1
|
Kostaki EG, Roussos S, Kefala AM, Limnaios S, Psichogiou M, Papachristou E, Nikolopoulos G, Flountzi E, Friedman SR, Lagiou P, Hatzakis A, Sypsa V, Magiorkinis G, Beloukas A, Paraskevis D. Molecular epidemiology of HIV among people who inject drugs after the HIV-outbreak in Athens, Greece: Evidence for a 'slow burn' outbreak. Infect Genet Evol 2024; 121:105597. [PMID: 38663466 DOI: 10.1016/j.meegid.2024.105597] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND New diagnoses of HIV-1 infection among people who inject drugs (PWID) in Athens, Greece, saw a significant increase in 2011 and a subsequent decline after 2013. Despite this, ongoing HIV-1 transmission persisted from 2014 to 2020 within this population. Our objective was to estimate the time of infection for PWID in Athens following the HIV-1 outbreak, explore the patterns of HIV-1 dispersal over time, and determine the duration from infection to diagnosis. METHODS Time from HIV-1 infection to diagnosis was estimated for 844 individuals infected within 4 PWID-specific clusters and for 8 PWID infected with sub-subtype A6 diagnosed during 2010-2019. Phylogeny reconstruction was performed using the maximum-likelihood method. HIV-1 infection dates were based on molecular clock calculations. RESULTS In total 86 of 92 (93.5%) sequences from PWID diagnosed during 2016-2019 were either related to the previously identified PWID-specific clusters (n = 81) or belonged to a new A6 cluster (n = 5). The median time between infection and diagnosis was 0.42 years during the outbreak period and 0.70 years during 2016-2019 (p < 0.001). The proportion of clustered sequences from PWID was very low at 5.3% during the pre-outbreak period (1998-2009), saw an increase to 41.7% one year before the outbreak in 2010, and consistently remained high during the whole period after 2011, spanning the post-outbreak period (2016-2019) with a range from 92.9% to 100%. CONCLUSIONS The substantial proportion of clustered infections (93.5%) during 2016-2019 implies a persistent 'slow burn' HIV outbreak among PWID in Athens, suggesting that the outbreak was not successfully eliminated. The consistently high proportion of clustered sequences since the onset of the outbreak suggests the persistence of ongoing HIV-1 transmission attributed to injection practices. Our findings underscore the importance of targeted interventions among PWID, considering the ongoing transmission rate and prolonged time from infection to diagnosis.
Collapse
Affiliation(s)
- Evangelia Georgia Kostaki
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Roussos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Stefanos Limnaios
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Mina Psichogiou
- First Department of Internal Medicine, "Laiko" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Papachristou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Eleni Flountzi
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Samuel R Friedman
- Center for Opioid Epidemiology and Policy, Department of Population Health, New York University Grossman School of Medicine, New York City, USA
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gkikas Magiorkinis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Apostolos Beloukas
- Department of Biomedical Sciences, University of West Attica, Athens, Greece; National AIDS Reference Centre of Southern Greece, Department of Public Health Policy, University of West Attica, Athens, Greece.
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| |
Collapse
|
2
|
Roussos S, Angelopoulos T, Cholongitas E, Savvanis S, Papadopoulos N, Kapatais A, Chounta A, Ioannidou P, Deutsch M, Manolakopoulos S, Sevastianos V, Papageorgiou MV, Vlachogiannakos I, Mela M, Elefsiniotis I, Vrakas S, Karagiannakis D, Pliarchopoulou F, Chaikalis S, Tsirogianni E, Psichogiou M, Kalamitsis G, Leobilla F, Paraskevis D, Malliori M, Goulis I, Papatheodoridis G, Hatzakis A, Sypsa V. High levels of all-cause mortality among people who inject drugs from 2018 to 2022. Int J Drug Policy 2024; 126:104356. [PMID: 38394950 DOI: 10.1016/j.drugpo.2024.104356] [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: 07/28/2023] [Revised: 02/06/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Mortality among people who inject drugs (PWID) is high, with overdose and HIV infection being the main causes of death. In Greece, there have been no data on mortality, and two HIV outbreaks have been recorded in this population in the past decade. In this study, we aim to estimate the all-cause crude mortality rate and the standardised mortality ratio in this population during 2018-2022. METHODS PWID recruited from two community-based programs in Athens and Thessaloniki during 2018-2021 were interviewed and tested for HIV/HCV. Data on vital status (deceased/alive) and date of death were obtained from death registries through December 31, 2022. All-cause crude mortality rates (CMR) and standardised mortality ratios (SMR) were estimated. Determinants of mortality were assessed using Cox proportional-hazards model. RESULTS Of 2,530 participants, 301 died over 8,543 person-years (PYs) of follow-up. The CMR (95 % CI) was 3.52 (3.15-3.94) deaths per 100 PYs; 3.10 per 100 PYs (2.68-3.58) in Athens and 4.48 per 100 PYs (3.74-5.37) in Thessaloniki. An increasing trend in CMR was identified over 2018-2022 in Athens (from 2.90 to 4.11 per 100 PYs, 41.5 % increase, p = 0.018). The pooled SMR (95 % CI) was 15.86 (14.17-17.76) for both cities and was particularly increased in younger individuals, females, those injecting daily, not enrolled to opioid agonist treatment and HIV-infected individuals. Older age, living in Thessaloniki, Greek origin, homelessness, history of injection in the past 12 months, and HIV infection were independently associated with higher risk of death. CONCLUSION Mortality among PWID in the two largest cities (Athens and Thessaloniki) in Greece in 2018-2022 was high, with the population in Thessaloniki being particularly affected. The increasing trend in mortality in Athens may reflect the long-term impact of the COVID-19 pandemic. Preventive programs such as take-home naloxone, screening and treatment for HIV, are urgently needed.
Collapse
Affiliation(s)
- Sotirios Roussos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Angelopoulos
- Gastroenterology Resident, Gastroenterology Department, G.H.A. Korgialeneio Mpenakeio Hellenic Red Cross, Athens, Greece
| | - Evangelos Cholongitas
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Savvanis
- Department of Internal Medicine, General Hospital of Athens "Elpis", Athens, Greece
| | - Nikolaos Papadopoulos
- 2nd Department of Internal Medicine, 401 General Army Hospital of Athens, Athens, Greece
| | - Andreas Kapatais
- 1st Department of Internal Medicine, Western Attica General Hospital "Agia Varvara", Athens, Greece
| | - Athina Chounta
- 4th Department of Internal Medicine, General University Hospital "Attikon", Athens, Greece
| | - Panagiota Ioannidou
- Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Melani Deutsch
- 2nd Academic Department of Internal Medicine, Hippokration General Hospital, Athens, Greece
| | - Spilios Manolakopoulos
- 2nd Academic Department of Internal Medicine, Hippokration General Hospital, Athens, Greece
| | | | - Maria-Vasiliki Papageorgiou
- Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Ioannis Vlachogiannakos
- Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Maria Mela
- Department of Gastroenterology, Evangelismos General Hospital, Athens, Greece
| | - Ioannis Elefsiniotis
- Department of Internal Medicine-Hepatogastroenterology, "Agioi Anargyroi" General and Oncology Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Vrakas
- Department of Gastroenterology, Tzaneion General Hospital of Piraeus, Piraeus, Greece
| | - Dimitrios Karagiannakis
- Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Fani Pliarchopoulou
- 4th Department of Internal Medicine, General University Hospital "Attikon", Athens, Greece
| | - Savvas Chaikalis
- Hellenic Scientific Society for the Study of AIDS, Sexually Transmitted and Emerging Diseases, Athens, Greece
| | - Effrosyni Tsirogianni
- Fourth Department of Internal Medicine, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mina Psichogiou
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Meni Malliori
- Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Goulis
- Fourth Department of Internal Medicine, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Papatheodoridis
- Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Hellenic Scientific Society for the Study of AIDS, Sexually Transmitted and Emerging Diseases, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| |
Collapse
|
3
|
Chun HS, Papatheodoridis GV, Lee M, Lee HA, Kim YH, Kim SH, Oh YS, Park SJ, Kim J, Lee HA, Kim HY, Kim TH, Yoon EL, Jun DW, Ahn SH, Sypsa V, Yurdaydin C, Lampertico P, Calleja JL, Janssen HLA, Dalekos GN, Goulis J, Berg T, Buti M, Kim SU, Kim YJ. PAGE-B incorporating moderate HBV DNA levels predicts risk of HCC among patients entering into HBeAg-positive chronic hepatitis B. J Hepatol 2024; 80:20-30. [PMID: 37734683 DOI: 10.1016/j.jhep.2023.09.011] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 07/31/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND & AIMS Recent studies reported that moderate HBV DNA levels are significantly associated with hepatocellular carcinoma (HCC) risk in hepatitis B e antigen (HBeAg)-positive, non-cirrhotic patients with chronic hepatitis B (CHB). We aimed to develop and validate a new risk score to predict HCC development using baseline moderate HBV DNA levels in patients entering into HBeAg-positive CHB from chronic infection. METHODS This multicenter cohort study recruited 3,585 HBeAg-positive, non-cirrhotic patients who started antiviral treatment with entecavir or tenofovir disoproxil fumarate at phase change into CHB from chronic infection in 23 tertiary university-affiliated hospitals of South Korea (2012-2020). A new HCC risk score (PAGED-B) was developed (training cohort, n = 2,367) based on multivariable Cox models. Internal validation using bootstrap sampling and external validation (validation cohort, n = 1,218) were performed. RESULTS Sixty (1.7%) patients developed HCC (median follow-up, 5.4 years). In the training cohort, age, gender, platelets, diabetes and moderate HBV DNA levels (5.00-7.99 log10 IU/ml) were independently associated with HCC development; the PAGED-B score (based on these five predictors) showed a time-dependent AUROC of 0.81 for the prediction of HCC development at 5 years. In the validation cohort, the AUROC of PAGED-B was 0.85, significantly higher than for other risk scores (PAGE-B, mPAGE-B, CAMD, and REAL-B). When stratified by the PAGED-B score, the HCC risk was significantly higher in high-risk patients than in low-risk patients (sub-distribution hazard ratio = 8.43 in the training and 11.59 in the validation cohorts, all p <0.001). CONCLUSIONS The newly established PAGED-B score may enable risk stratification for HCC at the time of transition into HBeAg-positive CHB. IMPACT AND IMPLICATIONS In this study, we developed and validated a new risk score to predict hepatocellular carcinoma (HCC) development in patients entering into hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB) from chronic infection. The newly established PAGED-B score, which included baseline moderate HBV DNA levels (5-8 log10 IU/ml), improved on the predictive performance of prior risk scores. Based on a patient's age, gender, diabetic status, platelet count, and moderate DNA levels (5-8 log10 IU/ml) at the phase change into CHB from chronic infection, the PAGED-B score represents a reliable and easily available risk score to predict HCC development during the first 5 years of antiviral treatment in HBeAg-positive patients entering into CHB. With a scoring range from 0 to 12 points, the PAGED-B score significantly differentiated the 5-year HCC risk: low <7 points and high ≥7 points.
Collapse
Affiliation(s)
- Ho Soo Chun
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea; Department of Internal Medicine, Ewha Womans University Medical Center, Seoul, Korea
| | - George V Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Minjong Lee
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea; Department of Internal Medicine, Ewha Womans University Medical Center, Seoul, Korea.
| | - Hye Ah Lee
- Clinical Trial Center, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Yeong Hwa Kim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Seo Hyun Kim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Yun-Seo Oh
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Su Jin Park
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jihye Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Han Ah Lee
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea; Department of Internal Medicine, Ewha Womans University Medical Center, Seoul, Korea
| | - Hwi Young Kim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea; Department of Internal Medicine, Ewha Womans University Medical Center, Seoul, Korea
| | - Tae Hun Kim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea; Department of Internal Medicine, Ewha Womans University Medical Center, Seoul, Korea
| | - Eileen L Yoon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Dae Won Jun
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sang Hoon Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea; Yonsei Liver Center, Severance Hospital, Seoul, Korea
| | - Vana Sypsa
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Cihan Yurdaydin
- Department of Gastroenterology & Hepatology, Koc University Medical School, Istanbul, Turkey
| | - Pietro Lampertico
- Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Harry LA Janssen
- Department of Gastroenterology & Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - John Goulis
- 4th Department of Internal Medicine, Αristotle University of Thessaloniki Medical School, Thessaloniki, Greece
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Maria Buti
- Hospital General Universitario Vall Hebron and Ciberehd, Barcelona, Spain
| | - Seung Up Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea; Yonsei Liver Center, Severance Hospital, Seoul, Korea.
| | - Yoon Jun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
| |
Collapse
|
4
|
Styliari M, Alexandrou M, Polychronidou G, Poulakou G, Sypsa V, Fountoulakis KΝ. Depression in medical students during the COVID-19 lockdown in Greece. Psychiatriki 2023; 34:322-330. [PMID: 37793037 DOI: 10.22365/jpsych.2023.023] [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] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
The COVID-19 pandemic has caused a mental health crisis. The purpose of this study was to estimate the prevalence of depression in medical students in Greece during a nationwide lockdown. The secondary aims were to assess the association of depression with socio-demographic factors and students' attitudes regarding the quality of their studies. The data was gathered anonymously through a self-administered online questionnaire between January 11 and 27, 2021. The CES-D scale was used to measure depression rates. Multiple logistic regression was used to identify factors independently associated with depression. Analyses were conducted using Stata version 16.0 and the IBM® SPSS® software. In total, 978 sixth- and fifth-year medical students participated; their mean age was 23.2 years and 65.6% were females. The prevalence of clinical depression was 21.3% (95% CI: 18.7%, 24.0%), whereas 17.9% (95% CI: 15.5%, 20.4%) experienced severe distress. Depression was more prevalent in females (25.4% vs 13.1% in males, p<0.001). Approximately half (53.4%) of the participants reported a change in plans regarding their medical career due to the pandemic and 16.9% expressed a decreased willingness to practice medicine. Factors independently associated with depression were female gender, living alone or with housemates at high risk for COVID-19, being anxious about becoming infected with SARS-CoV-2, studying in one of the three largest medical schools, negatively evaluating the adjustment of the teaching personnel to online teaching and the university's response to the pandemic. The findings of this study report depression in one out of five medical students during the COVID-19 pandemic, highlighting the need to protect the most vulnerable medical students during a pandemic. Medical students must be able to seek professional mental health services, even in the era of a pandemic. Universities should increase accessibility to support services and provide a student-centered approach in their strategies, as the pandemic has placed a spotlight on an existing phenomenon.
Collapse
Affiliation(s)
- Mariana Styliari
- Medical School, National and Kapodistrian University of Athens, Greece
| | | | | | - Garyfallia Poulakou
- 3rd Department of Internal Medicine and Laboratory, Medical School, National and Kapodistrian University of Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece
| | - Konstantinos Ν Fountoulakis
- 3rd Department of Psychiatry, Division of Neurosciences, Medical School, Aristotle University of Thessaloniki, Greece
| |
Collapse
|
5
|
Uusküla A, Rannap J, Weijler L, Abagiu A, Arendt V, Barrio G, Barros H, Brummer-Korvenkontio H, Casabona J, Croes E, Jarlais DD, Seguin-Devaux C, Dudás M, Eritsyan K, Folch C, Hatzakis A, Heimer R, Heinsbroek E, Hope V, Jipa R, Ķīvīte-Urtāne A, Levina O, Lyubimova A, Malczewski A, Matser A, McAuley A, Meireles P, Mravčík V, Op de Coul E, Ojavee SE, Parés-Badell O, Prins M, Pulido J, Romanyak E, Rosinska M, Seyler T, Stone J, Sypsa V, Talu A, Tarján A, Taylor A, Vickerman P, Vorobjov S, Dolan K, Wiessing L. Incarceration history is associated with HIV infection among community-recruited people who inject drugs in Europe: A propensity-score matched analysis of cross-sectional studies. Addiction 2023; 118:2177-2192. [PMID: 37991429 DOI: 10.1111/add.16283] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 05/22/2023] [Indexed: 11/23/2023]
Abstract
AIMS We measured the association between a history of incarceration and HIV positivity among people who inject drugs (PWID) across Europe. DESIGN, SETTING AND PARTICIPANTS This was a cross-sectional, multi-site, multi-year propensity-score matched analysis conducted in Europe. Participants comprised community-recruited PWID who reported a recent injection (within the last 12 months). MEASUREMENTS Data on incarceration history, demographics, substance use, sexual behavior and harm reduction service use originated from cross-sectional studies among PWID in Europe. Our primary outcome was HIV status. Generalized linear mixed models and propensity-score matching were used to compare HIV status between ever- and never-incarcerated PWID. FINDINGS Among 43 807 PWID from 82 studies surveyed (in 22 sites and 13 countries), 58.7% reported having ever been in prison and 7.16% (n = 3099) tested HIV-positive. Incarceration was associated with 30% higher odds of HIV infection [adjusted odds ratio (aOR) = 1.32, 95% confidence interval (CI) = 1.09-1.59]; the association between a history of incarceration and HIV infection was strongest among PWID, with the lowest estimated propensity-score for having a history of incarceration (aOR = 1.78, 95% CI = 1.47-2.16). Additionally, mainly injecting cocaine and/or opioids (aOR = 2.16, 95% CI = 1.33-3.53), increased duration of injecting drugs (per 8 years aOR = 1.31, 95% CI = 1.16-1.48), ever sharing needles/syringes (aOR = 1.91, 95% CI = 1.59-2.28) and increased income inequality among the general population (measured by the Gini index, aOR = 1.34, 95% CI = 1.18-1.51) were associated with a higher odds of HIV infection. Older age (per 8 years aOR = 0.84, 95% CI = 0.76-0.94), male sex (aOR = 0.77, 95% CI = 0.65-0.91) and reporting pharmacies as the main source of clean syringes (aOR = 0.72, 95% CI = 0.59-0.88) were associated with lower odds of HIV positivity. CONCLUSIONS A history of incarceration appears to be independently associated with HIV infection among people who inject drugs (PWID) in Europe, with a stronger effect among PWID with lower probability of incarceration.
Collapse
Affiliation(s)
- Anneli Uusküla
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Jürgen Rannap
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Lisa Weijler
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - Adrian Abagiu
- National Institute for Infectious diseases 'Professor Dr Matei Bals', Bucharest, Romania
| | - Vic Arendt
- Service National des Maladies Infectieuses, Centre Hospitalier de Luxembourg, Luxembourg
| | - Gregorio Barrio
- National School of Public Health, Carlos III Health Institute, Madrid, Spain
| | - Henrique Barros
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | | | - Jordi Casabona
- Centre for Epidemiological Studies on Sexually Transmitted Infections and HIV/AIDS of Catalonia (CEEISCAT), Catalonia Public Health Agency (ASPCAT), Badalona, Spain
- Biomedical Research Networking Centre in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Don Des Jarlais
- School of Global Public Health, New York University, New York, NY, 10012, USA
| | - Carole Seguin-Devaux
- Department of Infection and Immunity, Luxembourg Institute of Health, Luxembourg
| | - Mária Dudás
- National Public Health Center, Budapest, Hungary
| | - Ksenia Eritsyan
- National Research University Higher School of Economics, St Petersburg, Russia
| | - Cinta Folch
- Centre for Epidemiological Studies on Sexually Transmitted Infections and HIV/AIDS of Catalonia (CEEISCAT), Catalonia Public Health Agency (ASPCAT), Badalona, Spain
- Biomedical Research Networking Centre in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Robert Heimer
- Department of the Epidemiology of Microbial Diseases, Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Ellen Heinsbroek
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Vivian Hope
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Raluca Jipa
- National Institute for Infectious diseases 'Professor Dr Matei Bals', Bucharest, Romania
| | | | - Olga Levina
- National Research University Higher School of Economics, St Petersburg, Russia
- Acuity Systems, Herndon, VA, USA
| | - Alexandra Lyubimova
- National Research University Higher School of Economics, St Petersburg, Russia
| | - Artur Malczewski
- EMCDDA Polish National Focal Point, National Bureau for Drug Prevention, Warsaw, Poland
| | - Amy Matser
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Infectious Diseases, Amsterdam Infection andd Immunity Institute, Amsterdam, the Netherlands
| | - Andrew McAuley
- Public Health Scotland, Meridian Court, Glasgow, Scotland, UK
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Paula Meireles
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Viktor Mravčík
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
- Společnost Podané ruce, Brno, Czech Republic
- Klinika Podané ruce, Brno, Czech Republic
| | - Eline Op de Coul
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Sven E Ojavee
- Department of Computational Biology, University of Lausanne, Lausanne, Switzerland
| | | | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Infectious Diseases, Amsterdam Infection andd Immunity Institute, Amsterdam, the Netherlands
| | - José Pulido
- National School of Public Health, Carlos III Health Institute, Madrid, Spain
- Biomedical Research Networking Centre in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Department of Public Health and Maternal and Child Health, Complutense University of Madrid, Madrid, Spain
| | | | - Magdalena Rosinska
- Department of Infectious Diseases Epidemiology and Surveillance, National Institute of Public Health NIH, National Research Institute, Warsaw, Poland
| | - Thomas Seyler
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Ave Talu
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Anna Tarján
- Hungarian Reitox National Focal Point, Budapest, Hungary
| | - Avril Taylor
- Emeritus Professor of Public Health, School of Education and Social Sciences, University of West Scotland, Paisley, Scotland, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sigrid Vorobjov
- Department of Drug and Infectious Diseases Epidemiology, National Institute for Health Development, Tallinn, Estonia
| | - Kate Dolan
- National Drug and Alcohol Research Centre, the University of New South Wales, Sydney, NSW, Australia
| | - Lucas Wiessing
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| |
Collapse
|
6
|
Razavi-Shearer D, Gamkrelidze I, Pan C, Jia J, Berg T, Gray R, Lim YS, Chen CJ, Ocama P, Desalegn H, Abbas Z, Abdallah A, Aghemo A, Ahmadbekova S, Ahn SH, Aho I, Akarca U, Al Masri N, Alalwan A, Alavian S, Al-Busafi S, Aleman S, Alfaleh F, Alghamdi A, Al-Hamoudi W, Aljumah A, Al-Naamani K, Al-Rifai A, Alserkal Y, Altraif I, Amarsanaa J, Anderson M, Andersson M, Armstrong P, Asselah T, Athanasakis K, Baatarkhuu O, Ben-Ari Z, Bensalem A, Bessone F, Biondi M, Bizri AR, Blach S, Braga W, Brandão-Mello C, Brosgart C, Brown K, Brown, Jr R, Bruggmann P, Brunetto M, Buti M, Cabezas J, Casanovas T, Chae C, Chan HLY, Cheinquer H, Chen PJ, Cheng KJ, Cheon ME, Chien CH, Choudhuri G, Christensen PB, Chuang WL, Chulanov V, Cisneros L, Coffin C, Contreras F, Coppola N, Cornberg M, Cowie B, Cramp M, Craxi A, Crespo J, Cui F, Cunningham C, Dalgard O, De Knegt R, De Ledinghen V, Dore G, Drazilova S, Duberg AS, Egeonu S, Elbadri M, El-Kassas M, El-Sayed M, Estes C, Etzion O, Farag E, Ferradini L, Ferreira P, Flisiak R, Forns X, Frankova S, Fung J, Gane E, Garcia V, García-Samaniego J, Gemilyan M, Genov J, Gheorghe L, Gholam P, Gish R, Goleij P, Gottfredsson M, Grebely J, Gschwantler M, Guingane NA, Hajarizadeh B, Hamid S, Hamoudi W, Harris A, Hasan I, Hatzakis A, Hellard M, Hercun J, Hernandez J, Hockicková I, Hsu YC, Hu CC, Husa P, Janicko M, Janjua N, Jarcuska P, Jaroszewicz J, Jelev D, Jeruma A, Johannessen A, Kåberg M, Kaita K, Kaliaskarova K, Kao JH, Kelly-Hanku A, Khamis F, Khan A, Kheir O, Khoudri I, Kondili L, Konysbekova A, Kristian P, Kwon J, Lagging M, Laleman W, Lampertico P, Lavanchy D, Lázaro P, Lazarus JV, Lee A, Lee MH, Liakina V, Lukšić B, Malekzadeh R, Malu A, Marinho R, Mendes-Correa MC, Merat S, Meshesha BR, Midgard H, Mohamed R, Mokhbat J, Mooneyhan E, Moreno C, Mortgat L, Müllhaupt B, Musabaev E, Muyldermans G, Naveira M, Negro F, Nersesov A, Nguyen VTT, Ning Q, Njouom R, Ntagirabiri R, Nurmatov Z, Oguche S, Omuemu C, Ong J, Opare-Sem O, Örmeci N, Orrego M, Osiowy C, Papatheodoridis G, Peck-Radosavljevic M, Pessoa M, Pham T, Phillips R, Pimenov N, Pincay-Rodríguez L, Plaseska-Karanfilska D, Pop C, Poustchi H, Prabdial-Sing N, Qureshi H, Ramji A, Rautiainen H, Razavi-Shearer K, Remak W, Ribeiro S, Ridruejo E, Ríos-Hincapié C, Robalino M, Roberts L, Roberts S, Rodríguez M, Roulot D, Rwegasha J, Ryder S, Sadirova S, Saeed U, Safadi R, Sagalova O, Said S, Salupere R, Sanai F, Sanchez-Avila JF, Saraswat V, Sargsyants N, Sarrazin C, Sarybayeva G, Schréter I, Seguin-Devaux C, Seto WK, Shah S, Sharara A, Sheikh M, Shouval D, Sievert W, Simojoki K, Simonova M, Sinn DH, Sonderup M, Sonneveld M, Spearman CW, Sperl J, Stauber R, Stedman C, Sypsa V, Tacke F, Tan SS, Tanaka J, Tergast T, Terrault N, Thompson A, Thompson P, Tolmane I, Tomasiewicz K, Tsang TY, Uzochukwu B, Van Welzen B, Vanwolleghem T, Vince A, Voeller A, Waheed Y, Waked I, Wallace J, Wang C, Weis N, Wong G, Wong V, Wu JC, Yaghi C, Yesmembetov K, Yip T, Yosry A, Yu ML, Yuen MF, Yurdaydin C, Zeuzem S, Zuckerman E, Razavi H. Global prevalence, cascade of care, and prophylaxis coverage of hepatitis B in 2022: a modelling study. Lancet Gastroenterol Hepatol 2023; 8:879-907. [PMID: 37517414 DOI: 10.1016/s2468-1253(23)00197-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/25/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND The 2016 World Health Assembly endorsed the elimination of hepatitis B virus (HBV) infection as a public health threat by 2030; existing therapies and prophylaxis measures make such elimination feasible, even in the absence of a virological cure. We aimed to estimate the national, regional, and global prevalence of HBV in the general population and among children aged 5 years and younger, as well as the rates of diagnosis, treatment, prophylaxis, and the future burden globally. METHODS In this modelling study, we used a Delphi process with data from literature reviews and interviews with country experts to quantify the prevalence, diagnosis, treatment, and prevention measures for HBV infection. The PRoGReSs Model, a dynamic Markov model, was used to estimate the country, regional, and global prevalence of HBV infection in 2022, and the effects of treatment and prevention on disease burden. The future incidence of morbidity and mortality in the absence of additional interventions was also estimated at the global level. FINDINGS We developed models for 170 countries which resulted in an estimated global prevalence of HBV infection in 2022 of 3·2% (95% uncertainty interval 2·7-4·0), corresponding to 257·5 million (216·6-316·4) individuals positive for HBsAg. Of these individuals, 36·0 million were diagnosed, and only 6·8 million of the estimated 83·3 million eligible for treatment were on treatment. The prevalence among children aged 5 years or younger was estimated to be 0·7% (0·6-1·0), corresponding to 5·6 million (4·5-7·8) children with HBV infection. Based on the most recent data, 85% of infants received three-dose HBV vaccination before 1 year of age, 46% had received a timely birth dose of vaccine, and 14% received hepatitis B immunoglobulin along with the full vaccination regimen. 3% of mothers with a high HBV viral load received antiviral treatment to reduce mother-to-child transmission. INTERPRETATION As 2030 approaches, the elimination targets remain out of reach for many countries under the current frameworks. Although prevention measures have had the most success, there is a need to increase these efforts and to increase diagnosis and treatment to work towards the elimination goals. FUNDING John C Martin Foundation, Gilead Sciences, and EndHep2030.
Collapse
|
7
|
Sypsa V, Roussos S, Tsirogianni E, Tsiara C, Paraskeva D, Chrysanthidis T, Chatzidimitriou D, Papadimitriou E, Paraskevis D, Goulis I, Kalamitsis G, Hatzakis A. A new outbreak of HIV infection among people who inject drugs during the COVID-19 pandemic in Greece. Int J Drug Policy 2023; 117:104073. [PMID: 37263112 DOI: 10.1016/j.drugpo.2023.104073] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/08/2023] [Accepted: 05/12/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Multiple HIV outbreaks have been recorded among people who inject drugs (PWID) since 2010. During an intervention for PWID in 2019-2021 in Thessaloniki, Greece, an increasing number of HIV cases was documented. Here, we provide an analysis of this new outbreak. METHODS ALEXANDROS was a community-based program and participation included interviewing, rapid HIV/HCV tests, counselling and linkage to care. PWID were recruited through Respondent-Driven Sampling (RDS) in five sampling rounds. Crude and RDS-weighted HIV prevalence estimates were obtained. HIV incidence was estimated from data on 380 initially seronegative PWID with at least two tests. Multivariable Cox proportional hazards model was used to assess risk factors for HIV seroconversion. RESULTS In total, 1,101 PWID were recruited. At first participation, 53.7% were current PWID, 20.1% homeless, 20.3% on opioid substitution treatment and 4.8% had received syringes in the past 12 months. HIV prevalence (95% CI) was 7.0% (5.6-8.7%) and an increasing trend was observed over 2019-2021 (p = 0.002). Two-thirds of the cases (67.5%) were new diagnoses. HIV incidence was 7.0 new infections/100 person-years (95% CI:4.8-10.2). Homelessness in the past 12 months (HR:2.68; 95% CI:1.24-5.81) and receptive syringe sharing (HR:3.86; 95% CI:1.75-8.51) were independently associated with increased risk of seroconversion. By the end of the program, 67.3% of the newly diagnosed cases initiated antiretroviral treatment. CONCLUSIONS A new HIV outbreak among PWID was documented in Greece during the COVID-19 pandemic with homelessness and syringe sharing being associated with increased risk of HIV acquisition. Peer-driven programs targeting the population of high-risk underserved PWID can be used to early identify emerging outbreaks and to improve linkage to HIV care.
Collapse
Affiliation(s)
- Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Sotirios Roussos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Efrossini Tsirogianni
- Fourth Department of Internal Medicine, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; Greek Organisation Against Drugs (OKANA), Athens, Greece
| | - Chrissa Tsiara
- Hellenic National Public Health Organization, Marousi, Greece
| | | | - Theofilos Chrysanthidis
- Infectious Diseases Unit, 1st Internal Medicine Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Dimitrios Chatzidimitriou
- National AIDS Reference Centre of Northern Greece, Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evaggelia Papadimitriou
- National AIDS Reference Centre of Northern Greece, Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Goulis
- Fourth Department of Internal Medicine, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Hellenic Scientific Society for the Study of AIDS, Sexually Transmitted Diseases and Emerging Diseases, Athens, Greece
| |
Collapse
|
8
|
Wiessing L, Sypsa V, Abagiu AO, Arble A, Berndt N, Bosch A, Buskin S, Chemtob D, Combs B, Conyngham C, Feelemyer J, Fitzgerald M, Goldberg D, Hatzakis A, Patrascu RE, Keenan E, Khan I, Konrad S, Leahy J, McAuley A, Menza T, Merrick S, Metcalfe R, Rademaker T, Revivo S, Rosca P, Seguin-Devaux C, Skinner S, Smith C, Tinsley J, Wilberg M, Des Jarlais D. Impact of COVID-19 & Response Measures on HIV-HCV Prevention Services and Social Determinants in People Who Inject Drugs in 13 Sites with Recent HIV Outbreaks in Europe, North America and Israel. AIDS Behav 2023; 27:1140-1153. [PMID: 36367613 PMCID: PMC9651099 DOI: 10.1007/s10461-022-03851-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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 11/13/2022]
Abstract
HIV/HCV prevention among people who inject drugs (PWID) is of key public health importance. We aimed to assess the impact of COVID-19 and associated response measures on HIV/HCV prevention services and socio-economic status of PWID in high-HIV-risk sites. Sites with recent (2011-2019) HIV outbreaks among PWID in Europe North America and Israel, that had been previously identified, were contacted early May 2020. Out of 17 sites invited to participate, 13 accepted. Semi-structured qualitative site reports were prepared covering data from March to May 2020, analyzed/coded and confirmed with a structured questionnaire, in which all sites explicitly responded to all 103 issues reported in the qualitative reports. Opioid maintenance treatment, needle/syringe programs and antiretroviral treatment /hepatitis C treatment continued, but with important reductions and operational changes. Increases in overdoses, widespread difficulties with food and hygiene needs, disruptions in drug supply, and increased homelessness were reported. Service programs rapidly reformed long established, and politically entrenched, restrictive service delivery policies. Future epidemic control measures should include mitigation of negative side-effects on service provision and socio-economic determinants in PWID.
Collapse
Affiliation(s)
- Lucas Wiessing
- Public Health Unit, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Praça Europa 1, Cais do Sodré, 1249-289, Lisbon, Portugal.
| | - V Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - A O Abagiu
- National Institute for Infectious Diseases, Bucharest, Romania
| | - A Arble
- Hamilton County Public Health, Cincinnati, OH, USA
| | - N Berndt
- Luxembourg National Focal Point of the European Monitoring Centre for Drugs and Drug Addiction, Department of Epidemiology and Statistics, Directorate of Health, Luxembourg-Hamm, Luxembourg
| | - A Bosch
- STD, HIV, and TB Section - Infectious Disease Epidemiology, Prevention and Control, Minnesota Department of Health, St. Paul, MN, USA
| | - S Buskin
- University of Washington, Seattle, WA, USA
- Public Health - Seattle & King County, Seattle, WA, USA
| | - D Chemtob
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - B Combs
- Scott County Health Department, Scottsburg, IN, USA
| | - C Conyngham
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - J Feelemyer
- School of Global Public Health, New York University, New York, NY, USA
| | - M Fitzgerald
- National Social Inclusion Office, Health Services Executive, Dublin, Ireland
| | - D Goldberg
- Public Health Scotland, Glasgow, Scotland, United Kingdom
| | - A Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - R E Patrascu
- National Institute for Infectious Diseases, Bucharest, Romania
| | - E Keenan
- National Social Inclusion Office, Health Services Executive, Dublin, Ireland
| | - I Khan
- First Nations and Inuit Health Branch, Indigenous Services Canada, Regina, Canada
| | - S Konrad
- First Nations and Inuit Health Branch, Indigenous Services Canada, Regina, Canada
| | - J Leahy
- Oregon Health Authority, Portland, OR, USA
| | - A McAuley
- Public Health Scotland, Glasgow, Scotland, United Kingdom
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom
| | - T Menza
- Oregon Health Authority, Portland, OR, USA
- Oregon Health and Science University, Portland, OR, USA
| | - S Merrick
- Hamilton County Public Health, Cincinnati, OH, USA
| | - R Metcalfe
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom
- Sandyford Sexual Health Service, Glasgow, Scotland, United Kingdom
| | - T Rademaker
- Hamilton County Public Health, Cincinnati, OH, USA
| | - S Revivo
- Izhar Needle and Syringe Programme, Public Health Association, Jerusalem, Israel
| | - P Rosca
- Department for the Treatment of Substance Abuse, Ministry of Health, Jerusalem, Israel
| | - C Seguin-Devaux
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - S Skinner
- University of Saskatchewan, Saskatoon, Canada
| | - C Smith
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - J Tinsley
- Public Health - Seattle & King County, Seattle, WA, USA
| | - M Wilberg
- Minnesota Department of Human Services, St. Paul, Minnesota, USA
| | - D Des Jarlais
- School of Global Public Health, New York University, New York, NY, USA
| |
Collapse
|
9
|
Masklavanou C, Triantafyllou K, Paparrigopoulos T, Sypsa V, Pehlivanidis A. Internet gaming disorder, exercise and attention deficit hyperactivity disorder: The role of symptoms of depression, anxiety and stress. Psychiatriki 2023; 34:13-20. [PMID: 36436217 DOI: 10.22365/jpsych.2022.098] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
One of the issues that have risen the past few decades due to excessive use of technological advances is internet gaming disorder (IGD). Past research has concluded that there is a negative association between IGD and exercise as well as a positive association between IGD and attention deficit hyperactivity disorder (ADHD). However, the existing studies on these subjects are scarce. Furthermore, researchers have showcased that symptoms of depression, anxiety and stress are positively associated with IGD and ADHD but negatively associated with exercise. Consequently, maybe these symptoms mediate the relationships between IGD, exercise and ADHD. The purpose of the present study is to investigate the relationship between IGD and exercise as well as between IGD and ADHD. A correlational study was conducted on 515 adults through Google forms. The Internet Gaming Disorder Scale-Short-Form was used to detect IGD symptoms, the Leisure-Time Exercise Questionnaire was utilized so as to evaluate participants' leisure - time exercise habits, and the Barkley Adult ADHD Rating Scale was used to assess ADHD symptoms. Furthermore, the Depression, Anxiety and Stress Scale-21 was utilized to evaluate symptoms of depression, anxiety, and stress. It was found that there is a negative correlation between IGD symptoms and leisure time exercise as well as a positive correlation between IGD symptoms and ADHD symptoms. Moreover, when taking all the variables that were examined into consideration, it was indicated that inattention symptoms and impulsivity symptoms were significantly associated with IGD symptoms whereas symptoms of depression were partially and significantly mediating the association between IGD symptoms and Attention deficit as well as the association between IGD symptoms and Impulsivity. The findings of the current study suggest that people who deal with IGD symptoms tend to exercise less on their free time. Additionally, people with more IGD symptoms display not only more ADHD symptoms, symptoms of inattention and impulsivity specifically, but also more symptoms of depression. Therefore, clinicians should evaluate the possible coexistence of such symptoms when treating people with IGD, in order to prevent as well as treat more efficiently IGD and its consequences.
Collapse
Affiliation(s)
- Christina Masklavanou
- First Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, Athens
| | - Kalliopi Triantafyllou
- First Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, Athens
| | - Thomas Paparrigopoulos
- First Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, Athens
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Artemios Pehlivanidis
- First Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, Athens
| |
Collapse
|
10
|
Wedemeyer H, Tergast TL, Lazarus JV, Razavi H, Bakoyannis K, Baptista-Leite R, Bartoli M, Bruggmann P, Buşoi CS, Buti M, Carballo M, Castera L, Colombo M, Coutinho RS, Dadon Y, Esmat G, Esteban R, Farran JC, Gillyon-Powell M, Goldberg D, Hutchinson S, Janssen HLA, Kalamitsis G, Kondili LA, Lambert JS, Marinho RT, Maticic M, Patricello A, Peck-Radosavljevic M, Pol S, Poljak M, Pop C, Sokol T, Sypsa V, Tözün N, Younossi Z, Aghemo A, Papatheodoridis GV, Hatzakis A. Securing wider EU commitment to the elimination of hepatitis C virus. Liver Int 2023; 43:276-291. [PMID: 36196744 DOI: 10.1111/liv.15446] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 07/23/2022] [Revised: 09/04/2022] [Accepted: 09/29/2022] [Indexed: 01/25/2023]
Abstract
In 2016, the Hepatitis B and C Public Policy Association (HepBCPPA), gathered all the main stakeholders in the field of hepatitis C virus (HCV) to launch the now landmark HCV Elimination Manifesto, calling for the elimination of HCV in the EU by 2030. Since then, many European countries have made progress towards HCV elimination. Multiple programmes-from the municipality level to the EU level-were launched, resulting in an overall decrease in viremic HCV infections and liver-related mortality. However, as of 2021, most countries are not on track to reach the 2030 HCV elimination targets set by the WHO. Moreover, the COVID-19 pandemic has resulted in a decrease in HCV diagnoses and fewer direct-acting antiviral treatment initiations in 2020. Diagnostic and therapeutic tools to easily diagnose and treat chronic HCV infection are now well established. Treating all patients with chronic HCV infection is more cost-saving than treating and caring for patients with liver-related complications, decompensated cirrhosis or hepatocellular carcinoma. It is more important than ever to reinforce and scale-up action towards HCV elimination. Yet, efforts urgently need the dedicated commitment of policymakers at all governmental and policy levels. Therefore, the third EU Policy Summit, held in March 2021, featured EU parliamentarians and other key decision makers to promote dialogue and take strides towards securing wider EU commitment to advance and achieve HCV elimination by 2030. We have summarized the key action points and reported the 'Call-to-Action' statement supported by all the major relevant European associations in the field.
Collapse
Affiliation(s)
- Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Tammo L Tergast
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Homie Razavi
- Center for Disease Analysis Foundation, Lafayette, Colorado, USA
| | | | - Ricardo Baptista-Leite
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.,Institute of Health Sciences, Católica University of Portugal, Lisbon, Portugal
| | | | | | | | - Maria Buti
- Liver Unit, Hospital Universitari Vall d'Hebron and CIBERHED del Instituto Carlos III, Barcelona, Spain
| | - Manuel Carballo
- International Centre for Migration, Health and Development, Geneva, Switzerland
| | - Laurent Castera
- Department of Hepatology, Hôpital Beaujon AP-HP-University of Paris-VII, Clichy, France
| | | | | | | | - Gamal Esmat
- Endemic Medicine and Department of HepatoGastroenterology Faculty of Medicine, Cairo University Hospital, Cairo, Egypt
| | - Rafael Esteban
- Liver Unit, Hospital Universitari Vall d'Hebron and CIBERHED del Instituto Carlos III, Barcelona, Spain
| | | | | | | | - Sharon Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Harry L A Janssen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | | | | | - John S Lambert
- Mater Misericordiae University Hospital, and UCD School of Medicine, Dublin, Ireland
| | - Rui Tato Marinho
- Serviço de Gastrenterologia e Hepatologia, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
| | - Mojca Maticic
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Markus Peck-Radosavljevic
- Department of Internal Medicine and Gastroenterology (IMuG) Hepatology, Endocrinology, Rheumatology and Nephrology with Centralized Emergency Department (ZAE), Klagenfurt, Austria
| | - Stanislas Pol
- Department of Hepatology, Université de Paris, APHP, Hopital Cochin, Paris, France
| | - Mario Poljak
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, Ljubljana, Slovenia
| | - Cora Pop
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Vana Sypsa
- Epidemiology and Preventive Medicine, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Nurdan Tözün
- Department of Gastroenterology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Zobair Younossi
- Department of Medicine, Inova Health Fairfax Medical Campus, Fairfax, Virginia, USA
| | - Alessio Aghemo
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Clinical and Research Hospital, Milan, Italy
| | - George V Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Angelos Hatzakis
- Epidemiology and Preventive Medicine, National and Kapodistrian University of Athens Medical School, Athens, Greece
| |
Collapse
|
11
|
Roussos S, Paraskevis D, Malliori M, Hatzakis A, Sypsa V. Estimating the number of people who inject drugs using repeated respondent-driven sampling (RDS) in a community-based program: implications for the burden of hepatitis C and HIV infections and harm reduction coverage. AIDS Behav 2023; 27:424-430. [PMID: 35947234 DOI: 10.1007/s10461-022-03777-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 11/30/2022]
Abstract
Estimates of the population size of people who inject drugs (PWID) are essential for efficient program planning and for monitoring key targets. Existing estimates in Greece are based on the capture-recapture method applied to drug treatment sources. We aimed to obtain estimates based on data collected from a community-based program addressing PWID in Athens, Greece. The program was implemented in 2012-2013 to increase diagnosis and treatment for HIV among PWID during an HIV outbreak. Five Responden-Driven Sampling (RDS) rounds were used to recruit participants. A unique code was used to identify participants among rounds. Capture-recapture was applied to estimate the population size in 2013 (PWID with injection in the past 12 months; active PWID with injection in the past 30 days). Log-linear models were applied. In 2013, the estimated number of active PWID in Athens was 4,117 [95% confidence interval (CI): 3,728-4,507] (vs. 1,956 [95% CI: 1,525-2,565] the existing population size estimate). Based on this estimate, the coverage of needle and syringe programs in 2013 was 103 syringes/PWID/year (vs. 216 based on the existing estimate). The population prevalence of injecting drug use in Athens (past 12 months) was 0.222% (95% CI: 0.200-0.245). The inclusion of data from community-based programs in the estimation of the PWID population size resulted in 2.1-fold higher estimates, compared to the official estimates obtained from drug treatment data, and indicates the need for re-evaluation of necessary resources for harm reduction and elimination of HIV and hepatitis C in PWID.
Collapse
Affiliation(s)
- Sotirios Roussos
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias street, 11527, Athens, Greece
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias street, 11527, Athens, Greece
| | - Meni Malliori
- First Department of Psychiatry, School of Medicine, National and Kapodistrian University of Athens, 72 Vasilissis Sofias Avenue, (Aiginiteio University Hospital), 11528, Athens, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias street, 11527, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias street, 11527, Athens, Greece.
| |
Collapse
|
12
|
Papafotiou C, Roussos S, Sypsa V, Bampali S, Spyridopoulou K, Karapanou A, Moussouli A, Samarkos M, Daikos GL, Psichogiou M. Predictive score for patients with carbapenemase-producing enterobacterales colonization upon admission in a tertiary care hospital in an endemic area. J Antimicrob Chemother 2022; 77:3331-3339. [PMID: 36203392 DOI: 10.1093/jac/dkac321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/30/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Carbapenemase-producing Enterobacterales (CPE) comprise important nosocomial pathogens worldwide. Colonized patients are the source of further dissemination in healthcare settings. Considering that timely detection of CPE carriers is pivotal but universal screening is unfeasible, we aimed to develop and validate a prediction score to detect patients harbouring CPE on hospital admission. METHODS The study was conducted in a tertiary care hospital located in a CPE endemic area. Rectal swabs were obtained from 2303 patients, screened shortly after hospital admission. The Enterobacterales isolated in cultures were examined for the presence of blaVIM, KPC, NDM, OXA-48 by PCR. Demographic data and patient history of the previous 6 months were recorded. Risk factors for CPE carriage were identified using a multivariable logistic regression model and a points-system risk score was developed. The discriminative ability of the risk score was assessed using the AUC and its predictive performance was validated in a second dataset of 1391 patients in a different time period. RESULTS Seven predictors were identified: previous CPE colonization or infection, prior hospitalization, stay in a long-term health care facility, history of ≥2 interventions, renal replacement therapy, diabetes with end-organ damage and Karnofsky score. The developed risk score in the derivation dataset ranged between 0 and 79 points, with an AUC of 0.84 in the derivation and 0.85 in the validation dataset. CONCLUSIONS This prediction tool may assist in identifying patients who are at risk of harbouring CPE on hospital admission in an endemic area and guide clinicians to implement prompt and appropriate infection control measures.
Collapse
Affiliation(s)
- Chrysanthe Papafotiou
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Sotirios Roussos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Sofia Bampali
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Kalliopi Spyridopoulou
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Amalia Karapanou
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Anastasia Moussouli
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Michael Samarkos
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - George L Daikos
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Mina Psichogiou
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| |
Collapse
|
13
|
Abstract
Since May 2022, a large number of monkeypox cases have been reported in Europe, the United States, and other nonendemic settings. Taking into account the strict measures implemented due to the coronavirus disease 2019 pandemic and the desire of people to reclaim what is perceived as lost time, mass gatherings this summer were highly attended. Based on data for the secondary attack rate among unvaccinated contacts from endemic countries, we estimate that, on average, >1 secondary case is anticipated per infectious person if he/she has a high number of group contacts (>30) or >8 close contacts. Although the role of group contacts in mass gatherings is uncertain (less likely to involve physical contact, shorter duration), close contacts associated with the event (eg, intimate/sexual contact with other attendees) might be the amplifying event. Enforcing awareness, early recognition, and engaging affected populations in the monkeypox response are important to control transmission.
Collapse
Affiliation(s)
- Vana Sypsa
- Correspondence: Vana Sypsa, PhD, Department of Hygiene, Epidemiology and Medical Statistics, Medical School, M. Asias 75 11527, Athens, Greece ()
| | | | | |
Collapse
|
14
|
Paraskevis D, Papatheodoridis G, Sypsa V, Sfikakis P, Tsiodras S, Zaoutis T. A Proposed Etiology for an Aberrant Response to Enteric Adenovirus Infection in Previously SARS-CoV-2-Infected Children With Acute Hepatitis. J Pediatric Infect Dis Soc 2022; 11:352-353. [PMID: 35674694 PMCID: PMC9384245 DOI: 10.1093/jpids/piac053] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/03/2022] [Indexed: 12/11/2022]
Affiliation(s)
- Dimitrios Paraskevis
- Corresponding Author: Dimitrios Paraskevis, PhD, Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 115 27 Athens, Greece. E-mail:
| | - Georgios Papatheodoridis
- Department of Gastroenterology, Medical School, National and Kapodistrian University of Athens, General Hospital of Athens “Laiko”, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros Sfikakis
- Joint Rheumatology Program, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Tsiodras
- Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theoklis Zaoutis
- National Public Health Organization, Athens, Greece,Second Department of Paediatrics, “P. & A. Kyriakou” Children’s Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
15
|
Roussos S, Paraskevis D, Psichogiou M, Kostaki EG, Flountzi E, Angelopoulos T, Chaikalis S, Papadopoulou M, Pavlopoulou ID, Malliori M, Hatzitheodorou E, Pylli M, Tsiara C, Paraskeva D, Beloukas A, Kalamitsis G, Hatzakis A, Sypsa V. Ongoing HIV transmission following a large outbreak among people who inject drugs in Athens, Greece (2014-20). Addiction 2022; 117:1670-1682. [PMID: 35072299 DOI: 10.1111/add.15812] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/04/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS The human immunodeficiency virus (HIV) outbreak among people who inject drugs (PWID) in Athens, Greece in 2011-13 was the largest recent epidemic in Europe and North America. We aimed to assess trends in HIV prevalence, drug use and access to prevention among PWID in Athens to estimate HIV incidence and identify risk factors and to explore HIV-1 dispersal using molecular methods during 2014-20. METHODS Two community-based HIV/hepatitis C programmes on PWID were implemented in 2012-13 (n = 3320) and 2018-20 (n = 1635) through consecutive respondent-driven sampling (RDS) rounds. PWID were uniquely identified among rounds/programmes. We obtained RDS-weighted HIV prevalence estimates per round for 2018-20 and compared them to 2012-13. We assessed changes in HIV status, behaviours and access to prevention in PWID participating in both periods. We estimated HIV incidence in a cohort of seronegative PWID as the number of HIV seroconversions/100 person-years during 2014-20 and used Cox regression to identify associated risk factors. Molecular sequencing and phylogenetic analysis were performed in HIV seroconverters. RESULTS HIV prevalence per round ranged between 12.0 and 16.2% in 2012-13 and 10.7 and 11.3% in 2018-20 with overlapping 95% confidence intervals (95% CI). Among PWID participating in both programmes, HIV prevalence (95% CI) increased from 14.2% (11.7-17.1%) in 2012-13 to 22.0% (19.0-25.3%) in 2018-20 (P < 0.001). There was a deterioration in socio-economic characteristics such as homelessness [from 16.2% (95% CI = 13.5-19.2%) to 25.6% (22.3-29.0%)], a shift in cocaine use [16.6% (13.9-19.6%) versus 28.1% (24.7-31.7%], reduced access to free syringes [51.8% (48.0-55.7%) versus 44.5% (40.7-48.3%)] and a decrease in daily injecting [36.2% (32.6-39.9%) versus 28.5% (25.2-32.1%)]. HIV incidence (95% CI) in 2014-20 was 1.94 (1.50-2.52) new cases/100 person-years and younger age, lower educational level, larger injection network and daily injecting were risk factors. Almost 9% of HIV seroconversions occurred within a newly expanding phylogenetic cluster. CONCLUSIONS In Athens, Greece, compared with the period 2012-13, in the period 2018-20 there was a deterioration in socio-economic conditions among people who inject drugs, an increase in the use of cocaine, reduced access to needle and syringe programmes and stable low levels of human immunodeficiency virus testing. Ongoing human immunodeficiency virus transmission was documented during 2014-20 in existing as well as new transmission clusters.
Collapse
Affiliation(s)
- Sotirios Roussos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Hellenic Scientific Society for the Study of AIDS, STDs and Emerging Diseases, Athens, Greece
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Mina Psichogiou
- First Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Georgia Kostaki
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Flountzi
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Angelopoulos
- Hellenic Scientific Society for the Study of AIDS, STDs and Emerging Diseases, Athens, Greece
| | - Savvas Chaikalis
- Hellenic Scientific Society for the Study of AIDS, STDs and Emerging Diseases, Athens, Greece
| | - Martha Papadopoulou
- Hellenic Scientific Society for the Study of AIDS, STDs and Emerging Diseases, Athens, Greece.,First Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna D Pavlopoulou
- Pediatric Research Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Meni Malliori
- Psychiatric Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Magdalini Pylli
- Hellenic National Public Health Organization, Marousi, Greece
| | - Chrissa Tsiara
- Hellenic National Public Health Organization, Marousi, Greece
| | | | - Apostolos Beloukas
- Department of Biomedical Sciences, University of West Attica, Athens, Greece.,Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | | | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Hellenic Scientific Society for the Study of AIDS, STDs and Emerging Diseases, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
16
|
Jang H, Yoon JS, Park SY, Lee HA, Jang MJ, Kim SU, Sinn DH, Seo YS, Kim HY, Kim SE, Jun DW, Yoon EL, Sohn JH, Ahn SB, Shim JJ, Jeong SW, Cho YK, Kim HS, Nam JY, Lee YB, Kim YJ, Yoon JH, Zoulim F, Lampertico P, Dalekos GN, Idilman R, Sypsa V, Berg T, Buti M, Calleja JL, Goulis J, Manolakopoulos S, Janssen HLA, Papatheodoridis GV, Lee JH. Impact of HBeAg on Hepatocellular Carcinoma Risk During Oral Antiviral Treatment in Patients With Chronic Hepatitis B. Clin Gastroenterol Hepatol 2022; 20:1343-1353.e16. [PMID: 34500103 DOI: 10.1016/j.cgh.2021.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 07/07/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND & AIMS Antiviral treatment from hepatitis B envelope antigen (HBeAg)-positive status may attenuate the integration of hepatitis B virus DNA into the host genome causing hepatocellular carcinoma (HCC). We investigated the impact of HBeAg status at the onset of antiviral treatment on the risk of HCC. METHODS The incidence of HCC was evaluated in Korean patients with chronic hepatitis B who started entecavir or tenofovir in either HBeAg-positive or HBeAg-negative phase. The results in the Korean cohort were validated in a Caucasian PAGE-B cohort. RESULTS A total of 9143 Korean patients (mean age, 49.2 years) were included: 49.1% were HBeAg-positive and 49.2% had cirrhosis. During follow-up (median, 5.1 years), 916 patients (10.0%) developed HCC. Baseline HBeAg positivity was not associated with the risk of HCC in the entire cohort or cirrhotic subcohort. However, in the non-cirrhotic subcohort, HBeAg positivity was independently associated with a lower risk of HCC in multivariable (adjusted hazard ratio [aHR], 0.41; 95% confidence interval [CI], 0.26-0.66), propensity score-matching (aHR, 0.46; 95% CI, 0.28-0.76), and inverse probability weighting analyses (aHR, 0.44; 95% CI, 0.28-0.70). In the Caucasian cohort (n = 719; mean age, 51.8 years; HBeAg-positive, 20.3%; cirrhosis, 34.8%), HBeAg-positivity was not associated with the risk of HCC either in the entire cohort or cirrhotic subcohort. In the non-cirrhotic subcohort, none of the HBeAg-positive group developed HCC, although the difference failed to reach statistical significance (aHR, 0.21; 95% CI, 0.00-1.67). CONCLUSIONS This multinational cohort study implies that HBeAg positivity at the onset of antiviral treatment seems to be an independent factor associated with a lower risk of HCC in patients with chronic hepatitis B without cirrhosis, but not in those with cirrhosis.
Collapse
Affiliation(s)
- Heejoon Jang
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jun Sik Yoon
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Soo Young Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Han Ah Lee
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Myoung-Jin Jang
- Medical Research Collaboration Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung Up Kim
- Department of Internal Medicine and Yonsei Liver Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Hyun Sinn
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yeon Seok Seo
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hwi Young Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Sung Eun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Republic of Korea
| | - Dae Won Jun
- Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Eileen L Yoon
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Joo Hyun Sohn
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri-si, Republic of Korea
| | - Sang Bong Ahn
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Republic of Korea
| | - Jae-Jun Shim
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Soung Won Jeong
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Yong Kyun Cho
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyoung Su Kim
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Joon Yeul Nam
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yun Bin Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoon Jun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Hwan Yoon
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Fabien Zoulim
- Cancer Research Centre of Lyon, INSERM U, Lyon University, Hospices Civils de Lyon, Lyon, France
| | - Pietro Lampertico
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy; CRC "A. M. and A. Migliavacca" Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Maria Buti
- Hospital General Universitario Vall Hebron and Ciberehd, Barcelona, Spain
| | | | - John Goulis
- The Department of Internal Medicine, Αristotle University of Thessaloniki Medical School, General Hospital of Thessaloniki "Hippokratio", Thessaloniki, Greece
| | - Spilios Manolakopoulos
- Second Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Hippokratio", Athens, Greece
| | - Harry LA Janssen
- Liver Clinic, Toronto Western and General Hospital, University Health Network, Toronto, ON, Canada
| | - George V Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece.
| | - Jeong-Hoon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
17
|
Flountzi E, Lim AG, Vickerman P, Paraskevis D, Psichogiou M, Hatzakis A, Sypsa V. Modeling the impact of interventions during an outbreak of HIV infection among people who inject drugs in 2012-2013 in Athens, Greece. Drug Alcohol Depend 2022; 234:109396. [PMID: 35349919 DOI: 10.1016/j.drugalcdep.2022.109396] [Citation(s) in RCA: 1] [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: 12/16/2021] [Revised: 03/03/2022] [Accepted: 03/03/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND A large HIV outbreak in People Who Inject Drugs (PWID) occurred in Athens, Greece in 2011-2013. In response, opioid substitution treatment (OST) and needle and syringe programs (NSP) were scaled-up and a seek-test-treat program was introduced in mid-2012. We aim to assess the impact of these interventions. METHODS A mathematical model of HIV transmission among PWID was calibrated to data available over time (2009-2013) on HIV prevalence, NSP/antiretroviral treatment (ART) coverage and high-risk injection. A combined interventions scenario, including decrease in high-risk injection through linkage to OST and modification of risk behaviours and access to NSP and ART, was compared to a counterfactual scenario (no improvement at the levels of these interventions), with HIV incidence being the main outcome. RESULTS HIV incidence increased from <0.1 new cases/100 person-years (in 2009) to 11.0 new cases/100 person-years (in 2012). Under both models, a subsequent decline was projected following early 2012, with incidence at the end of 2013 in the combined interventions scenario being lower by 77% compared to the counterfactual. The projected reduction in incidence under the intervention scenario was in agreement with empirical data. HIV prevalence would have escalated to 20.4% (95% CrI: 16.9%, 23.6%) in 2013 under the counterfactual scenario (vs. 16.8% (95% CrI: 11.2%, 23.0%) under the combined interventions scenario). In total, 31.4% of HIV cases (392) were averted over 2012-2013. CONCLUSION These results underline the importance of high-coverage harm reduction programs and of community-based interventions to rapidly reach PWID most in need.
Collapse
Affiliation(s)
- Eleni Flountzi
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Aaron G Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Mina Psichogiou
- First Department of Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| |
Collapse
|
18
|
Barmpounakis P, Demiris N, Kontoyiannis I, Pavlakis GN, Sypsa V. Evaluating the effects of second-dose vaccine-delay policies in European countries: A simulation study based on data from Greece. PLoS One 2022; 17:e0263977. [PMID: 35446847 PMCID: PMC9022792 DOI: 10.1371/journal.pone.0263977] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 02/01/2022] [Indexed: 12/12/2022] Open
Abstract
The results of a simulation-based evaluation of several policies for vaccine rollout are reported, particularly focusing on the effects of delaying the second dose of two-dose vaccines. In the presence of limited vaccine supply, the specific policy choice is a pressing issue for several countries worldwide, and the adopted course of action will affect the extension or easing of non-pharmaceutical interventions in the next months. We employ a suitably generalised, age-structure, stochastic SEIR (Susceptible → Exposed → Infectious → Removed) epidemic model that can accommodate quantitative descriptions of the major effects resulting from distinct vaccination strategies. The different rates of social contacts among distinct age-groups (as well as some other model parameters) are informed by a recent survey conducted in Greece, but the conclusions are much more widely applicable. The results are summarised and evaluated in terms of the total number of deaths and infections as well as life years lost. The optimal strategy is found to be one based on fully vaccinating the elderly/at risk as quickly as possible, while extending the time-interval between the two vaccine doses to 12 weeks for all individuals below 75 years old, in agreement with epidemic theory which suggests targeting a combination of susceptibility and infectivity. This policy, which is similar to the approaches adopted in the UK and in Canada, is found to be effective in reducing deaths and life years lost in the period while vaccination is still being carried out.
Collapse
Affiliation(s)
- Petros Barmpounakis
- Department of Statistics, Athens University of Economics and Business, Athens, Greece
- * E-mail:
| | - Nikolaos Demiris
- Department of Statistics, Athens University of Economics and Business, Athens, Greece
| | - Ioannis Kontoyiannis
- Department of Pure Mathematics and Mathematical Statistics, University of Cambridge, Cambridge, United Kingdom
| | - George N. Pavlakis
- Human Retrovirus Section, VB, National Cancer Institute, Frederick, Maryland, United States of America
| | - Vana Sypsa
- Departments of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
19
|
Waetjen M, Papadopoulou M, Flores R, Sypsa V, Roussos S, Chanos S, Dedes N, Liao C, Paraskevis D, Hatzakis A, Schneider J, Psichogiou M. Pre-exposure Prophylaxis Persistence Among Greek Sexual Minority Men: Results from PrEP for Greece (P4G) Study. AIDS Behav 2022; 26:1039-1046. [PMID: 34494178 DOI: 10.1007/s10461-021-03459-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 01/24/2023]
Abstract
Nearly half the new HIV infections in Greece occur in sexual minority men, yet pre-exposure prophylaxis is not currently supported in the national HIV program. We examined factors associated with PrEP persistence among Greek SMM in PrEP for Greece, the first PrEP study in Greece. Participants (n = 100) were recruited from 2016 to 2018 through respondent-driven sampling among SMM in Athens, receiving supplies for daily PrEP at interval visits over 12-months. PrEP persistence, operationalized as Total PrEP Time, was high, 74% of participants achieving perfect persistence. Higher alcohol risk scores (OR 1.27, 95% CI 1.08-1.49) and adherence to HIV testing guidelines (OR 1.23, 95% CI 1.00-1.51) were associated with persistence. Housing impermanence (OR 0.14, 95% CI 0.04-0.48) and serostatus disclosure concerns (OR 0.77, 95% CI 0.60-0.97) were associated with limited PrEP persistence. While PrEP persistence among Greek SMM is high, socioeconomic factors and societal attitudes may challenge prevention efforts.
Collapse
|
20
|
Rachaniotis NP, Dasaklis TK, Fotopoulos F, Chouzouris M, Sypsa V, Lyberaki A, Tinios P. Is Mandatory Vaccination in Population over 60 Adequate to Control the COVID-19 Pandemic in E.U.? Vaccines (Basel) 2022; 10:vaccines10020329. [PMID: 35214788 PMCID: PMC8880699 DOI: 10.3390/vaccines10020329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/30/2022] [Revised: 02/08/2022] [Accepted: 02/14/2022] [Indexed: 12/13/2022] Open
Abstract
Vaccine hesitancy, which potentially leads to the refusal or delayed acceptance of COVID-19 vaccines, is considered a key driver of the increasing death toll from the pandemic in the EU. The European Commission and several member states’ governments are either planning or have already directly or indirectly announced mandatory vaccination for individuals aged over 60, the group which has repeatedly proved to be the most vulnerable. In this paper, an assessment of this strategy’s benefits is attempted by deriving a metric for the potential gains of vaccination mandates that can be used to compare EU member states. This is completed by examining the reduction in Standard Expected Years of Life Lost (SEYLL) per person for the EU population over 60 as a function of the member states’ vaccination percentage in these ages. The publicly available data and results of the second iteration of the SHARE COVID-19 survey on the acceptance of COVID-19 vaccines, conducted during the summer of 2021, are used as inputs.
Collapse
Affiliation(s)
- Nikolaos P. Rachaniotis
- Department of Industrial Management and Technology, University of Piraeus, 18534 Piraeus, Greece
- Correspondence:
| | - Thomas K. Dasaklis
- School of Social Sciences, Hellenic Open University, 26335 Patras, Greece;
| | | | - Michalis Chouzouris
- Department of Statistics and Insurance Science, University of Piraeus, 18534 Piraeus, Greece; (M.C.); (P.T.)
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Antigone Lyberaki
- Department of Economic & Regional Development, Panteion University, 17671 Athens, Greece;
| | - Platon Tinios
- Department of Statistics and Insurance Science, University of Piraeus, 18534 Piraeus, Greece; (M.C.); (P.T.)
| |
Collapse
|
21
|
Petala M, Kostoglou M, Karapantsios T, Dovas CI, Lytras T, Paraskevis D, Roilides E, Koutsolioutsou-Benaki A, Panagiotakopoulos G, Sypsa V, Metallidis S, Papa A, Stylianidis E, Papadopoulos A, Tsiodras S, Papaioannou N. Relating SARS-CoV-2 shedding rate in wastewater to daily positive tests data: A consistent model based approach. Sci Total Environ 2022; 807:150838. [PMID: 34627900 PMCID: PMC8497956 DOI: 10.1016/j.scitotenv.2021.150838] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/15/2021] [Accepted: 10/02/2021] [Indexed: 05/13/2023]
Abstract
During the COVID-19 pandemic, wastewater-based epidemiology (WBE) has been engaged to complement medical surveillance and in some cases to also act as an early diagnosis indicator of viral spreading in the community. Most efforts worldwide by the scientific community and commercial companies focus on the formulation of protocols for SARS-CoV-2 analysis in wastewater and approaches addressing the quantitative relationship between WBE and medical surveillance are lacking. In the present study, a mathematical model is developed which uses as input the number of daily positive medical tests together with the highly non-linear shedding rate curve of individuals to estimate the evolution of global virus shedding rate in wastewater along calendar days. A comprehensive parametric study by the model using as input actual medical surveillance and WBE data for the city of Thessaloniki (~700,000 inhabitants, North Greece) during the outbreak of November 2020 reveals the conditions under which WBE can be used as an early warning tool for predicting pandemic outbreaks. It is shown that early warning capacity is different along the days of an outbreak and depends strongly on the number of days apart between the day of maximum shedding rate of infected individuals in their disease cycle and the day of their medical testing. The present data indicate for Thessaloniki an average early warning capacity of around 2 days. Moreover, the data imply that there exists a proportion between unreported cases (asymptomatic persons with mild symptoms that do not seek medical advice) and reported cases. The proportion increases with the number of reported cases. The early detection capacity of WBE improves substantially in the presence of an increasing number of unreported cases. For Thessaloniki at the peak of the pandemic in mid-November 2020, the number of unreported cases reached a maximum around 4 times the number of reported cases.
Collapse
Affiliation(s)
- M Petala
- Laboratory of Environmental Engineering & Planning, Department of Civil Engineering, Aristotle University of Thessaloniki, Thessaloniki 54 124, Greece
| | - M Kostoglou
- Laboratory of Chemical and Environmental Technology, Dept. of Chemistry, Aristotle University of Thessaloniki, 54 124, Thessaloniki 54124, Greece
| | - Th Karapantsios
- Laboratory of Chemical and Environmental Technology, Dept. of Chemistry, Aristotle University of Thessaloniki, 54 124, Thessaloniki 54124, Greece.
| | - C I Dovas
- Faculty of Veterinary Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Th Lytras
- National Public Health Organization, Athens, Greece; European University Cyprus, Nicosia, Cyprus
| | - D Paraskevis
- National and Kapodistrian University of Athens, Athens, Greece
| | - E Roilides
- Infectious Diseases Unit and 3rd Department of Pediatrics, Aristotle University School of Health Sciences, Hippokration Hospital, Thessaloniki 54642, Greece
| | - A Koutsolioutsou-Benaki
- Department of Environmental Health, Directory of Epidemiology and Prevention of Non Communicable Diseases and Injuries, National Public Health Organization, Athens, Greece
| | | | - V Sypsa
- National and Kapodistrian University of Athens, Athens, Greece
| | - S Metallidis
- Department of Haematology, First Department of Internal Medicine, Faculty of Medicine, AHEPA General Hospital, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - A Papa
- Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - E Stylianidis
- School of Spatial Planning and Development, Faculty of Engineering, Aristotle University of Thessaloniki, 54124, Greece
| | - A Papadopoulos
- EYATH S.A., Thessaloniki Water Supply and Sewerage Company S.A., Thessaloniki 54636, Greece
| | - S Tsiodras
- National and Kapodistrian University of Athens, Athens, Greece
| | - N Papaioannou
- Faculty of Veterinary Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| |
Collapse
|
22
|
Kim HY, Lampertico P, Nam JY, Lee HC, Kim SU, Sinn DH, Seo YS, Lee HA, Park SY, Lim YS, Jang ES, Yoon EL, Kim HS, Kim SE, Ahn SB, Shim JJ, Jeong SW, Jung YJ, Sohn JH, Cho YK, Jun DW, Dalekos GN, Idilman R, Sypsa V, Berg T, Buti M, Calleja JL, Goulis J, Manolakopoulos S, Janssen HLA, Jang MJ, Lee YB, Kim YJ, Yoon JH, Papatheodoridis GV, Lee JH. An artificial intelligence model to predict hepatocellular carcinoma risk in Korean and Caucasian patients with chronic hepatitis B. J Hepatol 2022; 76:311-318. [PMID: 34606915 DOI: 10.1016/j.jhep.2021.09.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Several models have recently been developed to predict risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). Our aims were to develop and validate an artificial intelligence-assisted prediction model of HCC risk. METHODS Using a gradient-boosting machine (GBM) algorithm, a model was developed using 6,051 patients with CHB who received entecavir or tenofovir therapy from 4 hospitals in Korea. Two external validation cohorts were independently established: Korean (5,817 patients from 14 Korean centers) and Caucasian (1,640 from 11 Western centers) PAGE-B cohorts. The primary outcome was HCC development. RESULTS In the derivation cohort and the 2 validation cohorts, cirrhosis was present in 26.9%-50.2% of patients at baseline. A model using 10 parameters at baseline was derived and showed good predictive performance (c-index 0.79). This model showed significantly better discrimination than previous models (PAGE-B, modified PAGE-B, REACH-B, and CU-HCC) in both the Korean (c-index 0.79 vs. 0.64-0.74; all p <0.001) and Caucasian validation cohorts (c-index 0.81 vs. 0.57-0.79; all p <0.05 except modified PAGE-B, p = 0.42). A calibration plot showed a satisfactory calibration function. When the patients were grouped into 4 risk groups, the minimal-risk group (11.2% of the Korean cohort and 8.8% of the Caucasian cohort) had a less than 0.5% risk of HCC during 8 years of follow-up. CONCLUSIONS This GBM-based model provides the best predictive power for HCC risk in Korean and Caucasian patients with CHB treated with entecavir or tenofovir. LAY SUMMARY Risk scores have been developed to predict the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B. We developed and validated a new risk prediction model using machine learning algorithms in 13,508 antiviral-treated patients with chronic hepatitis B. Our new model, based on 10 common baseline characteristics, demonstrated superior performance in risk stratification compared with previous risk scores. This model also identified a group of patients at minimal risk of developing HCC, who could be indicated for less intensive HCC surveillance.
Collapse
Affiliation(s)
- Hwi Young Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Pietro Lampertico
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy; CRC "A. M. and A. Migliavacca" Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Joon Yeul Nam
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyung-Chul Lee
- Department of Anesthesiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Up Kim
- Department of Internal Medicine and Yonsei Liver Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Hyun Sinn
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yeon Seok Seo
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College, Republic of Korea
| | - Han Ah Lee
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College, Republic of Korea; Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Soo Young Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Young-Suk Lim
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Eun Sun Jang
- Departments of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea
| | - Eileen L Yoon
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hyoung Su Kim
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Sung Eun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Republic of Korea
| | - Sang Bong Ahn
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Republic of Korea
| | - Jae-Jun Shim
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Soung Won Jeong
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Yong Jin Jung
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Republic of Korea
| | - Joo Hyun Sohn
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri-si, Republic of Korea
| | - Yong Kyun Cho
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dae Won Jun
- Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Vana Sypsa
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Maria Buti
- Hospital General Universitario Vall Hebron and Ciberehd, Barcelona, Spain
| | | | - John Goulis
- 4th Department of Internal Medicine, Aristotle University of Thessaloniki Medical School, General Hospital of Thessaloniki "Hippokratio", Thessaloniki, Greece
| | - Spilios Manolakopoulos
- 2nd Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Hippokratio", Athens, Greece
| | - Harry L A Janssen
- Liver Clinic, Toronto Western & General Hospital, University Health Network, Toronto, ON, Canada
| | - Myoung-Jin Jang
- Medical Research Collaboration Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yun Bin Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoon Jun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Hwan Yoon
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - George V Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece.
| | - Jeong-Hoon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
23
|
D'Ambrosio R, Degasperi E, Anolli MP, Fanetti I, Borghi M, Soffredini R, Iavarone M, Tosetti G, Perbellini R, Sangiovanni A, Sypsa V, Lampertico P. Incidence of liver- and non-liver-related outcomes in patients with HCV-cirrhosis after SVR. J Hepatol 2022; 76:302-310. [PMID: 34592366 DOI: 10.1016/j.jhep.2021.09.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS As the long-term benefits of a sustained virological response (SVR) in HCV-related cirrhosis following direct-acting antiviral (DAA) treatment remain undefined, we assessed the incidence and predictors of liver-related events (LREs), non-liver-related events (NLREs) and mortality in DAA-treated patients with cirrhosis. METHODS Consecutive patients with cirrhosis and SVR were enrolled in a longitudinal, single-center study, and divided into 3 cohorts: Cohort A (Child-Pugh A without a previous LRE), Cohort B (Child-Pugh B or Child-Pugh A with prior non-hepatocellular carcinoma [HCC] LREs), Cohort C (previous HCC). RESULTS A total of 636 patients with cirrhosis (median 65 years-old, 58% males, 89% Child-Pugh A) were followed for 51 (8-68) months (Cohort A n = 480, Cohort B n = 89, Cohort C n = 67). The 5-year estimated cumulative incidences of LREs were 10.4% in Cohort A vs. 32.0% in Cohort B (HCC 7.7% vs. 19.7%; ascites 1.4% vs. 8.6%; variceal bleeding 1.3% vs. 7.8%; encephalopathy 0 vs. 2.5%) vs. 71% in Cohort C (HCC only) (p <0.0001). The corresponding figures for NLREs were 11.7% in Cohort A vs. 17.9% in Cohort B vs. 17.5% in Cohort C (p = 0.32). The 5-year estimated probabilities of liver-related vs. non-liver-related deaths were 0.5% vs. 4.5% in Cohort A, 16.2% vs. 8.8% in Cohort B and 12.1% vs. 7.7% in Cohort C. The all-cause mortality rate in Cohort A was similar to the rate expected for the general population stratified by age, sex and calendar year according to the Human Mortality Database, while it was significantly higher in Cohort B. CONCLUSIONS Patients with cirrhosis and an SVR on DAAs face risks of liver-related and non-liver-related events and mortality; however, their incidence is strongly influenced by pre-DAA patient history. LAY SUMMARY In this large single-center study enrolling patients with hepatitis C virus (HCV)-related cirrhosis cured by direct-acting antivirals, pre-treatment liver disease history strongly influenced long-term outcomes. In patients with HCV-related cirrhosis, hepatocellular carcinoma was the most frequent liver-related complication after viral cure. Due to improved long-term outcomes, patients with cirrhosis after HCV cure are exposed to a significant proportion of non-liver-related events.
Collapse
Affiliation(s)
- Roberta D'Ambrosio
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy.
| | - Elisabetta Degasperi
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
| | - Maria Paola Anolli
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
| | - Ilaria Fanetti
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
| | - Marta Borghi
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
| | - Roberta Soffredini
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
| | - Massimo Iavarone
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
| | - Giulia Tosetti
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
| | - Riccardo Perbellini
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
| | - Angelo Sangiovanni
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School National and Kapodistrian University of Athens, Athens, Greece
| | - Pietro Lampertico
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy; CRC "A. M. and A. Migliavacca" Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| |
Collapse
|
24
|
Marinaki S, Degiannis D, Roussos S, Xagas E, Tsoutsoura P, Adamopoulos S, Sypsa V, Chaidaroglou A, Pavlopoulou ID, Hatzakis A, Boletis IN. Head-To-Head Comparison of Response Rates to the Two mRNA SARS-CοV-2 Vaccines in a Large Cohort of Solid Organ Transplant (SOT) Recipients. Vaccines (Basel) 2022; 10:vaccines10020190. [PMID: 35214649 PMCID: PMC8876597 DOI: 10.3390/vaccines10020190] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 12/27/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 02/04/2023] Open
Abstract
Due to their higher risk of developing life-threatening COVID-19 disease, solid organ transplant (SOT) recipients have been prioritized in the vaccination programs of many countries. However, there is increasing evidence of reduced immunogenicity to SARS-CοV-2 vaccination. The present study investigated humoral response, safety, and effectiveness after the two mRNA vaccines in 455 SOT recipients. Overall, the antibody response rate was low, at 39.6%. Higher immunogenicity was detected among individuals vaccinated with the mRNA1273 compared to those with the BNT162b2 vaccine (47% vs. 36%, respectively, p = 0.025) as well as higher median antibody levels of 31 (7, 372) (AU/mL) vs. 11 (7, 215) AU/mL, respectively. Among the covariates assessed, vaccination with the BNT162b2 vaccine, antimetabolite- and steroid-containing immunosuppression, female gender, the type of transplanted organ and older age were factors that negatively influenced immune response. Only mild adverse effects were observed. Our findings confirm poor immunogenicity after vaccination, implicating a reevaluation of vaccination policy in SOT recipients.
Collapse
Affiliation(s)
- Smaragdi Marinaki
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, 11527 Athens, Greece; (E.X.); (P.T.); (I.N.B.)
- Correspondence:
| | - Dimitrios Degiannis
- Molecular Immunopathology and Histocompatibility Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece; (D.D.); (A.C.)
| | - Sotirios Roussos
- Department of Hygiene, Epidemiology & Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 15772 Athens, Greece; (S.R.); (V.S.); (A.H.)
| | - Efstathios Xagas
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, 11527 Athens, Greece; (E.X.); (P.T.); (I.N.B.)
| | - Paraskevi Tsoutsoura
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, 11527 Athens, Greece; (E.X.); (P.T.); (I.N.B.)
| | - Stamatis Adamopoulos
- Heart Failure and Transplant Units, Onassis Cardiac Surgery Center, 17674 Athens, Greece;
| | - Vana Sypsa
- Department of Hygiene, Epidemiology & Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 15772 Athens, Greece; (S.R.); (V.S.); (A.H.)
| | - Antigoni Chaidaroglou
- Molecular Immunopathology and Histocompatibility Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece; (D.D.); (A.C.)
| | - Ioanna D. Pavlopoulou
- Pediatric Research Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, 15772 Athens, Greece;
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology & Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 15772 Athens, Greece; (S.R.); (V.S.); (A.H.)
| | - Ioannis N. Boletis
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, 11527 Athens, Greece; (E.X.); (P.T.); (I.N.B.)
| |
Collapse
|
25
|
Limnaios S, Kostaki EG, Adamis G, Astriti M, Chini M, Mangafas N, Lazanas M, Patrinos S, Metallidis S, Tsachouridou O, Papastamopoulos V, Kakalou E, Chatzidimitriou D, Antoniadou A, Papadopoulos A, Psichogiou M, Basoulis D, Gova M, Pilalas D, Paraskeva D, Chrysos G, Paparizos V, Kourkounti S, Sambatakou H, Bolanos V, Sipsas NV, Lada M, Barbounakis E, Kantzilaki E, Panagopoulos P, Maltezos E, Drimis S, Sypsa V, Lagiou P, Magiorkinis G, Hatzakis A, Skoura L, Paraskevis D. Dating the Origin and Estimating the Transmission Rates of the Major HIV-1 Clusters in Greece: Evidence about the Earliest Subtype A1 Epidemic in Europe. Viruses 2022; 14:v14010101. [PMID: 35062305 PMCID: PMC8782043 DOI: 10.3390/v14010101] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/20/2021] [Accepted: 12/30/2021] [Indexed: 12/16/2022] Open
Abstract
Our aim was to estimate the date of the origin and the transmission rates of the major local clusters of subtypes A1 and B in Greece. Phylodynamic analyses were conducted in 14 subtype A1 and 31 subtype B clusters. The earliest dates of origin for subtypes A1 and B were in 1982.6 and in 1985.5, respectively. The transmission rate for the subtype A1 clusters ranged between 7.54 and 39.61 infections/100 person years (IQR: 9.39, 15.88), and for subtype B clusters between 4.42 and 36.44 infections/100 person years (IQR: 7.38, 15.04). Statistical analysis revealed that the average difference in the transmission rate between the PWID and the MSM clusters was 6.73 (95% CI: 0.86 to 12.60; p = 0.026). Our study provides evidence that the date of introduction of subtype A1 in Greece was the earliest in Europe. Transmission rates were significantly higher for PWID than MSM clusters due to the conditions that gave rise to an extensive PWID HIV-1 outbreak ten years ago in Athens, Greece. Transmission rate can be considered as a valuable measure for public health since it provides a proxy of the rate of epidemic growth within a cluster and, therefore, it can be useful for targeted HIV prevention programs.
Collapse
Affiliation(s)
- Stefanos Limnaios
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.L.); (E.G.K.); (M.G.); (V.S.); (P.L.); (G.M.); (A.H.)
| | - Evangelia Georgia Kostaki
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.L.); (E.G.K.); (M.G.); (V.S.); (P.L.); (G.M.); (A.H.)
| | - Georgios Adamis
- 1st Department of Internal Medicine, G. Gennimatas General Hospital, 11527 Athens, Greece; (G.A.); (M.A.)
| | - Myrto Astriti
- 1st Department of Internal Medicine, G. Gennimatas General Hospital, 11527 Athens, Greece; (G.A.); (M.A.)
| | - Maria Chini
- 3rd Department of Internal Medicine-Infectious Diseases Unit, “Korgialeneio-Benakeio” Red Cross General Hospital, 11526 Athens, Greece; (M.C.); (N.M.); (M.L.)
| | - Nikos Mangafas
- 3rd Department of Internal Medicine-Infectious Diseases Unit, “Korgialeneio-Benakeio” Red Cross General Hospital, 11526 Athens, Greece; (M.C.); (N.M.); (M.L.)
| | - Marios Lazanas
- 3rd Department of Internal Medicine-Infectious Diseases Unit, “Korgialeneio-Benakeio” Red Cross General Hospital, 11526 Athens, Greece; (M.C.); (N.M.); (M.L.)
| | | | - Simeon Metallidis
- 1st Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (S.M.); (O.T.)
| | - Olga Tsachouridou
- 1st Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (S.M.); (O.T.)
| | - Vasileios Papastamopoulos
- 5th Department of Internal Medicine and Infectious Diseases, Evaggelismos General Hospital, 10676 Athens, Greece; (V.P.); (E.K.)
| | - Eleni Kakalou
- 5th Department of Internal Medicine and Infectious Diseases, Evaggelismos General Hospital, 10676 Athens, Greece; (V.P.); (E.K.)
| | - Dimitrios Chatzidimitriou
- National AIDS Reference Centre of Northern Greece, Department of Microbiology, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.C.); (L.S.)
| | - Anastasia Antoniadou
- 4th Department of Medicine, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.A.); (A.P.)
| | - Antonios Papadopoulos
- 4th Department of Medicine, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.A.); (A.P.)
| | - Mina Psichogiou
- 1st Department of Medicine, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.P.); (D.B.)
| | - Dimitrios Basoulis
- 1st Department of Medicine, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.P.); (D.B.)
| | - Maria Gova
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.L.); (E.G.K.); (M.G.); (V.S.); (P.L.); (G.M.); (A.H.)
| | - Dimitrios Pilalas
- Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Dimitra Paraskeva
- Department of Internal Medicine, Tzaneio General Hospital, 18536 Piraeus, Greece; (D.P.); (G.C.); (S.D.)
| | - Georgios Chrysos
- Department of Internal Medicine, Tzaneio General Hospital, 18536 Piraeus, Greece; (D.P.); (G.C.); (S.D.)
| | - Vasileios Paparizos
- HIV/AIDS Unit, A. Syngros Hospital of Dermatology and Venereology, 16121 Athens, Greece; (V.P.); (S.K.)
| | - Sofia Kourkounti
- HIV/AIDS Unit, A. Syngros Hospital of Dermatology and Venereology, 16121 Athens, Greece; (V.P.); (S.K.)
| | - Helen Sambatakou
- HIV Unit, 2nd Department of Internal Medicine, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (H.S.); (V.B.)
| | - Vasileios Bolanos
- HIV Unit, 2nd Department of Internal Medicine, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (H.S.); (V.B.)
| | - Nikolaos V. Sipsas
- Department of Pathophysiology, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Malvina Lada
- 2nd Department of Internal Medicine, Sismanogleion General Hospital, 15126 Marousi, Greece;
| | - Emmanouil Barbounakis
- Department of Internal Medicine, University Hospital of Heraklion “PAGNI”, Medical School, University of Crete, 71110 Heraklion, Greece; (E.B.); (E.K.)
| | - Evrikleia Kantzilaki
- Department of Internal Medicine, University Hospital of Heraklion “PAGNI”, Medical School, University of Crete, 71110 Heraklion, Greece; (E.B.); (E.K.)
| | - Periklis Panagopoulos
- Department of Internal Medicine, University General Hospital, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (P.P.); (E.M.)
| | - Efstratios Maltezos
- Department of Internal Medicine, University General Hospital, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (P.P.); (E.M.)
| | - Stelios Drimis
- Department of Internal Medicine, Tzaneio General Hospital, 18536 Piraeus, Greece; (D.P.); (G.C.); (S.D.)
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.L.); (E.G.K.); (M.G.); (V.S.); (P.L.); (G.M.); (A.H.)
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.L.); (E.G.K.); (M.G.); (V.S.); (P.L.); (G.M.); (A.H.)
| | - Gkikas Magiorkinis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.L.); (E.G.K.); (M.G.); (V.S.); (P.L.); (G.M.); (A.H.)
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.L.); (E.G.K.); (M.G.); (V.S.); (P.L.); (G.M.); (A.H.)
| | - Lemonia Skoura
- National AIDS Reference Centre of Northern Greece, Department of Microbiology, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.C.); (L.S.)
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.L.); (E.G.K.); (M.G.); (V.S.); (P.L.); (G.M.); (A.H.)
- Correspondence:
| |
Collapse
|
26
|
Wiessing L, Kalamara E, Stone J, Altan P, Van Baelen L, Fotiou A, Garcia D, Goulao J, Guarita B, Hope V, Jauffret-Roustide M, Jurgelaitienė L, Kåberg M, Kamarulzaman A, Lemsalu L, Kivite-Urtane A, Kolarić B, Montanari L, Rosińska M, Sava L, Horváth I, Seyler T, Sypsa V, Tarján A, Yiasemi I, Zimmermann R, Ferri M, Dolan K, Uusküla A, Vickerman P. Univariable associations between a history of incarceration and HIV and HCV prevalence among people who inject drugs across 17 countries in Europe 2006 to 2020 – is the precautionary principle applicable? Euro Surveill 2021; 26. [PMID: 34886941 PMCID: PMC8662800 DOI: 10.2807/1560-7917.es.2021.26.49.2002093] [Citation(s) in RCA: 4] [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] [Indexed: 12/04/2022] Open
Abstract
Background People who inject drugs (PWID) are frequently incarcerated, which is associated with multiple negative health outcomes. Aim We aimed to estimate the associations between a history of incarceration and prevalence of HIV and HCV infection among PWID in Europe. Methods Aggregate data from PWID recruited in drug services (excluding prison services) or elsewhere in the community were reported by 17 of 30 countries (16 per virus) collaborating in a European drug monitoring system (2006–2020; n = 52,368 HIV+/−; n = 47,268 HCV+/−). Country-specific odds ratios (OR) and prevalence ratios (PR) were calculated from country totals of HIV and HCV antibody status and self-reported life-time incarceration history, and pooled using meta-analyses. Country-specific and overall population attributable risk (PAR) were estimated using pooled PR. Results Univariable HIV OR ranged between 0.73 and 6.37 (median: 2.1; pooled OR: 1.92; 95% CI: 1.52–2.42). Pooled PR was 1.66 (95% CI 1.38–1.98), giving a PAR of 25.8% (95% CI 16.7–34.0). Univariable anti-HCV OR ranged between 1.06 and 5.04 (median: 2.70; pooled OR: 2.51; 95% CI: 2.17–2.91). Pooled PR was 1.42 (95% CI: 1.28–1.58) and PAR 16.7% (95% CI: 11.8–21.7). Subgroup analyses showed differences in the OR for HCV by geographical region, with lower estimates in southern Europe. Conclusion In univariable analysis, a history of incarceration was associated with positive HIV and HCV serostatus among PWID in Europe. Applying the precautionary principle would suggest finding alternatives to incarceration of PWID and strengthening health and social services in prison and after release (‘throughcare’).
Collapse
Affiliation(s)
- Lucas Wiessing
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Public Health Unit, Lisbon, Portugal
| | - Eleni Kalamara
- EASO MTC Block A, Winemakers Wharf, Grand Harbour Valletta, Malta
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Public Health Unit, Lisbon, Portugal
| | - Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Peyman Altan
- Ministry of Health, Public Health General Directorate, Ankara, Turkey
| | - Luk Van Baelen
- Sciensano, Epidemiology and public health, Lifestyle and chronic diseases, Brussels, Belgium
| | - Anastasios Fotiou
- University Mental Health, Neurosciences, & Precision Medicine Research Institute, Athens, Greece
| | - D’Jamila Garcia
- NOVA FCSH – Universidade Nova de Lisboa, Lisbon, Portugal
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Public Health Unit, Lisbon, Portugal
| | - Joao Goulao
- General Director on Addictive Behaviours and Dependencies, Ministry of Health, Lisbon, Portugal
| | - Bruno Guarita
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Public Health Unit, Lisbon, Portugal
| | - Vivian Hope
- Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom
| | - Marie Jauffret-Roustide
- Santé Publique France, Saint-Maurice, France
- British Columbia Centre on Substance Use (BCCSU), Vancouver, Canada
- Centre d’Étude des Mouvements Sociaux (Inserm U1276/CNRS UMR8044/EHESS), Paris, France
- Baldy Center for Law and Social Policy, Buffalo University of Social Sciences, New York, United States
| | - Lina Jurgelaitienė
- Social Innovations and Science Centre, Vilnius, Lithuania
- Drug, Tobacco and Alcohol Control Department, Vilnius, Lithuania
| | - Martin Kåberg
- Department of Medicine Huddinge, Division of Infection and Dermatology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden
| | - Adeeba Kamarulzaman
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Liis Lemsalu
- Centre for Prevention of Drug Addiction and Infectious Diseases, National Institute for Health Development, Tallinn, Estonia
| | | | - Branko Kolarić
- Medical Faculty, University of Rijeka, Rijeka, Croatia
- Andrija Stampar Teaching Institute of Public Health, Zagreb, Croatia
| | - Linda Montanari
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Public Health Unit, Lisbon, Portugal
| | - Magdalena Rosińska
- National Institute of Public Health NIH – National Research Institute, Warsaw, Poland
| | - Lavinius Sava
- National Antidrug Agency – Ministry of Internal Affairs, Bucharest, Romania
| | - Ilonka Horváth
- Gesundheit Österreich GmbH – Austrian National Public Health Institution, International Affairs and Consulting, Vienna, Austria
| | - Thomas Seyler
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Public Health Unit, Lisbon, Portugal
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Tarján
- Hungarian Reitox National Focal Point, Budapest, Hungary
| | - Ioanna Yiasemi
- Monitoring Department, Cyprus National Addictions Authority, Nicosia, Cyprus
| | - Ruth Zimmermann
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany
| | - Marica Ferri
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Public Health Unit, Lisbon, Portugal
| | - Kate Dolan
- Program of International Research and Training, National Drug and Alcohol Research Centre, Sydney, Australia
| | - Anneli Uusküla
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
27
|
Bistaraki A, Roussos S, Tsiodras S, Sypsa V. Age-dependent effects on infectivity and susceptibility to SARS-CoV-2 infection: results from nationwide contact tracing data in Greece. Infect Dis (Lond) 2021; 54:186-195. [PMID: 34743646 DOI: 10.1080/23744235.2021.1995627] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Understanding the factors that affect the transmissibility of SARS-CoV-2 remains important to keep transmission low and maximize the health benefits of vaccination. We assessed the factors associated with the transmissibility of SARS-CoV-2 based on contact tracing data. METHODS From 1 October to 9 December 2020, 29,385 laboratory-confirmed SARS-CoV-2 cases (index cases, i.e. the first identified laboratory-confirmed cases or with the earliest symptom onset in a setting) and 64,608 traced contacts were identified in Greece. We assessed the prevalence of symptoms in cases, calculated secondary attack rates and assessed factors associated with infectivity and susceptibility to infection. RESULTS There were 11,232 contacts secondarily infected (secondary attack rate: 17.4%, 95% CI:17.0-17.8). Contacts aged 0-11 and 12-17 years were less susceptible to infection than adults 65 years or older (odds ratio (OR) [95% CI]: 0.28 [0.26-0.32] and 0.44 [0.40-0.49], respectively). Index cases aged 65 years or older were more likely to infect their contacts than other adults or children/adolescents. The odds of infection [95% CI] were higher in contacts exposed within the household (1.71 [1.59-1.85] vs. other) and in cases with cough (1.17 [1.11-1.25] vs. no cough). There was an interaction between the age of the index and the age of the contact with contacts 65 years or older having a higher probability of infection when exposed to cases of similar age than to children. CONCLUSIONS Our findings highlight the role of age and age mixing in infectivity and susceptibility to SARS-CoV-2 infection. Precautions are necessary for individuals 65 or older as they have higher infectivity and susceptibility in contact with their peers.
Collapse
Affiliation(s)
- Angeliki Bistaraki
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, Crete, Greece
| | - Sotirios Roussos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Tsiodras
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
28
|
Roussos S, Anagnostou O, Detsi I, Kokolesis E, Malliori M, Kalamitsis G, Sypsa V, Hatzakis A. Assessing the impact of COVID-19 pandemic in vulnerable social groups in Athens, Greece. Eur J Public Health 2021. [PMCID: PMC8574852 DOI: 10.1093/eurpub/ckab165.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background The first case of SARS-CoV-2 in Greece was identified in February 2020. During the COVID-19 pandemic two lockdowns took place (March-May 2020/November 2020-ongoing). People who use drugs (PWUD), as well as the homeless, constitute vulnerable social groups. The main aim of this study is to assess the impact of social distancing measures during the COVID-19 pandemic on these groups. Methods A program was implemented in Athens between December 2020 and January 2021 in a sample of PWUD and homeless recruited both in Substitution Treatment Units and the Homeless Shelters. The interview was conducted with a structured questionnaire. Results The study included 303 participants (215 PWUD and 88 homeless individuals (HI)). The mean (SD) age was 49.2 (9.7) and 61.9 (10.2) years for PWUD and HI respectively. Chronic hepatitis C was reported by 33% of PWUD and 1.1% of HI. HIV infection was reported in 9.3% of PWUD. Testing for SARS-CoV-2 was reported by 55% and 100% of PWUD and HI respectively; 0.8% of PWUD and 5.7% of HI were found positive. Compliance with individual measures against SARS-CoV-2 was reported to be high (98-100%) during lockdowns. 88.8% and 98.9% of PWUD and HI reported change in the quality life. Feelings of isolation were reported by 46.6% and 11.5% on PWUD and HI, respectively. PWID enrollment in OST programmes during the 1st and 2nd lockdown was 67.1% and 92.9% respectively. OST attendees did not report changes in treatment during lockdowns. Access to hygiene materials was 9.8% and 100% in 1st and 2nd lockdown. Access to drugs was high (91.5% and 94.3%) in both lockdowns. The illegal drug use as compared to regular use was increased 12.2%/14.3%, decreased 40.2%/40%, stable 47.6%/45.7% for 1st/2nd lockdown respectively. Conclusions The population studied is well-aware and compliant with the prevention measures against COVID-19 with access to frequent laboratory testing, low levels of SARS-CoV-2 and access to prevention materials. Key messages Among PWUD the OST services provision was stable. Provision of antiseptics was higher during the 2nd lockdown while changes in drug use were similar during the 1st and 2nd lockdown. Limitation: This study does not assess PWUD with limited access to OST and HI living in the streets.
Collapse
Affiliation(s)
- S Roussos
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece
| | - O Anagnostou
- OKANA - Organization Against Drugs, Athens, Greece
| | - I Detsi
- OKANA - Organization Against Drugs, Athens, Greece
| | - E Kokolesis
- Hellenic Scientific Society for the Study of AIDS, Sexually, Athens, Greece
| | - M Malliori
- First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - G Kalamitsis
- Hellenic Liver Patient Association, Athens, Greece
| | - V Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece
| | - A Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
29
|
Psichogiou M, Karabinis A, Poulakou G, Antoniadou A, Kotanidou A, Degiannis D, Pavlopoulou ID, Chaidaroglou A, Roussos S, Mastrogianni E, Eliadi I, Basoulis D, Petsios K, Leontis K, Kakalou E, Protopapas K, Jahaj E, Pratikaki M, Syrigos KN, Lagiou P, Gogas H, Tsiodras S, Magiorkinis G, Paraskevis D, Sypsa V, Hatzakis A. Comparative Immunogenicity of BNT162b2 mRNA Vaccine with Natural SARS-CoV-2 Infection. Vaccines (Basel) 2021; 9:1017. [PMID: 34579254 PMCID: PMC8471735 DOI: 10.3390/vaccines9091017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Received: 08/12/2021] [Revised: 08/31/2021] [Accepted: 09/07/2021] [Indexed: 12/04/2022] Open
Abstract
BNT162b2 has proven to be highly effective, but there is a paucity of data regarding immunogenicity factors and comparison between response to vaccination and natural infection. This study included 871 vaccinated healthcare workers (HCW) and 181 patients with natural infection. Immunogenicity was assessed by measuring anti-SARS-CoV-2 against the RBD domain of the spike protein (anti-RBD). Samples were collected 1-2 weeks after vaccination or 15-59 days post-onset of symptoms. Post-vaccine anti-RBD concentrations were associated with age, gender, vaccination side-effects (VSE) and prior infection (Pr-CoV). Anti-RBD median levels (95%CI) were lower by 2466 (651-5583), 6228 (3254-9203) and 7651 (4479-10,823) AU/mL in 35-44, 45-54, 55-70 yrs, respectively, compared with the 18-34 yrs group. In females, the median levels were higher by 2823 (859-4787), 5024 (3122-6926) in individuals with VSE, and 9971 (5158-14,783) AU/mL in HCWs with Pr-CoV. The ratio of anti-RBD in vaccinated individuals versus those with natural infection varied from 1.0 to 19.4. The high immunogenicity of BNT162b2 is verified, although its sustainability has yet to be elucidated. The use of comparative data from natural infection serological panels, expressing the clinical heterogeneity of natural infection, may facilitate early decisions for candidate vaccines to be evaluated in clinical trials.
Collapse
Affiliation(s)
- Mina Psichogiou
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.M.); (I.E.); (D.B.); (H.G.)
| | - Andreas Karabinis
- Onassis Cardiac Surgery Center, 17674 Athens, Greece; (A.K.); (D.D.); (A.C.)
| | - Garyphallia Poulakou
- 3rd Department of Internal Medicine, Sotiria General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.P.); (K.L.); (E.K.); (K.N.S.)
| | - Anastasia Antoniadou
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.A.); (K.P.); (S.T.)
| | - Anastasia Kotanidou
- 1st Department of Critical Care & Pulmonary Services, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, 10676 Athens, Greece; (A.K.); (E.J.); (M.P.)
| | - Dimitrios Degiannis
- Onassis Cardiac Surgery Center, 17674 Athens, Greece; (A.K.); (D.D.); (A.C.)
| | - Ioanna D. Pavlopoulou
- Pediatric Research Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | | | - Sotirios Roussos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.R.); (P.L.); (G.M.); (D.P.); (V.S.); (A.H.)
| | - Elpida Mastrogianni
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.M.); (I.E.); (D.B.); (H.G.)
| | - Irene Eliadi
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.M.); (I.E.); (D.B.); (H.G.)
| | - Dimitrios Basoulis
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.M.); (I.E.); (D.B.); (H.G.)
| | | | - Konstantinos Leontis
- 3rd Department of Internal Medicine, Sotiria General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.P.); (K.L.); (E.K.); (K.N.S.)
| | - Eleni Kakalou
- 3rd Department of Internal Medicine, Sotiria General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.P.); (K.L.); (E.K.); (K.N.S.)
| | - Konstantinos Protopapas
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.A.); (K.P.); (S.T.)
| | - Edison Jahaj
- 1st Department of Critical Care & Pulmonary Services, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, 10676 Athens, Greece; (A.K.); (E.J.); (M.P.)
| | - Maria Pratikaki
- 1st Department of Critical Care & Pulmonary Services, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, 10676 Athens, Greece; (A.K.); (E.J.); (M.P.)
| | - Konstantinos N. Syrigos
- 3rd Department of Internal Medicine, Sotiria General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.P.); (K.L.); (E.K.); (K.N.S.)
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.R.); (P.L.); (G.M.); (D.P.); (V.S.); (A.H.)
| | - Helen Gogas
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.M.); (I.E.); (D.B.); (H.G.)
| | - Sotirios Tsiodras
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.A.); (K.P.); (S.T.)
| | - Gkikas Magiorkinis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.R.); (P.L.); (G.M.); (D.P.); (V.S.); (A.H.)
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.R.); (P.L.); (G.M.); (D.P.); (V.S.); (A.H.)
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.R.); (P.L.); (G.M.); (D.P.); (V.S.); (A.H.)
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.R.); (P.L.); (G.M.); (D.P.); (V.S.); (A.H.)
- Hellenic Scientific Society for the Study of AIDS, Sexually Transmitted and Emerging Diseases, 11527 Athens, Greece
| |
Collapse
|
30
|
Chaintoutis SC, Thomou Z, Mouchtaropoulou E, Tsiolas G, Chassalevris T, Stylianaki I, Lagou M, Michailidou S, Moutou E, Koenen JJH, Dijkshoorn JW, Paraskevis D, Poutahidis T, Siarkou VI, Sypsa V, Argiriou A, Fortomaris P, Dovas CI. Outbreaks of SARS-CoV-2 in naturally infected mink farms: Impact, transmission dynamics, genetic patterns, and environmental contamination. PLoS Pathog 2021; 17:e1009883. [PMID: 34492088 PMCID: PMC8448373 DOI: 10.1371/journal.ppat.1009883] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 05/05/2021] [Revised: 09/17/2021] [Accepted: 08/10/2021] [Indexed: 12/14/2022] Open
Abstract
SARS-CoV-2 infection outbreaks in minks have serious implications associated with animal health and welfare, and public health. In two naturally infected mink farms (A and B) located in Greece, we investigated the outbreaks and assessed parameters associated with virus transmission, immunity, pathology, and environmental contamination. Symptoms ranged from anorexia and mild depression to respiratory signs of varying intensity. Although the farms were at different breeding stages, mortality was similarly high (8.4% and 10.0%). The viral strains belonged to lineages B.1.1.218 and B.1.1.305, possessing the mink-specific S-Y453F substitution. Lung histopathology identified necrosis of smooth muscle and connective tissue elements of vascular walls, and vasculitis as the main early key events of the acute SARS-CoV-2-induced broncho-interstitial pneumonia. Molecular investigation in two dead minks indicated a consistently higher (0.3-1.3 log10 RNA copies/g) viral load in organs of the male mink compared to the female. In farm A, the infected farmers were responsible for the significant initial infection of 229 out of 1,000 handled minks, suggesting a very efficient human-to-mink transmission. Subsequent infections across the sheds wherein animals were being housed occurred due to airborne transmission. Based on a R0 of 2.90 and a growth rate equal to 0.293, the generation time was estimated to be 3.6 days, indicative of the massive SARS-CoV-2 dispersal among minks. After the end of the outbreaks, a similar percentage of animals were immune in the two farms (93.0% and 93.3%), preventing further virus transmission whereas, viral RNA was detected in samples collected from shed surfaces and air. Consequently, strict biosecurity is imperative during the occurrence of clinical signs. Environmental viral load monitoring, in conjunction with NGS should be adopted in mink farm surveillance. The minimum proportion of minks that need to be immunized to avoid outbreaks in farms was calculated at 65.5%, which is important for future vaccination campaigns.
Collapse
Affiliation(s)
- Serafeim C. Chaintoutis
- Diagnostic Laboratory, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Zoi Thomou
- Pecon Hellas PC, Dispilio, Kastoria, Greece
| | | | - George Tsiolas
- Institute of Applied Biosciences, Centre of Research and Technology Hellas, Thermi, Greece
| | - Taxiarchis Chassalevris
- Diagnostic Laboratory, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioanna Stylianaki
- Laboratory of Pathology, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Lagou
- Laboratory of Pathology, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sofia Michailidou
- Institute of Applied Biosciences, Centre of Research and Technology Hellas, Thermi, Greece
| | - Evangelia Moutou
- Diagnostic Laboratory, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theofilos Poutahidis
- Laboratory of Pathology, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Victoria I. Siarkou
- Laboratory of Microbiology and Infectious Diseases, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anagnostis Argiriou
- Institute of Applied Biosciences, Centre of Research and Technology Hellas, Thermi, Greece
- Department of Food Science and Nutrition, University of the Aegean, Myrina, Greece
| | - Paschalis Fortomaris
- Laboratory of Animal Husbandry, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Chrysostomos I. Dovas
- Diagnostic Laboratory, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
31
|
Petraki I, Kalpourtzi N, Terzidis A, Gavana M, Vantarakis A, Rachiotis G, Karakosta A, Sypsa V, Touloumi G. Living in Roma Settlements in Greece: Self-Perceived Health Status, Chronic Diseases and Associated Social Determinants of Health. Int J Environ Res Public Health 2021; 18:ijerph18168403. [PMID: 34444153 PMCID: PMC8394944 DOI: 10.3390/ijerph18168403] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/26/2021] [Accepted: 08/04/2021] [Indexed: 11/16/2022]
Abstract
We aimed to assess the self-perceived health status and the presence of chronic diseases of adult Roma living in settlements in Greece, and to explore associated social determinants of health. Data were derived from the Hprolipsis Health Survey. Multivariable regression models were applied. In total, 534 adults, 287 women, and 247 men were recruited from twelve Roma settlements in four prefectures. Although 62% of the participants perceived their health status as good/very good, about half of them had been diagnosed with at least one chronic disease. Several structural and intermediary social determinants of health were found to be significantly associated with the health outcomes; prefecture, settlement type, sex, age group, living with a partner, presence of depression symptoms, food insecurity, and alcohol consumption were associated with self-perceived health status; settlement type, sex, age group, presence of anxiety symptoms, food insecurity and number of persons living in the house with the presence of a chronic disease. This is one of the few studies assessing the self-perceived health status and presence of chronic diseases in Roma settlements in Greece and investigating the associated social determinants of health in the world. Community-based participatory action research and health literacy programs are needed to mitigate health inequalities in Roma settlements.
Collapse
Affiliation(s)
- Ioanna Petraki
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., Goudi, 11527 Athens, Greece; (N.K.); (A.K.); (V.S.); (G.T.)
- Correspondence: ; Tel.: +30-6946185619
| | - Natasa Kalpourtzi
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., Goudi, 11527 Athens, Greece; (N.K.); (A.K.); (V.S.); (G.T.)
| | - Agapios Terzidis
- International Medicine-Health Crisis Management, School of Medicine, National and Kapodistrian University of Athens, 1, Dilou & Mikras Asias Str., Goudi, 11527 Athens, Greece;
| | - Magda Gavana
- Department of Primary Health Care, General Practice, and Health Services Research, Medical School of Aristotle University, 54124 Thessaloniki, Greece;
| | - Apostolos Vantarakis
- Environmental Microbiology Unit of Public Health, Medical School, University of Patras, Rio Achaia, 26504 Patra, Greece;
| | - Georgios Rachiotis
- Department of Hygiene and Epidemiology, Medical Faculty, University of Thessaly, 3, Panepistimiou Str., Viopolis, 41500 Larisa, Greece;
| | - Argiro Karakosta
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., Goudi, 11527 Athens, Greece; (N.K.); (A.K.); (V.S.); (G.T.)
| | - Vana Sypsa
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., Goudi, 11527 Athens, Greece; (N.K.); (A.K.); (V.S.); (G.T.)
| | - Giota Touloumi
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Str., Goudi, 11527 Athens, Greece; (N.K.); (A.K.); (V.S.); (G.T.)
| | | |
Collapse
|
32
|
Kostaki EG, Pavlopoulos GA, Verrou KM, Ampatziadis-Michailidis G, Harokopos V, Hatzis P, Moulos P, Siafakas N, Pournaras S, Hadjichristodoulou C, Chatzopoulou F, Chatzidimitriou D, Panagopoulos P, Lourida P, Argyraki A, Lytras T, Sapounas S, Gerolymatos G, Panagiotakopoulos G, Prezerakos P, Tsiodras S, Sypsa V, Hatzakis A, Anastassopoulou C, Spanakis N, Tsakris A, Dimopoulos MA, Kotanidou A, Sfikakis P, Kollias G, Magiorkinis G, Paraskevis D. Molecular Epidemiology of SARS-CoV-2 in Greece Reveals Low Rates of Onward Virus Transmission after Lifting of Travel Restrictions Based on Risk Assessment during Summer 2020. mSphere 2021; 6:e0018021. [PMID: 34190583 PMCID: PMC8265632 DOI: 10.1128/msphere.00180-21] [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] [Received: 02/25/2021] [Accepted: 06/06/2021] [Indexed: 12/16/2022] Open
Abstract
The novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread rapidly during the first months of 2020 and continues to expand in multiple areas across the globe. Molecular epidemiology has provided an added value to traditional public health tools by identifying SARS-CoV-2 clusters or providing evidence that clusters based on virus sequences and contact tracing are highly concordant. Our aim was to infer the levels of virus importation and to estimate the impact of public health measures related to travel restrictions to local transmission in Greece. Our phylogenetic and phylogeographic analyses included 389 full-genome SARS-CoV-2 sequences collected during the first 7 months of the pandemic in Greece and a random collection in five replicates of 3,000 sequences sampled globally, as well as the best hits to our data set identified by BLAST. Phylogenetic trees were reconstructed by the maximum likelihood method, and the putative source of SARS-CoV-2 infections was inferred by phylogeographic analysis. Phylogenetic analyses revealed the presence of 89 genetically distinct viruses identified as independent introductions into Greece. The proportion of imported strains was 41%, 11.5%, and 8.8% during the three periods of sampling, namely, March (no travel restrictions), April to June (strict travel restrictions), and July to September (lifting of travel restrictions based on thorough risk assessment), respectively. The results of phylogeographic analysis were confirmed by a Bayesian approach. Our findings reveal low levels of onward transmission from imported cases during summer and underscore the importance of targeted public health measures that can increase the safety of international travel during a pandemic. IMPORTANCE Our study based on current state-of-the-art molecular epidemiology methods suggests that virus screening and public health measures after the lifting of travel restrictions prevented SARS-CoV-2 onward transmission from imported cases during summer 2020 in Greece. These findings provide important data on the efficacy of targeted public health measures and have important implications regarding the safety of international travel during a pandemic. Our results can provide a roadmap about prevention policy in the future regarding the reopening of borders in the presence of differences in vaccination coverage, the circulation of the virus, and the presence of newly emergent variants across the globe.
Collapse
Affiliation(s)
- Evangelia Georgia Kostaki
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios A. Pavlopoulos
- Center of New Biotechnologies & Precision Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Institute for Fundamental Biomedical Research, Biomedical Sciences Research Center “Alexander Fleming,” Vari, Greece
| | - Kleio-Maria Verrou
- Center of New Biotechnologies & Precision Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Giannis Ampatziadis-Michailidis
- Center of New Biotechnologies & Precision Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vaggelis Harokopos
- Institute for Fundamental Biomedical Research, Biomedical Sciences Research Center “Alexander Fleming,” Vari, Greece
| | - Pantelis Hatzis
- Center of New Biotechnologies & Precision Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Institute for Fundamental Biomedical Research, Biomedical Sciences Research Center “Alexander Fleming,” Vari, Greece
| | - Panagiotis Moulos
- Center of New Biotechnologies & Precision Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Institute for Fundamental Biomedical Research, Biomedical Sciences Research Center “Alexander Fleming,” Vari, Greece
| | - Nikolaos Siafakas
- Laboratory of Clinical Microbiology, ATTIKON University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Pournaras
- Laboratory of Clinical Microbiology, ATTIKON University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Dimitrios Chatzidimitriou
- Labnet, Laboratories, Thessaloniki, Greece
- Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Periklis Panagopoulos
- 2nd Department of Internal Medicine, General Hospital of Alexandroupoli, Democritus University of Thrace, Alexandroupoli, Greece
| | - Panagiota Lourida
- Infectious Diseases Clinic A, Thoracic Diseases General Hospital Sotiria, Athens, Greece
| | - Aikaterini Argyraki
- Infectious Diseases Clinic A, Thoracic Diseases General Hospital Sotiria, Athens, Greece
| | | | | | | | | | | | - Sotirios Tsiodras
- 4th Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Cleo Anastassopoulou
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Spanakis
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Meletios Athanasios Dimopoulos
- Center of New Biotechnologies & Precision Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Department of Therapeutics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Kotanidou
- 1st Intensive Care Unit, General Hospital Evangelismos, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros Sfikakis
- Center of New Biotechnologies & Precision Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- 1st Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Kollias
- Center of New Biotechnologies & Precision Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Institute for Bioinnovation, Biomedical Sciences Research Center “Alexander Fleming,” Vari, Greece
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gkikas Magiorkinis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
33
|
Bowman B, Psichogyiou M, Papadopoulou M, Sypsa V, Khanna A, Paraskevis D, Chanos S, Friedman SR, Hatzakis A, Schneider J. Sexual Mixing and HIV Transmission Potential Among Greek Men Who have Sex with Men: Results from SOPHOCLES. AIDS Behav 2021; 25:1935-1945. [PMID: 33555414 PMCID: PMC8081711 DOI: 10.1007/s10461-020-03123-6] [Citation(s) in RCA: 3] [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] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Abstract
HIV incidence among men who have sex with men (MSM) in Greece remains unchanged despite effective response to a recent outbreak among people who inject drugs (PWID). Network factors are increasingly understood to drive transmission in epidemics. The primary objective of the study was to characterize MSM in Greece, their sexual behaviors, and sexual network mixing patterns. We investigated the relationship between serostatus, sexual behaviors, and self-reported sex networks in a sample of MSM in Athens, Greece, generated using respondent driven sampling. We estimated mixing coefficients (r) based on survey-generated egonets. Additionally, multiple logistic regression was used to estimate adjusted odds ratios (AOR) and to assess relationships between serostatus, sexual behaviors, and sociodemographic indicators. A sample of 1,520 MSM participants included study respondents (n = 308) and their network members (n = 1,212). Mixing based on serostatus (r = 0.12, σr = 0.09–0.15) and condomless sex (r = 0.11, σr = 0.07–0.14) was random. However, mixing based on sex-drug use was highly assortative (r = 0.37, σr = 0.32–0.42). This study represents the first analysis of Greek MSM sexual networks. Our findings highlight protective behavior in two distinct network typologies. The first typology mixed assortatively based on serostatus and sex-drug use and was less likely to engage in condomless sex. The second typology mixed randomly based on condomless sex but was less likely to engage in sex-drug use. These findings support the potential benefit of HIV prevention program scale-up for this population including but not limited to PrEP.
Collapse
Affiliation(s)
- Benjamin Bowman
- Pritzker School of Medicine, University of Chicago, Chicago, IL USA
| | - Mina Psichogyiou
- First Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Martha Papadopoulou
- Department of Hygiene, Epidemiology & Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece
| | - Vana Sypsa
- First Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aditya Khanna
- Department of Medicine, Infectious Diseases, University of Chicago, Chicago, IL USA
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology & Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Samuel R. Friedman
- Institute for Infectious Disease Research, National Development & Research Institutes, New York, NY USA
- Department of Population Health, New York University Langone Medical School, New York, NY USA
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology & Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece
| | - John Schneider
- Pritzker School of Medicine, University of Chicago, Chicago, IL USA
- Department of Medicine, Infectious Diseases, University of Chicago, Chicago, IL USA
| |
Collapse
|
34
|
Arum C, Fraser H, Artenie AA, Bivegete S, Trickey A, Alary M, Astemborski J, Iversen J, Lim AG, MacGregor L, Morris M, Ong JJ, Platt L, Sack-Davis R, van Santen DK, Solomon SS, Sypsa V, Valencia J, Van Den Boom W, Walker JG, Ward Z, Stone J, Vickerman P. Homelessness, unstable housing, and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis. Lancet Public Health 2021; 6:e309-e323. [PMID: 33780656 PMCID: PMC8097637 DOI: 10.1016/s2468-2667(21)00013-x] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND People who inject drugs (PWID) are at increased risk for HIV and hepatitis C virus (HCV) infection and also have high levels of homelessness and unstable housing. We assessed whether homelessness or unstable housing is associated with an increased risk of HIV or HCV acquisition among PWID compared with PWID who are not homeless or are stably housed. METHODS In this systematic review and meta-analysis, we updated an existing database of HIV and HCV incidence studies published between Jan 1, 2000, and June 13, 2017. Using the same strategy as for this existing database, we searched MEDLINE, Embase, and PsycINFO for studies, including conference abstracts, published between June 13, 2017, and Sept 14, 2020, that estimated HIV or HCV incidence, or both, among community-recruited PWID. We only included studies reporting original results without restrictions to study design or language. We contacted authors of studies that reported HIV or HCV incidence, or both, but did not report on an association with homelessness or unstable housing, to request crude data and, where possible, adjusted effect estimates. We extracted effect estimates and pooled data using random-effects meta-analyses to quantify the associations between recent (current or within the past year) homelessness or unstable housing compared with not recent homelessness or unstable housing, and risk of HIV or HCV acquisition. We assessed risk of bias using the Newcastle-Ottawa Scale and between-study heterogeneity using the I2 statistic and p value for heterogeneity. FINDINGS We identified 14 351 references in our database search, of which 392 were subjected to full-text review alongside 277 studies from our existing database. Of these studies, 55 studies met inclusion criteria. We contacted the authors of 227 studies that reported HIV or HCV incidence in PWID but did not report association with the exposure of interest and obtained 48 unpublished estimates from 21 studies. After removal of duplicate data, we included 37 studies with 70 estimates (26 for HIV; 44 for HCV). Studies originated from 16 countries including in North America, Europe, Australia, east Africa, and Asia. Pooling unadjusted estimates, recent homelessness or unstable housing was associated with an increased risk of acquiring HIV (crude relative risk [cRR] 1·55 [95% CI 1·23-1·95; p=0·0002]; I2= 62·7%; n=17) and HCV (1·65 [1·44-1·90; p<0·0001]; I2= 44·8%; n=28]) among PWID compared with those who were not homeless or were stably housed. Associations for both HIV and HCV persisted when pooling adjusted estimates (adjusted relative risk for HIV: 1·39 [95% CI 1·06-1·84; p=0·019]; I2= 65·5%; n=9; and for HCV: 1·64 [1·43-1·89; p<0·0001]; I2= 9·6%; n=14). For risk of HIV acquisition, the association for unstable housing (cRR 1·82 [1·13-2·95; p=0·014]; n=5) was higher than for homelessness (1·44 [1·13-1·83; p=0·0036]; n=12), whereas no difference was seen between these outcomes for risk of HCV acquisition (1·72 [1·48-1·99; p<0·0001] for unstable housing, 1·66 [1·37-2·00; p<0·0001] for homelessness). INTERPRETATION Homelessness and unstable housing are associated with increased risk of HIV and HCV acquisition among PWID. Our findings support the development of interventions that simultaneously address homelessness and unstable housing and HIV and HCV transmission in this population. FUNDING National Institute for Health Research, National Institute on Drug Abuse, National Institute of Allergy and Infectious Diseases, and Commonwealth Scholarship Commission.
Collapse
Affiliation(s)
- Chiedozie Arum
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Hannah Fraser
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Sandra Bivegete
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Adam Trickey
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Michel Alary
- Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada; Département de médecine sociale et préventive, Université Laval, Quebec City, QC, Canada; Institut national de santé publique du Québec, Québec, QC, Canada
| | - Jacquie Astemborski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer Iversen
- Kirby Institute for Infection and Immunity, UNSW Sydney, NSW, Australia
| | - Aaron G Lim
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Louis MacGregor
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Meghan Morris
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Jason J Ong
- Population Health Sciences, University of Bristol, Bristol, UK; Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Rachel Sack-Davis
- Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Daniela K van Santen
- Burnet Institute, Melbourne, VIC, Australia; Department of Infectious Disease Research and Prevention, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - Sunil S Solomon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Jorge Valencia
- Harm Reduction Unit "SMASD", Department of Addictions and Mental Health, Madrid, Spain
| | | | | | - Zoe Ward
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Jack Stone
- Population Health Sciences, University of Bristol, Bristol, UK.
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
| |
Collapse
|
35
|
Papatheodoridis GV, Dalekos GN, Idilman R, Sypsa V, Van Boemmel F, Buti M, Calleja JL, Goulis J, Manolakopoulos S, Loglio A, Papatheodoridi M, Gatselis N, Veelken R, Lopez-Gomez M, Hansen BE, Savvidou S, Kourikou A, Vlachogiannakos J, Galanis K, Yurdaydin C, Esteban R, Janssen HL, Berg T, Lampertico P. Predictive performance of newer Asian hepatocellular carcinoma risk scores in treated Caucasians with chronic hepatitis B. JHEP Rep 2021; 3:100290. [PMID: 34041470 PMCID: PMC8144729 DOI: 10.1016/j.jhepr.2021.100290] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 12/22/2022] Open
Abstract
Background & Aims Recently, several risk scores for prediction of hepatocellular carcinoma (HCC) were developed in cohorts of treated Asian patients with chronic hepatitis B (CHB), but they have not been assessed in non-Asian patients. We evaluated the predictability and comparative utility of our PAGE-B and recent Asian HCC risk scores in nucleos(t)ide analogue (NA)-treated adult Caucasian patients with CHB, with or without well-documented compensated cirrhosis but not previous diagnosis of HCC. Methods We included 1,951 patients treated with entecavir/tenofovir and followed up for a median of 7.6 years. The c-statistic was used to estimate the predictability of PAGE-B, HCC-Rescue, CAMD, mPAGE-B, and AASL score for HCC development within 5 or 10 years. The low- and high-risk group cut-offs were used for estimation of negative (NPV) and positive predictive values (PPV), respectively. Results HCC developed in 103/1,951 (5.3%) patients during the first 5 years and in another 39/1,428 (2.7%) patients between years 5 and 10. The 3-, 5-, and 10-year cumulative HCC rates were 3.3%, 5.9%, and 9.6%, respectively. All scores offered good 5- and 10-year HCC prediction (c-statistic: 0.78–0.82). NPVs were always >99% (99.3–100%), whereas PPV ranged between 13% and 24%. Conclusions In NA-treated Caucasian patients with CHB including compensated cirrhosis, HCC risk scores developed in NA-treated Asian patients offer good 5- and 10-year HCC predictability, similar to that of PAGE-B. PAGE-B and mPAGE-B scores are simpler in clinical practice, as they do not require an accurate diagnosis of cirrhosis, but the addition of albumin in mPAGE-B score does not seem to offer an advantage in patients with well compensated liver disease. Lay summary Several risk scores for prediction of hepatocellular carcinoma (HCC) were recently developed in cohorts of treated Asian patients with chronic hepatitis B (CHB). In Caucasian patients with CHB treated with oral antivirals, newer Asian HCC risk scores offer good 5- and 10-year HCC predictability, similar to that of PAGE-B. For clinical practice, PAGE-B and mPAGE-B scores are simpler, as they do not require an accurate diagnosis of cirrhosis. In treated Caucasian patients with chronic hepatitis B, newer Asian hepatocellular carcinoma risk scores offer good 5- and 10-year predictability, similar to that of PAGE-B. PAGE-B and mPAGE-B scores are simpler in clinical practice, as they do not require an accurate diagnosis of cirrhosis. The addition of albumin in mPAGE-B does not seem to offer an advantage in patients with well-compensated liver disease.
Collapse
Key Words
- ALT, alanine aminotransferase
- AUROC, area under receiver operating characteristic
- CHB, chronic hepatitis B
- Cirrhosis
- ETV, entecavir
- Entecavir
- HCC, hepatocellular carcinoma
- HR, hazard ratio
- NA, nucleos(t)ide analogue
- NPV, negative predictive value
- PPV, positive predictive value
- Prediction
- TDF, tenofovir disoproxil fumarate
- Tenofovir
- ULN, upper limit of normal
Collapse
Affiliation(s)
- George V. Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens “Laiko”, Athens, Greece
- Corresponding author. Address: Department of Gastroenterology, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital of Athens, 17 Agiou Thoma Street, 11527 Athens, Greece. Tel: +30-2132061115, Fax: +30-2107462601
| | - George N. Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Vana Sypsa
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Florian Van Boemmel
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Maria Buti
- Hospital General Universitario Vall Hebron and Ciberehd, Barcelona, Spain
| | | | - John Goulis
- 4th Department of Internal Medicine, Αristotle University of Thessaloniki Medical School, Thessaloniki, Greece
| | - Spilios Manolakopoulos
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens “Laiko”, Athens, Greece
- 2nd Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens “Hippokratio”, Athens, Greece
| | - Alessandro Loglio
- Division of Gastroenterology and Hepatology, CRC “A. M. and A. Migliavacca” Center for Liver Disease, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Margarita Papatheodoridi
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens “Laiko”, Athens, Greece
| | - Nikolaos Gatselis
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Rhea Veelken
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | | | - Bettina E. Hansen
- Department of Gastroenterology & Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
- Liver Clinic, Toronto Western & General Hospital, University Health Network, Toronto, ON, Canada
| | - Savvoula Savvidou
- 4th Department of Internal Medicine, Αristotle University of Thessaloniki Medical School, Thessaloniki, Greece
| | - Anastasia Kourikou
- 2nd Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens “Hippokratio”, Athens, Greece
| | - John Vlachogiannakos
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens “Laiko”, Athens, Greece
| | - Kostas Galanis
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Cihan Yurdaydin
- Department of Gastroenterology & Hepatology, Koc University Medical School, Istanbul, Turkey
| | - Rafael Esteban
- Hospital General Universitario Vall Hebron and Ciberehd, Barcelona, Spain
| | - Harry L.A. Janssen
- Liver Clinic, Toronto Western & General Hospital, University Health Network, Toronto, ON, Canada
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Pietro Lampertico
- Division of Gastroenterology and Hepatology, CRC “A. M. and A. Migliavacca” Center for Liver Disease, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| |
Collapse
|
36
|
Kostaki EG, Limnaios S, Roussos S, Psichogiou M, Nikolopoulos GK, Friedman SR, Antoniadou A, Chini M, Hatzakis A, Sypsa V, Magiorkinis G, Seguin-Devaux C, Paraskevis D. Validation of molecular clock inferred HIV infection ages: Evidence for accurate estimation of infection dates. Infect Genet Evol 2021; 91:104799. [PMID: 33677110 DOI: 10.1016/j.meegid.2021.104799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Improving HIV diagnosis, access to care and effective antiretroviral treatment provides our global strategy to reduce HIV incidence. To reach this goal we need to increase our knowledge about local epidemics. HIV infection dates would be an important information towards this goal, but they are largely unknown. To date, methods to estimate the dates of HIV infection are based mainly on laboratory or molecular methods. Our aim was to validate molecular clock inferred infection dates that were estimated by analysing sequences from 145 people living with HIV (PLHIV) with known transmission dates (clinically estimated infection dates). METHODS All HIV sequences were obtained by Sanger sequencing and were previously found to belong to well-established molecular transmission clusters (MTCs). RESULTS Our analysis showed that the molecular clock inferred infection dates were correlated with the clinically estimated ones (Spearman's Correlation coefficient = 0.93, p < 0.001) and that there was an agreement between them (Lin's concordance correlation coefficient = 0.92, p < 0.001). For the 61.4% of cases the molecular clock inferred preceded the clinically estimated infection dates. The median difference between clinically and molecularly estimated dates of infection was of 0.18 (IQR: -0.21, 0.89) years. The lowest differences were identified in people who inject drugs of our study population. CONCLUSIONS The estimated time to more recent common ancestor (tMRCA) of nodes within clusters provides a reliable approximation of HIV infections for PLHIV infected within MTCs. Next-generation sequencing data and molecular clock estimates based on heterochronous sequences provide, probably, more reliable methods for inferring infection dates. However, since these data are not available in most of the HIV clinical laboratories, our approach, under specific conditions, can provide a reliable estimation of HIV infection dates and can be used for HIV public health interventions.
Collapse
Affiliation(s)
- Evangelia Georgia Kostaki
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stefanos Limnaios
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Roussos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Mina Psichogiou
- 1st Department of Medicine, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Samuel R Friedman
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Anastasia Antoniadou
- 4th Department of Medicine, Attikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Chini
- 3rd Department of Internal Medicine-Infectious Diseases Unit, "Korgialeneio-Benakeio" Red Cross General Hospital, Athens, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gkikas Magiorkinis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Carole Seguin-Devaux
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch sur Alzette, Luxembourg
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| |
Collapse
|
37
|
Sypsa V, Roussos S, Paraskevis D, Lytras T, Tsiodras S, Hatzakis A. Effects of Social Distancing Measures during the First Epidemic Wave of Severe Acute Respiratory Syndrome Infection, Greece. Emerg Infect Dis 2021; 27:452-462. [PMID: 33496221 PMCID: PMC7853557 DOI: 10.3201/eid2702.203412] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Greece imposed a nationwide lockdown in March 2020 to mitigate transmission of severe acute respiratory syndrome coronavirus 2 during the first epidemic wave. We conducted a survey on age-specific social contact patterns to assess effects of physical distancing measures and used a susceptible-exposed-infectious-recovered model to simulate the epidemic. Because multiple distancing measures were implemented simultaneously, we assessed their overall effects and the contribution of each measure. Before measures were implemented, the estimated basic reproduction number (R0) was 2.38 (95% CI 2.01-2.80). During lockdown, daily contacts decreased by 86.9% and R0 decreased by 81.0% (95% credible interval [CrI] 71.8%-86.0%); each distancing measure decreased R0 by 10%-24%. By April 26, the attack rate in Greece was 0.12% (95% CrI 0.06%-0.26%), one of the lowest in Europe, and the infection fatality ratio was 1.12% (95% CrI 0.55%-2.31%). Multiple social distancing measures contained the first epidemic wave in Greece.
Collapse
|
38
|
Papatheodoridis G, Sypsa V, Lampertico P. Reply to: "Similar risk of hepatocellular carcinoma during long-term entecavir or tenofovir therapy in Caucasian patients with chronic hepatitis B". J Hepatol 2021; 74:246-247. [PMID: 32988659 DOI: 10.1016/j.jhep.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 12/04/2022]
Affiliation(s)
- George Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece.
| | - Vana Sypsa
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Pietro Lampertico
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| |
Collapse
|
39
|
Psichogiou M, Karabinis A, Pavlopoulou ID, Basoulis D, Petsios K, Roussos S, Pratikaki M, Jahaj E, Protopapas K, Leontis K, Rapti V, Kotanidou A, Antoniadou A, Poulakou G, Paraskevis D, Sypsa V, Hatzakis A. Antibodies against SARS-CoV-2 among health care workers in a country with low burden of COVID-19. PLoS One 2020; 15:e0243025. [PMID: 33270691 PMCID: PMC7714091 DOI: 10.1371/journal.pone.0243025] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/15/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Greece is a country with limited spread of SARS-CoV-2 and cumulative infection attack rate of 0.12% (95% CI 0.06-0.26). Health care workers (HCWs) are a well-recognized risk group for COVID-19. The study aimed to estimate the seroprevalence of antibodies to SARS-CoV-2 in a nosocomial setting and assess potential risk factors. METHODS HCWs from two hospitals participated in the study. Hospital-1 was a tertiary university affiliated center, involved in the care of COVID-19 patients while hospital-2 was a tertiary specialized cardiac surgery center not involved in the care of these patients. A validated, CE, rapid, IgM/IgG antibody point-of-care test was used. Comparative performance with a reference globally available assay was assessed. RESULTS 1,495 individuals consented to participate (response rate 77%). The anti-SARS-CoV-2 weighted prevalence was 1.26% (95% CI 0.43, 3.26) overall and 0.53% (95% CI 0.06, 2.78) and 2.70% (95% CI 0.57, 9.19) in hospital-1 and hospital-2, respectively although the study was underpowered to detect statistically significant differences. The overall, hospital-1, and hospital-2 seroprevalence was 10, 4 and 22 times higher than the estimated infection attack rate in general population, respectively. Suboptimal use of personal protective equipment was noted in both hospitals. CONCLUSIONS These data have implications for the preparedness of a second wave of COVID-19 epidemic, given the low burden of SARS-CoV-2 infection rate, in concordance with national projections.
Collapse
Affiliation(s)
- Mina Psichogiou
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Ioanna D. Pavlopoulou
- Pediatric Research Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Basoulis
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Sotirios Roussos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Pratikaki
- 1st Department of Critical Care & Pulmonary Services, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Edison Jahaj
- 1st Department of Critical Care & Pulmonary Services, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Konstantinos Protopapas
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Leontis
- 3rd Department of Internal Medicine, Sotiria General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasiliki Rapti
- 3rd Department of Internal Medicine, Sotiria General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Kotanidou
- 1st Department of Critical Care & Pulmonary Services, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Anastasia Antoniadou
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Garyphallia Poulakou
- 3rd Department of Internal Medicine, Sotiria General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
40
|
Fan R, Papatheodoridis G, Sun J, Innes H, Toyoda H, Xie Q, Mo S, Sypsa V, Guha IN, Kumada T, Niu J, Dalekos G, Yasuda S, Barnes E, Lian J, Suri V, Idilman R, Barclay ST, Dou X, Berg T, Hayes PC, Flaherty JF, Zhou Y, Zhang Z, Buti M, Hutchinson SJ, Guo Y, Calleja JL, Lin L, Zhao L, Chen Y, Janssen HLA, Zhu C, Shi L, Tang X, Gaggar A, Wei L, Jia J, Irving WL, Johnson PJ, Lampertico P, Hou J. aMAP risk score predicts hepatocellular carcinoma development in patients with chronic hepatitis. J Hepatol 2020; 73:1368-1378. [PMID: 32707225 DOI: 10.1016/j.jhep.2020.07.025] [Citation(s) in RCA: 136] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/02/2020] [Accepted: 07/14/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Hepatocellular carcinoma (HCC) is the leading cause of death in patients with chronic hepatitis. In this international collaboration, we sought to develop a global universal HCC risk score to predict the HCC development for patients with chronic hepatitis. METHODS A total of 17,374 patients, comprising 10,578 treated Asian patients with chronic hepatitis B (CHB), 2,510 treated Caucasian patients with CHB, 3,566 treated patients with hepatitis C virus (including 2,489 patients with cirrhosis achieving a sustained virological response) and 720 patients with non-viral hepatitis (NVH) from 11 international prospective observational cohorts or randomised controlled trials, were divided into a training cohort (3,688 Asian patients with CHB) and 9 validation cohorts with different aetiologies and ethnicities (n = 13,686). RESULTS We developed an HCC risk score, called the aMAP score (ranging from 0 to 100), that involves only age, male, albumin-bilirubin and platelets. This metric performed excellently in assessing HCC risk not only in patients with hepatitis of different aetiologies, but also in those with different ethnicities (C-index: 0.82-0.87). Cut-off values of 50 and 60 were best for discriminating HCC risk. The 3- or 5-year cumulative incidences of HCC were 0-0.8%, 1.5-4.8%, and 8.1-19.9% in the low- (n = 7,413, 43.6%), medium- (n = 6,529, 38.4%), and high-risk (n = 3,044, 17.9%) groups, respectively. The cut-off value of 50 was associated with a sensitivity of 85.7-100% and a negative predictive value of 99.3-100%. The cut-off value of 60 resulted in a specificity of 56.6-95.8% and a positive predictive value of 6.6-15.7%. CONCLUSIONS This objective, simple, reliable risk score based on 5 common parameters accurately predicted HCC development, regardless of aetiology and ethnicity, which could help to establish a risk score-guided HCC surveillance strategy worldwide. LAY SUMMARY In this international collaboration, we developed and externally validated a simple, objective and accurate prognostic tool (called the aMAP score), that involves only age, male, albumin-bilirubin and platelets. The aMAP score (ranged from 0 to 100) satisfactorily predicted the risk of hepatocellular carcinoma (HCC) development among over 17,000 patients with viral and non-viral hepatitis from 11 global prospective studies. Our findings show that the aMAP score had excellent discrimination and calibration in assessing the 5-year HCC risk among all the cohorts irrespective of aetiology and ethnicity.
Collapse
Affiliation(s)
- Rong Fan
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - George Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Jian Sun
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hamish Innes
- Glasgow Caledonian University, School of Health and Life Sciences, Glasgow, UK
| | - Hidenori Toyoda
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Qing Xie
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Vana Sypsa
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Indra Neil Guha
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Takashi Kumada
- Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan
| | - Junqi Niu
- Department of Hepatology, First Hospital, Jilin University, Changchun, China
| | - George Dalekos
- Department of Internal Medicine, Thessalia University Medical School, Larissa, Greece
| | - Satoshi Yasuda
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Eleanor Barnes
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine and the Oxford NIHR Biomedical Research Centre, Oxford University, Oxford, UK
| | - Jianqi Lian
- Centers of Infectious Diseases, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China
| | | | - Ramazan Idilman
- Department of Gastroenterology, University of Ankara Medical School, Ankara, Turkey
| | | | - Xiaoguang Dou
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang, China
| | - Thomas Berg
- Division of Hepatology, Clinic and Polyclinic for Gastroenterology, Hepatology Infectious Disease and Pneumology, University Clinic Leipzig, Leipzig, Germany
| | | | | | - Yuanping Zhou
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhengang Zhang
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Maria Buti
- Hospital General Universitario Valle Hebron and Ciberehd, Barcelona, Spain
| | - Sharon J Hutchinson
- Glasgow Caledonian University, School of Health and Life Sciences, Glasgow, UK
| | - Yabing Guo
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | | | | | - Longfeng Zhao
- Department of Infectious Diseases, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yongpeng Chen
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Harry L A Janssen
- Liver Clinic, Toronto Western & General Hospital, University Health Network, Toronto, ON, Canada
| | - Chaonan Zhu
- Big Data Research and Biostatistics Center, Hangzhou YITU Healthcare Technology Co. Ltd., Hangzhou, China
| | - Lei Shi
- Big Data Research and Biostatistics Center, Hangzhou YITU Healthcare Technology Co. Ltd., Hangzhou, China
| | - Xiaoping Tang
- Guangzhou Eighth People's Hospital, Guangzhou, China
| | | | - Lai Wei
- Peking University Hepatology Institute, Peking University People's Hospital, Beijing, China
| | - Jidong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - William L Irving
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Philip J Johnson
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.
| | - Pietro Lampertico
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico - Division of Gastroenterology and Hepatology - CRC 'A.M. and A. Migliavacca' Center for Liver Disease, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Jinlin Hou
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| |
Collapse
|
41
|
Pehlivanidis A, Pehlivanidi N, Papanikolaou K, Mantas V, Bertou E, Chalimourdas T, Sypsa V, Papageorgiou C. The Emotion of Disgust among Medical and Psychology Students. Diseases 2020; 8:diseases8040043. [PMID: 33203074 PMCID: PMC7709109 DOI: 10.3390/diseases8040043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 11/16/2022] Open
Abstract
The emotion of disgust evolved as a way to protect oneself from illness and is associated with aspects of disease avoidance. Disgust Scale–Revised (DS-R) (Olatunji et al., 2008) measures the disgust propensity of three kinds of disgust (core, animal reminder, contamination). Contextual factors, such as academic background, might influence DS-R scoring, especially among medical students, where the notion of disease is central. We examined DS-R scoring and the choice of postgraduate studies in medical (n = 94) and psychology (n = 97) students. In an anonymous web-based survey, participants completed the DS-R and a questionnaire including plans for postgraduate studies. Females outnumbered males and scored higher in total DS-R score (p = 0.003). Psychology students scored higher in all three kinds of disgust (p < 0.001 for core disgust and animal reminder, p = 0.069 for contamination disgust), indicating a higher level of disease avoidance. Medical students willing to follow Internal Medicine scored higher in core disgust (p < 0.05), while psychology students willing to study Experimental Psychology scored lower in the animal reminder subscale (p = 0.019 and p < 0.001 for the association between these subscales and the orientation of Medical and Psychology Students, respectively). In conclusion, disgust propensity as rated by DS-R is related to academic background and orientation preferences in postgraduate studies.
Collapse
Affiliation(s)
- Artemios Pehlivanidis
- 1st Department of Psychiatry, Medical School-National and Kapodistrian University of Athens, Eginition Hospital, Vas Sophias 72, 11528 Athens, Greece; (V.M.); (T.C.); (C.P.)
- Correspondence:
| | - Niki Pehlivanidi
- Medical School-National and Kapodistrian University of Athens, Eginition Hospital, Vas Sophias 72, 11528 Athens, Greece;
| | - Katerina Papanikolaou
- Department of Child Psychiatry, Medical School-National and Kapodistrian University of Athens, “Agia Sophia” Children’s Hospital, Thivon and Papadiamantopoulou Street, 11527 Athens, Greece;
| | - Vassileios Mantas
- 1st Department of Psychiatry, Medical School-National and Kapodistrian University of Athens, Eginition Hospital, Vas Sophias 72, 11528 Athens, Greece; (V.M.); (T.C.); (C.P.)
| | - Elpida Bertou
- School of Psychology-National and Kapodistrian University of Athens, Eginition Hospital, Vas Sophias 72, 11528 Athens, Greece;
| | - Theodoros Chalimourdas
- 1st Department of Psychiatry, Medical School-National and Kapodistrian University of Athens, Eginition Hospital, Vas Sophias 72, 11528 Athens, Greece; (V.M.); (T.C.); (C.P.)
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, 11527 Athens, Greece;
| | - Charalambos Papageorgiou
- 1st Department of Psychiatry, Medical School-National and Kapodistrian University of Athens, Eginition Hospital, Vas Sophias 72, 11528 Athens, Greece; (V.M.); (T.C.); (C.P.)
| |
Collapse
|
42
|
Papatheodoridis GV, Dalekos GN, Idilman R, Sypsa V, Van Boemmel F, Buti M, Calleja JL, Goulis J, Manolakopoulos S, Loglio A, Papatheodoridi M, Gatselis N, Veelken R, Lopez-Gomez M, Hansen BE, Savvidou S, Kourikou A, Vlachogiannakos J, Galanis K, Yurdaydin C, Esteban R, Janssen HLA, Berg T, Lampertico P. Similar risk of hepatocellular carcinoma during long-term entecavir or tenofovir therapy in Caucasian patients with chronic hepatitis B. J Hepatol 2020; 73:1037-1045. [PMID: 32553667 DOI: 10.1016/j.jhep.2020.06.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [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: 01/25/2020] [Revised: 05/15/2020] [Accepted: 06/05/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS A recent study in Asian patients with chronic hepatitis B (CHB) reported that the incidence of hepatocellular carcinoma (HCC) was lower in patients treated with tenofovir disoproxil fumarate (TDF) than entecavir (ETV), but this finding remains controversial. We aimed to identify any differences in HCC incidence, or other patient outcomes, between patients receiving TDF or ETV in the well monitored, multicenter European PAGE-B cohort. METHODS We included 1,935 Caucasians with CHB, with or without compensated cirrhosis, treated with ETV (n = 772) or TDF (n = 1,163) monotherapy. Mean follow-up was 7.1 ± 3.0 years from ETV/TDF onset. RESULTS The 5-year cumulative HCC incidence was 5.4% in ETV- and 6.0% in TDF-treated patients (log-rank, p = 0.321), with no significant difference in any patient subgroup (with or without cirrhosis, naïve or experienced to oral antiviral(s) [total, with or without cirrhosis]). In multivariable Cox regression analyses, the hazard of HCC was similar between ETV- and TDF-treated patients after adjustment for several HCC risk factors. ETV- and TDF-treated patients had similar rates of on-therapy biochemical and virological remission, HBsAg loss, liver transplantation and/or death. Elastographic reversion of cirrhosis at year 5 (liver stiffness <12 kPa) was observed in 245/347 (70.6%) patients with pretreatment cirrhosis, being more frequent in TDF- than ETV- treated patients (73.8% vs. 61.5%, p = 0.038). CONCLUSION In Caucasian patients with CHB, with or without cirrhosis, long-term ETV or TDF monotherapy is associated with similar HCC risk, rates of biochemical/virological remission, HBsAg loss and liver transplantation or death, but elastographic reversion of cirrhosis at year 5 was more frequent with TDF. LAY SUMMARY In a large cohort of Caucasians with chronic hepatitis B treated with entecavir (ETV) or tenofovir disoproxil fumarate (TDF) monotherapy, cumulative rates of hepatocellular carcinoma did not differ (up to 12 years). Nor did rates of biochemical/virological remission, HBsAg loss and liver transplantation or death. However, elastographic reversion of cirrhosis at year 5 was more frequent in TDF- than ETV-treated patients with pretreatment cirrhosis.
Collapse
Affiliation(s)
- George V Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.
| | - George N Dalekos
- Department of Internal Medicine, Thessalia University Medical School, Larissa, Greece
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Vana Sypsa
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Florian Van Boemmel
- Division of Hepatology, Clinic for Oncology, Gastroenterology, Hepatology, Infectious Diseases and Pneumology, University Clinic Leipzig, Leipzig, Germany
| | - Maria Buti
- Hospital General Universitario Valle Hebron and CIBERehd, Barcelona, Spain
| | | | - John Goulis
- 4th Department of Internal Medicine, Aristotle University of Thessaloniki Medical School, Thessaloniki, Greece
| | - Spilios Manolakopoulos
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece; 2nd Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokratio General Hospital of Athens, Athens, Greece
| | - Alessandro Loglio
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy
| | - Margarita Papatheodoridi
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Nikolaos Gatselis
- Department of Internal Medicine, Thessalia University Medical School, Larissa, Greece
| | - Rhea Veelken
- Division of Hepatology, Clinic for Oncology, Gastroenterology, Hepatology, Infectious Diseases and Pneumology, University Clinic Leipzig, Leipzig, Germany
| | | | - Bettina E Hansen
- Department of Gastroenterology & Hepatology, Erasmus MC, University Medical Center, Rotterdam, Netherlands; Liver Clinic, Toronto Western & General Hospital, University Health Network, Toronto, ON, Canada
| | - Savvoula Savvidou
- 4th Department of Internal Medicine, Aristotle University of Thessaloniki Medical School, Thessaloniki, Greece
| | - Anastasia Kourikou
- 2nd Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokratio General Hospital of Athens, Athens, Greece
| | - John Vlachogiannakos
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Kostas Galanis
- Department of Internal Medicine, Thessalia University Medical School, Larissa, Greece
| | - Cihan Yurdaydin
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey; Department of Gastroenterology and Hepatology, Koc University Medical School, Istanbul, Turkey
| | - Rafael Esteban
- Hospital General Universitario Valle Hebron and CIBERehd, Barcelona, Spain
| | - Harry L A Janssen
- Liver Clinic, Toronto Western & General Hospital, University Health Network, Toronto, ON, Canada
| | - Thomas Berg
- Division of Hepatology, Clinic for Oncology, Gastroenterology, Hepatology, Infectious Diseases and Pneumology, University Clinic Leipzig, Leipzig, Germany
| | - Pietro Lampertico
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| |
Collapse
|
43
|
Uusküla A, Vickerman P, Raag M, Walker J, Paraskevis D, Eritsyan K, Sypsa V, Lioznov D, Avi R, Des Jarlais D. Presenting a conceptual framework for an HIV prevention and care continuum and assessing the feasibility of empirical measurement in Estonia: A case study. PLoS One 2020; 15:e0240224. [PMID: 33035238 PMCID: PMC7546465 DOI: 10.1371/journal.pone.0240224] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 09/23/2020] [Indexed: 12/03/2022] Open
Abstract
Objective We aim to show the feasibility of using an integrated prevention and care continuum (PCC) model as a complete and improved tool for HIV control measurement and programming. Alignment of prevention and care continua is essential to further improve health outcomes and minimize HIV transmission risk. Design Cross-sectional study. Methods Data from 977 persons who inject drugs (PWID) collected in 2011–2016 in Tallinn, Estonia, were used to construct an HIV PCC for PWID, stratified by risk for acquiring or transmitting HIV infection and by coverage of combined interventions. We also estimated the average protective effect of current levels of intervention provision. Results 74.4%, 20.3% and 35.2% of PWID were currently using needle and syringe programmes (NSP), drug treatment and HIV testing, respectively. 51.1% of current PWID were HIV seropositive and of those 62.5% were currently on ART and 19.0% were virally suppressed. Across the PCC, individuals moved between categories of being aware and ever using drug treatment (resulting in -50% “leakage”); from ever having used to currently using drug treatment (-59%); between “ever testing” and “current (continuous) testing” (-62%); and from self-reported antiretroviral therapy (ART) adherence to viral suppression (-70%). Use of prevention services was higher among those at risk of transmission (HIV positive). The overall reduction in acquisition risk among HIV-negative PWID was 77.7% (95% CrI 67.8–84.5%), estimated by the modelled protective effects of current levels of NSP, drug treatment and ART compared to none of these services. Conclusions Our findings suggest that developing a cohesive model for HIV prevention and treatment is feasible and reflects the bi-directional relationships between prevention and care. The integrated continuum model indicates the major factors which may predict the epidemic course and control response.
Collapse
Affiliation(s)
- Anneli Uusküla
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
- * E-mail:
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Mait Raag
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Josephine Walker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | | | - Ksenia Eritsyan
- National Research University Higher School of Economics, Saint-Petersburg, Russian Federation
| | - Vana Sypsa
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dmitry Lioznov
- Smorodintsev Research Institute of Influenza, St. Petersburg, Russia
- First Pavlov State Medical University, St. Petersburg, Russia
| | - Radko Avi
- Department of Microbiology, University of Tartu, Tartu, Estonia
| | - Don Des Jarlais
- College of Global Public Health, New York University, New York, NY, United States of America
| |
Collapse
|
44
|
Spyridopoulou K, Psichogiou M, Sypsa V, Miriagou V, Karapanou A, Hadjihannas L, Tzouvelekis L, Daikos GL. Containing Carbapenemase-producing Klebsiella pneumoniae in an endemic setting. Antimicrob Resist Infect Control 2020; 9:102. [PMID: 32631456 PMCID: PMC7339575 DOI: 10.1186/s13756-020-00766-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 04/10/2020] [Accepted: 06/23/2020] [Indexed: 12/02/2022] Open
Abstract
Background Carbapenemase-producing K. pneumoniae (CP-Kp) has been established as important nosocomial pathogen in most tertiary care hospitals in Greece. The aim of the present study was to examine the impact of an enhanced infection control program on the containment of CP-Kp in a haematology unit where the incidence of CP-Kp infections was high. Methods The study was conducted from June 2011 to December 2014 in a haematology unit of a tertiary-care 500-bed hospital located in Athens, Greece. A bundled intervention (active surveillance cultures, separation of carriers from non-carriers, assignment of dedicated nursing staff, contact precautions, environmental cleaning, and promotion of hand hygiene) was tested whether would reduce colonization and infection caused by CP-Kp. Results A total of 2507 rectal swabs were obtained; 1199 upon admission from June 2011 to June 2013 and 1307 during hospitalization from June 2011 to December 2012. During intervention the admission prevalence of CP-Kp colonization (p < 0.001 for linear trend), the hospitalization prevalence (p = 0.001 for linear trend) and the incidence rate of CP-Kp colonization (p = 0.072 for linear trend) were declining. Application of segmented linear regression revealed that both the change in the level of CP-Kp BSI incidence rates (p = 0.001) as well as the difference between pre- and post-intervention slopes were statistically significant (p < 0.001). Conclusions A bundled intervention including active surveillance cultures on admission can attain maximum containment of CP-Kp colonization and infection in endemic acute healthcare settings.
Collapse
Affiliation(s)
- Kalliopi Spyridopoulou
- First Department of Medicine, Medical School, "Laiko" General Hospital, National and Kapodistrian University of Athens, 75, 11527, Athens, Greece
| | - Mina Psichogiou
- First Department of Medicine, Medical School, "Laiko" General Hospital, National and Kapodistrian University of Athens, 75, 11527, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vivi Miriagou
- Laboratory of Bacteriology, Hellenic Pasteur Institute, Athens, Greece
| | - Amalia Karapanou
- First Department of Medicine, Medical School, "Laiko" General Hospital, National and Kapodistrian University of Athens, 75, 11527, Athens, Greece
| | - Linos Hadjihannas
- First Department of Medicine, Medical School, "Laiko" General Hospital, National and Kapodistrian University of Athens, 75, 11527, Athens, Greece
| | - Leonidas Tzouvelekis
- Department of Microbiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George L Daikos
- First Department of Medicine, Medical School, "Laiko" General Hospital, National and Kapodistrian University of Athens, 75, 11527, Athens, Greece.
| |
Collapse
|
45
|
Des Jarlais DC, Sypsa V, Feelemyer J, Abagiu AO, Arendt V, Broz D, Chemtob D, Seguin-Devaux C, Duwve JM, Fitzgerald M, Goldberg DJ, Hatzakis A, Jipa RE, Katchman E, Keenan E, Khan I, Konrad S, McAuley A, Skinner S, Wiessing L. HIV outbreaks among people who inject drugs in Europe, North America, and Israel. Lancet HIV 2020; 7:e434-e442. [PMID: 32504576 PMCID: PMC10150936 DOI: 10.1016/s2352-3018(20)30082-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [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: 01/25/2020] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 01/25/2023]
Abstract
During 2011-16, HIV outbreaks occurred among people who inject drugs (PWID) in Canada (southeastern Saskatchewan), Greece (Athens), Ireland (Dublin), Israel (Tel Aviv), Luxembourg, Romania (Bucharest), Scotland (Glasgow), and USA (Scott County, Indiana). Factors common to many of these outbreaks included community economic problems, homelessness, and changes in drug injection patterns. The outbreaks differed in size (from under 100 to over 1000 newly reported HIV cases among PWID) and in the extent to which combined prevention had been implemented before, during, and after the outbreaks. Countries need to ensure high coverage of HIV prevention services and coverage higher than the current UNAIDS recommendation might be needed in areas in which short acting drugs are injected. In addition, monitoring of PWID with special attention for changing drug use patterns, risk behaviours, and susceptible subgroups (eg, PWID experiencing homelessness) needs to be in place to prevent or rapidly detect and contain new HIV outbreaks.
Collapse
Affiliation(s)
- Don C Des Jarlais
- College of Global Public Health, New York University, New York, NY, USA.
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Adrian O Abagiu
- National Institute for Infectious Diseases, Bucharest, Romania
| | - Vic Arendt
- Service National des Maladies Infectieuses, Centre Hospitalier de Luxembourg, Luxembourg, USA
| | - Dita Broz
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Daniel Chemtob
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel; Faculty of Medicine, Hebrew University-Hadassah Medical School, Braun School of Public Health and Community Medicine, Jerusalem, Israel
| | - Carole Seguin-Devaux
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch sur Alzette, Luxembourg
| | - Joan M Duwve
- Richard M Fairbanks School of Public Health, Indianapolis, IN, USA
| | | | | | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece; NHS National Services Scotland, Glasgow, UK
| | - Raluca E Jipa
- National Institute for Infectious Diseases, Bucharest, Romania
| | - Eugene Katchman
- Infectious Diseases Unit, Tel Aviv Sourasky Medical Centre and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Ibrahim Khan
- First Nations and Inuit Health Branch, Indigenous Services Canada, Regina, SK, Canada
| | - Stephanie Konrad
- First Nations and Inuit Health Branch, Indigenous Services Canada, Regina, SK, Canada
| | - Andrew McAuley
- NHS National Services Scotland, Glasgow, UK; School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Stuart Skinner
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Lucas Wiessing
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| |
Collapse
|
46
|
Touloumi G, Karakosta A, Sypsa V, Petraki I, Anagnostou O, Terzidis A, Voudouri NM, Gavana M, Vantarakis A, Rachiotis G, Kantzanou M, Rosenberg T, Papatheodoridis G, Hatzakis A. Design and Development of a Viral Hepatitis and HIV Infection Screening Program (Hprolipsis) for the General, Greek Roma, and Migrant Populations of Greece: Protocol for Three Cross-Sectional Health Examination Surveys. JMIR Res Protoc 2020; 9:e13578. [PMID: 32004142 PMCID: PMC7055811 DOI: 10.2196/13578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 06/25/2019] [Accepted: 07/19/2019] [Indexed: 01/17/2023] Open
Abstract
Background Although infectious diseases are globally on the decline, they remain a major global public health problem. Among them, the hepatitis B virus (HBV) or hepatitis C virus (HCV) and HIV infection are of primary interest. Valid prevalence data on these infections are sparse in Greece, especially for vulnerable populations. Objective This study aimed to present the design and methods of Hprolipsis, an integrated viral hepatitis and HIV screening program administered to adults (≥18 years) from the general, Greek Roma, and migrant populations. Its aims were to estimate the prevalence of HBV, HCV, and HIV; assess infectious disease knowledge level; design, implement, and assess population-specific awareness actions; and offer individual counseling and referral when indicated and HBV vaccination to susceptible Roma and migrants. Methods Multistage, stratified, random sampling based on the 2011 Census was applied to select the general population sample, and nonprobability multistage quota sampling was used for Roma and migrant sample selection. Trained personnel made home (general population) or community (Roma and migrants) visits. Collected blood samples were tested for Hepatitis B surface Antigen, Hepatitis B core Antibody, Hepatitis B surface Antibody, Hepatitis C Antibody, and HIV 1,2 Antibody. The surveys were conducted during May 2013 and June 2016. To estimate an HCV prevalence of 1.5% with 0.3 precision, the required general population sample size was estimated to be 6000. As migrants constitute 10% of the whole Greek population, the migrant sample size was set to 600. A feasible sample size of 500 Greek Roma was set. Results In total, 6006 individuals from the general population (response rate 72%), 534 Greek Roma, and 612 migrants were recruited. Blood test results are available for 4245 individuals from the general population, 523 Roma, and 537 migrants. Conclusions Hprolipsis is the first nationwide survey on HBV, HCV, and HIV. Its results will enhance our understanding of the health needs and disease burden of these diseases in the 3 studied populations. Its implementation provided useful recommendations for future studies, particularly in vulnerable populations. International Registered Report Identifier (IRRID) DERR1-10.2196/13578
Collapse
Affiliation(s)
- Giota Touloumi
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Argiro Karakosta
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Petraki
- International Medicine-Health Crisis Management, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Olga Anagnostou
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Agis Terzidis
- International Medicine-Health Crisis Management, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Niki Maria Voudouri
- Programs of Development, Social Support, and Medical Cooperation (PRAKSIS), Athens, Greece
| | | | - Magda Gavana
- Department of Primary Health Care, General Practice, and Health Services Research, Medical School of Aristotle University, Thessaloniki, Greece
| | - Apostolos Vantarakis
- Environmental Microbiology Unit of Public Health, Medical School, University of Patras, Patra, Greece
| | - George Rachiotis
- Department of Hygiene and Epidemiology, Medical Faculty, University of Thessaly, Larisa, Greece
| | - Maria Kantzanou
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theofilos Rosenberg
- International Medicine-Health Crisis Management, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George Papatheodoridis
- Department of Gastroenterology, Laiko General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | |
Collapse
|
47
|
Pavlopoulou ID, Dikalioti SK, Gountas I, Sypsa V, Malliori M, Pantavou K, Jarlais DD, Nikolopoulos GK, Hatzakis A. High-risk behaviors and their association with awareness of HIV status among participants of a large-scale prevention intervention in Athens, Greece. BMC Public Health 2020; 20:105. [PMID: 31992240 PMCID: PMC6986033 DOI: 10.1186/s12889-020-8178-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 12/22/2018] [Accepted: 01/08/2020] [Indexed: 11/25/2022] Open
Abstract
Background Aristotle was a seek-test-treat intervention during an outbreak of human immunodeficiency virus (HIV) infection among people who inject drugs (PWID) in Athens, Greece that started in 2011. The aims of this analysis were: (1) to study changes of drug injection-related and sexual behaviors over the course of Aristotle; and (2) to compare the likelihood of risky behaviors among PWID who were aware and unaware of their HIV status. Methods Aristotle (2012–2013) involved five successive respondent-driven sampling rounds of approximately 1400 PWID each; eligible PWID could participate in multiple rounds. Participants were interviewed using a questionnaire, were tested for HIV, and were classified as HIV-positive aware of their status (AHS), HIV-positive unaware of their status (UHS), and HIV-negative. Piecewise linear generalized estimating equation models were used to regress repeatedly measured binary outcomes (high-risk behaviors) against covariates. Results Aristotle recruited 3320 PWID (84.5% males, median age 34.2 years). Overall, 7110 interviews and blood samples were collected. The proportion of HIV-positive first-time participants who were aware of their HIV infection increased from 21.8% in round A to 36.4% in the last round. The odds of dividing drugs at least half of the time in the past 12 months with a syringe someone else had already used fell from round A to B by 90% [Odds Ratio (OR) (95% Confidence Interval-CI): 0.10 (0.04, 0.23)] among AHS and by 63% among UHS [OR (95% CI): 0.37 (0.19, 0.72)]. This drop was significantly larger (p = 0.02) among AHS. There were also decreases in frequency of injection and in receptive syringe sharing in the past 12 months but they were not significantly different between AHS (66 and 47%, respectively) and UHS (63 and 33%, respectively). Condom use increased only among male AHS from round B to the last round [OR (95% CI): 1.24 (1.01, 1.52)]. Conclusions The prevalence of risky behaviors related to drug injection decreased in the context of Aristotle. Knowledge of HIV infection was associated with safer drug injection-related behaviors among PWID. This highlights the need for comprehensive interventions that scale-up HIV testing and help PWID become aware of their HIV status.
Collapse
Affiliation(s)
- Ioanna D Pavlopoulou
- Pediatric Research Laboratory, National and Kapodistrian University of Athens, Faculty of Nursing, Athens, Greece
| | - Stavroula K Dikalioti
- Pediatric Research Laboratory, National and Kapodistrian University of Athens, Faculty of Nursing, Athens, Greece
| | - Ilias Gountas
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece.,Hellenic Scientific Society for the Study of AIDS and Sexually Transmitted Diseases, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Meni Malliori
- Psychiatric Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Katerina Pantavou
- Medical School, University of Cyprus, P.O.Box 20537, Nicosia, Cyprus
| | | | | | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece.,Hellenic Scientific Society for the Study of AIDS and Sexually Transmitted Diseases, Athens, Greece
| |
Collapse
|
48
|
Gountas I, Sypsa V, Papatheodoridis G, Paraskevis D, Kalamitsis G, Anagnostou O, Antaraki A, Fotiou A, Hatzakis A. A hepatitis C outbreak preceded the HIV outbreak among persons who inject drugs in Athens, Greece: Insights from a mathematical modelling study. J Viral Hepat 2019; 26:1311-1317. [PMID: 31322302 DOI: 10.1111/jvh.13178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 05/03/2019] [Accepted: 06/20/2019] [Indexed: 01/08/2023]
Abstract
People who inject drugs (PWID) comprise one of the major transmission risk groups for human immunodeficiency virus (HIV) and hepatitis C virus (HCV). In 2011, Athens experienced a large HIV outbreak among PWID. Significant public health interventions were implemented in response to the HIV outbreak. The aims of this study were to estimate the indirect effects of the HIV interventions on HCV infection and to evaluate the concept of the association between HCV and HIV infections in the case of Athens. A dynamic, stochastic, individual-based model was developed to simulate HCV transmission among PWID. We calibrated the model to reproduce the observed HCV prevalence among PWID in Greece. Two years prior to the HIV outbreak, an undetected HCV outbreak has occurred. In 2009, the incidence of HCV infection increased from 640 (495, 842) cases in 2008 to 1260 (1060, 1500). The mean time from initiation of injecting drug use to HCV acquisition decreased from 29 months in 2008 to 13 months in 2009. After HIV interventions, HCV incidence declined by 64.8% in 2012, compared to 2009. The averted HCV incidence cases attributed to the HIV-implemented interventions were 2200 (1950, 2480), during 2012-2015. The cumulative number incident HCV cases in Athens during 2002-2015 was about 9900 (7800, 12 100). Our results highlight that before the 2011 HIV outbreak in Athens, an HCV outbreak occurred in 2009. Prevention measures for HIV that took place in the Athens metropolitan area in 2012 reduced significantly the incidence of HCV.
Collapse
Affiliation(s)
- Ilias Gountas
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Hellenic Scientific Society for the Study of AIDS and Sexually Transmitted Diseases, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Papatheodoridis
- Department of Gastroenterology, Medical School, National and Kapodistrian University of Athens, General Hospital of Athens 'Laiko', Athens, Greece
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Argiro Antaraki
- Greek Reitox focal point at the Athens University Mental Health, Neurosciences, & Precision Medicine Research Institute (MHRI), Athens, Greece
| | - Anastasios Fotiou
- Greek Reitox focal point at the Athens University Mental Health, Neurosciences, & Precision Medicine Research Institute (MHRI), Athens, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Hellenic Scientific Society for the Study of AIDS and Sexually Transmitted Diseases, Athens, Greece
| |
Collapse
|
49
|
Giannou F, Nikolopoulos GK, Pantavou K, Benetou V, Kantzanou M, Sypsa V, Williams LD, Friedman SR, Hatzakis A. Knowledge, Normative Beliefs and Attitudes Related to Recent HIV Infection among People who Inject Drugs in Athens, Greece. Curr HIV Res 2019; 15:386-395. [PMID: 29173178 DOI: 10.2174/1570162x15666171122165636] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 09/26/2017] [Accepted: 10/23/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite great improvements in prevention over the last years, much has to be done to reduce new human immunodeficiency virus (HIV) infections. Substantial evidence shows that the six-month period of recent HIV infection contributes disproportionately to HIV transmission. OBJECTIVE This study aims to investigate knowledge, normative beliefs, and attitudes of people who inject drugs (PWID) regarding recent HIV infection. METHODS People who inject drugs in Athens, Greece were recruited in the fifth round of a respondent- driven sampling program (ARISTOTLE). The participants were tested for HIV and answered a structured questionnaire, which also included items on knowledge, normative beliefs, and attitudes regarding recent infection to address needs of the social network-based Transmission Reduction Intervention Project. The multivariable analyses included logistic regression models, which produced odds ratios (OR) and 95% confidence intervals (CI). RESULTS In total, 1,407 people (mean age: 36.3 ± 7.9 years old; males: 81.9%) took part in the fifth round of ARISTOTLE. Of these, 61.5% knew that HIV-infected people who are not on treatment are more likely to transmit HIV during the first six months of their infection and 58.4% reported that people in their network would react positively towards a recently HIV-infected person. People who inject drugs who were knowledgeable of recent HIV infection were more likely to disagree with statements such as that one should avoid all contact with a person recently infected by HIV (adjusted OR: 1.510, 95% CI: 1.090, 2.091) or more likely to agree with statements such as that an HIV+ person is much less likely to transmit HIV when h/she is on combination antiretroviral treatment (adjusted OR: 2.083, 95% CI: 1.231, 3.523). CONCLUSION A considerable proportion of PWID in Athens, Greece, were aware of the high HIV transmission risk of recent HIV infection, although improvement is needed for some population segments. People who inject drugs who were knowledgeable of the role of recent HIV infection were more likely to have normative beliefs and attitudes that favor behaviors that could help rather than harm or stigmatize people who have recently been infected with HIV. Interventions that are based on the role of recent HIV infection in HIV transmission could be important to HIV prevention.
Collapse
Affiliation(s)
- Foteini Giannou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Vassiliki Benetou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Kantzanou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Leslie D Williams
- Institute for Infectious Diseases Research, National Development and Research Institutes, New York, United States
| | - Samuel R Friedman
- Institute for Infectious Diseases Research, National Development and Research Institutes, New York, United States
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
50
|
Papatheodoridis GV, Goulis J, Sypsa V, Lionis C, Manolakopoulos S, Elefsiniotis I, Anagnostou O, Tsoulas C, Hatzakis A, Dalekos GN. Aiming towards hepatitis C virus elimination in Greece. Ann Gastroenterol 2019; 32:321-329. [PMID: 31263353 PMCID: PMC6595935 DOI: 10.20524/aog.2019.0375] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/12/2019] [Indexed: 02/06/2023] Open
Abstract
There are estimated to be 74,000-134,000 patients living with chronic hepatitis C in Greece, but only 20-30% of them are aware of their disease status. In July 2017, the Hellenic National Plan for Hepatitis C was announced in alignment with the World Health Organization goals for the eradication of hepatitis C virus (HCV) by the year 2030. This article discusses the epidemiology and current treatment of chronic hepatitis C in Greece. Additionally the authors propose actions on how to bring back to care diagnosed patients lost to follow up, optimize access to care for HCV-infected people who inject drugs, and increase HCV screening in the general population. The medical community in Greece can play a pivotal role in the implementation of the HCV National Plan and in the efforts to reach the goal of HCV elimination.
Collapse
Affiliation(s)
- George V Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital (George V. Papatheodoridis)
| | - John Goulis
- 4 Department of Internal Medicine, Αristotle University of Thessaloniki Medical School (John Goulis)
| | - Vana Sypsa
- Department of Hygiene, Medical School of National and Kapodistrian, University of Athens, Epidemiology and Medical Statistics, Athens (Vana Sypsa, Angelos Hatzakis)
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion-Crete (Christos Lionis)
| | - Spilios Manolakopoulos
- 2 Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokratio General Hospital of Athens (Spilios Manolakopoulos)
| | - Ioannis Elefsiniotis
- Academic Department of Internal Medicine-Hepatogastroenterology, "Agioi Anargyroi" General and Oncology Hospital, Athens (Ioannis Elefsiniotis)
| | - Olga Anagnostou
- Greek Organisation Against Drugs (OKANA), Athens (Olga Anagnostou)
| | - Christos Tsoulas
- Medical Department, Gilead Sciences Hellas, Athens (Christos Tsoulas)
| | - Angelos Hatzakis
- Department of Hygiene, Medical School of National and Kapodistrian, University of Athens, Epidemiology and Medical Statistics, Athens (Vana Sypsa, Angelos Hatzakis)
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, University of Thessaly Medical School, Larissa (George N. Dalekos), Greece
| |
Collapse
|