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Clark PJ, Valery PC, Strasser SI, Weltman M, Thompson A, Levy MT, Leggett B, Zekry A, Rong J, Sinclair M, George J, Bollipo S, McGarity B, Sievert W, MacQuillan G, Tse E, Nicoll A, Wade A, Cheng W, Roberts SK. Broadening and strengthening the health providers caring for patients with chronic hepatitis C may improve continuity of care. J Gastroenterol Hepatol 2024; 39:568-575. [PMID: 38114452 DOI: 10.1111/jgh.16440] [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: 07/13/2023] [Revised: 11/14/2023] [Accepted: 11/19/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Direct-acting antiviral (DAA) therapies for hepatitis C virus infection (HCV) lead to excellent rates of sustained virological response (SVR). However, loss to follow-up (LTFU) for SVR testing remains a challenge. We examine factors associated with LTFU in a real-world setting. METHODS Adults who received DAA therapy for HCV in one of 26 centers across Australia during 2016-2021 were followed up for 2 years. Data sources included the patient medical records and the national Pharmaceutical and Medicare Benefits Schemes. Linkage to Medicare provided utilization data of other health-care providers and re-treatment with DAAs. LTFU was defined as no clinic attendance for SVR testing by at least 52 weeks after DAA treatment commencement. Multivariable logistic regression assessed factors associated with LTFU. RESULTS In 3619 patients included in the study (mean age 52.0 years; SD = 10.5), 33.6% had cirrhosis (69.4% Child-Pugh class B/C), and 19.3% had HCV treatment prior to the DAA era. Five hundred and fifteen patients (14.2%) were LTFU. HCV treatment initiation in 2017 or later (adj-OR = 2.82, 95% confidence interval [CI] 2.25-3.54), younger age (adj-OR = 2.63, 95% CI 1.80-3.84), Indigenous identification (adj-OR = 1.99, 95% CI 1.23-3.21), current injection drug use or opioid replacement therapy (adj-OR = 1.66, 95% CI 1.25-2.20), depression treatment (adj-OR = 1.49, 95% CI 1.17-1.90), and male gender (adj-OR = 1.31, 95% CI 1.04-1.66) were associated with LTFU. CONCLUSIONS These findings stress the importance of strengthening the network of providers caring for patients with HCV. In particular, services targeting vulnerable groups of patients such as First Nations Peoples, youth health, and those with addiction and mental health disorders should be equipped to treat HCV.
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Affiliation(s)
- Paul J Clark
- Department of Gastroenterology, Princess Alexandra and Mater Hospitals, and Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Patricia C Valery
- QIMR Berghofer Medical Research Institute, and Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Simone I Strasser
- AW Morrow Gastroenterology and Liver Centre Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Martin Weltman
- Hepatology Services, Nepean Hospital, Penrith, New South Wales, Australia
| | - Alex Thompson
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Miriam T Levy
- USYD, Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Barbara Leggett
- Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital and Faculty of Medicine, Brisbane, Queensland, Australia
| | - Amany Zekry
- Department of Gastroenterology and Hepatology, St George Hospital, Sydney, New South Wales, Australia
| | - Julian Rong
- Gippsland Gastroenterology, Latrobe Regional Hospital, Traralgon, Victoria, 3844, Australia
| | - Marie Sinclair
- Department of Gastroenterology and Hepatology, Austin Hospital, Melbourne, Victoria, Australia
| | - Jacob George
- Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
- Storr Liver Unit, Westmead Hospital, Westmead, New South Wales, Australia
| | - Steven Bollipo
- Gastroenterology Department, John Hunter Hospital, New Lambton, New South Wales, Australia
- Gastroenterology Department, John Hunter Hospital, Newcastle and School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Bruce McGarity
- Bathurst Liver Clinic Bathurst Hospital, Bathurst, New South Wales, Australia
| | - William Sievert
- Gastrointestinal and Liver Unit, Monash Health and Monash University, Melbourne, Victoria, Australia
| | - Gerry MacQuillan
- Department of Hepatology and Liver Transplant Unit, Sir Charles Gairdner Hospital, Nedlands, West Australia, Australia
| | - Edmund Tse
- Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Amanda Wade
- Burnet Institute, Melbourne, Victoria, Australia
- Barwon Health Liver Clinic University Hospital, Geelong, Victoria, Australia
| | - Wendy Cheng
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, West Australia, Australia
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Moniruzzaman M, Rahman MA, Wang R, Wong KY, Chen ACH, Mueller A, Taylor S, Harding A, Illankoon T, Wiid P, Sajiir H, Schreiber V, Burr LD, McGuckin MA, Phipps S, Hasnain SZ. Interleukin-22 suppresses major histocompatibility complex II in mucosal epithelial cells. J Exp Med 2023; 220:e20230106. [PMID: 37695525 PMCID: PMC10494524 DOI: 10.1084/jem.20230106] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/16/2023] [Revised: 05/22/2023] [Accepted: 08/18/2023] [Indexed: 09/12/2023] Open
Abstract
Major histocompatibility complex (MHC) II is dynamically expressed on mucosal epithelial cells and is induced in response to inflammation and parasitic infections, upon exposure to microbiota, and is increased in chronic inflammatory diseases. However, the regulation of epithelial cell-specific MHC II during homeostasis is yet to be explored. We discovered a novel role for IL-22 in suppressing epithelial cell MHC II partially via the regulation of endoplasmic reticulum (ER) stress, using animals lacking the interleukin-22-receptor (IL-22RA1), primary human and murine intestinal and respiratory organoids, and murine models of respiratory virus infection or with intestinal epithelial cell defects. IL-22 directly downregulated interferon-γ-induced MHC II on primary epithelial cells by modulating the expression of MHC II antigen A α (H2-Aα) and Class II transactivator (Ciita), a master regulator of MHC II gene expression. IL-22RA1-knockouts have significantly higher MHC II expression on mucosal epithelial cells. Thus, while IL-22-based therapeutics improve pathology in chronic disease, their use may increase susceptibility to viral infections.
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Affiliation(s)
- Md Moniruzzaman
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Immunopathology Group, Translational Research Institute, Mater Research Institute—The University of Queensland, Brisbane, Australia
| | - M. Arifur Rahman
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Immunopathology Group, Translational Research Institute, Mater Research Institute—The University of Queensland, Brisbane, Australia
| | - Ran Wang
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Immunopathology Group, Translational Research Institute, Mater Research Institute—The University of Queensland, Brisbane, Australia
| | - Kuan Yau Wong
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Immunopathology Group, Translational Research Institute, Mater Research Institute—The University of Queensland, Brisbane, Australia
| | - Alice C.-H. Chen
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Immunopathology Group, Translational Research Institute, Mater Research Institute—The University of Queensland, Brisbane, Australia
| | - Alexandra Mueller
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Immunopathology Group, Translational Research Institute, Mater Research Institute—The University of Queensland, Brisbane, Australia
| | - Steven Taylor
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Alexa Harding
- Immunopathology Group, Translational Research Institute, Mater Research Institute—The University of Queensland, Brisbane, Australia
| | - Thishan Illankoon
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Immunopathology Group, Translational Research Institute, Mater Research Institute—The University of Queensland, Brisbane, Australia
| | - Percival Wiid
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Immunopathology Group, Translational Research Institute, Mater Research Institute—The University of Queensland, Brisbane, Australia
| | - Haressh Sajiir
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Immunopathology Group, Translational Research Institute, Mater Research Institute—The University of Queensland, Brisbane, Australia
| | - Veronika Schreiber
- Immunopathology Group, Translational Research Institute, Mater Research Institute—The University of Queensland, Brisbane, Australia
| | - Lucy D. Burr
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Immunopathology Group, Translational Research Institute, Mater Research Institute—The University of Queensland, Brisbane, Australia
- Department of Respiratory and Sleep Medicine, Mater Health, South Brisbane, Australia
| | - Michael A. McGuckin
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia
| | - Simon Phipps
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, Australia
- Respiratory Immunology Laboratory, QIMR Berghofer Medical Research Institute, Herston, Australia
| | - Sumaira Z. Hasnain
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Immunopathology Group, Translational Research Institute, Mater Research Institute—The University of Queensland, Brisbane, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, Australia
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Narayana S, Nugent M, Woodman R, Larkin M, Ramachandran J, Muller K, Wigg A. Measuring quality of hepatitis B care in a remote Australian Aboriginal community: opportunities for improvement. Intern Med J 2022; 52:1347-1353. [PMID: 33979037 DOI: 10.1111/imj.15349] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/02/2021] [Accepted: 05/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic hepatitis B (CHB) infection remains a significant public health issue for Indigenous Australians, in particular for remote communities. AIM To evaluate the spectrum of hepatitis B virus (HBV) care provided to a remote Aboriginal community. Measures studied included screening, seroprevalence, vaccination rates and efficacy, and HCC risk and surveillance adherence. METHODS A retrospective audit of HBV care received by all permanent residents currently attending a remote Aboriginal Health service. This study was endorsed by both the local Aboriginal Health service and the Aboriginal Health Council of South Australia. RESULTS A total of 208 patients attended the clinic, of whom 52% (109) were screened for HBV. Of these, 12% (13) had CHB and 20% (22) had evidence of past infection. Similarly, of the 208 attending patients, complete vaccination was documented in 48% (99). Of the 33 patients with post-vaccination serology, 24% (8) had subtherapeutic (<10 IU/mL) levels of HBsAb. Subtherapeutic HBsAb was independently associated with higher Charlson Comorbidity scores (odds ratio = 17.1; 95% confidence interval 1.2-243.3; P = 0.036). Definitive breakthrough infection was identified in 6% (2) patients. One HBsAg positive patient was identified as needing HCC surveillance, but had not undertaken HCC surveillance. CONCLUSION Opportunities to improve the quality of CHB care through increased HBV vaccination, screening and adherence to HCC surveillance were identified. High rates of subtherapeutic vaccine responses and documented breakthrough infection raises concerns about the effectiveness of current CHB vaccines in this population.
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Affiliation(s)
- Sumudu Narayana
- Hepatology and Liver Transplantation Medicine Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Michael Nugent
- Tullawon Health Service, Yalata, South Australia, Australia
| | - Richard Woodman
- Flinders Centre for Epidemiology and Biostatistics, School of Medicine and Public Health, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Michael Larkin
- Aboriginal Health Council of South Australia, Adelaide, South Australia, Australia
| | - Jeyamani Ramachandran
- Hepatology and Liver Transplantation Medicine Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Kate Muller
- Hepatology and Liver Transplantation Medicine Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Alan Wigg
- Hepatology and Liver Transplantation Medicine Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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Chen Yi Mei SLG, Thompson AJ, Christensen B, Cunningham G, McDonald L, Bell S, Iser D, Nguyen T, Desmond PV. Sustained virological response halts fibrosis progression: A long-term follow-up study of people with chronic hepatitis C infection. PLoS One 2017; 12:e0185609. [PMID: 29065124 PMCID: PMC5655473 DOI: 10.1371/journal.pone.0185609] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 07/11/2017] [Accepted: 09/15/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIMS Long-term follow-up studies validating the clinical benefit of sustained virological response (SVR) in people with chronic hepatitis C (CHC) infection are lacking. Our aim was to identify rates and predictors of liver fibrosis progression in a large, well characterized cohort of CHC patients in whom paired liver fibrosis assessments were performed more than 10 years apart. METHODS CHC patients who had undergone a baseline liver biopsy pre-2004 and a follow up liver fibrosis assessment more than 10 years later (biopsy or liver stiffness measurement (LSM) using transient elastography [FibroScan]) were identified. Subjects who had undergone a baseline liver biopsy but had no follow up fibrosis assessment were recalled for LSM. Fibrosis was categorised as mild-moderate (METAVIR F0-2 / LSM result of ≤ 9.5 kPa) or advanced (METAVIR F3-4/ LSM >9.5 kPa). The primary objective was to assess the association between SVR and the rate of liver fibrosis progression over at least 10 years, defined as an increase from mild-moderate fibrosis at baseline liver biopsy (METAVIR F0-2) to advanced fibrosis at follow-up liver fibrosis assessment. RESULTS 131 subjects were included in this analysis: 69% male, 82% Caucasian, 60% G1 HCV, 25% G3 HCV. The median age at F/U fibrosis staging was 57 (IQR 54-62) years with median estimated duration of infection 33-years (IQR 29-38). At F/U, liver fibrosis assessment was performed by LSM in 86% and liver biopsy in 14%. The median period between fibrosis assessments was 14-years (IQR 12-17). 109 (83%) participants had received interferon-based antiviral therapy. 40% attained SVR. At F/U, there was a significant increase in the proportion of subjects with advanced liver fibrosis: 27% at baseline vs. 46% at F/U (p = 0.002). The prevalence of advanced fibrosis did not change among subjects who attained SVR, 30% at B/L vs 25% at F/U (p = 0.343). However, advanced fibrosis became more common at F/U among subjects with persistent viremia: 10% at B/L vs 31% at F/U (p = 0.0001). SVR was independently associated with protection from liver fibrosis progression after adjustment for other variables including baseline ALT (p = 0.011), duration of HCV infection and mode of acquisition. CONCLUSION HCV eradication is associated with lower rates of liver fibrosis progression. The data support early treatment to prevent long-term liver complications of HCV infection.
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Affiliation(s)
- Swee Lin G. Chen Yi Mei
- Department of Gastroenterology, St Vincent’s Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
- * E-mail:
| | - Alexander J. Thompson
- Department of Gastroenterology, St Vincent’s Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Britt Christensen
- Department of Gastroenterology, St Vincent’s Hospital, Melbourne, Australia
| | | | - Lucy McDonald
- Department of Gastroenterology, St Vincent’s Hospital, Melbourne, Australia
| | - Sally Bell
- Department of Gastroenterology, St Vincent’s Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - David Iser
- Department of Gastroenterology, St Vincent’s Hospital, Melbourne, Australia
| | - Tin Nguyen
- Department of Gastroenterology, St Vincent’s Hospital, Melbourne, Australia
| | - Paul V. Desmond
- Department of Gastroenterology, St Vincent’s Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
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