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De A, Charak S, Bhagat N, Rathi S, Verma N, Premkumar M, Taneja S, Sharma A, Goel K, Singh V, Duseja A. Efficacy and safety of pan-genotypic sofosbuvir and velpatasvir in patients with hepatitis C and HIV coinfection on dolutegravir-based antiretroviral therapy. J Viral Hepat 2023; 30:740-745. [PMID: 37260083 DOI: 10.1111/jvh.13844] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 04/30/2023] [Accepted: 05/13/2023] [Indexed: 06/02/2023]
Abstract
Hepatitis C virus (HCV) infection is more prevalent in people living with HIV-AIDS (PLHA) and portends a poorer prognosis. Pharmacokinetic studies suggest the absence of significant interaction between velpatasvir and dolutegravir which has been recently recommended as part of preferred first-line antiretroviral therapy (ART) regimens by WHO. However, clinical data on the use of velpatasvir-based regimen in PLHA taking dolutegavir is lacking. Hence, we aimed to assess the efficacy and safety of sofosbuvir and velpatasvir (SOF + VEL) in HCV and HIV coinfected patients on dolutegravir-based ART. Forty-five consecutive PLHA with HCV coinfection on dolutegravir-based ART were prospectively enrolled. All patients were treated SOF + VEL for 12 weeks. Complete haemogram, liver and renal function tests were assessed at baseline, 4 weeks and at end of treatment. Sustained virological response (SVR) was assessed at 12 weeks after end of treatment. The majority were males (95.5%) with a mean age of 32.8 ± 12.3 years. Cirrhosis was present in 6 (13.3%) patients. All patients completed 12 weeks of therapy with SOF + VEL, but SVR could not be assessed in two patients. Forty-two (97.7%) of the remaining 43 patients attained SVR-12. SVR-12 rate was 97.7% and 93.3% by per protocol and intention to treat analysis, respectively. No grade III/IV adverse events were reported, and there was no worsening of blood counts, liver or renal function test parameters. The pan-genotypic regimen of SOF + VEL is safe and effective in PLHA with HCV coinfection who are on dolutegravir-based ART.
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Affiliation(s)
- Arka De
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Swati Charak
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Bhagat
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahaj Rathi
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nipun Verma
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhumita Premkumar
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Taneja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kapil Goel
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Virendra Singh
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Khemnark S, Manosuthi W. Real-world treatment outcomes of sofosbuvir-based regimens for treatment of chronic hepatitis C with and without human immunodeficiency virus co-infection. JGH Open 2023; 7:157-162. [PMID: 36852142 PMCID: PMC9958333 DOI: 10.1002/jgh3.12869] [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: 10/23/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 01/28/2023]
Abstract
Background and Aim The efficacy of sofosbuvir (SOF)-based regimens in the treatment of chronic hepatitis C (HCV) patients with and without human immunodeficiency virus (HIV) co-infected patients in real-world setting is limited. Methods This was a retrospective cohort study, conducted between 1 January 2017 and 31 December 2021 at Bamrasnaradura Infectious Disease Institute, Thailand. All HCV patients received 12 weeks of SOF-based regimens and had follow-up for at least 12 weeks after therapy discontinuation. The primary outcome was sustained virological response (SVR) at 12 weeks after the end of treatment. Treatment outcomes were compared between HCV patients with and without HIV co-infection. Results A total of 163 patients were included in the study, 130 (79.8%) were HCV/HIV co-infected, and 33 (20.2%) were HCV mono-infected. Of all, 106 (64%) patients received SOF and ledipasvir. Genotype 1 (GT1) was predominant at 66.4%, followed by GT3 at 22.2%, and GT6 at 11.4%. Overall SVR was 96.9%. SVR in HCV mono-infected was 96.9% and SVR in HIV-HCV co-infected patients was 96.9%. The factor associated with SVR was HCV genotype (P = 0.001). Patients with HCV GT6 had lower SVR rates compared with GT1 and GT3 patients (83.3%, 100%, and 97.1% [P = 0.000] respectively). There was no association between SVR and other factors such as gender, age, BMI, underlying cirrhosis, baseline HCV viral load, or prior treatment history (all P > 0.05). All patients completed 12-week SOF-based treatment. Conclusion In real-world setting, HCV treatment with SOF-based regimens between patients with and without HIV co-infection showed high rates of SVR. SOF-based regimens were highly efficacious and tolerated.
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Affiliation(s)
- Suparat Khemnark
- Department of MedicineBamrasnaradura Infectious Disease Institute, Ministry of Public HealthNonthaburiThailand
| | - Weerawat Manosuthi
- Department of MedicineBamrasnaradura Infectious Disease Institute, Ministry of Public HealthNonthaburiThailand
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Cammarata F, Benuzzi L, Crespi M, Troci A, Pennacchi L, Schiavini M, Foschi D. Liver resection of hepatocellular carcinoma in HIV-HCV co-infected patients: a retrospective case series. EGYPTIAN LIVER JOURNAL 2022. [DOI: 10.1186/s43066-022-00215-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
Introduction
Despite the effectiveness of new therapies and awareness campaigns, the number of seropositive patients is increasing every year. Recently, other causes of death, not directly related to HIV, have emerged, such as chronic liver disease. The risk of hepatocellular carcinoma (HCC) is seven times greater in HIV patients than in noninfected patients, and it is especially attributable to HCV infection. The aim of our study was to evaluate clinical outcomes of HCC in HIV-HCV co-infected patients after liver resection (LR).
Materials and methods
The current study was conducted on a prospective database and reviewed retrospectively. All consecutive patients with HCC treated by LR from January 2013 to March 2019 at the Luigi Sacco University Hospital in Milan were enrolled. We included patients older than 18 years of age with HCV-related HCC, and in this set of patients, we identified two groups based on the presence of HIV infection.
Results
We identified 16 patients with HCV infection and precisely five with HIV-HCV co-infection and eleven with HCV infection alone. All HIV patients were male against 72.7% in the non-HIV group (p = 0.509). All patients had optimal HIV virologic control and a normal CD4 T-cell count. The mean diagnosis-to-treatment interval was statistically different between the two groups (HIV versus non-HIV: 1.2 ± 0.55 months versus 2.39 ± 1.09 months, p = 0.039).
No other significant differences were found between HIV-HCV co-infected patients and HCV-infected patients. Long-term outcomes in terms of OS and RFS were similar between the two groups.
Conclusions
With a multidisciplinary approach and intensive support, LR can be a safe and efficacious procedure in HIV-HCV patients. For these reasons, we should not exclude potential patients merely on the basis of their HIV seropositivity.
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Cepeda JA, Thomas DL, Astemborski J, Rudolph JE, Gicquelais R, Kirk GD, Mehta SH. Impact of Hepatitis C Treatment Uptake on Cirrhosis and Mortality in Persons Who Inject Drugs : A Longitudinal, Community-Based Cohort Study. Ann Intern Med 2022; 175:1083-1091. [PMID: 35816712 PMCID: PMC9706936 DOI: 10.7326/m21-3846] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection can be cured, and the United States has joined the World Health Organization in calling for HCV elimination by 2030. However, historically low uptake of HCV treatment among people who inject drugs (PWID) threatens HCV elimination and exacerbates social and racial health disparities. OBJECTIVE To assess whether all-oral HCV treatments were accessed by PWID and reduced liver disease burden and mortality. DESIGN Community-based, longitudinal cohort study of persons with a history of injection drug use. SETTING Baltimore, Maryland. PARTICIPANTS 1323 participants enrolled in the ALIVE (AIDS Linked to the IntraVenous Experience) study from 2006 to 2019 and chronically infected with HCV. MEASUREMENTS Liver stiffness measures (LSMs) by transient elastography, HCV RNA, and mortality from the National Death Index. RESULTS Among 1323 persons with evidence of chronic HCV infection at baseline, the median age was 49 years. Most were Black (82%), male (71%), and HIV-negative (66%). The proportion in whom HCV RNA was detected decreased from 100% (by definition) in 2006 to 48% in 2019. Across 10 350 valid LSMs, cirrhosis was detected in 15% of participants in 2006, 19% in 2015, and 8% in 2019. Undetectable HCV RNA was significantly associated with reduced odds of cirrhosis (adjusted odds ratio, 0.28 [95% CI, 0.17 to 0.45]) and reduced all-cause mortality risk (adjusted hazard ratio, 0.54 [CI, 0.38 to 0.77]). LIMITATION Noninvasive markers of liver fibrosis have not been validated in persons with sustained virologic response. CONCLUSION Many community-based PWID in Baltimore are receiving HCV treatment, which is associated with sharp decreases in liver disease and mortality. Additional efforts will be needed to reduce residual barriers to treatment and to eliminate HCV as a public health threat for PWID. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- Javier A Cepeda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.A.C., J.A., J.E.R., S.H.M.)
| | - David L Thomas
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, and Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland (D.L.T., G.D.K.)
| | - Jacqueline Astemborski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.A.C., J.A., J.E.R., S.H.M.)
| | - Jacqueline E Rudolph
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.A.C., J.A., J.E.R., S.H.M.)
| | - Rachel Gicquelais
- School of Nursing, University of Wisconsin, Madison, Wisconsin (R.G.)
| | - Gregory D Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, and Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland (D.L.T., G.D.K.)
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.A.C., J.A., J.E.R., S.H.M.)
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Stefan I, Stefani C, Sirbu CA, Docu Axelerad A, Ionita Radu F. Management of hepatitis C virus (HCV) infection: an update. ROMANIAN JOURNAL OF MILITARY MEDICINE 2022. [DOI: 10.55453/rjmm.2022.125.3.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Million people worldwide are affected by the hepatitis C virus (HCV). The highest incidence of illness was between 1945 and 1975. It was also estimated that 70% of those people were not tested for the disease. Most recent treatment concepts are safe, highly effective and have a vital public health influence by achieving a viral constant response in a significant proportion of treated patients. It helps reduce liver fibrosis, liver cancer risk and dissemination. With its increased population incidence, HCV becomes a serious public health problem. This review discusses the current literature in this field in terms of the importance of screening of HCV, follow-up, treatment and includes considerations in specific populations such as patients with cirrhosis, with HIV/HCV co-infection, patients with HBV/HCV co-infection and with renal damage
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Liu CH, Sun HY, Peng CY, Hsieh SM, Yang SS, Kao WY, Shih YL, Lin CL, Liu CJ, Sheng WH, Lo YC, Liu WC, Wu JH, Su TH, Tseng TC, Chen PJ, Hung CC, Kao JH. Hepatitis C virus reinfection in people living with human immunodeficiency virus in Taiwan after achieving sustained virologic response with antiviral treatment: the RECUR study. Open Forum Infect Dis 2022; 9:ofac348. [PMID: 35928504 PMCID: PMC9345411 DOI: 10.1093/ofid/ofac348] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Data on hepatitis C virus (HCV) reinfection in East Asian people living with human immunodeficiency virus (HIV) after treatment-induced sustained virologic response (SVR) are limited.
Methods
HIV/HCV-coinfected patients in Taiwan who achieved SVR12 with interferon (IFN) or direct-acting antivirals (DAAs) between 2005 and 2021 underwent HCV RNA measurements at SVR24 and then biannually. HCV reinfection was defined as the detection of different HCV strains beyond SVR12. HIV-negative, low-risk individuals with SVR12 served as reference patients. Crude reinfection rates and secular trends were assessed. Multivariate Cox regression analysis was performed to identify baseline factors associated with HCV reinfection.
Results
A total of 216 HIV-positive and 1589 reference patients were recruited with median follow-up durations of 3.0 and 6.0 years. During a total of 772 person-years of follow-up (PYFU), the HCV reinfection rate in HIV-positive patients was 4.02 per 100 PYFU (95% confidence interval [CI]: 2.85-5.65), while the HCV reinfection rate in reference patients was 0.14 per 100 PYFU (95% CI: 0.09-0.23) during 10862 PYFU. HIV-positive patients had a higher risk of HCV reinfection than reference patients (hazard ratio [HR]: 17.63; 95% CI: 7.10-43.80, p < 0.001). No baseline factors were predictive of HCV reinfection in HIV-positive patients. The incidence of HCV reinfection in HIV-positive patients increased after 2015 when DAAs were available in Taiwan.
Conclusions
The risk of HCV reinfection remains high in HIV/HCV-coinfected patients with treatment-induced SVR12. In addition to mass screening and treatment scale-up, strategies to reduce reinfection are needed for HCV microelimination in HIV-positive patients in Taiwan.
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Affiliation(s)
- Chen Hua Liu
- Department of Internal Medicine, National Taiwan University Hospital , Taipei , Taiwan
- Hepatitis Research Center, National Taiwan University Hospital , Taipei , Taiwan
- Department of Internal Medicine, National Taiwan University Hospital , Yun-Lin Branch, Yunlin , Taiwan
| | - Hsin Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital , Taipei , Taiwan
| | - Cheng Yuan Peng
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital , Taichung , Taiwan
- School of Medicine, China Medical University , Taichung , Taiwan
| | - Szu Min Hsieh
- Department of Internal Medicine, National Taiwan University Hospital , Taipei , Taiwan
| | - Sheng Shun Yang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital , Taichung , Taiwan
- School of Medicine, Chung Shan Medical University , Taichung , Taiwan
- Institute of Biomedical Sciences, National Chung Hsing University , Taichung , Taiwan
| | - Wei Yu Kao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital , Taipei , Taiwan
- School of Medicine, Taipei Medical University College of Medicine , Taipei , Taiwan
- Graduate Institute of Clinical Medicine, Taipei Medical University College of Medicine , Taipei , Taiwan
| | - Yu Lueng Shih
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center , Taipei , Taiwan
| | - Chih Lin Lin
- Department of Gastroenterology, Taipei City Hospital , Ren-Ai Branch, Taipei , Taiwan
| | - Chun Jen Liu
- Department of Internal Medicine, National Taiwan University Hospital , Taipei , Taiwan
- Hepatitis Research Center, National Taiwan University Hospital , Taipei , Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine , Taipei , Taiwan
| | - Wang Hui Sheng
- Department of Internal Medicine, National Taiwan University Hospital , Taipei , Taiwan
| | - Yi Chun Lo
- Centers for Disease Control , Taipei , Taiwan
| | - Wen Chun Liu
- Department of Internal Medicine, National Taiwan University Hospital , Taipei , Taiwan
| | - Jo Hsuan Wu
- Hamilton Glaucoma Center, Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California , San Diego, California , USA
| | - Tung Hung Su
- Department of Internal Medicine, National Taiwan University Hospital , Taipei , Taiwan
- Hepatitis Research Center, National Taiwan University Hospital , Taipei , Taiwan
| | - Tai Chung Tseng
- Department of Internal Medicine, National Taiwan University Hospital , Taipei , Taiwan
- Hepatitis Research Center, National Taiwan University Hospital , Taipei , Taiwan
- Department of Medical Research, National Taiwan University Hospital , Taipei , Taiwan
| | - Pei Jer Chen
- Department of Internal Medicine, National Taiwan University Hospital , Taipei , Taiwan
- Hepatitis Research Center, National Taiwan University Hospital , Taipei , Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine , Taipei , Taiwan
| | - Chien Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital , Taipei , Taiwan
- Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine , Taipei , Taiwan
| | - Jia Horng Kao
- Department of Internal Medicine, National Taiwan University Hospital , Taipei , Taiwan
- Hepatitis Research Center, National Taiwan University Hospital , Taipei , Taiwan
- Department of Medical Research, National Taiwan University Hospital , Taipei , Taiwan
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Ferra-Murcia S, Collado-Romacho AR, Nievas-Soriano BJ, Reche-Lorite F, Parrón-Carreño T. Real-Life Early Anthropometric, Lipid and Liver Changes after Direct-Acting Antiviral Therapy in PLWHIV with HCV Co-Infection. J Clin Med 2022; 11:2639. [PMID: 35566765 PMCID: PMC9102310 DOI: 10.3390/jcm11092639] [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: 04/01/2022] [Revised: 04/28/2022] [Accepted: 05/06/2022] [Indexed: 02/01/2023] Open
Abstract
Treatment with interferon-free direct-acting antivirals (DAA) has become the gold standard in chronic hepatitis C virus (HCV) infection. Nevertheless, little research about the metabolic impact of achieving sustained virological response (SVR) is available in HCV/HIV co-infected patients. This research aimed to evaluate early anthropometric, lipid and liver parameters changes after achieving SVR 12 weeks after treatment (SVR12). A real-life retrospective descriptive before-after study assessed 128 DAA treatment episodes from 2015 to 2019 in HCV/HIV co-infected patients. Anthropometric parameters (weight, body mass index), lipid profile, genotype (GT) and viral load, liver data (basics laboratory necroinflammatory parameters and transient elastography (TE)) were collected before treatment with DAA (baseline), and when SVR12 was achieved. Significant increases (p < 0.01) were found in the early lipid profile, measured by LDLc (84.6 ± 35.0 vs. 108.6 ± 35.1 mg/dL) and total cholesterol (161.3 ± 41.0 vs. 183.3 ± 41.6 mg/dL). Significant changes (p < 0.05) were found in liver parameters, measured by ALT (58.2 ± 34.0 vs. 22.0 ± 16.0 U/L), bilirubin (0.8 ± 0.6 vs. 0.6 ± 0.5 mg/dL), albumin (4.2 ± 0.4 vs. 4.3 ± 0.3 g/dL) and liver stiffness (LS) (13.7 ± 13.3 vs. 11.8 ± 12.1 kPa). The main conclusions were that the use of DAA has an early negative impact on lipid metabolism. Achieving SVR12 against HCV leads to an early improvement in liver function and LS in HCV/HIV co-infected patients without interference with antiretroviral treatment (ART) and DAA. Short-term close lipid monitoring may be necessary when combining protease inhibitors. HCV-GT-3/HIV co-infected patients might require further close monitoring for residual fibrosis. These findings can be relevant for actual clinical practice.
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Affiliation(s)
- Sergio Ferra-Murcia
- Infectious Diseases Unit, Internal Medicine Service, Torrecárdenas University Hospital, 04009 Almeria, Spain; (S.F.-M.); (A.R.C.-R.)
| | - Antonio Ramón Collado-Romacho
- Infectious Diseases Unit, Internal Medicine Service, Torrecárdenas University Hospital, 04009 Almeria, Spain; (S.F.-M.); (A.R.C.-R.)
| | | | - Fernando Reche-Lorite
- Department of Mathematics-Statistics and Operations Research Area, University of Almeria, 04120 Almeria, Spain;
| | - Tesifón Parrón-Carreño
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almeria, Spain;
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Horvath S, Lin DTS, Kobor MS, Zoller JA, Said JW, Morgello S, Singer E, Yong WH, Jamieson BD, Levine AJ. HIV, pathology and epigenetic age acceleration in different human tissues. GeroScience 2022; 44:1609-1620. [PMID: 35411474 PMCID: PMC9213580 DOI: 10.1007/s11357-022-00560-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/30/2022] [Indexed: 11/29/2022] Open
Abstract
Epigenetic clocks based on patterns of DNA methylation have great importance in understanding aging and disease; however, there are basic questions to be resolved in their application. It remains unknown whether epigenetic age acceleration (EAA) within an individual shows strong correlation between different primary tissue sites, the extent to which tissue pathology and clinical illness correlate with EAA in the target organ, and if EAA variability across tissues differs according to sex. Considering the outsized role of age-related illness in Human Immunodeficiency Virus-1 (HIV), these questions were pursued in a sample enriched for tissue from HIV-infected individuals. We used a custom methylation array to generate DNA methylation data from 661 samples representing 11 human tissues (adipose, blood, bone marrow, heart, kidney, liver, lung, lymph node, muscle, spleen and pituitary gland) from 133 clinically characterized, deceased individuals, including 75 infected with HIV. We developed a multimorbidity index based on the clinical disease history. Epigenetic age was moderately correlated across tissues. Blood had the greatest number and degree of correlation, most notably with spleen and bone marrow. However, blood did not correlate with epigenetic age of liver. EAA in liver was weakly correlated with EAA in kidney, adipose, lung and bone marrow. Clinically, hypertension was associated with EAA in several tissues, consistent with the multiorgan impacts of this illness. HIV infection was associated with positive age acceleration in kidney and spleen. Male sex was associated with increased epigenetic acceleration in several tissues. Preliminary evidence indicates that amyotrophic lateral sclerosis is associated with positive EAA in muscle tissue. Finally, greater multimorbidity was associated with greater EAA across all tissues. Blood alone will often fail to detect EAA in other tissues. While hypertension is associated with increased EAA in several tissues, many pathologies are associated with organ-specific age acceleration.
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Affiliation(s)
- Steve Horvath
- Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA. .,Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, 90095, USA.
| | - David T S Lin
- Centre for Molecular Medicine and Therapeutics, BC Childrens Hospital Research Institute, Vancouver, Canada
| | - Michael S Kobor
- Centre for Molecular Medicine and Therapeutics, BC Childrens Hospital Research Institute, Vancouver, Canada
| | - Joseph A Zoller
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Jonathan W Said
- Department of Pathology and Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, Los Angeles, USA
| | - Susan Morgello
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Departments of Neuroscience and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elyse Singer
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - William H Yong
- Department of Pathology and Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, Los Angeles, USA
| | - Beth D Jamieson
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Andrew J Levine
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, USA
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Proulx J, Ghaly M, Park IW, Borgmann K. HIV-1-Mediated Acceleration of Oncovirus-Related Non-AIDS-Defining Cancers. Biomedicines 2022; 10:biomedicines10040768. [PMID: 35453518 PMCID: PMC9024568 DOI: 10.3390/biomedicines10040768] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/22/2022] [Accepted: 03/22/2022] [Indexed: 11/25/2022] Open
Abstract
With the advent of combination antiretroviral therapy (cART), overall survival has been improved, and the incidence of acquired immunodeficiency syndrome (AIDS)-defining cancers has also been remarkably reduced. However, non-AIDS-defining cancers among human immunodeficiency virus-1 (HIV-1)-associated malignancies have increased significantly so that cancer is the leading cause of death in people living with HIV in certain highly developed countries, such as France. However, it is currently unknown how HIV-1 infection raises oncogenic virus-mediated cancer risks in the HIV-1 and oncogenic virus co-infected patients, and thus elucidation of the molecular mechanisms for how HIV-1 expedites the oncogenic viruses-triggered tumorigenesis in the co-infected hosts is imperative for developing therapeutics to cure or impede the carcinogenesis. Hence, this review is focused on HIV-1 and oncogenic virus co-infection-mediated molecular processes in the acceleration of non-AIDS-defining cancers.
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Quinn JR, Goyal A, Ribeiro RM, Massaccesi G, Bailey JR, Thomas DL, Balagopal A. Antiretroviral therapy for HIV and intrahepatic hepatitis C virus replication. AIDS 2022; 36:337-346. [PMID: 34690280 PMCID: PMC9296270 DOI: 10.1097/qad.0000000000003116] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVE HIV alters host responses to hepatitis C virus (HCV). However, the impact of antiretroviral therapy (ART) on HCV is rarely understood in relevant tissues and never before within individual hepatocytes. DESIGN HIV and HCV kinetics were studied before and after ART initiation among 19 HIV/HCV co-infected persons. From five persons with the largest decline in plasma HCV RNA, liver tissues collected before and during ART, when plasma HIV RNA was undetectable, were studied. METHODS We used single-cell laser capture microdissection and quantitative PCR to assess intrahepatic HCV. Immunohistochemistry was performed to characterize intrahepatic immune cell populations. RESULTS Plasma HCV RNA declined by 0.81 (0.52-1.60) log10 IU/ml from a median (range) 7.26 (6.05-7.29) log10 IU/ml and correlated with proportions of HCV-infected hepatocytes (r = 0.89, P = 2 × 10-5), which declined from median (range) of 37% (6-49%) to 23% (0.5-52%) after plasma HIV clearance. Median (range) HCV RNA abundance within cells was unchanged in four of five participants. Liver T-cell abundance unexpectedly decreased, whereas natural killer (NK) and NK T-cell infiltration increased, correlating with changes in proportions of HCV-infected hepatocytes (r = -0.82 and r = -0.73, respectively). Hepatocyte expression of HLA-E, an NK cell restriction marker, correlated with proportions of HCV-infected hepatocytes (r = 0.79). CONCLUSION These are the first data to show that ART control of HIV reduces the intrahepatic burden of HCV. Furthermore, our data suggest that HIV affects the pathogenesis of HCV infection by an NK/NK T-cell-mediated mechanism that may involve HLA-E and can be rescued, at least in part, by ART.
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Affiliation(s)
| | - Ashish Goyal
- Los Alamos National Laboratory, Los Alamos, New Mexico, USA
| | - Ruy M Ribeiro
- Los Alamos National Laboratory, Los Alamos, New Mexico, USA
| | | | | | - David L Thomas
- The Johns Hopkins Medical Institutions, Baltimore, Maryland
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Shahriar S, Araf Y, Ahmad R, Kattel P, Sah GS, Rahaman TI, Sadiea RZ, Sultana S, Islam MS, Zheng C, Hossain MG. Insights Into the Coinfections of Human Immunodeficiency Virus-Hepatitis B Virus, Human Immunodeficiency Virus-Hepatitis C Virus, and Hepatitis B Virus-Hepatitis C Virus: Prevalence, Risk Factors, Pathogenesis, Diagnosis, and Treatment. Front Microbiol 2022; 12:780887. [PMID: 35222296 PMCID: PMC8865087 DOI: 10.3389/fmicb.2021.780887] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/21/2021] [Indexed: 12/15/2022] Open
Abstract
Human immunodeficiency virus, hepatitis B virus, and hepatitis C virus are three blood-borne viruses that can cause major global health issues by increasing severe morbidity. There is a high risk of coinfection with these viruses in individuals because of their same transmission routes through blood using shared needles, syringes, other injection equipment, sexual transmission, or even vertical transmission. Coinfection can cause various liver-related illnesses, non-hepatic organ dysfunction, followed by death compared to any of these single infections. The treatment of coinfected patients is complicated due to the side effects of antiviral medication, resulting in drug resistance, hepatotoxicity, and a lack of required responses. On the other hand, coinfected individuals must be treated with multiple drugs simultaneously, such as for HIV either along with HBV or HCV and HBV and HCV. Therefore, diagnosing, treating, and controlling dual infections with HIV, HBV, or HCV is complicated and needs further investigation. This review focuses on the current prevalence, risk factors, and pathogenesis of dual infections with HIV, HBV, and HCV. We also briefly overviewed the diagnosis and treatment of coinfections of these three blood-borne viruses.
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Affiliation(s)
- Sagarika Shahriar
- Biotechnology Program, Department of Mathematics and Natural Sciences, BRAC University, Dhaka, Bangladesh
| | - Yusha Araf
- Department of Genetic Engineering and Biotechnology, School of Life Sciences, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Rasel Ahmad
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Pravakar Kattel
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Ganga Sagar Sah
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Tanjim Ishraq Rahaman
- Department of Biotechnology and Genetic Engineering, Faculty of Life Sciences, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, Bangladesh
| | - Rahila Zannat Sadiea
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Shahnaj Sultana
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Md. Sayeedul Islam
- Department of Biological Sciences, Graduate School of Science, Osaka University, Osaka, Japan
| | - Chunfu Zheng
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB, Canada
| | - Md. Golzar Hossain
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh, Bangladesh
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12
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Tran T, Pencina KM, Schultz MB, Li Z, Ghattas C, Lau J, Sinclair DA, Montano M. Reduced Levels of NAD in Skeletal Muscle and Increased Physiologic Frailty Are Associated With Viral Coinfection in Asymptomatic Middle-Aged Adults. J Acquir Immune Defic Syndr 2022; 89:S15-S22. [PMID: 35015741 PMCID: PMC8751286 DOI: 10.1097/qai.0000000000002852] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 09/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND People living with HIV (PLWH) are disproportionately burdened with multimorbidity and decline in physiologic function compared with their uninfected counterparts, but biological mechanisms that differentially contribute to the decline in muscle function in PLWH compared with uninfected people remain understudied. SETTING The study site was Brigham and Women's Hospital, Harvard Medical School, Boston, MA. METHODS We evaluated skeletal muscle tissue for levels of total nicotinamide adenine dinucleotide (NAD), NAD+, and nicotinamide adenine dinucleotide (NADH) in middle-aged asymptomatic PLWH, coinfected with hepatitis C virus and/or cytomegalovirus and compared them with uninfected control participants. RESULTS Of the 54 persons with muscle biopsy data, the mean age was 57 years with 33% women. Total NAD levels declined in skeletal muscle in association with HIV infection and was exacerbated by hepatitis C virus and cytomegalovirus coinfection, with lowest levels of total NAD, NAD+, and NADH among persons who were coinfected with all 3 viruses (P = 0.015, P = 0.014, and P = 0.076, respectively). Levels of total NAD, NAD+, and NADH in skeletal muscle were inversely associated with inflammation (P = 0.014, P = 0.013, and P = 0.055, respectively). Coinfections were also associated with measures of inflammation (CD4/CD8 ratio: P < 0.001 and sCD163: P < 0.001) and immune activation (CD38 and human leukocyte antigen-DR expression on CD8 T cells: P < 0.001). In addition, coinfection was associated with increased physiologic frailty based on the Veteran Aging Cohort Study 1.0 index assessment (P = 0.001). CONCLUSIONS Further research is warranted to determine the clinical relevance of preclinical deficits in NAD metabolites in skeletal muscle in association with viral coinfection and inflammation, as well as the observed association between viral coinfection and physiologic frailty.
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Affiliation(s)
- Thanh Tran
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Karol M. Pencina
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Boston Claude D. Pepper Older Americans Independence Center, Boston, MA; and
| | - Michael B. Schultz
- Department of Genetics, Blavatnik Institute, Paul F. Glenn Labs for the Biology of Aging, Harvard Medical School, Boston, MA
| | - Zhuoying Li
- Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Catherine Ghattas
- Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jackson Lau
- Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David A. Sinclair
- Department of Genetics, Blavatnik Institute, Paul F. Glenn Labs for the Biology of Aging, Harvard Medical School, Boston, MA
| | - Monty Montano
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Boston Claude D. Pepper Older Americans Independence Center, Boston, MA; and
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13
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Kouroumalis E, Voumvouraki A. Hepatitis C virus: A critical approach to who really needs treatment. World J Hepatol 2022; 14:1-44. [PMID: 35126838 PMCID: PMC8790391 DOI: 10.4254/wjh.v14.i1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/14/2021] [Accepted: 12/31/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction of effective drugs in the treatment of hepatitis C virus (HCV) infection has prompted the World Health Organization to declare a global eradication target by 2030. Propositions have been made to screen the general population and treat all HCV carriers irrespective of the disease status. A year ago the new severe acute respiratory syndrome coronavirus 2 virus appeared causing a worldwide pandemic of coronavirus disease 2019 disease. Huge financial resources were redirected, and the pandemic became the first priority in every country. In this review, we examined the feasibility of the World Health Organization elimination program and the actual natural course of HCV infection. We also identified and analyzed certain comorbidity factors that may aggravate the progress of HCV and some marginalized subpopulations with characteristics favoring HCV dissemination. Alcohol consumption, HIV coinfection and the presence of components of metabolic syndrome including obesity, hyperuricemia and overt diabetes were comorbidities mostly responsible for increased liver-related morbidity and mortality of HCV. We also examined the significance of special subpopulations like people who inject drugs and males having sex with males. Finally, we proposed a different micro-elimination screening and treatment program that can be implemented in all countries irrespective of income. We suggest that screening and treatment of HCV carriers should be limited only in these particular groups.
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Affiliation(s)
- Elias Kouroumalis
- Department of Gastroenterology, University of Crete Medical School, Heraklion 71500, Crete, Greece
| | - Argyro Voumvouraki
- First Department of Internal Medicine, AHEPA University Hospital, Thessaloniki 54621, Greece
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14
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Zarębska-Michaluk D, Jaroszewicz J, Parfieniuk-Kowerda A, Pawłowska M, Janczewska E, Berak H, Janocha-Litwin J, Klapaczyński J, Tomasiewicz K, Piekarska A, Krygier R, Citko J, Tronina O, Dobrowolska K, Flisiak R. Pangenotypic and Genotype-Specific Antivirals in the Treatment of HCV Genotype 4 Infected Patients with HCV Monoinfection and HIV/HCV Coinfection. J Clin Med 2022; 11:jcm11020389. [PMID: 35054088 PMCID: PMC8781964 DOI: 10.3390/jcm11020389] [Citation(s) in RCA: 2] [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: 12/29/2021] [Accepted: 01/11/2022] [Indexed: 02/07/2023] Open
Abstract
The introduction of the direct-acting antivirals (DAA) has substantially improved the effectiveness of the therapy in patients with chronic hepatitis C. We aimed to compare the efficacy of pangenotypic and genotype-specific DAA in the cohort of genotype (GT) four patients with HCV monoinfection and HIV coinfection. A total of 662 GT4-infected patients treated in 2015–2020—of whom 168 (25.3%) were coinfected with HIV, selected from the retrospective EpiTer-2 database—were enrolled in the analysis. Among HIV-coinfected patients, 54% (90) were treated with genotype-specific regimens and 46% (78) with pangenotypic options, while among HCV-monoinfected patients, the rates were 72% and 28%, respectively. Significantly higher rate of males (67.9% vs. 57.7%, p = 0.01), a lower rate of liver cirrhosis (10.2% vs. 18.1%, p = 0.02), and higher of treatment-naïve patients (87.5% vs. 76.7%, p = 0.003) were documented in the HIV coinfected population. The overall sustained virologic response after exclusion of non-virologic failures was achieved in 98% with no significant difference between HIV-positive and HIV-negative patients, 96.2% vs. 98.5%, respectively. While the genotype-specific regimens resulted in a similar cure rate regardless of the HIV status, the pangenotypic options were more efficacious in patients with HCV monoinfection (99.3% vs. 94.4%, p = 0.05). Hereby, we demonstrated the high effectiveness and good safety profile of the DAA therapy in the population of HCV GT4 infected patients with HIV coinfection supporting the current recommendations to treat HCV/HIV coinfected patients with the same options as those with HCV monoinfection.
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Affiliation(s)
- Dorota Zarębska-Michaluk
- Department of Infectious Diseases, Jan Kochanowski University Kielce, 25-516 Kielce, Poland
- Correspondence: (D.Z.-M.); (R.F.)
| | - Jerzy Jaroszewicz
- Department of Infectious Diseases and Hepatology, Medical University of Silesia in Katowice, 40-055 Katowice, Poland;
| | - Anna Parfieniuk-Kowerda
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, 15-540 Białystok, Poland;
| | - Małgorzata Pawłowska
- Department of Infectious Diseases and Hepatology, Ludwik Rydygier Collegium Medicum, Bydgoszcz Faculty of Medicine Nicolaus Copernicus University in Toruń, 85-030 Bydgoszcz, Poland;
| | - Ewa Janczewska
- Faculty of Health Sciences in Bytom, Department of Basic Medical Sciences, Medical University of Silesia, ID Clinic, Hepatology Outpatient Department, 41-902 Bytom, Poland;
| | - Hanna Berak
- Hospital for Infectious Diseases in Warszawa, 02-091 Warszawa, Poland;
| | - Justyna Janocha-Litwin
- Department of Infectious Diseases and Hepatology, Medical University Wrocław, 50-367 Wrocław, Poland;
| | - Jakub Klapaczyński
- Department of Internal Medicine and Hepatology, Central Clinical Hospital of the Ministry of Internal Affairs and Administration, 02-507 Warszawa, Poland;
| | - Krzysztof Tomasiewicz
- Department of Infectious Diseases, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Anna Piekarska
- Department of Infectious Diseases and Hepatology, Medical University of Łódź, 90-419 Łódź, Poland;
| | - Rafał Krygier
- Outpatients Hepatology Department, State University of Applied Sciences, 62-510 Konin, Poland;
| | - Jolanta Citko
- Medical Practice of Infections, Regional Hospital, 10-561 Olsztyn, Poland;
| | - Olga Tronina
- Department of Transplantation Medicine, Nephrology, and Internal Diseases, Medical University of Warsaw, 02-006 Warszawa, Poland;
| | | | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, 15-540 Białystok, Poland;
- Correspondence: (D.Z.-M.); (R.F.)
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15
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Discordant Liver Fibrosis Predictors in Virologically Suppressed People Living with HIV without Hepatitis Virus Infection. Diagnostics (Basel) 2021; 12:diagnostics12010014. [PMID: 35054179 PMCID: PMC8775200 DOI: 10.3390/diagnostics12010014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 12/17/2022] Open
Abstract
Severe liver fibrosis (LF) is associated with poor long-term liver-related outcomes in people living with HIV (PLWH). The study aimed to explore the prevalence and predictors of LF and the concordance between different non-invasive methods for the estimation of LF in HIV-infected individuals without hepatitis virus infection. We enrolled PLWH with HIV-1-RNA <50 copies/mL for >12 months, excluding individuals with viral hepatitis. LF was assessed by transient elastography (TE) (significant >6.65 kPa), fibrosis-4 (FIB-4) (significant >2.67), and AST-to-platelet ratio index (APRI) (significant >1.5). We included 234 individuals (67% males, median age 49 years, median time from HIV diagnosis 11 years, 38% treated with integrase strand transfer inhibitors). In terms of the TE, 13% had ≥F2 stage; FIB-4 score was >1.5 in 7%; and APRI > 0.5 in 4%. Higher body mass index, diabetes mellitus, detectable baseline HIV-1 RNA and longer atazanavir exposure were associated with higher liver stiffness as per TE. Predictors of higher APRI score were CDC C stage and longer exposure to tenofovir alafenamide, while HBcAb positivity and longer exposure to tenofovir alafenamide were associated to higher FIB-4 scores. Qualitative agreement was poor between FIB-4/TE and between APRI/TE by non-parametric Spearman correlation and kappa statistic. In our study, in the group of PLWH without viral hepatitis, different non-invasive methods were discordant in predicting liver fibrosis.
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16
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Lim DH, Jeong JY, Nam S, Choi J, Kwon HC, Yoon YB, Kim Y, Chin B. Clinical Characteristics and Treatment Outcomes of Patients with Hepatitis C Virus and Human Immunodeficiency Virus Coinfection: Experience at a Single Center in Korea. J Korean Med Sci 2021; 36:e308. [PMID: 34845874 PMCID: PMC8629715 DOI: 10.3346/jkms.2021.36.e308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/13/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Because of the very low incidence of human immunodeficiency virus (HIV) coinfection in Korea, data on hepatitis C virus (HCV)/HIV coinfection are limited. This study aimed to investigate the clinical characteristics and treatment outcomes of patients with HCV/HIV coinfection in Korea. METHODS We performed a retrospective cohort study of all HCV-monoinfected and HCV/HIV-coinfected patients treated with antivirals at National Medical Center in Seoul, Korea, between January 2009 and March 2020. RESULTS We enrolled 220 HCV-monoinfected and 23 HCV/HIV-coinfected patients treated with antivirals. The HCV/HIV-coinfected patients were younger (HCV vs. HCV/HIV: 57.3 ± 11.3 vs. 40.7 ± 10.1 years, P < 0.001) and had a higher proportion of men (HCV vs. HCV/HIV: 54.5% [n = 120] vs. 91.3% [n = 21], P < 0.001) than the HCV-monoinfected patients. Genotype 1b and 2 were most common in both HCV monoinfection and HCV/HIV coinfection groups. HCV-monoinfected patients had a higher incidence of genotype 1b and 2 than HCV/HIV-coinfected patients (HCV vs. HCV/HIV: 95.4% [n = 210] vs. 73.9% [n = 17], P < 0.001), while the HCV/HIV-coinfected patients had genotype 1a (HCV vs. HCV/HIV: 1.8% [n = 4] vs. 21.7% [n = 5], P < 0.001). The fibrosis-4 index was significantly lower in the HCV/HIV-coinfected patients than in the HCV-monoinfected patients (HCV vs. HCV/HIV: 3.81 ± 3.38 vs. 1.66 ± 1.10, P < 0.001). Among the direct-acting antivirals (DAA)-treated patients, the sustained viral response (SVR) rate did not differ significantly between both groups (HCV vs. HCV/HIV: 94.9% [93/99] vs. 90.9% [10/11], P = 0.480). CONCLUSION In Korea, the HCV/HIV-coinfected patients who received antiviral treatment were younger, had higher proportion of men and incidence of genotype 1a, and had less advanced fibrosis than the HCV-monoinfected patients. In actual clinical settings, HCV/HIV-coinfected patients show excellent SVR to DAA treatment, similar to HCV-monoinfected patients.
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Affiliation(s)
- Dae Hyun Lim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Jae Yoon Jeong
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Medical Center, Seoul, Korea.
| | - Seongwoo Nam
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Medical Center, Seoul, Korea.
| | - Jongkyoung Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Hyeok Choon Kwon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Yong Bum Yoon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Yeonjae Kim
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - BumSik Chin
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, Korea
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17
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Mastrorosa I, Tempestilli M, Notari S, Lorenzini P, Fabbri G, Grilli E, Bellagamba R, Vergori A, Cicalini S, Ammassari A, Agrati C, Antinori A. Association of Sofosbuvir and Daclatasvir Plasma Trough Concentrations with Patient-, Treatment-, and Disease-Related Factors Among HIV/HCV-Coinfected Persons. Eur J Drug Metab Pharmacokinet 2021; 47:135-142. [PMID: 34623616 DOI: 10.1007/s13318-021-00725-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sofosbuvir plus daclatasvir achieves high rates of sustained virologic response (SVR), with no differences according to HIV serostatus. However, only limited information is available on the pharmacokinetic variability of sofosbuvir and daclatasvir in HIV/HCV-coinfected patients. OBJECTIVES The aim of this study was to identify patient-, treatment-, and disease-related factors that are significantly associated with sofosbuvir and daclatasvir plasma trough concentrations (Ctrough), including liver and renal function, among HIV/HCV-coinfected persons. METHODS In this observational cohort pilot study, HIV/HCV-coinfected patients undergoing sofosbuvir plus daclatasvir treatment were prospectively enrolled. Biochemical and viro-immunological parameters were assessed at baseline, week 4 (W4), end of treatment (EOT), and after EOT. The FIB-4 score and CKD-EPI equation were used to estimate liver disease and glomerular filtration rate (eGFR), respectively. For sofosbuvir, sofosbuvir metabolite (GS-331007), and daclatasvir, Ctrough was measured at W4 and week 8 (W8), and the mean of the values at those two time points (mean-Ctrough) was calculated. The Mann-Whitney test and Spearman's rank correlation were used to evaluate the correlations between the mean-Ctrough of each direct-acting antiviral (DAA) and the considered variables. RESULTS Thirty-five patients were included (SVR 94%). An increased GS-331007 mean-Ctrough was significantly correlated with a decreased eGFR at W4 (rho = -0.36; p = 0.037) and EOT (rho = -0.34; p = 0.048). There was a significant correlation between daclatasvir mean-Ctrough and FIB-4 at all time points: baseline (rho = -0.35; p = 0.037), W4 (rho = -0.44; p = 0.008), EOT (rho = -0.40; p = 0.023), and after EOT (rho = -0.39; p = 0.028). CONCLUSIONS In HIV/HCV-coinfected patients in a real-world setting, exposure to a high GS-331007 Ctrough was associated with a slight decrease in renal function, while advanced hepatic impairment was significantly associated with a lower daclatasvir Ctrough. Though the clinical and therapeutic relevance of these findings may be limited, increasing clinicians' knowledge regarding DAA exposure in difficult-to-treat patients could be relevant in single cases, and further investigations are warranted.
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Affiliation(s)
- Ilaria Mastrorosa
- National Institute for Infectious Diseases "L. Spallanzani" I.R.C.C.S., Via Portuense 292, 00149, Rome, Italy
| | - Massimo Tempestilli
- National Institute for Infectious Diseases "L. Spallanzani" I.R.C.C.S., Via Portuense 292, 00149, Rome, Italy.
- Immunology and Pharmacology Laboratory, National Institute for Infectious Diseases "L. Spallanzani" I.R.C.C.S., Via Portuense 292, 00149, Rome, Italy.
| | - Stefania Notari
- National Institute for Infectious Diseases "L. Spallanzani" I.R.C.C.S., Via Portuense 292, 00149, Rome, Italy
| | - Patrizia Lorenzini
- National Institute for Infectious Diseases "L. Spallanzani" I.R.C.C.S., Via Portuense 292, 00149, Rome, Italy
| | - Gabriele Fabbri
- National Institute for Infectious Diseases "L. Spallanzani" I.R.C.C.S., Via Portuense 292, 00149, Rome, Italy
| | - Elisabetta Grilli
- National Institute for Infectious Diseases "L. Spallanzani" I.R.C.C.S., Via Portuense 292, 00149, Rome, Italy
| | - Rita Bellagamba
- National Institute for Infectious Diseases "L. Spallanzani" I.R.C.C.S., Via Portuense 292, 00149, Rome, Italy
| | - Alessandra Vergori
- National Institute for Infectious Diseases "L. Spallanzani" I.R.C.C.S., Via Portuense 292, 00149, Rome, Italy
| | - Stefania Cicalini
- National Institute for Infectious Diseases "L. Spallanzani" I.R.C.C.S., Via Portuense 292, 00149, Rome, Italy
| | - Adriana Ammassari
- National Institute for Infectious Diseases "L. Spallanzani" I.R.C.C.S., Via Portuense 292, 00149, Rome, Italy
| | - Chiara Agrati
- National Institute for Infectious Diseases "L. Spallanzani" I.R.C.C.S., Via Portuense 292, 00149, Rome, Italy
| | - Andrea Antinori
- National Institute for Infectious Diseases "L. Spallanzani" I.R.C.C.S., Via Portuense 292, 00149, Rome, Italy
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18
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Simoncini GM, Hou Q, Carlson K, Buchacz K, Tedaldi E, Palella F, Durham M, Li J. Disparities in Treatment with Direct-Acting Hepatitis C Virus Antivirals Persist Among Adults Coinfected with HIV and Hepatitis C Virus in US Clinics, 2010-2018. AIDS Patient Care STDS 2021; 35:392-400. [PMID: 34623891 PMCID: PMC10951816 DOI: 10.1089/apc.2021.0087] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) coinfection carries substantial risk for all-cause mortality and liver-related morbidity and mortality, yet many persons coinfected with HIV/HCV remain untreated for HCV. We explored demographic, clinical, and sociodemographic factors among participants in routine HIV care associated with prescription of direct-acting antivirals (DAAs). The HIV Outpatient Study (HOPS) is an ongoing longitudinal cohort study of persons with HIV in care at participating clinics since 1993. There are currently eight study sites in six US cities. We analyzed medical records data of HOPS participants diagnosed with HCV since June 2010. Sustained virological response (SVR) was documented with first undetectable HCV viral load (VL). We assessed factors associated with being prescribed DAAs by multi-variable logistic regression and described the cumulative rate of SVR. Among 306 eligible participants, 131 (43%) were prescribed DAA therapy. Factors associated with greater odds of being prescribed DAA were older age, private health insurance, higher CD4 cell count, being a person who injects drugs, and receiving care at publicly funded sites (p < 0.05). Of 127 (97%) participants with at least 1 follow-up HCV VL, 110 (87%) achieved SVR at 12 weeks. Of the total 131 participants, 123 (94%) eventually achieved SVR. Less than half of HIV/HCV coinfected patients in HOPS have been prescribed DAAs. Interventions are needed to address deficits in DAA prescription, including among patients with public or no health insurance, younger age, and lower CD4 cell count.
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Affiliation(s)
- Gina M. Simoncini
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | | | | | - Kate Buchacz
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ellen Tedaldi
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Frank Palella
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Marcus Durham
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jun Li
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Selfridge M, Cunningham EB, Barnett T, Drost A, Gray-Schleihauf C, Guarasci K, Lundgren K, Milne R, Grebely J, Fraser C. Reinfection following successful direct-acting antiviral therapy for HCV infection among people attending an inner-city community health centre in Victoria, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103418. [PMID: 34538704 DOI: 10.1016/j.drugpo.2021.103418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/08/2021] [Accepted: 08/06/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Studies of HCV reinfection following direct-acting antiviral (DAA) therapy among PWID have been limited by short follow-up and small case numbers. This study evaluated the incidence of HCV reinfection following successful DAA therapy among people attending an inner-city community health centre in Victoria, Canada. METHODS In this observational study, participants treated with DAA therapy between November 2014 and December 31, 2019 were included. Retrospective chart review was performed to assess demographics, recent injecting drug use at treatment initiation (previous six months), opioid agonist treatment (OAT), and HIV. Endpoints included sustained virologic response (SVR), HCV reinfection, and mortality. RESULTS Of 482 participants initiating DAA treatment, 30% were female, 46% were receiving OAT, 49% had recent injection drug use, 15% had HIV/HCV coinfection, and 22% had cirrhosis. Treatment completion was 97% (468/482; 12 discontinued therapy, and 2 died during treatment). SVR was 87% (418/482). Outcomes among those who completed treatment but did not achieve SVR (n=53), included loss to follow-up (n=11), HCV RNA for SVR testing not completed (n=18), viral relapse (n=6), reinfection (n=5) and viral recurrence (n=5, unable to distinguish viral relapse from reinfection), and death (n=7). The rate of HCV reinfection was 3.6/100 person-years (95% confidence interval [CI] 2.4-5.5; 22 cases; 602 person-years follow-up). Factors associated with an increased risk of HCV reinfection included recent injection drug use (adjusted relative risk [aRR] 8.55, 95% CI 1.98-36.96) and HIV co-infection (aRR 2.35, 95% CI 1.01-5.44). Fifty-five people died (overdose, n=19) during (n=2) or following (n=53) therapy (7.4/100 person-years; 95% CI 5.6-9.6). CONCLUSION This study demonstrates ongoing reinfection among a marginalized population at an inner-city community health centre, with higher rates among those with HIV and recent injecting drug use. The rates of reinfection and mortality highlight the importance of integrating HCV care with strategies to address drug-related harms.
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Affiliation(s)
| | | | | | - Anne Drost
- Cool Aid Community Health Centre, Victoria, Canada
| | | | | | | | - Roz Milne
- Cool Aid Community Health Centre, Victoria, Canada
| | | | - Chris Fraser
- Cool Aid Community Health Centre, Victoria, Canada
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20
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Llamosas-Falcón L, Shield KD, Gelovany M, Hasan OSM, Manthey J, Monteiro M, Walsh N, Rehm J. Impact of alcohol on the progression of HCV-related liver disease: A systematic review and meta-analysis. J Hepatol 2021; 75:536-546. [PMID: 33892007 DOI: 10.1016/j.jhep.2021.04.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 04/02/2021] [Accepted: 04/08/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND & AIMS Despite a marked reduction in new cases of cirrhosis caused by HCV infection, over 500,000 new cirrhosis cases in this category were estimated globally in 2019. This contribution quantifies the relationship between alcohol use and the progression of liver disease in people with HCV infections. METHODS The causal impact of different levels of alcohol use on cirrhosis has previously been established. The quantification of this relationship was undertaken based on a systematic search of the literature and a meta-analysis. We limited our search to longitudinal and case-control studies with biologically verified outcomes. Different sensitivity analyses were conducted to check on key assumptions and on the generalizability of the relationship. RESULTS Alcohol use has a dose-dependent relationship with incident cirrhosis, which is linear on the log-linear level, and thus exponential on the level of odds ratios or other risk indicators. Each standard drink of 12 grams of pure alcohol per day increases the risk by about 11%. The results were stable regardless of the statistical model used, level of adjustment, quality of the study, or outcome (i.e., cirrhosis, decompensated cirrhosis, liver-related death). CONCLUSIONS Alcohol use has a marked impact on the progression of HCV infections to cirrhosis and more severe liver outcomes. LAY SUMMARY Alcohol consumption has a significant impact on the progression of liver disease in people with HCV infections. Each alcoholic drink per day is associated with an increase in the risk of cirrhosis of 11%.
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Affiliation(s)
- Laura Llamosas-Falcón
- Preventive Medicine and Public Health, Hospital Universitario 12 de Octubre, Avda de Córdoba s/n, 28041 - Madrid, Spain; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, Canada, M5S 2S1
| | - Kevin D Shield
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, Canada, M5S 2S1; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada; World Health Organization / Pan American Health Organization Collaborating Centre, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, Canada, M5S 2S1
| | - Maya Gelovany
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, Canada, M5S 2S1
| | - Omer S M Hasan
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, Canada, M5S 2S1; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada
| | - Jakob Manthey
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany; Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; Department of Psychiatry, Medical Faculty, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany
| | - Maristela Monteiro
- Pan American Health Organization/ WHO Regional Office for the Americas, 525 23rd St, Washington DC 20037, USA
| | - Nick Walsh
- Pan American Health Organization/ WHO Regional Office for the Americas, 525 23rd St, Washington DC 20037, USA
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, Canada, M5S 2S1; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada; World Health Organization / Pan American Health Organization Collaborating Centre, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, Canada, M5S 2S1; Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany; Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, Canada, M5T 2S1; Faculty of Medicine, Institute of Medical Science, University of Toronto, Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, Ontario, Canada, M5S 1A8; Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario, Canada, M5T 1R8; Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya str., 8, b. 2, 119992, Moscow, Russian Federation.
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21
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Eletreby R, Esmat G, Elsharkawy A, Alsehemy L, Mohamed R, Alem SA, Yousof H, Cordie A, Lithy RM. HCV/HIV coinfected Egyptian patients: a cross-sectional study of their main characteristics and barriers to HCV treatment initiation. Trans R Soc Trop Med Hyg 2021; 116:227-232. [PMID: 34291286 DOI: 10.1093/trstmh/trab106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/23/2021] [Accepted: 06/30/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study investigates different barriers preventing a cohort of Egyptian HIV/HCV coinfected patients from accessing HCV treatment, despite being available and free of charge, aiming to improve the long-term outcomes of coinfected patients and decreasing their liver-related morbidity and mortality. METHODS This study included HIV patients who were referred to Kasr Alainy Viral Hepatitis Center to receive HCV treatment and who had to continue pretreatment assessment in order to receive direct acting antiviral agents free of charge. Patients who did not attend within 90 d were questioned via a telephone interview. Questions addressed sociodemographic status, HIV status and the main barriers to accessing healthcare. RESULTS Overall, 474 HIV/HCV coinfected patients were eligible for HCV treatment and 223 (47.1%) patients did not complete work-up for HCV treatment. Fear of community stigma concerning HIV/HCV was the most important barrier to compliance with treatment (73.3%), followed by lack of a supportive work environment and employment opportunities (51.5%), whereas 39.3% stopped follow-up due to the lack of integrated services in the healthcare facility. CONCLUSIONS Managing HCV in HCV/HIV coinfected patients still represents a major challenge, not only for healthcare providers, but also at a community level, to improve community awareness and manage the major obstacle facing those patients regarding community stigma.
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Affiliation(s)
- Rasha Eletreby
- Endemic Medicine Hepato-Gastroentrology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Gamal Esmat
- Endemic Medicine Hepato-Gastroentrology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.,Endemic Medicine and Hepato-Gastroentrology Department, Badr University, Cairo, Egypt
| | - Aisha Elsharkawy
- Endemic Medicine Hepato-Gastroentrology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Lamiaa Alsehemy
- Endemic Medicine Hepato-Gastroentrology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rahma Mohamed
- Endemic Medicine Hepato-Gastroentrology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Shereen Abdel Alem
- Endemic Medicine Hepato-Gastroentrology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hanaa Yousof
- Department of Public Health and Community Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt.,Scientific Research Department, Armed Forces College of Medicine (AFCM), Cairo, Egypt
| | - Ahmed Cordie
- Endemic Medicine Hepato-Gastroentrology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rania M Lithy
- Endemic Medicine Hepato-Gastroentrology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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22
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Liu CH, Sun HY, Hsieh SM, Liu WC, Sheng WH, Liu CJ, Su TH, Tseng TC, Chen PJ, Hung CC, Kao JH. Evolution of estimated glomerular filtration rate in human immunodeficiency virus and hepatitis C virus-coinfected patients receiving sofosbuvir-based direct-acting antivirals and antiretroviral therapy. J Viral Hepat 2021; 28:887-896. [PMID: 33759290 DOI: 10.1111/jvh.13502] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/06/2021] [Accepted: 02/26/2021] [Indexed: 12/13/2022]
Abstract
The nephrotoxicity of sofosbuvir (SOF) on human immunodeficiency virus and hepatitis C virus (HIV/HCV)-coinfected patients receiving antiretroviral therapy (ART) remains controversial. We prospectively compared the estimated glomerular filtration rate (eGFR) changes in 167 patients receiving SOF-based direct-acting antivirals (DAAs) who also received tenofovir disoproxil fumarate (TFV)-based (n = 116) and TFV-free ART (n = 51). The eGFR was assessed by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, and the eGFR changes between ART regimens were compared by the generalized estimated equation. During DAA treatment, participants on TFV-based ART had a higher eGFR decline than those on TFV-free ART (slope coefficient difference: -0.82 ml/min/1.73 m2 /month [95% CI: -1.21 to -0.43]; p < 0.001), whereas the eGFR changes did not differ between groups (slope coefficient difference: 0.13 ml/min/1.73 m2 /month [95% CI: -0.32 to 0.58]; p = 0.42) after discontinuing DAAs. Participants on TFV TDF-based ART had a higher eGFR decline than those on TFV alafenamide fumarate (TAF)-based ART (slope coefficient difference: -0.31 ml/min/1.73 m2 /month [95% CI: -0.50 to -0.12]; p = 0.01). After discontinuing DAAs, the eGFR changes did not differ between groups (slope coefficient difference: 0.06 ml/min/1.73 m2 /month [95% CI: -0.98 to 1.10]; p = 0.91). In conclusion, HIV/HCV-coinfected patients on TFV-based ART had a slight eGFR decline compared to those on TFV-free ART during SOF-based DAA therapy. A similar trend between TDF-based and TAF-based ART was also observed. Because the differences of eGFR changes are limited, the physicians should not discourage the use of SOF-based DAAs in HIV-positive patients on TFV-based ART.
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Affiliation(s)
- Chen-Hua Liu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Douliou, Taiwan
| | - Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Szu-Min Hsieh
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chun Liu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wang-Hui Sheng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Jen Liu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tung-Hung Su
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Tai-Chung Tseng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Jer Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,China Medical University, Taichung, Taiwan
| | - Jia-Horng Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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23
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Liver Fibrosis during Antiretroviral Treatment in HIV-Infected Individuals. Truth or Tale? Cells 2021; 10:cells10051212. [PMID: 34063534 PMCID: PMC8156893 DOI: 10.3390/cells10051212] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 12/13/2022] Open
Abstract
After the introduction of antiretroviral treatment (ART) back in 1996, the lifespan of people living with HIV (PLWH) has been substantially increased, while the major causes of morbidity and mortality have switched from opportunistic infections and AIDS-related neoplasms to cardiovascular and liver diseases. HIV itself may lead to liver damage and subsequent liver fibrosis (LF) through multiple pathways. Apart from HIV, viral hepatitis, alcoholic and especially non-alcoholic liver diseases have been implicated in liver involvement among PLWH. Another well known cause of hepatotoxicity is ART, raising clinically significant concerns about LF in long-term treatment. In this review we present the existing data and analyze the association of LF with all ART drug classes. Published data derived from many studies are to some extent controversial and therefore remain inconclusive. Among all the antiretroviral drugs, nucleoside reverse transcriptase inhibitors, especially didanosine and zidovudine, seem to carry the greatest risk for LF, with integrase strand transfer inhibitors and entry inhibitors having minimal risk. Surprisingly, even though protease inhibitors often lead to insulin resistance, they do not seem to be associated with a significant risk of LF. In conclusion, most ART drugs are safe in long-term treatment and seldom lead to severe LF when no liver-related co-morbidities exist.
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24
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The Impact of Markers of HIV Infection on Change in Liver Stiffness in People With HIV and Hepatitis C Virus Co-infection After Treatment and Cure of Hepatitis C. J Acquir Immune Defic Syndr 2021; 85:e81-e89. [PMID: 32842055 DOI: 10.1097/qai.0000000000002487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Markers of HIV disease severity are associated with increased liver fibrosis in HIV/Hepatitis C virus (HCV) co-infected individuals. HCV treatment may reverse liver fibrosis, but evidence among HIV/HCV-co-infected populations and the impact of HIV parameters on fibrosis regression is limited. We aimed to assess the influence of surrogate markers of HIV-infection and other determinants of liver stiffness before HCV treatment and changes after HCV cure in people living with HIV. METHODS We used data from an HCV treatment implementation study aiming for HCV micro-elimination among gay and bisexual men with HIV in Melbourne, Australia (co-EC Study). We obtained liver stiffness measurements (LSM) before and after direct-acting antiviral treatment using transient elastography (FibroScan). Linear mixed models were used to evaluate determinants of pretreatment LSM and changes in LSM following cure with duration in years between pre- and post-LSM assessment as main exposure variable. RESULTS At least one LSM was available in 173 participants, and 98 participants had 2 LSMs. Median pre- and post-treatment LSMs were 5.7 and 5.1 kPa, respectively. Median time between transient elastography measurements was 1.3 years (interquartile range = 0.9-2.1). In multivariable analysis, longer duration of known HIV infection, a lower CD4 and CD8 T-cell count and hazardous alcohol consumption were associated with higher LSM values before treatment initiation. Successfully treated patients had a 6% (95% confidence interval = -10% to -2%) annual decrease (0.34 kPa predicted decrease) in LSM following cure. Changes in LSM values did not depend on any of the pretreatment HIV markers or other factors. CONCLUSION Low levels of liver stiffness were observed before treatment initiation and a small decrease (6%) in LSM following HCV cure in people living with HIV. No clear predictors affecting change in LSM following cure were found in this study, including markers of HIV infection. However, markers of advanced HIV immunodeficiency and hazardous alcohol consumption remained associated with higher LSM values even after HCV cure.
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25
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Jatt LP, Gandhi MM, Guo R, Sukhija-Cohen A, Bhattacharya D, Tseng CH, Chew KW. Barriers to hepatitis C direct-acting antiviral therapy among HIV/hepatitis C virus-coinfected persons. J Gastroenterol Hepatol 2021; 36:1095-1102. [PMID: 32840904 PMCID: PMC7904967 DOI: 10.1111/jgh.15228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Direct-acting antivirals (DAAs) have increased hepatitis C virus (HCV) treatment opportunities for vulnerable HIV/HCV coinfected persons. The aim of this study was to identify the frequency of and potential barriers to DAA prescription in HIV/HCV patients during the first few years of DAA availability in the United States. METHODS The AIDS Healthcare Foundation electronic medical record system was queried to identify all HCV viremic HIV-infected patients in care at AIDS Healthcare Foundation Healthcare centers in January 2015-August 2017 and compare characteristics by receipt of a DAA prescription. Multivariate logistic regression analyses were conducted to examine factors associated with DAA prescription. RESULTS Of 826 eligible patients, 355 (43%) were prescribed a DAA; among those not prescribed a DAA, 301 (64%) had well-controlled HIV (HIV RNA ≤ 200 copies per mL). In multivariate logistic regression analysis, patients with a history of substance use (odds ratio [OR], 0.51 [95% confidence interval 0.35-0.73]) or on select HIV antiretroviral regimens were less likely to be prescribed a DAA. Those who had well-controlled HIV (OR, 5.03 [3.06-8.27]), CD4 + T cell count >200 cells per mm3 (OR, 1.85 [1.04-3.30]), estimated glomerular filtration rate >60 mL/min/1.73 m2 (OR, 3.32 [1.08-10.15]), or established care prior to January 2015 (OR, 1.57 [1.08-2.29] were more likely to be prescribed a DAA. CONCLUSIONS In addition to lack of HIV suppression, select antiretroviral regimens, substance use, and kidney disease appeared to limit DAA prescription in the early interferon-free DAA era. Many were not prescribed DAAs despite HIV suppression. Further research is needed to determine if the observed associations persist today.
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Affiliation(s)
- Lauren P Jatt
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Malini M Gandhi
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Rong Guo
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Adam Sukhija-Cohen
- Public Health Division, AIDS Healthcare Foundation, Los Angeles, California, USA
| | - Debika Bhattacharya
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Chi-Hong Tseng
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Kara W Chew
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
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26
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Irvin R, Ntiri-Reid B, Kleinman M, Agee T, Hitt J, Anaedozie O, Arowolo T, Cassidy-Stewart H, Bush C, Wilson LE, Millman AJ, Nelson NP, Canary L, Brinkley S, Moon J, Falade-Nwulia O, Sulkowski MS, Thomas DL, Melia MT. Sharing the cure: Building primary care and public health infrastructure to improve the hepatitis C care continuum in Maryland. J Viral Hepat 2020; 27:1388-1395. [PMID: 32671942 PMCID: PMC7721959 DOI: 10.1111/jvh.13360] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/23/2020] [Accepted: 07/01/2020] [Indexed: 12/14/2022]
Abstract
In 2014, trained healthcare provider capacity was insufficient to deliver care to an estimated 70 000 persons in Maryland with chronic hepatitis C virus (HCV) infection. The goal of Maryland Community Based Programs to Test and Cure Hepatitis C, a public health implementation project, was to improve HCV treatment access by expanding the workforce. Sharing the Cure (STC) was a package of services deployed 10/1/14-9/30/18 that included enhanced information technology and public health infrastructure, primary care provider training and practice transformation. Nine primary care sites enrolled. HCV clinical outcomes were documented among individuals who presented for care at sites and met criteria for HCV testing including risk factor or birth cohort (born between 1945 and 1965) based testing. Fifty-three providers completed the STC training. STC providers identified 3237 HCV antibody-positive patients of which 2624 (81%) were RNA+. Of those HCV RNA+, 1739 (66%) were staged, 932 (36%) were prescribed treatment, 838 (32%) started treatment, 721 (27%) completed treatment and 543 (21%) achieved cure. Among 1739 patients staged, 693 (40%) patients had a liver fibrosis assessment score < F2, rendering them ineligible for treatment under Maryland Medicaid guidelines. HCV RNA testing among HCV antibody-positive people increased from 40% (baseline) to 95% among STC providers. Of 554 patients with virologic data reported, 543 (98%) achieved cure. Primary care practices can effectively serve as HCV treatment centers to expand treatment access. However, criteria by insurance providers in Maryland were a major barrier to treatment.
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Affiliation(s)
- Risha Irvin
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Boatemaa Ntiri-Reid
- Infectious Disease Prevention and Health Services Bureau, Maryland Department of Health, Baltimore, MD, United States
| | - Mary Kleinman
- Infectious Disease Prevention and Health Services Bureau, Maryland Department of Health, Baltimore, MD, United States
| | - Tracy Agee
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jeffrey Hitt
- Infectious Disease Prevention and Health Services Bureau, Maryland Department of Health, Baltimore, MD, United States
| | - Onyeka Anaedozie
- Infectious Disease Prevention and Health Services Bureau, Maryland Department of Health, Baltimore, MD, United States
| | - Tolu Arowolo
- Infectious Disease Prevention and Health Services Bureau, Maryland Department of Health, Baltimore, MD, United States
| | - Hope Cassidy-Stewart
- Infectious Disease Prevention and Health Services Bureau, Maryland Department of Health, Baltimore, MD, United States
| | - CaSaundra Bush
- Infectious Disease Prevention and Health Services Bureau, Maryland Department of Health, Baltimore, MD, United States
| | - Lucy E. Wilson
- Infectious Disease Prevention and Health Services Bureau, Maryland Department of Health, Baltimore, MD, United States
| | - Alexander J. Millman
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Noele P. Nelson
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Lauren Canary
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sherilyn Brinkley
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Juhi Moon
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Oluwaseun Falade-Nwulia
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mark S. Sulkowski
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - David L. Thomas
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michael T. Melia
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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27
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Tamori A, Uchida-Kobayashi S, Kozuka R, Motoyama H, Yoshida K, Odagiri N, Kotani K, Kawamura E, Fujii H, Hagihara A, Enomoto M, Kawada N. High dropout rate from aftercare program of antihepatitis C therapy for patients with history of injection drug use. JGH Open 2020; 4:964-969. [PMID: 33102771 PMCID: PMC7578294 DOI: 10.1002/jgh3.12376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/13/2020] [Accepted: 06/04/2020] [Indexed: 12/16/2022]
Abstract
Background and Aim We assessed direct‐acting antiviral (DAA) treatment for patients with hepatitis C virus (HCV) and a history of injection drug use (IDU) in Japan. Method This retrospective observational study was based on clinical records. Overall, 804 DAA‐naïve HCV‐infected patients were enrolled, treated with a 12‐week regimen of DAAs, and had available information about a history of IDU. Anti‐HCV efficacy was defined as a sustained viral response 12 weeks post‐treatment (SVR12) only in patients who were assessed after 12 weeks [modified intention‐to‐treat (ITT) analyses]. We compared the antiviral effect between patients with (past‐IDU) and without a history of IDU (non‐IDU). We also evaluated the characteristics of each group, including the overall dropout rate and economic background. Results Overall, 78 (9.7%) patients had a history of IDU. Compared to the non‐IDU group at baseline, the past‐IDU group consisted of predominantly male and younger patients infected with HCV genotype 2. Overall, 3% (3/78) and 16% (116/726) of the patients had cirrhosis in the past‐IDU and non‐IDU group, respectively. There was a significantly higher rate of welfare recipients in the past‐IDU group. SVR rate was 97% (59/61) in the past‐IDU group and 99% (689/699) in the non‐IDU group. The cumulative rate of dropout from an aftercare program was high in the past‐IDU group (P < 0.01). Conclusions DAAs had a remarkable anti‐HCV effect in patients with past‐IDU who continued in an aftercare program. It is necessary to understand the characteristics of past‐IDU patients to establish a support system for aftercare programs.
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Affiliation(s)
- Akihiro Tamori
- Department of Hepatology, Graduate School of Medicine Osaka City University Osaka Japan
| | | | - Ritsuzo Kozuka
- Department of Hepatology, Graduate School of Medicine Osaka City University Osaka Japan
| | - Hiroyuki Motoyama
- Department of Hepatology, Graduate School of Medicine Osaka City University Osaka Japan
| | - Kanako Yoshida
- Department of Hepatology, Graduate School of Medicine Osaka City University Osaka Japan
| | - Naoshi Odagiri
- Department of Hepatology, Graduate School of Medicine Osaka City University Osaka Japan
| | - Kohei Kotani
- Department of Hepatology, Graduate School of Medicine Osaka City University Osaka Japan
| | - Etsushi Kawamura
- Department of Hepatology, Graduate School of Medicine Osaka City University Osaka Japan
| | - Hideki Fujii
- Department of Premier Preventive Medicine, Graduate School of Medicine Osaka City University Osaka Japan
| | - Atsushi Hagihara
- Department of Hepatology, Graduate School of Medicine Osaka City University Osaka Japan
| | - Masaru Enomoto
- Department of Hepatology, Graduate School of Medicine Osaka City University Osaka Japan
| | - Norifumi Kawada
- Department of Hepatology, Graduate School of Medicine Osaka City University Osaka Japan
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Wekesa C, Kirk GD, Aizire J, Benson EM, Karabarinde A, Parkes-Ratanshi R, Ocama P. Prevalence and Factors Associated With Liver Fibrosis Among Adult HIV-Infected Patients Attending Urban and Rural Care Clinics in Uganda. Open Forum Infect Dis 2020; 7:ofaa483. [PMID: 33241065 PMCID: PMC7676506 DOI: 10.1093/ofid/ofaa483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/07/2020] [Indexed: 12/25/2022] Open
Abstract
Background Liver fibrosis is common among HIV-infected patients. Risk factors vary by location. Understanding this variation may inform prevention strategies. We compared the prevalence and correlates of liver fibrosis among HIV-infected patients attending care clinics in Uganda. Methods This was a cross-sectional study involving 2030 HIV-infected patients attending care clinics in urban and rural Uganda. Liver fibrosis was defined as liver stiffness measurement (LSM) >7.1 KPa. Proportions and correlates of liver fibrosis were assessed and compared using logistic regression stratified by gender and site. Results Prevalence of liver fibrosis was higher among participants in the rural clinic (15% vs 11%; P = .017). History of tobacco use (urban P = .022; rural P = .035) and serologic evidence of hepatitis C infection (HCV; urban P = .028; rural P = .03) was associated with liver fibrosis in all men. Elevated liver transaminases (urban P = .002; rural P = .028) and increasing age (urban P = .008; rural P = .052) were risk factors among all women. Tobacco use among women was only a risk factor in those attending the rural clinic (P = .003), and detectable HIV viral load (P = .002) for men in the urban clinic. Conclusions Liver fibrosis is prevalent among HIV-infected persons in Uganda. HIV viral suppression and avoiding tobacco may be strategies to prevent liver fibrosis and cancer risk.
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Affiliation(s)
- Clara Wekesa
- MRC/UVRI and London School of Hygiene and Tropical Medicine Uganda Research, Entebbe, Uganda.,HIV and HCC in Uganda (H2U) Consortium, Infectious Diseases Institute, Kampala, Uganda
| | - Gregory D Kirk
- John Hopkins University, Baltimore, Maryland, USA.,HIV and HCC in Uganda (H2U) Consortium, Infectious Diseases Institute, Kampala, Uganda
| | - Jim Aizire
- John Hopkins University, Baltimore, Maryland, USA.,HIV and HCC in Uganda (H2U) Consortium, Infectious Diseases Institute, Kampala, Uganda
| | - Eve-Marie Benson
- John Hopkins University, Baltimore, Maryland, USA.,HIV and HCC in Uganda (H2U) Consortium, Infectious Diseases Institute, Kampala, Uganda
| | - Alex Karabarinde
- MRC/UVRI and London School of Hygiene and Tropical Medicine Uganda Research, Entebbe, Uganda
| | | | - Ponsiano Ocama
- HIV and HCC in Uganda (H2U) Consortium, Infectious Diseases Institute, Kampala, Uganda.,Makerere University, College of Health Sciences, Kampala, Uganda
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29
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Liu CH, Kao JH. Last Mile to Microelimination of Hepatitis C Virus Infection Among People Living With Human Immunodeficiency Virus. Clin Infect Dis 2020; 73:e2172-e2174. [DOI: 10.1093/cid/ciaa1499] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 09/29/2020] [Indexed: 12/18/2022] Open
Affiliation(s)
- Chen-Hua Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Douliou, Taiwan
| | - Jia-Horng Kao
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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30
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Falade-Nwulia O, Gicquelais RE, Astemborski J, McCormick SD, Kirk G, Sulkowski M, Thomas DL, Mehta SH. Hepatitis C treatment uptake among people who inject drugs in the oral direct-acting antiviral era. Liver Int 2020; 40:2407-2416. [PMID: 32770638 PMCID: PMC7706292 DOI: 10.1111/liv.14634] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/22/2020] [Accepted: 07/20/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Increased uptake of hepatitis C virus (HCV) treatment among people who inject drugs (PWID) will be critical to achieve HCV elimination goals. There are limited data on HCV treatment uptake among PWID recruited from community-based settings in the HCV direct-acting antiviral (DAA) era. METHODS We analysed data from PWID with HCV newly recruited into the Baltimore, Maryland-based AIDS Linked to the IntraVenous Experience (ALIVE) cohort between 2015 and 2018. We characterized the HCV care continuum and evaluated factors associated with HCV treatment uptake. RESULTS Of the 418 PWID with HCV, the median age was 49 years and most (88%) reported recent injection drug use (IDU). Overall, 23% had ever been evaluated by a provider for HCV treatment, 17% ever initiated DAA treatment and 13% were cured of HCV infection. Treatment uptake approximately doubled between 2015 and 2018 (13% to 26%, P = .01). In multivariable analyses, HIV infection (adjusted Odds Ratio [aOR] 2.5 [95% Confidence Interval (CI) 1.3, 4.8]), current employment (aOR 4.1 [CI 1.2, 14.4]), having a primary care provider (aOR 4.3 [CI 1.2, 14.9) and longer duration of IDU (aOR 1.3 [CI 1.1, 1.6]) were positively associated with HCV treatment. PWID with a lower annual income (≤$5000) were less likely to have initiated HCV treatment (aOR 0.5 [CI 0.3, 0.98]). CONCLUSIONS Although HCV treatment uptake among PWID in this community-based setting in the DAA era remains suboptimal, it is encouraging that treatment uptake has increased in recent years. Innovative strategies are needed to reach all PWID infected with HCV.
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Affiliation(s)
| | - Rachel E. Gicquelais
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jacquie Astemborski
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sean D. McCormick
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Greg Kirk
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mark Sulkowski
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David L. Thomas
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shruti H. Mehta
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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31
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Zheng YX, Ma SJ, Xiong YH, Fan XG. Efficacy and safety of direct acting antiviral regimens for hepatitis C virus and human immunodeficiency virus co-infection: systematic review and network meta-analysis. J Gastroenterol Hepatol 2020; 35:1477-1487. [PMID: 32246857 DOI: 10.1111/jgh.15051] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 03/07/2020] [Accepted: 03/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Various all-oral direct-acting antiviral (DAA) regimens are being widely used in the treatment of human immunodeficiency virus (HIV)/hepatitis C virus (HCV) co-infected patients; however, the comparative efficacy and safety of different types and combinations of DAAs are not completely clear. There is still a lack of integration of evidence for optimized therapies for HIV/HCV co-infection. METHODS We conducted a systematic literature search in several databases up to January 1, 2020. All the studies that reported the sustained virologic response (SVR) and adverse events of DAAs in HIV/HCV co-infected patients were included. The Bayesian Markov Chain Monte Carlo method was used for the pooled estimates of network meta-analysis. RESULTS We identified 33 eligible articles with 7 combinations of all-oral DAAs for the analyses of efficacy and safety. Grazoprevir-elbasvir ± ribavirin (GZR/EBR ± RBV: 95.6%; 95% CrI, 91.7-98.1%), ombitasvir/paritaprevir/ritonavir and dasabuvir ± ribavirin (3D ± RBV: 95.3%; 95% CrI, 93.4-96.9%), sofosbuvir-ledipasvir ± ribavirin (SOF/LDV ± RBV: 95.2%; 95% CrI, 93.7-96.6%), and sofosbuvir-daclatasvir ± ribavirin (SOF/DCV ± RBV: 94.8%; 95% CrI, 92.5-96.6%) were the most effective combinations for HIV/HCV co-infected patients, with SVR rates of approximately 94% and above while severe adverse events were rare. However, the SVR rates of sofosbuvir-ribavirin (SOF/RBV) and sofosbuvir-simeprevir ± ribavirin (SOF/SMV ± RBV) both failed to reach 90%, and the incidences of adverse events were higher than 5%. CONCLUSIONS Efficacy and safety of all-oral DAAs were in prospect for HIV/HCV co-infection patients. GZR/EBR ± RBV was the optimal combination recommended for HIV/HCV co-infected patients based on the excellent treatment effects and insignificant adverse events.
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Affiliation(s)
- Yi-Xiang Zheng
- Department of Infectious Diseases, Key Laboratory of Viral Hepatitis of Hunan, Xiangya Hospital, Central South University, Changsha, China
| | - Shu-Juan Ma
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, China
| | - Ying-Hui Xiong
- Department of Infectious Diseases, Key Laboratory of Viral Hepatitis of Hunan, Xiangya Hospital, Central South University, Changsha, China
| | - Xue-Gong Fan
- Department of Infectious Diseases, Key Laboratory of Viral Hepatitis of Hunan, Xiangya Hospital, Central South University, Changsha, China
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Androutsakos T, Schina M, Pouliakis A, Kontos A, Sipsas N, Hatzis G. Liver Fibrosis Assessment in a Cohort of Greek HIV Mono-Infected Patients by Non-Invasive Biomarkers. Curr HIV Res 2020; 17:173-182. [PMID: 31549590 DOI: 10.2174/1570162x17666190809153245] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/26/2019] [Accepted: 08/03/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Non-alcoholic Fatty Liver Disease (NAFLD) is common in HIV-infected individuals. Liver biopsy remains the gold-standard procedure for the diagnosis of liver fibrosis, but both Transient Elastography (TE) and Non-invasive Biomarkers (NIBMs) have emerged as alternatives. OBJECTIVES Our study's aim was to validate commonly used NIBMs for the assessment of liver fibrosis in a cohort of Greek HIV-mono-infected patients. METHODS Inclusion criteria were confirmed HIV-infection and age>18 years and exclusion criteria HBV or HCV seropositivity, liver disease other than NAFLD, alcohol abuse, ascites, transaminases levels>4xULN(upper limit of normal) and Body-Mass index(BMI)>40. Liver stiffness (LS) measurement with TE and thorough laboratory work up and medical history were acquired at study entry. FIB-4, APRI, NFS, BARD, Forns and Lok scores were calculated for each patient. RESULTS A total of 157 patients were eligible for this study. Significant liver fibrosis, compatible with Metavir score of F3-F4, was found in only 11(7%) patients. These findings were in accordance with those of the NIBMs; the BARD score constituting the only exception, allocating 102(65%) patients as having significant liver fibrosis. In order to obtain a balance between sensitivity and specificity new cut-offs for each NIBM were calculated; FIB-4 score yielded the best results, since by changing the cut-off to 1.49 a sensitivity and specificity balanced for both close to 85% was achieved. CONCLUSION Our findings suggest that NIBMs can be used for the evaluation of liver fibrosis in HIV mono-infected patients. New cut-offs for NIBMs should probably be calculated, to help distinguishing patients with significant from those with mild/no fibrosis.
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Affiliation(s)
- Theodoros Androutsakos
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Schina
- Liver unit, Euroclinic of Athens, Athens, Greece
| | - Abraham Pouliakis
- Second Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Nikolaos Sipsas
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Infectious Diseases Unit, Laiko General Hospital, Athens, Greece
| | - Gregorios Hatzis
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Chan J, Schwartz J, Kaba F, Bocour A, Akiyama MJ, Hobstetter L, Rosner Z, Winters A, Yang P, MacDonald R. Outcomes of Hepatitis C Virus Treatment in the New York City Jail Population: Successes and Challenges Facing Scale up of Care. Open Forum Infect Dis 2020; 7:ofaa263. [PMID: 33123613 PMCID: PMC7580175 DOI: 10.1093/ofid/ofaa263] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/23/2020] [Indexed: 12/19/2022] Open
Abstract
Background The population detained in the New York City (NYC) jail system bears a high burden of hepatitis C virus (HCV) infection. Challenges to scaling up treatment include short and unpredictable lengths of stay. We report on the clinical outcomes of direct-acting antiviral (DAA) treatment delivered by NYC Health + Hospitals/Correctional Health Services in NYC jails from 2014 to 2017. Methods We performed a retrospective observational cohort study of HCV patients with detectable HCV ribonucleic acid treated with DAA therapy while in NYC jails. Some patients initiated treatment in jail, whereas others initiated treatment in the community and were later incarcerated. Our primary outcome was sustained virologic response at 12 weeks (SVR12). Results There were 269 patients included in our cohort, with 181 (67%) initiating treatment in jail and 88 (33%) continuing treatment started in the community. The SVR12 virologic outcome data were available for 195 (72%) individuals. Of these, 172 (88%) achieved SVR12. Patients who completed treatment in jail were more likely to achieve SVR12 relative to those who were released on treatment (adjusted risk ratio, 2.93; 95% confidence interval, 1.35-6.34). Of those who achieved SVR12, 114 (66%) had a subsequent viral load checked. We detected recurrent viremia in 18 (16%) of these individuals, which corresponded to 10.6 cases per 100 person-years of follow-up. Conclusions Hepatitis C virus treatment with DAA therapy is effective in a jail environment. Future work should address challenges related to discharging patients while they are on treatment, loss to follow-up, and a high incidence of probable reinfection.
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Affiliation(s)
- Justin Chan
- Correctional Health Services, NYC Health + Hospitals, New York, New York, USA
| | - Jessie Schwartz
- Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Fatos Kaba
- Correctional Health Services, NYC Health + Hospitals, New York, New York, USA
| | - Angelica Bocour
- Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Matthew J Akiyama
- Correctional Health Services, NYC Health + Hospitals, New York, New York, USA.,Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Laura Hobstetter
- Correctional Health Services, NYC Health + Hospitals, New York, New York, USA
| | - Zachary Rosner
- Correctional Health Services, NYC Health + Hospitals, New York, New York, USA
| | - Ann Winters
- Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Patricia Yang
- Correctional Health Services, NYC Health + Hospitals, New York, New York, USA
| | - Ross MacDonald
- Correctional Health Services, NYC Health + Hospitals, New York, New York, USA
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34
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Irvin R, Chander G, Ward KM, Manogue S, Falade-Nwulia O, Moon J, Sutcliffe CG, Brinkley S, Haselhuhn T, Katz S, Herne K, Arteaga L, Thomas DL, Mehta SH, Sulkowski MS. Unreported alcohol use was common but did not impact hepatitis C cure in HIV-infected persons who use drugs. J Viral Hepat 2020; 27:476-483. [PMID: 31854069 PMCID: PMC7890377 DOI: 10.1111/jvh.13251] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/19/2019] [Accepted: 11/25/2019] [Indexed: 12/20/2022]
Abstract
We investigated the prevalence and impact of heavy alcohol use on the hepatitis C virus (HCV) care continuum amongst HIV/HCV co-infected persons who use drugs. In the CHAMPS study, 144 HIV/HCV co-infected persons were randomized to contingent cash incentives, peer mentors and usual care to evaluate the impact on HCV care. Alcohol use was ascertained using the 10-item AUDIT (hazardous: male ≥8, female ≥4) and phosphatidylethanol (PEth) (heavy: ≥50 ng/mL), an alcohol biomarker. Log binomial regression was used to evaluate the association between heavy alcohol use and failure to initiate treatment and to achieve sustained virologic response (SVR). Of the 135 participants with PEth data, median age was 55 years, 59% were male, 92% were Black, 91% reported a history of drug use, and 97% were on antiretroviral therapy. Hazardous drinking was reported on AUDIT by 28% of participants, and 35% had heavy alcohol use by PEth. Of the 47 individuals with a PEth ≥50 ng/mL, 23 (49%) reported no or minimal alcohol use by AUDIT. HCV treatment was initiated in 103 of 135 participants, and SVR was achieved in 92%. PEth ≥50 ng/mL (Relative Risk [RR] 0.72, 95% CI 0.35-1.48) was not significantly associated with failure to initiate HCV treatment or failure to achieve SVR (RR 0.85, 95% CI 0.46-1.57).In conclusion, alcohol use was common and frequently not detected by self-report. However, heavy alcohol use, even when measured objectively, was not associated with failure to initiate HCV treatment or to achieve cure.
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Affiliation(s)
- Risha Irvin
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kathleen M. Ward
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Sean Manogue
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Oluwaseun Falade-Nwulia
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Juhi Moon
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Catherine G. Sutcliffe
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Sherilyn Brinkley
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Taryn Haselhuhn
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Stephanie Katz
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kayla Herne
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Lilian Arteaga
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - David L. Thomas
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Shruti H. Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Mark S. Sulkowski
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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35
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Falade-Nwulia O, Sacamano P, McCormick SD, Yang C, Kirk G, Thomas D, Sulkowski M, Latkin C, Mehta SH. Individual and network factors associated with HCV treatment uptake among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 78:102714. [PMID: 32135398 DOI: 10.1016/j.drugpo.2020.102714] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/15/2020] [Accepted: 02/23/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) treatment uptake among people who inject drugs (PWID), a population with disproportionately high rates of HCV, remains low. Peers have been shown to positively impact a broad range of health outcomes for PWID. There is, however, limited data on the impact of PWID social network members on HCV treatment. METHODS HCV-infected PWID enrolled in an ongoing community-based cohort were recruited as "indexes" to complete an egocentric social network survey. The survey elicited from the index PWID a list of their network members and the index's perception of network member characteristics. Logistic regression analyses were conducted to compare individual and network factors associated with HCV treatment in the index PWID. RESULTS Among 540 HCV-infected PWID, the mean age was 55.7 years and the majority were black (87.2%) and male (69.8%). PWID reported a mean of 4.4 (standard deviation [SD] 3.2) network members, most of whom were relatives (mean 2.2 [SD 1.5]). In multivariable analysis, increasing index age and HIV infection were positively associated with HCV treatment, while drug use and homelessness in the preceding 6 months were negatively associated with HCV treatment. From a network perspective, having at least one network member who regularly talked with the index about seeing their doctor for HIV care was associated with HCV treatment (Adjusted Odds Ratio [AOR] 2.7; 95% Confidence Interval (CI) [1.3, 5.6]). Conversely, PWID who had at least one network member who helped them understand their HCV care were less likely to have been HCV treated (AOR 0.2; CI [0.1, 0.6). CONCLUSION HCV treatment uptake in this group of PWID appeared to be positively influenced by discussions with network members living with HIV who were in care and negatively influenced by HCV information sharing within PWID networks. These findings underscore the influence of peers on health seeking behaviors of their network members and emphasizes the importance of well-informed peers.
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Affiliation(s)
- Oluwaseun Falade-Nwulia
- Johns Hopkins University School of Medicine, 725 N. Wolfe Street, Suite 215, Baltimore, MD 21205, USA.
| | - Paul Sacamano
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sean D McCormick
- Johns Hopkins University School of Medicine, 725 N. Wolfe Street, Suite 215, Baltimore, MD 21205, USA
| | - Cui Yang
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Greg Kirk
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - David Thomas
- Johns Hopkins University School of Medicine, 725 N. Wolfe Street, Suite 215, Baltimore, MD 21205, USA
| | - Mark Sulkowski
- Johns Hopkins University School of Medicine, 725 N. Wolfe Street, Suite 215, Baltimore, MD 21205, USA
| | - Carl Latkin
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shruti H Mehta
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Banga J, Nizami S, Slim J, Nagarakanti S, Portilla M, Swaminathan S. Hepatitis C virus treatment response to ledipasvir/sofosbuvir among patients coinfected with HIV and HCV: Real world data in a black population. Medicine (Baltimore) 2020; 99:e19140. [PMID: 32176039 PMCID: PMC7440318 DOI: 10.1097/md.0000000000019140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Treatment of hepatitis C virus (HCV) infection for patients with human immunodeficiency virus (HIV) has improved with direct acting antivirals. However, outcomes among Black persons treated with ledipasvir/sofosbuvir (LDV/SOF) may be inferior to non-Blacks. We assessed responses to LDV/SOF in a cohort of Black HIV/HCV coinfected persons.Retrospective chart reviews were conducted for Black, genotype 1 (GT1), HIV/HCV coinfected patients treated with LDV/SOF at 3 hospitals in Newark, NJ between January 2014 and July 2016. Data collected included demographics, HCV treatment history, treatment duration, and response.One hundred seventeen HIV/HCV coinfected Black patients started treatment with LDV/SOF but 5 had no follow-up data and 5 prematurely discontinued treatment (1 due to side effects). We included 107 HIV/HCV coinfected patients who completed LDV/SOF at all 3 sites. The study population was 65% male, median age 58 years, 26% had cirrhosis, and 78% had GT1a. Thirty-one percent were treatment experienced but none with prior NS5a treatment. At baseline, median CD4 count was 680 cells/mm, HIV viral load (VL) was <40 copies/mL in 94% and median HCV VL was 2,257,403 IU/mL. Twenty-nine percent of patients changed antiretroviral treatment before LDV/SOF treatment due to drug interactions. Six, 89, and 12 patients completed 8, 12, and 24 weeks of LDV/SOF, respectively. Overall sustained virologic response rate was 93% with 7 relapses.In this real-world cohort of Black, GT1, HIV/HCV coinfected patients, LDV/SOF had high sustained virologic response 12 weeks post completion of treatment rate of 93%. This data supports the overall high efficacy of LDV/SOF in a historically difficult-to-treat patient population.
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Collins LF, Adekunle RO, Cartwright EJ. Metabolic Syndrome in HIV/HCV Co-infected Patients. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2020; 11:351-371. [PMID: 32030090 DOI: 10.1007/s40506-019-00207-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose of review We review the scope and burden of metabolic syndrome in HIV/HCV co-infected patients, risk factors and potential mechanisms driving the increased cardio-metabolic risk in this population, and discuss relevant clinical considerations for management in the era of highly effective antiretroviral therapy (ART) and curative anti-HCV direct-acting antivirals. Recent findings HIV/HCV co-infected patients are at elevated risk of metabolic syndrome, attributed to (1) patient-specific factors, (2) viral-mediated effects, and (3) ART exposure. Risk factors for cardio-metabolic disorders are common in this population and include poor socioeconomic conditions, substance use, cardiovascular comorbidities, and liver/kidney disease. Chronic HIV/HCV infection induces an inflammatory and immune activated state in the host leading to alterations in glucose and lipid metabolism. Selection of life-saving ART must carefully consider the differential metabolic risk associated with each drug class and agent, such as dyslipidemia, hyperglycemia and insulin resistance, weight gain and hypertension. Emerging evidence supports metabolic derangements in chronic HCV may be improved by viral eradication with direct-acting antivirals, however, additional study in HIV/HCV co-infected patients is needed. Summary Future research programs should aim to better characterize metabolic syndrome in HIV/HCV co-infected patients with the goal of improved screening, treatment and prevention.
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Affiliation(s)
- Lauren F Collins
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Ruth O Adekunle
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Emily J Cartwright
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Atlanta VA Medical Center, Decatur, GA, USA
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Levine A, Sacktor N, Becker JT. Studying the neuropsychological sequelae of SARS-CoV-2: lessons learned from 35 years of neuroHIV research. J Neurovirol 2020; 26:809-823. [PMID: 32880873 PMCID: PMC7471564 DOI: 10.1007/s13365-020-00897-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/11/2020] [Accepted: 08/18/2020] [Indexed: 01/14/2023]
Abstract
The virology of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and the human immune response to the virus are under vigorous investigation. There are now several reports describing neurological symptoms in individuals who develop coronavirus disease 2019 (COVID-19), the syndrome associated with SARS-CoV-2 infection. The prevalence, incidence, and clinical course of these symptoms will become clearer in the coming months and years through epidemiological studies. However, the long-term neurological and cognitive consequence of SARS-CoV-2 infection will remain conjectural for some time and will likely require the creation of cohort studies that include uninfected individuals. Considering the early evidence for neurological involvement in COVID-19 it may prove helpful to compare SARS-CoV-2 with another endemic and neurovirulent virus, human immunodeficiency virus-1 (HIV-1), when designing such cohort studies and when making predictions about neuropsychological outcomes. In this paper, similarities and differences between SARS-CoV-2 and HIV-1 are reviewed, including routes of neuroinvasion, putative mechanisms of neurovirulence, and factors involved in possible long-term neuropsychological sequelae. Application of the knowledge gained from over three decades of neuroHIV research is discussed, with a focus on alerting researchers and clinicians to the challenges in determining the cause of neurocognitive deficits among long-term survivors.
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Affiliation(s)
- Andrew Levine
- grid.19006.3e0000 0000 9632 6718Department of Neurology David Geffen School of Medicine, University of California, Los Angeles, CA 90095 USA
| | - Ned Sacktor
- grid.21107.350000 0001 2171 9311Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205 USA
| | - James T. Becker
- grid.21925.3d0000 0004 1936 9000Departments of Psychiatry, Neurology, and Psychology, University of Pittsburgh, Pittsburgh, PA 15260 USA
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Breskin A, Westreich D, Hurt CB, Cole SR, Hudgens MG, Seaberg EC, Thio CL, Tien PC, Adimora AA. The Effects of Hepatitis C Treatment Eligibility Criteria on All-cause Mortality Among People With Human Immunodeficiency Virus. Clin Infect Dis 2019; 69:1613-1620. [PMID: 30615096 PMCID: PMC6792128 DOI: 10.1093/cid/ciz008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 01/04/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The cost of direct-acting antivirals (DAAs) for hepatitis C virus (HCV) prompted many payers to restrict treatment to patients who met non-evidence-based criteria. These restrictions have implications for survival of people with HCV, especially for people with human immunodeficiency virus (HIV)/HCV coinfection who are at high risk for liver disease progression. The goal of this work was to estimate the effects of DAA access policies on 10-year all-cause mortality among people with HIV. METHODS The study population included 3056 adults with HIV in the Women's Interagency HIV Study and Multicenter AIDS Cohort Study from 1 October 1994 through 30 September 2015. We used the parametric g-formula to estimate 10-year all-cause mortality under DAA access policies that included treating (i) all people with HCV; (ii) only people with suppressed HIV; (iii) only people with severe fibrosis; and (iv) only people with HIV suppression and severe fibrosis. RESULTS The 10-year risk difference of treating all coinfected persons with DAAs compared with no treatment was -3.7% (95% confidence interval [CI], -9.1% to .6%). Treating only those with suppressed HIV and severe fibrosis yielded a risk difference of -1.1% (95% CI, -2.8% to .6%), with 51% (95% CI, 38%-59%) of coinfected persons receiving DAAs. Treating a random selection of 51% of coinfected persons at baseline decreased the risk by 1.9% (95% CI, -4.7% to .3%). CONCLUSIONS Restrictive DAA access policies may decrease survival compared to treating similar proportions of people with HIV/HCV coinfection with DAAs at random. These findings suggest that lives could be saved by thoughtfully revising access policies.
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Affiliation(s)
- Alexander Breskin
- Department of EpidemiologyInstitute for Global Health and Infectious Diseases, Baltimore, Maryland
| | - Daniel Westreich
- Department of EpidemiologyInstitute for Global Health and Infectious Diseases, Baltimore, Maryland
| | - Christopher B Hurt
- Institute for Global Health and Infectious Diseases, Baltimore, Maryland
| | - Stephen R Cole
- Department of EpidemiologyInstitute for Global Health and Infectious Diseases, Baltimore, Maryland
| | - Michael G Hudgens
- Department of Biostatistics, University of North Carolina at Chapel Hill, Baltimore, Maryland
| | - Eric C Seaberg
- Department Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Chloe L Thio
- Department Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco
| | - Adaora A Adimora
- Department of EpidemiologyInstitute for Global Health and Infectious Diseases, Baltimore, Maryland
- Institute for Global Health and Infectious Diseases, Baltimore, Maryland
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German P, Mathias A, Brainard DM, Kearney BP. Drug-Drug Interaction Profile of the Fixed-Dose Combination Tablet Regimen Ledipasvir/Sofosbuvir. Clin Pharmacokinet 2019; 57:1369-1383. [PMID: 29644537 DOI: 10.1007/s40262-018-0654-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ledipasvir/sofosbuvir (Harvoni®), a fixed-dose combination tablet of an NS5A inhibitor ledipasvir and an NS5B polymerase inhibitor sofosbuvir, is approved for the treatment of chronic hepatitis C virus infection. Ledipasvir/sofosbuvir exhibits a favorable drug-drug interaction profile and can be administered with various medications that may be used by hepatitis C virus-infected patients, including patients with comorbidities, such as co-infection with human immunodeficiency virus or immunosuppression following liver transplantation. Ledipasvir/sofosbuvir is not expected to act as a victim or perpetrator of cytochrome P450- or UDP-glucuronosyltransferase 1A1-mediated drug-drug interactions. With the exception of strong inducers of P-glycoprotein, such as rifampin, ledipasvir/sofosbuvir is not expected to act as a victim of clinically relevant drug-drug interactions. As a perpetrator of pharmacokinetic drug-drug interactions via P-glycoprotein/BCRP, ledipasvir/sofosbuvir should not be used with rosuvastatin and elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate, whereas its co-administration with amiodarone is not recommended because of a pharmacodynamic interaction. This review summarizes a number of drug interaction studies conducted in support of the clinical development of ledipasvir/sofosbuvir.
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Affiliation(s)
- Polina German
- Gilead Sciences, Inc., 333 Lakeside Drive, Foster City, CA, 94404, USA.
| | - Anita Mathias
- Gilead Sciences, Inc., 333 Lakeside Drive, Foster City, CA, 94404, USA
| | - Diana M Brainard
- Gilead Sciences, Inc., 333 Lakeside Drive, Foster City, CA, 94404, USA
| | - Brian P Kearney
- Gilead Sciences, Inc., 333 Lakeside Drive, Foster City, CA, 94404, USA
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Pham T, Rathbun RC, Keast S, Nesser N, Farmer K, Skrepnek G. National estimates of case-mix, mortality, and economic outcomes among inpatient HIV/AIDS mono-infection and hepatitis C co-infection cases in the US. J Eval Clin Pract 2019; 25:806-821. [PMID: 30485617 DOI: 10.1111/jep.13076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 12/27/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES To assess inpatient clinical and economic outcomes for AIDS/HIV and Hepatitis C (HCV) co-infection in the United States from 2003 to 2014. METHOD This historical cohort study utilized nationally representative hospital discharge data to investigate inpatient mortality, length of stay (LoS), and inflation-adjusted charges among adults (≥18 years). Outcomes were analysed via multivariable generalized linear models according to demographics, hospital and clinical characteristics, and AIDS/HIV or HCV sequelae. RESULTS Overall, 17.8% of the 2.75 million estimated AIDS/HIV inpatient cases involved HCV from 2003 to 2014, averaging 48.5 ± 9.0 years of age and 68.0% being male. Advanced sequalae of AIDS and HCV incurred a LoS of 10.3 ± 11.9 days, charges of $88 789 ± 131 787, and a 16.9% mortality. Many cases involved noncompliance, tobacco use disorders, and substance abuse. Although mortality decreased over time, multivariable analyses indicated that poorer outcomes were generally associated with more advanced clinical conditions and AIDS-associated sequalae, although mixed results were observed for specific manifestations of HCV. Rural residence was independently associated with a 3.26 times higher adjusted odds of mortality from 2009 to 2014 for HIV/HCV co-infection (P < 0.001), although not for AIDS/HCV (OR = 1.38, P = 0.166). CONCLUSION Given the systemic nature and modifiable risks inherent within coinfection, more proactive screening and intervention appear warranted, particularly within rural areas.
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Affiliation(s)
- Timothy Pham
- The University of Oklahoma Health Sciences Center College of Pharmacy, Oklahoma City, USA
| | - R Chris Rathbun
- The University of Oklahoma Health Sciences Center College of Pharmacy, Oklahoma City, USA
| | - Shellie Keast
- The University of Oklahoma Health Sciences Center College of Pharmacy, Oklahoma City, USA
| | - Nancy Nesser
- Oklahoma Health Care Authority, Oklahoma City, USA
| | - Kevin Farmer
- The University of Oklahoma Health Sciences Center College of Pharmacy, Oklahoma City, USA
| | - Grant Skrepnek
- The University of Oklahoma Health Sciences Center College of Pharmacy, Oklahoma City, USA
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Falade-Nwulia O, Sutcliffe CG, Mehta SH, Moon J, Chander G, Keruly J, Katzianer J, Thomas DL, Moore RD, Sulkowski MS. Hepatitis C Elimination in People With HIV Is Contingent on Closing Gaps in the HIV Continuum. Open Forum Infect Dis 2019; 6:ofz426. [PMID: 31667200 PMCID: PMC6814283 DOI: 10.1093/ofid/ofz426] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 09/25/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Bolstered by the high efficacy of hepatitis C virus (HCV) treatment, the World Health Organization has called for HCV elimination by 2030. People with HIV (PWH) have been identified as a population in which elimination should be prioritized. METHODS We examined progress in HCV elimination through the HCV care continuum among patients infected with HIV/HCV receiving HIV care at Johns Hopkins Hospital in Baltimore, Maryland, United States. Patients with HIV care visits in at least 2 consecutive years were followed through December 15, 2018, for referral to HCV care, treatment initiation, and cure. RESULTS Among 593 HIV/HCV-coinfected individuals, 547 (92%) were referred for HCV care, 517 (87%) were evaluated for HCV treatment, 457 (77%) were prescribed HCV treatment, 426 (72%) initiated treatment, and 370 (62%) achieved HCV cure. In multivariable analysis, advanced liver disease (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.17-1.88) remained significantly positively associated with HCV treatment initiation. Conversely, being insured by state Medicaid (HR, 0.75; 95% CI, 0.61-0.92), having an HIV RNA >400 copies/mL (HR, 0.29; 95% CI, 0.18-0.49), and having missed 1%-24% (HR, 0.72; 95% CI, 0.54-0.97), 25%-49% (HR, 0.66; 95% CI, 0.49-0.89), and ≥50% of HIV care visits (HR, 0.39; 95% CI, 0.25-0.60) were significantly negatively associated with HCV treatment initiation. CONCLUSIONS HCV infection can be eliminated in PWH. However, HCV elimination requires unrestricted access to HCV treatment and improved methods of retaining people in medical care.
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Affiliation(s)
- Oluwaseun Falade-Nwulia
- Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Catherine G Sutcliffe
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shruti H Mehta
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Juhi Moon
- Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Geetanjali Chander
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jeanne Keruly
- Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer Katzianer
- Johns Hopkins Pharmaquip, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - David L Thomas
- Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Richard D Moore
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mark S Sulkowski
- Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Struble K, Chan-Tack K, Qi K, Valappil T, Connelly S, Mishra P, Price D, Murray J, Birnkrant D. Sustained virological response rates with direct-acting antivirals in black subjects with HCV genotype 1 infection: systematic analysis of clinical trials. J Virus Erad 2019; 5:138-144. [PMID: 31700657 PMCID: PMC6816118] [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: 11/23/2022] Open
Abstract
OBJECTIVES Under representation of black subjects in trials of hepatitis C virus (HCV) direct-acting antivirals (DAAs) complicates assessment of differential outcomes for black individuals vs non-black individuals. HCV trials submitted to the Food and Drug Administration (2013-2017) to support approval or to expand an indication of 12-week interferon-free DAA regimens with or without ribavirin to treat HCV genotype 1 (GT1) infection were pooled to explore efficacy comparisons by ethnicity. METHODS Twenty-six trials were pooled and included 2869 individuals with HCV GT1 alone and 742 individuals with both HCV GT1 and HIV. RESULTS Of the 2869 HCV GT1-mono-infected subjects, 408 (14.2%) were black. Sustained virological response assessed 12 weeks following cessation of treatment (SVR12) was 92%-100% in black individuals and 87.5%-100.0% in non-black individuals. In pooled analyses, SVR12 was numerically similar between black and non-black subjects (97.1% vs 97.3%). Baseline characteristics did not affect SVR12 for the two groups. Of the 742 subjects with both HCV GT1 and HIV, 243 (32.7%) were black: SVR12 was 89.5%-100% in black individuals and 94.4%-100% in non-black individuals. In pooled analyses for HCV GT1/HIV co-infection, black individuals had a 4% (95% confidence interval -7.7% to 0.3%) lower SVR12 than non-black individuals (93.4% vs 97.0%). This difference was driven by ION-4 in which study SVR12 was approximately 10% lower for black than for non-black individuals (89.5% vs 99.1%). Baseline characteristics did not affect SVR12 for the two groups. CONCLUSION No notable SVR12 differences were seen in between black and non-black individuals with HCV GT1 alone. Although a numerical difference was observed between black and non-black individuals with both HCV GT1 and HIV, this finding was driven by results from a single trial and may be due to reasons other than ethnicity: 19 subgroup analyses showed baseline characteristics did not affect SVR12 for black and non-black individuals with both HCV GT1 and HIV.
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Affiliation(s)
- Kimberly Struble
- Division of Antiviral Products,
Office of Antimicrobial Products,
Center for Drug Evaluation and Research, Food and Drug Administration,
Silver Spring,
MD,
USA
| | - Kirk Chan-Tack
- Division of Antiviral Products,
Office of Antimicrobial Products,
Center for Drug Evaluation and Research, Food and Drug Administration,
Silver Spring,
MD,
USA
| | - Karen Qi
- Office of Biostatistics,
Center for Drug Evaluation and Research, Food and Drug Administration,
Silver Spring,
MD,
USA
| | - Thamban Valappil
- Office of Biostatistics,
Center for Drug Evaluation and Research, Food and Drug Administration,
Silver Spring,
MD,
USA
| | - Sarah Connelly
- Division of Antiviral Products,
Office of Antimicrobial Products,
Center for Drug Evaluation and Research, Food and Drug Administration,
Silver Spring,
MD,
USA
| | - Poonam Mishra
- Division of Antiviral Products,
Office of Antimicrobial Products,
Center for Drug Evaluation and Research, Food and Drug Administration,
Silver Spring,
MD,
USA
| | - Dionne Price
- Office of Biostatistics,
Center for Drug Evaluation and Research, Food and Drug Administration,
Silver Spring,
MD,
USA
| | - Jeffrey Murray
- Division of Antiviral Products,
Office of Antimicrobial Products,
Center for Drug Evaluation and Research, Food and Drug Administration,
Silver Spring,
MD,
USA
| | - Debra Birnkrant
- Division of Antiviral Products,
Office of Antimicrobial Products,
Center for Drug Evaluation and Research, Food and Drug Administration,
Silver Spring,
MD,
USA
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Irvin R, Chander G, Falade-Nwulia O, Astemborski J, Starbird L, Kirk GD, Sulkowski MS, Thomas DL, Mehta SH. Overlapping epidemics of alcohol and illicit drug use among HCV-infected persons who inject drugs. Addict Behav 2019; 96:56-61. [PMID: 31035079 PMCID: PMC6718047 DOI: 10.1016/j.addbeh.2019.04.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 04/21/2019] [Accepted: 04/22/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Alcohol use in people who inject drugs (PWID) with hepatitis C virus (HCV) infection accelerates liver disease progression. This paper describes the prevalence and associated correlates of alcohol use among HCV antibody positive PWID. METHODS In a large cohort of HCV antibody positive PWID (N = 1623) followed from 2005 to 2013, we characterized alcohol use using the AUDIT-C. We used multivariable logistic regression with generalized estimated equations to examine socio-demographic, clinical, and substance use correlates of alcohol use. RESULTS At their initial visit, 41% reported no, 21% reported moderate, and 38% reported heavy alcohol use. The odds of moderate and heavy alcohol use increased with greater intensity of substance use represented by a composite summary variable which ranged from 0 to 3 substances (street-acquired prescription drugs, non-injection cocaine/heroin, and injection drugs) used. Compared to those who used no drugs, those who used 3 substances had 3.71 odds (95% CI: 3.07-4.48) of moderate alcohol use and 3.65 odds (95% CI: 3.20-4.16) of heavy alcohol use. CONCLUSIONS The prevalence of moderate/heavy alcohol use is high among HCV antibody positive PWID and occurs frequently in combination with other drug use. This may contribute to progressive liver fibrosis thus limiting the gains achieved from HCV cure. Public health interventions need to address the overlapping epidemics of HCV, alcohol use, and other substance use in this population.
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Affiliation(s)
- Risha Irvin
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Oluwaseun Falade-Nwulia
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jacquie Astemborski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Laura Starbird
- Johns Hopkins School of Nursing, Baltimore, MD, United States
| | - Gregory D Kirk
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Mark S Sulkowski
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - David L Thomas
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Sherman KE, Peters MG, Thomas DL. HIV and the liver. TOPICS IN ANTIVIRAL MEDICINE 2019; 27:101-110. [PMID: 31634861 PMCID: PMC6892621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/05/2019] [Indexed: 06/10/2023]
Abstract
Among individuals with HIV infection, liver disease remains an important cause of morbidity and mortality, even with the availability of agents that cure hepatitis C infection and suppress hepatitis B replication. The causes of liver disease are multifaceted and continue to evolve as the population ages and new etiologies arise. Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis and hepatitis viruses such as A, D, and E have emerged even as hepatitis C has receded. Newer antiretroviral agents may increase risk of weight gain and subsequent fatty infiltration, and prior use of nucleotide-based therapies may continue to impact liver health. Several barriers including economics, social stigma, and psychiatric disease impact identification of liver disease, as well as management and treatment interventions. Hepatocellular carcinoma is emerging as a more common and late-diagnosed complication in those with HIV infection and liver disease.
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Affiliation(s)
- Kenneth E. Sherman
- Send correspondence to Kenneth E. Sherman, MD, PhD, University of Cincinnati College of Medicine, Division of Digestive Diseases, 231 Albert Sabin Way, Cincinnati, OH 45267-0595, or to
| | - Marion G. Peters
- Professor of Medicine at University of California San Francisco in San Francisco, California
| | - David L. Thomas
- Professor of Medicine at Johns Hopkins University in Baltimore, Maryland
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Sustained virological response rates with direct-acting antivirals in black subjects with HCV genotype 1 infection: systematic analysis of clinical trials. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30043-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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El-Garem H, AbdAllah M, Omar H, Cordie A, Abdel Alem S, Mohey Eldin Elzahry MA, Ghaith D, Abou El-Soud NH, Kamal W, Elsharkawy A, Esmat G. DAAs therapy associated with improved hepatic fibrosis in HCV-GT4 patients co-infected with HIV. Expert Rev Gastroenterol Hepatol 2019; 13:693-698. [PMID: 31043104 DOI: 10.1080/17474124.2019.1614441] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: The present work aimed at evaluation of the potential dynamic changes in hepatic fibrosis following treatment of chronic HCV using DAAs in patients coinfected with HIV. Patients and methods: In total, 50 HCV/HIV coinfected patients [age; 34.68 ± 10.38 years, 82% men] were included. For all included patients, liver stiffness measured using transient elastography as well as serum liver fibrosis scores; [fibrosis-4 (FIB-4) score and the aspartate aminotransferase to platelet ratio index (APRI)] were calculated at baseline and at 12 and 24-weeks following 12 weeks therapy of HCV with once daily sofosbuvir 400 mg plus daclatasvir 60 mg. Results: Most of the included patients (70%, n = 35) were on anti-retroviral therapy. SVR24 was achieved by 93.48% of the patients. There was significant serial improvement in baseline liver stiffness measurement (LSM), FIB-4 and APRI among responders; [LSM: baseline, 7.05 ± 4.84 kPa vs. 5.66 ± 2.63 kPa at SVR24, p < 0.001], [FIB-4: baseline, 1.24 ± 1.08 vs. 0.93 ± 0.64 at SVR24, p 0.001) and (APRI: baseline, 0.725 ± 0.66 vs. 0.36 ± 0.19at SVR24, p 0.001) respectively. Conclusion: Treatment of HCV patients coinfected with HIV using DAAs is associated with a rapid significant regression in hepatic fibrosis, as evaluated by FibroScan, FIB-4, and APRI scores.
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Affiliation(s)
- Hassan El-Garem
- a Endemic Medicine and Hepatology Department, Faculty of Medicine , Cairo University , Giza , Egypt
| | - Mohamed AbdAllah
- b Medical Research Division , National Research Center , Giza , Egypt
| | - Heba Omar
- a Endemic Medicine and Hepatology Department, Faculty of Medicine , Cairo University , Giza , Egypt
| | - Ahmed Cordie
- a Endemic Medicine and Hepatology Department, Faculty of Medicine , Cairo University , Giza , Egypt
| | - Shereen Abdel Alem
- a Endemic Medicine and Hepatology Department, Faculty of Medicine , Cairo University , Giza , Egypt
| | | | - Doaa Ghaith
- c Clinical and Chemical Pathology Department, Faculty of Medicine , Cairo University , Giza , Egypt
| | | | - Walid Kamal
- d Preventive sector , Ministry of Health , Cairo , Egypt
| | - Aisha Elsharkawy
- a Endemic Medicine and Hepatology Department, Faculty of Medicine , Cairo University , Giza , Egypt
| | - Gamal Esmat
- a Endemic Medicine and Hepatology Department, Faculty of Medicine , Cairo University , Giza , Egypt.,e Badr University , Cairo , Egypt
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Werbel WA, Durand CM. Solid Organ Transplantation in HIV-Infected Recipients: History, Progress, and Frontiers. Curr HIV/AIDS Rep 2019; 16:191-203. [PMID: 31093920 PMCID: PMC6579039 DOI: 10.1007/s11904-019-00440-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW End-stage organ disease prevalence is increasing among HIV-infected (HIV+) individuals. Trial and registry data confirm that solid organ transplantation (SOT) is efficacious in this population. Optimizing access to transplant and decreasing complications represent active frontiers. RECENT FINDINGS HIV+ recipients historically experienced 2-4-fold higher rejection. Integrase strand transferase inhibitors (INSTIs) minimize drug interactions and may reduce rejection along with lymphodepleting induction immunosuppression. Hepatitis C virus (HCV) coinfection has been associated with inferior outcomes, yet direct-acting antivirals (DAAs) may mitigate this. Experience in South Africa and the US HIV Organ Policy Equity (HOPE) Act support HIV+ donor to HIV+ recipient (HIV D+/R+) transplantation. SOT is the optimal treatment for end-stage organ disease in HIV+ individuals. Recent advances include use of INSTIs and DAAs in transplant recipients; however, strategies to improve access to transplant are needed. HIV D+/R+ transplantation is under investigation and may improve access and provide insights for HIV cure and pathogenesis research.
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Affiliation(s)
- William A. Werbel
- Department of Medicine, Johns Hopkins University School
of Medicine, Baltimore, MD
| | - Christine M. Durand
- Department of Medicine, Johns Hopkins University School
of Medicine, Baltimore, MD
- Sidney Kimmel Cancer Center, Johns Hopkins University
School of Medicine, Baltimore, MD
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Prevalence and genetic diversity of HCV among HIV-1 infected individuals living in Ahvaz, Iran. BMC Infect Dis 2019; 19:389. [PMID: 31068133 PMCID: PMC6505195 DOI: 10.1186/s12879-019-4052-x] [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] [Received: 02/25/2019] [Accepted: 04/30/2019] [Indexed: 12/18/2022] Open
Abstract
Background To explore the prevalence, transmission routes and genotypes distribution of HCV in HIV-1/HCV co-infected individuals in Ahvaz, Iran. Methods The present cross-sectional study was conducted among HIV adult voluntary counseling and testing (VCT) clients, from September to November 2016. Reverse transcription (RT) nested PCR was performed to amplify the HCV core and 5′UTR regions from 90 HIV/HCV co-infected individuals. The PCR products were then sequenced for HCV subtyping. Genetic analysis was done by MEGA6 software. Results The prevalence of HCV in HIV-1-infected individuals was 58.7%. Injection drug use (IDU) was the most common route (99.1%) of transmission, and most of the patients (97.8%) had a history of imprisonment. The HCV subtypes were identified as 1a (55.2%), 3a (35.8%), 3 h (4.5%), 1b (3%) and 4a (1.5%) respectively, HCV 1a and 3a subtypes were predominant. Conclusions The diversity of HCV subtypes in HIV-1/HCV co-infected individuals in Ahvaz city was high, although two subtypes (1a and 3a) are predominant.
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Adams B, Yee J. Eradicating the Viral Triad in Hemodialysis Units. Adv Chronic Kidney Dis 2019; 26:157-161. [PMID: 31202386 DOI: 10.1053/j.ackd.2019.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 01/29/2019] [Indexed: 12/31/2022]
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