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Martin-Cardona A, Horta D, Florez-Diez P, Vela M, Mesonero F, Ramos Belinchón C, García MJ, Masnou H, de la Peña-Negro L, Suarez Ferrer C, Casanova MJ, Durán MO, Peña E, Calvet X, Fernández-Prada SJ, González-Muñoza C, Piqueras M, Rodríguez-Lago I, Sainz E, Bas-Cutrina F, Mancediño Marcos N, Ojeda A, Orts B, Sicilia B, García AC, Domènech E, Esteve M. Safety and effectiveness of direct-acting antiviral drugs in the treatment of hepatitis C in patients with inflammatory bowel disease. Dig Liver Dis 2024; 56:468-476. [PMID: 37770282 DOI: 10.1016/j.dld.2023.09.004] [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: 04/25/2023] [Revised: 08/22/2023] [Accepted: 09/04/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND AND AIMS Hepatitis C virus (HCV) management in Inflammatory Bowel Disease (IBD) is uncertain. The ECCO guidelines 2021 recommended HCV treatment but warn about the risk of IBD reactivation. We aimed to evaluate 1) the effectiveness and safety of direct-acting antivirals (DAAs) in IBD; 2) the interaction of DAAs with IBD drugs. METHODS Multicentre study of IBD patients and HCV treated with DAAs. Variables related to liver diseases and IBD, as well as adverse events (AEs) and drug interactions, were recorded. McNemar's test was used to assess differences in the proportion of active IBD during the study period. RESULTS We included 79 patients with IBD and HCV treated with DAAs from 25,998 IBD patients of the ENEIDA registry. Thirty-one (39.2 %) received immunomodulators/biologics. There were no significant differences in the percentage of active IBD at the beginning (n = 11, 13.9 %) or at the 12-week follow-up after DAAs (n = 15, 19 %) (p = 0.424). Sustained viral response occurred in 96.2 % (n = 76). A total of 8 (10.1 %) AEs occurred and these were unrelated to activity, type of IBD, liver fibrosis, immunosuppressants/biologics, and DAAs. CONCLUSIONS We demonstrate a high efficacy and safety of DAAs in patients with IBD and HCV irrespective of activity and treatment of IBD.
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Affiliation(s)
- A Martin-Cardona
- Digestive Diseases Department, Hospital Universitari Mútua Terrassa, Terrassa, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - D Horta
- Digestive Diseases Department, Hospital Universitari Mútua Terrassa, Terrassa, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - P Florez-Diez
- Digestive Diseases Department, H.U. Central de Asturias, Oviedo, Spain
| | - M Vela
- Digestive Diseases Department, H. Nuestra Sra. de la Candelaria, Santa Cruz de Tenerife, Spain
| | - F Mesonero
- Digestive Diseases Department, H. Ramón y Cajal, Madrid, Spain
| | | | - M J García
- Gastroenterology and Hepatology Department, H. U. Marques de Valdecilla, IDIVAL, Santander, Spain
| | - H Masnou
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain; Digestive Diseases Department, H.U. Germans Trias i Pujol, Badalona, Spain
| | - L de la Peña-Negro
- Digestive Diseases Department, H.U. Bellvitge, Hospitalet de Llobregat, Spain
| | | | - M J Casanova
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain; Digestive Diseases Department, Hospital Universitario de La Princesa-Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | - M Ortiz Durán
- Digestive Diseases Department, H.U. Infanta Cristina, Madrid, Spain
| | - E Peña
- Digestive Diseases Department, Hospital Royo Villanova, Zaragoza, Spain
| | - X Calvet
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain; Digestive Diseases Department, Corporació Sanitària Universitària Parc Taulí, Sabadell, Spain
| | | | - C González-Muñoza
- Digestive Diseases Department, H. de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M Piqueras
- Digestive Diseases Department, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - I Rodríguez-Lago
- Digestive Diseases Department, Hospital Universitario de Galdakao and Biocruces Bizkaia Health Research Institute- Galdakao, Galdakao, Spain
| | - E Sainz
- Digestive Diseases Department, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - F Bas-Cutrina
- Digestive Diseases Department, H. General de Granollers, Granollers, Spain
| | - N Mancediño Marcos
- Digestive Diseases Department, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - A Ojeda
- Digestive Diseases Department, H.G.U. Elche, Elche, Spain
| | - B Orts
- Clinical Pharmacology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - B Sicilia
- Digestive Diseases Department, Hospital Universitario de Burgos, Burgos, Spain
| | - A Castaño García
- Digestive Diseases Department, H.U. Central de Asturias, Oviedo, Spain
| | - E Domènech
- Digestive Diseases Department, H.U. Germans Trias i Pujol, Badalona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - M Esteve
- Digestive Diseases Department, Hospital Universitari Mútua Terrassa, Terrassa, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.
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Marcellusi A, Mennini FS, Andreoni M, Kondili LA. Screening strategy to advance HCV elimination in Italy: a cost-consequence analysis. Eur J Health Econ 2024:10.1007/s10198-023-01652-0. [PMID: 38280068 DOI: 10.1007/s10198-023-01652-0] [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: 03/06/2023] [Accepted: 11/21/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND AND AIMS Italy has the greatest burden of hepatitis C virus (HCV) infection in Western Europe. The screening strategy represents a crucial prevention tool to achieve HCV elimination in Italy. We evaluated the cost-consequences of different screening strategies for the diagnosis of HCV active infection in the birth cohort 1948-1968 to achieve the HCV elimination goal. METHODS We designed a probabilistic model to estimate the clinical, and economic outcomes of different screening coverage uptakes, considering the direct costs of HCV management according to each liver fibrosis stage, in the Italian context. A decision probabilistic tree simulates 4 years of HCV testing of the 1948-1968 general population birth cohort, (15,485,565 individuals to be tested) considering different coverage rates. A No-screening scenario was compared with two alternative screening scenarios that represented different coverage rates each year: (1) Incremental approach (coverage rates equal to 5%, 10%, 30%, and 50% at years 1, 2, 3, and 4, respectively) and (2) Fast approach (50% coverage rate at years 1, 2, 3 and 4). Overall 106,200 cases were previously estimated to have an HCV active infection. A liver disease progression Markov model was considered for an additional 6 years (horizon-time 10 years). RESULTS The highest increased number of deaths and clinical events are reported for the No-screening scenario (21,719 cumulative deaths at the end of ten years; 10,148 cases with HCC and/or 7618 cases with Decompensated Cirrhosis). Following the Fast-screening scenario, the reductions in clinical outcomes and deaths were higher compared with No-screening and Incremental-screening. At ten years time horizon, less than 5696 liver deaths (PSA CI95%: - 3873 to 7519), 3,549 HCC (PSA CI95%: - 2413 to 4684) and less than 3005 liver decompensations (PSA CI 95%: - 2104 to 3907) were estimated compared with the Incremental-scenario. The overall costs of the Fast-screening, including the costs of the DAA and liver disease management of the infected patients for 10 years, are estimated to be € 43,107,543 more than no-investment in screening and € 62,289,549 less compared with the overall costs estimated by the Incremental-scenario. CONCLUSION It is necessary to guarantee dedicated funds and efficiency of the system for the cost-efficacious screening of the 1948-1968 birth cohort in Italy. A delay in HCV diagnosis and treatment in the general population, yet not addressed for the HCV free-of-charge screening, will have important clinical and economic consequences in Italy.
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Affiliation(s)
- Andrea Marcellusi
- Faculty of Economics, CEIS, Economic Evaluation and HTA (EEHTA), University of Rome "Tor Vergata", Rome, Italy
| | - Francesco Saverio Mennini
- Faculty of Economics, CEIS, Economic Evaluation and HTA (EEHTA), University of Rome "Tor Vergata", Rome, Italy
- Institute for Leadership and Management in Health, Kingston University London, London, UK
| | - Massimo Andreoni
- Policlinico Tor Vergata, University of Rome "Tor Vergata", Rome, Italy
| | - Loreta A Kondili
- Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.
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Abbasi F, Almukhtar M, Fazlollahpour-Naghibi A, Alizadeh F, Behzad Moghadam K, Jafari Tadi M, Ghadimi S, Bagheri K, Babaei H, Bijani MH, Rouholamin S, Razavi M, Rezaeinejad M, Chemaitelly H, Sepidarkish M, Farid-Mojtahedi M, Rostami A. Hepatitis C infection seroprevalence in pregnant women worldwide: a systematic review and meta-analysis. EClinicalMedicine 2023; 66:102327. [PMID: 38045801 PMCID: PMC10692665 DOI: 10.1016/j.eclinm.2023.102327] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/26/2023] [Accepted: 11/06/2023] [Indexed: 12/05/2023] Open
Abstract
Background Monitoring progress towards the WHO global target to eliminate hepatitis C virus (HCV) infection by 2030, entails reliable prevalence estimates for HCV infection in different populations. Little is known about the global burden of HCV infection in pregnant women. Here, for the first time to our knowledge, we estimated the global and regional seroprevalence of HCV antibody (Ab) and determinants in pregnant women. Methods In this systematic review and meta-analysis study, we searched PubMed/MEDLINE, Web of Science, Embase, Scopus, and SciELO databases for peer-reviewed observational studies between January 1, 2000 and April 1, 2023, without language or geographical restrictions. Pooled global seroprevalence (and 95% confidence interval, CI) were estimated using random-effects meta-analysis and seroprevalences were categorised according to World Health Organization regions and subregions, publishing year, countries' income and human development index (HDI) levels. We used sensitivity analysis to assess the effect of four large sample size studies on pooled global prevalence through the "leave-one-out" method. We also investigated the association of potential risk factors with HCV seropositivity in pregnant women by subgroup and meta-regression analyses. The Protocol was registered in PROSPERO CRD42023423259. Findings We included 192 eligible studies (208 datasets), with data for 148,509,760 pregnant women from 53 countries. The global seroprevalence of HCV Ab in pregnant women was 1.80% (95% CI, 1.72-1.89%) and 3.29% (3.01-3.57%) in overall and sensitivity analyses, respectively. The seroprevalence was highest in the Eastern Mediterranean region (6.21%, 4.39-8.29%) and lowest in the Western Pacific region (0.75%, 0.38-1.22%). Subgroup analysis indicated that the seroprevalence of HCV Ab among pregnant women was significantly higher for those with opioid use disorder (51.94%, 95% CI: 37.32-66.39) and HIV infection (4.34%, 95% CI: 2.21-7.06%) than for the general population of pregnant women (1.08%, 95% CI: 1.02-1.15%), as confirmed by multivariable meta-regression (p < 0.001). A significant decreasing trend was observed with increasing human development index levels. Other important risk factors for HCV seropositivity included older age, lower educational levels, poly sexual activity, history of blood transfusion, hospitalization, surgery, abortion and sexual transmitted diseases, having scarification/tattoo or piercing, and testing hepatitis B positive. Interpretation This meta-analysis showed relatively high burden of exposure to HCV infection (2.2-5.3 million) in pregnant women globally. However, due to substantial heterogeneity between studies, our estimates might be different than the true seroprevalence. Our findings highlighted the need to expand HCV screening for women of reproductive age or during pregnancy, particularly in countries with high prevalence; as well as for more studies that assess safety of existing therapeutic drugs during pregnancy or potentially support development of drugs for pregnant women. Funding There was no funding source for this study.
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Affiliation(s)
- Farzaneh Abbasi
- Infectious Diseases and Tropical Medicine Research Centre, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | | | - Andarz Fazlollahpour-Naghibi
- Infectious Diseases and Tropical Medicine Research Centre, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Faezeh Alizadeh
- Department of Pharmaceutical Sciences, University of Illinois, Chicago, USA
| | | | - Mehrdad Jafari Tadi
- Department of Cell and Molecular Medicine, Rush University Medical Centre, Chicago, IL, 60607, USA
| | - Saleh Ghadimi
- Infectious Diseases and Tropical Medicine Research Centre, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Kimia Bagheri
- Infectious Diseases and Tropical Medicine Research Centre, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Hedye Babaei
- Infectious Diseases and Tropical Medicine Research Centre, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Hossein Bijani
- Infectious Diseases and Tropical Medicine Research Centre, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Safoura Rouholamin
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Razavi
- Department of Obstetrics and Gynecology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mahroo Rezaeinejad
- Department of Obstetrics and Gynecology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Mahdi Sepidarkish
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran
| | - Maryam Farid-Mojtahedi
- Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Centre, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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Heidarpour H, Hooshmand F, Isapanah Amlashi F, Khodabakhshi B, Mahmoudi M, Amiriani T, Besharat S. Unexpected high frequency of anti-thyroid peroxidase (anti-TPO) antibodies in Golestan province, Iran. Caspian J Intern Med 2023; 14:371-375. [PMID: 37223294 PMCID: PMC10201118 DOI: 10.22088/cjim.14.2.371] [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] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 01/23/2022] [Accepted: 05/07/2022] [Indexed: 05/25/2023]
Abstract
Background Anti-TPO antibodies are one of the characteristic factors in autoimmune thyroiditis (AIT). Previous studies reported a high prevalence of anti-TPO antibodies (Abs) in Iran. We have therefore assessed the prevalence of anti-TPO Abs in Gorgan, Iran. Methods This cross-sectional study, conducted from 2015 to 2018 in Gorgan city, Northeast of Iran. The Participants included women with Poly cystic ovary syndrome (PCOs), celiac patients, men with hepatitis C infection, and age and sex-matched controls. ELISA method was used for the analysis of laboratory tests. Results The number of enrolled subjects in PCOs, celiac disease, and Hepatitis C infection groups were 76, 67, and 60, respectively. Anti-TPO Abs positivity was significantly higher in patients with PCOS than in the control group (18.4% vs. 0.00%; p = 0.000). There were no significant differences in the frequency of anti-TPO Abs positive cases between CD patients and the controls (26.9% vs. 21.1% p =0.413). The incidence of anti-TPO Abs positivity was significantly higher in the control group (10% vs. 25%; P = 0.031). Conclusion Very high level of anti-TPO Abs was observed in both patients and healthy population in Golestan province. Considering this rate and its association with autoimmune disorders, it is suggested to prioritize screening programs for related disease in this area.
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Affiliation(s)
- Hadise Heidarpour
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
- Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran
| | - Farnaz Hooshmand
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
- Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran
| | - Fazel Isapanah Amlashi
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
- Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran
| | - Behnaz Khodabakhshi
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mahsa Mahmoudi
- Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Taghi Amiriani
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Sima Besharat
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
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Zito A, De Pascalis A, Montinaro V, Ria P, Carbonara MC, Ferramosca E, Napoli M. Successful treatment of infectious endocarditis-associated glomerulonephritis during active hepatitis C infection: a case report. BMC Nephrol 2022; 23:390. [PMID: 36476330 PMCID: PMC9730680 DOI: 10.1186/s12882-022-02985-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 10/24/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) may play a pathogenic role in several forms of immune complex glomerulonephritis (GN). We present a patient whose initial clinical presentation instilled suspicion of HCV-related renal involvement. Yet, histopathologic data oriented towards a different diagnosis. CASE PRESENTATION A 68-year old man presented with kidney dysfunction, cryoglobulins, low C4 level, high HCV-RNA and cutaneous vasculitis. The first hypothesis was a hepatitis C-related cryoglobulinemic glomerulonephritis. Renal biopsy revealed endocapillary and mesangial cells hypercellularity with complement C3 and IgM deposits. The echocardiography showed an infectious endocarditis (IE) on aortic valve. Appropriate antibiotic therapy and a prosthetic valve replacement were performed, obtaining recovery of renal function. CONCLUSION HCV infection may be linked to multiple renal manifestations, often immune-complex GN such as cryoglobulinemic membrano-proliferative GN. Renal disease due to IE is usually associated to focal, segmental or diffuse proliferative GN, with prominent endocapillary proliferation. The most common infectious agents are Staphylococcus aureus and Streptococcus species. This case report may be relevant because the renal dysfunction was highly suggestive of a cryoglobulinemic GN on a clinical ground, but the histologic pattern after performing the renal biopsy oriented towards a different cause of the underlying disease, that required a specific antibiotic treatment. The renal biopsy is always required to confirm a clinical suspicious in patients affected by multiple comorbidities.
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Affiliation(s)
- Anna Zito
- grid.417011.20000 0004 1769 6825Department of Nephrology, Vito Fazzi Hospital, Lecce, Italy
| | - Antonio De Pascalis
- grid.417011.20000 0004 1769 6825Department of Nephrology, Vito Fazzi Hospital, Lecce, Italy
| | - Vincenzo Montinaro
- grid.415987.60000 0004 1758 8613Department of Nephrology, Miulli General Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Paolo Ria
- grid.417011.20000 0004 1769 6825Department of Nephrology, Vito Fazzi Hospital, Lecce, Italy
| | | | - Emiliana Ferramosca
- grid.417011.20000 0004 1769 6825Department of Nephrology, Vito Fazzi Hospital, Lecce, Italy
| | - Marcello Napoli
- grid.417011.20000 0004 1769 6825Department of Nephrology, Vito Fazzi Hospital, Lecce, Italy
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Kondili LA, Andreoni M, Aghemo A, Mastroianni CM, Merolla R, Gallinaro V, Craxì A. Prevalence of hepatitis C virus estimates of undiagnosed individuals in different Italian regions: a mathematical modelling approach by route of transmission and fibrosis progression with results up to January 2021. New Microbiol 2022; 45:249-259. [PMID: 36066213] [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] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 06/15/2023]
Abstract
This study provides an update on hepatitis C virus (HCV) estimates across Italy up to January 2021. A mathematical probabilistic modelling approach, including a Markov chain for liver disease progression, was used to estimate current HCV viraemic burden. Prevalence was defined by geographic area using an estimated annual historical HCV incidence by age, treatment, and migration rate from the Italian National database (ISTAT). Viraemic infection was estimated for the main HCV transmission routes by stages F0-F3 (patients without liver cirrhosis, i.e., potentially asymptomatic liver disease) and F4 (patients with liver cirrhosis, i.e., potentially symptomatic liver disease). By January 2021, we estimated that there were 398,610 individuals in Italy with active HCV infection (prevalence of 0.66%; 95% CI: 0.66-0.67), of which 287,730 (0.48%; 95% CI: 0.46-0.59%) were stage F0-F3. Prevalence values for all individuals with active HCV infection were: North 0.54% (95% CI: 0.53-0.54%), Central 0.88% (95% CI: 0.87-0.89%), South 0.72% (95% CI: 0.71-0.73%), and the Isles 0.67% (95% CI: 0.66-0.68%). The population at risk for previous/current drug injection accounted for 48.6% of all individuals with active HCV infection. A modelling approach such as this to estimate and update the prevalence of active HCV infection could be a useful methodology for the evaluation of healthcare policies related to HCV elimination plans.
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Affiliation(s)
- Loreta A Kondili
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | | | - Alessio Aghemo
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | | | | | | | - Antonio Craxì
- Gastroenterology and Liver Unit, DiBiMIS, University of Palermo, Palermo, Italy
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Chozie NA, Satiti MA, Sjarif DR, Oswari H, Ritchie NK. The impact of nucleic acid testing as a blood donor screening method in transfusion-associated hepatitis C among children with bleeding disorders in Indonesia: a single-center experience. Blood Res 2022; 57:129-134. [PMID: 35620907 PMCID: PMC9242827 DOI: 10.5045/br.2022.2021219] [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] [Received: 12/22/2021] [Revised: 02/08/2022] [Accepted: 04/07/2022] [Indexed: 11/29/2022] Open
Abstract
Background Children with bleeding disorders, such as hemophilia and von Willebrand disease (VWD), have an increased risk of acquiring transfusion-transmitted infections (TTI). Screening methods to exclude blood donations that are at risk of transmitting infection from donors to recipients are critical to preventing disease transmission. Nucleic acid testing (NAT) is the latest blood donor-screening method. This study aimed to determine the incidence of hepatitis C virus (HCV) infection in children with hemophilia and VWD at Dr. Cipto Mangunkusumo Hospital with a history of blood transfusion before and after implementation of a NAT screening method. Methods A cohort retrospective study was conducted on children aged 0‒18 years with bleeding disorders and a history of blood transfusion. In our center, all blood transfusions before 2015 were screened using non-NAT methods, while all blood transfusions were screened using NAT starting in 2015. Eligible patient characteristics were collected from medical records. From July to December 2019, blood samples were obtained from eligible patients for anti-HCV examination. HCV RNA examinations were performed on subjects with reactive anti-HCV results, and the relative risk was calculated. Results In total, 108 eligible participants were included in this study. We observed that 91 (94.3%) patients had history of receiving non-NAT blood transfusions, while 17 (15.7%) patients received NAT-screened blood transfusions. The proportion of anti-HCV reactivity in the non-NAT group and that in the NAT group were 3.3% (3/91) and 0% (0/17), respectively. Conclusion None of the patients exhibited reactivity to anti-HCV after implementing the NAT screening method.
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Affiliation(s)
- Novie Amelia Chozie
- Department of Child Health, Faculty of Medicine University of Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta Pusat, Indonesia
| | - Melati Arum Satiti
- Department of Child Health, Faculty of Medicine University of Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta Pusat, Indonesia
| | - Damayanti Rusli Sjarif
- Department of Child Health, Faculty of Medicine University of Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta Pusat, Indonesia
| | - Hanifah Oswari
- Department of Child Health, Faculty of Medicine University of Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta Pusat, Indonesia
| | - Ni Ken Ritchie
- Jakarta Blood Center, Indonesian Red Cross Society, Jakarta Pusat, Indonesia
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Di Stasio D, Lucchese A, Romano A, Elio Adinolfi L, Serpico R, Marrone A. The clinical impact of direct-acting antiviral treatment on patients affected by hepatitis C virus-related oral lichen planus: a cohort study. Clin Oral Investig 2022; 26:5409-5417. [PMID: 35477818 PMCID: PMC9381460 DOI: 10.1007/s00784-022-04507-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/13/2022] [Indexed: 12/11/2022]
Abstract
Objectives Oral lichen planus (OLP) is a chronic inflammatory mucocutaneous disease. Literature supports an association between OLP and Hepatitis C virus (HCV) infection. The current treatment for HCV infection with direct-acting antivirals (DAAs) is highly effective and safe. The aim of this study is to evaluate the clinical impact of viral eradication with DAAs in patients with HCV and OLP. Materials and methods For this cohort observational study, 18 patients with HCV and OLP were recruited; all patients received DAAs. Nineteen patients with OLP without HCV were recruited as controls. Both groups received an oral clinical examination, taking photographs of the oral mucosa, at three time points. Size and type of lesions, clinical and efficacy scores, were evaluated at each time point with ImageJ software. Changes were assessed by a general linear model repeated measures analysis. Kruskal–Wallis H and Mann–Whitney U tests were used to evaluate the differences between subgroups. Results All patients of the study group reached a sustained virological response. The study group showed a correlation between viral load and clinical status (p < 0.05), higher clinical scores at baseline (p = 0.001) and higher efficacy index than controls (p < 0.001), improving over time (p < 0.001); controls did not show significant changes (p = 0.196). One patient of the experimental group developed oral squamous cell carcinoma (OSCC) of the tongue during the DAAs treatment. Conclusions In this study, patients with HCV and OLP showed a worst clinical oral status than controls at baseline. However, treatment for virus eradication can improve the oral lichen planus clinical course. Clinical relevance HCV eradication can improve the clinical course of patients with HCV-related OLP.
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Affiliation(s)
- Dario Di Stasio
- Multidisciplinary Department of Medical and Dental Specialties, University of Campania- "Luigi Vanvitelli", Via L. De Crecchio, 6, 80138, Naples, Italy
| | - Alberta Lucchese
- Multidisciplinary Department of Medical and Dental Specialties, University of Campania- "Luigi Vanvitelli", Via L. De Crecchio, 6, 80138, Naples, Italy.
| | - Antonio Romano
- Multidisciplinary Department of Medical and Dental Specialties, University of Campania- "Luigi Vanvitelli", Via L. De Crecchio, 6, 80138, Naples, Italy
| | - Luigi Elio Adinolfi
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Miraglia, Naples, Italy
| | - Rosario Serpico
- Multidisciplinary Department of Medical and Dental Specialties, University of Campania- "Luigi Vanvitelli", Via L. De Crecchio, 6, 80138, Naples, Italy
| | - Aldo Marrone
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Miraglia, Naples, Italy
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9
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Che Noh I, Avoi R, Abdullah Nurul A, Ahmad I, Abu Bakar R. Analysis of serum and gene expression profile of cytokines (IL-6, TNF-α and TGF-β1) in chronic hepatitis C virus infection. PeerJ 2022; 10:e13330. [PMID: 35469194 PMCID: PMC9034700 DOI: 10.7717/peerj.13330] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/04/2022] [Indexed: 01/13/2023] Open
Abstract
Background Chronic hepatitis C virus (HCV) infection is one of the major causes of liver cirrhosis and liver carcinoma. Studies have indicated that an imbalance of cytokine activities could contribute to the pathogenesis of chronic HCV infection. This study aimed to investigate serum levels and gene expression of cytokines (IL-6, TNF-α and TGF-β1) in chronic HCV infection among Malay male subjects. Methods Thirty-nine subjects were enrolled from various health clinics in Kelantan, Malaysia, and divided into two groups: patients with chronic HCV infection (HP) and healthy control (HS). The serum cytokines IL-6, TNF-a-were measured using Luminex assay, and serum TGF-β1 was measured by ELISA. The mRNA gene expression for IL-6, TNF-α and TGF-β1 was measured by real-time reverse transcriptase polymerase chain reaction (RT-PCR). Results There were statistically significant differences in the mean serum levels of IL-6, and TGF-β1 in HP compared to HS group (p = 0.0180 and p = 0.0005, respectively). There was no significant difference in the mean serum level of TNF-α in HP compared to HS group. The gene expression for the studied cytokines showed no significant differences in HP compared to HS group. Conclusion Serum IL-6 was significantly associated with chronic HCV infection.
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Affiliation(s)
- Ismail Che Noh
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Sabah, Malaysia,Department of Pharmacology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Richard Avoi
- Department of Community and Family Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Sabah, Malaysia
| | - Asma Abdullah Nurul
- Biomedicine Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Imran Ahmad
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Ruzilawati Abu Bakar
- Department of Pharmacology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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10
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Huang CC, Wu KL, Liu JS, Chang YY. Autonomic impairment in treatment-naive patients with chronic hepatitis B and C infections. Auton Neurosci 2022; 238:102928. [PMID: 35021146 DOI: 10.1016/j.autneu.2021.102928] [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: 06/11/2021] [Revised: 11/16/2021] [Accepted: 12/10/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Peripheral neuropathy is not an uncommon manifestation in patients with chronic hepatitis. The role of cryoglobulin (CG) in neuropathy in patients with chronic hepatitis remains controversial. There is limited information about the autonomic neuropathy in chronic hepatitis. This study aimed to evaluate autonomic function in treatment-naive patients with chronic hepatitis B or hepatitis C infection and to elucidate the association between autonomic neuropathy and CG in these patients. METHODS A total of 29 treatment-naive patients with chronic, yet mild degrees of hepatitis B or C infection were evaluated for autonomic function, including those in the sympathetic sudomotor, cardiovagal, and adrenergic domains, to compare with the control subjects. The autonomic impairment was graded using the Composite Autonomic Scoring Scale. Then, association analyses between autonomic parameters/scores and CG were performed. RESULTS Patients with chronic hepatitis B or C infection had significantly worse autonomic function than control subjects, especially in the sudomotor and cardiovagal domains. The autonomic manifestations in cases with and without CG were similar. There was no significant difference in autonomic dysfunction between patients with hepatitis B and C infections. CONCLUSION The study demonstrated that autonomic neuropathy was not uncommon in patients with chronic hepatitis B or C infection. There was no association between autonomic neuropathy and CG.
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Affiliation(s)
- Chih-Cheng Huang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan
| | - Keng-Liang Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan
| | - Jia-Shou Liu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan
| | - Yung-Yee Chang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan.
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11
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Zahid MN. Transplantation of Organs from Hepatitis C Virus-Positive Donors under Direct-Acting Antiviral Regimens. J Clin Med 2022; 11:770. [PMID: 35160222 DOI: 10.3390/jcm11030770] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/28/2021] [Accepted: 01/27/2022] [Indexed: 01/27/2023] Open
Abstract
There is a discrepancy between the patients requiring organ transplants and the donors available to meet that demand. Many patients die every year while on the waiting list, and there is a need to bridge this gap. For many years, medical practitioners have been apprehensive of using donor organs from donors who have tested positive for the Hepatitis C virus (HCV), and with good reason. HCV has been proven to be among the leading causes of liver diseases requiring liver transplants. Over the years, studies have been carried out to find a treatment for Hepatitis C. The advent of direct-acting antivirals revolutionized the medical world. These medication regimens have been proven to treat Hepatitis C in transplant patients effectively. This systematic review will examine how DAA treatments affect transplants of different organs from HCV-positive donors to HCV-negative recipients.
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Kondili LA, Andreoni M, Alberti A, Lobello S, Babudieri S, De Michina A, Merolla R, Marrocco W, Craxì A. A mathematical model by route of transmission and fibrosis progression to estimate undiagnosed individuals with HCV in different Italian regions. BMC Infect Dis 2022; 22:58. [PMID: 35038987 PMCID: PMC8761836 DOI: 10.1186/s12879-022-07042-w] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 11/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although an increase in hepatitis C virus (HCV) prevalence from Northern to Southern Italy has been reported, the burden of asymptomatic individuals in different Italian regions is currently unknown. METHODS A probabilistic approach, including a Markov chain for liver disease progression, was applied to estimate current HCV viraemic burden. The model defined prevalence by geographic area using an estimated annual historical HCV incidence by age, treatment rate, and migration rate from the Italian National database. Viraemic infection by age group was estimated for each region by main HCV transmission routes of individuals for stage F0-F3 (i.e. patients without liver cirrhosis and thus potentially asymptomatic) and F4 (patients with liver cirrhosis, thus potentially symptomatic). RESULTS By January 2020, it was estimated that there were 409,184 Italian individuals with HCV (prevalence of 0.68%; 95% CI: 0.54-0.82%), of which 300,171 (0.50%; 95% CI: 0.4-0.6%) were stage F0-F3. Considering all individuals with HCV in stage F0-F3, the geographical distributions (expressed as the proportion of HCV infected individuals by macroarea within the overall estimated number of F0-F3 individuals and prevalence values, expressed as the percentage of individuals with HCV versus the overall number of individuals for each macroarea) were as follows: North 42.1% (0.45%; 95% CI: 0.36-0.55%), Central 24.1% (0.61%; 95% CI: 0.48-0.74%), South 23.2% (0.50%; 95% CI: 0.4-0.61%), and the Isles 10.6% (0.49%; 95% CI: 0.39-0.59%). The population of people who inject drugs accounted for 50.4% of all individuals infected (F0-F3). Undiagnosed individuals (F0-F3) were ~ 15 years younger (⁓ 50 years) compared with patients with stage F4 (⁓ 65 years), with similar age distributions across macroareas. In contrast to what has been reported on HCV epidemiology in Italy, an increasing trend in the proportion of potentially undiagnosed individuals with HCV (absolute number within the F0-F3) from South (23.2%) to North (42.1%) emerged, independent of similar regional prevalence values. CONCLUSION This targeted approach, which addresses the specific profile of undiagnosed individuals, is helpful in planning effective elimination strategies by region in Italy and could be a useful methodology for other countries in implementing their elimination plans.
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Affiliation(s)
- Loreta A Kondili
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy.
| | | | - Alfredo Alberti
- Department of Molecular Medicine DMM, University of Padova, Padua, Italy
| | | | | | | | | | | | - Antonio Craxì
- Gastroenterology and Liver Unit, DiBiMIS, University of Palermo, Palermo, Italy
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13
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Girardin F, Painter C, Hearmon N, Eddowes L, Kaiser S, Negro F, Vernaz N. Hepatitis C prevalences in the psychiatric setting: Cost-effectiveness of scaling-up screening and direct-acting antiviral therapy. JHEP Rep 2021; 3:100279. [PMID: 34522875 PMCID: PMC8424278 DOI: 10.1016/j.jhepr.2021.100279] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND & AIMS Patients hospitalised because of mental illness often have risk factors for contracting HCV. Scaling-up HCV screening for all psychiatric inpatients as a case-detection strategy for viral elimination is underexplored. This study aimed to evaluate the cost-effectiveness of scaling-up HCV screening and treatment for psychiatry hospital admissions in Switzerland vs. the current standard-of-care risk-based approach, where only those with a history of substance misuse disorder are offered testing. METHODS HCV prevalence by history of substance misuse disorder was analysed in medical records from inpatient admissions to a Swiss psychiatry department. Cost-effectiveness was analysed from a healthcare provider perspective through a decision-tree screening model, using these HCV prevalence data. Model and parameter uncertainty were assessed using deterministic and probabilistic sensitivity analyses. RESULTS Prevalence of HCV in psychiatry inpatients with a history of substance misuse disorder (n = 1,013) was 25.7%, compared with 3.5% among the remaining inpatients (n = 3,535). Scaling up HCV screening and treatment for all psychiatry admissions was cost-effective vs. the risk-based approach, with an incremental cost-effectiveness ratio of US$9,188 per quality-adjusted life-year gained. The incremental cost-effectiveness ratio remained cost-effective considering a HCV prevalence as low as 0.07%. The population-level net monetary benefit of the generalised screening approach was US$435,156,348, with 917 additional patients per year detected and treated at a cost of US$3,294 per person (vs. US$2,122 under risk-based screening). CONCLUSIONS Scaling up HCV screening and treatment at diagnosis with all-oral, interferon-free regimens as a generalised approach for psychiatric admissions was cost-effective and could support reaching World Health Organization targets for HCV elimination by 2030. LAY SUMMARY Patients hospitalised because of mental illness often have risk factors for HCV. We found that testing all psychiatry patients in hospital for HCV was cost-effective compared with testing only patients who have a history of substance misuse. Scaling up HCV testing and treatment could help to wipe out HCV.
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Affiliation(s)
- François Girardin
- Division of Clinical Pharmacology and Toxicology, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
- Service of Clinical Pharmacology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | | | - Natalie Hearmon
- Division of Adult Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | | | - Stefan Kaiser
- Division of Adult Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Francesco Negro
- Divisions of Gastroenterology and Hepatology and of Clinical Pathology, Geneva University Hospitals, Geneva, Switzerland
| | - Nathalie Vernaz
- Division of Clinical Pharmacology and Toxicology, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
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14
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Kondili LA, Andreoni M, Alberti A, Lobello S, Babudieri S, Roscini AS, Merolla R, Marrocco W, Craxì A. Estimated prevalence of undiagnosed HCV infected individuals in Italy: A mathematical model by route of transmission and fibrosis progression. Epidemics 2021; 34:100442. [PMID: 33607538 DOI: 10.1016/j.epidem.2021.100442] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 02/14/2020] [Revised: 12/02/2020] [Accepted: 02/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The universal treatment of diagnosed patients with chronic HCV infection has been widely conducted in Italy since 2017. However, the pool of individuals diagnosed but yet to be treated in Italy has been estimated to end around 2025, leaving a significant proportion of infected individuals undiagnosed/without care. Estimates of this population are currently unknown. METHODS A probabilistic modelling approach was applied to estimate annual historical HCV incident cases by their age-group (0-100 years) distribution from available literature and Italian National database (1952 to October 2019). Viraemic infection rates were modelled on the main infection routes in Italy: people who inject drugs (PWID), tattoos, sexual transmission, glass syringe use, blood transfusion and vertical transmission. Annual liver fibrosis stage transition probabilities were modelled using a Markov model. The number of HCV viraemic asymptomatic (fibrosis stage F0-F3:potentially undiagnosed/unlinked to care) and symptomatic (fibrosis stage F4: potentially linked to care) individuals was estimated. RESULTS By October 2019, total viraemic HCV individuals in Italy (excluding treated patients since 1992) were estimated to be 410,775 (0.68 % of current population of Italy; 95 % CI: 0.64-0.71%, based on the current Italian population), of which 281,809 (0.47 %; 95 % CI:0.35-0.60%) were fibrosis stage F0-F3. Among different high risk groups in stage F0-F3, the following distribution was estimated: PWID; 52.0 % (95 % CI:37.9-66.6 %), tattoo; 28.8 % (95 % CI:23-32.3 %), sexual transmission; 12.0 % (95 % CI:9.6-13.7 %), glass syringe and transfusion; 6.4 % (95 % CI:2.4-17.8 %), and vertical transmission; 0.7 % (95 % CI:0.4-1.2 %). CONCLUSION Under the assumption that most untreated HCV-infected individuals with stage F0-F3 are undiagnosed, more than 280,000 individuals are undiagnosed and/or unlinked to care in Italy. Marked heterogeneity across the major routes of HCV transmission was estimated. This modelling approach may be a useful tool to characterise the HCV epidemic profile also in other countries, based on country specific epidemiology and HCV main transmission routes.
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Affiliation(s)
- Loreta A Kondili
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy.
| | | | | | | | | | | | | | - Walter Marrocco
- Federazione Italiana Medici di Medicina Generale (FIMMG), Rome, Italy
| | - Antonio Craxì
- Gastroenterology and Liver Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
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15
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Gaspar R, Liberal R, Tavares J, Morgado R, Macedo G. HIPPOCRATES ® project: A proof of concept of a collaborative program for hepatitis C virus micro-elimination in a prison setting. World J Hepatol 2020; 12:1314-1325. [PMID: 33442457 PMCID: PMC7772731 DOI: 10.4254/wjh.v12.i12.1314] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/29/2020] [Accepted: 11/05/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In the last few years we have witnessed a revolution in the treatment of hepatitis C virus (HCV) infection. With the introduction of direct-acting antiviral agents (DAAs), sustained virological response (SVR) is achieved in more than 95% of the patients. The focus is now being turned to the global targets set by the World Health Organization, with the aim of achieving HCV elimination by 2030. Prison inmates constitute one of the high-risk groups, and receive treatment less frequently due to several barriers in access to health care.
AIM To describe the management and follow-up of a cohort of HCV monoinfected patients treated with DAA in the prison setting, where tertial referral liver center specialists locally provide, on-site assessment and treatment for the prisoners.
METHODS A prospective observational study was conducted from April 2017 to March 2020, which included all HCV monoinfected prison inmates in the largest Northern Portugal prison. Demographic, clinical, and laboratory data, as well as transient elastography measurements, were collected onsite by the medical team and prospectively recorded. Patients were treated with DAA according to international guidelines. The primary endpoint was SVR at post-treatment week 12.
RESULTS There were 98 monoinfected HCV male inmates (mean age, 42.7 ± 8.6 years) included in the analysis. Injecting drugs or tattooing were reported in 74.5%, with 38.8% of the latter being done in prison. Alcohol consumption of more than 30 g/d was referred in 69.4%. The most prevalent genotype was 1a (54.1%), followed by 3 (27.6%), 4 (9.2%) and 1b (6.1%). Pretreatment fibrosis degree was mild-to-moderate (F0-F2) in 77.6% and severe in 22.4% (F3-F4). Treatment regimens chosen were: 45.9% elbasvir/grazoprevir, 29.6% sofosbuvir/velpatasvir, and 12.2% sofosbuvir/ledispavir and glecaprevir/pibrentasvir. No major adverse events were observed. SVR at post-treatment week 12 was 99%.
CONCLUSION In a population considered to be both hard-to-access and a cornerstone for HCV elimination, the onsite evaluation and treatment of HCV-infected prisoners, achieved an exceptional highly effective success rate. This type of collaborative program should be considered to be expanded, to support hepatitis C elimination efforts.
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Affiliation(s)
- Rui Gaspar
- Department of Gastroenterology, Centro Hospitalar de São João, Porto 4200, Portugal
| | - Rodrigo Liberal
- Department of Gastroenterology and Hepatology, Centro Hospitalar de São João, Porto 4200, Portugal
| | - Jorge Tavares
- Estabelecimento Prisional do Porto, Porto 4200, Portugal
| | - Rui Morgado
- Estabelecimento Prisional do Porto, Porto 4200, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, Centro Hospitalar de São João, Porto 4200, Portugal
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16
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Catanzaro R, Sciuto M, Lanzafame C, Balakrishnan B, Marotta F. Platelet to lymphocyte ratio as a predictive biomarker of liver fibrosis (on elastography) in patients with hepatitis C virus (HCV)-related liver disease. Indian J Gastroenterol 2020; 39:253-260. [PMID: 32833144 DOI: 10.1007/s12664-020-01038-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 04/13/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Liver fibrosis is a frequent complication of chronic hepatitis C virus (HCV) infection. Its evaluation is very important for the prognosis of these patients. The aim of this study was to evaluate the possibility of exploiting the platelet to lymphocyte ratio and the neutrophil to lymphocyte ratio as non-invasive predictive markers of liver fibrosis. METHODS We recruited 120 patients with chronic HCV infection. They were subjected to various clinical investigations to assess the severity of fibrosis. Transient elastography and some serological tests were performed, and the platelet to lymphocyte ratio and the neutrophil to lymphocyte ratio were estimated. RESULTS Sixty-four patients had F4 fibrosis (defined by elastography) and their platelet to lymphocyte ratio (69.92 ± 26.47) was lower than in patients with non-F4 fibrosis (95.19 ± 48.15) (p = 0.001). The neutrophil to lymphocyte ratio was also estimated, but the difference between the 2 groups of patients was not significant statistically (p = 0.07). CONCLUSION The platelet to lymphocyte ratio can be used as a predictive biomarker of liver fibrosis, unlike the neutrophil to lymphocyte ratio which is not predictive of this HCV-related chronic hepatitis complication. More studies are needed to validate this hypothesis.
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Affiliation(s)
- Roberto Catanzaro
- Department of Clinical and Experimental Medicine, Gastroenterology Section, "Gaspare Rodolico" Policlinico Hospital, University of Catania, Via Santa Sofia, 78, 95123, Catania, Italy.
| | - Morena Sciuto
- Department of Clinical and Experimental Medicine, Gastroenterology Section, "Gaspare Rodolico" Policlinico Hospital, University of Catania, Via Santa Sofia, 78, 95123, Catania, Italy
| | - Cristina Lanzafame
- Department of Clinical and Experimental Medicine, Gastroenterology Section, "Gaspare Rodolico" Policlinico Hospital, University of Catania, Via Santa Sofia, 78, 95123, Catania, Italy
| | | | - Francesco Marotta
- ReGenera R&D International for Aging Intervention & San Babila Clinic, Milan, Italy
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17
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Abstract
Objective Serum Vitamin-D plays pivotal role in inflammatory and infectious diseases; among them liver infections are more distinct. This study was aimed to determine Vitamin-D status in HCV-infected patients and healthy controls in Faisalabad, Pakistan. Methods We performed randomized cross-sectional study of 74 individuals from 20th August, 2017 to 20th February 2018 at The University of Faisalabad and Dar us Shifa Clinic, Faisalabad. Fifty-one patients were hepatitis C RNA-PCR positive (22 compensated cirrhotic and 29 decompensated cirrhotic patients). In addition, 23 subjects without liver disease were recruited as healthy control. HCV RNA-PCR was performed by ARTUS ® HCV QS-RGQ V1. Vitamin-D levels were measured by chemiluminescence. SPSS version 20 was used for statistical analysis. Results The mean level of Vitamin-D was significantly lower in HCV patients in compensated and decompensated cirrhotic patients (26.85 ng/mL & 20.65 ng/mL respectively) as compared to healthy controls (30.41 ng/mL). This study showed sub optimal level of Vitamin-D in 76.5% of HCV patients. Vitamin-D insufficiency (21-29 ng/mL) as prevalent among healthy individuals (47.8%) as well as in HCV patients (39.2%) (P < 0.001). In addition, Vitamin-D levels showed inverse relationship with more severe conditions of liver disease as 55.2% of decompensated cirrhosis patients were sufferer of Vitamin-D deficiency as compared to 13.6% deficiency of Vitamin-D in compensated cirrhotic group (P <0.0001). Conclusion Suboptimal levels of Vitamin-D (deficiency or insufficiency) are prevalent in patients having hepatitis C infection as compared to healthy controls. Deficiency of Vitamin-D was directly associated with severity of disease.
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Affiliation(s)
- Sadia Falak
- Dr. Sadia Falak, PhD. School of Pharmacy, The University of Faisalabad, Faisalabad-38040, Pakistan
| | - Lubna Aftab
- Dr. Lubna Aftab, MBBS. Department of Biochemistry, Faculty of Sciences, University Medical and Dental College, Faisalabad-38040, Pakistan
| | - Muhammad Saeed
- Dr. Muhammad Saeed, PhD. Department of Biochemistry, Faculty of Sciences, University Medical and Dental College, Faisalabad-38040, Pakistan
| | - Aftab Islam
- Dr. Aftab Islam, MBBS. Medical Practitioner, Dar-us-Shifa Clinic, Faisalabad-38040, Pakistan
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18
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Marshall AD, Madden A, Treloar C. Enhancing engagement in hepatitis C care among people who inject drugs. Addiction 2019; 114:2104-2106. [PMID: 31140205 DOI: 10.1111/add.14698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/24/2019] [Accepted: 05/10/2019] [Indexed: 01/26/2023]
Affiliation(s)
- Alison D Marshall
- The Kirby Institute, University of New South Wales, Sydney, Australia.,Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Annie Madden
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
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Donà S, Borsetto D, Fussey J, Biscaro V, Vian E, Spinato G, Menegaldo A, Da Mosto MC, Rigoli R, Polesel J, Boscolo-Rizzo P. Association between hepatitis C and B viruses and head and neck squamous cell carcinoma. J Clin Virol 2019; 121:104209. [PMID: 31711028 DOI: 10.1016/j.jcv.2019.104209] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/19/2019] [Accepted: 10/31/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatitis B and C viruses are known to be carcinogenic and have been associated with the development of non-Hodgkin's lymphoma as well as hepatocellular carcinoma. The incidence of head and neck cancer is increasing worldwide, and early diagnosis is vital in order to achieve good oncological outcomes. OBJECTIVES To investigate the association between chronic hepatitis B and C infection, and head and neck squamous cell carcinoma (HNSCC). STUDY DESIGN We performed a retrospective case control study with 774 head and neck squamous cell carcinoma (HNSCC) patients undergoing treatment, and 1518 cancer-free controls undergoing hernia surgery. Hepatitis B and C serologies were tested prior to treatment, and cases and controls were age- and sex-matched before analysing rates of infection. RESULTS HNSCC patients were more likely than controls to have evidence of chronic hepatitis B (OR = 2.76; CI 95 %, 1.64-4.64) and hepatitis C (OR = 2.59; 95 % CI, 1.46-4.60) infection. No substantial association was found between hepatitis B and C infection and other known risk factors for head and neck cancer. CONCLUSIONS These findings suggest a positive association between both hepatitis B and hepatitis C chronic infection, and HNSCC. More work is needed to establish a causal role, however an awareness of the possibility of increased risk of HNSCC may lead to earlier diagnosis and better outcomes in patients with hepatitis B and C.
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Affiliation(s)
- Sara Donà
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Treviso, Italy
| | - Daniele Borsetto
- Cambridge ENT Unit, Cambridge University Hospitals NHS Foundation Trust, United Kingdom.
| | - Jonathan Fussey
- Department of Otolaryngology, Royal Devon and Exeter Hospital, Exeter, United Kingdom
| | - Valeria Biscaro
- Department of Clinical Pathology, AULSS 2, Marca Trevigiana, Treviso, Italy
| | - Elisa Vian
- Department of Clinical Pathology, AULSS 2, Marca Trevigiana, Treviso, Italy
| | - Giacomo Spinato
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Treviso, Italy; Department of Surgery, Oncology and Gastroenterology, Section of Oncology and Immunology, University of Padova, Padova, Italy
| | - Anna Menegaldo
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Treviso, Italy
| | - Maria Cristina Da Mosto
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Treviso, Italy
| | - Roberto Rigoli
- Department of Clinical Pathology, AULSS 2, Marca Trevigiana, Treviso, Italy
| | - Jerry Polesel
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Paolo Boscolo-Rizzo
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Treviso, Italy.
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Sinha MK, Raghuwanshi B, Mishra B. Menace of Hepatitis C virus among multitransfused thalassemia patients in Balasore district of Odisha state in India. J Family Med Prim Care 2019; 8:2850-2854. [PMID: 31681654 PMCID: PMC6820385 DOI: 10.4103/jfmpc.jfmpc_449_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 06/07/2019] [Revised: 06/19/2019] [Accepted: 07/12/2019] [Indexed: 02/01/2023] Open
Abstract
CONTEXT Hepatitis C virus (HCV) is a potential cause of morbidity and mortality worldwide. It is most commonly transmitted through injecting drug use; the reuse or inadequate sterilization of medical equipment and the transfusion of unscreened blood products. Management of thalassemia requires long-term blood transfusion. Though it improves the overall survival, it carries a definite risk of infection which is expected to be higher in resource limited settings. AIMS To find the percentage of transfusion-transmitted infections (TTIs) in multitransfused patients of thalassemia in Eastern India. SETTINGS AND DESIGN The study was conducted to assess blood safety in rural population in India by measuring the percentage of TTIs including HCV in multitransfused thalassemia patients. METHODS AND MATERIALS One hundred and twenty three patients with major beta-thalassemia were enrolled in this study. The blood samples were tested using ELISA technique for all TTIs. HIV fourth generation kits, HbsAg, HCV third generation kits, malaria and syphilis, parbovirus IgM and parbovirus IgG kits, HEV Antigen and IgM antibody were used. STATISTICAL ANALYSIS USED Proportions and means were calculated for categorical and continuous variables, respectively. Chi-square test was applied and P value of <0.05 was taken as significant. RESULTS The mean age of patients was 9.5 years ± 5.2 years. Among various TTIs, Hepatitis C and HIV was prevalent among 59.3% and 4.1% of the study participants, respectively. CONCLUSIONS The causes of high prevalence of HCV may be due to donors being usually asymptomatic in early stages, despite being screened for HCV possibly due to missing early window period infections. The screening methodology of TTIs particularly HCV at the district and village level and consequent increased prevalence of HCV in multitransfused rustic population of India shows the extent of blood safety.
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Affiliation(s)
- Mithilesh K. Sinha
- Department of Surgery, All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
| | - Babita Raghuwanshi
- Department of Transfusion Medicine and Blood Bank, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Bijayanimala Mishra
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
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Maier S, Donnini D, De Luca L, Avellini C, Sechi LA, Soardo G. Hepatocellular metastasis recurrence in liver transplant after treatment with direct antiviral agents. Clin J Gastroenterol 2020; 13:260-6. [PMID: 31410743 DOI: 10.1007/s12328-019-01031-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 08/06/2019] [Indexed: 10/26/2022]
Abstract
Chronic HCV liver infection is considered one of the main causes of liver cirrhosis and hepatocellular carcinoma (HCC). For a selected group of patients, orthotopic liver transplantation (OLTx) is the most effective option to cure both liver diseases. After liver transplantation, patients may be at risk of viral infection reactivation and HCC recurrence. HCV recurrence on the transplanted organ can lead to graft cirrhosis and therefore the clearance of virus with antiviral therapies has a pivotal role on the prevention of graft damage. Nowadays, direct antiviral agents (DAAs) represent the choice treatment for HCV recurrence in liver transplanted patients, ensuring high eradication rates. We present the case of a liver transplant recipient who developed, 7 years after OLTx and immediately after a DAAs treatment, a subcutaneous abdominal mass with histological characteristics of HCC.
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Chang YK, Tseng YT, Chen KH, Chen KT. Long-term outcomes and risk factors of thyroid dysfunction during pegylated interferon and ribavirin treatment in patients with chronic hepatitis C infection in Taiwan. BMC Endocr Disord 2019; 19:36. [PMID: 30953492 PMCID: PMC6451221 DOI: 10.1186/s12902-019-0362-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 03/31/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This study aimed to investigate the occurrence and risk factors of thyroid dysfunction (TD) in patients with chronic hepatitis C (CHC) infection in Taiwan. METHODS The data in this study were obtained from the Taiwan National Health Insurance Research (Taiwan NHIR) database between 2001 and 2013. CHC patients treated with pegylated interferon/ribavirin (PEG-IFN/RBV) were enrolled as case patients, and nontreated CHC patients were enrolled as controls and were matched at a control:case ratio of 3:1 by index date, age (± 3 years), and sex. We compared the cumulative incidence of TD between the cohorts at follow-up until 2013. RESULTS During the study period, 3810 cases and 9393 controls were included in the study. Among the study subjects, 173 (4.5%) case patients and 244 (2.6%) controls were diagnosed with TD during the follow-up period. The types of TD were hypothyroidism (42.9%), hyperthyroidism (31.2%), and thyroiditis (25.9%). Compared to controls during the 13-year follow-up, patients treated with PEG-IFN/RBV had a higher incidence rate of TD (P < 0.0001), as determined using the Kaplan-Meier method. Cox proportional hazards regression analysis showed that female sex (adjusted hazard ratio (HR): 1.49; 95% confidence interval (CI): 1.23-1.75; P < 0.001), treatment with PEG-IFN/RBV (HR: 1.68; 95% CI: 1.38-2.06; P < 0.001), hyperlipidemia (HR: 1.38; 95% CI: 1.12-1.71; P < 0.001), and past history of goiter (HR: 6.40; 95% CI: 5.00-8.18; P < 0.001) were independent predictors for the development of TD. CONCLUSIONS PEG-IFN/RBV treatment may be an independent risk factor for thyroid dysfunction among patients with hepatitis C virus (HCV) infection. Monitoring thyroid function keenly during PEG-IFN/RBV therapy in patients with chronic HCV infection is recommended for clinicians, especially for female patients and for patients with a history of hyperlipidemia and goiter.
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Affiliation(s)
- Yu-Kang Chang
- Department of Radiology, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Yuan-Tsung Tseng
- Department of Medical Research, Tainan Municipal Hospital (managed by Show Chwan Medical Care Corporation), Tainan, Taiwan
| | - Kou-Huang Chen
- School of Mechanical & Electrical Engineering, Sanming University, Sanming, Fujian Province China
| | - Kow-Tong Chen
- Department of Occupational Medicine, Tainan Municipal Hospital (managed by Show Chwan Medical Care Corporation), Tainan, Taiwan. No. 670, Chongde Road, East District, Tainan, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Ekpanyapong S, Reddy KR. Hepatitis C virus therapy in advanced liver disease: Outcomes and challenges. United European Gastroenterol J 2019; 7:642-650. [PMID: 31210942 DOI: 10.1177/2050640619840149] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 01/30/2019] [Accepted: 02/26/2019] [Indexed: 01/06/2023] Open
Abstract
While for many years investigators had worked on highly effective direct-acting antiviral agent (DAA) therapy, we are now encountering challenges on the appropriate timing of DAA therapy in patients with decompensated cirrhosis. Improvement in hepatic function and quality of life can be achieved following successful therapy but not in all patients. Predictors of improvement or failure to improve have been noted but these are currently not robust enough to ubiquitously apply them to clinical practice. The lowest probability of improvement in hepatic function and avoidance of Model for End-stage Liver Disease (MELD) "purgatory" appears to be in those with MELD >20 while the more likely scenario of improvements is in those with MELD <15. Ideally, patients with a MELD score >20 should be transplanted first and treated for hepatitis C virus (HCV) infection after liver transplantation (LT). Those with MELD score <15 should be considered readily for treatment while in those with MELD of 15-20, treatment has to be individualized with full discussion of the pros and cons of treating them pre- or post-LT. However, it is to be appreciated that the majority of patients with decompensated cirrhosis across the world may not be eligible for liver transplant or may not have access to LT; thus, these patients should be considered for HCV therapy with the hope and expectation that they still gain variable degrees of benefit from successful DAA therapy.
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Affiliation(s)
- Sirina Ekpanyapong
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, USA
| | - K Rajender Reddy
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, USA
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Burton MJ, Voluse AC, Anthony V. Integrating comprehensive hepatitis C virus care within a residential substance use disorder treatment program. J Subst Abuse Treat 2018; 98:9-14. [PMID: 30665610 DOI: 10.1016/j.jsat.2018.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/14/2018] [Accepted: 11/19/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Although central to the hepatitis C virus (HCV) epidemic, many patients with both substance use disorders (SUD) and HCV have difficultly engaging in treatment for either condition. To facilitate HCV care in Veterans with active SUD, a comprehensive HCV screening, education, referral, and treatment program was integrated into a VA residential SUD treatment program. METHODS Evaluation of HCV screening, education, referral, and treatment initiative among admissions to a residential SUD treatment program from December 2014 to April 2018. RESULTS To date, 97.49% (582/597) of admissions to the program have been screened for HCV infection, with 12.71% (74/582) of the cases confirmed HCV-positive, and 100% (74/74) of the positive cases being connected or re-connected to the infectious disease clinic for further evaluation and, if appropriate, to begin HCV pharmacotherapy. Importantly, 18.92% (14/74) of the HCV-positive cases were newly diagnosed and would have likely gone undetected without this program. Of the HCV-positive cases, 78.38% (58/74) have received pharmacotherapy, with a sustained virologic response rate of 82.76% (48/58). CONCLUSIONS Integrating comprehensive HCV care within a residential SUD treatment program using a collaborative care model can substantially increase the detection of previously undiagnosed infections, facilitate linkage to care, and promote HCV treatment uptake among HCV-infected Veterans with SUD.
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Affiliation(s)
- Mary Jane Burton
- G. V. (Sonny) Montgomery VA Medical Center, Jackson, MS, USA; University of Mississippi Medical Center, Jackson, MS, USA.
| | - Andrew C Voluse
- G. V. (Sonny) Montgomery VA Medical Center, Jackson, MS, USA
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Clement ME, Collins LF, Wilder JM, Mugavero M, Barker T, Naggie S. Hepatitis C Virus Elimination in the Human Immunodeficiency Virus-Coinfected Population: Leveraging the Existing Human Immunodeficiency Virus Infrastructure. Infect Dis Clin North Am 2018; 32:407-423. [PMID: 29778263 PMCID: PMC6592269 DOI: 10.1016/j.idc.2018.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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] [Indexed: 12/15/2022]
Abstract
The objective of this review is to consider how existing human immunodeficiency virus (HIV) infrastructure may be leveraged to inform and improve hepatitis C virus (HCV) treatment efforts in the HIV-HCV coinfected population. Current gaps in HCV care relevant to the care continuum are reviewed. Successes in HIV treatment are then applied to the HCV treatment model for coinfected patients. Finally, the authors give examples of HCV treatment strategies for coinfected patients in both domestic and international settings.
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Affiliation(s)
- Meredith E Clement
- Division of Infectious Diseases, Duke University Medical Center, 315 Trent Drive, Hanes House, Room 181, DUMC Box 102359, Durham, NC 27710, USA
| | - Lauren F Collins
- Department of Medicine, Emory School of Medicine, 49 Jesse Hill Drive Southeast, Atlanta, GA 30303, USA
| | - Julius M Wilder
- Duke Division of Gastroenterology, Box 90120, Durham, NC 27708-0120, USA; Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27705, USA
| | - Michael Mugavero
- Division of Infectious Diseases, University of Alabama Birmingham, Community Care Building, 908 20th Street South, Birmingham, AL 35294, USA
| | - Taryn Barker
- Clinton Health Access Initiative, 383 Dorchester Avenue, Boston, MA 02127, USA
| | - Susanna Naggie
- Division of Infectious Diseases, Duke University Medical Center, 315 Trent Drive, Hanes House, Room 181, DUMC Box 102359, Durham, NC 27710, USA; Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27705, USA.
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T Yin M, RoyChoudhury A, Nishiyama K, Lang T, Shah J, Olender S, Ferris DC, Zeana C, Sharma A, Zingman B, Bucovsky M, Colon I, Shane E. Bone density and microarchitecture in hepatitis C and HIV-coinfected postmenopausal minority women. Osteoporos Int 2018; 29:871-879. [PMID: 29387910 DOI: 10.1007/s00198-017-4354-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/14/2017] [Accepted: 12/17/2017] [Indexed: 01/17/2023]
Abstract
UNLABELLED We found that HIV+/HCV+ women had 7-8% lower areal bone mineral density (aBMD) by dual-energy x-ray absorptiometry (DXA) at the spine, hip, and radius (p < 0.01) and 5-7% lower volumetric BMD (vBMD) by central quantitative computed tomography (cQCT) at the spine and hip (p < 0.05). These data suggest that true deficits in vBMD may contribute to bone fragility and excess fractures reported in HIV+/HCV+ women. INTRODUCTION aBMD by DXA is lower in persons coinfected with HIV and HCV (HIV+/HCV+) than with HIV monoinfection (HIV+). However, weight is often also lower with HCV infection, and measurement of aBMD by DXA can be confounded by adiposity; we aimed to determine whether true vBMD is also lower in HIV+/HCV+ coinfection. METHODS We measured aBMD of the lumbar spine (LS), total hip (TH), femoral neck (FN), and ultradistal radius (UDR) by DXA and vBMD of the spine and hip by cQCT and of the distal radius and tibia by high-resolution peripheral QCT (HRpQCT) in 37 HIV+/HCV+ and 119 HIV+ postmenopausal women. Groups were compared using Student's t tests with covariate adjustment by multiple regression analysis. RESULTS HIV+/HCV+ and HIV+ women were of similar age and race/ethnicity. HIV+/HCV+ women had lower body mass index (BMI) and trunk fat and were more likely to smoke and less likely to have a history of AIDS. In HIV+/HCV+ women, aBMD by DXA was 7-8% lower at the LS, TH, and UDR (p < 0.01). Similarly, vBMD by cQCT was 5-7% lower at the LS and TH (p < 0.05). Between-group differences in LS aBMD and vBMD remained significant after adjustment for BMI, smoking, and AIDS history. Tibial total vBMD by HRpQCT was 10% lower in HIV+/HCV+ women. CONCLUSION HIV+/HCV+ postmenopausal women had significantly lower spine aBMD and vBMD. These deficits in vBMD may contribute to bone fragility and excess fractures reported in HIV+/HCV+ women.
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Affiliation(s)
- M T Yin
- Columbia University Medical Center, 630 w168th street, New York, NY, 10032, USA.
| | - A RoyChoudhury
- Cornell University Joan and Sanford I Weill Medical College, New York, NY, USA
| | - K Nishiyama
- Columbia University Medical Center, 630 w168th street, New York, NY, 10032, USA
| | - T Lang
- University of California San Francisco, San Francisco, CA, USA
| | - J Shah
- Columbia University Medical Center, 630 w168th street, New York, NY, 10032, USA
| | - S Olender
- Columbia University Medical Center, 630 w168th street, New York, NY, 10032, USA
| | - D C Ferris
- Bronx-Lebanon Hospital Center, Bronx, NY, USA
| | - C Zeana
- Bronx-Lebanon Hospital Center, Bronx, NY, USA
| | - A Sharma
- Montefiore, Yeshiva University Albert Einstein College of Medicine, Bronx, NY, USA
| | - B Zingman
- Montefiore, Yeshiva University Albert Einstein College of Medicine, Bronx, NY, USA
| | - M Bucovsky
- Columbia University Medical Center, 630 w168th street, New York, NY, 10032, USA
| | - I Colon
- Columbia University Medical Center, 630 w168th street, New York, NY, 10032, USA
| | - E Shane
- Columbia University Medical Center, 630 w168th street, New York, NY, 10032, USA
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Zhu L, Li H, Chan P, Eley T, Gandhi Y, Bifano M, Osawa M, Ueno T, Hughes E, AbuTarif M, Bertz R, Garimella T. Population Pharmacokinetic Analysis of Asunaprevir in Subjects with Hepatitis C Virus Infection. Infect Dis Ther 2018; 7:261-275. [PMID: 29589331 PMCID: PMC5986681 DOI: 10.1007/s40121-018-0197-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Indexed: 12/19/2022] Open
Abstract
Introduction Asunaprevir (ASV) is a potent, pangenotypic, twice-daily hepatitis C virus (HCV) NS3 inhibitor indicated for the treatment of chronic HCV infection. Methods A population pharmacokinetic (PPK) model was developed using pooled ASV concentration data from 1239 HCV-infected subjects who received ASV either as part of the DUAL regimen with daclatasvir or as part of the QUAD regimen with daclatasvir and peg-interferon/ribavirin. Results A two-compartment model with first-order elimination from the central compartment, an induction effect on clearance, and an absorption model consisted of zero-order release followed by first-order absorption adequately described ASV PK after oral administration. A typical value for ASV clearance (CL/F) was 50.8 L/h, increasing by 43% after 2 days to a CL/F of 72.5 L/h at steady-state, likely due to auto-induction of cytochrome P450 3A4 (CYP3A4). Factors indicative of hepatic function were identified as key influential covariates on ASV exposures. Subjects with cirrhosis had an 84% increase in ASV area under the concentration time curve (AUC) and subjects with baseline aspartate aminotransferase (AST) above 78 IU/L had a 58% increase in area under the concentration time curve (AUC). Asians subjects had a 46% higher steady-state AUC relative to White/Caucasian subjects. Other significant covariates were formulation, age, and gender. Conclusion The current PPK model provided a parsimonious description of ASV concentration data in HCV-infected subjects. Key covariates identified in the model help explain the observed variability in ASV exposures and may guide clinical use of the drug. Funding Bristol-Myers Squibb. Electronic supplementary material The online version of this article (10.1007/s40121-018-0197-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Li Zhu
- Bristol-Myers Squibb Research and Development, Lawrenceville, NJ, USA
| | - Hanbin Li
- Quantitative Solutions, Menlo Park, CA, USA
| | - Phyllis Chan
- Bristol-Myers Squibb Research and Development, Lawrenceville, NJ, USA
| | - Timothy Eley
- Bristol-Myers Squibb Research and Development, Lawrenceville, NJ, USA
| | - Yash Gandhi
- Bristol-Myers Squibb Research and Development, Lawrenceville, NJ, USA.
| | - Marc Bifano
- Bristol-Myers Squibb Research and Development, Lawrenceville, NJ, USA
| | | | | | - Eric Hughes
- Bristol-Myers Squibb Research and Development, Lawrenceville, NJ, USA
| | - Malaz AbuTarif
- Bristol-Myers Squibb Research and Development, Lawrenceville, NJ, USA
| | - Richard Bertz
- Bristol-Myers Squibb Research and Development, Lawrenceville, NJ, USA
| | - Tushar Garimella
- Bristol-Myers Squibb Research and Development, Lawrenceville, NJ, USA
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Garvey P, Murphy N, Flanagan P, Brennan A, Courtney G, Crosbie O, Crowe J, Hegarty J, Lee J, McIver M, McNulty C, Murray F, Nolan N, O'Farrelly C, Stewart S, Tait M, Norris S, Thornton L. Disease outcomes in a cohort of women in Ireland infected by hepatitis C-contaminated anti-D immunoglobulin during 1970s. J Hepatol 2017; 67:1140-1147. [PMID: 28843656 DOI: 10.1016/j.jhep.2017.07.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 06/21/2017] [Accepted: 07/15/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIM In the mid-1990s, a group of Rh negative women was diagnosed with hepatitis C virus (HCV) genotype 1b infection, following administration of contaminated anti-D immunoglobulin in 1977-79. We aimed to describe their disease history and estimate the effect of selected host and treatment factors on disease progression. METHODS We conducted a cohort study on the women infected with HCV. Information was collected from records at seven HCV treatment centres on demographics, treatment and health outcomes up to the 31st December 2013. We calculated cumulative incidence, case fatality, and sub hazard ratios (SHR) for disease progression using competing risks regression. RESULTS Six hundred and eighty-two patients were included in the study. Among the chronically infected patients (n=374), 35% completed interferon-based antiviral treatment; 42% of whom had a sustained virological response. At the end of 2013, 19%, 1.9%, and 4.9% of chronically infected patients had developed cirrhosis, hepatocellular carcinoma, and liver-related death, respectively, compared with 10%, 0.8%, and 2.4% at the end of 2008. At the end of 2013, 321 (86%) of the chronically infected patients remained alive, 247 (77%) of whom were still chronically infected. Factors associated with increased cirrhosis rates included high alcohol intake (aSHR=4.9 [2.5-9.5]) and diabetes mellitus (aSHR=5.0 [2.9-8.8]). CONCLUSIONS Development of liver-related outcomes accelerated with time, with the risk of cirrhosis, hepatocellular carcinoma, and liver-related death doubling in the last five years of follow-up, particularly in women with high alcohol consumption and diabetes mellitus. We recommend that patients with chronic HCV infection be advised of the additive harmful effect of alcohol, and that data be collected on this cohort after a further five years to analyse the effect of subsequent antiviral treatment during this rapidly evolving period in HCV treatment history. LAY SUMMARY In the mid-1990s, a group of women were diagnosed with chronic hepatitis C virus (HCV) infection following receipt of contaminated anti-D immunoglobulin between 1977 and 1979 in Ireland. Seventy-two (19%) developed cirrhosis and 18 had died from liver-related causes (5%) after 36years of infection. Disease progression accelerated in the last five years of follow-up, particularly in women with diabetes mellitus and high alcohol consumption. We recommend that patients with chronic HCV infection be advised of the additive harmful effect of high alcohol consumption.
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Affiliation(s)
- Patricia Garvey
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden.
| | - Niamh Murphy
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | - Paula Flanagan
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | - Aline Brennan
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | | | | | - John Crowe
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - John Hegarty
- St Vincent's University Hospital, Dublin, Ireland
| | - John Lee
- University College Hospital, Galway, Ireland
| | - Margaret McIver
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | | | | | - Niamh Nolan
- St Vincent's University Hospital, Dublin, Ireland
| | | | | | - Michele Tait
- Health Service Executive, Dr. Steevens Hospital, Dublin, Ireland
| | | | - Lelia Thornton
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
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Pérez-Matute P, Oteo JA. Is it enough to eliminate hepatitis C virus to reverse the damage caused by the infection? World J Clin Infect Dis 2017; 7:1-5. [DOI: 10.5495/wjcid.v7.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/03/2016] [Accepted: 12/02/2016] [Indexed: 02/07/2023] Open
Abstract
Hepatitis C virus (HCV) infection represents one of the major causes of chronic liver disease, hepatocellular carcinoma and morbidity/mortality worldwide. It is also a major burden to the healthcare systems. A complete elimination of the HCV from the body through treatment is now possible. However, HCV not only alters the hepatic function. Several extra-hepatic manifestations are present in HCV-infected patients, which increase the mortality rate. Liver and gut are closely associated in what is called the “gut-liver axis”. A disrupted gut barrier leads to an increase in bacterial translocation and an activation of the mucosal immune system and secretion of inflammatory mediators that plays a key role in the progression of liver disease towards decompensated cirrhosis in HCV-infected patients. In addition, both qualitative and quantitative changes in the composition of the gut microbiota (GM) and states of chronic inflammation have been observed in patients with cirrhosis. Thus, a successful treatment of HCV infection should be also accompanied by a complete restoration of GM composition in order to avoid activation of the mucosal immune system, persistent inflammation and the development of long-term complications. Evaluation of GM composition after treatment could be of interest as a reliable indicator of the total or partial cure of these patients. However, studies focused on microbiota composition after HCV eradication from the body are lacking, which opens unique opportunities to deeply explore and investigate this exciting field.
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Gupta E, Agarwala P, Kumar G, Maiwall R, Sarin SK. Point -of -care testing (POCT) in molecular diagnostics: Performance evaluation of GeneXpert HCV RNA test in diagnosing and monitoring of HCV infection. J Clin Virol 2017; 88:46-51. [PMID: 28160728 DOI: 10.1016/j.jcv.2017.01.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [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: 09/09/2016] [Revised: 01/16/2017] [Accepted: 01/23/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND Molecular testing at the point-of-care may turn out to be game changer for HCV diagnosis and treatment monitoring, through increased sensitivity, reduced turnaround time, and ease of performance. One such assay GeneXpert® has recently been released. OBJECTIVES Comparative analysis between performances of GeneXpert® and Abbott HCV-RNA was done. STUDY DESIGN 174 HCV infected patients were recruited and, one time plasma samples from 154 patients and repeated samples from 20 patients, obtained at specific treatment time-points (0, 4, 12 and 24) weeks were serially re-tested on Xpert®. RESULTS Genotype 3 was the commonest, seen in 80 (66%) of the cases, genotype 1 in 34 (28.3%), genotype 4 in 4 (3.3%) and genotypes 2 and 5 in 1 (0.8%) each. Median HCV RNA load was 4.69 log10 (range: 0-6.98log10) IU/ml. Overall a very good correlation was seen between the two assays (R2=0.985), concordance of the results between the assays was seen in 138 samples (89.6%). High and low positive standards were tested ten times on Xpert® to evaluate the precision and the coefficient of variation was 0.01 for HPC and 0.07 for the LPC. Monitoring of patients on two different regimes of treatment, pegylated interferon plus ribavirin and sofosbuvir plus ribavirin was done by both the systems at baseline, 4, 12 and 24 weeks. Perfect correlation between the assays in the course of therapy at different treatment time- point in genotypes 3 and 1 was seen. CONCLUSION The study demonstrates excellent performance of the Xpert® HCV assay in viral load assessment and in treatment course monitoring consistency.
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Affiliation(s)
- Ekta Gupta
- Department of Clinical Virology, Institute of Liver & Biliary Sciences (ILBS), Vasant Kunj, New Delhi 110070, India.
| | - Pragya Agarwala
- Department of Clinical Virology, Institute of Liver & Biliary Sciences (ILBS), Vasant Kunj, New Delhi 110070, India
| | - Guresh Kumar
- Department of Clinical Virology, Institute of Liver & Biliary Sciences (ILBS), Vasant Kunj, New Delhi 110070, India
| | - Rakhi Maiwall
- Department of Clinical Virology, Institute of Liver & Biliary Sciences (ILBS), Vasant Kunj, New Delhi 110070, India
| | - Shiv Kumar Sarin
- Department of Clinical Virology, Institute of Liver & Biliary Sciences (ILBS), Vasant Kunj, New Delhi 110070, India
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Boone JM, Cui W. Spectrum of bone marrow morphologic findings in hepatitis C patients with and without prior liver transplantation. Int J Lab Hematol 2016; 38:694-702. [PMID: 27572295 DOI: 10.1111/ijlh.12559] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 06/15/2016] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Cytopenia is a common hematologic finding in patients with HCV infection. Only a few studies have addressed bone marrow (BM) morphologic findings in these patients. No systemic study has been performed in these patients with liver transplantation (LT). METHODS We retrospectively examined BMs in 49 hepatitis C patients with and without prior LT (n = 19 and n = 30). RESULTS Among the patients with an available complete blood count (n = 46), the majority of them presented with cytopenia involving one or multiple cell lineages including unicytopenia (13%, n = 6), bicytopenia (31%, n = 14), and pancytopenia (43%, n = 20). Examination of the BM revealed a wide spectrum of morphologic findings ranging from benign reactive processes to overt malignant processes which included myeloid, lymphoid, and plasma cell neoplasms. The severity of cytopenia was not correlated with cirrhosis or antiviral therapy. However, the severity of cytopenia was partly correlated with splenomegaly or LT (P < 0.05). CONCLUSIONS Cytopenia is a common finding in hepatitis C patients. Hypersplenism or LT has an adverse impact on some blood cell counts. Lastly, hepatitis C patients present with a wide spectrum of BM findings including malignant neoplasms, which indicates a diagnostic value of BM examination in these patients.
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Affiliation(s)
- J M Boone
- Department of Lab Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - W Cui
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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Bastos JCS, Padilla MA, Caserta LC, Miotto N, Vigani AG, Arns CW. Hepatitis C virus: Promising discoveries and new treatments. World J Gastroenterol 2016; 22:6393-6401. [PMID: 27605875 PMCID: PMC4968121 DOI: 10.3748/wjg.v22.i28.6393] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/07/2016] [Accepted: 06/15/2016] [Indexed: 02/06/2023] Open
Abstract
Despite advances in therapy, hepatitis C virus (HCV) infection remains an important global health issue. It is estimated that a significant part of the world population is chronically infected with the virus, and many of those affected may develop cirrhosis or liver cancer. The virus shows considerable variability, a characteristic that directly interferes with disease treatment. The response to treatment varies according to HCV genotype and subtype. The continuous generation of variants (quasispecies) allows the virus to escape control by antivirals. Historically, the combination of ribavirin and interferon therapy has represented the only treatment option for the disease. Currently, several new treatment options are emerging and are available to a large part of the affected population. In addition, the search for new substances with antiviral activity against HCV continues, promising future improvements in treatment. Researchers should consider the mutation capacity of the virus and the other variables that affect treatment success.
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Jha R, Fatima R, Lakhtakia S, Jha A, Srikant P, Narayan G. Ledipasvir and sofosbuvir for treatment of post- renal transplant hepatitis C infection: A case report with review of literature. Indian J Nephrol 2016; 26:216-9. [PMID: 27194839 PMCID: PMC4862270 DOI: 10.4103/0971-4065.163432] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Liver disease due to hepatitis C infection in renal transplant recipients is difficult to treat and often associated with reduced patient survival. A 43-year-old male, a renal allograft recipient, presented at 6 years follow-up with significant weight loss over 3 months. He was detected to have new onset diabetes mellitus together with hepatitis C virus (HCV) infection (genotype 1). His HCV load remained high despite the change of immuno-suppression from tacrolimus to cyclosporine. A decision to treat with a new anti-viral combination of ledipasvir and sofosbuvir for 12 weeks was taken. Within 3 weeks, his raised serum transaminases levels normalized and viral load became undetectable. At the end of 16 weeks, he continues to do well with normal renal function, has sustained remission from hepatitis C infection and resolution of diabetes.
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Affiliation(s)
- R Jha
- Department of Nephrology, Medwin Hospital, Hyderabad, Telangana, India
| | - R Fatima
- Department of Nephrology, Medwin Hospital, Hyderabad, Telangana, India
| | - S Lakhtakia
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - A Jha
- Department of Medicine, Mediciti Medical College, Hyderabad, Telangana, India
| | - P Srikant
- Department of Nephrology, Medwin Hospital, Hyderabad, Telangana, India
| | - G Narayan
- Department of Nephrology, Medwin Hospital, Hyderabad, Telangana, India
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Marinaki S, Boletis JN, Sakellariou S, Delladetsima IK. Hepatitis C in hemodialysis patients. World J Hepatol 2015; 7:548-558. [PMID: 25848478 PMCID: PMC4381177 DOI: 10.4254/wjh.v7.i3.548] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 12/10/2014] [Accepted: 12/31/2014] [Indexed: 02/06/2023] Open
Abstract
Despite reduction of hepatitis C prevalence after recognition of the virus and testing of blood products, hemodialysis (HD) patients still comprise a high risk group. The natural history of hepatitis C virus (HCV) infection in dialysis is not fully understood while the clinical outcome differs from that of the general population. HD patients show a milder liver disease with lower aminotransferase and viral levels depicted by milder histological features on liver biopsy. Furthermore, the “silent” clinical course is consistent with a slower disease progression and a lower frequency of cirrhosis and hepatocellular carcinoma. Potential explanations for the “beneficial” impact of uremia and hemodialysis on chronic HCV infection are impaired immunosurveillance leading to a less aggressive host response to the virus and intradialytic release of “hepatoprotective” cytokines such as interferon (IFN)-α and hepatocyte growth factor. However, chronic hepatitis C is associated with a higher liver disease related cardiovascular and all-cause mortality of HD patients. Therapy is indicated in selected patients groups including younger patients with low comorbidity burden and especially renal transplant candidates, preferably after performance of a liver biopsy. According to current recommendations, choice of treatment is IFN or pegylated interferon with a reported sustained viral response at 30%-40% and a withdrawal rate ranging from 17% to 30%. New data regarding combination therapy with low doses of ribavirin which provide higher standard variable rates and good safety results, offer another therapeutic option. The new protease inhibitors may be the future for HCV infected HD patients, though data are still lacking.
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Montaldo C, Mattei S, Baiocchini A, Rotiroti N, Del Nonno F, Pucillo LP, Cozzolino AM, Battistelli C, Amicone L, Ippolito G, van Noort V, Conigliaro A, Alonzi T, Tripodi M, Mancone C. Spike-in SILAC proteomic approach reveals the vitronectin as an early molecular signature of liver fibrosis in hepatitis C infections with hepatic iron overload. Proteomics 2014; 14:1107-15. [PMID: 24616218 DOI: 10.1002/pmic.201300422] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 01/08/2014] [Accepted: 01/09/2014] [Indexed: 01/06/2023]
Abstract
Hepatitis C virus (HCV)-induced iron overload has been shown to promote liver fibrosis, steatosis, and hepatocellular carcinoma. The zonal-restricted histological distribution of pathological iron deposits has hampered the attempt to perform large-scale in vivo molecular investigations on the comorbidity between iron and HCV. Diagnostic and prognostic markers are not yet available to assess iron overload-induced liver fibrogenesis and progression in HCV infections. Here, by means of Spike-in SILAC proteomic approach, we first unveiled a specific membrane protein expression signature of HCV cell cultures in the presence of iron overload. Computational analysis of proteomic dataset highlighted the hepatocytic vitronectin expression as the most promising specific biomarker for iron-associated fibrogenesis in HCV infections. Next, the robustness of our in vitro findings was challenged in human liver biopsies by immunohistochemistry and yielded two major results: (i) hepatocytic vitronectin expression is associated to liver fibrogenesis in HCV-infected patients with iron overload; (ii) hepatic vitronectin expression was found to discriminate also the transition between mild to moderate fibrosis in HCV-infected patients without iron overload.
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Affiliation(s)
- Claudia Montaldo
- Department of Cellular Biotechnologies and Haematology, Istituto Pasteur-Fondazione Cenci Bolognetti, Sapienza University of Rome, Italy; "L. Spallanzani" National Institute for Infectious Diseases, IRCCS, Rome, Italy
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Khoury T, Chen S, Adar T, Jacob EO, Mizrahi M. Hepatitis C infection and lymphoproliferative disease: Accidental comorbidities? World J Gastroenterol 2014; 20:16197-16202. [PMID: 25473174 PMCID: PMC4239508 DOI: 10.3748/wjg.v20.i43.16197] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 06/04/2014] [Accepted: 06/26/2014] [Indexed: 02/06/2023] Open
Abstract
Chronic hepatitis C virus (HCV) infection has been associated with liver cancer and cirrhosis, autoimmune disorders such as thyroiditis and mixed cryoglobulinema, and alterations in immune function and chronic inflammation, both implicated in B cell lymphoproliferative diseases that may progress to non-Hodgkin lymphoma (NHL). HCV bound to B cell surface receptors can induce lymphoproliferation, leading to DNA mutations and/or lower antigen response thresholds. These findings and epidemiological reports suggest an association between HCV infection and NHL. We performed a systematic review of the literature to clarify this potential relationship. We searched the English-language literature utilizing Medline, Embase, Paper First, Web of Science, Google Scholar, and the Cochrane Database of Systematic Reviews, with search terms broadly defined to capture discussions of HCV and its relationship with NHL and/or lymphoproliferative diseases. References were screened to further identify relevant studies and literature in the basic sciences. A total of 62 reports discussing the relationship between HCV, NHL, and lymphoproliferative diseases were identified. Epidemiological studies suggest that at least a portion of NHL may be etiologically attributable to HCV, particularly in areas with high HCV prevalence. Studies that showed a lack of association between HCV infection and lymphoma may have been influenced by small sample size, short follow-up periods, and database limitations. The association appears strongest with the B-cell lymphomas relative to other lymphoproliferative diseases. Mechanisms by which chronic HCV infection promotes lymphoproliferative disease remains unclear. Lymphomagenesis is a multifactorial process involving genetic, environmental, and infectious factors. HCV most probably have a role in the lymphomagenesis but further study to clarify the association and underlying mechanisms is warranted.
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Tosone G, Maraolo AE, Mascolo S, Palmiero G, Tambaro O, Orlando R. Vertical hepatitis C virus transmission: Main questions and answers. World J Hepatol 2014; 6:538-548. [PMID: 25232447 PMCID: PMC4163737 DOI: 10.4254/wjh.v6.i8.538] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 05/07/2014] [Accepted: 06/11/2014] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) affects about 3% of the world’s population and peaks in subjects aged over 40 years. Its prevalence in pregnant women is low (1%-2%) in most western countries but drastically increases in women in developing countries or with high risk behaviors for blood-transmitted infections. Here we review clinical, prognostic and therapeutic aspects of HCV infection in pregnant women and their offspring infected through vertical transmission. Pregnancy-related immune weakness does not seem to affect the course of acute hepatitis C but can affect the progression of chronic hepatitis C. In fact, postpartum immune restoration can exacerbate hepatic inflammation, thereby worsening the liver disease, particularly in patients with liver cirrhosis. HCV infection increases the risk of gestational diabetes in patients with excessive weight gain, premature rupture of membrane and caesarean delivery. Only 3%-5% of infants born to HCV-positive mothers have been infected by intrauterine or perinatal transmission. Maternal viral load, human immunodeficiency virus coinfection, prolonged rupture of membranes, fetal exposure to maternal infected blood consequent to vaginal or perineal lacerations and invasive monitoring of fetus increase the risk of viral transmission. Cesarean delivery and breastfeeding increases the transmission risk in HCV/human immunodeficiency virus coinfected women. The consensus is not to offer antiviral therapy to HCV-infected pregnant women because it is based on ribavirin (pregnancy category X) because of its embryocidal and teratogenic effects in animal species. In vertically infected children, chronic C hepatitis is often associated with minimal or mild liver disease and progression to liver cirrhosis and hepatocarcinoma is lower than in adults. Infected children may be treated after the second year of life, given the adverse effects of current antiviral agents.
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Xue JH, Zhu HH, Wang J, Chen Z. Interferon-associated retinopathy risk in patients with diabetes and hypertensive hepatitis C. World J Gastroenterol 2014; 20:7505-7513. [PMID: 24966622 PMCID: PMC4064097 DOI: 10.3748/wjg.v20.i23.7505] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 02/11/2014] [Accepted: 03/05/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the association of hypertension and diabetes mellitus (DM) with interferon-associated retinopathy (IAR) risk in chronic hepatitis C (CHC).
METHODS: Two investigators independently searched PubMed and Embase for eligible articles published prior to December 2013; additional studies were identified by reviewing the bibliographies. Only case-control or cohort studies that evaluated the association between hypertension and/or DM and IAR incidence in CHC patients were included. IAR was characterized by the presence of cotton-wool spots and/or retinal hemorrhage, and was defined as the primary efficacy measure. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were estimated using data extracted from papers based on random-effects models.
RESULTS: Eight eligible studies were included in the present meta-analysis. The outcomes showed that patients with CHC and hypertension were at higher risk of IAR (48/189 vs 96/455, RR = 1.90; 95%CI: 1.15-3.15, P < 0.05). Patients with DM receiving interferon (IFN)-based therapy for CHC infection may be at higher risk for IAR (18/72 vs 60/256, RR = 1.56, 95%CI: 1.11-2.20, P < 0.05); however, the outcome was not stable. There was no significant difference in IAR risk between genotype-1-infected patients and non-genotype-1-infected patients (RR = 1.09, 95%CI: 0.64-1.87, P > 0.05). Comparable incidences of IAR were also found between patients treated with pegylated interferon (PIFN) α-2a and those treated with PIFN α-2b (RR = 0.84, 95%CI: 0.56-1.24, P > 0.05) and between patients treated with IFN α and those treated with PIFN α (RR = 1.04, 95%CI: 0.72-1.50, P > 0.05).
CONCLUSION: Patients with hypertension have a higher risk of retinopathy when receiving IFN-based therapy for CHC.
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Ditah I, Ditah F, Devaki P, Ewelukwa O, Ditah C, Njei B, Luma HN, Charlton M. The changing epidemiology of hepatitis C virus infection in the United States: National Health and Nutrition Examination Survey 2001 through 2010. J Hepatol 2014; 60:691-8. [PMID: 24291324 DOI: 10.1016/j.jhep.2013.11.014] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [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: 07/17/2013] [Revised: 11/09/2013] [Accepted: 11/19/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS In light of the dramatically changing hepatitis C therapeutic landscape, knowledge of the current burden of HCV infection in the general population of the United States is critical. METHODS The National Health and Nutrition Examination survey collects nationally representative data on HCV infection in the civilian population of the United States. Data from 2001 to 2010 were combined for this study. HCV testing was completed in 38,025 participants. RESULTS The prevalence of anti-HCV in the United Sates decreased from 1.9% (95% CI 1.5%-2.5%) in 2001-2002 to 1.3% (95% CI 0.9%-1.8%) in 2005-2006, and remained stable up to 2010. About 67% of all infected persons were positive for HCV RNA, indicating 2.3 million people with chronic HCV infection, of whom 68% have genotype 1. Seventy percent of infected persons were born between 1945 and 1965, with prevalence of 3.5% (95% CI 2.2%-4.8%). The stable rate since 2006 is mostly related to prevalent cases and foreign born persons migrating into US. Other important risk factors include less education and low economic status. Race, HIV status, number of sexual partners, and blood transfusions are no longer associated with HCV infection. CONCLUSIONS As of 2010, approximately 2.3 million persons were chronically infected with Hepatitis C in the US. Most of those infected are prevalent, rather than incident cases. The prevalence of HCV was on the decline, but has stabilized since 2006. Future studies should explore reasons for no decline in HCV prevalence since 2006.
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Affiliation(s)
- Ivo Ditah
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States.
| | - Fausta Ditah
- Division of Gastroenterology Hepatology, and Nutrition, Vanderbilt University School of Medicine, United States
| | | | | | | | - Basile Njei
- University of Connecticut School of Medicine, Birmingham, CT, United States
| | | | - Michael Charlton
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States
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Abstract
Chronic hepatitis C (CHC) infection affects almost 3% of the global population and can lead to cirrhosis, liver failure, and hepatocellular carcinoma in a significant number of those infected. Until recently, the only treatments available were pegylated interferon and ribavirin, which traditionally were not very effective and have considerable side effects. For this reason, interest in complementary and alternative medications (CAM) in the management of hepatitis C has been investigated. Some CAM has demonstrated therapeutic potential in chronic hepatitis C treatment. Unfortunately, some CAM has been shown to have the potential to cause drug-induced liver injury. This article will review and evaluate many of the natural molecules that interact with the hepatitis C virus (HCV) life cycle and discuss their potential use and safety in HCV therapy, as well as highlight some important interactions between medical and complementary treatments.
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Affiliation(s)
- Dina L Halegoua-De Marzio
- Dina L Halegoua-De Marzio, Jonathan M Fenkel, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, United States
| | - Jonathan M Fenkel
- Dina L Halegoua-De Marzio, Jonathan M Fenkel, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, United States
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Bibi S, Dars S, Ashfaq S, Ara Qazi R, Akhund S. Seroprevalence and risk factors for hepatitis C virus (HCV) infection in pregnant women attending public sector tertiary care hospital in Hyderabad Sindh. Pak J Med Sci 2013; 29:505-8. [PMID: 24353565 PMCID: PMC3809250 DOI: 10.12669/pjms.292.3211] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 01/11/2013] [Accepted: 01/12/2013] [Indexed: 11/18/2022] Open
Abstract
Background and Objectives: Pakistan is among the countries having high prevalence of HCV infection in the population but there is dearth of proper epidemiological data regarding acquisition of HCV infection in the pregnant population. Our objective was to determine the seroprevalence of HCV antibodies in healthy pregnant women and to assess the potential risk factors for HCV infection in HCV positive subjects and in the control group. Methodology: This cross sectional and comparative study was conducted from 1st January to 31st December 2010 in the Department of Obstetrics/Gynaecology Unit–I, Liaquat University Hospital Hyderabad. Sera were collected from all admitted pregnant women and tested for HCV anti bodies using Elisa kits (Abbott, USA). Data were analyzed using SPSS version 16.0 statistical package. Results: The seroprevalence of HCV among pregnant population was found to be 4.7%. HCV positive women were more likely to have a history of blood transfusion (OR 1.99, 95% CI 1.26- 3.12), History of therapeutic injection use (OR 2.46, 95% CI 1.43-4.26), history of surgery (OR 1.72, 95% CI 1.12-2.66) and history of sharing household products (OR 1.81, 95% CI 1.14-2.87). Conclusion: HCV seropositive pregnant women were more likely to have a history of blood transfusion, therapeutic injection use, surgery and sharing household items.
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Affiliation(s)
- Seema Bibi
- Dr. Seema Bibi, FCPS(Obs/Gyn), Associate Professor, Department of Obstetrics/Gynaecology, Liaquat University of Medical & Health Sciences Jamshoro, Sindh, Pakistan
| | - Saira Dars
- Dr. Saira Dars, MS(Obs/Gyn), Consultant Gynaecologist, Department of Obstetrics/Gynaecology, Liaquat University Hospital Hyderabad/Jamshoro, Sindh, Pakistan
| | - Sanober Ashfaq
- Dr. Sanober Ashfaq, MS(Obs/Gyn), Registrar, Department of Obstetrics/Gynaecology, Liaquat University Hospital Hyderabad/Jamshoro, Sindh, Pakistan
| | - Roshan Ara Qazi
- Roshan Ara Qazi, FCPS(Obs/Gyn), Chairperson/Professor, Department of Obstetrics/Gynaecology, Liaquat University of Medical & Health Sciences Jamshoro, Sindh, Pakistan
| | - Sadaf Akhund
- Dr. Sadaf Akhund, DGO, Trainee Registrar, Department of Obstetrics/Gynaecology, Liaquat University of Medical & Health Sciences Jamshoro, Sindh, Pakistan
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Nishida N, Tokunaga K, Mizokami M. Genome-Wide Association Study Reveals Host Genetic Factors for Liver Diseases. J Clin Transl Hepatol 2013; 1:45-50. [PMID: 26357606 PMCID: PMC4521269 DOI: 10.14218/jcth.2013.010xx] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 05/13/2013] [Accepted: 05/22/2013] [Indexed: 12/11/2022] Open
Abstract
A number of disease-associated genetic markers for common liver diseases have been identified using genome-wide association studies (GWASs). The GWAS strategy is based on genome-wide single-nucleotide polymorphism typing technologies, which are now commercially available, accompanied by statistical methods to identify host genetic factors that are associated with target diseases or complex genetic traits. One of the most striking features of the GWAS strategy is the ability to identify unexpected disease-associated genetic markers across the entire human genome. Here, we describe the technological aspects of the GWAS strategy with examples from actual GWAS reports related to hepatitis research, including drug response for patients with chronic hepatitis C, susceptibility to primary biliary cirrhosis, and hepatitis-B-related hepatocellular carcinoma.
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Affiliation(s)
- Nao Nishida
- The Research Center for Hepatitis & Immunology, National Center for Global Health and Medicine, Ichikawa, Chiba, Japan
- Department of Human Genetics, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Katsushi Tokunaga
- Department of Human Genetics, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Masashi Mizokami
- The Research Center for Hepatitis & Immunology, National Center for Global Health and Medicine, Ichikawa, Chiba, Japan
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Scaggiante R, Chemello L, Rinaldi R, Bartolucci GB, Trevisan A. Acute hepatitis C virus infection in a nurse trainee following a needlestick injury. World J Gastroenterol 2013; 19:581-5. [PMID: 23382640 PMCID: PMC3558585 DOI: 10.3748/wjg.v19.i4.581] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 07/31/2012] [Accepted: 08/08/2012] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) infection after biological accident (needlestick injury) is a rare event. This report describes the first case of acute HCV infection after a needlestick injury in a female nursing student at Padua University Hospital. The student nurse was injured on the second finger of the right hand when recapping a 23-gauge needle after taking a blood sample. The patient who was the source was a 72-year-old female with weakly positive anti-HCV test results. Three months after the injury, at the second step of follow-up, a relevant increase in transaminases with a low viral replication activity (350 IU/mL) was observed in the student, indicating HCV infection. The patient tested positive for the same genotype (1b) of HCV as the injured student. A rapid decline in transaminases, which was not accompanied by viral clearance, and persistently positive HCV-RNA was described 1 mo later. Six months after testing positive for HCV, the student was treated with pegylated interferon plus ribavirin for 24 wk. A rapid virological response was observed after 4 wk of treatment, and a sustained virological response (SVR) was evident 6 mo after therapy withdrawal, confirming that the patient was definitively cured. Despite the favourable IL28B gene (rs12979860) CC- polymorphism observed in the patient, which is usually predictive of a spontaneous clearance and SVR, spontaneous viral clearance did not take place; however, infection with this genotype was promising for a sustained virological response after therapy.
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Jafari N, Farajzadegan Z, Ataei B. Surveillance system for hepatitis C infection: A practical approach. Int J Prev Med 2012; 3:S48-57. [PMID: 22826770 PMCID: PMC3399297] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Accepted: 06/28/2011] [Indexed: 12/04/2022] Open
Abstract
Hepatitis C virus (HCV) infection is a serious public health concern throughout the world. Despite its public health prominence, however, how surveillance systems for hepatitis C should be designed is still a challenging issue especially in developing countries such as Iran. Establishing a surveillance system needs an ongoing process of case investigation, data collection, analysis of data and also dissemination of data to public health professionals and health care providers.This review article tries to provide the best recommendations for planning and implantation a surveillance system for HCV infection.
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Affiliation(s)
- Najmeh Jafari
- Department of Community Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ziba Farajzadegan
- Department of Community Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behrooz Ataei
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Rostami Z, Nourbala MH, Alavian SM, Bieraghdar F, Jahani Y, Einollahi B. The impact of Hepatitis C virus infection on kidney transplantation outcomes: A systematic review of 18 observational studies: The impact of HCV on renal transplantation. Hepat Mon 2011; 11:247-54. [PMID: 22087151 PMCID: PMC3206701] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 01/31/2011] [Accepted: 02/28/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection occursin 0% to 51% of dialysis patients, and manyHCV-positive patients are urged to undergo kidney transplantation. However, the outcome of renal transplantation in HCV-positive recipients is unknown. OBJECTIVES Our review aimed to address the outcomesof renal transplantation recipients (RTRs)following kidney transplantation. MATERIALS AND METHODS We selected studies that used the adjusted relative risk (aRR) and 95% CI of all-cause mortality and graft loss in HCV-positive compared with HCV-negative RTRs as study endpoints. Cox proportional hazard analysis was usedin all studies to calculate the independent effects of HCV infection on RTR outcomes. Sixteen retrospective cohort studies and 2 clinical trials were selected for our review. Sixteen studies were related to patient survival, and 12 examined graft survival. RESULTS The combined hazard ratio in HCV-infected recipients was 1.69-fold (1.33-1.97, p < 0.0001) and 1.56 times (1.22-2.004, p < 0.0001) greaterthan that of HCV-negative recipients for mortality and graft loss, respectively. CONCLUSIONS Although HCV-infected RTRs have worseoutcomes than HCV-negative RTRs,kidney transplantation is the preferred treatment for patients with HCV infection and end-stage renal disease.
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Affiliation(s)
- Zohreh Rostami
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran,* Corresponding author at: Zohreh Rostami, Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Molla Sadra Ave, Vanak Sq, Tehran, IR Iran. Tel.: +98-2181262073, Fax: +98-2188067114, E-mail:
| | - Mohammad Hossien Nourbala
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Seyed Moayed Alavian
- Baqiyatallah Research Center for Gastroenterology and Liver Disease, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Fatemeh Bieraghdar
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Yunes Jahani
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Behzad Einollahi
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
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Toniutto P, Fabris C, Avellini C, Minisini R, Bitetto D, Rossi E, Smirne C, Pirisi M. Excess body weight, liver steatosis, and early fibrosis progression due to hepatitis C recurrence after liver transplantation. World J Gastroenterol 2005; 11:5944-50. [PMID: 16273604 PMCID: PMC4436715 DOI: 10.3748/wjg.v11.i38.5944] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate how weight gain after OLT affects the speed of fibrosis progression (SFP) during recurrent hepatitis C virus (HCV) infection of the graft.
METHODS: Ninety consecutive patients (63 males, median age 53 years; 55 with HCV-related liver disease), transplanted at a single institution, were studied. All were followed for at least 2 years after OLT and had at least one follow-up graft biopsy, performed not earlier than 1 year after the transplant operation. For each biopsy, a single, experienced pathologist gave an estimate of both the staging according to Ishak and the degree of hepatic steatosis. The SFP was quantified in fibrosis units/month (FU/mo). The lipid metabolism status of patients was summarized by the plasma triglycerides/cholesterol (T/C) ratio. Body mass index (BMI) was measured before OLT, and 1 and 2 years after it.
RESULTS: In the HCV positive group, the highest SFP was observed in the first post-OLT year. At that time point, a SFP ≤0.100 FU/mo was observed more frequently among recipients who had received their graft from a young donor and had a pre-transplant BMI value >26.0 kg/m2. At completion of the first post-transplant year, a BMI value >26.5 kg/m2 was associated with a T/C ratio ≤1. The proportion of patients with SFP >0.100 FU/mo descended in the following order: female recipients with a high T/C ratio, male recipients with high T/C ratio, and recipients of either gender with low T/C ratio. Hepatic steatosis was observed more frequently in recipients who, in the first post-transplant year, had increased their BMI ≥1.5 kg/m2 in comparison to the pre-transplant value. Hepatic steatosis was inversely associated with the staging score.
CONCLUSION: Among HCV positive recipients, excess weight gain post-OLT does not represent a factor favoring early liver fibrosis development and might even be protective against it.
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Affiliation(s)
- Pierluigi Toniutto
- Clinica di Medicina Interna, Universita degli Studi, Piazzale Santa Maria della Misericordia, 1, Udine 33100, Italy.
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