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Wu H, Shih ST, Applegate TL, Kwon JA, Cunningham EB, Grebely J, Gray RT. Impact of simplified HCV diagnostic strategies on the HCV epidemic among men who have sex with men in the era of HIV oral pre-exposure prophylaxis in Taiwan: a modelling study. J Int AIDS Soc 2024; 27:e26251. [PMID: 38695100 PMCID: PMC11063777 DOI: 10.1002/jia2.26251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 04/12/2024] [Indexed: 05/04/2024] Open
Abstract
INTRODUCTION Simplified hepatitis C virus (HCV) diagnostic strategies have the potential to improve HCV diagnoses and treatment. We aimed to investigate the impact of simplified HCV diagnostic strategies on HCV incidence and its effect on HCV diagnosis and treatment among men who have sex with men (MSM) regardless of HIV status and use of HIV pre-exposure prophylaxis (PrEP) in Taiwan. METHODS A compartmental deterministic model was developed to describe the natural history of HCV disease progression, the HCV care cascade and the HIV status and PrEP using among MSM. The model was calibrated to available data for HCV and HIV epidemiology and population demographics in Taiwan. We simulated the epidemic from 2004 and projected the impact of simplified testing strategies on the HCV epidemic among MSM over 2022-2030. RESULTS Under the current testing approach in Taiwan, total HCV incidence would increase to 12.6 per 1000 person-years among MSM by 2030. Single-visit point-of-care RNA testing had the largest impact on reducing the number of new HCV infections over 2022-2030, with a 31.1% reduction (interquartile range: 24.9%-32.8%). By 2030, single-visit point-of-care HCV testing improved HCV diagnosis to 90.9%, HCV treatment to 87.7% and HCV cure to 81.5% among MSM living with HCV. Compared to status quo, prioritized simplified HCV testing for PrEP users and MSM living with diagnosed HIV had considerable impact on the broader HCV epidemic among MSM. A sensitivity analysis suggests that reinfection risk would have a large impact on the effectiveness of each point-of-care testing scenario. CONCLUSIONS Simplified HCV diagnostic strategies could control the ongoing HCV epidemic and improve HCV testing and treatment among Taiwanese MSM. Single-visit point-of-care RNA testing would result in large reductions in HCV incidence and prevalence among MSM. Efficient risk-reduction strategies will need to be implemented alongside point-of-care testing to achieve HCV elimination among MSM in Taiwan.
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Affiliation(s)
- Huei‐Jiuan Wu
- The Kirby InstituteUNSWSydneyNew South WalesAustralia
- Department of Public HealthCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
| | | | | | - Jisoo A. Kwon
- The Kirby InstituteUNSWSydneyNew South WalesAustralia
| | | | - Jason Grebely
- The Kirby InstituteUNSWSydneyNew South WalesAustralia
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Grebely J, Matthews S, Causer LM, Feld JJ, Cunningham P, Dore GJ, Applegate TL. We have reached single-visit testing, diagnosis, and treatment for hepatitis C infection, now what? Expert Rev Mol Diagn 2024; 24:177-191. [PMID: 38173401 DOI: 10.1080/14737159.2023.2292645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Progress toward hepatitis C virus (HCV) elimination is impeded by low testing and treatment due to the current diagnostic pathway requiring multiple visits leading to loss to follow-up. Point-of-care testing technologies capable of detecting current HCV infection in one hour are a 'game-changer.' These tests enable diagnosis and treatment in a single visit, overcoming the barrier of multiple visits that frequently leads to loss to follow-up. Combining point-of-care HCV antibody and RNA tests should improve cost-effectiveness, patient/provider acceptability, and testing efficiency. However, implementing HCV point-of-care testing programs at scale requires multiple considerations. AREAS COVERED This commentary explores the need for point-of-care HCV tests, diagnostic strategies to improve HCV testing, key considerations for implementing point-of-care HCV testing programs, and remaining challenges for point-of-care testing (including operator training, quality management, connectivity and reporting systems, regulatory approval processes, and the need for more efficient tests). EXPERT OPINION It is exciting that single-visit testing, diagnosis, and treatment for HCV infection have been achieved. Innovations afforded through COVID-19 should facilitate the accelerated development of low-cost, rapid, and accurate tests to improve HCV testing. The next challenge will be to address barriers and facilitators for implementing point-of-care testing to deliver them at scale.
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Affiliation(s)
- Jason Grebely
- The Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - Susan Matthews
- Flinders University International Centre for Point-of-Care Testing, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Louise M Causer
- The Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, Canada
| | - Philip Cunningham
- Flinders University International Centre for Point-of-Care Testing, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - Tanya L Applegate
- The Kirby Institute, UNSW, Sydney, New South Wales, Australia
- NSW State Reference Laboratory for HIV, St Vincent's Centre for Applied Medical Research, Sydney, New South Wales, Australia
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Zhang Y, Holt M, Chan C, Applegate TL, Bavinton BR, Broady TR, Keen P, Wulandari LPL, Mao L, McManus H, Medland NA, Prestage G, Wiseman V, Guy RJ. National Surveillance of Home-Based HIV Testing Among Australian Gay and Bisexual Men, 2018-2020: Uptake After Commercial Availability of HIV Self-Tests. AIDS Behav 2023; 27:4106-4113. [PMID: 37439916 PMCID: PMC10598086 DOI: 10.1007/s10461-023-04124-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2023] [Indexed: 07/14/2023]
Abstract
HIV self-testing allows people to collect samples and test themselves at home, addressing known barriers to facility-based testing. We aimed to measure the uptake of home HIV testing among Australian gay and bisexual men (GBM). Using national cross-sectional data from the Australian Gay Community Periodic Surveys, we assessed trends in home HIV testing among non-HIV positive GBM between 2018 and 2020. Overall, the use of home HIV testing was low, but slightly increased during 2018-2020 (from 0.3 to 0.8%, RR = 1.54, 95%CI = 1.23-1.92, p-trend < 0.001). Testing at home was more likely among non-HIV-positive GBM who were born overseas and recently arrived in Australia, at higher risk of HIV, and infrequent HIV testers. Given the greater use of home testing by men at higher risk of HIV, recent migrants and infrequent testers, all priority groups in Australia's HIV epidemic, we recommend increasing access to HIV self-testing to enhance uptake in these and other groups of GBM.
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Affiliation(s)
- Ye Zhang
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Sydney, NSW, 2031, Australia.
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Curtis Chan
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Sydney, NSW, 2031, Australia
| | - Tanya L Applegate
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Sydney, NSW, 2031, Australia
| | - Benjamin R Bavinton
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Sydney, NSW, 2031, Australia
| | - Timothy R Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Phillip Keen
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Sydney, NSW, 2031, Australia
| | - Luh Putu Lila Wulandari
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Sydney, NSW, 2031, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Hamish McManus
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Sydney, NSW, 2031, Australia
| | - Nicholas A Medland
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Sydney, NSW, 2031, Australia
| | - Garrett Prestage
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Sydney, NSW, 2031, Australia
| | - Virginia Wiseman
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Sydney, NSW, 2031, Australia
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca J Guy
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Sydney, NSW, 2031, Australia
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Koopsen J, Matthews G, Rockstroh J, Applegate TL, Bhagani S, Rauch A, Grebely J, Sacks-Davis R, Ingiliz P, Boesecke C, Rebers S, Feld J, Bruneau J, Martinello M, Hellard M, Dore GJ, Schinkel J, van der Valk M. Hepatitis C virus transmission between eight high-income countries among men who have sex with men: a whole-genome analysis. Lancet Microbe 2023; 4:e622-e631. [PMID: 37336226 DOI: 10.1016/s2666-5247(23)00108-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 02/23/2023] [Accepted: 03/20/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Microelimination of the hepatitis C virus (HCV) among men who have sex with men (MSM) could be complicated by continuous external introductions and the emergence of phylogenetic clusters harbouring clinically significant resistance-associated substitutions (RAS). To investigate international clustering and the prevalence and transmission of RAS, we aimed to analyse whole-genome HCV sequences from MSM with a recently acquired infection who participated in a large, international HCV treatment trial. METHODS For this whole-genome analysis, we obtained HCV sequences from 128 MSM who had acquired HCV within the past 12 months and were participating in the REACT trial. The participants from whom sequences were obtained were recruited at 24 sites in eight countries. We inferred maximum-likelihood phylogenies and identified transmission clusters for HCV genotypes separately. We constructed time-scaled phylogenies to estimate cluster introduction dates and used a Bayesian Skygrid approach to estimate the effective population size over the past 50 years. We calculated the prevalence of RAS and the extent of RAS transmission in the study population. FINDINGS The majority of recent HCV infections were part of international networks that arose in the late 1990s and early 2000s. Sequences obtained in the same country clustered frequently, and in 36% of subclusters since 2015 we found evidence of international transmission. European MSM were more likely than non-European MSM to be in a cluster (odds ratio 11·9 [95% CI 3·6-43·4], p<0·0001). The effective population size decreased rapidly since around 2015 in Europe. RAS associated with substantially diminished cure rates were infrequently detected and transmission of highly resistant viruses was not observed. INTERPRETATION Despite antiviral treatment becoming widely available, international transmission of HCV among MSM has still occurred over the past 8 years, which could complicate microelimination of the virus in this population. RAS-enriched clusters and widespread RAS transmission are currently not a threat to elimination goals. These findings support an international approach for HCV microelimination among MSM. FUNDING National Institutes of Health and Dr. C.J. Vaillant Fonds.
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Affiliation(s)
- Jelle Koopsen
- Laboratory of Applied Evolutionary Biology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.
| | - Gail Matthews
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; St Vincent's Hospital, Sydney, NSW, Australia
| | | | | | - Sanjay Bhagani
- Royal Free Hospital, London, UK; Division of Infection and Immunity, University College London, London, UK
| | - Andri Rauch
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Jason Grebely
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | - Patrick Ingiliz
- Zentrum für Infektiologie Berlin-Prenzlauer Berg, Berlin, Germany; Henri-Mondor University Hospital, Hepatology Department, INSERM U955, Créteil, France
| | | | - Sjoerd Rebers
- Section of Clinical Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Jordan Feld
- Toronto Centre for Liver Diseases, Toronto General Hospital, Toronto, ON, Canada
| | - Julie Bruneau
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | | | - Margaret Hellard
- Burnet Institute, Melbourne, VIC, Australia; The Alfred Hospital, Melbourne, VIC, Australia
| | - Gregory J Dore
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; St Vincent's Hospital, Sydney, NSW, Australia
| | - Janke Schinkel
- Section of Clinical Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Marc van der Valk
- Division of Infectious Diseases, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands; Stichting HIV Monitoring, Amsterdam, Netherlands
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Zhang Y, Guy R, Camara H, Applegate TL, Wiseman V, Treloar C, Lafferty L. Barriers and facilitators to HIV and syphilis rapid diagnostic testing in antenatal care settings in low-income and middle-income countries: a systematic review. BMJ Glob Health 2022; 7:bmjgh-2022-009408. [PMID: 36319030 PMCID: PMC9628546 DOI: 10.1136/bmjgh-2022-009408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/24/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Testing and treatment during pregnancy is a well-established and cost-effective prevention strategy, which relies largely on use of rapid diagnostic tests (RDTs). Yet, in many low-income and-middle-income countries, the uptake of RDTs is suboptimal. A qualitative meta-synthesis was conducted to identify the barriers and enablers to use of HIV and syphilis RDTs among pregnant women in low-income and middle-income countries. METHODS This review was conducted using PRISMA guidelines. Eligible studies included peer-reviewed publications, which used qualitative methods to explore HIV and syphilis RDT in antenatal care clinics in low-income and middle-income countries. Studies focusing on perspectives of pregnant women, healthcare workers and/or stakeholders were included. We used an inductive approach informed by a modified socioecological model to synthesise the data. RESULTS 62 manuscripts met the eligibility criteria. For pregnant women, initial acceptance of the RDT and continuation in antenatal care depends on the perception that engaging in testing will be a beneficial experience for their baby and themselves, often influenced by the provision of services that are gender-sensitive, confidential, respectful, flexible and considers their well-being into the future. Local sociocultural beliefs about pregnancy and diseases, awareness of diseases and gender roles in society also influenced RDT acceptability among pregnant women. For healthcare workers, the ability to provide high-quality RDT care required ongoing training, accurate and easy to use tests, support from supervisors and communities, sufficient resources and staffing to provide services, and reliable salary. At the stakeholder level, well-developed guidelines and health system infrastructures were imperative to the delivery of RDT in antenatal clinics. CONCLUSION Our findings highlight clear gaps to the provision of sustainable and culturally acceptable maternal HIV and/or syphilis screening using RDTs. In addition, greater attention needs to be paid to community stakeholders in promoting the uptake of RDT in antenatal clinics. PROSPERO REGISTRATION NUMBER CRD42018112190.
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Affiliation(s)
- Ye Zhang
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Hawa Camara
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Tanya L Applegate
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Virginia Wiseman
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Carla Treloar
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Lise Lafferty
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
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Adawiyah RA, Boettiger D, Applegate TL, Probandari A, Marthias T, Guy R, Wiseman V. Supply-side readiness to deliver HIV testing and treatment services in Indonesia: Going the last mile to eliminate mother-to-child transmission of HIV. PLOS Glob Public Health 2022; 2:e0000845. [PMID: 36962570 PMCID: PMC10021386 DOI: 10.1371/journal.pgph.0000845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 07/06/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Despite national efforts to integrate Prevention of Mother-to-Child Transmission (PMTCT) of HIV services into antenatal care in Indonesia, the rate of mother-to-child transmission of HIV remains the highest in the world. A range of barriers to uptake and long-term engagement in care have been identified, but far less is known about health system preparedness to deliver PMTCT of HIV services. This study explored supply-side barriers to the delivery of PMTCT services in Indonesia and whether these factors are associated with the uptake of antenatal HIV testing. MATERIALS AND METHODS An ecological analysis was undertaken, linking data from the World Bank Quality Service and Delivery Survey (2016) with routine data from Indonesia's HIV and AIDS case surveillance system and district health profile reports (2016). Supply-side readiness scores-generated from a readiness index that measures overall structural capacity and is often used as proxy for quality of care-were adapted from the WHO Service Availability and Readiness Assessment and presented by sector and geographic area. Univariate and multivariate regression analysis was used to explore factors associated with the uptake of antenatal HIV testing in public facilities. RESULTS In general, public facilities scored more highly in most inputs compared to private facilities. Facilities located in urban areas also scored more highly in the majority of inputs compared to ones in rural areas. Readiness scores were lowest for PMTCT services compared to Antenatal Care and HIV Care and Support services, especially for the availability of medicines such as zidovudine and nevirapine. The national composite readiness score for PMTCT was only 0.13 (based on a maximum score of 1) with a composite score of 0.21 for public facilities and 0.06 for private facilities. The multivariate analysis shows that the proportion of pregnant women tested for HIV was more likely to be greater than or equal to 10% in facilities with a higher readiness score and a higher number of trained counsellors available, and less likely in facilities located outside of Java-Bali and in facilities supporting a higher number of village midwives. DISCUSSION Despite targeted efforts by the Indonesian government and multinational agencies, significant gaps exist in the delivery of PMTCT that compromise the standard of care delivered in Indonesia. Future strategies should focus on improving the availability of tests and treatment, especially in the private sector and in rural areas.
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Affiliation(s)
| | - David Boettiger
- The Kirby Institute, University New South Wales, Sydney, Australia
| | | | - Ari Probandari
- The Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Tiara Marthias
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
| | - Rebecca Guy
- The Kirby Institute, University New South Wales, Sydney, Australia
| | - Virginia Wiseman
- The Kirby Institute, University New South Wales, Sydney, Australia
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
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Zhang Y, Wiseman V, Applegate TL, Lourenco RDA, Street DJ, Smith K, Jamil MS, Terris-Prestholt F, Fairley CK, McNulty A, Hynes A, Johnson K, Chow EPF, Bavinton BR, Grulich A, Stoove M, Holt M, Kaldor J, Guy R, Ong JJ. Preferences for HIV Testing Services and HIV Self-Testing Distribution Among Migrant Gay, Bisexual, and Other Men Who Have Sex With Men in Australia. Front Med (Lausanne) 2022; 9:839479. [PMID: 35514755 PMCID: PMC9063480 DOI: 10.3389/fmed.2022.839479] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/16/2022] [Indexed: 01/13/2023] Open
Abstract
Background In Australia, undiagnosed HIV rates are much higher among migrant gay, bisexual, or other men who have sex with men (GBMSM) than Australian-born GBMSM. HIV self-testing is a promising tool to overcome barriers to HIV testing and improve HIV testing uptake among migrant GBMSM. We compared the preferences for HIV testing services, including HIV self-testing, among migrant and Australian-born GBMSM. Methods Preferences were assessed via two discrete choice experiments (DCEs). Participants were recruited between December 2017 and January 2018 using online and offline advertising and randomly assigned to complete one of two online DCE surveys. Migrant GBMSM were classified as being born in a country with a reciprocal healthcare agreement (RHCA) with Australia (providing free or subsided health care) or not. Latent class analysis and mixed logit models were used to explore heterogeneity in preferences. Findings We recruited 1,606 GBMSM, including 583 migrant men of whom 419 (72%) were born in non-RHCA countries. Most participants preferred a free or cheap oral test with higher accuracy and a shorter window period to facilitate early detection of infections. Cost was more important for men born in non-RHCA countries than for men from RHCA countries or Australia. All groups preferred accessing kits through online distributers or off the shelf purchasing from pharmacies. Men born in RHCA countries least preferred accessing HIV self-testing kits from a medical clinic, while more than half of men from non-RHCA countries most preferred sourcing kits from a clinic. Sex-on-premises venues were the least preferred location to access test kits among all groups. In addition, two latent class analyses explored heterogeneity in preferences among men from non-RHCA countries and we found four latent classes for HIV testing services and two latent classes for HIVST distribution. Interpretation Our findings emphasise the need for high-performing and low-cost HIV self-testing kits that are accessible from a variety of distribution points as a component of Australia's HIV response, especially for those who do not have access to free or subsidised health care in Australia.
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Affiliation(s)
- Ye Zhang
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia,*Correspondence: Ye Zhang
| | - Virginia Wiseman
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tanya L. Applegate
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Deborah J. Street
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Kirsty Smith
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Muhammad S. Jamil
- Global Human immunodeficiency virus (HIV), Hepatitis and Sexually transmitted infections (STIs) Programmes, World Health Organization, Geneva, Switzerland
| | - Fern Terris-Prestholt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Christopher K. Fairley
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Anna McNulty
- Sydney Sexual Health Centre, Sydney, NSW, Australia,School of Population Health, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Adam Hynes
- Thorne Harbour Health, Melbourne, VIC, Australia
| | | | - Eric P. F. Chow
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia,Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Benjamin R. Bavinton
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Andrew Grulich
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | | | - Martin Holt
- Centre for Social Research in Health, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - John Kaldor
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Rebecca Guy
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Jason J. Ong
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Zhang Y, Jamil MS, Smith KS, Applegate TL, Prestage G, Holt M, Keen P, Bavinton BR, Chen M, Conway DP, Wand H, McNulty AM, Russell D, Vaughan M, Batrouney C, Wiseman V, Fairley CK, Grulich AE, Law M, Kaldor JM, Guy RJ. The longer-term effects of access to HIV self-tests on HIV testing frequency in high-risk gay and bisexual men: follow-up data from a randomised controlled trial. Lancet Reg Health West Pac 2021; 14:100214. [PMID: 34671752 PMCID: PMC8484892 DOI: 10.1016/j.lanwpc.2021.100214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/31/2021] [Accepted: 06/29/2021] [Indexed: 11/02/2022]
Abstract
Background A wait-list randomised controlled trial in Australia (FORTH) in high-risk gay and bisexual men (GBM) showed access to free HIV self-tests (HIVSTs) doubled the frequency of HIV testing in year 1 to reach guideline recommended levels of 4 tests per year, compared to two tests per year in the standard-care arm (facility-based testing). In year 2, men in both arms had access to HIVSTs. We assessed if the effect was maintained for a further 12 months. Methods Participants included GBM reporting condomless anal intercourse or > 5 male partners in the past 3 months. We included men who had completed at least one survey in both year 1 and 2 and calculated the mean tests per person, based on the validated self-report and clinic records. We used Poisson regression and random effects Poisson regression models to compare the overall testing frequency by study arm, year and testing modality (HIVST/facility-based test). Findings Overall, 362 men completed at least one survey in year 1 and 343 in year 2. Among men in the intervention arm (access to HIVSTs in both years), the mean number of HIV tests in year 2 (3⋅7 overall, 2⋅3 facility-based tests, 1⋅4 HIVSTs) was lower compared to year 1 (4⋅1 overall, 1⋅7 facility-based tests, 2⋅4 HIVSTs) (RR:0⋅84, 95% CI:0⋅75-0⋅95, p=0⋅002), but higher than the standard-care arm in year 1 (2⋅0 overall, RR:1⋅71, 95% CI:1⋅48-1.97, p<0⋅001). Findings were not different when stratified by sociodemographic characteristics or recent high risk sexual history. Interpretation In year 2, fewer HIVSTs were used on average compared to year 1, but access to free HIVSTs enabled more men to maintain higher HIV testing frequency, compared with facility-based testing only. HIV self-testing should be a key component of HIV testing and prevention strategies. Funding This work was supported by grant 568971 from the National Health and Medical Research Council of Australia.
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Affiliation(s)
- Ye Zhang
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Muhammad S Jamil
- Global HIV, Hepatitis and STI Programme, World Health Organization, Geneva, Switzerland
| | | | | | | | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Phillip Keen
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | - Marcus Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | | | - Handan Wand
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Anna M McNulty
- Sydney Sexual Health Centre, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Darren Russell
- Cairns Sexual Health Service, Cairns North, QLD, Australia.,James Cook University, Townsville, QLD, Australia
| | | | | | - Virginia Wiseman
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.,London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | | | - Matthew Law
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - John M Kaldor
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Rebecca J Guy
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
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9
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Matthews GV, Bhagani S, Van der Valk M, Rockstroh J, Feld JJ, Rauch A, Thurnheer C, Bruneau J, Kim A, Hellard M, Shaw D, Gane E, Nelson M, Ingiliz P, Applegate TL, Grebely J, Marks P, Martinello M, Petoumenos K, Dore GJ. Sofosbuvir/velpatasvir for 12 vs. 6 weeks for the treatment of recently acquired hepatitis C infection. J Hepatol 2021; 75:829-839. [PMID: 34023350 PMCID: PMC9831671 DOI: 10.1016/j.jhep.2021.04.056] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/28/2021] [Accepted: 04/28/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND & AIMS Shortened duration therapy for acute and recent HCV infection has been shown to be highly effective in several small non-randomised studies with direct-acting antiviral regimens; however, large randomised studies are lacking. METHODS REACT was an NIH-funded multicentre international, open-label, randomised, phase IV non-inferiority trial examining the efficacy of short course (6-week) vs. standard course (12-week) therapy with sofosbuvir-velpatasvir for recent HCV infection (estimated duration of infection ≤12 months). Randomisation occurred at week 6. The primary endpoint was sustained virological response 12 weeks after treatment end (SVR12) in the intention-to treat (ITT) population. A total of 250 participants were due to be enrolled, but on advice of the data safety and monitoring board the study was halted early. RESULTS The primary analysis population consisted of 188 randomised participants at termination of study enrolment; short arm (n = 93), standard arm (n = 95). Ninety-seven percent were male and 69% HIV positive. ITT SVR12 was 76/93, 81.7% (95% CI 72.4-89.0) in the short arm and 86/95, 90.5% (95% CI 82.7-95.6) in the standard arm. The difference between the arms was -8.8 (95% CI -18.6 to 1.0). In modified ITT analysis, wherein non-virological reasons for failure were excluded (death, reinfection, loss to follow-up), SVR12 was 76/85, 89.4% (95% CI 80.8-95.0) in the short arm and 86/88, 97.7% in the standard arm (95% CI 92.0-99.7; difference -8.3%, p = 0.025). CONCLUSIONS In this randomised study in recent HCV infection, a 6-week course of sofosbuvir-velpatasvir did not meet the criteria for non-inferiority to standard 12-week therapy. LAY SUMMARY In this randomised trial, 188 people with recently acquired hepatitis C infection were randomly assigned to treatment using either a short 6-week course (93 people) or standard 12-week course (95 people) of the hepatitis C treatment sofosbuvir/velpatasvir. There were 9 cases of relapse after treatment with the short course and 2 following the standard course. A shortened course of 6-week therapy for hepatitis C infection appeared to be less effective than a standard 12-week course in people with recently acquired hepatitis C infection. CLINICALTRIALS. GOV IDENTIFIER NCT02625909.
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Affiliation(s)
- Gail V Matthews
- Kirby Institute, UNSW Sydney, Australia; St Vincent's Hospital, Sydney, Australia.
| | | | - Marc Van der Valk
- Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Department of Infectious Diseases, Amsterdam Infection & Immunity Institute, Amsterdam, the Netherlands
| | | | - Jordan J Feld
- Toronto Centre for Liver Diseases, Toronto General Hospital, Toronto, Canada
| | - Andri Rauch
- Department of Infectious Diseases, Inselspital, Bern, Switzerland
| | | | - Julie Bruneau
- Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Arthur Kim
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, United States
| | - Margaret Hellard
- The Alfred Hospital, Melbourne, Australia; The Burnet Institute, Melbourne, Australia
| | - David Shaw
- Royal Adelaide Hospital, Adelaide, Australia
| | - Ed Gane
- Auckland City Hospital, Auckland, New Zealand
| | - Mark Nelson
- Chelsea & Westminster Hospital, London, United Kingdom
| | - Patrick Ingiliz
- Zentrum für Infektiologie Berlin-Prenzlauer Berg, Berlin, Germany
| | | | | | | | | | | | - Gregory J Dore
- Kirby Institute, UNSW Sydney, Australia; St Vincent's Hospital, Sydney, Australia
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10
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Adawiyah RA, Saweri OPM, Boettiger DC, Applegate TL, Probandari A, Guy R, Guinness L, Wiseman V. The costs of scaling up HIV and syphilis testing in low- and middle-income countries: a systematic review. Health Policy Plan 2021; 36:939-954. [PMID: 33693731 PMCID: PMC8227996 DOI: 10.1093/heapol/czab030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 12/18/2022] Open
Abstract
Around two-thirds of all new HIV infections and 90% of syphilis cases occur in low- and middle-income countries (LMICs). Testing is a key strategy for the prevention and treatment of HIV and syphilis. Decision-makers in LMICs face considerable uncertainties about the costs of scaling up HIV and syphilis testing. This paper synthesizes economic evidence on the costs of scaling up HIV and syphilis testing interventions in LMICs and evidence on how costs change with the scale of delivery. We systematically searched multiple databases (Medline, Econlit, Embase, EMCARE, CINAHL, Global Health and the NHS Economic Evaluation Database) for peer-reviewed studies examining the costs of scaling up HIV and syphilis testing in LMICs. Thirty-five eligible studies were identified from 4869 unique citations. Most studies were conducted in Sub-Saharan Africa (N = 17) and most explored the costs of rapid HIV in facilities targeted the general population (N = 19). Only two studies focused on syphilis testing. Seventeen studies were cost analyses, 17 were cost-effectiveness analyses and 1 was cost-benefit analysis of HIV or syphilis testing. Most studies took a modelling approach (N = 25) and assumed costs increased linearly with scale. Ten studies examined cost efficiencies associated with scale, most reporting short-run economies of scale. Important drivers of the costs of scaling up included testing uptake and the price of test kits. The 'true' cost of scaling up testing is likely to be masked by the use of short-term decision frameworks, linear unit-cost projections (i.e. multiplying an average cost by a factor reflecting activity at a larger scale) and availability of health system capacity and infrastructure to supervise and support scale up. Cost data need to be routinely collected alongside other monitoring indicators as HIV and syphilis testing continues to be scaled up in LMICs.
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Affiliation(s)
- Rabiah Al Adawiyah
- The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia
| | - Olga P M Saweri
- The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia.,Population Health and Demography, Papua New Guinea Institute of Medical Research, PO Box 60 Homate Street, Goroka, Papua New Guinea
| | - David C Boettiger
- The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia
| | - Tanya L Applegate
- The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia
| | - Ari Probandari
- Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Jl. Ir. Sutami 36A. Surakarta, 57126, Indonesia
| | - Rebecca Guy
- The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia
| | - Lorna Guinness
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.,Centre for Global DevelopmentEurope, Great Peter House, Great College St, London SW1P 3SE, UK
| | - Virginia Wiseman
- The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia.,London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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11
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Cunningham EB, Hajarizadeh B, Amin J, Hellard M, Bruneau J, Feld JJ, Cooper C, Powis J, Litwin AH, Marks P, Dalgard O, Conway B, Moriggia A, Stedman C, Read P, Bruggmann P, Lacombe K, Dunlop A, Applegate TL, Matthews GV, Fraser C, Dore GJ, Grebely J. Reinfection Following Successful Direct-acting Antiviral Therapy for Hepatitis C Virus Infection Among People Who Inject Drugs. Clin Infect Dis 2021; 72:1392-1400. [PMID: 32166305 DOI: 10.1093/cid/ciaa253] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/10/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The aim of this analysis was to calculate the incidence of hepatitis C virus (HCV) reinfection and associated factors among 2 clinical trials of HCV direct-acting antiviral treatment in people with recent injecting drug use or currently receiving opioid agonist therapy (OAT). METHODS Participants who achieved an end-of-treatment response in 2 clinical trials of people with recent injecting drug use or currently receiving OAT (SIMPLIFY and D3FEAT) enrolled between March 2016 and February 2017 in 8 countries were assessed for HCV reinfection, confirmed by viral sequencing. Incidence was calculated using person-time of observation and associated factors were assessed using Cox proportional hazard models. RESULTS Seventy-three percent of the population at risk of reinfection (n = 177; median age, 48 years; 73% male) reported ongoing injecting drug use. Total follow-up time at risk was 254 person-years (median, 1.8 years; range, 0.2-2.8 years). Eight cases of reinfection were confirmed for an incidence of 3.1/100 person-years (95% confidence interval [CI], 1.6-6.3) overall and 17.9/100 person-years (95% CI, 5.8-55.6) among those who reported sharing needles/syringes. Younger age and needle/syringe sharing were associated with HCV reinfection. CONCLUSIONS These data demonstrate the need for ongoing monitoring and improved strategies to prevent HCV reinfection following successful treatment among people with ongoing injecting drug use to achieve HCV elimination. CLINICAL TRIALS REGISTRATION NCT02336139 and NCT02498015.
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Affiliation(s)
- Evan B Cunningham
- The Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | - Behzad Hajarizadeh
- The Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | - Janaki Amin
- The Kirby Institute, University of New South Wales Sydney, Sydney, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Margaret Hellard
- The Burnet Institute, Melbourne, Australia.,Department of Infectious Disease, The Alfred Hospital, Melbourne, Australia
| | - Julie Bruneau
- Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | | | | | - Jeff Powis
- South Riverdale Community Health Centre, Toronto, Canada
| | - Alain H Litwin
- Albert Einstein College of Medicine, New York, New York, USA
| | - Philippa Marks
- The Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | | | - Brian Conway
- Vancouver Infectious Diseases Center, Vancouver, Canada
| | - Alberto Moriggia
- Fondazione Epatocentro Ticino, Lugano, Switzerland.,Ingrado Addiction Services, Lugano, Switzerland
| | - Catherine Stedman
- Christchurch Hospital and University of Otago, Christchurch, New Zealand
| | - Phillip Read
- The Kirby Institute, University of New South Wales Sydney, Sydney, Australia.,Kirketon Road Centre, Sydney, Australia
| | | | - Karine Lacombe
- Inserm UMR-S1136, Sorbonne Université, Hôpital Saint-Antoine, Paris, France
| | - Adrian Dunlop
- Newcastle Pharmacotherapy Service, Newcastle, Australia
| | - Tanya L Applegate
- The Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | - Gail V Matthews
- The Kirby Institute, University of New South Wales Sydney, Sydney, Australia.,St Vincent's Hospital, Sydney, Australia
| | - Chris Fraser
- Coolaid Community Health Centre, Victoria, Canada
| | - Gregory J Dore
- The Kirby Institute, University of New South Wales Sydney, Sydney, Australia.,St Vincent's Hospital, Sydney, Australia
| | - Jason Grebely
- The Kirby Institute, University of New South Wales Sydney, Sydney, Australia
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12
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Bajis S, Applegate TL, Grebely J, Matthews GV, Dore GJ. Novel Hepatitic C Virus (HCV) Diagnosis and Treatment Delivery Systems: Facilitating HCV Elimination by Thinking Outside the Clinic. J Infect Dis 2021; 222:S758-S772. [PMID: 33245354 DOI: 10.1093/infdis/jiaa366] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The World Health Organization has set a goal to eliminate hepatitis C virus (HCV) infection as public health threat by 2030. Although the advent of highly effective and tolerable direct-acting antiviral therapy has paved the way for HCV elimination, most people with HCV infection remain undiagnosed and untreated globally, with striking disparities between high-income and low- to middle-income countries. Novel decentralized and cost-effective "test-and-treat" strategies are critically needed to identify the millions of people unaware of their status and link them to treatment.
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Affiliation(s)
- Sahar Bajis
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Tanya L Applegate
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Gail V Matthews
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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13
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van Bockel D, Munier CML, Turville S, Badman SG, Walker G, Stella AO, Aggarwal A, Yeang M, Condylios A, Kelleher AD, Applegate TL, Vallely A, Whiley D, Rawlinson W, Cunningham P, Kaldor J, Guy R. Evaluation of Commercially Available Viral Transport Medium (VTM) for SARS-CoV-2 Inactivation and Use in Point-of-Care (POC) Testing. Viruses 2020; 12:E1208. [PMID: 33114233 PMCID: PMC7690900 DOI: 10.3390/v12111208] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/16/2020] [Accepted: 10/21/2020] [Indexed: 01/14/2023] Open
Abstract
Critical to facilitating SARS-CoV-2 point-of-care (POC) testing is assurance that viruses present in specimens are inactivated onsite prior to processing. Here, we conducted experiments to determine the virucidal activity of commercially available Viral Transport Mediums (VTMs) to inactivate SARS-CoV-2. Independent testing methods for viral inactivation testing were applied, including a previously described World Health Organization (WHO) protocol, in addition to a buffer exchange method where the virus is physically separated from the VTM post exposure. The latter method enables sensitive detection of viral viability at higher viral titre when incubated with VTM. We demonstrate that VTM formulations, Primestore® Molecular Transport Medium (MTM) and COPAN eNAT™ completely inactivate high-titre SARS-CoV-2 virus (>1 × 107 copies/mL) and are compatible with POC processing. Furthermore, full viral inactivation was rapidly achieved in as little as 2 min of VTM exposure. We conclude that adding certain VTM formulations as a first step post specimen collection will render SARS-CoV-2 non-infectious for transport, or for further in-field POC molecular testing using rapid turnaround GeneXpert platforms or equivalent.
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Affiliation(s)
- David van Bockel
- Kirby Institute for Infection and Immunity in Society, UNSW Medicine, UNSW Sydney, Kensington, NSW 2052, Australia; (C.M.L.M.); (S.T.); (S.G.B.); (A.O.S.); (A.A.); (A.D.K.); (T.L.A.); (A.V.); (J.K.); (R.G.)
| | - C. Mee Ling Munier
- Kirby Institute for Infection and Immunity in Society, UNSW Medicine, UNSW Sydney, Kensington, NSW 2052, Australia; (C.M.L.M.); (S.T.); (S.G.B.); (A.O.S.); (A.A.); (A.D.K.); (T.L.A.); (A.V.); (J.K.); (R.G.)
| | - Stuart Turville
- Kirby Institute for Infection and Immunity in Society, UNSW Medicine, UNSW Sydney, Kensington, NSW 2052, Australia; (C.M.L.M.); (S.T.); (S.G.B.); (A.O.S.); (A.A.); (A.D.K.); (T.L.A.); (A.V.); (J.K.); (R.G.)
| | - Steven G. Badman
- Kirby Institute for Infection and Immunity in Society, UNSW Medicine, UNSW Sydney, Kensington, NSW 2052, Australia; (C.M.L.M.); (S.T.); (S.G.B.); (A.O.S.); (A.A.); (A.D.K.); (T.L.A.); (A.V.); (J.K.); (R.G.)
| | - Gregory Walker
- NSW Health Pathology, Prince of Wales Hospital, Randwick, NSW 2052, Australia; (G.W.); (M.Y.); (A.C.); (W.R.)
| | - Alberto Ospina Stella
- Kirby Institute for Infection and Immunity in Society, UNSW Medicine, UNSW Sydney, Kensington, NSW 2052, Australia; (C.M.L.M.); (S.T.); (S.G.B.); (A.O.S.); (A.A.); (A.D.K.); (T.L.A.); (A.V.); (J.K.); (R.G.)
| | - Anupriya Aggarwal
- Kirby Institute for Infection and Immunity in Society, UNSW Medicine, UNSW Sydney, Kensington, NSW 2052, Australia; (C.M.L.M.); (S.T.); (S.G.B.); (A.O.S.); (A.A.); (A.D.K.); (T.L.A.); (A.V.); (J.K.); (R.G.)
| | - Malinna Yeang
- NSW Health Pathology, Prince of Wales Hospital, Randwick, NSW 2052, Australia; (G.W.); (M.Y.); (A.C.); (W.R.)
| | - Anna Condylios
- NSW Health Pathology, Prince of Wales Hospital, Randwick, NSW 2052, Australia; (G.W.); (M.Y.); (A.C.); (W.R.)
| | - Anthony D. Kelleher
- Kirby Institute for Infection and Immunity in Society, UNSW Medicine, UNSW Sydney, Kensington, NSW 2052, Australia; (C.M.L.M.); (S.T.); (S.G.B.); (A.O.S.); (A.A.); (A.D.K.); (T.L.A.); (A.V.); (J.K.); (R.G.)
| | - Tanya L. Applegate
- Kirby Institute for Infection and Immunity in Society, UNSW Medicine, UNSW Sydney, Kensington, NSW 2052, Australia; (C.M.L.M.); (S.T.); (S.G.B.); (A.O.S.); (A.A.); (A.D.K.); (T.L.A.); (A.V.); (J.K.); (R.G.)
| | - Andrew Vallely
- Kirby Institute for Infection and Immunity in Society, UNSW Medicine, UNSW Sydney, Kensington, NSW 2052, Australia; (C.M.L.M.); (S.T.); (S.G.B.); (A.O.S.); (A.A.); (A.D.K.); (T.L.A.); (A.V.); (J.K.); (R.G.)
| | - David Whiley
- NSW State Reference Laboratory for HIV-AIDS/St Vincent’s Hospital Sydney, St Vincent’s Centre for Applied Medical Research, St Vincent’s Hospital Sydney Limited, Darlinghurst, NSW 2010, Australia;
- Australia Pathology Queensland, Royal Brisbane and Women’s Hospital, Herston, QLD 4006, Australia
| | - William Rawlinson
- NSW Health Pathology, Prince of Wales Hospital, Randwick, NSW 2052, Australia; (G.W.); (M.Y.); (A.C.); (W.R.)
| | - Phillip Cunningham
- Centre for Clinical Research, The University of Queensland, Royal Brisbane and Women’s Hospital Campus, Herston, QLD 4006, Australia;
| | - John Kaldor
- Kirby Institute for Infection and Immunity in Society, UNSW Medicine, UNSW Sydney, Kensington, NSW 2052, Australia; (C.M.L.M.); (S.T.); (S.G.B.); (A.O.S.); (A.A.); (A.D.K.); (T.L.A.); (A.V.); (J.K.); (R.G.)
| | - Rebecca Guy
- Kirby Institute for Infection and Immunity in Society, UNSW Medicine, UNSW Sydney, Kensington, NSW 2052, Australia; (C.M.L.M.); (S.T.); (S.G.B.); (A.O.S.); (A.A.); (A.D.K.); (T.L.A.); (A.V.); (J.K.); (R.G.)
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14
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Catlett B, Bajis S, Starr M, Dore GJ, Hajarizadeh B, Cunningham PH, Applegate TL, Grebely J. Evaluation of the Aptima HCV Quant Dx Assay for Hepatitis C Virus RNA Detection from Fingerstick Capillary Dried Blood Spot and Venepuncture-Collected Samples. J Infect Dis 2020; 223:818-826. [PMID: 32710758 DOI: 10.1093/infdis/jiaa442] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 07/21/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Simplified diagnostic strategies are needed increase hepatitis C virus (HCV) testing to determine active infection and link people into treatment. Collection methods such as dried blood spots (DBS) have advantages over standard phlebotomy, especially within marginalized populations. METHODS We evaluated the diagnostic performance of the Aptima HCV Quant assay for the quantification and detection of HCV RNA from paired DBS and venepuncture samples. Specimens were collected from participants enrolled in an Australian observational study. We compared HCV RNA detection from DBS against venepuncture samples (gold standard). RESULTS One hundred sixty-four participants had paired samples and HCV RNA was detected in 45 (27% [95% confidence interval, 21%-35%]) by the Aptima assay in venepuncture samples. Sensitivity of the Aptima assay for HCV RNA quantification from DBS (≥10 IU/mL in plasma) was 100% and specificity was 100%. Sensitivity for HCV RNA detection from DBS was 95.6% and specificity was 94.1%. A small bias in plasma over DBS was observed with good agreement (R2 = 0.96). CONCLUSIONS The Aptima HCV Quant assay detects active infection from DBS samples with acceptable diagnostic performance and is clinically comparable to plasma. These data will strengthen the case for the registration of a DBS kit insert claim, enabling future clinical utility.
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Affiliation(s)
- Beth Catlett
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.,New South Wales State Reference Laboratory for HIV, St Vincent's Centre for Applied Medical Research, Darlinghurst, Sydney, New South Wales, Australia
| | - Sahar Bajis
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Mitchell Starr
- New South Wales State Reference Laboratory for HIV, St Vincent's Centre for Applied Medical Research, Darlinghurst, Sydney, New South Wales, Australia
| | - Gregory J Dore
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | | | - Philip H Cunningham
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.,New South Wales State Reference Laboratory for HIV, St Vincent's Centre for Applied Medical Research, Darlinghurst, Sydney, New South Wales, Australia
| | | | - Jason Grebely
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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15
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Grebely J, Read P, Cunningham EB, Weltman M, Matthews GV, Dunlop A, Montebello M, Martinello M, Gilliver R, Marks P, Applegate TL, Dore GJ. Elbasvir and grazoprevir for hepatitis C virus genotype 1 infection in people with recent injecting drug use (DARLO-C): An open-label, single-arm, phase 4, multicentre trial. Health Sci Rep 2020; 3:e151. [PMID: 32270056 PMCID: PMC7136479 DOI: 10.1002/hsr2.151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/15/2020] [Accepted: 02/21/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND AND AIMS Direct-acting antiviral therapy for hepatitis C virus (HCV) is effective, but few prospective studies among people with ongoing injecting drug use exist. This study evaluated the efficacy of elbasvir/grazoprevir in people with HCV genotype 1/4 (G1/4) infection and recent injecting drug use. An exploratory aim evaluated the feasibility of fingerstick point-of-care HCV RNA testing prior to and following treatment. METHODS DARLO-C (http://clinicaltrials.gov: NCT02940691) is an open-label phase 4 trial. Participants were recruited between May 2017 and March 2018 from two drug treatment clinics, two hospital clinics, and one community clinic in Australia. Inclusion criteria included recent injection drug use (previous 6 months) and HCV G1/4 infection. Exclusion criteria included prior HCV treatment and decompensated liver disease. Participants received elbasvir/grazoprevir once-daily for 12 weeks. The primary endpoint was undetectable HCV RNA 12 weeks post-treatment (SVR). Fingerstick whole-blood samples were tested using the Xpert HCV Viral Load Fingerstick (Xpert HCV VL Fingerstick) assay and compared to the Aptima HCV Quant Dx Assay on plasma samples. RESULTS Of a planned 150 participants, 32 were enrolled due to slower than anticipated recruitment [median age 46 years, 10 (31%) female, 29 (91%) G1a]. Eighteen (56%) were receiving opioid agonist therapy and 29 (91%) injected in the previous month. Twenty-six (81%) of 32 completed treatment (lost to follow-up, n = 5; incarceration, n = 1). There were no virological failures. Twenty-four (75%, 95% CI 59%-91%) of 32 achieved SVR. Two participants who completed treatment did not have SVR (loss to follow-up, n = 1; refused test, n = 1). Among paired samples (n = 36), sensitivity of the Xpert HCV VL Fingerstick assay for HCV RNA detection was 100.0% (95% CI 75.3%-100.0%) and specificity was 95.7% (95% CI 78.1%-99.9%). CONCLUSION Elbasvir/grazoprevir is effective among people with HCV G1 with recent injecting drug use. Implementation of point-of-care HCV RNA testing was feasible, but the high error rate requires investigation.
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Affiliation(s)
- Jason Grebely
- Viral Hepatitis Clinical Research ProgramThe Kirby Institute, UNSW SydneySydneyAustralia
| | | | - Evan B. Cunningham
- Viral Hepatitis Clinical Research ProgramThe Kirby Institute, UNSW SydneySydneyAustralia
| | - Martin Weltman
- Department of Gastroenterology and HepatologyNepean HospitalPenrithAustralia
| | - Gail V. Matthews
- Viral Hepatitis Clinical Research ProgramThe Kirby Institute, UNSW SydneySydneyAustralia
- Department of Infectious DiseasesSt Vincent's HospitalSydneyAustralia
| | | | - Mark Montebello
- Drug and Alcohol ServicesSouth East Sydney Local Health DistrictSydneyAustralia
| | - Marianne Martinello
- Viral Hepatitis Clinical Research ProgramThe Kirby Institute, UNSW SydneySydneyAustralia
- Department of Infectious DiseasesSt Vincent's HospitalSydneyAustralia
| | | | - Philippa Marks
- Viral Hepatitis Clinical Research ProgramThe Kirby Institute, UNSW SydneySydneyAustralia
| | - Tanya L. Applegate
- Viral Hepatitis Clinical Research ProgramThe Kirby Institute, UNSW SydneySydneyAustralia
| | - Gregory J. Dore
- Viral Hepatitis Clinical Research ProgramThe Kirby Institute, UNSW SydneySydneyAustralia
- Department of Infectious DiseasesSt Vincent's HospitalSydneyAustralia
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16
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Douglas MW, Tay ESE, Wang DS, Ong ATL, Wilson C, Phu A, Kok J, Dwyer DE, Bull RA, Lloyd AR, Applegate TL, Dore GJ, Howe AY, Harrigan R, George J. Impact of an Open Access Nationwide Treatment Model on Hepatitis C Virus Antiviral Drug Resistance. Hepatol Commun 2020; 4:904-915. [PMID: 32490325 PMCID: PMC7262285 DOI: 10.1002/hep4.1496] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/07/2020] [Indexed: 12/21/2022] Open
Abstract
Direct acting antivirals (DAAs) have revolutionized hepatitis C virus (HCV) treatment, but drug resistance could undermine proposed global elimination targets. Real‐world studies are needed to inform the impact of widespread DAA treatment on antiviral resistance in the community. The prevalence and range of posttreatment resistance‐associated substitutions (RASs) was determined in Australian patients with open access to DAAs through a wide range of prescribers. NS3, NS5A, and NS5B regions were amplified by polymerase chain reaction and analyzed by population sequencing. Clinically relevant RASs were identified using online databases (ReCALL and Geno2Pheno[hcv]). Of 572 samples, 60% were from genotype 3 and 27% from genotype 1a. Ninety‐two percent of people failed a DAA regimen containing an NS5A inhibitor, including 10% with a pangenotype regimen. NS5A RASs were detected in 72% of people with genotype 1 and 80% with genotype 3. For genotype 1, there was a range of RASs across the NS5A region, while for genotype 3, the Y93H RAS predominated (72%). The prevalence of NS3 RASs was higher in people exposed to an NS3 inhibitor (35% vs. 3.9%; P < 0.0001). NS5B resistance was rare, with a single case of sofosbuvir resistance. Multiclass drug resistance was found in 33% of people exposed to both NS3 and NS5A inhibitors. Conclusion: The high prevalence of NS5A RASs among people failing DAA therapy reinforces the importance of specific retreatment regimens, ideally guided by resistance testing. The impact of multiclass drug resistance on retreatment in people exposed to both NS3 and NS5A inhibitors needs to be assessed in real‐world studies. Surveillance for increasing antiviral resistance during treatment scale‐up is essential to maintain the efficacy of current DAA regimens.
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Affiliation(s)
- Mark W Douglas
- Storr Liver Centre The Westmead Institute for Medical Research The University of Sydney and Westmead Hospital Sydney Australia.,Centre for Infectious Diseases and Microbiology Westmead Hospital Sydney Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity University of Sydney Sydney Australia
| | - Enoch S E Tay
- Storr Liver Centre The Westmead Institute for Medical Research The University of Sydney and Westmead Hospital Sydney Australia.,Centre for Infectious Diseases and Microbiology Laboratory Services NSW Health Pathology-Institute of Clinical Pathology and Medical Research Westmead Hospital Westmead Australia
| | - Dao Sen Wang
- Storr Liver Centre The Westmead Institute for Medical Research The University of Sydney and Westmead Hospital Sydney Australia
| | - Adrian T L Ong
- Storr Liver Centre The Westmead Institute for Medical Research The University of Sydney and Westmead Hospital Sydney Australia.,Centre for Infectious Diseases and Microbiology Westmead Hospital Sydney Australia
| | - Caroline Wilson
- Storr Liver Centre The Westmead Institute for Medical Research The University of Sydney and Westmead Hospital Sydney Australia
| | - Amy Phu
- Storr Liver Centre The Westmead Institute for Medical Research The University of Sydney and Westmead Hospital Sydney Australia
| | - Jen Kok
- Centre for Infectious Diseases and Microbiology Laboratory Services NSW Health Pathology-Institute of Clinical Pathology and Medical Research Westmead Hospital Westmead Australia
| | - Dominic E Dwyer
- Marie Bashir Institute for Infectious Diseases and Biosecurity University of Sydney Sydney Australia.,Centre for Infectious Diseases and Microbiology Laboratory Services NSW Health Pathology-Institute of Clinical Pathology and Medical Research Westmead Hospital Westmead Australia
| | - Rowena A Bull
- The Kirby Institute University of New South Wales Sydney Australia
| | - Andrew R Lloyd
- The Kirby Institute University of New South Wales Sydney Australia
| | | | - Gregory J Dore
- The Kirby Institute University of New South Wales Sydney Australia
| | - Anita Y Howe
- British Columbia Centre for Disease Control BC Canada
| | | | - Jacob George
- Storr Liver Centre The Westmead Institute for Medical Research The University of Sydney and Westmead Hospital Sydney Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity University of Sydney Sydney Australia
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17
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Grebely J, Catlett B, Jayasinghe I, Valerio H, Hajarizadeh B, Verich A, Cunningham P, Martinello M, Tillakeratne S, Silk D, Dore GJ, Applegate TL. Time to Detection of Hepatitis C Virus Infection With the Xpert HCV Viral Load Fingerstick Point-of-Care Assay: Facilitating a More Rapid Time to Diagnosis. J Infect Dis 2020; 221:2043-2049. [DOI: 10.1093/infdis/jiaa037] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 01/27/2020] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background
Xpert HCV Viral Load Fingerstick assay (Xpert HCV VL FS) is a point-of-care test quantifying HCV RNA in <1 hour, enabling same-visit diagnosis and treatment.
Methods
This study evaluated time to HCV RNA detection using the Xpert HCV VL FS assay. Fingerstick whole-blood samples were collected from participants in an observational cohort in Australia.
Results
In May 2018–2019, 1468 participants were enrolled, 1426 had Xpert HCV VL FS testing performed, and 1386 had a valid result. HCV RNA was detected in 23% (325/1386). Among people with undetectable HCV RNA (n = 1061), median time to result was 57 minutes. Among people with detectable HCV RNA (n = 325), median time to HCV RNA detection was 32 minutes and 80% (261/325) had a detectable HCV RNA result in ≤40 minutes. Median time to HCV RNA detection was dependent on HCV RNA level.
Conclusions
A quicker HCV diagnosis could be achieved by monitoring the time when HCV RNA is first detected with the Xpert HCV VL FS test, rather than HCV RNA quantification, although the current platform does not allow for this. These findings could facilitate new strategies to reduce waiting times for an HCV diagnosis and improve linkage to treatment.
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Affiliation(s)
| | - Beth Catlett
- The Kirby Institute, UNSW, Sydney, Australia
- St Vincent’s Centre for Applied Medical Research, Sydney, Australia
| | | | | | | | | | - Philip Cunningham
- The Kirby Institute, UNSW, Sydney, Australia
- St Vincent’s Centre for Applied Medical Research, Sydney, Australia
| | | | | | - David Silk
- The Kirby Institute, UNSW, Sydney, Australia
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18
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Catlett B, Lamoury FMJ, Bajis S, Hajarizadeh B, Martinez D, Mowat Y, Cunningham PH, Jacka BP, Cloherty GA, Marks P, Dore GJ, Grebely J, Applegate TL. Evaluation of a hepatitis C virus core antigen assay from venepuncture and dried blood spot collected samples: A cohort study. J Viral Hepat 2019; 26:1423-1430. [PMID: 31448470 DOI: 10.1111/jvh.13196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/30/2019] [Accepted: 08/05/2019] [Indexed: 12/19/2022]
Abstract
The global scale-up of hepatitis C virus (HCV) diagnosis requires simplified and affordable HCV diagnostic pathways. This study evaluated the sensitivity and specificity of the HCV Architect core antigen (HCVcAg) assay for detection of active HCV infection in plasma and capillary whole blood dried blood spots (DBS) compared with HCV RNA testing in plasma (Abbott RealTime HCV Viral Load). Samples were collected from participants in an observational cohort enrolled at three sites in Australia (two-drug treatment and alcohol clinics and one homelessness service). Of 205 participants, 200 had results across all samples and assay types and 186 were included in this analysis (14 participants receiving HCV therapy were excluded). HCV RNA was detected in 29% of participants ([95% CI: 22.6-36.1], 54 of 186). The sensitivity of HCVcAg for detection of active HCV infection in plasma was 98.1% (95% CI: 90-100) and 100% (95% CI: 93-100) when compared to HCV RNA thresholds of ≥12 and ≥1000 IU/mL, respectively. The sensitivity of the HCVcAg assay for detection of active HCV infection in DBS was 90.7% (95% CI: 80-97) and 92.5% (95% CI: 82-98) when compared to HCV RNA thresholds of ≥12 and ≥1000 IU/mL, respectively. The specificity of HCV core antigen for detection of active infection was 100% (95% CI: 97-100) for all samples and RNA thresholds. These data indicate that the detection of HCVcAg is a useful tool for determining active HCV infection; to facilitate enhanced testing, linkage to care and treatment particularly when testing plasma samples are collected by venepuncture.
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Affiliation(s)
- Beth Catlett
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.,St Vincent's Centre for Applied Medical Research, Darlinghurst, Sydney, NSW, Australia
| | | | - Sahar Bajis
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | | | - Yasmin Mowat
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Philip H Cunningham
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.,St Vincent's Centre for Applied Medical Research, Darlinghurst, Sydney, NSW, Australia
| | - Brendan P Jacka
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.,Centre de recherche du CHUM, Montreal, QC, Canada
| | | | - Philippa Marks
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
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19
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Cooke GS, Andrieux-Meyer I, Applegate TL, Atun R, Burry JR, Cheinquer H, Dusheiko G, Feld JJ, Gore C, Griswold MG, Hamid S, Hellard ME, Hou J, Howell J, Jia J, Kravchenko N, Lazarus JV, Lemoine M, Lesi OA, Maistat L, McMahon BJ, Razavi H, Roberts T, Simmons B, Sonderup MW, Spearman CW, Taylor BE, Thomas DL, Waked I, Ward JW, Wiktor SZ. Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission. Lancet Gastroenterol Hepatol 2019; 4:135-184. [PMID: 30647010 DOI: 10.1016/s2468-1253(18)30270-x] [Citation(s) in RCA: 330] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 08/10/2018] [Accepted: 08/13/2018] [Indexed: 01/26/2023]
Abstract
Viral hepatitis is a major public health threat and a leading cause of death worldwide. Annual mortality from viral hepatitis is similar to that of other major infectious diseases such as HIV and tuberculosis. Highly effective prevention measures and treatments have made the global elimination of viral hepatitis a realistic goal, endorsed by all WHO member states. Ambitious targets call for a global reduction in hepatitis-related mortality of 65% and a 90% reduction in new infections by 2030. This Commission draws together a wide range of expertise to appraise the current global situation and to identify priorities globally, regionally, and nationally needed to accelerate progress. We identify 20 heavily burdened countries that account for over 75% of the global burden of viral hepatitis. Key recommendations include a greater focus on national progress towards elimination with support given, if necessary, through innovative financing measures to ensure elimination programmes are fully funded by 2020. In addition to further measures to improve access to vaccination and treatment, greater attention needs to be paid to access to affordable, high-quality diagnostics if testing is to reach the levels needed to achieve elimination goals. Simplified, decentralised models of care removing requirements for specialised prescribing will be required to reach those in need, together with sustained efforts to tackle stigma and discrimination. We identify key examples of the progress that has already been made in many countries throughout the world, demonstrating that sustained and coordinated efforts can be successful in achieving the WHO elimination goals.
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Affiliation(s)
- Graham S Cooke
- Division of Infectious Diseases, Imperial College London, London, UK.
| | | | | | - Rifat Atun
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | | | - Hugo Cheinquer
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | - Jordan J Feld
- Toronto Center for Liver Disease, Toronto General Hospital, Toronto, Canada
| | | | - Max G Griswold
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | | | - JinLin Hou
- Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Guangzhou, China
| | - Jess Howell
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Jidong Jia
- Liver Research Center, Beijing Friendship Hospital, Beijing, China
| | | | - Jeffrey V Lazarus
- Health Systems Research Group, Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Maud Lemoine
- Division of Surgery and Cancer, Imperial College London, London, UK
| | | | | | - Brian J McMahon
- Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AL, USA
| | - Homie Razavi
- Center for Disease Analysis Foundation, Lafayette, CO, USA
| | | | - Bryony Simmons
- Division of Infectious Diseases, Imperial College London, London, UK
| | - Mark W Sonderup
- Division of Hepatology, Department of Medicine, University of Cape Town, South Africa
| | - C Wendy Spearman
- Division of Hepatology, Department of Medicine, University of Cape Town, South Africa
| | | | - David L Thomas
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Imam Waked
- National Liver Institute, Menoufiya University, Egypt
| | - John W Ward
- Program for Viral Hepatitis Elimination, Task Force for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stefan Z Wiktor
- Department of Global Health, University of Washington, Seattle, WA, USA
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20
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Bartlett SR, Applegate TL, Jacka BP, Martinello M, Lamoury FMJ, Danta M, Bradshaw D, Shaw D, Lloyd AR, Hellard M, Dore GJ, Matthews GV, Grebely J. A latent class approach to identify multi-risk profiles associated with phylogenetic clustering of recent hepatitis C virus infection in Australia and New Zealand from 2004 to 2015. J Int AIDS Soc 2019; 22:e25222. [PMID: 30746864 PMCID: PMC6371014 DOI: 10.1002/jia2.25222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 12/05/2018] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Over the last two decades, the incidence of hepatitis C virus (HCV) co-infection among men who have sex with men (MSM) living with HIV began increasing in post-industrialized countries. Little is known about transmission of acute or recent HCV, in particular among MSM living with HIV co-infection, which creates uncertainty about potential for reinfection after HCV treatment. Using phylogenetic methods, clinical, epidemiological and molecular data can be combined to better understand transmission patterns. These insights may help identify strategies to reduce reinfection risk, enhancing effectiveness of HCV treatment as prevention strategies. The aim of this study was to identify multi-risk profiles and factors associated with phylogenetic pairs and clusters among people with recent HCV infection. METHODS Data and specimens from five studies of recent HCV in Australia and New Zealand (2004 to 2015) were used. HCV Core-E2 sequences were used to infer maximum likelihood trees. Clusters were identified using 90% bootstrap and 5% genetic distance threshold. Multivariate logistic regression and latent class analyses were performed. RESULTS Among 237 participants with Core-E2 sequences, 47% were in a pair/cluster. Among HIV/HCV co-infected participants, 60% (74/123) were in a pair/cluster, compared to 30% (34/114) with HCV mono-infection (p < 0.001). HIV/HCV co-infection (vs. HCV mono-infection; adjusted odds ratio (AOR), 2.37, 95% confidence interval (CI), 1.45, 5.15) was independently associated with phylogenetic clustering. Latent class analysis identified three distinct risk profiles: (1) people who inject drugs, (2) HIV-positive gay and bisexual men (GBM) with low probability of injecting drug use (IDU) and (3) GBM with IDU & sexual risk behaviour. Class 2 (vs. Class 1, AOR 3.40; 95% CI, 1.52, 7.60), was independently associated with phylogenetic clustering. Many clusters displayed homogeneous characteristics, such as containing individuals exclusively from one city, individuals all with HIV/HCV co-infection or individuals sharing the same route of acquisition of HCV. CONCLUSIONS Clusters containing individuals with specific characteristics suggest that HCV transmission occurs through discrete networks, particularly among HIV/HCV co-infected individuals. The greater proportion of clustering found among HIV/HCV co-infected participants highlights the need to provide broad direct-acting antiviral access encouraging rapid uptake in this population and ongoing monitoring of the phylogeny.
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Affiliation(s)
| | | | | | | | | | - Mark Danta
- St Vincent's Clinical SchoolUNSWSydneyNSWAustralia
- Department of GastroenterologySt Vincent's Hospital SydneySydneyAustralia
| | | | - David Shaw
- Royal Adelaide HospitalAdelaideSAAustralia
| | - Andrew R Lloyd
- Kirby InstituteUNSWSydneyNSWAustralia
- School of Medical SciencesUNSWSydneyNSWAustralia
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21
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Catlett B, Carrera A, Starr M, Applegate TL, Lowe P, Grebely J, Philip Cunningham H. Performance evaluation of the Hologic Aptima HCV Quant Dx assay for detection of HCV RNA from dried blood spots. J Clin Virol 2019; 112:40-44. [PMID: 30776575 DOI: 10.1016/j.jcv.2019.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/14/2019] [Accepted: 01/24/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The availability of effective direct-acting antiviral therapy for hepatitis C virus (HCV) has led to a need for simplified diagnostic pathways. Barriers to treatment uptake, specifically in people who inject drugs and in remote and resource limited settings, may be overcome by utilizing novel collection methods, such as dried blood spots (DBS). However, there are currently no registered assays for HCV RNA testing from DBS samples. OBJECTIVES To evaluate the sensitivity and specificity of the Aptima HCV Dx Quant assay for HCV RNA detection in DBS samples STUDY DESIGN: 107 paired venepuncture and DBS samples from HCV antibody positive individuals were analyzed for HCV RNA on the Aptima HCV Dx Quant and Roche CAP/CTM (gold standard) HCV assays. RESULTS 78% (n=83) had detectable HCV RNA in plasma. Sensitivity of the Aptima assay for HCV RNA detection in DBS was 96.4% (95% CI 89.8-99.3%) and specificity was 95.8% (95% CI 78.8-99.9%). Sensitivity for HCV RNA detection in DBS using a quantitative threshold of ≥15 IU/mL in plasma was 95.1% (95% CI 88%-98.7%) and specificity was 96.0% (95% CI 79.7%-99.9%). The sensitivity of HCV RNA detection in DBS using a quantitative threshold of ≥1000 IU/mL (based on a clinically relevant threshold) was 100% (95% CI 95.3-100%) and specificity was 100% (95% CI 88.4-100%). CONCLUSIONS Our data indicates that the Aptima HCV Dx Quant can detect active HCV infection from a DBS sample with good sensitivity and specificity, particularly when using a threshold of ≥1000 IU/mL.
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Affiliation(s)
- Beth Catlett
- NSW State Reference Laboratory for HIV, St Vincent's Centre for Applied Medical Research, Darlinghurst, Sydney, Australia; The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.
| | - Alex Carrera
- NSW State Reference Laboratory for HIV, St Vincent's Centre for Applied Medical Research, Darlinghurst, Sydney, Australia
| | - Mitchell Starr
- NSW State Reference Laboratory for HIV, St Vincent's Centre for Applied Medical Research, Darlinghurst, Sydney, Australia
| | - Tanya L Applegate
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Peter Lowe
- Hologic Australia, Macquarie Park, New South Wales, Australia
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - H Philip Cunningham
- NSW State Reference Laboratory for HIV, St Vincent's Centre for Applied Medical Research, Darlinghurst, Sydney, Australia
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22
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Olmstead AD, Montoya V, Chui CK, Dong W, Joy JB, Tai V, Poon AFY, Nguyen T, Brumme CJ, Martinello M, Matthews GV, Richard Harrigan P, Dore GJ, Applegate TL, Grebely J, Howe AYM. A systematic, deep sequencing-based methodology for identification of mixed-genotype hepatitis C virus infections. Infect Genet Evol 2019; 69:76-84. [PMID: 30654177 DOI: 10.1016/j.meegid.2019.01.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 01/10/2019] [Accepted: 01/13/2019] [Indexed: 02/06/2023]
Abstract
Hepatitis C virus (HCV) mixed genotype infections can affect treatment outcomes and may have implications for vaccine design and disease progression. Previous studies demonstrate 0-39% of high-risk, HCV-infected individuals harbor mixed genotypes however standardized, sensitive methods of detection are lacking. This study compared PCR amplicon, random primer (RP), and probe enrichment (PE)-based deep sequencing methods coupled with a custom sequence analysis pipeline to detect multiple HCV genotypes. Mixed infection cutoff values, based on HCV read depth and coverage, were identified using receiver operating characteristic curve analysis. The methodology was validated using artificially mixed genotype samples and then applied to two clinical trials of HCV treatment in high-risk individuals (ACTIVATE, 114 samples from 90 individuals; DARE-C II, 26 samples from 18 individuals) and a cohort of HIV/HCV co-infected individuals (Canadian Coinfection Cohort (CCC), 3 samples from 2 individuals with suspected mixed genotype infections). Amplification bias of genotype (G)1b, G2, G3 and G5 was observed in artificially mixed samples using the PCR method while no genotype bias was observed using RP and PE. RP and PE sequencing of 140 ACTIVATE and DARE-C II samples identified the following primary genotypes: 15% (n = 21) G1a, 76% (n = 106) G3, and 9% (n = 13) G2. Sequencing of ACTIVATE and DARE-C II demonstrated, on average, 2% and 1% of HCV reads mapping to a second genotype using RP and PE, respectively, however none passed the mixed infection cutoff criteria and phylogenetics confirmed no mixed infections. From CCC, one mixed infection was confirmed while the other was determined to be a recombinant genotype. This study underlines the risk for false identification of mixed HCV infections and stresses the need for standardized methods to improve prevalence estimates and to understand the impact of mixed infections for management and elimination of HCV.
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Affiliation(s)
| | | | - Celia K Chui
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Winnie Dong
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Jeffrey B Joy
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Medicine, Department of Medicine, Division of AIDS, University of British Columbia, Vancouver, BC, Canada
| | - Vera Tai
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Art F Y Poon
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Thuy Nguyen
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | | | | | | - P Richard Harrigan
- Faculty of Medicine, Department of Medicine, Division of AIDS, University of British Columbia, Vancouver, BC, Canada
| | - Gregory J Dore
- UNSW Sydney, The Kirby Institute, Sydney, NSW, Australia
| | | | - Jason Grebely
- UNSW Sydney, The Kirby Institute, Sydney, NSW, Australia
| | - Anita Y M Howe
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
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23
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Grebely J, Conway B, Cunningham EB, Fraser C, Moriggia A, Gane E, Stedman C, Cooper C, Castro E, Schmid P, Petoumenos K, Hajarizadeh B, Marks P, Erratt A, Dalgard O, Lacombe K, Feld JJ, Bruneau J, Daulouede JP, Powis J, Bruggmann P, Matthews GV, Kronborg I, Shaw D, Dunlop A, Hellard M, Applegate TL, Crawford S, Dore GJ. Paritaprevir, ritonavir, ombitasvir, and dasabuvir with and without ribavirin in people with HCV genotype 1 and recent injecting drug use or receiving opioid substitution therapy. International Journal of Drug Policy 2018; 62:94-103. [DOI: 10.1016/j.drugpo.2018.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/27/2018] [Accepted: 10/09/2018] [Indexed: 01/09/2023]
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24
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Bajis S, Maher L, Treloar C, Hajarizadeh B, Lamoury FMJ, Mowat Y, Schulz M, Marshall AD, Cunningham EB, Cock V, Ezard N, Gorton C, Hayllar J, Smith J, Whelan M, Martinello M, Applegate TL, Dore GJ, Grebely J. Acceptability and preferences of point-of-care finger-stick whole-blood and venepuncture hepatitis C virus testing among people who inject drugs in Australia. Int J Drug Policy 2018; 61:23-30. [PMID: 30388566 DOI: 10.1016/j.drugpo.2018.08.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 08/08/2018] [Accepted: 08/15/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Uptake of hepatitis C virus (HCV) testing remains inadequate globally. Simplified point-of-care tests should enhance HCV diagnosis and elimination. We aimed to assess the acceptability of finger-stick and venepuncture HCV RNA testing among people who inject drugs (PWID). METHODS Participants were enrolled in an observational cohort study with recruitment at 13 sites between June 2016 and February 2018. Capillary whole-blood collected by finger-stick and plasma collected by venepuncture were performed for Xpert® HCV viral load testing. Participants completed a questionnaire on acceptability of, and preferences for, blood collection methods. RESULTS Among 565 participants (mean age, 44 years; 69% male), 64% reported injecting drugs in the last month, and 63% were receiving opioid substitution treatment. Eighty three percent reported that finger-stick testing was very acceptable. Overall, 65% of participants preferred finger-stick over venepuncture testing, with 61% of these preferring to receive results in 60 min. The most common reason for preferring finger-stick over venepuncture testing was it was quick (62%) followed by venous access difficulties (21%). The main reasons for preferring venepuncture over finger-stick testing were that it was quick (61%) and accurate (29%). Females were more likely to prefer finger-stick testing than males (adjusted OR 1.96; 95% CI 1.30, 2.99; p = 0.002). Among people with recent (previous month) injecting drug use, Aboriginal and/or Torres Strait Islander people were less likely than non-Aboriginal people to prefer finger-stick testing (adjusted OR 0.57; 95% CI 0.34, 0.9; p = 0.033). CONCLUSIONS Finger-stick whole-blood collection is acceptable to people who inject drugs, with males and Aboriginal and/or Torres Strait Islander people with recent injecting drug use less likely to prefer finger-stick testing. Further research is needed to evaluate interventions integrating simplified point-of-care HCV testing to engage people in care in a single-visit, thereby facilitating HCV treatment scale-up.
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Affiliation(s)
- Sahar Bajis
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.
| | - Lisa Maher
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia; The Burnet Institute, Melbourne, Victoria, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | | | | | - Yasmin Mowat
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Marcel Schulz
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Alison D Marshall
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Evan B Cunningham
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Victoria Cock
- Drug and Alcohol Services of South Australia, Adelaide, South Australia, Australia
| | - Nadine Ezard
- Alcohol and Drug Service, St Vincent's Hospital, Sydney, New South Wales, Australia; Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Carla Gorton
- Cairns Sexual Health Service, Cairns, Queensland, Australia
| | - Jeremy Hayllar
- Alcohol and Drug Service, Metro North Mental Health, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Julie Smith
- Matthew Talbot Hostel, St Vincent de Paul Society NSW Support Services, Sydney, New South Wales, Australia
| | - Michelle Whelan
- Campbelltown Drug Health Services, Sydney, New South Wales, Australia
| | | | - Tanya L Applegate
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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Cunningham EB, Amin J, Feld JJ, Bruneau J, Dalgard O, Powis J, Hellard M, Cooper C, Read P, Conway B, Dunlop AJ, Norton B, Litwin AH, Hajarizadeh B, Thurnheer MC, Dillon JF, Weltman M, Shaw D, Bruggmann P, Gane E, Fraser C, Marks P, Applegate TL, Quiene S, Siriragavan S, Matthews GV, Dore GJ, Grebely J. Adherence to sofosbuvir and velpatasvir among people with chronic HCV infection and recent injection drug use: The SIMPLIFY study. Int J Drug Policy 2018; 62:14-23. [PMID: 30352330 DOI: 10.1016/j.drugpo.2018.08.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/10/2018] [Accepted: 08/10/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND This study investigated treatment adherence among people with recent injecting drug use in a study of sofosbuvir/velpatasvir therapy for HCV infection. METHODS SIMPLIFY is an international open-label, single-arm multicentre study that recruited participants with recent injecting drug use (previous six months) and chronic HCV genotype (G) 1-6 infection between March and October 2016 in seven countries (19 sites). Participants received sofosbuvir/velpatasvir once-daily for 12 weeks administered in a one-week electronic blister pack (records the time and date of each dose) for 12 weeks. We evaluated non-adherence (<90% adherent) as measured by electronic blister-pack assessed using logistic regression and generalised estimating equations (continuous) with detailed analyses of dosing dynamics. RESULTS Among 103 participants, 97% (n = 100) completed treatment. Median adherence to therapy was 94%. Overall, 32% (n = 33) were considered non-adherent (<90% adherence). Adherence significantly decreased over the course of therapy. Recent stimulant injecting (cocaine and/or amphetamines) at treatment initiation and during treatment was independently associated with non-adherence. Inconsistent dose timing (standard deviation of daily dose timing of ≥240 min) was also independently associated with non-adherence to therapy. Factors associated with inconsistent dose timing included lower levels of education and recent stimulant injecting. SVR was similar among adherent and non-adherent populations (94% vs. 94%, P = 0.944). CONCLUSION This study demonstrated high adherence to once-daily sofosbuvir/velpatasvir therapy among a population of people with recent injecting drug use. Recent stimulant injecting prior to and during DAA therapy and inconsistent dose-timing during treatment was associated with non-adherence. However, there was no impact of non-adherence on response to therapy, suggesting that adherence is not a significant barrier to successful DAA therapy in people with recent injecting drug use.
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Affiliation(s)
| | - Janaki Amin
- The Kirby Institute, UNSW Sydney, Sydney, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | | | - Julie Bruneau
- Centre Hospitalier de l'Université de Montréal, Canada
| | - Olav Dalgard
- Akershus University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jeff Powis
- South Riverdale Community Health Centre, Toronto, Canada
| | - Margaret Hellard
- The Burnet Institute, Melbourne, Australia; Department of Infectious Disease, The Alfred Hospital, Melbourne, Australia
| | | | - Phillip Read
- The Kirby Institute, UNSW Sydney, Sydney, Australia; Kirketon Road Centre, Sydney, Australia
| | - Brian Conway
- Vancouver Infectious Diseases Center, Vancouver, Canada
| | - Adrian J Dunlop
- Drug & Alcohol Clinical Services, Hunter New England Local Health District, Australia; Centre for Translational Neuroscience and Mental Health, Hunter Medical Research Institute & University of Newcastle, Australia
| | - Briana Norton
- Montefiore Medical Centre, New York, United States; Albert Einstein College of Medicine, New York, United States
| | - Alain H Litwin
- Montefiore Medical Centre, New York, United States; Albert Einstein College of Medicine, New York, United States
| | | | | | - John F Dillon
- Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | | | - David Shaw
- Royal Adelaide Hospital, Adelaide, Australia
| | | | - Edward Gane
- Auckland City Hospital, Auckland, New Zealand
| | - Chris Fraser
- Coolaid Community Health Centre, Victoria, Canada
| | | | | | | | | | - Gail V Matthews
- The Kirby Institute, UNSW Sydney, Sydney, Australia; St Vincent's Hospital, Sydney, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, Australia; St Vincent's Hospital, Sydney, Australia
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Martinello M, Bhagani S, Gane E, Orkin C, Cooke G, Dore GJ, Petoumenos K, Applegate TL, Tu E, Marks P, Pagani N, Grebely J, Nelson M, Matthews GV. Shortened therapy of eight weeks with paritaprevir/ritonavir/ombitasvir and dasabuvir is highly effective in people with recent HCV genotype 1 infection. J Viral Hepat 2018; 25:1180-1188. [PMID: 29660224 DOI: 10.1111/jvh.12917] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/12/2018] [Indexed: 12/13/2022]
Abstract
Paritaprevir/ritonavir/ombitasvir and dasabuvir with or without ribavirin for 12 weeks are approved for treatment of chronic HCV genotype 1 infection. This study assessed the efficacy of shortened duration paritaprevir/ritonavir/ombitasvir and dasabuvir with or without ribavirin for 8 weeks among people with recent HCV infection. In this open-label single-arm trial conducted in Australia, England and New Zealand, adults with recent HCV (duration of infection <12 months) received paritaprevir/ritonavir/ombitasvir and dasabuvir (with weight-based ribavirin for genotypes 1a and 1, no subtype) for 8 weeks. The primary endpoint was sustained virological response at 12 weeks post-treatment (SVR12) in the intention-to-treat (ITT) population. Thirty people (median age 38 years, male 93%) commenced treatment (with ribavirin, 97%), of whom 77% (n = 23) were HIV-positive, 93% (n = 28) had genotype 1a infection and 53% (n = 16) had ever injected drugs. Median maximum ALT in the preceding 12 months was 433 IU/L (IQR 321, 1012). Acute clinical hepatitis with ALT > 10 x ULN was documented in 83% (n = 25); one participant (3%) had jaundice. At baseline, median estimated duration of infection was 30 weeks (range 11, 51), and median HCV RNA was 5.7 log10 IU/mL (range 2.7, 7.3). SVR12 was achieved in 97% (29/30; early discontinuation at week 2, n = 1; per protocol 100%, 29/29). No relapse or reinfection was observed. In conclusion, paritaprevir/ritonavir/ombitasvir and dasabuvir (with ribavirin) for eight weeks were highly effective among HIV-positive and HIV-negative individuals with recent HCV infection. These data support the use of this shortened duration direct-acting antiviral regimen in this population.
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Affiliation(s)
- M Martinello
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.,Department of Infectious Diseases and Immunology, St Vincent's Hospital, Sydney, NSW, Australia
| | - S Bhagani
- Department of Infectious Diseases/HIV Medicine, Royal Free Hospital, London, UK
| | - E Gane
- New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand
| | - C Orkin
- Barts Health, Royal London Hospital, London, UK
| | - G Cooke
- Department of Infectious Diseases, Imperial College NHS Trust, St Mary's Hospital, London, UK
| | - G J Dore
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.,Department of Infectious Diseases and Immunology, St Vincent's Hospital, Sydney, NSW, Australia
| | - K Petoumenos
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - T L Applegate
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - E Tu
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - P Marks
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - N Pagani
- Chelsea and Westminster Hospital, London, UK
| | - J Grebely
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - M Nelson
- Chelsea and Westminster Hospital, London, UK
| | - G V Matthews
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.,Department of Infectious Diseases and Immunology, St Vincent's Hospital, Sydney, NSW, Australia
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Lamoury FM, Hajarizadeh B, Soker A, Martinez D, Quek C, Cunningham P, Catlett B, Cloherty G, Marks P, Amin J, Grebely J, Dore GJ, Applegate TL. Evaluation of a Hepatitis C Virus Core Antigen Assay in Plasma and Dried Blood Spot Samples. J Mol Diagn 2018; 20:621-627. [DOI: 10.1016/j.jmoldx.2018.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 04/19/2018] [Accepted: 05/07/2018] [Indexed: 01/20/2023] Open
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Lamoury FMJ, Bajis S, Hajarizadeh B, Marshall AD, Martinello M, Ivanova E, Catlett B, Mowat Y, Marks P, Amin J, Smith J, Ezard N, Cock V, Hayllar J, Persing DH, Kleman M, Cunningham P, Dore GJ, Applegate TL, Grebely J. Evaluation of the Xpert HCV Viral Load Finger-Stick Point-of-Care Assay. J Infect Dis 2018. [DOI: 10.1093/infdis/jiy114] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
| | - Sahar Bajis
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | | | | | - Elena Ivanova
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Beth Catlett
- St Vincent’s Applied Medical Research, Darlinghurst, Sydney, New South Wales
| | - Yasmin Mowat
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | - Janaki Amin
- The Kirby Institute, UNSW Sydney, Sydney, Australia
- Macquarie University, Sydney, New South Wales
| | - Julie Smith
- Matthew Talbot Hostel, St Vincent de Paul Society New South Wales Support Services, Sydney
| | - Nadine Ezard
- Alcohol and Drug Service, St Vincent’s Hospital, Sydney, New South Wales
- Faculty of Medicine, University of New South Wales, Sydney
| | - Victoria Cock
- Drug and Alcohol Services of South Australia, Adelaide
| | - Jeremy Hayllar
- Alcohol and Drug Service, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | | | | | - Philip Cunningham
- St Vincent’s Applied Medical Research, Darlinghurst, Sydney, New South Wales
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Grebely J, Dalgard O, Conway B, Cunningham EB, Bruggmann P, Hajarizadeh B, Amin J, Bruneau J, Hellard M, Litwin AH, Marks P, Quiene S, Siriragavan S, Applegate TL, Swan T, Byrne J, Lacalamita M, Dunlop A, Matthews GV, Powis J, Shaw D, Thurnheer MC, Weltman M, Kronborg I, Cooper C, Feld JJ, Fraser C, Dillon JF, Read P, Gane E, Dore GJ. Sofosbuvir and velpatasvir for hepatitis C virus infection in people with recent injection drug use (SIMPLIFY): an open-label, single-arm, phase 4, multicentre trial. Lancet Gastroenterol Hepatol 2018; 3:153-161. [PMID: 29310928 DOI: 10.1016/s2468-1253(17)30404-1] [Citation(s) in RCA: 212] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 11/16/2017] [Accepted: 11/16/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite revised guidelines that no longer exclude people who inject drugs (PWID) from treatment for hepatitis C virus (HCV) infection, many clinicians are reluctant to treat recent PWID. This study aimed to evaluate the efficacy of sofosbuvir and velpatasvir therapy in people with chronic HCV infection and recent injection drug use. METHODS In this open-label, single-arm phase 4 trial (SIMPLIFY), we recruited participants with recent injection drug use (past 6 months) and chronic HCV genotype 1-6 infection from seven countries (19 sites). Participants received oral sofosbuvir (400 mg) and velpatasvir (100 mg) once daily for 12 weeks. Therapy was given in 1-week electronic blister packs to record the time and date of each dose. The primary endpoint was the proportion of patients with sustained virological response 12 weeks after completion of treatment (SVR12; defined as HCV RNA <12 IU/mL), analysed in all patients who received at least one dose. This study is registered with ClinicalTrials.gov, number NCT02336139, and follow-up is ongoing to evaluate the secondary endpoint of HCV reinfection. FINDINGS Between March 29, and Oct 31, 2016, we enrolled 103 participants; 29 (28%) of whom were female, nine (9%) had cirrhosis, 36 (35%) had HCV genotype 1, five (5%) had genotype 2, 60 (58%) had genotype 3, and two (2%) had genotype 4. 61 (59%) participants were receiving opioid substitution therapy during the study, 76 (74%) injected in the past month, and 27 (26%) injected at least daily in the past month. 100 (97%) of 103 participants completed treatment; two people were lost to follow-up and one person died from an overdose. There were no virological failures. 97 (94%, 95% CI 88-98) of 103 people achieved SVR12. Three participants with an end-of-treatment response did not have a SVR; two were lost to follow-up and one had reinfection. Drug use before and during treatment did not affect SVR12. Treatment-related adverse events were seen in 48 (47%) patients (one grade 3, no grade 4). Seven (7%) patients had at least one serious adverse event; only one such event (rhabdomyolysis, resolved) was possibly related to the therapy. One case of HCV reinfection was observed. INTERPRETATION HCV treatment should be offered to PWID, irrespective of ongoing drug use. Recent injection drug use should not be used as a reason to withhold reimbursement of HCV therapy. FUNDING Gilead Sciences.
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Affiliation(s)
- Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
| | | | - Brian Conway
- Vancouver Infectious Diseases Center, Vancouver, BC, Canada
| | | | | | | | - Janaki Amin
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Julie Bruneau
- Centre Hospitalier de l'Université de Montréal, QC, Canada
| | - Margaret Hellard
- The Burnet Institute, Melbourne, VIC, Australia; Department of Infectious Disease, The Alfred Hospital, Melbourne, VIC, Australia
| | - Alain H Litwin
- Montefiore Medical Center, United States and Albert Einstein College of Medicine, New York, NY, USA
| | - Philippa Marks
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Sophie Quiene
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | | | - Tracy Swan
- International Network on Hepatitis in Substance Users, New York, NY, USA
| | - Jude Byrne
- Australian Injecting & Illicit Drug Users League, Canberra, NSW, Australia
| | - Melanie Lacalamita
- Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland
| | - Adrian Dunlop
- Newcastle Pharmacotherapy Service, Newcastle, NSW, Australia
| | - Gail V Matthews
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; St Vincent's Hospital, Sydney, NSW, Australia
| | - Jeff Powis
- South Riverdale Community Health Centre, Toronto, ON, Canada
| | - David Shaw
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | | | | | - Curtis Cooper
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Chris Fraser
- Cool Aid Community Health Centre, Victoria, BC, Canada
| | - John F Dillon
- Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Phillip Read
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Kirketon Road Centre, Sydney, NSW, Australia
| | - Ed Gane
- Auckland City Hospital, Auckland, New Zealand
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; St Vincent's Hospital, Sydney, NSW, Australia
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Jacka B, Bray B, Applegate TL, Marshall BDL, Lima VD, Hayashi K, DeBeck K, Raghwani J, Harrigan PR, Krajden M, Montaner J, Grebely J. Drug use and phylogenetic clustering of hepatitis C virus infection among people who use drugs in Vancouver, Canada: A latent class analysis approach. J Viral Hepat 2018; 25:28-36. [PMID: 28719060 PMCID: PMC5743579 DOI: 10.1111/jvh.12758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 06/19/2017] [Indexed: 12/28/2022]
Abstract
This study estimated latent classes (ie, unobserved subgroups in a population) of people who use drugs in Vancouver, Canada, and examined how these classes relate to phylogenetic clustering of hepatitis C virus (HCV) infection. HCV antibody-positive people who use drugs from two cohorts in Vancouver, Canada (1996-2012), with a Core-E2 sequence were included. Time-stamped phylogenetic trees were inferred, and phylogenetic clustering was determined by time to most common recent ancestor. Latent classes were estimated, and the association with the phylogenetic clustering outcome was assessed using an inclusive classify/analyse approach. Among 699 HCV RNA-positive participants (26% female, 24% HIV+), recent drug use included injecting cocaine (80%), injecting heroin (70%), injecting cocaine/heroin (ie, speedball, 38%) and crack cocaine smoking (28%). Latent class analysis identified four distinct subgroups of drug use typologies: (i) cocaine injecting, (ii) opioid and cocaine injecting, (iii) crack cocaine smoking and (iv) heroin injecting and currently receiving opioid substitution therapy. After adjusting for age and HIV infection, compared to the group defined by heroin injecting and currently receiving opioid substitution therapy, the odds of phylogenetic cluster membership was greater in the cocaine injecting group (adjusted OR [aOR]: 3.06; 95% CI: 1.73, 5.42) and lower in the crack cocaine smoking group (aOR: 0.06; 95% CI: 0.01, 0.48). Combining latent class and phylogenetic clustering analyses provides novel insights into the complex dynamics of HCV transmission. Incorporating differing risk profiles associated with drug use may provide opportunities to further optimize and target HCV treatment and prevention strategies.
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Affiliation(s)
- Brendan Jacka
- Viral Hepatitis Clinical Research Program, The Kirby Institute, UNSW Australia, Sydney NSW, Australia
| | - Bethany Bray
- The Methodology Center, Pennsylvania University, University Park, PA, USA
| | - Tanya L Applegate
- Viral Hepatitis Clinical Research Program, The Kirby Institute, UNSW Australia, Sydney NSW, Australia
| | | | - Viviane Dias Lima
- BC Centre for Excellence in HIV/AIDS, St Paul’s Hospital, Vancouver BC,Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kanna Hayashi
- BC Centre for Excellence in HIV/AIDS, St Paul’s Hospital, Vancouver BC,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada
| | - Kora DeBeck
- BC Centre for Excellence in HIV/AIDS, St Paul’s Hospital, Vancouver BC,School of Public Policy, Simon Fraser University, Vancouver, BC, Canada
| | | | - P Richard Harrigan
- BC Centre for Excellence in HIV/AIDS, St Paul’s Hospital, Vancouver BC,Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Julio Montaner
- BC Centre for Excellence in HIV/AIDS, St Paul’s Hospital, Vancouver BC,Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jason Grebely
- Viral Hepatitis Clinical Research Program, The Kirby Institute, UNSW Australia, Sydney NSW, Australia
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Affiliation(s)
- Jason Grebely
- Viral Hepatitis Clinical Research Program, The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Tanya L. Applegate
- Viral Hepatitis Clinical Research Program, The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Philip Cunningham
- St Vincent’s Centre for Applied Medical Research, Darlinghurst, Sydney, Australia
| | - Jordan J. Feld
- Toronto Centre for Liver Disease, Sandra Rotman Centre for Global Health, University of Toronto, Toronto, Canada
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Shepherd SJ, McDonald SA, Palmateer NE, Gunson RN, Aitken C, Dore GJ, Goldberg DJ, Applegate TL, Lloyd AR, Hajarizadeh B, Grebely J, Hutchinson SJ. HCV avidity as a tool for detection of recent HCV infection: Sensitivity depends on HCV genotype. J Med Virol 2017; 90:120-130. [PMID: 28843002 DOI: 10.1002/jmv.24919] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 08/15/2017] [Indexed: 12/26/2022]
Abstract
Accurate detection of incident hepatitis C virus (HCV) infection is required to target and evaluate public health interventions, but acute infection is largely asymptomatic and difficult to detect using traditional methods. Our aim was to evaluate a previously developed HCV avidity assay to distinguish acute from chronic HCV infection. Plasma samples collected from recent seroconversion subjects in two large Australian cohorts were tested using the avidity assay, and the avidity index (AI) was calculated. Demographic and clinical characteristics of patients with low/high AI were compared via logistic regression. Sensitivity and specificity of the assay for recent infection and the mean duration of recent infection (MDRI) were estimated stratified by HCV genotype. Avidity was assessed in 567 samples (from 215 participants), including 304 with viraemia (defined as ≥250 IU/mL). An inverse relationship between AI and infection duration was found in viraemic samples only. The adjusted odds of a low AI (<30%) decreased with infection duration (odds ratio [OR] per week of 0.93; 95% CI:0.89-0.97), and were lower for G1 compared with G3 samples (OR = 0.14; 95% CI:0.05-0.39). Defining recent infection as <26 weeks, sensitivity (at AI cut-off of 20%) was estimated at 48% (95% CI:39-56%), 36% (95% CI:20-52%), and 65% (95% CI:54-75%) and MDRI was 116, 83, and 152 days for all genotypes, G1, and G3, respectively. Specificity (≥52 weeks infection duration, all genotypes) was 96% (95% CI:90-98%). HCV avidity testing has utility for detecting recent HCV infection in patients, and for assessing progress in reaching incidence targets for eliminating transmission, but variation in assay performance across genotype should be recognized.
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Affiliation(s)
- Samantha J Shepherd
- West of Scotland Specialist Virology Centre, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - Scott A McDonald
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK.,Health Protection Scotland, Glasgow, Scotland, UK
| | | | - Rory N Gunson
- West of Scotland Specialist Virology Centre, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - Celia Aitken
- West of Scotland Specialist Virology Centre, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - Gregory J Dore
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - David J Goldberg
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK.,Health Protection Scotland, Glasgow, Scotland, UK
| | | | - Andrew R Lloyd
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - Jason Grebely
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Sharon J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK.,Health Protection Scotland, Glasgow, Scotland, UK
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Grebely J, Lamoury FMJ, Hajarizadeh B, Mowat Y, Marshall AD, Bajis S, Marks P, Amin J, Smith J, Edwards M, Gorton C, Ezard N, Persing D, Kleman M, Cunningham P, Catlett B, Dore GJ, Applegate TL. Evaluation of the Xpert HCV Viral Load point-of-care assay from venepuncture-collected and finger-stick capillary whole-blood samples: a cohort study. Lancet Gastroenterol Hepatol 2017; 2:514-520. [DOI: 10.1016/s2468-1253(17)30075-4] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 02/27/2017] [Accepted: 02/27/2017] [Indexed: 01/10/2023]
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Cunningham EB, Hajarizadeh B, Dalgard O, Amin J, Hellard M, Foster GR, Bruggmann P, Conway B, Backmund M, Robaeys G, Swan T, Marks PS, Quiene S, Applegate TL, Weltman M, Shaw D, Dunlop A, Bruneau J, Midgard H, Bourgeois S, Thurnheer MC, Dore GJ, Grebely J. Adherence to response-guided pegylated interferon and ribavirin for people who inject drugs with hepatitis C virus genotype 2/3 infection: the ACTIVATE study. BMC Infect Dis 2017; 17:420. [PMID: 28610605 PMCID: PMC5470219 DOI: 10.1186/s12879-017-2517-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 06/01/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The aims of this analysis were to investigate treatment completion and adherence among people with ongoing injecting drug use or receiving opioid substitution therapy (OST) in a study of response-guided therapy for chronic HCV genotypes 2/3 infection. METHODS ACTIVATE was a multicenter clinical trial recruited between 2012 and 2014. Participants with genotypes 2/3 were treated with directly observed peg-interferon alfa-2b (PEG-IFN) and self-administered ribavirin for 12 (undetectable HCV RNA at week 4) or 24 weeks (detectable HCV RNA at week 4). Outcomes included treatment completion, PEG-IFN adherence, ribavirin adherence, and sustained virological response (SVR, undetectable HCV RNA >12 weeks post-treatment). RESULTS Among 93 people treated, 59% had recently injected drugs (past month), 77% were receiving OST and 56% injected drugs during therapy. Overall, 76% completed treatment. Mean on-treatment adherence to PEG-IFN and ribavirin were 98.2% and 94.6%. Overall, 6% of participants missed >1 dose of PEG-IFN and 31% took <95% of their prescribed ribavirin., Higher treatment completion was observed among those receiving 12 vs. 24 weeks of treatment (97% vs. 46%, P < 0.001) while the proportion of participants with 95% on-treatment ribavirin adherence was similar between groups (67% vs. 72%, P = 0.664). Receiving 12 weeks of therapy was independently associated with treatment completion. No factors were associated with 95% RBV adherence. Neither recent injecting drug use at baseline nor during therapy was associated with treatment completion or adherence to ribavirin. In adjusted analysis, treatment completion was associated with SVR (aOR 23.9, 95% CI 2.9-193.8). CONCLUSIONS This study demonstrated a high adherence to directly observed PEG-IFN and self-administered ribavirin among people with ongoing injecting drug use or receiving OST. These data also suggest that shortening therapy from 24 to 12 weeks can lead to improved treatment completion. Treatment completion was associated with improved response to therapy. ACTIVATE trial registration number: NCT01364090 - May 31, 2011.
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Affiliation(s)
| | | | | | - Janaki Amin
- The Kirby Institute, UNSW Sydney, Sydney, NSW Australia
| | | | | | | | - Brian Conway
- Vancouver Infectious Diseases Center, Vancouver, BC Canada
| | | | - Geert Robaeys
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Genk, Belgium
- Department of Hepatology, UZ Leuven, Leuven, Belgium
- UHasselt, Hasselt, Belgium
| | - Tracy Swan
- Treatment Action Group, New York, NY USA
| | | | - Sophie Quiene
- The Kirby Institute, UNSW Sydney, Sydney, NSW Australia
| | | | | | - David Shaw
- Royal Adelaide Hospital, Adelaide, South Australia Australia
| | - Adrian Dunlop
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW Australia
| | - Julie Bruneau
- Research Center, Centre Hospitalier de l’Universite de Montreal (CRCHUM), Montreal, Quebec, Canada
| | | | | | | | | | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW Australia
| | - on behalf of the ACTIVATE Study Group
- The Kirby Institute, UNSW Sydney, Sydney, NSW Australia
- Akershus University Hospital, Oslo, Norway
- The Liver Unit, Queen Mary University of London, London, UK
- Arud Centres for Addiction Medicine, Zurich, Switzerland
- Vancouver Infectious Diseases Center, Vancouver, BC Canada
- Ludwig Maximilians-University Munich, Munich, Germany
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Genk, Belgium
- Department of Hepatology, UZ Leuven, Leuven, Belgium
- UHasselt, Hasselt, Belgium
- Treatment Action Group, New York, NY USA
- Nepean Hospital, Sydney, NSW Australia
- Royal Adelaide Hospital, Adelaide, South Australia Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW Australia
- Burnet Institute, Melbourne, VIC Australia
- Research Center, Centre Hospitalier de l’Universite de Montreal (CRCHUM), Montreal, Quebec, Canada
- Stuivenberg ZNA, Antwerp, Belgium
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
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Bartlett SR, Grebely J, Eltahla AA, Reeves JD, Howe AYM, Miller V, Ceccherini-Silberstein F, Bull RA, Douglas MW, Dore GJ, Harrington P, Lloyd AR, Jacka B, Matthews GV, Wang GP, Pawlotsky JM, Feld JJ, Schinkel J, Garcia F, Lennerstrand J, Applegate TL. Sequencing of hepatitis C virus for detection of resistance to direct-acting antiviral therapy: A systematic review. Hepatol Commun 2017; 1:379-390. [PMID: 29404466 PMCID: PMC5721421 DOI: 10.1002/hep4.1050] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/17/2017] [Accepted: 04/20/2017] [Indexed: 01/08/2023] Open
Abstract
The significance of the clinical impact of direct‐acting antiviral (DAA) resistance‐associated substitutions (RASs) in hepatitis C virus (HCV) on treatment failure is unclear. No standardized methods or guidelines for detection of DAA RASs in HCV exist. To facilitate further evaluations of the impact of DAA RASs in HCV, we conducted a systematic review of RAS sequencing protocols, compiled a comprehensive public library of sequencing primers, and provided expert guidance on the most appropriate methods to screen and identify RASs. The development of standardized RAS sequencing protocols is complicated due to a high genetic variability and the need for genotype‐ and subtype‐specific protocols for multiple regions. We have identified several limitations of the available methods and have highlighted areas requiring further research and development. The development, validation, and sharing of standardized methods for all genotypes and subtypes should be a priority. (Hepatology Communications 2017;1:379–390)
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Affiliation(s)
| | - Jason Grebely
- Kirby Institute University of New South Wales Sydney Australia
| | - Auda A Eltahla
- Kirby Institute University of New South Wales Sydney Australia.,School of Medical Sciences, Faculty of Medicine University of New South Wales Sydney Australia
| | - Jacqueline D Reeves
- Monogram Biosciences, Laboratory Corporation of America Holdings South San Francisco CA
| | - Anita Y M Howe
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital Vancouver Canada
| | - Veronica Miller
- Forum for Collaborative HIV Research University of California Berkeley Washington DC
| | | | - Rowena A Bull
- Kirby Institute University of New South Wales Sydney Australia.,School of Medical Sciences, Faculty of Medicine University of New South Wales Sydney Australia
| | - Mark W Douglas
- Storr Liver Centre, The Westmead Institute for Medical Research University of Sydney Sydney Australia
| | - Gregory J Dore
- Kirby Institute University of New South Wales Sydney Australia
| | - Patrick Harrington
- U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Division of Antiviral Products Silver Spring MD
| | - Andrew R Lloyd
- Kirby Institute University of New South Wales Sydney Australia.,School of Medical Sciences, Faculty of Medicine University of New South Wales Sydney Australia
| | - Brendan Jacka
- Kirby Institute University of New South Wales Sydney Australia
| | - Gail V Matthews
- Kirby Institute University of New South Wales Sydney Australia
| | - Gary P Wang
- Department of Medicine University of Florida College of Medicine Gainesville FL
| | - Jean-Michel Pawlotsky
- National Reference Center for Viral Hepatitis B, C, and D, Department of Virology and INSERM U955, Hopital Henri Mondor Université Paris-Est Creteil France
| | - Jordan J Feld
- Toronto Western Hospital Liver Centre, University Health Network University of Toronto Toronto Canada
| | - Janke Schinkel
- Department of Medical Microbiology Academic Medical Center Amsterdam the Netherlands
| | - Federico Garcia
- Clinical Microbiology Service Complejo Hospitalario Universitario de Granada Granada Spain
| | - Johan Lennerstrand
- Section of Clinical Virology, Department of Medical Science Uppsala University Uppsala Sweden
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Lamoury FMJ, Soker A, Martinez D, Hajarizadeh B, Cunningham EB, Cunningham P, Bruggmann P, Foster GR, Dalgard O, Backmund M, Conway B, Robaeys G, Swan T, Cloherty G, Marks P, Grebely J, Dore GJ, Applegate TL. Hepatitis C virus core antigen: A simplified treatment monitoring tool, including for post-treatment relapse. J Clin Virol 2017; 92:32-38. [PMID: 28521211 DOI: 10.1016/j.jcv.2017.05.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/18/2017] [Accepted: 05/06/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Simple, affordable diagnostic tools are essential to facilitate global hepatitis C virus (HCV) elimination efforts. OBJECTIVES This study evaluated the clinical performance of core antigen (HCVcAg) assay from plasma samples to monitor HCV treatment efficacy and HCV viral recurrence. STUDY DESIGN Plasma samples from a study of response-guided pegylated-interferon/ribavirin therapy for people who inject drugs with chronic HCV genotype 2/3 infection were assessed for HCV RNA (AmpliPrep/COBAS Taqman assay, Roche) and HCVcAg (ARCHITECT HCV Ag, Abbott Diagnostics) during and after therapy. The sensitivity and specificity of the HCVcAg assay was compared to the HCV RNA assay (gold standard). RESULTS A total of 335 samples from 92 enrolled participants were assessed (mean 4 time-points per participant). At baseline, end of treatment response (ETR) and sustained virological response (SVR) visits, the sensitivity of the HCVcAg assay with quantifiable HCV RNA threshold was 94% (95% CI: 88%, 98%), 56% (21%, 86%) and 100%, respectively. The specificity was between 98 to 100% for all time-points assessed. HCVcAg accurately detected all six participants with viral recurrence, demonstrating 100% sensitivity and specificity. One participant with detectable (non-quantifiable) HCV RNA and non-reactive HCVcAg at SVR12 subsequently cleared HCV RNA at SVR24. CONCLUSIONS HCVcAg demonstrated high sensitivity and specificity for detection of pre-treatment and post-treatment viraemia. This study indicates that confirmation of active HCV infection, including recurrent viraemia, by HCVcAg is possible. Reduced on-treatment sensitivity of HCVcAg may be a clinical advantage given the moves toward simplification of monitoring schedules.
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Affiliation(s)
| | | | | | | | | | - Philip Cunningham
- St. Vincent's Applied Medical Research, Darlinghurst, Sydney, Australia
| | | | - Graham R Foster
- Queen Mary University of London, Institute of Cell and Molecular Science, London, UK
| | - Olav Dalgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Markus Backmund
- Department of Addiction Medicine, Munich-Schwabing Hospital, Munich, Germany
| | - Brian Conway
- Department of Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada
| | - Geert Robaeys
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Schiepse, Belgium; Faculty of Medicine and Life Sciences, Limburg Clinical Research Program, Belgium; Department of Hepatology UZ Leuven, Leuven, Belgium
| | - Tracy Swan
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Schiepse, Belgium
| | | | - Pip Marks
- The Kirby Institute, UNSW Sydney, Sydney, Australia
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38
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Bartlett SR, Wertheim JO, Bull RA, Matthews GV, Lamoury FMJ, Scheffler K, Hellard M, Maher L, Dore GJ, Lloyd AR, Applegate TL, Grebely J. A molecular transmission network of recent hepatitis C infection in people with and without HIV: Implications for targeted treatment strategies. J Viral Hepat 2017; 24:404-411. [PMID: 27882678 PMCID: PMC5400687 DOI: 10.1111/jvh.12652] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 10/11/2016] [Indexed: 12/13/2022]
Abstract
Combining phylogenetic and network methodologies has the potential to better inform targeted interventions to prevent and treat infectious diseases. This study reconstructed a molecular transmission network for people with recent hepatitis C virus (HCV) infection and modelled the impact of targeting directly acting antiviral (DAA) treatment for HCV in the network. Participants were selected from three Australian studies of recent HCV from 2004 to 2014. HCV sequence data (Core-E2) from participants at the time of recent HCV detection were analysed to infer a network by connecting pairs of sequences whose divergence was ≤.03 substitutions/site. Logistic regression was used to identify factors associated with connectivity. Impact of targeting HCV DAAs at both HIV co-infected and random nodes was simulated (1 million replicates). Among 236 participants, 21% (n=49) were connected in the network. HCV/HIV co-infected participants (47%) were more likely to be connected compared to HCV mono-infected participants (16%) (OR 4.56; 95% CI; 2.13-9.74). Simulations targeting DAA HCV treatment to HCV/HIV co-infected individuals prevented 2.5 times more onward infections than providing DAAs to randomly selected individuals. Results demonstrate that genetic distance-based network analyses can be used to identify characteristics associated with HCV transmission, informing targeted prevention and treatment strategies.
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Affiliation(s)
| | - Joel O Wertheim
- Department of Medicine, University of California, San Diego, California, 92093, United States
| | - Rowena A Bull
- Kirby Institute, UNSW Australia, Sydney, 2052, Australia
| | | | | | - Konrad Scheffler
- Department of Medicine, University of California, San Diego, California, 92093, United States
| | | | - Lisa Maher
- Kirby Institute, UNSW Australia, Sydney, 2052, Australia
| | - Gregory J Dore
- Kirby Institute, UNSW Australia, Sydney, 2052, Australia
| | - Andrew R Lloyd
- Kirby Institute, UNSW Australia, Sydney, 2052, Australia
| | | | - Jason Grebely
- Kirby Institute, UNSW Australia, Sydney, 2052, Australia
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39
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Martinello M, Grebely J, Petoumenos K, Gane E, Hellard M, Shaw D, Sasadeusz J, Applegate TL, Dore GJ, Matthews GV. HCV reinfection incidence among individuals treated for recent infection. J Viral Hepat 2017; 24:359-370. [PMID: 28027424 PMCID: PMC5400730 DOI: 10.1111/jvh.12666] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 11/29/2016] [Indexed: 12/15/2022]
Abstract
One challenge to HCV elimination through therapeutic intervention is reinfection. The aim of this analysis was to calculate the incidence of HCV reinfection among both HIV-positive and HIV-negative individuals treated for recent HCV infection (estimated infection duration <18 months). Individuals with recent HCV infection who achieved an end-of-treatment response in four open-label studies between 2004 and 2015 in Australia and New Zealand were assessed for HCV reinfection, confirmed by sequencing of the Core-E2 and/or NS5B regions. Reinfection incidence was calculated using person-time of observation. Exact Poisson regression analysis was used to assess factors associated with HCV reinfection. The cohort at risk for reinfection (n=120; 83% male; median age 36 years) was composed of HIV-positive men-who-have-sex-with-men (53%) and people who inject drugs (current 49%, ever 69%). Total follow-up time at risk was 135 person-years (median 1.08 years, range 0.17, 2.53). Ten cases of HCV reinfection were identified, for an incidence of 7.4 per 100 py (95% CI 4.0, 13.8). Reinfection incidence was significantly higher among participants who reported injection drug use at end of or post-treatment, irrespective of HIV status (15.5 per 100 py, 95% CI 7.8, 31.1). In adjusted analysis, factors associated with reinfection were older age (aIRR 5.3, 95% CI 1.15, 51.5, P=.042) and injection drug use at end of or post-treatment (aIRR 7.9, 95% CI 1.6, 77.2, P=.008). High reinfection incidence following treatment for recent HCV infection in individuals with ongoing risk behaviour emphasizes the need for post-treatment surveillance, harm reduction strategies and education in at-risk populations.
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Affiliation(s)
- Marianne Martinello
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | - Jason Grebely
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | - Kathy Petoumenos
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | | | - Margaret Hellard
- Centre for Population Health, Burnet Institute, Melbourne, VIC, Australia,Infectious Diseases Unit, Alfred Hospital, Melbourne, VIC, Australia,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - David Shaw
- Infectious Diseases Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Joe Sasadeusz
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Tanya L Applegate
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | - Gregory J Dore
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Australia, Sydney, NSW, Australia,Department of Infectious Disease and Immunology, St Vincent’s Hospital, Sydney, NSW, Australia
| | - Gail V Matthews
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Australia, Sydney, NSW, Australia,Department of Infectious Disease and Immunology, St Vincent’s Hospital, Sydney, NSW, Australia
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40
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Bradshaw D, Raghwani J, Jacka B, Sacks-Davis R, Lamoury F, Down I, Prestage G, Applegate TL, Hellard M, Sasadeusz J, Dore GJ, Pybus OG, Matthews GV, Danta M. Venue-Based Networks May Underpin HCV Transmissions amongst HIV-Infected Gay and Bisexual Men. PLoS One 2016; 11:e0162002. [PMID: 27584149 PMCID: PMC5008823 DOI: 10.1371/journal.pone.0162002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 08/16/2016] [Indexed: 01/18/2023] Open
Abstract
Background This study aimed to investigate the potential influence of venue-based networks on HCV transmission in HIV-positive gay and bisexual men (GBM). Methods This was a prospectively recruited cohort of HIV-infected GBM with recently-acquired HCV infection resident in Melbourne and Sydney. Clinical and demographic data were collected together with blood samples for HCV sequencing. Phylogenies were inferred and clusters of individuals infected with HCV with genetic sequence homology were identified. Venues used for sourcing sexual partners were identified; sourcing partners from the same venue was considered a potential social link. Using the Jaccard similarity coefficient, associations were identified between the network of sites where men sourced sex partners and transmission relationships as defined by phylogenetic clustering. Results Forty individuals were recruited, of whom 62.5% were considered to have sexually- and 37.5% IDU-acquired HCV. Venue use was consistent with men being members of a more sexually adventurous gay community subculture. Six phylogenetically-determined pairs or clusters were identified, comprising fifteen (15/28, 53.6%) individuals. Participants belonging to phylogenetic clusters were observed within the same networks. There was a significant correlation between the network and phylogenetic clustering when both cities were considered simultaneously (p = 0.005), raising the possibility that social connections may be important for HCV transmissions. Conclusions Venue-based network elicitation is a promising approach for elucidating HCV transmissions amongst HIV-infected GBM. Public health approaches targeting individuals and venues prominent within networks may reduce onward HCV transmission.
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Affiliation(s)
- Daniel Bradshaw
- The Kirby Institute for Infection and Immunity in Society, UNSW Australia, Sydney, NSW, Australia
- Department of HIV/GU Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
- * E-mail:
| | - Jayna Raghwani
- Department of Zoology, Oxford University, Oxford, United Kingdom
| | - Brendan Jacka
- The Kirby Institute for Infection and Immunity in Society, UNSW Australia, Sydney, NSW, Australia
| | | | - Francois Lamoury
- The Kirby Institute for Infection and Immunity in Society, UNSW Australia, Sydney, NSW, Australia
| | - Ian Down
- The Kirby Institute for Infection and Immunity in Society, UNSW Australia, Sydney, NSW, Australia
| | - Garrett Prestage
- The Kirby Institute for Infection and Immunity in Society, UNSW Australia, Sydney, NSW, Australia
| | - Tanya L. Applegate
- The Kirby Institute for Infection and Immunity in Society, UNSW Australia, Sydney, NSW, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne University, Melbourne, Victoria, Australia
| | - Joe Sasadeusz
- Department of Infectious Diseases, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Gregory J. Dore
- The Kirby Institute for Infection and Immunity in Society, UNSW Australia, Sydney, NSW, Australia
| | - Oliver G. Pybus
- Department of Zoology, Oxford University, Oxford, United Kingdom
| | - Gail V. Matthews
- The Kirby Institute for Infection and Immunity in Society, UNSW Australia, Sydney, NSW, Australia
| | - Mark Danta
- St Vincent’s Clinical School, UNSW Australia, Sydney, NSW, Australia
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41
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Lamoury FMJ, Hajarizadeh B, Keoshkerian E, Feld JJ, Amin J, Teutsch S, Matthews GV, Hellard M, Dore GJ, Lloyd AR, Applegate TL, Grebely J. HIV infection is associated with higher levels of monocyte chemoattractant protein-1 and eotaxin among people with recent hepatitis C virus infection. BMC Infect Dis 2016; 16:241. [PMID: 27246604 PMCID: PMC4888248 DOI: 10.1186/s12879-016-1567-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 05/16/2016] [Indexed: 12/23/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) infection leads to more rapid progression of hepatitis C virus (HCV)-related liver fibrosis, which could be linked to differences in the severity of liver inflammation among HIV/HCV co-infected individuals compared to HCV mono-infected individuals. This study assessed the association of HIV co-infection with pro-inflammatory and pro-fibrogenic cytokines and chemokines during recent HCV infection. Methods Participants from the ATAHC study, a prospective cohort of recent HCV infection, with detectable HCV RNA at the time of acute HCV detection were included. Concentrations of 27 plasma cytokines and chemokines were measured by multiplex immunoassays and compared between those with, and without, HIV co-infection. Results Out of 117 individuals with recent HCV infection included in analysis, 73 had HCV mono-infection and 44 had HIV/HCV co-infection. Individuals with HIV/HCV co-infection had significantly higher mean levels of eotaxin (1.79 vs. 1.62 log pg/mL; P < 0.001), monocyte chemotactic protein 1 (MCP-1; 2.10 vs. 1.98 log pg/mL; P < 0.001), and interferon-gamma inducible protein-10 (IP-10; 3.11 vs. 2.98 log pg/mL; P = 0.013). Linear regression analyses adjusting for age, alanine transaminase (ALT), HCV RNA levels, and assay run, higher eotaxin levels were independently associated with HIV/HCV co-infection (adjusted β: 0.12; 95%CI: 0.01, 0.24; P = 0.039). Higher MCP-1 levels were also independently associated with HIV/HCV co-infection in adjusted analysis (adjusted β: 0.11; 95%CI: 0.03, 0.18; P = 0.009). Conclusions During recent HCV, those with HIV/HCV co-infection had a stronger pro-fibrogenic mediator profile compared to those with HCV mono-infection. These findings may provide a potential explanation for accelerated liver fibrosis in HIV/HCV co-infection. Trial registration Australian Trial in Acute Hepatitis C (ATAHC) study was registered with ClinicalTrials.gov registry on September 11, 2005. NCT00192569. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1567-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- François M J Lamoury
- The Kirby Institute, UNSW Australia, Sydney, Australia. .,Viral Hepatitis Clinical Research Program, The Kirby Institute, UNSW Australia, Sydney, NSW, 2010, Australia.
| | | | - Elizabeth Keoshkerian
- Inflammation and Infection Research Centre, School of Medical Sciences, UNSW Australia, Sydney, Australia
| | - Jordan J Feld
- Toronto Centre for Liver Disease, McLaughlin-Rotman Centre for Global Health, University of Toronto, Toronto, Canada
| | - Janaki Amin
- The Kirby Institute, UNSW Australia, Sydney, Australia
| | - Suzy Teutsch
- Inflammation and Infection Research Centre, School of Medical Sciences, UNSW Australia, Sydney, Australia
| | - Gail V Matthews
- The Kirby Institute, UNSW Australia, Sydney, Australia.,HIV/Immunology/Infectious Diseases Clinical Services Unit, St Vincent's Hospital, Sydney, Australia
| | | | - Gregory J Dore
- The Kirby Institute, UNSW Australia, Sydney, Australia.,HIV/Immunology/Infectious Diseases Clinical Services Unit, St Vincent's Hospital, Sydney, Australia
| | - Andrew R Lloyd
- Inflammation and Infection Research Centre, School of Medical Sciences, UNSW Australia, Sydney, Australia
| | | | - Jason Grebely
- The Kirby Institute, UNSW Australia, Sydney, Australia
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42
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Hajarizadeh B, Lamoury FM, Feld JJ, Amin J, Keoshkerian E, Matthews GV, Hellard M, Dore GJ, Lloyd AR, Grebely J, Applegate TL. Alanine aminotransferase, HCV RNA levels and pro-inflammatory and pro-fibrogenic cytokines/chemokines during acute hepatitis C virus infection. Virol J 2016; 13:32. [PMID: 26911712 PMCID: PMC4765111 DOI: 10.1186/s12985-016-0482-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 02/02/2016] [Indexed: 12/12/2022] Open
Abstract
Background This study assessed the association of alanine-aminotransferase (ALT) and hepatitis C virus (HCV) RNA levels with pro-inflammatory and pro-fibrogenic cytokines and chemokines during acute HCV infection to provide further insight into the potential HCV immunopathogenesis. Methods Participants in the ATAHC study, a prospective study of recent HCV infection, with detectable HCV RNA at the time of HCV detection were included. Plasma levels of 27 cytokines and chemokines were measured and their correlation with ALT and HCV RNA levels were assessed. Log10 transformed cytokines and ALT values were used in the analysis. Results Among 117 individuals, the plasma levels of interferon-gamma inducible protein-10 (IP-10) and macrophage inflammatory protein-1beta (MIP-1β) were positively correlated with ALT levels (IP-10: r = 0.42, P < 0.001; MIP-1β: r = 0.29, P = 0.001) and HCV RNA levels (IP-10: rs = 0.44, P < 0.001; MIP-1β: rs = 0.43, P < 0.001). Using linear regression, after adjusting for sex, age, infection duration, symptomatic infection, HIV co-infection, interferon-lambda rs12979860 genotype, HCV genotype, and assay run, higher ALT levels (β = 0.20; 95 % CI: 0.07, 0.32; P = 0.002) and HCV RNA levels >400,000 IU/mL (vs. <8,500 IU/mL; β = 0.16; 95 % CI: 0.03, 0.28; P = 0.014) were independently associated with higher IP-10 levels. HCV RNA levels >400,000 IU/mL (vs. <8,500 IU/mL; β = 0.16; 95 % CI: 0.01, 0.31; P = 0.036) were associated with higher MIP-1β levels. Conclusions During acute HCV infection, high ALT and HCV RNA levels were associated with increased IP-10 levels, while high HCV RNA levels were also associated with increased MIP-1β levels. These data suggest that IP-10 and MIP-1β may have a role in HCV immuno-pathogenesis starting early in acute HCV infection. Electronic supplementary material The online version of this article (doi:10.1186/s12985-016-0482-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Behzad Hajarizadeh
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, 2052, Australia.
| | - François Mj Lamoury
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, 2052, Australia.
| | - Jordan J Feld
- Toronto Centre for Liver Disease, McLaughlin-Rotman Centre for Global Health, University of Toronto, Toronto, Canada.
| | - Janaki Amin
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, 2052, Australia.
| | - Elizabeth Keoshkerian
- Inflammation and Infection Research Centre, School of Medical Sciences, UNSW Australia, Sydney, Australia.
| | - Gail V Matthews
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, 2052, Australia. .,HIV/Immunology/Infectious Diseases Clinical Services Unit, St Vincent's Hospital, Sydney, Australia.
| | | | - Gregory J Dore
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, 2052, Australia. .,HIV/Immunology/Infectious Diseases Clinical Services Unit, St Vincent's Hospital, Sydney, Australia.
| | - Andrew R Lloyd
- Inflammation and Infection Research Centre, School of Medical Sciences, UNSW Australia, Sydney, Australia.
| | - Jason Grebely
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, 2052, Australia.
| | - Tanya L Applegate
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, 2052, Australia.
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43
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Bartlett SR, Jacka B, Bull RA, Luciani F, Matthews GV, Lamoury FMJ, Hellard ME, Hajarizadeh B, Teutsch S, White B, Maher L, Dore GJ, Lloyd AR, Grebely J, Applegate TL. HIV infection and hepatitis C virus genotype 1a are associated with phylogenetic clustering among people with recently acquired hepatitis C virus infection. Infect Genet Evol 2016; 37:252-8. [PMID: 26631810 PMCID: PMC4728154 DOI: 10.1016/j.meegid.2015.11.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 11/20/2015] [Accepted: 11/25/2015] [Indexed: 12/29/2022]
Abstract
The aim of this study was to identify factors associated with phylogenetic clustering among people with recently acquired hepatitis C virus (HCV) infection. Participants with available sample at time of HCV detection were selected from three studies; the Australian Trial in Acute Hepatitis C, the Hepatitis C Incidence and Transmission Study - Prison and Community. HCV RNA was extracted and Core to E2 region of HCV sequenced. Clusters were identified from maximum likelihood trees with 1000 bootstrap replicates using 90% bootstrap and 5% genetic distance threshold. Among 225 participants with available Core-E2 sequence (ATAHC, n=113; HITS-p, n=90; and HITS-c, n=22), HCV genotype prevalence was: G1a: 38% (n=86), G1b: 5% (n=12), G2a: 1% (n=2), G2b: 5% (n=11), G3a: 48% (n=109), G6a: 1% (n=2) and G6l 1% (n=3). Of participants included in phylogenetic trees, 22% of participants were in a pair/cluster (G1a-35%, 30/85, mean maximum genetic distance=0.031; G3a-11%, 12/106, mean maximum genetic distance=0.021; other genotypes-21%, 6/28, mean maximum genetic distance=0.023). Among HCV/HIV co-infected participants, 50% (18/36) were in a pair/cluster, compared to 16% (30/183) with HCV mono-infection (P=<0.001). Factors independently associated with phylogenetic clustering were HIV co-infection [vs. HCV mono-infection; adjusted odds ratio (AOR) 4.24; 95%CI 1.91, 9.39], and HCV G1a infection (vs. other HCV genotypes; AOR 3.33, 95%CI 0.14, 0.61).HCV treatment and prevention strategies, including enhanced antiviral therapy, should be optimised. The impact of targeting of HCV treatment as prevention to populations with higher phylogenetic clustering, such as those with HIV co-infection, could be explored through mathematical modelling.
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Affiliation(s)
| | | | - Rowena A Bull
- Inflammation and Infection Research Centre (IIRC), UNSW Australia, Sydney, Australia
| | - Fabio Luciani
- Inflammation and Infection Research Centre (IIRC), UNSW Australia, Sydney, Australia
| | | | | | | | | | - Suzy Teutsch
- Inflammation and Infection Research Centre (IIRC), UNSW Australia, Sydney, Australia
| | | | - Lisa Maher
- Kirby Institute, UNSW Australia, Sydney, Australia
| | | | - Andrew R Lloyd
- Inflammation and Infection Research Centre (IIRC), UNSW Australia, Sydney, Australia
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Lamoury FMJ, Bartlett S, Jacka B, Hajarizadeh B, Grebely J, Matthews GV, Dore GJ, Applegate TL. Interferon λ 3 and 4 Genotyping Using High-Resolution Melt Curve Analysis Suitable for Multiple Clinical Sample Types. J Mol Diagn 2015; 17:583-9. [PMID: 26150150 PMCID: PMC4597282 DOI: 10.1016/j.jmoldx.2015.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 05/06/2015] [Accepted: 05/11/2015] [Indexed: 11/21/2022] Open
Abstract
Many people living with hepatitis C virus (HCV) infection will continue to rely on interferon-based regimens until effective strategies to minimize the cost of directly acting antivirals (DAAs) and to improve treatment access are implemented. Host single-nucleotide polymorphisms related to IFNL3 and IFNL4 are associated with spontaneous clearance of HCV, and pegylated interferon- and DAA-based treatment outcomes. We describe a simple and rapid genotyping method for IFNL rs12979860, rs8099917, and rs368234815 using high-resolution melting analysis for DNA extracted from whole blood, buffy coat, plasma, serum, and dried blood spots. This assay successfully detected all three polymorphisms on DNA extracted by the automated platform easyMAG from all samples when compared to sequenced amplicons. Analysis of 126 participants with recent HCV infection from the Australian Trial in Acute Hepatitis C study demonstrated the prevalence of favorable single-nucleotide polymorphisms were 62%, 51%, and 45% for rs8099917 TT, rs12979860 CC, and rs368234815 TT/TT, respectively. The genotyping assay described here provides a rapid and affordable IFNL3 and IFNL4 genotyping method for a range of clinical sample types. Until global access to DAAs is achieved, IFNL3 and IFNL4 genotyping could identify those likely to clear naturally and in whom treatment could be delayed, or help prioritize DAA treatment to those less likely to respond to interferon-containing regimens.
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Affiliation(s)
- François M J Lamoury
- Viral Hepatitis Clinical Research Program, The Kirby Institute, University of New South Wales Australia, Sydney, Australia.
| | - Sofia Bartlett
- Viral Hepatitis Clinical Research Program, The Kirby Institute, University of New South Wales Australia, Sydney, Australia
| | - Brendan Jacka
- Viral Hepatitis Clinical Research Program, The Kirby Institute, University of New South Wales Australia, Sydney, Australia
| | - Behzad Hajarizadeh
- Viral Hepatitis Clinical Research Program, The Kirby Institute, University of New South Wales Australia, Sydney, Australia
| | - Jason Grebely
- Viral Hepatitis Clinical Research Program, The Kirby Institute, University of New South Wales Australia, Sydney, Australia
| | - Gail V Matthews
- Viral Hepatitis Clinical Research Program, The Kirby Institute, University of New South Wales Australia, Sydney, Australia; HIV/Immunology/Infectious Diseases Clinical Services Unit, St. Vincent's Hospital, Sydney, Australia
| | - Gregory J Dore
- Viral Hepatitis Clinical Research Program, The Kirby Institute, University of New South Wales Australia, Sydney, Australia; HIV/Immunology/Infectious Diseases Clinical Services Unit, St. Vincent's Hospital, Sydney, Australia
| | - Tanya L Applegate
- Viral Hepatitis Clinical Research Program, The Kirby Institute, University of New South Wales Australia, Sydney, Australia
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Lamoury FMJ, Jacka B, Bartlett S, Bull RA, Wong A, Amin J, Schinkel J, Poon AF, Matthews GV, Grebely J, Dore GJ, Applegate TL. The Influence of Hepatitis C Virus Genetic Region on Phylogenetic Clustering Analysis. PLoS One 2015; 10:e0131437. [PMID: 26192190 PMCID: PMC4507989 DOI: 10.1371/journal.pone.0131437] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/01/2015] [Indexed: 02/06/2023] Open
Abstract
Sequencing is important for understanding the molecular epidemiology and viral evolution of hepatitis C virus (HCV) infection. To date, there is little standardisation among sequencing protocols, in-part due to the high genetic diversity that is observed within HCV. This study aimed to develop a novel, practical sequencing protocol that covered both conserved and variable regions of the viral genome and assess the influence of each subregion, sequence concatenation and unrelated reference sequences on phylogenetic clustering analysis. The Core to the hypervariable region 1 (HVR1) of envelope-2 (E2) and non-structural-5B (NS5B) regions of the HCV genome were amplified and sequenced from participants from the Australian Trial in Acute Hepatitis C (ATAHC), a prospective study of the natural history and treatment of recent HCV infection. Phylogenetic trees were constructed using a general time-reversible substitution model and sensitivity analyses were completed for every subregion. Pairwise distance, genetic distance and bootstrap support were computed to assess the impact of HCV region on clustering results as measured by the identification and percentage of participants falling within all clusters, cluster size, average patristic distance, and bootstrap value. The Robinson-Foulds metrics was also used to compare phylogenetic trees among the different HCV regions. Our results demonstrated that the genomic region of HCV analysed influenced phylogenetic tree topology and clustering results. The HCV Core region alone was not suitable for clustering analysis; NS5B concatenation, the inclusion of reference sequences and removal of HVR1 all influenced clustering outcome. The Core-E2 region, which represented the highest genetic diversity and longest sequence length in this study, provides an ideal method for clustering analysis to address a range of molecular epidemiological questions.
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Affiliation(s)
- François M. J. Lamoury
- The Kirby Institute, University of New South Wales Australia, Sydney, Australia
- * E-mail:
| | - Brendan Jacka
- The Kirby Institute, University of New South Wales Australia, Sydney, Australia
| | - Sofia Bartlett
- The Kirby Institute, University of New South Wales Australia, Sydney, Australia
| | - Rowena A. Bull
- Inflammation and Infection Research Centre, School of Medical Sciences, University of New South Wales Australia, Sydney, Australia
| | - Arthur Wong
- The Kirby Institute, University of New South Wales Australia, Sydney, Australia
| | - Janaki Amin
- The Kirby Institute, University of New South Wales Australia, Sydney, Australia
| | - Janke Schinkel
- Academic Medical Centre, Department of Medical Microbiology, Section of Clinical Virology, Amsterdam, The Netherlands
| | - Art F. Poon
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Gail V. Matthews
- The Kirby Institute, University of New South Wales Australia, Sydney, Australia
| | - Jason Grebely
- The Kirby Institute, University of New South Wales Australia, Sydney, Australia
| | - Gregory J. Dore
- The Kirby Institute, University of New South Wales Australia, Sydney, Australia
- HIV/Immunology/Infectious Diseases Clinical Services Unit, St Vincent’s Hospital, Sydney, Australia
| | - Tanya L. Applegate
- The Kirby Institute, University of New South Wales Australia, Sydney, Australia
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Bradshaw D, Lamoury F, Catlett B, Applegate TL, Mcallister J, Dore GJ, Matthews GV, Danta M. A comparison of seminal hepatitis C virus (HCV) RNA levels during recent and chronic HCV infection in HIV-infected and HIV-uninfected individuals. J Infect Dis 2014; 211:736-43. [PMID: 25293369 DOI: 10.1093/infdis/jiu550] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We aimed to characterize seminal hepatitis C virus (HCV) RNA dynamics in human immunodeficiency virus (HIV)-positive men with acute HCV infection given its potential role in sexual transmission of HCV. METHODS Men with acute HCV infection (duration, ≤12 months) or chronic HCV infection (duration, >12 months) were prospectively recruited. Paired semen and blood samples were assayed for HCV RNA levels. Results were analyzed using χ(2), Fisher exact, Mann-Whitney U, and Kruskal-Wallis tests. RESULTS Eighteen men (27.3%) had acute HCV and HIV coinfection, 22 (33.3%) had chronic HCV infection and HIV coinfection, and 26 (39.4%) had chronic HCV monoinfection. HCV RNA was detected in semen specimens from 29 of 66 men (43.9%). The median HCV RNA level in blood was 4.0 log IU/mL higher than that in semen. HCV RNA levels were correlated in semen and blood (r(2) = 0.142). Neither HIV positivity nor acute HCV infection was associated with an increased frequency of seminal HCV RNA detection. Among men with acute HCV and HIV coinfection, the median HCV RNA level in blood specimens from those with seminal HCV RNA was higher than that in blood specimens from those without seminal HCV RNA (P = .001). Seminal HCV RNA was detected in ≥1 sample for 26 of 35 men (74.3%) attending follow up. CONCLUSIONS HCV RNA was detected in semen during both acute and chronic HCV infection. This was unaffected by HIV positivity or the phase of HCV infection. Elevated seminal HCV RNA levels could contribute to sexual transmission of HCV, but other factors, including high-risk behaviors, may be the main drivers for HCV transmission in HIV-infected individuals.
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Affiliation(s)
- Daniel Bradshaw
- Kirby Institute Chelsea and Westminster Hospital, London, United Kingdom
| | | | | | | | | | | | | | - Mark Danta
- St Vincent's Clinical School, UNSW Australia
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Applegate TL, Gaudieri S, Plauzolles A, Chopra A, Grebely J, Lucas M, Hellard M, Luciani F, Dore GJ, Matthews GV. Naturally occurring dominant drug resistance mutations occur infrequently in the setting of recently acquired hepatitis C. Antivir Ther 2014; 20:199-208. [PMID: 25105742 DOI: 10.3851/imp2821] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Direct-acting antivirals (DAAs) are predicted to transform hepatitis C therapy, yet little is known about the prevalence of naturally occurring resistance mutations in recently acquired HCV. This study aimed to determine the prevalence and frequency of drug resistance mutations in the viral quasispecies among HIV-positive and -negative individuals with recent HCV. METHODS The NS3 protease, NS5A and NS5B polymerase genes were amplified from 50 genotype 1a participants of the Australian Trial in Acute Hepatitis C. Amino acid variations at sites known to be associated with possible drug resistance were analysed by ultra-deep pyrosequencing. RESULTS A total of 12% of individuals harboured dominant resistance mutations, while 36% demonstrated non-dominant resistant variants below that detectable by bulk sequencing (that is, <20%) but above a threshold of 1%. Resistance variants (<1%) were observed at most sites associated with DAA resistance from all classes, with the exception of sofosbuvir. CONCLUSIONS Dominant resistant mutations were uncommonly observed in the setting of recent HCV. However, low-level mutations to all DAA classes were observed by deep sequencing at the majority of sites and in most individuals. The significance of these variants and impact on future treatment options remains to be determined. Clinicaltrials.gov NCT00192569.
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Mcintyre GJ, Groneman JL, Yu YH, Tran A, Applegate TL. Multiple shRNA combinations for near-complete coverage of all HIV-1 strains. AIDS Res Ther 2011; 8:1. [PMID: 21226969 PMCID: PMC3033792 DOI: 10.1186/1742-6405-8-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 01/13/2011] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Combinatorial RNA interference (co-RNAi) approaches are needed to account for viral variability in treating HIV-1 with RNAi, as single short hairpin RNAs (shRNA) are rapidly rendered ineffective by resistant strains. Current work suggests that 4 simultaneously expressed shRNAs may prevent the emergence of resistant strains. RESULTS In this study we assembled combinations of highly-conserved shRNAs to target as many HIV-1 strains as possible. We analyzed intersecting conservations of 10 shRNAs to find combinations with 4+ matching the maximum number of strains using 1220+ HIV-1 sequences from the Los Alamos National Laboratory (LANL). We built 26 combinations of 2 to 7 shRNAs with up to 87% coverage for all known strains and 100% coverage of clade B subtypes, and characterized their intrinsic suppressive activities in transient expression assays. We found that all combinations had high combined suppressive activities, though there were also large changes in the individual activities of the component shRNAs in our multiple expression cassette configurations. CONCLUSION By considering the intersecting conservations of shRNA combinations we have shown that it is possible to assemble combinations of 6 and 7 highly active, highly conserved shRNAs such that there is always at least 4 shRNAs within each combination covering all currently known variants of entire HIV-1 subtypes. By extension, it may be possible to combine several combinations for complete global coverage of HIV-1 variants.
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Affiliation(s)
- Glen J Mcintyre
- Johnson and Johnson Research Pty Ltd, Level 4 Biomedical Building, 1 Central Avenue, Australian Technology Park, Eveleigh, NSW, 1430, Australia
| | - Jennifer L Groneman
- Johnson and Johnson Research Pty Ltd, Level 4 Biomedical Building, 1 Central Avenue, Australian Technology Park, Eveleigh, NSW, 1430, Australia
| | - Yi-Hsin Yu
- Johnson and Johnson Research Pty Ltd, Level 4 Biomedical Building, 1 Central Avenue, Australian Technology Park, Eveleigh, NSW, 1430, Australia
| | - Anna Tran
- Johnson and Johnson Research Pty Ltd, Level 4 Biomedical Building, 1 Central Avenue, Australian Technology Park, Eveleigh, NSW, 1430, Australia
| | - Tanya L Applegate
- Johnson and Johnson Research Pty Ltd, Level 4 Biomedical Building, 1 Central Avenue, Australian Technology Park, Eveleigh, NSW, 1430, Australia
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Mcintyre GJ, Yu YH, Tran A, Jaramillo AB, Arndt AJ, Millington ML, Boyd MP, Elliott FA, Shen SW, Murray JM, Applegate TL. Cassette deletion in multiple shRNA lentiviral vectors for HIV-1 and its impact on treatment success. Virol J 2009; 6:184. [PMID: 19878571 PMCID: PMC2775741 DOI: 10.1186/1743-422x-6-184] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Accepted: 10/30/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple short hairpin RNA (shRNA) gene therapy strategies are currently being investigated for treating viral diseases such as HIV-1. It is important to use several different shRNAs to prevent the emergence of treatment-resistant strains. However, there is evidence that repeated expression cassettes delivered via lentiviral vectors may be subject to recombination-mediated repeat deletion of 1 or more cassettes. RESULTS The aim of this study was to determine the frequency of deletion for 2 to 6 repeated shRNA cassettes and mathematically model the outcomes of different frequencies of deletion in gene therapy scenarios. We created 500+ clonal cell lines and found deletion frequencies ranging from 2 to 36% for most combinations. While the central positions were the most frequently deleted, there was no obvious correlation between the frequency or extent of deletion and the number of cassettes per combination. We modeled the progression of infection using combinations of 6 shRNAs with varying degrees of deletion. Our in silico modeling indicated that if at least half of the transduced cells retained 4 or more shRNAs, the percentage of cells harboring multiple-shRNA resistant viral strains could be suppressed to < 0.1% after 13 years. This scenario afforded a similar protection to all transduced cells containing the full complement of 6 shRNAs. CONCLUSION Deletion of repeated expression cassettes within lentiviral vectors of up to 6 shRNAs can be significant. However, our modeling showed that the deletion frequencies observed here for 6x shRNA combinations was low enough that the in vivo suppression of replication and escape mutants will likely still be effective.
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Affiliation(s)
- Glen J Mcintyre
- Johnson and Johnson Research Pty Ltd, Level 4 Biomedical Building, 1 Central Avenue, Australian Technology Park, Eveleigh, NSW, 1430, Australia
| | - Yi-Hsin Yu
- Johnson and Johnson Research Pty Ltd, Level 4 Biomedical Building, 1 Central Avenue, Australian Technology Park, Eveleigh, NSW, 1430, Australia
| | - Anna Tran
- Johnson and Johnson Research Pty Ltd, Level 4 Biomedical Building, 1 Central Avenue, Australian Technology Park, Eveleigh, NSW, 1430, Australia
| | - Angel B Jaramillo
- Johnson and Johnson Research Pty Ltd, Level 4 Biomedical Building, 1 Central Avenue, Australian Technology Park, Eveleigh, NSW, 1430, Australia
| | - Allison J Arndt
- Johnson and Johnson Research Pty Ltd, Level 4 Biomedical Building, 1 Central Avenue, Australian Technology Park, Eveleigh, NSW, 1430, Australia
| | - Michelle L Millington
- Johnson and Johnson Research Pty Ltd, Level 4 Biomedical Building, 1 Central Avenue, Australian Technology Park, Eveleigh, NSW, 1430, Australia
| | - Maureen P Boyd
- Johnson and Johnson Research Pty Ltd, Level 4 Biomedical Building, 1 Central Avenue, Australian Technology Park, Eveleigh, NSW, 1430, Australia
| | - Fiona A Elliott
- Johnson and Johnson Research Pty Ltd, Level 4 Biomedical Building, 1 Central Avenue, Australian Technology Park, Eveleigh, NSW, 1430, Australia
| | - Sylvie W Shen
- Johnson and Johnson Research Pty Ltd, Level 4 Biomedical Building, 1 Central Avenue, Australian Technology Park, Eveleigh, NSW, 1430, Australia
| | - John M Murray
- School of Mathematics and Statistics, The University of New South Wales, Sydney, NSW, 2052, Australia
- The National Center in HIV Epidemiology and Clinical Research, The University of New South Wales, 376 Victoria St. Darlinghurst, NSW, 2010, Australia
| | - Tanya L Applegate
- Johnson and Johnson Research Pty Ltd, Level 4 Biomedical Building, 1 Central Avenue, Australian Technology Park, Eveleigh, NSW, 1430, Australia
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Mokany E, Todd AV, Fuery CJ, Applegate TL. Diagnosis and monitoring of PML-RARalpha-positive acute promyelocytic leukemia by quantitative RT-PCR. Methods Mol Med 2006; 125:127-47. [PMID: 16502582 DOI: 10.1385/1-59745-017-0:127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The last 15 yr have produced dramatic improvements in the survival rate of patients with acute promyelocytic leukemia (APL). These improvements have been due mainly to the introduction of targeted therapies and improved methods for diagnosing and monitoring this disease. The underlying molecular lesion in APL involves a t(15:17) translocation which leads to the generation of PML-RARalpha fusion transcripts and proteins. The PML-RARalpha fusion transcripts have been shown to be useful markers for establishing the diagnosis and for monitoring the response to treatment. This manuscript describes the application of QZyme reverse-transcription polymerase chain reaction (RT-PCR) to the quantification of PML-RARalpha transcripts as a marker of APL. QZyme is a method for real time detection and quantification of target genes or transcripts. The principle of QZyme analysis is similar to other quantitative PCR systems; however, the mechanism is quite different. QZyme exploits the catalytic activity of DNAzymes (deoxyribozymes), which are oligonucleotides that can bind and cleave nucleic acid substrates. The approach is well suited to monitoring minimal residual disease (MRD) in patients with APL, as a result of its ability to detect low numbers of transcripts and accurately measure differences in concentration over a broad dynamic range. Further, its capacity for duplex analysis has multiple advantages for analysis of clinical specimens. Protocols for duplex, single-tube QZyme RT-PCR assays, which allow simultaneous quantification of PML-RARalpha fusion transcripts (either L-type and V-type, or S-type) and the internal control BCR transcript, are provided. These protocols can be used for analyzing patient RNA specimens and are suitable for clinical trial monitoring. For this type of work, it is recommended that investigators validate the assays to ensure reproducible, accurate, and specific results on the equipment in their own laboratories. Assay validation is critical for real-time quantitative RT-PCR (RQ-PCR) and is often overlooked. A guide to the steps involved in validation and recommendations for acceptance criteria is included in this chapter.
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MESH Headings
- Chromosomes, Human, Pair 15
- Chromosomes, Human, Pair 17
- Humans
- Leukemia, Promyelocytic, Acute/genetics
- Monitoring, Physiologic/methods
- Neoplasm Proteins/genetics
- Oncogene Proteins, Fusion/genetics
- RNA, Neoplasm/genetics
- Reverse Transcriptase Polymerase Chain Reaction/methods
- Transcription, Genetic
- Translocation, Genetic
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Affiliation(s)
- Elisa Mokany
- Johnson & Johnson Research Pty Limited, NSW, Australia
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