusion The sero-prevalence of HBsAg, HCV and HIV are high in the two centres. HIV prevalence may have reflected its etiology as a cause of ESKD. HCV remains a cause for concern and needs further evaluation. There is urgent need for the implementation of preventive and control measures.
Collapse
Affiliation(s)
- Henry Namme Luma
- Internal Medicine Service, Douala General Hospital, Douala, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon
| | - Marie Patrice Halle
- Internal Medicine Service, Douala General Hospital, Douala, Cameroon.,Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Servais Albert Fiacre Bagnaka Eloumou
- Internal Medicine Service, Douala General Hospital, Douala, Cameroon.,Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | | | - Felicite Kamdem
- Internal Medicine Service, Douala General Hospital, Douala, Cameroon.,Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | | | - Gloria Ashuntantang
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon
| |
Collapse
|
16
|
Duong MC, McLaws ML. Dangerous practices in a hemodialysis unit in Vietnam identify from mixed methods. BMC Infect Dis 2017; 17:181. [PMID: 28249573 PMCID: PMC5333403 DOI: 10.1186/s12879-017-2290-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 02/24/2017] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Non-compliance with infection control practices poses a serious risk to patients receiving chronic hemodialysis. We aimed to identify the type and frequency of non-compliance with infection control practices in a hemodialysis unit in Vietnam where a large outbreak of hepatitis C infection had occurred. METHODS Mixed methods approach included observations and discussions of non-compliance with all 12 nurses at the Hemodialysis Unit, District-6 Hospital in Ho Chi Minh City. Observations of nursing care activities were made between September 2013 and January 2014. Compliance with hand hygiene and glove use during nursing care activities were classified according to the potential for a serious risk of transmission of infection and reported as percentages. Each nurse was expected to provide 11 nursing care activities to three patients assigned per hemodialysis sessions. Activities were to be given on an individual patient-centered care basis, that is, one patient was to receive all 11 activities by their assigned nurse. On completion of the observations all nurses were enrolled in a focus group where observed non-compliance was discussed and transcripts were examined for themes. RESULTS Hand hygiene compliance rate was low (27%, 95%CI 25%-28%, 1633/6140) regardless of classification of seriousness of risk from this breach. Although glove use (76%, 95%CI 74-78%, 1211/1586) and other personal protective equipment use (81%, 95%CI 78%-83%, 773/959) were high gloves were observed to be reused with multiple patients during a single nursing care activity provided to consecutive patients. Nurses explained the breakdown of providing nursing care activities on an individual patient-centered basis was a response to limited supply of gloves and hand hygiene facilities and was exacerbated by nursing being co-opted by overly demanding patients to provide services without delay. CONCLUSIONS The adaption by the nurses to provide 11 single care activities to multiple consecutive patients in the absence of changing gloves and low hand hygiene compliance was potentially the central risk factor that facilitated the hepatitis C outbreak. Patient-centered care needs to be enforced to minimize multiple nurse-patient contacts that are associated with non-compliance classified as serious risk of infection transmission. Nurse empowerment to resist unreasonable patient demands may also be pivotal to assisting their compliance with hand hygiene and single patient-centered care. An audit program to measure infection control resources and practices may facilitate enforcement of the guidelines.
Collapse
Affiliation(s)
- Minh Cuong Duong
- School of Public Health and Community Medicine, UNSW Medicine, UNSW Australia, Level 3 Samuels Building, Sydney, NSW 2052 Australia
| | - Mary-Louise McLaws
- School of Public Health and Community Medicine, UNSW Medicine, UNSW Australia, Level 3 Samuels Building, Sydney, NSW 2052 Australia
| |
Collapse
|
17
|
Zaki MSE. The effect of Hepatitis C Virus infection on cardiovascular complications in end stage kidney disease patients on regular hemodialysis. Electron Physician 2017; 9:3857-3861. [PMID: 28465818 PMCID: PMC5410917 DOI: 10.19082/3857] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 01/26/2017] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Cardiovascular complications are the most important cause of mortality in patients with ESKD, such as coronary artery disease, left ventricular hypertrophy, heart failure and arrhythmia. Other well-known risk factors, such as diabetes mellitus, hypertension and dyslipidemia are prevalent in ESKD, yet they are not sufficient enough to explain the high prevalence of cardiovascular mortality, hence searching for other hidden risk factors to explain this high prevalence is of an utmost importance. The aim of this study was to identify the exact mechanisms connecting HCV infection, chronic liver disease, and atherogenesis. METHODS This case control study was done on 80 patients with chronic renal failure undergoing haemodialysis at Sheikh Zayed Specialized Hospital in Giza, Egypt in 2016. The participants were divided into four groups: a control group with HCV negative by PCR (20 patients), and three HCV Positive groups according to viral load by PCR: low, moderate and high viremia. Inclusion criteria were normal serum calcium (8.5-10.5 mg/dL), phosphorus ≤5mg/dL, PTH≤250 pg/ml, Hb 10-12 g/dL, and duration of dialysis less than two years. Data were analyzed using Chi square, t-test, Mann-Whitney U test, ANOVA, and Spearman rank correlation coefficient. RESULTS The study showed significant increase in LVM index in hemodialysis patients with high and moderate viremia compared to low viremia (p<0.001) and to control group (p<0.001). Also, significant increase in end diastolic diameter in high and moderate viremia (p<0.001), significant difference in end systolic diameter in the high viremia group (p<0.001), significant increase in the interventricular septal thickness (p<0.002) and posterior wall thickness (p<0.002) among moderate viremia were determined. CONCLUSION HCV has a significant effect on the development of cardiovascular diseases in the general population, and in renal disease patients on the structural level.
Collapse
Affiliation(s)
- Mohamed Salah Eldin Zaki
- MD, Assistant Professor, Nephrology Department, National Institute of Urology and Nephrology, Cairo, Egypt
| |
Collapse
|
18
|
Carrier P, Essig M, Debette-Gratien M, Sautereau D, Rousseau A, Marquet P, Jacques J, Loustaud-Ratti V. Anti-hepatitis C virus drugs and kidney. World J Hepatol 2016; 8:1343-1353. [PMID: 27917261 PMCID: PMC5114471 DOI: 10.4254/wjh.v8.i32.1343] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 07/08/2016] [Accepted: 09/18/2016] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) mainly targets the liver but can also induce extrahepatic manifestations. The kidney may be impacted via an immune mediated mechanism or a cytopathic effect. HCV patients are clearly at a greater risk of chronic kidney disease (CKD) than uninfected patients are, and the presence of CKD increases mortality. Interferon-based therapies and ribavirin are difficult to manage and are poorly effective in end-stage renal disease and hemodialysis. These patients should be given priority treatment with new direct anti-viral agents (DAAs) while avoiding peginterferon and ribavirin. The first results were convincing. To aid in the correct use of these drugs in patients with renal insufficiency, their pharmacokinetic properties and potential renal toxicity must be known. The renal toxicity of these new drugs was not a safety signal in clinical trials, and the drugs are generally efficient in these frail populations. These drugs are usually well tolerated, but recent cohort studies have demonstrated that these new regimens may be associated with renal side effects, especially when using sofosbuvir combinations. HCV, renal diseases and comorbidities are intimately linked. The close monitoring of renal function is required, particularly for at-risk patients (transplanted, HIV-coinfected, CKD, hypertensive or diabetic patients). New DAA regimens, which will soon be approved, will probably change the landscape.
Collapse
|
19
|
Vilibic-Cavlek T, Kucinar J, Kaic B, Vilibic M, Pandak N, Barbic L, Stevanovic V, Vranes J. Epidemiology of hepatitis C in Croatia in the European context. World J Gastroenterol 2015; 21:9476-93. [PMID: 26327756 PMCID: PMC4548109 DOI: 10.3748/wjg.v21.i32.9476] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/03/2015] [Accepted: 07/18/2015] [Indexed: 02/06/2023] Open
Abstract
We analyzed prevalence, risk factors and hepatitis C virus (HCV) genotype distribution in different population groups in Croatia in the context of HCV epidemiology in Europe, with the aim to gather all existing information on HCV infection in Croatia which will be used to advise upon preventive measures. It is estimated that 35000-45000 of the Croatian population is chronically infected with HCV. Like in other European countries, there have been changes in the HCV epidemiology in Croatia over the past few decades. In some risk groups (polytransfused and hemodialysis patients), a significant decrease in the HCV prevalence was observed after the introduction of routine HCV screening of blood/blood products in 1992. Injecting drug users (IDUs) still represent a group with the highest risk for HCV infection with prevalence ranging from 29% to 65%. Compared to the prevalence in the Croatian general population (0.9%), higher prevalence rates were found in prison populations (8.3%-44%), human immunodeficiency virus-infected patients (15%), persons with high-risk sexual behavior (4.6%) and alcohol abusers (2.4%). Low/very low prevalence was reported in children and adolescents (0.3%) as well as in blood donors (0%-0.009%). In addition, distribution of HCV genotypes has changed due to different routes of transmission. In the general population, genotypes 1 and 3 are most widely distributed (60.4%-79.8% and 12.9%-47.9%, respectively). The similar genotype distribution is found in groups with high-risk sexual behavior. Genotype 3 is predominant in Croatian IDUs (60.5%-83.9%) while in the prison population genotypes 3 and 1 are equally distributed (52.4% and 47.6%). Data on HCV prevalence and risk factors for transmission are useful for implementation of preventive measures and HCV screening.
Collapse
|
20
|
Duong CM, Olszyna DP, McLaws ML. Hepatitis B and C virus infections among patients with end stage renal disease in a low-resourced hemodialysis center in Vietnam: a cross-sectional study. BMC Public Health 2015; 15:192. [PMID: 25886623 PMCID: PMC4347907 DOI: 10.1186/s12889-015-1532-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 02/13/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Hemodialysis services in Vietnam are being decentralised outside of tertiary hospitals. To identify the challenges to infection control standards for the prevention of bloodborne infections including hepatitis B virus (HBV) and hepatitis C virus (HCV) we tested the magnitude of HBV and HCV infections in the largest unit in Ho Chi Minh City servicing patients with end stage renal disease. METHODS All 113 patients provided consent HBV surface antigen (HBsAg) and HCV core antigen (HCV-coreAg) testing. Positive patients were tested for viral genotypes. All participants completed a questionnaire on demographic characteristics, risk factors and previous attendance to other hemodialysis units. RESULTS Seroprevalence of 113 patients enrolled was 7% (8/113, 95% CI 2.3%-11.8%) HBsAg, 6% (7/113, 95% CI 1.7%-10.6%) HCV-coreAg and 1% (1/113, 95% CI 0.8%-2.6%) co-infection. Having a HBV positive sexual partner significantly increased the risk of acquiring HBV (P = 0.016, Odds Ratio (OR) =29, 95% CI 2-365). Risk factors for HCV included blood transfusion (P = 0.049), multiple visits to different hemodialysis units (P = 0.048, OR = 5.7, 95% CI 1.2-27.5), frequency of hemodialysis (P = 0.029) and AST plasma levels >40 IU/L (P = 0.020, OR = 19.8, 95% CI 2.3-171). On multivariate analysis only blood transfusion remained significant risk factor for HCV (P = 0.027, adjusted OR = 1.2). CONCLUSIONS HCV screening for HCV of blood products must improve to meet the infection prevention challenges of decentralizing hemodialysis services. The level of HCV and HBV in our hemodialysis unit is a warning that universal precautions will be the next challenge for decentralised hemodialysis services in Vietnam.
Collapse
Affiliation(s)
- Cuong Minh Duong
- School of Public Health and Community Medicine, UNSW Medicine, UNSW Australia, Level 3 Samuels Building, Sydney, NSW, 2052, Australia.
| | - Dariusz Piotr Olszyna
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore, Singapore.
| | - Mary-Louise McLaws
- School of Public Health and Community Medicine, UNSW Medicine, UNSW Australia, Level 3 Samuels Building, Sydney, NSW, 2052, Australia.
| |
Collapse
|