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Fricker GP, Ghany MG, Mera J, Pinsky BA, Ward JW, Chung RT. Tools Needed to Support Same-Day Diagnosis and Treatment of Current Hepatitis C Virus Infection. J Infect Dis 2024; 229:S362-S369. [PMID: 37739799 PMCID: PMC11078313 DOI: 10.1093/infdis/jiad177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 09/24/2023] Open
Abstract
The current multiday diagnosis and treatment paradigm for hepatitis C virus (HCV) infection results in far fewer patients receiving treatment with direct-acting antiviral agents than those with diagnosed HCV infection. To achieve HCV elimination, a paradigm shift in access to HCV treatment is needed from multiday testing and treatment algorithms to same-day diagnosis and treatment. This shift will require new tools, such as point-of-care (POC) antigen tests or nucleic acid tests for HCV and hepatitis B virus (HBV) and nucleic acid tests for human immunodeficiency virus (HIV) that do not require venous blood. This shift will also require better use of existing resources, including expanded access to HCV treatment and available POC tests, novel monitoring approaches, and removal of barriers to approval. A same-day diagnosis and treatment paradigm will substantially contribute to HCV elimination by improving HCV treatment rates and expanding access to treatment in settings where patients have brief encounters with healthcare.
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Affiliation(s)
- Gregory P Fricker
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marc G Ghany
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Jorge Mera
- Infectious Diseases, Cherokee Nation Health Services, Tahlequah, Oklahoma, USA
- Department of Medicine, Division of Infectious Diseases, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Benjamin A Pinsky
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, University School of Medicine, Stanford, CaliforniaUSA
| | - John W Ward
- Coalition for Global Hepatitis Elimination, The Task Force for Global Health, Atlanta, Georgia, USA
| | - Raymond T Chung
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Hepatology and Liver Center, Massachusetts General Hospital, Boston, Massachusetts, USA
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Auma AWN, Shive CL, Lange A, Damjanovska S, Kowal C, Zebrowski E, Pandiyan P, Wilson B, Kalayjian RC, Canaday DH, Anthony DD. Naïve CD4+ T Cell Lymphopenia and Apoptosis in Chronic Hepatitis C Virus Infection Is Driven by the CD31+ Subset and Is Partially Normalized in Direct-Acting Antiviral Treated Persons. Front Immunol 2021; 12:641230. [PMID: 33912168 PMCID: PMC8075159 DOI: 10.3389/fimmu.2021.641230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/24/2021] [Indexed: 12/29/2022] Open
Abstract
Background The mechanisms underlying naïve CD4+ lymphopenia during chronic Hepatitis C Virus (HCV) infection are unclear. Whether direct-acting antiviral (DAA) therapy restores peripheral naïve CD4+ T cell numbers and function is unknown. Methods We enumerated frequencies and counts of peripheral naïve CD4+, CD4+CD31+ and CD4+CD31- T cells by flow cytometry in a cross sectional analysis comparing chronic HCV infected (n=34), DAA-treated(n=29), and age-range matched controls (n=25), as well as in a longitudinal cohort of HCV DAA treated persons (n=16). The cross-sectional cohort was stratified by cirrhosis state. Cell apoptosis/survival (AnnexinV+7AAD+/BCL-2 labeling) and cell cycle entry (Ki67 expression) of CD31+ and CD31- naïve CD4+ T cells was analyzed directly ex vivo and following 3 and 5 days of in vitro culture with media, interleukin (IL) -7 or CD3/CD28 activator. Results In the cross-sectional cohort, naïve CD4+ proportions were lower in chronic HCV infected persons compared to controls and DAA-treated persons, an effect in part attributed to cirrhosis. Age was associated with naïve cell counts and proportions in HCV infected and treated persons as well. Naïve CD4+ cell proportions negatively correlated with plasma levels of soluble CD14 following therapy in DAA-treated persons. Naïve CD4+ cells from HCV infected persons exhibited greater direct ex vivo apoptosis and cell-cycling compared to cells from DAA-treated persons and controls, and this was localized to the CD4+CD31+ subset. On the other hand, no remarkable differences in expression of BCL-2 or IL-7 Receptor (CD127) at baseline or following in vitro media or IL7 containing culture were observed. In the longitudinal cohort, naïve CD4+CD31+/CD31- ratio tended to increase 24 weeks after DAA therapy initiation. Conclusions Activation and apoptosis of peripheral naïve CD4+CD31+ T cells appear to contribute to naïve CD4+ lymphopenia in chronic HCV infection, and this defect is partially reversible with HCV DAA therapy. Age and cirrhosis -associated naïve CD4+ lymphopenia is present both before and after HCV DAA therapy. These findings have implications for restoration of host immune function after DAA therapy.
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Affiliation(s)
- Ann W N Auma
- Department of Pathology, Case Western Reserve University, Cleveland, OH, United States
| | - Carey L Shive
- Department of Pathology, Case Western Reserve University, Cleveland, OH, United States.,GRECC, VA Northeast Ohio Healthcare System, Cleveland, OH, United States
| | - Alyssa Lange
- GRECC, VA Northeast Ohio Healthcare System, Cleveland, OH, United States
| | - Sofi Damjanovska
- GRECC, VA Northeast Ohio Healthcare System, Cleveland, OH, United States
| | - Corinne Kowal
- GRECC, VA Northeast Ohio Healthcare System, Cleveland, OH, United States
| | | | - Pushpa Pandiyan
- Department of Pathology, Case Western Reserve University, Cleveland, OH, United States
| | - Brigid Wilson
- GRECC, VA Northeast Ohio Healthcare System, Cleveland, OH, United States
| | - Robert C Kalayjian
- Department of Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - David H Canaday
- GRECC, VA Northeast Ohio Healthcare System, Cleveland, OH, United States
| | - Donald D Anthony
- Department of Pathology, Case Western Reserve University, Cleveland, OH, United States.,GRECC, VA Northeast Ohio Healthcare System, Cleveland, OH, United States.,Department of Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, United States
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Khan SI, Bachani P, Saleem A, Jameel A, Khawaja UA. Primary Biliary Cholangitis and CREST Syndrome: A Rare, Overlapping Presentation With a Review of the Literature. Cureus 2020; 12:e11986. [PMID: 33425554 PMCID: PMC7788041 DOI: 10.7759/cureus.11986] [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] [Indexed: 01/10/2023] Open
Abstract
CREST (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) syndrome, also known as the limited cutaneous form of systemic sclerosis (lcSSc), is a multisystem connective tissue disorder often manifesting as a consequence of superimposed autoimmune hepatitis. Herein, we present a case of a 40-year-old female with a past one-year history of hepatitis C presenting with the chief complaints of progressive thickness and tightness of the skin of hands and face and dysphagia for the past three months, along with arthralgia of the hands for the past two months, suggestive of CREST syndrome. Through this case, we intend to emphasize the association between extrahepatic manifestations and the emergence of autoantibodies in patients with hepatitis C virus (HCV) infection and discuss the clinical relevance of the autoantibodies in extrahepatic disorders, in our case, CREST syndrome. It is well-known that chronic HCV infection plays a significant part in the production of non-organ-specific autoantibodies, including antinuclear antibodies (ANA) and smooth muscle antibodies, and organ-specific autoantibodies. Clinicians must be aware of the possibility of such liver damage in patients with systemic sclerosis.
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Affiliation(s)
- Shayan Iqbal Khan
- Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, PAK
| | - Parkash Bachani
- Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, PAK
| | - Amna Saleem
- Medicine, Jinnah Medical and Dental College, Karachi, PAK
| | - Arifa Jameel
- Internal Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, PAK
| | - Uzzam Ahmed Khawaja
- Internal Medicine, Jinnah Medical and Dental College, Karachi, PAK.,Clinical and Translational Research, Larkin Community Hospital, South Miami, USA
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Li CF, Tsao SM, Liao HH, Chen SC, Lee YT. Treatment of chronic hepatitis C regiments containing with recombinant interferon in patients with sustained virological response predicts risk of hepatocellular carcinoma: A meta-analysis. Medicine (Baltimore) 2020; 99:e22435. [PMID: 33019424 PMCID: PMC7535677 DOI: 10.1097/md.0000000000022435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Given that evidence supporting chronic hepatitis C (CHC) infection developed chance for hepatocellular carcinoma (HCC) following antiviral agents therapy is controversial. We conducted a meta-analysis to examine the risk.We evaluated 20 retrospective and prospective cohort studies published up to 31 December 2017 which investigated the association between sustained virological response (SVR) and incidence of HCC patients treated with monotherapy interferon (IFN) or IFN plus ribavirin (RBV) therapy. The primary outcome of the study was the cumulative incidence of HCC. Odds ratio (OR) was used to evaluate the index of effect size for the association between SVR and treatment with IFN alone or IFN/RBV in CHC patients.SVR patients demonstrated a lower incidence of HCC compared to non-SVR patients. Non-SVR patients had greater odds of HCC incidence compared to SVR patients in the treatment of IFN plus RBV (pooled OR = 7.405, 95% CI = 4.689 to 11.694, P < .001). Non-SVR patients had greater odds of HCC incidence compared to SVR patients in the treatment of IFN monotherapy (pooled OR = 4.135, 95% CI = 3.009 to 5.682, P < .001). Lack of SVR to IFN therapy was significantly associated with greater risk of HCC incidence (pooled OR = 5.035, 95% CI = 3.915 to 6.474, P < .001).SVR could be as a predictor of HCC in CHC patients treated with IFN or IFN plus RBV, and have important implications during HCC screening, whereby patients who fail to achieve SVR need to be screened more rigorously.
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Affiliation(s)
- Chien-Feng Li
- School of Medicine, Chung Shan Medical University
- Division of Infectious Diseases, Department of Internal Medicine
| | - Shih-Ming Tsao
- School of Medicine, Chung Shan Medical University
- Division of Infectious Diseases, Department of Internal Medicine
| | - Hsien-Hua Liao
- School of Medicine, Chung Shan Medical University
- Department of Plastic Surgery
| | - Shiuan-Chih Chen
- School of Medicine, Chung Shan Medical University
- Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yuan-Ti Lee
- School of Medicine, Chung Shan Medical University
- Division of Infectious Diseases, Department of Internal Medicine
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Abstract
OBJECTIVES To evaluate the effect of pegylated interferon maintenance therapy in patients with chronic hepatitis C who failed initial antiviral therapy. METHODS This is a meta-analysis of 6 randomized controlled trials that met the eligibility criteria. In all, 2438 chronic hepatitis C patients who failed to achieve sustained virologic response after initial treatment with pegylated interferon and ribavirin (antiviral therapy nonresponders or relapsers) were enrolled; 1237 patients received maintenance therapy (Maintenance group) and 1201 received no treatment (Observation group). RESULTS The pooled analyses found that patients in the Maintenance group had a significantly higher rate of normal alanine aminotransferase than did patients in the Observation group (pooled odds ratio [OR] 4.436, 95% confidence interval [CI] 1.225-16.064, P = .023), but there was no significant difference between the 2 groups in the incidence of hepatocellular carcinoma (pooled OR 0.872, 95% CI 0.501-1.519, P = .630), or the mortality rate (pooled OR 1.564, 95% CI 0.807-3.032, P = .185). CONCLUSIONS Interferon-based maintenance therapy in patients with chronic hepatitis C who failed initial antiviral therapy improved liver inflammation as indicated by blood chemistry (alanine aminotransferase).
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Affiliation(s)
- Hung-Chang Hung
- Division of Gastroenterology, Department of Internal Medicine, Nantou Hospital, Ministry of Health and Welfare, Nantou
- Department of Healthcare Administration, Central Taiwan University of Science and Technology
| | - Hsien-Hua Liao
- School of Medicine, Chung Shan Medical University
- Department of Plastic Surgery
| | - Shiuan-Chih Chen
- School of Medicine, Chung Shan Medical University
- Department of Family and Community Medicine
| | - Shih-Ming Tsao
- School of Medicine, Chung Shan Medical University
- Division of Infectious Diseases, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC
| | - Yuan-Ti Lee
- School of Medicine, Chung Shan Medical University
- Division of Infectious Diseases, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC
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Abstract
RATIONALE Membranoproliferative glomerulonephritis (MPGN) can be induced by autoimmune diseases, chronic infection, chronic hepatitis, and paraproteins (including cryoglobulinemia). In addition, the mixed cryoglobulinemic MPGN is reported to be highly correlated with hepatitis C virus (HCV) infection. PATIENT CONCERNS We reported a rare case of a 61-year-old woman without a history of viral hepatitis infection; she presented with bilateral leg edema and proteinuria. Renal pathology revealed MPGN with multiple positive immunofluorescent staining. The consequent serum survey revealed positive cryoglobulin and monoclonal gammopathy of kappa type of immunoglobulin M. However, bone marrow study showed no obvious plasma cell proliferation, indicating that multiple myeloma was less likely. DIAGNOSES This patient's cryoglobulinemic MPGN could be related to monoclonal gammopathy of undetermined significance. INTERVENTIONS Oral immunosuppressant. OUTCOMES After steroid treatment, her renal function normalized and proteinuria kept in low level. LESSONS We demonstrated a rare cause of cryoglobulinemic MPGN without HCV infection, which led to a favorable prognosis after receiving steroid therapy. Moreover, the diagnosis of monoclonal gammopathy should be considered when facing such case and aggressive steroid therapy might be beneficial.
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Affiliation(s)
- Jung-Hui Hsu
- Division of Gastroenterology, Department of Internal Medicine
| | - Yu-Wei Fang
- Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital
- Fu-Jen Catholic University School of Medicine
| | - An-Hung Yang
- Ultrastructural and Molecular Pathology, Department of Pathology, Taipei Veterans General Hospital, Taipei Taiwan (ROC)
| | - Ming-Hsein Tsai
- Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital
- Fu-Jen Catholic University School of Medicine
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Hoffmann F, Schmidt A, Chevillotte MD, Wisskirchen C, Hellmuth JC, Willms S, Gilmore RH, Glas J, Folwaczny M, Müller T, Berg T, Spengler U, Fitzmaurice K, Kelleher D, Reisch N, Rice CM, Endres S, Rothenfusser S. Polymorphisms in melanoma differentiation-associated gene 5 link protein function to clearance of hepatitis C virus. Hepatology 2015; 61:460-70. [PMID: 25130193 PMCID: PMC4315306 DOI: 10.1002/hep.27344] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [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: 12/04/2013] [Accepted: 07/28/2014] [Indexed: 12/24/2022]
Abstract
UNLABELLED Among patients newly infected with hepatitis C virus (HCV), only 20-30% clear the infection spontaneously. In the remaining 70% the infection persists, causing chronic liver inflammation and disease. It is well established that polymorphisms in host genes, especially in components of the innate immune response, contribute to the phenomenon of spontaneous HCV clearance. Retinoic acid inducible gene-I (RIG-I)-like helicases such as melanoma differentiation-associated gene 5 (MDA-5) are cytoplasmic sensors of viral RNA that are critical for triggering innate immune responses after infection with RNA viruses. We analyzed 14 nonsynonymous single-nucleotide polymorphisms in RIG-I-like helicase-pathway-genes comparing European patients who spontaneously cleared HCV (n = 285) or had persistent infection (n = 509). We found that polymorphic haplotypes in the MDA-5 gene IFIH1 encoding histidine at position 843 and threonine at position 946 strongly correlate with the resolution of HCV infection (odds ratio [OR]: 16.23; 95% confidence interval [CI]: 3.67-71.87; P = 1.1 × 10(-6) ). Overexpression of MDA-5 genetic variants in HEK 293 cells and in a tissue culture model of HCV infection revealed that the histidine 843/threonine 946 variant leads to increased baseline and ligand-induced expression of interferon-induced genes and confers an increased ability to suppress HCV replication. CONCLUSION These data suggest that MDA-5 plays a significant role in the defense against HCV and that polymorphisms in MDA-5 can influence the outcome of HCV infection.
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Affiliation(s)
- Franziska Hoffmann
- Center of Integrated Protein Research Munich (CIPS-M) and Division of Clinical Pharmacology, Medizinische Klinik IV, University of Munich,Institute of Clinical Neuroimmunology, Klinikum Großhadern, University of Munich
| | - Andreas Schmidt
- Center of Integrated Protein Research Munich (CIPS-M) and Division of Clinical Pharmacology, Medizinische Klinik IV, University of Munich
| | | | - Christian Wisskirchen
- Center of Integrated Protein Research Munich (CIPS-M) and Division of Clinical Pharmacology, Medizinische Klinik IV, University of Munich
| | - Johannes C. Hellmuth
- Center of Integrated Protein Research Munich (CIPS-M) and Division of Clinical Pharmacology, Medizinische Klinik IV, University of Munich
| | - Simone Willms
- Center of Integrated Protein Research Munich (CIPS-M) and Division of Clinical Pharmacology, Medizinische Klinik IV, University of Munich
| | - Rachel H. Gilmore
- Laboratory of Virology and Infectious Disease, The Rockefeller University, New York
| | - Jürgen Glas
- Department for Preventive Dentistry and Periodontology, University of Munich,Department of Human Genetics, RWTH Aachen
| | - Matthias Folwaczny
- Department for Preventive Dentistry and Periodontology, University of Munich
| | - Tobias Müller
- Department of Gastroenterology and Hepatology, Charité University Hospital, Berlin
| | - Thomas Berg
- Department of Gastroenterology and Rheumatology, Section Hepatology, University Hospital, Leipzig
| | | | - Karen Fitzmaurice
- Trinity Centre for Health Sciences, St. James’ Hospital, Dublin, Ireland
| | - Dermot Kelleher
- Trinity Centre for Health Sciences, St. James’ Hospital, Dublin, Ireland
| | - Nicole Reisch
- Section Gastroenterology and Endocrinology, Medizinische Klinik IV, University of Munich
| | - Charles M. Rice
- Laboratory of Virology and Infectious Disease, The Rockefeller University, New York
| | - Stefan Endres
- Center of Integrated Protein Research Munich (CIPS-M) and Division of Clinical Pharmacology, Medizinische Klinik IV, University of Munich
| | - Simon Rothenfusser
- Center of Integrated Protein Research Munich (CIPS-M) and Division of Clinical Pharmacology, Medizinische Klinik IV, University of Munich,Section Gastroenterology and Endocrinology, Medizinische Klinik IV, University of Munich
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Morrill JA, Shrestha M, Grant RW. Barriers to the treatment of hepatitis C. Patient, provider, and system factors. J Gen Intern Med 2005; 20:754-8. [PMID: 16050887 PMCID: PMC1490173 DOI: 10.1111/j.1525-1497.2005.0161.x] [Citation(s) in RCA: 154] [Impact Index Per Article: 8.1] [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: 03/18/2005] [Revised: 03/21/2005] [Accepted: 03/21/2005] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is both prevalent and undertreated. OBJECTIVE To identify barriers to HCV treatment in primary care practice. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS A cohort of 208 HCV-infected patients under the care of a primary care physician (PCP) between December 2001 and April 2004 at a single academically affiliated community health center. MEASUREMENTS Data were collected from the electronic medical record (EMR), the hospital clinical data repository, and interviews with PCPs. MAIN RESULTS Our cohort consisted of 208 viremic patients with HCV infection. The mean age was 47.6 (+/-9.7) years, 56% were male, and 79% were white. Fifty-seven patients (27.4% of the cohort) had undergone HCV treatment. Independent predictors of not being treated included: unmarried status (adjusted odds ratio [aOR] for treatment 0.36, P=.02), female gender (aOR 0.31, P=.01), current alcohol abuse (aOR 0.08, P=.0008), and a higher ratio of no-shows to total visits (aOR 0.005 per change of 1.0 in the ratio of no-shows to total visits, P=.002). The major PCP-identified reasons not to treat included: substance abuse (22.5%), patient preference (16%), psychiatric comorbidity (15%), and a delay in specialist input (12%). For 13% of the untreated patients, no reason was identified. CONCLUSIONS HCV treatment was infrequent in our cohort of outpatients. Barriers to treatment included patient factors (patient preference, alcohol use, missed appointments), provider factors (reluctance to treat past substance abusers), and system factors (referral-associated delays). Multimodal interventions may be required to increase HCV treatment rates.
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Affiliation(s)
- James A Morrill
- General Medicine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
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Bortolotti F, Resti M, Marcellini M, Giacchino R, Verucchi G, Nebbia G, Zancan L, Marazzi MG, Barbera C, Maccabruni A, Zuin G, Maggiore G, Balli F, Vajro P, Lepore L, Molesini M, Guido M, Bartolacci S, Noventa F. Hepatitis C virus (HCV) genotypes in 373 Italian children with HCV infection: changing distribution and correlation with clinical features and outcome. Gut 2005; 54:852-7. [PMID: 15888796 PMCID: PMC1774540 DOI: 10.1136/gut.2004.053744] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [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] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND AIMS Little is known of hepatitis C virus (HCV) genotypes in HCV infected children. This retrospective, multicentre study investigated genotype distribution and correlation with clinical features and outcome in a large series of Italian children. METHODS Between 1990 and 2002, 373 HCV RNA positive children, consecutively recruited in 15 centres, were assayed for genotypes by a commercial line probe assay. RESULTS The following genotype distribution pattern was recorded: genotype 1b = 41%; 1a = 20%; 2 = 17%; 3 = 14.5%; 4 = 5%; other = 2.5%. The prevalence of genotypes 1b and 2 decreased significantly (p<0.001) among children born from 1990 onwards compared with older children (46% v 70%) while the rate of genotypes 3 and 4 increased significantly (from 8% to 30%). Children infected with genotype 3 had the highest alanine aminotransferase levels and the highest rate of spontaneous viraemia clearance within the first three years of life (32% v 3% in children with genotype 1; p<0.001). Of 96 children enrolled in interferon trials during the survey, 22% definitely lost HCV RNA, including 57% of those with genotypes 2 and 3. CONCLUSION HCV genotypes 1 and 2 are still prevalent among infected adolescents and young adults in Italy but rates of infection with genotypes 3 and 4 are rapidly increasing among children. These changes could modify the clinical pattern of hepatitis C in forthcoming years as children infected with genotype 3 have the best chance of spontaneous viraemia clearance early in life, and respond to interferon in a high proportion of cases.
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Affiliation(s)
- F Bortolotti
- Clinica Medica 5, Via Giustiniani 2, 35100 Padova, Italy.
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Affiliation(s)
- J L Brown
- Cranfield Postgraduate Medical School in Gloucestershire, Gloucester Royal Hospital, Gloucester GL1 3NN, UK.
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11
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Affiliation(s)
- G Dusheiko
- Royal Free and University College School of Medicine, London NW3 2QG, UK.
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