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Ampuero J, Aller R, Gallego-Durán R, Crespo J, Calleja JL, García-Monzón C, Gómez-Camarero J, Caballería J, Lo Iacono O, Ibañez L, García-Samaniego J, Albillos A, Francés R, Fernández-Rodríguez C, Maya-Miles D, Diago M, Poca M, Andrade RJ, Latorre R, Jorquera F, Morillas RM, Escudero D, Hernández-Guerra M, Pareja-Megia MJ, Banales JM, Aspichueta P, Benlloch S, Rosales JM, Turnes J, Romero-Gómez M. The biochemical pattern defines MASLD phenotypes linked to distinct histology and prognosis. J Gastroenterol 2024:10.1007/s00535-024-02098-8. [PMID: 38619600 DOI: 10.1007/s00535-024-02098-8] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/09/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND MASLD can manifest as hepatocellular damage, which can result in mild elevation of aminotransferases. However, in some patients, MASLD presents with cholestatic pattern. OBJECTIVE To assess the impact of the biochemical pattern on the natural course of MASLD, including liver damage in histology, the accuracy of non-invasive tests(NITs), and prognosis. METHODS Multicenter study enrolling 2156 patients with biopsy-proven MASLD, who were classified based on their[ALT/ULN)]/[(ALP/ULN)] levels at the time of biopsy: (a) hepatocellular pattern(H), > 5; (b) mixed pattern(M),2-5; (c) cholestatic pattern(C), < 2. OUTCOMES (a) histological evaluation of the single components of NAS, MASH, and fibrosis; (b) NITs and transient elastography assessing advanced fibrosis; (c) prognosis determined by the appearance of decompensated cirrhosis and death. RESULTS Out of the 2156 patients, 22.9% exhibited the H-pattern, whilst 31.7% exhibited the C-pattern. Severe steatosis, ballooning, lobular inflammation, and MASH (56.4% H vs. 41.9% M vs. 31.9% C) were more common in H-pattern (p = 0.0001),whilst C-pattern was linked to cirrhosis (5.8% H vs. 5.6% M vs. 10.9% C; p = 0.0001). FIB-4(0.74(95% CI 0.69-0.79) vs. 0.83 (95% CI 0.80-0.85); p = 0.005) and Hepamet Fibrosis Score(0.77 (95% CI 0.69-0.85) vs. 0.84 (95% CI 0.80-0.87); p = 0.044)exhibited lower AUROCs in the H-pattern. The C-pattern[HR 2.37 (95% CI 1.12-5.02); p = 0.024], along with age, diabetes, and cirrhosis were independently associated with mortality. Most patients maintained their initial biochemical pattern during the second evaluation. CONCLUSIONS The H-pattern exhibited greater necro-inflammation in the histology than the C-pattern, whereas the latter showed more cirrhosis. The accuracy of NITs in detecting fibrosis was decreased in H-pattern. The occurrence of decompensated events and mortality was predominant in C-pattern. Therefore, identifying MASLD phenotypes based on the biochemical presentation could be relevant for clinical practice.
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Affiliation(s)
- Javier Ampuero
- Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain.
- SeLiver Group, Instituto de Biomedicina de Sevilla, Seville, Spain.
- Digestive Disease Department and CIBERehd, Virgen del Rocio University Hospital, Avenida Manuel Siurot S/N, 41013, Seville, Spain.
| | - Rocío Aller
- Centro de Investigación de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Universidad de Valladolid, Valladolid, Spain
| | - Rocío Gallego-Durán
- SeLiver Group, Instituto de Biomedicina de Sevilla, Seville, Spain
- Digestive Disease Department and CIBERehd, Virgen del Rocio University Hospital, Avenida Manuel Siurot S/N, 41013, Seville, Spain
| | - Javier Crespo
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Carmelo García-Monzón
- Liver Research Unit, Hospital Universitario Santa Cristina Instituto de Investigación Sanitaria Princesa Madrid, Madrid, Spain
| | | | - Joan Caballería
- Digestive Disease Department and CIBERehd, Virgen del Rocio University Hospital, Avenida Manuel Siurot S/N, 41013, Seville, Spain
- Liver Unit. Hospital Clínic. Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBPAS), Barcelona, Spain
| | | | - Luis Ibañez
- Digestive Disease Department and CIBERehd, Virgen del Rocio University Hospital, Avenida Manuel Siurot S/N, 41013, Seville, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier García-Samaniego
- Digestive Disease Department and CIBERehd, Virgen del Rocio University Hospital, Avenida Manuel Siurot S/N, 41013, Seville, Spain
- Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Agustín Albillos
- Digestive Disease Department and CIBERehd, Virgen del Rocio University Hospital, Avenida Manuel Siurot S/N, 41013, Seville, Spain
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Rubén Francés
- Digestive Disease Department and CIBERehd, Virgen del Rocio University Hospital, Avenida Manuel Siurot S/N, 41013, Seville, Spain
- Hospital General Universitario de Alicante, Universidad Miguel Hernández, Elche, Spain
| | | | - Douglas Maya-Miles
- SeLiver Group, Instituto de Biomedicina de Sevilla, Seville, Spain
- Digestive Disease Department and CIBERehd, Virgen del Rocio University Hospital, Avenida Manuel Siurot S/N, 41013, Seville, Spain
| | - Moisés Diago
- Hospital General Universitario de Valencia, Valencia, Spain
| | - Maria Poca
- Digestive Disease Department and CIBERehd, Virgen del Rocio University Hospital, Avenida Manuel Siurot S/N, 41013, Seville, Spain
- Hospital de la Santa Creu i San Pau, Barcelona, Spain
| | - Raúl J Andrade
- Digestive Disease Department and CIBERehd, Virgen del Rocio University Hospital, Avenida Manuel Siurot S/N, 41013, Seville, Spain
- Unidad de Gestión Clínica de Enfermedades Digestivas, Instituto de Investigación Biomédica de Málaga-IBIMA-Plataforma BIONAND, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Malaga, Spain
| | | | - Francisco Jorquera
- Digestive Disease Department and CIBERehd, Virgen del Rocio University Hospital, Avenida Manuel Siurot S/N, 41013, Seville, Spain
- Servicio de Aparato Digestivo, Complejo Asistencial Universitario de León, IBIOMED, León, España
| | - Rosa María Morillas
- Digestive Disease Department and CIBERehd, Virgen del Rocio University Hospital, Avenida Manuel Siurot S/N, 41013, Seville, Spain
- Hospital Germans Trias i Pujol, Badalona, Spain
| | - Desamparados Escudero
- Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
| | | | | | - Jesús M Banales
- Digestive Disease Department and CIBERehd, Virgen del Rocio University Hospital, Avenida Manuel Siurot S/N, 41013, Seville, Spain
- Department of Liver and Gastrointestinal Diseases, Biodonostia Research Institute, Donostia University Hospital, University of the Basque Country (UPV/EHU), Ikerbasque, San Sebastian, Spain
- Department of Biochemistry and Genetics, School of Sciences, University of Navarra, Pamplona, Spain
| | - Patricia Aspichueta
- Biocruces Research Institute, Barakaldo, Department of Physiology, Faculty of Medicine and Nursing, University of Basque Country UPV/EHU, Leioa, Spain
| | - Salvador Benlloch
- Digestive Disease Department and CIBERehd, Virgen del Rocio University Hospital, Avenida Manuel Siurot S/N, 41013, Seville, Spain
- Servicio de Digestivo Hospital Arnau de Vilanova, Valencia, Spain
| | | | - Juan Turnes
- Complejo Hospitalario Universitario de Pontevedra and IIS Galicia Sur, Pontevedra, Spain
| | - Manuel Romero-Gómez
- Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain
- SeLiver Group, Instituto de Biomedicina de Sevilla, Seville, Spain
- Digestive Disease Department and CIBERehd, Virgen del Rocio University Hospital, Avenida Manuel Siurot S/N, 41013, Seville, Spain
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Razavi-Shearer D, Child H, Razavi-Shearer K, Voeller A, Razavi H, Buti M, Tacke F, Terrault N, Zeuzem S, Abbas Z, Aghemo A, Akarca U, Al Masri N, Alalwan A, Blomé MA, Jerkeman A, Aleman S, Kamal H, Alghamdi A, Alghamdi M, Alghamdi S, Al-Hamoudi W, Ali E, Aljumah A, Altraif I, Amarsanaa J, Asselah T, Baatarkhuu O, Babameto A, Ben-Ari Z, Berg T, Biondi M, Braga W, Brandão-Mello C, Brown R, Brunetto M, Cabezas J, Cardoso M, Martins A, Chan H, Cheinquer H, Chen CJ, Yang HI, Chen PJ, Chien CH, Chuang WL, Garza LC, Coco B, Coffin C, Coppola N, Cornberg M, Craxi A, Crespo J, Cuko L, De Ledinghen V, Duberg AS, Etzion O, Ferraz M, Ferreira P, Forns X, Foster G, Fung J, Gaeta G, García-Samaniego J, Genov J, Gheorghe L, Gholam P, Gish R, Glenn J, Hamid S, Hercun J, Hsu YC, Hu CC, Huang JF, Idilman R, Jafri W, Janjua N, Jelev D, Jia J, Kåberg M, Kaita K, Kao JH, Khan A, Kim D, Kondili L, Lagging M, Lampertico P, Lázaro P, Lazarus J, Lee MH, Yang HI, Lim YS, Lobato C, Macedo G, Marinho R, Marotta P, Mendes-Correa M, Méndez-Sánchez N, Navas MC, Ning Q, Örmeci N, Orrego M, Osiowy C, Pan C, Pessoa M, Piracha Z, Pop C, Qureshi H, Raimondo G, Ramji A, Ribeiro S, Ríos-Hincapié C, Rodríguez M, Rosenberg W, Roulot D, Ryder S, Saeed U, Safadi R, Shouval D, Sanai F, Sanchez-Avila J, Santantonio T, Sarrazin C, Seto WK, Seto WK, Simonova M, Tanaka J, Tergast T, Tsendsuren O, Valente C, Villalobos-Salcedo J, Waheed Y, Wong G, Wong V, Yip T, Wong V, Wu JC, Yang HI, Yu ML, Yuen MF, Yurdaydin C, Zuckerman E. Adjusted estimate of the prevalence of hepatitis delta virus in 25 countries and territories. J Hepatol 2024; 80:232-242. [PMID: 38030035 DOI: 10.1016/j.jhep.2023.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/13/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND & AIMS Hepatitis delta virus (HDV) is a satellite RNA virus that requires the hepatitis B virus (HBV) for assembly and propagation. Individuals infected with HDV progress to advanced liver disease faster than HBV-monoinfected individuals. Recent studies have estimated the global prevalence of anti-HDV antibodies among the HBV-infected population to be 5-15%. This study aimed to better understand HDV prevalence at the population level in 25 countries/territories. METHODS We conducted a literature review to determine the prevalence of anti-HDV and HDV RNA in hepatitis B surface antigen (HBsAg)-positive individuals in 25 countries/territories. Virtual meetings were held with experts from each setting to discuss the findings and collect unpublished data. Data were weighted for patient segments and regional heterogeneity to estimate the prevalence in the HBV-infected population. The findings were then combined with The Polaris Observatory HBV data to estimate the anti-HDV and HDV RNA prevalence in each country/territory at the population level. RESULTS After adjusting for geographical distribution, disease stage and special populations, the anti-HDV prevalence among the HBsAg+ population changed from the literature estimate in 19 countries. The highest anti-HDV prevalence was 60.1% in Mongolia. Once adjusted for the size of the HBsAg+ population and HDV RNA positivity rate, China had the highest absolute number of HDV RNA+ cases. CONCLUSIONS We found substantially lower HDV prevalence than previously reported, as prior meta-analyses primarily focused on studies conducted in groups/regions that have a higher probability of HBV infection: tertiary care centers, specific risk groups or geographical regions. There is large uncertainty in HDV prevalence estimates. The implementation of reflex testing would improve estimates, while also allowing earlier linkage to care for HDV RNA+ individuals. The logistical and economic burden of reflex testing on the health system would be limited, as only HBsAg+ cases would be screened. IMPACT AND IMPLICATIONS There is a great deal of uncertainty surrounding the prevalence of hepatitis delta virus among people living with hepatitis B virus at the population level. In this study, we aimed to better understand the burden in 25 countries and territories, to refine techniques that can be used in future analyses. We found a lower prevalence in the majority of places studied than had been previously reported. These data can help inform policy makers on the need to screen people living with hepatitis B virus to find those coinfected with hepatitis delta virus and at high risk of progression, while also highlighting the pitfalls that other researchers have often fallen into.
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3
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Mehta G, Riva A, Ballester MP, Uson E, Pujadas M, Carvalho-Gomes Â, Sahuco I, Bono A, D’Amico F, Viganò R, Diago E, Lanseros BT, Inglese E, Vazquez DM, Sharma R, Tsou HLP, Harris N, Broekhoven A, Kikkert M, Morales SPT, Myeni SK, Riveiro-Barciela M, Palom A, Zeni N, Brocca A, Cussigh A, Cmet S, Escudero-García D, Stocco M, Natola LA, Ieluzzi D, Paon V, Sangiovanni A, Farina E, di Benedetto C, Sánchez-Torrijos Y, Lucena-Varela A, Román E, Sánchez E, Sánchez-Aldehuelo R, López-Cardona J, Canas-Perez I, Eastgate C, Jeyanesan D, Morocho AE, Di Cola S, Lapenna L, Zaccherini G, Bongiovanni D, Zanaga P, Sayaf K, Hossain S, Crespo J, Robles-Díaz M, Madejón A, Degroote H, Fernández J, Korenjak M, Verhelst X, García-Samaniego J, Andrade RJ, Iruzubieta P, Wright G, Caraceni P, Merli M, Patel VC, Gander A, Albillos A, Soriano G, Donato MF, Sacerdoti D, Toniutto P, Buti M, Duvoux C, Grossi PA, Berg T, Polak WG, Puoti M, Bosch-Comas A, Belli L, Burra P, Russo FP, Coenraad M, Calleja JL, Perricone G, Berenguer M, Claria J, Moreau R, Arroyo V, Angeli P, Sánchez C, Ampuero J, Piano S, Chokshi S, Jalan R. Serological response and breakthrough infection after COVID-19 vaccination in patients with cirrhosis and post-liver transplant. Hepatol Commun 2023; 7:e0273. [PMID: 37870985 PMCID: PMC10586829 DOI: 10.1097/hc9.0000000000000273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/21/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Vaccine hesitancy and lack of access remain major issues in disseminating COVID-19 vaccination to liver patients globally. Factors predicting poor response to vaccination and risk of breakthrough infection are important data to target booster vaccine programs. The primary aim of the current study was to measure humoral responses to 2 doses of COVID-19 vaccine. Secondary aims included the determination of factors predicting breakthrough infection. METHODS COVID-19 vaccination and Biomarkers in cirrhosis And post-Liver Transplantation is a prospective, multicenter, observational case-control study. Participants were recruited at 4-10 weeks following first and second vaccine doses in cirrhosis [n = 325; 94% messenger RNA (mRNA) and 6% viral vaccine], autoimmune liver disease (AILD) (n = 120; 77% mRNA and 23% viral vaccine), post-liver transplant (LT) (n = 146; 96% mRNA and 3% viral vaccine), and healthy controls (n = 51; 72% mRNA, 24% viral and 4% heterologous combination). Serological end points were measured, and data regarding breakthrough SARS-CoV-2 infection were collected. RESULTS After adjusting by age, sex, and time of sample collection, anti-Spike IgG levels were the lowest in post-LT patients compared to cirrhosis (p < 0.0001), AILD (p < 0.0001), and control (p = 0.002). Factors predicting reduced responses included older age, Child-Turcotte-Pugh B/C, and elevated IL-6 in cirrhosis; non-mRNA vaccine in AILD; and coronary artery disease, use of mycophenolate and dysregulated B-call activating factor, and lymphotoxin-α levels in LT. Incident infection occurred in 6.6%, 10.6%, 7.4%, and 15.6% of cirrhosis, AILD, post-LT, and control, respectively. The only independent factor predicting infection in cirrhosis was low albumin level. CONCLUSIONS LT patients present the lowest response to the SARS-CoV-2 vaccine. In cirrhosis, the reduced response is associated with older age, stage of liver disease and systemic inflammation, and breakthrough infection with low albumin level.
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Affiliation(s)
- Gautam Mehta
- Institute for Liver and Digestive Heath, University College London, London, UK
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Antonio Riva
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Maria Pilar Ballester
- Department of Gastroenterology and Hepatology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Eva Uson
- European Foundation for the Study of Chronic Liver Failure (EF CLIF), EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain
| | - Montserrat Pujadas
- European Foundation for the Study of Chronic Liver Failure (EF CLIF), EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain
| | - Ângela Carvalho-Gomes
- Hepatology, HBP Surgery and Transplantation, Hepatology & Liver Transplant Unit, La Fe University Hospital, Valencia, Spain
- Ciberehd, Universidad de Valencia, Valencia, Spain
| | - Ivan Sahuco
- Hepatology, HBP Surgery and Transplantation, Hepatology & Liver Transplant Unit, La Fe University Hospital, Valencia, Spain
- Ciberehd, Universidad de Valencia, Valencia, Spain
| | - Ariadna Bono
- Hepatology, HBP Surgery and Transplantation, Hepatology & Liver Transplant Unit, La Fe University Hospital, Valencia, Spain
- Ciberehd, Universidad de Valencia, Valencia, Spain
| | - Federico D’Amico
- ASST Grande Ospedale Metropolitano Niguarda, Infectious Diseases Unit, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, Milan, Italy
| | - Raffaela Viganò
- ASST Grande Ospedale Metropolitano Niguarda, Hepatology and Gastroenterology Unit, Milan, Italy
| | - Elena Diago
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHIM, Madrid, Spain
- Central Unit of Clinical Research and Clinical Trials, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
- CIBERehd, Madrid, Spain
| | - Beatriz Tormo Lanseros
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHIM, Madrid, Spain
- CIBERehd, Madrid, Spain
| | - Elvira Inglese
- ASST Grande Ospedale Metropolitano Niguarda, Hepatology and Gastroenterology Unit, Milan, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | - Rajni Sharma
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London, UK
| | - Hio Lam Phoebe Tsou
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London, UK
| | - Nicola Harris
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London, UK
| | - Annelotte Broekhoven
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, RC Leiden, the Netherlands
| | - Marjolein Kikkert
- Department of Medical Microbiology, Leiden University Medical Center, RC Leiden, the Netherlands
| | - Shessy P. Torres Morales
- Department of Medical Microbiology, Leiden University Medical Center, RC Leiden, the Netherlands
| | - Sebenzile K. Myeni
- Department of Medical Microbiology, Leiden University Medical Center, RC Leiden, the Netherlands
| | | | - Adriana Palom
- Liver Unit, Hospital Universitario Valle de Hebron, Barcelona, Spain
| | - Nicola Zeni
- Department of Medicine - DIMED, Unit of Internal Medicine and Hepatology (UIMH), University of Padova, Padova, Italy
| | - Alessandra Brocca
- Department of Medicine - DIMED, Unit of Internal Medicine and Hepatology (UIMH), University of Padova, Padova, Italy
| | - Annarosa Cussigh
- Hepatology and Liver Transplantation Unit, Azienda Sanitaria Universitaria Integrata, University of Udine, Udine, Italy
| | - Sara Cmet
- Hepatology and Liver Transplantation Unit, Azienda Sanitaria Universitaria Integrata, University of Udine, Udine, Italy
| | | | - Matteo Stocco
- Department of Gastroenterology and Hepatology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | | | - Veronica Paon
- Azienda Ospedaiera Universitaria Integrata Verona, Verona Italy
| | - Angelo Sangiovanni
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
| | - Elisa Farina
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
| | - Clara di Benedetto
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
| | - Yolanda Sánchez-Torrijos
- Hospital Universitario Virgen del Rocio, Sevilla. Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Sevilla, Spain
| | - Ana Lucena-Varela
- Hospital Universitario Virgen del Rocio, Sevilla. Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Sevilla, Spain
| | - Eva Román
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- EUI-Sant Pau School of Nursing, Barcelona, Spain
| | - Elisabet Sánchez
- CIBERehd, Madrid, Spain
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Rubén Sánchez-Aldehuelo
- Servicio de Gastroenterología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto Salud Carlos III, Madrid, Spain
- Universidad de Alcalá, Madrid, Spain
| | - Julia López-Cardona
- Servicio de Gastroenterología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto Salud Carlos III, Madrid, Spain
| | | | | | - Dhaarica Jeyanesan
- Institute of Liver Studies, King’s College Hospital NHS Foundation Trust, London, UK
| | | | - Simone Di Cola
- Department of Translational and Precision Medicine, University of Rome Sapienza, Roma, Italy
| | - Lucia Lapenna
- Department of Translational and Precision Medicine, University of Rome Sapienza, Roma, Italy
| | - Giacomo Zaccherini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Deborah Bongiovanni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Paola Zanaga
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Gastroenterology and Multivisceral Transplant Units, Azienda Ospedale Università’ di Padova, Padova, Italy
| | - Katia Sayaf
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Gastroenterology and Multivisceral Transplant Units, Azienda Ospedale Università’ di Padova, Padova, Italy
| | - Sabir Hossain
- Mid & South Essex NHS Foundation Trust, Basildon, UK
| | - Javier Crespo
- Gastroenterology and Hepatology Department, Marqués de Valdecilla University Hospital, Santander, Spain
- Clinical and Traslational Digestive Research Group, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Mercedes Robles-Díaz
- CIBERehd, Madrid, Spain
- Servicio de Aparato Digestivo, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | - Antonio Madejón
- Liver Unit, Hospital Universitario La Paz, CIBERehd, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
| | - Helena Degroote
- Department of Gastroenterology and Hepatology, Ghent University Hospital, Belgium
- Liver Research Center Ghent, Ghent University, Belgium
- European Reference Network (ERN)RARE-LIVER
| | - Javier Fernández
- European Foundation for the Study of Chronic Liver Failure (EF CLIF), EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain
- Liver Unit, Hospital Clínic, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS) and Centro de Investigación Biomèdica en Red (CIBEREHD), Barcelona, Spain
| | | | - Xavier Verhelst
- Department of Gastroenterology and Hepatology, Ghent University Hospital, Belgium
- Liver Research Center Ghent, Ghent University, Belgium
- European Reference Network (ERN)RARE-LIVER
| | - Javier García-Samaniego
- Liver Unit, Hospital Universitario La Paz, CIBERehd, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
| | - Raúl J. Andrade
- CIBERehd, Madrid, Spain
- Servicio de Aparato Digestivo, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | - Paula Iruzubieta
- Gastroenterology and Hepatology Department, Marqués de Valdecilla University Hospital, Santander, Spain
- Clinical and Traslational Digestive Research Group, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Gavin Wright
- Mid & South Essex NHS Foundation Trust, Basildon, UK
| | - Paolo Caraceni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-related Diseases, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Manuela Merli
- Department of Translational and Precision Medicine, University of Rome Sapienza, Roma, Italy
| | - Vishal C Patel
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
- Institute of Liver Studies, King’s College Hospital NHS Foundation Trust, London, UK
| | - Amir Gander
- Royal Free London NHS Foundation Trust, London, UK
| | - Agustín Albillos
- Servicio de Gastroenterología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto Salud Carlos III, Madrid, Spain
| | - Germán Soriano
- CIBERehd, Madrid, Spain
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Maria Francesca Donato
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
| | - David Sacerdoti
- Azienda Ospedaiera Universitaria Integrata Verona, Verona Italy
| | - Pierluigi Toniutto
- Hepatology and Liver Transplantation Unit, Azienda Sanitaria Universitaria Integrata, University of Udine, Udine, Italy
| | - Maria Buti
- Liver Unit, Hospital Universitario Valle de Hebron, Barcelona, Spain
| | - Christophe Duvoux
- Department of Hepatogy-Liver Transplant Unit, Henri Mondor Hospital-APHP, Paris Est University, Paris, France
| | - Paolo Antonio Grossi
- Department of Medicine and Surgery, University of Insubria, Infectious and Tropical Diseases Unit, ASST Sette Laghim, Varese, Italy
| | - Thomas Berg
- European Association for the Study of the Liver (EASL)
| | - Wojciech G. Polak
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Massimo Puoti
- University of Milano Bicocca, Infectious Diseases Niguarda Great Metropolitan Hospital, Milan, Italy
| | - Anna Bosch-Comas
- European Foundation for the Study of Chronic Liver Failure (EF CLIF), EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain
| | - Luca Belli
- ASST Grande Ospedale Metropolitano Niguarda, Hepatology and Gastroenterology Unit, Milan, Italy
| | - Patrizia Burra
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Gastroenterology and Multivisceral Transplant Units, Azienda Ospedale Università’ di Padova, Padova, Italy
| | - Francesco Paolo Russo
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Gastroenterology and Multivisceral Transplant Units, Azienda Ospedale Università’ di Padova, Padova, Italy
| | - Minneke Coenraad
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, RC Leiden, the Netherlands
| | - José Luis Calleja
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHIM, Madrid, Spain
- CIBERehd, Madrid, Spain
| | - Giovanni Perricone
- ASST Grande Ospedale Metropolitano Niguarda, Hepatology and Gastroenterology Unit, Milan, Italy
| | - Marina Berenguer
- Hepatology, HBP Surgery and Transplantation, Hepatology & Liver Transplant Unit, La Fe University Hospital, Valencia, Spain
- Ciberehd, Universidad de Valencia, Valencia, Spain
| | - Joan Claria
- European Foundation for the Study of Chronic Liver Failure (EF CLIF), EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain
- Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red (CIBERehd) and Universitat de Barcelona, Barcelona, Spain
| | - Richard Moreau
- European Foundation for the Study of Chronic Liver Failure (EF CLIF), EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain
- INSERM and Université Paris Cité, Centre de Recherche sur l’inflammation (CRI), Paris, France
- APHP, Service d’hépatologie, Hôpital Beaujon, Clichy, France
| | - Vicente Arroyo
- European Foundation for the Study of Chronic Liver Failure (EF CLIF), EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain
| | - Paolo Angeli
- Department of Medicine - DIMED, Unit of Internal Medicine and Hepatology (UIMH), University of Padova, Padova, Italy
| | - Cristina Sánchez
- European Foundation for the Study of Chronic Liver Failure (EF CLIF), EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain
| | - Javier Ampuero
- Hospital Universitario Virgen del Rocio, Sevilla. Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Sevilla, Spain
| | - Salvatore Piano
- Department of Medicine - DIMED, Unit of Internal Medicine and Hepatology (UIMH), University of Padova, Padova, Italy
| | - Shilpa Chokshi
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Rajiv Jalan
- Institute for Liver and Digestive Heath, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
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Razavi-Shearer D, Gamkrelidze I, Pan C, Jia J, Berg T, Gray R, Lim YS, Chen CJ, Ocama P, Desalegn H, Abbas Z, Abdallah A, Aghemo A, Ahmadbekova S, Ahn SH, Aho I, Akarca U, Al Masri N, Alalwan A, Alavian S, Al-Busafi S, Aleman S, Alfaleh F, Alghamdi A, Al-Hamoudi W, Aljumah A, Al-Naamani K, Al-Rifai A, Alserkal Y, Altraif I, Amarsanaa J, Anderson M, Andersson M, Armstrong P, Asselah T, Athanasakis K, Baatarkhuu O, Ben-Ari Z, Bensalem A, Bessone F, Biondi M, Bizri AR, Blach S, Braga W, Brandão-Mello C, Brosgart C, Brown K, Brown, Jr R, Bruggmann P, Brunetto M, Buti M, Cabezas J, Casanovas T, Chae C, Chan HLY, Cheinquer H, Chen PJ, Cheng KJ, Cheon ME, Chien CH, Choudhuri G, Christensen PB, Chuang WL, Chulanov V, Cisneros L, Coffin C, Contreras F, Coppola N, Cornberg M, Cowie B, Cramp M, Craxi A, Crespo J, Cui F, Cunningham C, Dalgard O, De Knegt R, De Ledinghen V, Dore G, Drazilova S, Duberg AS, Egeonu S, Elbadri M, El-Kassas M, El-Sayed M, Estes C, Etzion O, Farag E, Ferradini L, Ferreira P, Flisiak R, Forns X, Frankova S, Fung J, Gane E, Garcia V, García-Samaniego J, Gemilyan M, Genov J, Gheorghe L, Gholam P, Gish R, Goleij P, Gottfredsson M, Grebely J, Gschwantler M, Guingane NA, Hajarizadeh B, Hamid S, Hamoudi W, Harris A, Hasan I, Hatzakis A, Hellard M, Hercun J, Hernandez J, Hockicková I, Hsu YC, Hu CC, Husa P, Janicko M, Janjua N, Jarcuska P, Jaroszewicz J, Jelev D, Jeruma A, Johannessen A, Kåberg M, Kaita K, Kaliaskarova K, Kao JH, Kelly-Hanku A, Khamis F, Khan A, Kheir O, Khoudri I, Kondili L, Konysbekova A, Kristian P, Kwon J, Lagging M, Laleman W, Lampertico P, Lavanchy D, Lázaro P, Lazarus JV, Lee A, Lee MH, Liakina V, Lukšić B, Malekzadeh R, Malu A, Marinho R, Mendes-Correa MC, Merat S, Meshesha BR, Midgard H, Mohamed R, Mokhbat J, Mooneyhan E, Moreno C, Mortgat L, Müllhaupt B, Musabaev E, Muyldermans G, Naveira M, Negro F, Nersesov A, Nguyen VTT, Ning Q, Njouom R, Ntagirabiri R, Nurmatov Z, Oguche S, Omuemu C, Ong J, Opare-Sem O, Örmeci N, Orrego M, Osiowy C, Papatheodoridis G, Peck-Radosavljevic M, Pessoa M, Pham T, Phillips R, Pimenov N, Pincay-Rodríguez L, Plaseska-Karanfilska D, Pop C, Poustchi H, Prabdial-Sing N, Qureshi H, Ramji A, Rautiainen H, Razavi-Shearer K, Remak W, Ribeiro S, Ridruejo E, Ríos-Hincapié C, Robalino M, Roberts L, Roberts S, Rodríguez M, Roulot D, Rwegasha J, Ryder S, Sadirova S, Saeed U, Safadi R, Sagalova O, Said S, Salupere R, Sanai F, Sanchez-Avila JF, Saraswat V, Sargsyants N, Sarrazin C, Sarybayeva G, Schréter I, Seguin-Devaux C, Seto WK, Shah S, Sharara A, Sheikh M, Shouval D, Sievert W, Simojoki K, Simonova M, Sinn DH, Sonderup M, Sonneveld M, Spearman CW, Sperl J, Stauber R, Stedman C, Sypsa V, Tacke F, Tan SS, Tanaka J, Tergast T, Terrault N, Thompson A, Thompson P, Tolmane I, Tomasiewicz K, Tsang TY, Uzochukwu B, Van Welzen B, Vanwolleghem T, Vince A, Voeller A, Waheed Y, Waked I, Wallace J, Wang C, Weis N, Wong G, Wong V, Wu JC, Yaghi C, Yesmembetov K, Yip T, Yosry A, Yu ML, Yuen MF, Yurdaydin C, Zeuzem S, Zuckerman E, Razavi H. Global prevalence, cascade of care, and prophylaxis coverage of hepatitis B in 2022: a modelling study. Lancet Gastroenterol Hepatol 2023; 8:879-907. [PMID: 37517414 DOI: 10.1016/s2468-1253(23)00197-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/25/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND The 2016 World Health Assembly endorsed the elimination of hepatitis B virus (HBV) infection as a public health threat by 2030; existing therapies and prophylaxis measures make such elimination feasible, even in the absence of a virological cure. We aimed to estimate the national, regional, and global prevalence of HBV in the general population and among children aged 5 years and younger, as well as the rates of diagnosis, treatment, prophylaxis, and the future burden globally. METHODS In this modelling study, we used a Delphi process with data from literature reviews and interviews with country experts to quantify the prevalence, diagnosis, treatment, and prevention measures for HBV infection. The PRoGReSs Model, a dynamic Markov model, was used to estimate the country, regional, and global prevalence of HBV infection in 2022, and the effects of treatment and prevention on disease burden. The future incidence of morbidity and mortality in the absence of additional interventions was also estimated at the global level. FINDINGS We developed models for 170 countries which resulted in an estimated global prevalence of HBV infection in 2022 of 3·2% (95% uncertainty interval 2·7-4·0), corresponding to 257·5 million (216·6-316·4) individuals positive for HBsAg. Of these individuals, 36·0 million were diagnosed, and only 6·8 million of the estimated 83·3 million eligible for treatment were on treatment. The prevalence among children aged 5 years or younger was estimated to be 0·7% (0·6-1·0), corresponding to 5·6 million (4·5-7·8) children with HBV infection. Based on the most recent data, 85% of infants received three-dose HBV vaccination before 1 year of age, 46% had received a timely birth dose of vaccine, and 14% received hepatitis B immunoglobulin along with the full vaccination regimen. 3% of mothers with a high HBV viral load received antiviral treatment to reduce mother-to-child transmission. INTERPRETATION As 2030 approaches, the elimination targets remain out of reach for many countries under the current frameworks. Although prevention measures have had the most success, there is a need to increase these efforts and to increase diagnosis and treatment to work towards the elimination goals. FUNDING John C Martin Foundation, Gilead Sciences, and EndHep2030.
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5
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Martínez-Campreciós J, Riveiro-Barciela M, Muñoz-Gómez R, Londoño MC, Roget M, Serra MÁ, Escudero-García D, Purchades L, Rodríguez M, Losa-García JE, Gutiérrez ML, Carmona I, García-Samaniego J, Morano L, Martín-Granizo I, Montero-Alonso M, Prieto M, Delgado M, Ramos N, Azancot MA, Rodríguez-Frías F, Buti M. Long-term follow-up of HCV-infected patients with end-stage chronic kidney disease after sustained virological response with direct-acting antiviral therapy. Gastroenterol Hepatol 2023; 46:594-602. [PMID: 36584754 DOI: 10.1016/j.gastrohep.2022.12.004] [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] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/15/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIM Patients with chronic kidney disease (CKD) and hepatitis C infection can be safely and effectively treated with direct-acting antivirals (DAAs). However, there is scarce data on the long-term impact of hepatitis C cure on CKD. The aim of this study was to assess the long-term mortality, morbidity and hepatic/renal function outcomes in a cohort of HCV-infected individuals with CKD treated with DAAs. METHODS 135 HCV patients with CKD stage 3b-5 who received ombitasvir/paritaprevir/ritonavir±dasabuvir in a multicenter study were evaluated for long-term hepatic and renal outcomes and their associated mortality. RESULTS 125 patients achieved SVR and 66 were included. Prior to SVR, 53 were under renal replacement therapy (RRT) and 25 (37.8%) had liver cirrhosis. After a follow-up of 4.5 years, 25 (38%) required kidney transplantation but none combined liver-kidney. No changes in renal function were observed among the 51 patients who did not receive renal transplant although eGFR values improved in those with baseline CKD stage 3b-4. Three (5.6%) subjects were weaned from RRT. Eighteen (27.3%) patients died, mostly from cardiovascular events; 2 developed liver decompensation and 1 hepatocellular carcinoma. No HCV reinfection was observed. CONCLUSIONS Long-term mortality remained high among end-stage CKD patients despite HCV cure. Overall, no improvement in renal function was observed and a high proportion of patients required kidney transplantation. However, in CKD stage 3b-4 HCV cure may play a positive role in renal function.
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Affiliation(s)
- Joan Martínez-Campreciós
- Liver Unit, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Mar Riveiro-Barciela
- Liver Unit, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Bellaterra, Spain; CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.
| | - Raquel Muñoz-Gómez
- Department of Gastroenterology, Hospital General Universitario 12 de Octubre, Madrid, Spain
| | - María-Carlota Londoño
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Hospital Clínic/IDIBAPS, Barcelona, Spain
| | - Mercé Roget
- Liver Unit, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain
| | - Miguel Ángel Serra
- Digestive Medicine Service, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Desamparados Escudero-García
- Digestive Medicine Service, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Laura Purchades
- Digestive Medicine Service, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Manuel Rodríguez
- Department of Gastroenterology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Juan E Losa-García
- Infectious Diseases Unit, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - María L Gutiérrez
- Department of Gastroenterology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Isabel Carmona
- Digestive Disease Unit, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Javier García-Samaniego
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Hospital Universitario La Paz/IdiPaz, Madrid, Madrid, Spain
| | - Luís Morano
- Infectious Disease Unit, Internal Medicine Department, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain; RIS (Red Española de Investigación en SIDA), Madrid, Spain
| | - Ignacio Martín-Granizo
- Department of Gastroenterology, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Marta Montero-Alonso
- Infectious Diseases Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Martín Prieto
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain; Liver Transplantation and Hepatology Unit, Hospital Universitari I Politècnic La Fe-IIS, La Fe, Valencia, Spain
| | - Manuel Delgado
- Digestive Disease Unit, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Natalia Ramos
- Department of Nephrology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - María A Azancot
- Department of Nephrology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Francisco Rodríguez-Frías
- Medicine Department, Universitat Autònoma de Barcelona, Bellaterra, Spain; CIBERehd, Instituto de Salud Carlos III, Madrid, Spain; Liver Pathology Lab, Biochemistry and Microbiology Departments (Clinical Laboratories), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Maria Buti
- Liver Unit, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Bellaterra, Spain; CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
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6
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Razavi HA, Buti M, Terrault NA, Zeuzem S, Yurdaydin C, Tanaka J, Aghemo A, Akarca US, Al Masri NM, Alalwan AM, Aleman S, Alghamdi AS, Alghamdi S, Al-Hamoudi WK, Aljumah AA, Altraif IH, Asselah T, Ben-Ari Z, Berg T, Biondi MJ, Blach S, Braga WSM, Brandão-Mello CE, Brunetto MR, Cabezas J, Cheinquer H, Chen PJ, Cheon ME, Chuang WL, Coffin CS, Coppola N, Craxi A, Crespo J, De Ledinghen V, Duberg AS, Etzion O, Ferraz MLG, Ferreira PRA, Forns X, Foster GR, Gaeta GB, Gamkrelidze I, García-Samaniego J, Gheorghe LS, Gholam PM, Gish RG, Glenn J, Hercun J, Hsu YC, Hu CC, Huang JF, Janjua N, Jia J, Kåberg M, Kaita KDE, Kamal H, Kao JH, Kondili LA, Lagging M, Lázaro P, Lazarus JV, Lee MH, Lim YS, Marotta PJ, Navas MC, Naveira MCM, Orrego M, Osiowy C, Pan CQ, Pessoa MG, Raimondo G, Ramji A, Razavi-Shearer DM, Razavi-Shearer K, Ríos-Hincapié CY, Rodríguez M, Rosenberg WMC, Roulot DM, Ryder SD, Safadi R, Sanai FM, Santantonio TA, Sarrazin C, Shouval D, Tacke F, Tergast TL, Villalobos-Salcedo JM, Voeller AS, Yang HI, Yu ML, Zuckerman E. Hepatitis D double reflex testing of all hepatitis B carriers in low-HBV- and high-HBV/HDV-prevalence countries. J Hepatol 2023; 79:576-580. [PMID: 37030400 DOI: 10.1016/j.jhep.2023.02.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 09/30/2022] [Revised: 01/19/2023] [Accepted: 02/24/2023] [Indexed: 04/10/2023]
Abstract
Hepatitis D virus (HDV) infection occurs as a coinfection with hepatitis B and increases the risk of hepatocellular carcinoma, decompensated cirrhosis, and mortality compared to hepatitis B virus (HBV) monoinfection. Reliable estimates of the prevalence of HDV infection and disease burden are essential to formulate strategies to find coinfected individuals more effectively and efficiently. The global prevalence of HBV infections was estimated to be 262,240,000 in 2021. Only 1,994,000 of the HBV infections were newly diagnosed in 2021, with more than half of the new diagnoses made in China. Our initial estimates indicated a much lower prevalence of HDV antibody (anti-HDV) and HDV RNA positivity than previously reported in published studies. Accurate estimates of HDV prevalence are needed. The most effective method to generate estimates of the prevalence of anti-HDV and HDV RNA positivity and to find undiagnosed individuals at the national level is to implement double reflex testing. This requires anti-HDV testing of all hepatitis B surface antigen-positive individuals and HDV RNA testing of all anti-HDV-positive individuals. This strategy is manageable for healthcare systems since the number of newly diagnosed HBV cases is low. At the global level, a comprehensive HDV screening strategy would require only 1,994,000 HDV antibody tests and less than 89,000 HDV PCR tests. Double reflex testing is the preferred strategy in countries with a low prevalence of HBV and those with a high prevalence of both HBV and HDV. For example, in the European Union and North America only 35,000 and 22,000 cases, respectively, will require anti-HDV testing annually.
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Affiliation(s)
- Homie A Razavi
- Center for Disease Analysis Foundation, Lafayette, United States.
| | - Maria Buti
- Liver Unit, Hospital Universitari Vall d Hebron and CIBEREHD del Insituto Carlos III. Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Norah A Terrault
- Keck Medicine of University of Southern California, Los Angeles, United States
| | - Stefan Zeuzem
- Department of Medicine, University Hospital, Frankfurt, Germany
| | - Cihan Yurdaydin
- Department of Gastroenterology and Hepatology, Koç University Medical School, Istanbul, Turkey
| | - Junko Tanaka
- Epidemiology, Infectious Disease Control and Prevention, Hiroshima University, Hiroshima, Japan
| | - Alessio Aghemo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Gastroenterology, Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Ulus S Akarca
- Department of Gastroenterology, Ege University, Medical School, Izmir, Turkey
| | - Nasser M Al Masri
- Department of Gastroenterology & Hepatology, Prince Sultan Medical Military City (PSMMC), Riyadh, Saudi Arabia
| | - Abduljaleel M Alalwan
- Department of Hepatobiliary Science and Liver Transplantation King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Soo Aleman
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Abdullah S Alghamdi
- Gastroenterology Unit/Medical Department, King Fahad General Hospital, Jeddah, Saudi Arabia
| | - Saad Alghamdi
- Liver & Small Bowel Health Centre Department, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | | | - Abdulrahman A Aljumah
- Department of Clinical Sciences, College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - Ibrahim H Altraif
- Hepatology Division - Hepatobiliary Sciences and Organ Transplant Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Tarik Asselah
- Hepatology Department, University of Paris-Cité, Hôpital Beaujon, AP-HP, INSERM UMR1149, Paris, France
| | - Ziv Ben-Ari
- Liver Diseases Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Mia J Biondi
- School of Nursing, York University, Toronto, Canada
| | - Sarah Blach
- Epidemiology, Center for Disease Analysis Foundation, Lafayette, United States
| | - Wornei S M Braga
- Virology Department, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Carlos E Brandão-Mello
- Internal Medicine & Gastroenterology, University of Rio de Janeiro, Rio de Janeiro, Brazil; Clinica de Doenças do Fígado, Rio de Janeiro, Brazil
| | - Maurizia R Brunetto
- Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; Integrated Department of Medical Specialties, University Hospital of Pisa, Pisa, Italy
| | - Joaquin Cabezas
- Gastroenterology and Hepatology Department, Marques de Valdecilla University Hospital, Santander, Spain; Clinical and Translational Research in Digestive Diseases, IDIVAL, Santander, Spain
| | - Hugo Cheinquer
- Department of Gastroenterology and Hepatology, Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Pei-Jer Chen
- Hepatitis Research Center, National Taiwan University, Taipei, Taiwan
| | - Myeong-Eun Cheon
- Division of HIV/AIDS Prevention and Control, Korea Disease Control and Prevention Agency, Osong, Republic of Korea
| | - Wan-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Carla S Coffin
- Medicine / Microbiology and Infectious Diseases Department, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Nicola Coppola
- Mental Health and Public Medicine, University of Campania, Naples, Italy
| | - Antonio Craxi
- PROMISE, School of Medicine, University of Palermo, Palermo, Italy
| | - Javier Crespo
- Gastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, Santander, Spain; School of Medicine, University of Cantabria, Santander, Spain
| | - Victor De Ledinghen
- Service d'hepatologie et de Transplantation Hepatique, CHU, Bordeaux, France
| | - Ann-Sofi Duberg
- Department of Infectious Diseases, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ohad Etzion
- Department of Gastroenterology and Liver Diseases, Soroka University Medical Center, Beersheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheva, Israel
| | | | - Paulo R A Ferreira
- Division of Infectious Disease, Federal University of Sāo Paulo, Sāo Paulo, Brazil
| | - Xavier Forns
- Liver Unit, Hospital Clínic. IDIBAPS and CIBEREHD. University of Barcelona., Barcelona, Spain
| | - Graham R Foster
- Blizard Institute, Barts Liver Centre, Queen Mary University London, London, United Kingdom
| | | | | | - Javier García-Samaniego
- Liver Unit, Hospital Universitario La Paz, CIBERehd/IdiPAZ. Universidad Autónoma de Madrid, Madrid, Spain
| | - Liliana S Gheorghe
- Department of Gastroenterology & Hepatology, Carol Davila University of Medicine & Pharmacy, Bucharest, Romania; Department of Gastroenterology & Hepatology, Fundeni Clinical Institute, Bucharest, Romania
| | - Pierre M Gholam
- Medicine, Case Western Reserve University School of Medicine, Cleveland, United States
| | | | - Jeffrey Glenn
- Medicine and Microbiology & Immunology, Stanford University, Palo Alto, United States
| | - Julian Hercun
- Liver Unit, Centre Hospitalier de l'Universite de Montreal, Montreal, Canada
| | - Yao-Chun Hsu
- Department of Medical Research, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Ching-Chih Hu
- Gastroenterology and Hepatology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Jee-Fu Huang
- Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Jidong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China, Mainland
| | - Martin Kåberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Kelly D E Kaita
- Internal Medicine, Section of Hepatology, University of Manitoba, Winnipeg, Canada
| | - Habiba Kamal
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Jia-Horng Kao
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Loreta A Kondili
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Martin Lagging
- Department of Infectious Diseases / Virology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Microbiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Pablo Lázaro
- Independent Health Services Researcher, Madrid, Spain
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Mei-Hsuan Lee
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Young-Suk Lim
- Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Paul J Marotta
- Department of Medicine, Western University, London, Canada
| | - Maria-Cristina Navas
- Grupo de Gastrohepatología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | | | - Mauricio Orrego
- Gastroenterología y Hepatología, Clínica Las Americas AUNA, Medellín, Colombia; Hepatology Department, Clinica Las Vegas Quiron, Medellin, Colombia
| | - Carla Osiowy
- Viral Hepatitis and Bloodborne Pathogens Department, National Microbiology Lab, Public Health Agency of Canada, Winnipeg, Canada
| | - Calvin Q Pan
- Division of Gastroenterology and Hepatology, Department of Medicine, NYU Langone Health, NYU Grossman School of Medicine, New York, United States
| | - Mário G Pessoa
- Division of Gastroenterology and Hepatology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Giovanni Raimondo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alnoor Ramji
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | | | | | - Cielo Y Ríos-Hincapié
- Dirección de Promoción y Prevención, Ministerio de Salud y Protección Social, Bogotá, Colombia
| | - Manuel Rodríguez
- Liver Unit. Division of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - William M C Rosenberg
- Institute for Liver and Digestive Health, Division of Medicine, UCL, London, United Kingdom
| | - Dominique M Roulot
- APHP, Hopital Avicenne, Unité d'Hépatologie, Université Sorbonne Paris Nord, Bobigny, France
| | - Stephen D Ryder
- Hepatology, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Rifaat Safadi
- The Liver Institute, Hadassah Medical Organization, Jerusalem, Israel
| | - Faisal M Sanai
- Gastroenterology, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Teresa A Santantonio
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Christoph Sarrazin
- Medizinische Klinik 2, St. Josefs-Hospital, Wiesbaden, Germany; Medizinische Klinik 1, Goethe-University, Frankfurt Am Main, Germany
| | - Daniel Shouval
- The Liver Institute, Hadassah Medical Organization, Jerusalem, Israel
| | - Frank Tacke
- Department of Hepatology & Gastroenterology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Tammo L Tergast
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | | | - Alexis S Voeller
- Center for Disease Analysis Foundation, Lafayette, United States
| | - Hwai-I Yang
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Genomics Research Center, Academia Sinica, Taipei, Taiwan; Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Biomedical Translation Research Center, Academia Sinica, Taipei, Taiwan
| | - Ming-Lung Yu
- School of Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan; Hepatobiliary Section, Department of Internal Medicine, and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine and Hepatitis Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Eli Zuckerman
- Liver Unit, Carmel Medical Center, Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
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7
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Palom A, Almandoz E, Madejón A, Rando-Segura A, Pérez-Castaño Y, Vico J, Gándara S, Battulga N, Gómez-I-Prat J, Riveiro-Barciela M, Arenas Ruiz-Tapiador J, García-Samaniego J, Buti M. Community Strategy for Hepatitis B, C, and D Screening and Linkage to Care in Mongolians Living in Spain. Viruses 2023; 15:1506. [PMID: 37515192 PMCID: PMC10384786 DOI: 10.3390/v15071506] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
Mongolia has one of the highest viral hepatitis infection (B, C, and D) rates in the world. The aims of this study were to increase awareness of this disease and promote viral hepatitis screening in the Mongolian community living in Spain. Through a native community worker, Mongolian adults were invited to a community program consisting of an educational activity, an epidemiological questionnaire, and rapid point-of-care testing for hepatitis B and C. In those testing positive, blood extraction was performed to determine serological and virological parameters. In total, 280 Mongolians were invited to the program and 222 (79%) attended the event: 139 were women (63%), mean age was 42 years, and 78 (35%) had viral hepatitis risk factors. Testing found 13 (5.8%) anti-HCV-positive individuals, 1 with detectable HCV RNA (0.5%), 8 HBsAg-positive (3.6%), and 7 with detectable HBV DNA (3.1%). One additional individual had HBV/HCV co-infection with detectable HBV DNA and HCV RNA. Two subjects had hepatitis B/D co-infection (0.9%). The knowledge questionnaire showed a 1.64/8-point (20.5%) increase in correct answers after the educational activity. In summary, a viral hepatitis community program was feasible and widely accepted. It increased awareness of this condition in the Mongolian community in Spain and led to linkage to care in 22 participants, 50% of whom were unaware of their infection.
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Affiliation(s)
- Adriana Palom
- Departamento de Hepatología, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, 28029 Madrid, Spain
| | - Edurne Almandoz
- Departamento de Enfermedades Gastrointestinales, Hospital Universitario Donostia, Instituto de Investigación Biodonostia, 20014 San Sebastian, Spain
| | - Antonio Madejón
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, 28029 Madrid, Spain
- Departamento de Hepatología, Hospital Universitario La Paz, IdiPAZ, 28046 Madrid, Spain
| | - Ariadna Rando-Segura
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, 28029 Madrid, Spain
- Departamento de Microbiología, Laboratorios Clínicos, Hospital Universitario Vall d'Hebron, 08035 Barcelona, Spain
| | - Ylenia Pérez-Castaño
- Departamento de Digestivo, Hospital Bidasoa de Hondarribia, Instituto de Investigación Biodonostia, 20280 San Sebastian, Spain
| | - Judit Vico
- Departamento de Hepatología, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
| | - Sara Gándara
- Departamento de Hepatología, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
| | - Naranbaatar Battulga
- Departamento de Hepatología, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
| | - Jordi Gómez-I-Prat
- Equipo de Salud Pública y Comunitaria (ESPIC), Unidad de Salud Internacional Drassanes-Hospital Vall d'Hebron, 08001 Barcelona, Spain
| | - Mar Riveiro-Barciela
- Departamento de Hepatología, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, 28029 Madrid, Spain
| | - Juan Arenas Ruiz-Tapiador
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, 28029 Madrid, Spain
- Policlínica Gipuzkoa-Quiron Salud, 20012 San Sebastian, Spain
| | - Javier García-Samaniego
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, 28029 Madrid, Spain
- Departamento de Hepatología, Hospital Universitario La Paz, IdiPAZ, 28046 Madrid, Spain
| | - Maria Buti
- Departamento de Hepatología, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, 28029 Madrid, Spain
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8
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García-Crespo C, Francisco-Recuero I, Gallego I, Camblor-Murube M, Soria ME, López-López A, de Ávila AI, Madejón A, García-Samaniego J, Domingo E, Sánchez-Pacheco A, Perales C. Hepatitis C virus fitness can influence the extent of infection-mediated epigenetic modifications in the host cells. Front Cell Infect Microbiol 2023; 13:1057082. [PMID: 36992689 PMCID: PMC10040758 DOI: 10.3389/fcimb.2023.1057082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/28/2023] [Indexed: 03/14/2023] Open
Abstract
IntroductionCellular epigenetic modifications occur in the course of viral infections. We previously documented that hepatitis C virus (HCV) infection of human hepatoma Huh-7.5 cells results in a core protein-mediated decrease of Aurora kinase B (AURKB) activity and phosphorylation of Serine 10 in histone H3 (H3Ser10ph) levels, with an affectation of inflammatory pathways. The possible role of HCV fitness in infection-derived cellular epigenetic modifications is not known.MethodsHere we approach this question using HCV populations that display a 2.3-fold increase in general fitness (infectious progeny production), and up to 45-fold increase of the exponential phase of intracellular viral growth rate, relative to the parental HCV population.ResultsWe show that infection resulted in a HCV fitness-dependent, average decrease of the levels of H3Ser10ph, AURKB, and histone H4 tri-methylated at Lysine 20 (H4K20m3) in the infected cell population. Remarkably, the decrease of H4K20m3, which is a hallmark of cellular transformation, was significant upon infection with high fitness HCV but not upon infection with basal fitness virus.DiscussionHere we propose two mechanisms ─which are not mutually exclusive─ to explain the effect of high viral fitness: an early advance in the number of infected cells, or larger number of replicating RNA molecules per cell. The implications of introducing HCV fitness as an influence in virus-host interactions, and for the course of liver disease, are warranted. Emphasis is made in the possibility that HCV-mediated hepatocellular carcinoma may be favoured by prolonged HCV infection of a human liver, a situation in which viral fitness is likely to increase.
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Affiliation(s)
- Carlos García-Crespo
- Department of Interactions with the Environment, Centro de Biología Molecular “Severo Ochoa” (CSIC-UAM), Consejo Superior de Investigaciones Científicas (CSIC), Campus de Cantoblanco, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Irene Francisco-Recuero
- Department de Biochemistry, UAM, Instituto de Investigaciones Biomédicas Alberto Sols, CSIC-UAM, Madrid, Spain
| | - Isabel Gallego
- Department of Interactions with the Environment, Centro de Biología Molecular “Severo Ochoa” (CSIC-UAM), Consejo Superior de Investigaciones Científicas (CSIC), Campus de Cantoblanco, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Marina Camblor-Murube
- Department de Biochemistry, UAM, Instituto de Investigaciones Biomédicas Alberto Sols, CSIC-UAM, Madrid, Spain
| | - María Eugenia Soria
- Department of Interactions with the Environment, Centro de Biología Molecular “Severo Ochoa” (CSIC-UAM), Consejo Superior de Investigaciones Científicas (CSIC), Campus de Cantoblanco, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain
| | - Ana López-López
- Department de Biochemistry, UAM, Instituto de Investigaciones Biomédicas Alberto Sols, CSIC-UAM, Madrid, Spain
| | - Ana Isabel de Ávila
- Department of Interactions with the Environment, Centro de Biología Molecular “Severo Ochoa” (CSIC-UAM), Consejo Superior de Investigaciones Científicas (CSIC), Campus de Cantoblanco, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Madejón
- Department of Interactions with the Environment, Centro de Biología Molecular “Severo Ochoa” (CSIC-UAM), Consejo Superior de Investigaciones Científicas (CSIC), Campus de Cantoblanco, Madrid, Spain
- Hepatology Unit Hospital Universitario La Paz/Carlos III, Instituto de Investigación Sanitaria “La Paz”, Madrid, Spain
| | - Javier García-Samaniego
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Hepatology Unit Hospital Universitario La Paz/Carlos III, Instituto de Investigación Sanitaria “La Paz”, Madrid, Spain
| | - Esteban Domingo
- Department of Interactions with the Environment, Centro de Biología Molecular “Severo Ochoa” (CSIC-UAM), Consejo Superior de Investigaciones Científicas (CSIC), Campus de Cantoblanco, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- *Correspondence: Esteban Domingo, ; Aurora Sánchez-Pacheco, ; Celia Perales,
| | - Aurora Sánchez-Pacheco
- Department de Biochemistry, UAM, Instituto de Investigaciones Biomédicas Alberto Sols, CSIC-UAM, Madrid, Spain
- *Correspondence: Esteban Domingo, ; Aurora Sánchez-Pacheco, ; Celia Perales,
| | - Celia Perales
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain
- Department of Molecular and Cell Biology, Centro Nacional de Biotecnología (CNB-CSIC), Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
- *Correspondence: Esteban Domingo, ; Aurora Sánchez-Pacheco, ; Celia Perales,
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9
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Cabezas J, Crespo J, Aguilera A, Albillos A, Buti M, Calleja JL, Calvo Montes J, Casado Martín M, Diago Madrid M, Fernández Rodríguez C, Fernández Vázquez I, Forns X, García F, García-Samaniego J, Hernández-Guerra Aguilar M, Jorquera Plaza F, Lazarus JV, Lens S, Martró E, Molero García JM, Pena López MJ, Pineda JA, Rodríguez M, Romero Gómez M, Sanchez-Antolin G, A Serra M, Turnes J. Oportunistic diagnosis based on age and hepatitis C virus clearance: an essential step to improve the overall health of the liver. Rev Esp Enferm Dig 2023; 115:128-132. [PMID: 36514974 DOI: 10.17235/reed.2022.9325/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Back in January 2022, an EASL-Lancet Commission on the impact of liver disorders in the European region commissioned by the WHO demonstrated that this condition is, actually, the second leading cause of loss of labor years in Europe after ischemic heart disease (1). This is a very relevant piece of information since this is something that is going to impact the new generations of Europeans unless a significant change is made in public health policies. Despite the advances made over the last few years in hepatitis C virus clearance-understood as a significant reduction of morbidity and mortality associated with Hepatitis B and C viruses-there are still challenges ahead to improve liver health due to the high use of alcohol, and the inseparable triad obesity / diabetes mellitus / metabolic associated fatty liver disease. Also, access to healthcare for several population groups at risk of presenting higher rates of liver disease has become a problem.
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Affiliation(s)
- Joaquín Cabezas
- Aparato Digestivo/Unidad de Hepatología, Hospital Universitario Marqués de Valdecilla, España
| | - Javier Crespo
- Gastroenterología y Hepatología, Hospital Universitario Marqués de Valdecilla
| | - Antonio Aguilera
- Servicio de Microbiología, CHU de Santiago; Instituto de Investigación Sanitaria de Santiago(IDIS);Dep Microb Univers Santiago, España
| | - Agustín Albillos
- Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, España
| | - Maria Buti
- Liver Unit. Internal Medicine Department, Hospital Universitari Vall d´Hebron
| | - José Luís Calleja
- Digestivo, Hospital Universitario Puerta de Hierro Majadahonda, España
| | - Jorge Calvo Montes
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, España
| | - Marta Casado Martín
- Aparato digestivo, Sección Hepatología, Hospital Universitario Torrecárdenas
| | | | | | | | - Xavier Forns
- Servicio de Hepatología, Hospital Clínic Barcelona
| | - Federico García
- Servicio de Microbiología, Hospital Universitario Clínico San Cecilio
| | | | | | | | | | - Sabela Lens
- Servicio de Hepatología, Hospital Clinic Barcelona
| | - Elisa Martró
- Servicio de Microbiología, Hospital Universitario Germans Trias i Pujol
| | | | | | - Juan Antonio Pineda
- Unidad Clínica de Enfermedades Infecciosas y Micro, Hospital Universitario de Valme
| | - Manuel Rodríguez
- Sección de Hepatología. Servicio Aparato Digestivo, Hospital Universitario Central de Asturias
| | | | | | | | - Juan Turnes
- Servicio de Aparato Digestivo, Complejo Hospitalario Universitario de Pontevedra
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10
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Crespo J, Cabezas J, Aguilera A, Berenguer M, Buti M, Forns X, García F, García-Samaniego J, Hernández-Guerra M, Jorquera F, Lazarus JV, Lens S, Martró E, Pineda JA, Prieto M, Rodríguez-Frías F, Rodríguez M, Serra MÁ, Turnes J, Domínguez-Hernández R, Casado MÁ, Calleja JL. Recommendations for the integral diagnosis of chronic viral hepatitis in a single analytical extraction. Gastroenterol Hepatol 2023; 46:150-162. [PMID: 36257502 DOI: 10.1016/j.gastrohep.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/08/2022] [Accepted: 09/28/2022] [Indexed: 11/11/2022]
Abstract
The Spanish Society of Digestive Pathology (SEPD), the Spanish Association for the Study of the Liver (AEEH), the Spanish Society of Infections and Clinical Microbiology (SEIMC) and its Viral Hepatitis Study Group (GEHEP), and with the endorsement of the Alliance for the Elimination of Viral Hepatitis in Spain (AEHVE), have agreed on a document to carry out a comprehensive diagnosis of viral hepatitis (B, C and D), from a single blood sample; that is, a comprehensive diagnosis, in the hospital and/or at the point of care of the patient. We propose an algorithm, so that the positive result in a viral hepatitis serology (B, C and D), as well as human immunodeficiency virus (HIV), would trigger the analysis of the rest of the virus, including the viral load when necessary, in the same blood draw. In addition, we make two additional recommendations. First, the need to rule out a previous hepatitis A virus (VHA) infection, to proceed with its vaccination in cases where IgG-type studies against this virus are negative and the vaccine is indicated. Second, the determination of the HIV serology. Finally, in case of a positive result for any of the viruses analyzed, there must be an automated alerts and initiate epidemiological monitoring.
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Affiliation(s)
- Javier Crespo
- Servicio de Gastroenterología y Hepatología, Grupo de Investigación Clínica y Traslacional en Enfermedades Digestivas, Instituto de Investigación Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, España.
| | - Joaquín Cabezas
- Servicio de Gastroenterología y Hepatología, Grupo de Investigación Clínica y Traslacional en Enfermedades Digestivas, Instituto de Investigación Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Antonio Aguilera
- Servicio de Microbiología, Hospital Clínico Universitario de Santiago de Compostela, Departamento de Microbioloxía y Parasitoloxía, Universidade de Santiago de Compostela, A Coruña, España
| | - Marina Berenguer
- Unidad de Hepatología y Trasplante Hepático y CIBEREHD, Hospital Universitario y Politécnico La Fe; IIS La Fe y Universidad de Valencia, Valencia, España
| | - María Buti
- Servicio de Hepatología, Hospital Universitario Valle Hebrón y CIBEREHD del Instituto Carlos III, Barcelona, España
| | - Xavier Forns
- Servicio de Hepatología, Hospital Clínic, Universidad de Barcelona, IDIBAPS, CIBEREHD, Barcelona, España
| | - Federico García
- Servicio de Microbiología, Hospital Universitario Clínico San Cecilio, Instituto de Investigación IBS, Ciber de Enfermedades Infecciosas (CIBERINFEC), Granada, España
| | | | - Manuel Hernández-Guerra
- Servicio de Aparato Digestivo, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, España
| | - Francisco Jorquera
- Servicio de Aparato Digestivo, Complejo Asistencial Universitario de León, IBIOMED y CIBEREHD, León, España
| | - Jeffrey V Lazarus
- Instituto de Salud Global de Barcelona (ISGlobal), Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - Sabela Lens
- Servicio de Hepatología, Hospital Clínic de Barcelona, IDIBAPS, CIBEREHD, Universidad de Barcelona, Barcelona, España
| | - Elisa Martró
- Servicio de Microbiología, Laboratori Clínic Metropolitana Nord (LCMN), Hospital Universitario Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona (Barcelona), España, Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, España
| | - Juan Antonio Pineda
- Departamento de Medicina, Universidad de Sevilla, Hospital Universitario de Valme, Ciber de Enfermedades Infecciosas (CIBERINFEC), Sevilla, España
| | - Martín Prieto
- Unidad de Hepatología y Trasplante Hepático, Hospital Universitario y Politécnico La Fe, Valencia, CIBEREHD, Instituto de Salud Carlos III, Madrid, España
| | - Francisco Rodríguez-Frías
- Servicios de Microbiología y Bioquímica, Laboratorios Clínicos Hospital Universitario Vall d'Hebron, CIBEREHD, Instituto de investigación Vall d'Hebron (VHIR), Barcelona, España
| | - Manuel Rodríguez
- Sección de Hepatología, Servicio de Digestivo, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Universidad de Oviedo, Oviedo, España
| | - Miguel Ángel Serra
- Catedrático Jubilado de Medicina, Universidad de Valencia, Valencia, España
| | - Juan Turnes
- Servicio de Digestivo, Hospital Universitario de Pontevedra, Pontevedra, España
| | | | | | - José Luis Calleja
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Puerta de Hierro, Instituto de Investigación Puerta de Hierro Majadahonda (IDIPHIM), Universidad Autónoma de Madrid, Madrid, España
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11
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Colom J, Torrens M, Rodríguez-Cejas Á, Aguilar I, Álvarez-Crespo R, Armenteros L, Ayala V, Cantero H, Casado MÁ, Crespo J, Estévez J, García-Samaniego J, Hernández-Guerra M, Mur C, Pérez-Bech E, Ricote M, Pineda JA. Certification program of Addiction Centres for hepatitis C virus elimination in Spain. HepCelentes Project. Adicciones 2022; 0:1743. [PMID: 36200230 DOI: 10.20882/adicciones.1743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Microelimination strategies for the hepatitis C virus (HCV) in vulnerable populations, such as users of Addiction Centres (AC), are key for the elimination of hepatitis C. The aim of the HepCelentes project was to design a certification program for AC from the generation of a guide with the criteria to favour the prevention, diagnosis, control, and treatment of HCV in Spain. The project was structured in 4 phases: normalisation, implementation, certification, and communication. In the first phase, developed between July and December 2020, a Steering Committee was created (formed by representatives of scientific societies, healthcare professionals from AC, primary care centres and hospital units, and patient associations) that, from of an exhaustive bibliographic review, generated by consensus an accreditation guide for AC. The guide consists of 22 criteria (15 mandatory and 7 recommended) structured based on the requirements to be met by AC, justification for the selection, level of action (management, prevention, diagnosis and treatment/follow-up), measurement of the indicator, objective level to be achieved, evidence of compliance, clarifications to improve understanding, and mandatory / recommendation (depending on their relevance to achieve HCV elimination and its feasibility for implementation in real practice). The development of a certification system for the AC, based on consensus and coordination of multidisciplinary teams, is intended to favour the management of hepatitis C and its elimination in AC users, supporting the international, national, and regional elimination strategies.
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Affiliation(s)
- Joan Colom
- Programa de Prevención, Control y Atención al VIH, las ITS y las Hepatitis Víricas (PCAVIHV) y Subdirección General de Drogodependencias. Agencia de Salud Pública de Cataluña, Departamento de Salud, Generalitat de Catalunya, Barcelona.
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12
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Lazarus JV, Villota-Rivas M, Fernández I, Gea F, Ryan P, López SA, Guy D, Calleja JL, García-Samaniego J. A cascade of care analysis on the elimination of hepatitis C from public hospitals in Madrid. Commun Med 2022; 2:20. [PMID: 35603271 PMCID: PMC9053180 DOI: 10.1038/s43856-022-00077-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/13/2022] [Indexed: 11/26/2022] Open
Abstract
Background Direct-acting antivirals can cure ≥95% of hepatitis C virus (HCV) cases, but do not reach everyone in need. This cross-sectional study analyses the HCV cascade of care (CoC) in Madrid, Spain, in high-risk patients, to inform micro-elimination measures. Methods From September 2019 to May 2021, data from medical records were collected and analysed from six public hospitals in Madrid, including seven adult, high-risk patient groups: patients in haemodialysis or pre-dialysis programmes, co-infected with HIV, with advanced liver disease (ALD), with hereditary haematological diseases, with transplants and people who inject drugs (PWID). Results Here we present an analysis of 3994 patients (68.8% male), 91.2% were tested for anti-HCV and 28.9% were positive. Of the total, 34.5% were tested for HCV–RNA and 62.4% of these were positive. Of those HCV–RNA positive, 98.0% were treatment-eligible: in 7.4%, treatment is ongoing and in 89.3% completed. Of the latter, 92.2% obtained a sustained virological response 12 weeks post treatment (SVR12). Of those with ongoing or completed treatment, 9.8% experienced loss to follow-up (LTFU) or had unknown SVR12, 50.3% developed hepatic and 20.3% extrahepatic complications. ALD patients had the highest proportion of HCV–RNA positives (32.5%). The lowest proportion of patients treated were PWID (85.2%). Conclusions Almost one in ten high-risk patients in six of Madrid’s public hospitals remains untested for HCV antibodies. An almost equal percentage of those untested have experienced LTFU, with the highest proportion in PWID. This approach to monitoring the HCV CoC is vital to inform measures to eliminate HCV in hospitals. Despite the existence of effective treatments with few side effects for hepatitis C virus (HCV), such treatments do not reach everyone in need and this means we cannot eliminate HCV. Here, we analysed HCV diagnoses, patients’ access to care and treatment rates in high-risk populations in major public hospitals in Madrid. Data were collected from adult patients in haemodialysis or pre-dialysis programmes, co-infected with HIV, with advanced liver disease, with hereditary haematological diseases, with transplants and people who inject drugs (PWID). Nearly 10% of high-risk patients in six of Madrid’s public hospitals did not have an initial test for HCV. An almost equal percentage of those who were not tested for HCV have not continued to be followed for care, primarily PWID. This approach to monitoring the HCV cascade of care is vital to inform measures to eliminate HCV in hospitals. Lazarus et al. evaluate the cascade of care for people with hepatitis C virus (HCV) treated within six public hospitals in Madrid, Spain. The authors report on potential gaps in care in specific populations, including inadequate testing and loss to follow-up, and their implications on HCV micro-elimination in Madrid.
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13
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Ampuero J, Aller R, Gallego-Durán R, Crespo J, Abad J, González-Rodríguez Á, Gómez-Camarero J, Caballería J, Lo Iacono O, Ibañez L, García-Samaniego J, Martín-Mateos R, Francés R, Fernández-Rodríguez C, Diago M, Soriano G, Andrade RJ, Latorre R, Jorquera F, Morillas RM, Escudero D, Estévez P, Hernández-Guerra M, Augustín S, Pareja-Megia MJ, Banales JM, Aspichueta P, Benlloch S, Rosales JM, Salmerón J, Turnes J, Romero-Gómez M. Definite and indeterminate nonalcoholic steatohepatitis share similar clinical features and prognosis: A longitudinal study of 1893 biopsy-proven nonalcoholic fatty liver disease subjects. Liver Int 2021; 41:2076-2086. [PMID: 33896100 DOI: 10.1111/liv.14898] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Histological score systems may not fully capture the essential nonalcoholic steatohepatitis (NASH) features, which is one of the leading causes of screening failure in clinical trials. We assessed the NASH distribution and its components across the fibrosis stages and their impact on the prognosis and their relationship with the concept of metabolic-associated fatty liver disease (MAFLD). METHODS Spanish multicenter study including 1893 biopsy-proven nonalcoholic fatty liver disease (NAFLD) patients from HEPAmet registry. NASH was diagnosed by NAS score ≥4 (including steatosis, ballooning and lobular inflammation) and fibrosis by Kleiner score. The presence of MAFLD was determined. Progression to cirrhosis, first episode of decompensated cirrhosis and death were collected during the follow-up (4.7 ± 3.8 years). RESULTS Fibrosis was F0 34.3% (649/1893), F1 27% (511/1893), F2 16.5% (312/1893), F3 15% (284/1893) and F4 7.2% (137/1893). NASH diagnosis 51.9% (982/1893), and its individual components (severe steatosis, ballooning and lobular inflammation), increased from F0 (33.6%) to F2 (68.6%), and decreased significantly in F4 patients (51.8%) (P = .0001). More than 70% of non-NASH patients showed some inflammatory activity (ballooning or lobular inflammation), showing a similar MAFLD rate than NASH (96.2% [945/982] vs. 95.2% [535/562]) and significantly higher than nonalcoholic fatty liver (NAFL) subjects (89.1% [311/349]) (P < .0001). Progression to cirrhosis was similar between NASH (9.5% [51/539]) and indeterminate NASH (7.9% [25/316]), and higher than steatosis (5% [14/263]) (logRank 8.417; P = .015). Death and decompensated cirrhosis were similar between these. CONCLUSIONS The prevalence of steatohepatitis decreased in advanced liver disease. However, most of these patients showed some inflammatory activity histologically and had metabolic disturbances. These findings should be considered in clinical trials whose main aim is to prevent cirrhosis progression and complications, liver transplant and death.
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Affiliation(s)
- Javier Ampuero
- Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain.,SeLiver Group, Instituto de Biomedicina de Sevilla, Seville, Spain.,CIBERehd, Madrid, Spain
| | - Rocío Aller
- Centro de Investigación de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Universidad de Valladolid, Valladolid, Spain
| | - Rocío Gallego-Durán
- SeLiver Group, Instituto de Biomedicina de Sevilla, Seville, Spain.,CIBERehd, Madrid, Spain
| | - Javier Crespo
- Digestive Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Javier Abad
- Digestive Department, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Águeda González-Rodríguez
- Liver Research Unit, Hospital Universitario Santa Cristina Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | | | - Joan Caballería
- CIBERehd, Madrid, Spain.,Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBPAS), Barcelona, Spain
| | - Oreste Lo Iacono
- Digestive Department, Hospital Universitario Tajo, Aranjuez, Spain
| | - Luis Ibañez
- CIBERehd, Madrid, Spain.,Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | - Rosa Martín-Mateos
- CIBERehd, Madrid, Spain.,Digestive Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Rubén Francés
- CIBERehd, Madrid, Spain.,Hospital General Universitario de Alicante, Universidad Miguel Hernández, Elche, Spain
| | | | - Moisés Diago
- Digestive Department, Hospital General Universitario de Valencia, Valencia, Spain
| | - Germán Soriano
- CIBERehd, Madrid, Spain.,Digestive Department, Hospital de la Santa Creu i San Pau, Barcelona, Spain
| | - Raúl J Andrade
- CIBERehd, Madrid, Spain.,Unidad de Gestión Clínica de Enfermedades Digestivas, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | - Raquel Latorre
- Digestive Department, Hospital Universitari Son Llátzer, Mallorca, Spain
| | - Francisco Jorquera
- CIBERehd, Madrid, Spain.,Servicio de Aparato Digestivo, Complejo Asistencial Universitario de León, IBIOMED, León, Spain
| | - Rosa M Morillas
- CIBERehd, Madrid, Spain.,Digestive Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Desam Escudero
- Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
| | - Pamela Estévez
- Digestive Department, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | | | | | - Jesús M Banales
- CIBERehd, Madrid, Spain.,Department of Liver and Gastrointestinal Diseases, Biodonostia Research Institute-Donostia University Hospital, University of the Basque Country (UPV/EHU), Ikerbasque, San Sebastian, Spain
| | - Patricia Aspichueta
- CIBERehd, Madrid, Spain.,Department of Physiology, Faculty of Medicine and Nursing, Biocruces Research Institute, University of Basque Country UPV/EHU, Leioa, Spain
| | - Salvador Benlloch
- CIBERehd, Madrid, Spain.,Digestive Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | | | - Javier Salmerón
- Digestive Department, Hospital Universitario San Cecilio, Granada, Spain
| | - Juan Turnes
- Digestive Department, Complejo Hospitalario de Pontevedra, Pontevedra, Spain
| | - Manuel Romero-Gómez
- Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain.,SeLiver Group, Instituto de Biomedicina de Sevilla, Seville, Spain.,CIBERehd, Madrid, Spain
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14
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Palom A, Sopena S, Riveiro-Barciela M, Carvalho-Gomes A, Madejón A, Rodriguez-Tajes S, Roade L, García-Eliz M, García-Samaniego J, Lens S, Berenguer-Hayme M, Rodríguez-Frías F, Hernandez-Évole H, Isabel Gil-García A, Barreira A, Esteban R, Buti M. One-quarter of chronic hepatitis D patients reach HDV-RNA decline or undetectability during the natural course of the disease. Aliment Pharmacol Ther 2021; 54:462-469. [PMID: 34181772 DOI: 10.1111/apt.16485] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/15/2021] [Accepted: 06/02/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Spontaneous HDV-RNA fluctuations, assessed by nonstandardised in-house assays, have been reported during the course of chronic hepatitis delta (CHD). AIMS To evaluate changes in serum HDV-RNA concentrations in untreated CHD patients and correlate these changes with other HBV markers. METHODS A total of 323 consecutive serum samples from 56 CHD patients (detectable HDV-RNA) followed for >3 years were retested for HDV-RNA levels by a sensitive technique using the first WHO international HDV-RNA standard. Quantitative HBsAg, HBV-DNA, and HBV-RNA were also determined. RESULTS Most participants were male, middle-aged, white European, and HBeAg-negative (82%). Almost half had liver cirrhosis and 64% were receiving nucleos(t)ide analogues. At inclusion, median-HDV-RNA was 5.3 (4.2-6.5) log10 IU/mL, HBsAg 4.0 (3.5-4.3) log10 IU/mL, and HBV-DNA 1.6 (1.0-2.6) log10 IU/mL; ALT values were normal in 13 (23%). During a mean follow-up of 5.6 (3-16) years, 14 (25%) showed ≥2log10 HDV-RNA decline, including 11 (20%) who spontaneously achieved undetectable HDV-RNA. Four patients (7%) lost HBsAg, with undetectable HDV-RNA. The remaining 42 (75%) had persistently detectable HDV-RNA. During follow-up, patients with a ≥2log10 HDV-RNA decline showed a greater HBsAg drop (-0.7 ± 1.1 vs -0.09 ± 0.9 log IU/mL; P = 0.039) than those with a <2 log10 HDV-RNA decline. Overall, ALT and HBV-DNA levels decreased over time. There were no differences in clinical outcomes between groups. CONCLUSIONS One-quarter of untreated CHD patients showed a ≥2log10 decline in HDV-RNA and 20% reached HDV-RNA undetectability during a mean follow-up of 5.6 years. The decline was associated with ALT decrease. These findings have implications for designing new therapies for CHD.
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Affiliation(s)
- Adriana Palom
- Liver Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sara Sopena
- Biochemistry and Microbiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Mar Riveiro-Barciela
- Liver Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Instituto de Salud Carlos III, Madrid, Spain
| | - Angela Carvalho-Gomes
- Instituto de Salud Carlos III, Madrid, Spain
- Liver Transplantation and Hepatology Unit, Hospital U. y P. La Fe, Universitat de València, Valencia, Spain
| | - Antonio Madejón
- Instituto de Salud Carlos III, Madrid, Spain
- Liver Unit, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Sergio Rodriguez-Tajes
- Instituto de Salud Carlos III, Madrid, Spain
- Liver Unit, Hospital Clinic Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Luisa Roade
- Liver Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Instituto de Salud Carlos III, Madrid, Spain
| | - María García-Eliz
- Liver Transplantation and Hepatology Unit, Hospital U. y P. La Fe, Universitat de València, Valencia, Spain
| | - Javier García-Samaniego
- Instituto de Salud Carlos III, Madrid, Spain
- Liver Unit, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Sabela Lens
- Instituto de Salud Carlos III, Madrid, Spain
- Liver Unit, Hospital Clinic Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Marina Berenguer-Hayme
- Instituto de Salud Carlos III, Madrid, Spain
- Liver Transplantation and Hepatology Unit, Hospital U. y P. La Fe, Universitat de València, Valencia, Spain
| | - Francisco Rodríguez-Frías
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Biochemistry and Microbiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Instituto de Salud Carlos III, Madrid, Spain
| | - Helena Hernandez-Évole
- Liver Transplantation and Hepatology Unit, Hospital U. y P. La Fe, Universitat de València, Valencia, Spain
| | - Ana Isabel Gil-García
- Instituto de Salud Carlos III, Madrid, Spain
- Liver Unit, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Ana Barreira
- Liver Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Instituto de Salud Carlos III, Madrid, Spain
| | - Rafael Esteban
- Liver Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Instituto de Salud Carlos III, Madrid, Spain
| | - Maria Buti
- Liver Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Instituto de Salud Carlos III, Madrid, Spain
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15
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Crespo J, Lazarus JV, Iruzubieta P, García F, García-Samaniego J. Let's leverage SARS-CoV2 vaccination to screen for hepatitis C in Spain, in Europe, around the world. J Hepatol 2021; 75:224-226. [PMID: 33757805 PMCID: PMC7979603 DOI: 10.1016/j.jhep.2021.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/21/2021] [Accepted: 03/01/2021] [Indexed: 01/06/2023]
Affiliation(s)
- Javier Crespo
- Gastroenterology and Hepatology Department, Marqués de Valdecilla University Hospital. Clinical and Translational Digestive Research Group, IDIVAL. Santander, Spain; School of Medicine, University of Cantabria. Santander, Spain.
| | - Jeffrey V. Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona. Barcelona, Spain
| | - Paula Iruzubieta
- Gastroenterology and Hepatology Department, Marqués de Valdecilla University Hospital. Clinical and Translational Digestive Research Group, IDIVAL. Santander, Spain
| | - Federico García
- Microbiology Service, San Cecilio University Hospital. Instituto de Investigación Ibs. Granada, Spain
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16
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Fernández Carrillo C, Perelló C, Llop Herrera E, García-Samaniego J, Romero M, Mostaza JM, Ibáñez L, Bañares Cañizares R, Bighelli F, Usón Perón C, Fernández Vázquez I, Hernández Castro O, Albillos A, Lalueza A, Malo de Molina R, Muñez E, Jiménez Tejero E, Calleja Panero JL. Mild ast elevation as an early sign of COVID-19 severity in a multicenter Madrid cohort. Rev Esp Enferm Dig 2021; 113:780-786. [PMID: 33947196 DOI: 10.17235/reed.2021.8007/2021] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Liver enzyme elevation has been reported for SARS-CoV-2 disease (COVID-19) in heterogeneous cohorts, mainly from China. Comprehensive reports from other countries are needed. We dissect the pattern, evolution and predictive value of such abnormalities in a cohort from Madrid, Spain. METHODS Retrospective study with prospective 14-day follow-up of 373 patients with confirmed COVID-19 in five Madrid hospitals, including 50 outpatients. COVID-19 severe course was defined as need of mechanical ventilation. RESULTS A total of 33.1% hospitalised patients showed baseline AST elevation and 28.5% showed ALT elevation, contrasting with 12% and 8% of outpatients (P≤0.001). Baseline AST, ALT and GGT levels correlated with LDH and C-reactive protein levels (CRP) (r≤0.598, P<0.005). AST elevation was associated with other severity markers such as male sex, lymphopenia and pneumonia on X-ray (P<0.05 all). ALP and Bilirubin levels were rarely increased. Patients with elevated baseline AST displayed progressive normalization of this enzyme and increase in ALT and GGT levels. Patients with normal baseline AST showed a flattened evolution pattern with levels in range. Patients with a severe course of COVID-19 showed more frequently elevated baseline AST than those with a milder evolution (54.2% vs. 25.4%, P<0.001). Age, AST and CRP were independent risk factors for a severe course of COVID-19. CONCLUSION Mild liver enzyme elevation is associated with COVID-19 severity. Baseline AST is an independent predictor of severe COVID-19 course, while it tends to normalize over time. ALT and GGT show late elevation.
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Affiliation(s)
- Carlos Fernández Carrillo
- Liver Unit, Gastroenterology, IDIPHIM, CIBERehd, Hospital Universitario Puerta de Hierro-Majadahonda, España
| | - Christie Perelló
- Liver Unit, Gastroenterology, IDIPHIM, Hospital Universitario Puerta de Hierro-Majadahonda
| | - Elba Llop Herrera
- Liver Unit, Gastroenterology, IDIPHIM, CIBERehd, Hospital Universitario Puerta de Hierro Majadahonda
| | | | | | | | - Luis Ibáñez
- Liver Unit, Gastroenterology, IiSGM, Hospital Gregorio Marañón
| | - Rafael Bañares Cañizares
- Gastroenterology, IiSGM, CIBERehd, Hospital Universitario Ramón y Cajal, Universidad Complutense
| | | | - Clara Usón Perón
- Liver Unit, Gastroenterology, IiSGM, Hospital Universitario La Paz
| | | | | | - Agustín Albillos
- Gastroenterology and Hepatology, UAH, CIBERehd, Hospital Universitario Ramón y Cajal
| | - Antonio Lalueza
- Internal Medicine, Hospital Universitario 12 de Octubre, i+12
| | - Rosa Malo de Molina
- Pneumology Service, IDIPHISA, Hospital Universitario Puerta de Hierro-Majadahonda
| | - Elena Muñez
- Internal Medicine, Infectious Diseases, IDIPHISA, Hospital Universitario Puerta de Hierro-Majadahonda
| | | | - José Luis Calleja Panero
- Liver Unit, Gastroenterology,IDIPHISA,UAM,CIBErehd, Hospital Universitario Puerta de Hierro-Majadahonda
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17
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Ampuero J, Aller R, Gallego-Durán R, Crespo J, Calleja JL, García-Monzón C, Gómez-Camarero J, Caballería J, Lo Iacono O, Ibañez L, García-Samaniego J, Albillos A, Francés R, Fernández-Rodríguez C, Diago M, Soriano G, Andrade RJ, Latorre R, Jorquera F, Morillas RM, Escudero D, Estévez P, Hernandez-Guerra M, Augustín S, Bañales J, Aspichueta P, Benlloch S, Rosales JM, Salmerón J, Turnes J, Romero-Gómez M. Erratum to: "Significant fibrosis predicts new-onset diabetes mellitus and arterial hypertension in patients with NASH (J Hepatol 2020; 73: 17-25). J Hepatol 2020; 73:740-741. [PMID: 32654856 DOI: 10.1016/j.jhep.2020.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Javier Ampuero
- Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain; SeLiver group, Instituto de Biomedicina de Sevilla, Spain; CIBERehd, Spain.
| | - Rocío Aller
- Hospital Clínico Universitario de Valladolid. Centro de Investigación de Endocrinología y Nutrición. Universidad de Valladolid, Spain
| | | | - Javier Crespo
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Carmelo García-Monzón
- Liver Research Unit, Hospital Universitario Santa Cristina Instituto de Investigación Sanitaria Princesa Madrid, Spain
| | | | - Joan Caballería
- CIBERehd, Spain; Liver Unit. Hospital Clínic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBPAS). Barcelona, Spain
| | | | - Luis Ibañez
- CIBERehd, Spain; Hospital Gregorio Marañón, Madrid, Spain
| | | | - Agustín Albillos
- CIBERehd, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Rubén Francés
- CIBERehd, Spain; Hospital General Universitario de Alicante, Universidad Miguel Hernández, Spain
| | | | - Moisés Diago
- Hospital General Universitario de Valencia, Spain
| | | | - Raúl J Andrade
- CIBERehd, Spain; Unidad de Gestión Clínica de Enfermedades Digestivas, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | | | - Francisco Jorquera
- Servicio de Aparato Digestivo, Complejo Asistencial Universitario de León, IBIOMED y CIBERehd, León, España
| | | | | | | | | | | | - Jesús Bañales
- CIBERehd, Spain; Department of Liver and Gastrointestinal Diseases, Biodonostia Research Institute - Donostia University Hospital, University of the Basque Country (UPV/EHU), Ikerbasque, San Sebastian, Spain
| | - Patricia Aspichueta
- Biocruces Research Institute, Barakaldo. Department of Physiology, Faculty of Medicine and Nursing, University of Basque Country UPV/EHU, Leioa, Spain
| | | | | | | | | | - Manuel Romero-Gómez
- Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain; SeLiver group, Instituto de Biomedicina de Sevilla, Spain; CIBERehd, Spain.
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18
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Ibáñez-Samaniego L, Bighelli F, Usón C, Caravaca C, Fernández Carrillo C, Romero M, Barreales M, Perelló C, Madejón A, Marcos AC, Albillos A, Fernández I, García-Samaniego J, Calleja JL, Bañares R. Elevation of Liver Fibrosis Index FIB-4 Is Associated With Poor Clinical Outcomes in Patients With COVID-19. J Infect Dis 2020; 222:726-733. [PMID: 32563190 PMCID: PMC7337860 DOI: 10.1093/infdis/jiaa355] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [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: 05/11/2020] [Accepted: 06/16/2020] [Indexed: 02/07/2023] Open
Abstract
Background COVID-19 is a potentially severe disease caused by the recently described SARS-CoV-2. Whether liver fibrosis might be a relevant player in the natural history of COVID-19 is currently unknown. We aimed to evaluate the association between FIB-4 and the risk of progression to critical illness in middle-aged patients with COVID-19. Methods In this multicenter, retrospective study with prospective follow-up of 160 patients aged 35–65 years with COVID-19, FIB-4, clinical, and biochemical variables were collected at baseline. FIB-4 ≥2.67 defined patients with risk for advanced liver fibrosis. Results Risk for advanced fibrosis was estimated in 28.1% of patients. Patients with FIB-4 ≥2.67 more frequently required mechanical ventilation (37.8% vs 18.3%; P = .009). In multivariate analysis, FIB-4 ≥2.67 (odds ratio [OR], 3.41; 95% confidence interval [CI], 1.30–8.92), cardiovascular risk factors (OR, 5.05; 95% CI, 1.90–13.39), previous respiratory diseases (OR, 4.54; 95% CI, 1.36–15.10), and C-reactive protein (OR, 1.01; 95% CI, 1.01–1.02) increased significantly the risk of ICU admission. Bootstrap confirmed FIB-4 as an independent risk factor. Conclusions In middle-aged patients with COVID-19, FIB-4 may have a prognostic role. The link between liver fibrosis and the natural history of COVID-19 should be evaluated in future studies.
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Affiliation(s)
- Luis Ibáñez-Samaniego
- Liver Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain
| | - Federico Bighelli
- Liver Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Clara Usón
- Liver Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Celia Caravaca
- Liver Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Carlos Fernández Carrillo
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain.,Liver Unit, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Miriam Romero
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain.,Liver Unit, Hospital Universitario La Paz, Madrid, Spain
| | | | - Christie Perelló
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain.,Liver Unit, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Antonio Madejón
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain.,Liver Unit, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | - Agustín Albillos
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain.,Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Facultad de Medicina, Universidad de Alcalá, Madrid, Spain
| | | | - Javier García-Samaniego
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain.,Liver Unit, Hospital Universitario La Paz, Madrid, Spain
| | - José Luis Calleja
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain.,Liver Unit, Hospital Universitario Puerta de Hierro, Madrid, Spain.,Facultad de Medicina, Universidad Autónoma, Madrid, Spain
| | - Rafael Bañares
- Liver Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain.,Facultad de Medicina, Universidad Complutense, Madrid, Spain
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19
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Rodríguez M, Buti M, Esteban R, Lens S, Prieto M, Suárez E, García-Samaniego J. Consensus document of the Spanish Association for Study of the Liver on the treatment of hepatitis B virus infection (2020). Gastroenterol Hepatol 2020; 43:559-587. [PMID: 32778356 DOI: 10.1016/j.gastrohep.2020.03.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/31/2020] [Indexed: 12/14/2022]
Abstract
Hepatitis B virus (HBV) infection remains a global public health problem. HBV vaccination is the most effective tool to reduce the incidence of HBV disease. Despite there has not been new clinical developments for the treatment of chronic hepatitis B in the last few years, changing epidemiology and current insights on natural history, diagnostic tools and therapy indications make necessary an update of the former version of the consensus document of the Spanish Association for Study of the Liver on the treatment of hepatitis B infection published in 2012. The current document updates the management of chronic hepatitis B. The treatment of choice is the long-term administration of a nucleos(t)ide analogue with high barrier to resistance (entecavir, tenofovir or tenofovir alafenamide). Pegylated interferon may be an option in patients with non-advanced liver disease, but its applicability is limited due to the low efficacy and poor tolerability. All patients must be monitored for the risk of progression to advanced liver disease and development of hepatocellular carcinoma.
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Affiliation(s)
- Manuel Rodríguez
- Sección de Hepatología, Servicio de Digestivo, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, España.
| | - María Buti
- Servicio de Hepatología-Medicina Interna, Hospital Universitario Valle Hebrón, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CiBERehd), Barcelona, España
| | - Rafael Esteban
- Servicio de Hepatología-Medicina Interna, Hospital Universitario Valle Hebrón, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CiBERehd), Barcelona, España
| | - Sabela Lens
- Servicio de Hepatología, Hospital Clínic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CiBERehd), Universidad de Barcelona, Barcelona, España
| | - Martín Prieto
- Sección de Hepatología, Servicio de Medicina Digestiva, Hospital Universitari ì Politècnic La Fe, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CiBERehd), Valencia, España
| | - Emilio Suárez
- Unidad de Enfermedades Digestivas, Hospital Universitario Virgen de Valme, Sevilla, España
| | - Javier García-Samaniego
- Unidad de Hepatología, Hospital Universitario La Paz, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CiBERehd), Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España.
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20
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Cabañas R, Ramírez E, Sendagorta E, Alamar R, Barranco R, Blanca-López N, Doña I, Fernández J, Garcia-Nunez I, García-Samaniego J, Lopez-Rico R, Marín-Serrano E, Mérida C, Moya M, Ortega-Rodríguez NR, Rivas Becerra B, Rojas-Perez-Ezquerra P, Sánchez- González MJ, Vega-Cabrera C, Vila-Albelda C, Bellón T. Spanish Guidelines for Diagnosis, Management, Treatment, and Prevention of DRESS Syndrome. J Investig Allergol Clin Immunol 2020; 30:229-253. [DOI: 10.18176/jiaci.0480] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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21
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Ampuero J, Aller R, Gallego-Durán R, Crespo J, Calleja JL, García-Monzón C, Gómez-Camarero J, Caballería J, Lo Iacono O, Ibañez L, García-Samaniego J, Albillos A, Francés R, Fernández-Rodríguez C, Diago M, Soriano G, Andrade RJ, Latorre R, Jorquera F, Morillas RM, Escudero D, Estévez P, Guerra MH, Augustín S, Banales JM, Aspichueta P, Benlloch S, Rosales JM, Salmerón J, Turnes J, Romero Gómez M. Significant fibrosis predicts new-onset diabetes mellitus and arterial hypertension in patients with NASH. J Hepatol 2020; 73:17-25. [PMID: 32147361 DOI: 10.1016/j.jhep.2020.02.028] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Non-alcoholic fatty liver disease (NAFLD) could play a catalytic role in the development of metabolic comorbidities, although the magnitude of this effect in metabolically healthy patients with NAFLD remains unclear. We assessed the role of biopsy-proven NAFLD on the risk of developing type 2 diabetes mellitus (T2DM) and other metabolic comorbidities (arterial hypertension [AHT], and dyslipidemia) in metabolically healthy patients. METHODS We included 178 metabolically healthy-defined by the absence of baseline T2DM, AHT, dyslipidemia-patients with biopsy-proven NAFLD from the HEPAmet Registry (N = 1,030). Hepamet fibrosis score (HFS), NAFLD fibrosis score, and Fibrosis-4 were calculated. Follow-up was computed from biopsy to the diagnosis of T2DM, AHT, or dyslipidemia. RESULTS During a follow-up of 5.6 ± 4.4 years, T2DM occurred in 9% (16/178), AHT in 8.4% (15/178), low HDL in 9.6% (17/178), and hypertriglyceridemia in 23.6% (42/178) of patients. In multivariate analysis, significant fibrosis predicted T2DM and AHT. Independent variables related to T2DM appearance were significant fibrosis (HR 2.95; 95% CI 1.19-7.31; p = 0.019), glucose levels (p = 0.008), age (p = 0.007) and BMI (p = 0.039). AHT was independently linked to significant fibrosis (HR 2.39; 95% CI 1.14-5.10; p = 0.028), age (p = 0.0001), BMI (p = 0.006), glucose (p = 0.021) and platelets (p = 0.050). The annual incidence rate of T2DM was higher in patients with significant fibrosis (4.4 vs. 1.2 cases per 100 person-years), and increased in the presence of obesity, similar to AHT (4.6 vs. 1.1 cases per 100 person-years). HFS >0.12 predicted the risk of T2DM (25% [4/16] vs. HFS <0.12 4.5% [4/88]; logRank 6.658, p = 0.010). CONCLUSION Metabolically healthy patients with NAFLD-related significant fibrosis were at greater risk of developing T2DM and AHT. HFS >0.12, but not NAFLD fibrosis score or Fibrosis-4, predicted the occurrence of T2DM. LAY SUMMARY Patients with biopsy-proven non-alcoholic fatty liver disease and significant fibrosis were at risk of developing type 2 diabetes mellitus and arterial hypertension. The risk of metabolic outcomes in patients with significant fibrosis was increased in the presence of obesity. In addition to liver biopsy, patients at intermediate-to-high risk of significant fibrosis by Hepamet fibrosis score were at risk of type 2 diabetes mellitus.
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Affiliation(s)
- Javier Ampuero
- Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain; SeLiver group, Instituto de Biomedicina de Sevilla, Spain; CIBERehd, Spain.
| | - Rocío Aller
- Hospital Clínico Universitario de Valladolid, Centro de Investigación de Endocrinología y Nutrición, Universidad de Valladolid, Spain
| | | | - Javier Crespo
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Carmelo García-Monzón
- Liver Research Unit, Hospital Universitario Santa Cristina Instituto de Investigación Sanitaria Princesa Madrid, Spain
| | | | - Joan Caballería
- CIBERehd, Spain; Liver Unit. Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBPAS), Barcelona, Spain
| | | | - Luis Ibañez
- CIBERehd, Spain; Hospital Gregorio Marañón, Madrid, Spain
| | | | - Agustín Albillos
- CIBERehd, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Rubén Francés
- CIBERehd, Spain; Hospital General Universitario de Alicante, Universidad Miguel Hernández, Spain
| | | | - Moisés Diago
- Hospital General Universitario de Valencia, Spain
| | | | - Raúl J Andrade
- CIBERehd, Spain; Unidad de Gestión Clínica de Enfermedades Digestivas, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | | | - Francisco Jorquera
- Servicio de Aparato Digestivo, Complejo Asistencial Universitario de León, IBIOMED y CIBERehd, León, España
| | | | | | | | | | | | - Jesús M Banales
- CIBERehd, Spain; Department of Liver and Gastrointestinal Diseases, Biodonostia Research Institute - Donostia University Hospital, University of the Basque Country (UPV/EHU), Ikerbasque, San Sebastian, Spain
| | - Patricia Aspichueta
- Biocruces Research Institute, Barakaldo, Department of Physiology, Faculty of Medicine and Nursing, University of Basque Country UPV/EHU, Leioa, Spain
| | | | | | | | | | - Manuel Romero Gómez
- Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain; SeLiver group, Instituto de Biomedicina de Sevilla, Spain; CIBERehd, Spain.
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22
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Chen Q, Perales C, Soria ME, García-Cehic D, Gregori J, Rodríguez-Frías F, Buti M, Crespo J, Calleja JL, Tabernero D, Vila M, Lázaro F, Rando-Segura A, Nieto-Aponte L, Llorens-Revull M, Cortese MF, Fernandez-Alonso I, Castellote J, Niubó J, Imaz A, Xiol X, Castells L, Riveiro-Barciela M, Llaneras J, Navarro J, Vargas-Blasco V, Augustin S, Conde I, Rubín Á, Prieto M, Torras X, Margall N, Forns X, Mariño Z, Lens S, Bonacci M, Pérez-Del-Pulgar S, Londoño MC, García-Buey ML, Sanz-Cameno P, Morillas R, Martró E, Saludes V, Masnou-Ridaura H, Salmerón J, Quíles R, Carrión JA, Forné M, Rosinach M, Fernández I, García-Samaniego J, Madejón A, Castillo-Grau P, López-Núñez C, Ferri MJ, Durández R, Sáez-Royuela F, Diago M, Gimeno C, Medina R, Buenestado J, Bernet A, Turnes J, Trigo-Daporta M, Hernández-Guerra M, Delgado-Blanco M, Cañizares A, Arenas JI, Gomez-Alonso MJ, Rodríguez M, Deig E, Olivé G, Río OD, Cabezas J, Quiñones I, Roget M, Montoliu S, García-Costa J, Force L, Blanch S, Miralbés M, López-de-Goicoechea MJ, García-Flores A, Saumoy M, Casanovas T, Baliellas C, Gilabert P, Martin-Cardona A, Roca R, Barenys M, Villaverde J, Salord S, Camps B, Silvan di Yacovo M, Ocaña I, Sauleda S, Bes M, Carbonell J, Vargas-Accarino E, Ruzo SP, Guerrero-Murillo M, Von Massow G, Costafreda MI, López RM, González-Moreno L, Real Y, Acero-Fernández D, Viroles S, Pamplona X, Cairó M, Ocete MD, Macías-Sánchez JF, Estébanez A, Quer JC, Mena-de-Cea Á, Otero A, Castro-Iglesias Á, Suárez F, Vázquez Á, Vieito D, López-Calvo S, Vázquez-Rodríguez P, Martínez-Cerezo FJ, Rodríguez R, Macenlle R, Cachero A, Mereish G, Mora-Moruny C, Fábregas S, Sacristán B, Albillos A, Sánchez-Ruano JJ, Baluja-Pino R, Fernández-Fernández J, González-Portela C, García-Martin C, Sánchez-Antolín G, Andrade RJ, Simón MA, Pascasio JM, Romero-Gómez M, Antonio Del-Campo J, Domingo E, Esteban R, Esteban JI, Quer J. Deep-sequencing reveals broad subtype-specific HCV resistance mutations associated with treatment failure. Antiviral Res 2020; 174:104694. [PMID: 31857134 DOI: 10.1016/j.antiviral.2019.104694] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 04/15/2019] [Revised: 10/24/2019] [Accepted: 12/11/2019] [Indexed: 02/07/2023]
Abstract
A percentage of hepatitis C virus (HCV)-infected patients fail direct acting antiviral (DAA)-based treatment regimens, often because of drug resistance-associated substitutions (RAS). The aim of this study was to characterize the resistance profile of a large cohort of patients failing DAA-based treatments, and investigate the relationship between HCV subtype and failure, as an aid to optimizing management of these patients. A new, standardized HCV-RAS testing protocol based on deep sequencing was designed and applied to 220 previously subtyped samples from patients failing DAA treatment, collected in 39 Spanish hospitals. The majority had received DAA-based interferon (IFN) α-free regimens; 79% had failed sofosbuvir-containing therapy. Genomic regions encoding the nonstructural protein (NS) 3, NS5A, and NS5B (DAA target regions) were analyzed using subtype-specific primers. Viral subtype distribution was as follows: genotype (G) 1, 62.7%; G3a, 21.4%; G4d, 12.3%; G2, 1.8%; and mixed infections 1.8%. Overall, 88.6% of patients carried at least 1 RAS, and 19% carried RAS at frequencies below 20% in the mutant spectrum. There were no differences in RAS selection between treatments with and without ribavirin. Regardless of the treatment received, each HCV subtype showed specific types of RAS. Of note, no RAS were detected in the target proteins of 18.6% of patients failing treatment, and 30.4% of patients had RAS in proteins that were not targets of the inhibitors they received. HCV patients failing DAA therapy showed a high diversity of RAS. Ribavirin use did not influence the type or number of RAS at failure. The subtype-specific pattern of RAS emergence underscores the importance of accurate HCV subtyping. The frequency of "extra-target" RAS suggests the need for RAS screening in all three DAA target regions.
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Affiliation(s)
- Qian Chen
- Liver Unit, Liver Diseases - Viral Hepatitis, Vall d'Hebron Institut of Research (VHIR), Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Celia Perales
- Liver Unit, Liver Diseases - Viral Hepatitis, Vall d'Hebron Institut of Research (VHIR), Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - María Eugenia Soria
- Liver Unit, Liver Diseases - Viral Hepatitis, Vall d'Hebron Institut of Research (VHIR), Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain
| | - Damir García-Cehic
- Liver Unit, Liver Diseases - Viral Hepatitis, Vall d'Hebron Institut of Research (VHIR), Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Gregori
- Liver Unit, Liver Diseases - Viral Hepatitis, Vall d'Hebron Institut of Research (VHIR), Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Roche Diagnostics SL, Sant Cugat del Valles, Barcelona, Spain
| | - Francisco Rodríguez-Frías
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Biochemistry and Microbiology Department, VHIR-HUVH, Barcelona, Spain
| | - María Buti
- Liver Unit, Liver Diseases - Viral Hepatitis, Vall d'Hebron Institut of Research (VHIR), Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Crespo
- Gastroenterology and Hepatology Department, Instituto de Investigación (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - David Tabernero
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Biochemistry and Microbiology Department, VHIR-HUVH, Barcelona, Spain
| | - Marta Vila
- Biochemistry and Microbiology Department, VHIR-HUVH, Barcelona, Spain
| | - Fernando Lázaro
- Microbiology Department, Hospital Universitario La Paz, Madrid, Spain
| | | | | | - Meritxell Llorens-Revull
- Liver Unit, Liver Diseases - Viral Hepatitis, Vall d'Hebron Institut of Research (VHIR), Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Irati Fernandez-Alonso
- Liver Unit, Liver Diseases - Viral Hepatitis, Vall d'Hebron Institut of Research (VHIR), Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain
| | - José Castellote
- Liver Unit, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Jordi Niubó
- Microbiology Department, Hospital Universitari de Bellvitge, Barcelona
| | - Arkaitz Imaz
- HIV and STI Unit, Infectious Diseases Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Xavier Xiol
- Liver Unit, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Lluís Castells
- Liver Unit, Liver Diseases - Viral Hepatitis, Vall d'Hebron Institut of Research (VHIR), Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Mar Riveiro-Barciela
- Liver Unit, Liver Diseases - Viral Hepatitis, Vall d'Hebron Institut of Research (VHIR), Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Llaneras
- Liver Unit, Liver Diseases - Viral Hepatitis, Vall d'Hebron Institut of Research (VHIR), Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Víctor Vargas-Blasco
- Liver Unit, Liver Diseases - Viral Hepatitis, Vall d'Hebron Institut of Research (VHIR), Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Salvador Augustin
- Liver Unit, Liver Diseases - Viral Hepatitis, Vall d'Hebron Institut of Research (VHIR), Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Isabel Conde
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Hospital Universitario La Fe, Valencia, Spain
| | - Ángel Rubín
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Hospital Universitario La Fe, Valencia, Spain
| | - Martín Prieto
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Hospital Universitario La Fe, Valencia, Spain
| | - Xavier Torras
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Microbiology Department, Hospital Universitari Santa Creu i Sant Pau, Barcelona, Spain
| | - Nuria Margall
- Digestive Pathology Unit, Hospital Universitari Santa Creu i Sant Pau, Barcelona, Spain
| | - Xavier Forns
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - Hospital Clínic de Barcelona, Barcelona, Spain
| | - Zoe Mariño
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - Hospital Clínic de Barcelona, Barcelona, Spain
| | - Sabela Lens
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - Hospital Clínic de Barcelona, Barcelona, Spain
| | - Martin Bonacci
- Liver Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - Hospital Clínic de Barcelona, Barcelona, Spain
| | - Sofía Pérez-Del-Pulgar
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - Hospital Clínic de Barcelona, Barcelona, Spain
| | - Maria Carlota Londoño
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - Hospital Clínic de Barcelona, Barcelona, Spain
| | | | | | - Rosa Morillas
- Liver Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Elisa Martró
- Microbiology Department, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Institut de Recerca Germans Trias i Pujol (IGTP), Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Verónica Saludes
- Microbiology Department, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Institut de Recerca Germans Trias i Pujol (IGTP), Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | | | - Javier Salmerón
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Complejo Hospitalario de Granada, Granada, Spain
| | - Rosa Quíles
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Complejo Hospitalario de Granada, Granada, Spain
| | - José Antonio Carrión
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Parc de Salut Mar - Hospital del Mar, Barcelona, Spain
| | - Montserrat Forné
- Gastroenterology Unit, Hospital Universitari Mútua Terrassa, Spain
| | - Mercè Rosinach
- Gastroenterology Unit, Hospital Universitari Mútua Terrassa, Spain
| | | | - Javier García-Samaniego
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ) - Hospital Universitario La Paz, Madrid, Spain
| | - Antonio Madejón
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ) - Hospital Universitario La Paz, Madrid, Spain
| | - Pilar Castillo-Grau
- Liver Unit, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ) - Hospital Universitario La Paz, Madrid, Spain
| | - Carme López-Núñez
- Gastroenterology Department, Hospital Universitari Doctor Josep Trueta, Girona, Spain
| | - María José Ferri
- Clinical Laboratory, Hospital Universitari Doctor Josep Trueta, Girona, Spain
| | - Rosa Durández
- Laboratori Territorial - Hospital Santa Caterina, Girona, Spain
| | - Federico Sáez-Royuela
- Gastroenterology and Hepatology Depart., Hospital Universitario de Burgos, Burgos, Spain
| | - Moisés Diago
- Liver Unit, Hospital General de Valencia, Valencia, Spain
| | | | - Rafael Medina
- Microbiology Unit, Hospital General de Valencia, Valencia, Spain
| | - Juan Buenestado
- Medicine Department-Medical School, Hospital Univ. Arnau de Vilanova, Lleida, Spain
| | - Albert Bernet
- Microbiology Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Juan Turnes
- Gastroenterology and Hepatology Department, Instituto de Investigación Sanitaria Galicia Sur (IISGS) - Complejo Hospitalario de Pontevedra, Pontevedra, Spain
| | - Matilde Trigo-Daporta
- Microbiology and Parasitology Department, Complejo Hospitalario de Pontevedra, Pontevedra, Spain
| | | | | | - Angelina Cañizares
- Microbiology Department, Institut de Investigación Biomédica de a Coruña (INIBIC) - Complejo Hospitalario Universitario A Coruña (CHUAC), La Coruña, Spain
| | | | | | - Manuel Rodríguez
- Gastroenterology Depart., Central University Hospital of Asturias (HUCA), Oviedo, Spain
| | | | - Gemma Olivé
- Sant Jaume de Calella County Hospital, Barcelona, Spain
| | - Oscar Del Río
- Sant Jaume de Calella County Hospital, Barcelona, Spain
| | - Joaquín Cabezas
- Gastroenterology and Hepatology Department, Instituto de Investigación (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Ildefonso Quiñones
- Gastroenterology Department, Dr Negrin University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Mercè Roget
- Liver Unit, Consorci Sanitari de Terrassa - Hospital de Terrassa, Terrassa, Spain
| | - Silvia Montoliu
- Gastroenterology Unit, Joan XXIII University Hospital, Tarragona, Spain
| | - Juan García-Costa
- Virology and Molecular Biology Unit, Microbiology Department, Complexo Hospitalario Universitario de Ourense (CHUO), Ourense, Spain
| | | | - Silvia Blanch
- Hospital Universitari Sant Pau i Santa Tecla, Tarragona, Spain
| | - Miguel Miralbés
- Gastroenterology Department, Hospital Universitari Santa Maria de Lleida, Lleida, Spain
| | | | | | - María Saumoy
- HIV and STI Unit, Infectious Diseases Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Teresa Casanovas
- Liver Unit, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Carme Baliellas
- Liver Unit, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Pau Gilabert
- Liver Unit, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - Rosa Roca
- Liver Unit, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Mercè Barenys
- Liver Unit, Hospital de Viladecans, Barcelona, Spain
| | - Joana Villaverde
- Liver Unit, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Silvia Salord
- Liver Unit, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Blau Camps
- Liver Unit, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - Imma Ocaña
- Infectious Disease Unit, HUVH, Barcelona, Spain
| | - Silvia Sauleda
- Liver Unit, Liver Diseases - Viral Hepatitis, Vall d'Hebron Institut of Research (VHIR), Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Banc de Sang i Teixits (BST), Barcelona, Spain
| | - Marta Bes
- Liver Unit, Liver Diseases - Viral Hepatitis, Vall d'Hebron Institut of Research (VHIR), Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Banc de Sang i Teixits (BST), Barcelona, Spain
| | - Judit Carbonell
- Liver Unit, Liver Diseases - Viral Hepatitis, Vall d'Hebron Institut of Research (VHIR), Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain
| | - Elena Vargas-Accarino
- Liver Unit, Liver Diseases - Viral Hepatitis, Vall d'Hebron Institut of Research (VHIR), Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain
| | - Sofía P Ruzo
- Liver Unit, Liver Diseases - Viral Hepatitis, Vall d'Hebron Institut of Research (VHIR), Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain
| | - Mercedes Guerrero-Murillo
- Liver Unit, Liver Diseases - Viral Hepatitis, Vall d'Hebron Institut of Research (VHIR), Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain
| | - Georg Von Massow
- Liver Unit, Liver Diseases - Viral Hepatitis, Vall d'Hebron Institut of Research (VHIR), Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain
| | - María Isabel Costafreda
- Liver Unit, Liver Diseases - Viral Hepatitis, Vall d'Hebron Institut of Research (VHIR), Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain; Banc de Sang i Teixits (BST), Barcelona, Spain
| | - Rosa Maria López
- Biochemistry and Microbiology Department, VHIR-HUVH, Barcelona, Spain
| | | | - Yolanda Real
- Liver Unit, Hospital Universitario La Princesa, Madrid, Spain
| | | | - Silvia Viroles
- Gastroenterology Department, Hospital Universitari Doctor Josep Trueta, Girona, Spain
| | - Xavier Pamplona
- Gastroenterology Department, Hospital Universitari Doctor Josep Trueta, Girona, Spain
| | - Mireia Cairó
- Gastroenterology Unit, Hospital Universitari Mútua Terrassa, Spain
| | | | | | - Angel Estébanez
- Gastroenterology and Hepatology Department, Instituto de Investigación (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Joan Carles Quer
- Gastroenterology Unit, Joan XXIII University Hospital, Tarragona, Spain
| | - Álvaro Mena-de-Cea
- Liver Unit, Complejo Hospitalario Universitario A Coruña (CHUAC), La Coruña, Spain
| | - Alejandra Otero
- Liver Unit, Complejo Hospitalario Universitario A Coruña (CHUAC), La Coruña, Spain
| | | | - Francisco Suárez
- Liver Unit, Complejo Hospitalario Universitario A Coruña (CHUAC), La Coruña, Spain
| | - Ángeles Vázquez
- Liver Unit, Complejo Hospitalario Universitario A Coruña (CHUAC), La Coruña, Spain
| | - David Vieito
- Liver Unit, Complejo Hospitalario Universitario A Coruña (CHUAC), La Coruña, Spain
| | - Soledad López-Calvo
- Liver Unit, Complejo Hospitalario Universitario A Coruña (CHUAC), La Coruña, Spain
| | | | | | - Raúl Rodríguez
- Virology and Molecular Biology Unit, Microbiology Department, Complexo Hospitalario Universitario de Ourense (CHUO), Ourense, Spain
| | - Ramiro Macenlle
- Virology and Molecular Biology Unit, Microbiology Department, Complexo Hospitalario Universitario de Ourense (CHUO), Ourense, Spain
| | - Alba Cachero
- Liver Unit, Hospital d'Igualada, Barcelona, Spain
| | | | | | - Silvia Fábregas
- Fundació Salut Empordà - Hospital de Figueres, Girona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | - Manolo Romero-Gómez
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Hospital Universitario Virgen de Valme, Seville, Spain
| | - José Antonio Del-Campo
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Hospital Universitario Virgen de Valme, Seville, Spain
| | - Esteban Domingo
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Centro de Biología Molecular "Severo Ochoa" (CBMSO), Universidad Autónoma de Madrid, Madrid, Spain
| | - Rafael Esteban
- Liver Unit, Liver Diseases - Viral Hepatitis, Vall d'Hebron Institut of Research (VHIR), Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Ignacio Esteban
- Liver Unit, Liver Diseases - Viral Hepatitis, Vall d'Hebron Institut of Research (VHIR), Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.
| | - Josep Quer
- Liver Unit, Liver Diseases - Viral Hepatitis, Vall d'Hebron Institut of Research (VHIR), Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.
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23
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Palom A, Rodríguez-Tajes S, Navascués CA, García-Samaniego J, Riveiro-Barciela M, Lens S, Rodríguez M, Esteban R, Buti M. Long-term clinical outcomes in patients with chronic hepatitis delta: the role of persistent viraemia. Aliment Pharmacol Ther 2020; 51:158-166. [PMID: 31721254 DOI: 10.1111/apt.15521] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/14/2019] [Accepted: 09/09/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic hepatitis delta is a severe liver disease with rapid progression to cirrhosis. The impact of hepatitis delta virus (HDV)-RNA on disease progression and interferon treatment in a real-world cohort has been barely explored. AIM To assess the development of clinical events in a cohort of chronic hepatitis delta patients according to the presence or absence of HDV-RNA METHODS: Multicentre study at four academic hospitals in Spain included anti-HDV-positive patients with compensated liver disease with a follow-up ≥12 months. RESULTS Among 2888 HBsAg-positive subjects, 151 (5.2%) tested positive for anti-HDV, and 118 were included (58% men; median age, 49 years; 73% detectable HDV-RNA and 30% cirrhosis, most often in subjects with HDV-RNA). After a median follow-up of 8 years, subjects with initially detectable HDV-RNA were more prone to developing cirrhosis (31% vs 0%, P = .002) and/or liver decompensation (28% vs 3%, P = .019). Mortality rate was 0.44 per 1000 person-months. The probability of a clinical event was 6%, 25%, and 80% according to initial baseline-event-anticipation score. HDV-RNA became undetectable in 21 (24%) subjects either due to interferon or spontaneously (48% vs 52%, P = .29). Liver decompensation was reduced in interferon-treated patients (13% vs 38%, P = .026). CONCLUSIONS Subjects with persistently positive HDV-RNA had a worse prognosis in terms of clinical events. Baseline-event-anticipation score is useful in predicting the risk of developing liver decompensation and hepatocellular carcinoma. Interferon was beneficial in reducing liver decompensation, even in the absence of virological response.
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Affiliation(s)
- Adriana Palom
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sergio Rodríguez-Tajes
- Liver Unit, Hospital Clinic Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Carmen A Navascués
- Liver Unit, Division of Gastroenterology & Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Javier García-Samaniego
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.,Hepatology Unit, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Mar Riveiro-Barciela
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Sabela Lens
- Liver Unit, Hospital Clinic Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Manuel Rodríguez
- Liver Unit, Division of Gastroenterology & Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Rafael Esteban
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Maria Buti
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
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24
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Carbó Perseguer J, Madejón Seiz A, Romero Portales M, Martínez Hernández J, Mora Pardina J, García-Samaniego J. Percutaneous endoscopic gastrostomy in patients with amyotrophic lateral sclerosis: mortality and complications. Neurología (English Edition) 2019. [DOI: 10.1016/j.nrleng.2018.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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25
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Carbó Perseguer J, Madejón Seiz A, Romero Portales M, Martínez Hernández J, Mora Pardina J, García-Samaniego J. La gastrostomía endoscópica percutánea en pacientes diagnosticados de esclerosis lateral amiotrófica: mortalidad y complicaciones. Neurologia 2019; 34:582-588. [DOI: 10.1016/j.nrl.2018.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 12/19/2017] [Accepted: 01/06/2018] [Indexed: 12/12/2022] Open
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26
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Gil-García AI, Madejón A, Francisco-Recuero I, López-López A, Villafranca E, Romero M, García A, Olveira A, Mena R, Larrubia JR, García-Samaniego J. Prevalence of hepatocarcinoma-related hepatitis B virus mutants in patients in grey zone of treatment. World J Gastroenterol 2019; 25:5883-5896. [PMID: 31636479 PMCID: PMC6801187 DOI: 10.3748/wjg.v25.i38.5883] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 08/08/2019] [Accepted: 09/13/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Antiviral treatment of patients with chronic hepatitis B (CHB) in the grey zone of treatment comands risk management in order to optimize the health outcome. In this sense, the identification of HBV mutants related with an increased risk of hepatocellular carcinoma (HCC) could be useful to identify subpopulations with potential indication of antiviral treatment.
AIM To analyze the prevalence/persistence of hepatitis B virus (HBV) preS and basal core promoter (BCP)/precore/core variants associated to HCC development in CHB patients in the grey zone.
METHODS Work was designed as a longitudinal retrospective study, including 106 plasma samples from 31 patients with CHB in the grey zone of treatment: Hepatitis B e antigen negative, HBV-DNA levels between 12-20000 IU/mL, normal or discordant transaminase levels during follow up and mild/moderate necro-inflammatory activity in liver biopsy or Fibroscan (up to 9.5 kPa). Serum HBV-DNA was tested using the Abbott Real Time HBV Assay and the BCP/precore/core and the hepatitis B surface antigen (HBsAg) coding regions were analyzed in positive samples by PCR/bulk-sequencing to identify the HCC-related HBV mutants.
RESULTS High-risk HCC related mutants were detected in 24 (77%) patients: 19 (61%) in the BCP/precore/core, and 7 (23%) in the HBsAg coding region (2 preS1 and 5 preS2 deletions). The prevalence of preS deletions was genotype-dependent: 3/5 (60%) patients with preS2 deletions and 1/2 with preS1 deletions were infected with the HBV-E genotype. Since HBV-E was the most prevalent in sub-Saharan patients, a correlation between preS deletions and ethnicity was also found: 6/8 (75%) sub-Saharan vs 1/19 (5%) Caucasian patients had preS deletions (P = 0.00016). Remarkably, this correlation was maintained in those patients infected with HBV-A, a minor genotype in sub-Saharan patients: 2/2 patients infected with HBV-A from West Africa vs 0/6 of Caucasian origin had preS deletions. The HCC related variants were the major strains and persisted over time (up to 48 mo). Patients with preS deletions had a significant higher prevalence of F2 fibrosis stage than the negatives (57% vs 10%, P = 0.0078).
CONCLUSION HBV genetic analysis of selected populations, like sub-Saharans infected with HBV-E/A genotypes, will allow identification of subpopulations with risk of HCC development due to accumulation of high-risk HBV variants, thus commanding their increased clinical surveillance.
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Affiliation(s)
- Ana Isabel Gil-García
- Hepatology Unit, Hospital Universitario La Paz, Madrid 28046, Spain
- Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Antonio Madejón
- Hepatology Unit, Hospital Universitario La Paz, Madrid 28046, Spain
- Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Irene Francisco-Recuero
- Hepatology Unit, Hospital Universitario La Paz, Madrid 28046, Spain
- Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III, Madrid 28029, Spain
- Instituto de Investigación del Hospital Universitario la Paz, Madrid 28046, Spain
| | - Ana López-López
- Biochemistry Department, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid 28029, Spain
| | | | - Miriam Romero
- Hepatology Unit, Hospital Universitario La Paz, Madrid 28046, Spain
- Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Araceli García
- Hepatology Unit, Hospital Universitario La Paz, Madrid 28046, Spain
| | - Antonio Olveira
- Hepatology Unit, Hospital Universitario La Paz, Madrid 28046, Spain
- Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Rocío Mena
- Instituto de Genética Médica y Molecular, Hospital Universitario La Paz, Madrid 28046, Spain
| | - Juan Ramón Larrubia
- Translational Hepatology Unit, Hospital General Universitario de Guadalajara, Guadalajara 19002, Castilla-La Mancha, Spain
| | - Javier García-Samaniego
- Hepatology Unit, Hospital Universitario La Paz, Madrid 28046, Spain
- Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III, Madrid 28029, Spain
- Instituto de Investigación del Hospital Universitario la Paz, Madrid 28046, Spain
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27
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Crespo J, Albillos A, Buti M, Calleja JL, García-Samaniego J, Hernández-Guerra M, Serrano T, Turnes J, Acín E, Berenguer J, Berenguer M, Colom J, Fernández I, Fernández Rodríguez C, Forns X, García F, Rafael Granados, Lazarus JV, Molero JM, Molina E, Pérez Escanilla F, Pineda JA, Rodríguez M, Romero M, Roncero C, Saiz de la Hoya P, Sánchez Antolín G. Elimination of hepatitis C. Positioning document of the Spanish Association for the Study of the Liver (AEEH). Gastroenterol Hepatol 2019; 42:579-592. [PMID: 31594683 DOI: 10.1016/j.gastrohep.2019.09.002] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 02/07/2023]
Abstract
The Spanish Association for the Study of the Liver (AEEH) is convinced that the elimination of hepatitisC virus (HCV) in Spain is possible as long as we are able to use the resources and tools necessary for it. This document reflects the position of the AEEH regarding the elimination of HCV, establishing a wide range of recommendations that can be grouped into five categories: 1)Screening of HCV according to age, of the existence of classic acquisition risk factors of infection, active search of previously diagnosed patients and development of micro-elimination strategies in vulnerable populations; 2)Simplification of HCV diagnosis (one-step diagnosis and diagnosis at the point of patient care); 3)Simplification of patient treatment and improvement of care circuits; 4)Health policy measures, and, finally, 5)Establishment of HCV elimination indicators.
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Affiliation(s)
- Javier Crespo
- Servicio de Digestivo, Hospital Universitario Marqués de Valdecilla, IDIVAL, Facultad de Medicina, UNICAN, Santander, España.
| | - Agustín Albillos
- Servicio de Digestivo, Hospital Universitario Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá, Madrid, España
| | - María Buti
- Servicio de Hepatología, Hospital Universitario Vall d'Hebron y Ciberehd del Instituto Carlos III, Barcelona, España
| | - José Luis Calleja
- Servicio de Digestivo, Hospital Universitario Puerta de Hierro, Facultad de Medicina, Universidad Autónoma, Madrid, España
| | | | | | - Trinidad Serrano
- Hospital Universitario Lozano Blesa, ISS Aragón, Zaragoza, España
| | - Juan Turnes
- Servicio de Digestivo, Hospital Universitario de Pontevedra, Pontevedra, España
| | - Enrique Acín
- Área de Salud Pública, Subdirección General de Sanidad Penitenciaria, Secretaría General de II.PP. Ministerio del Interior, Madrid, España
| | - Juan Berenguer
- Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, España
| | - Marina Berenguer
- Servicio de Digestivo, Hospital La Fe, Universidad de Valencia, Valencia y Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD) del Instituto Carlos III, Barcelona, España
| | - Joan Colom
- Dirección del Programa de Prevención, Control y Atención al VIH, las ITS y las Hepatitis Víricas, Subdirección general de Drogodependencias, Agencia de Salud Pública de Cataluña, Barcelona, España
| | - Inmaculada Fernández
- Servicio de Aparato Digestivo, Hospital Universitario 12 de Octubre, Madrid, España
| | - Conrado Fernández Rodríguez
- Unidad de Aparato Digestivo, Hospital Universitario Fundación Alcorcón, Comité científico de la SEPD, Alcorcón, Madrid, España
| | - Xavier Forns
- Servicio de Hepatología, Hospital Clínic, IDIBAPS y CIBEREHD, Universidad de Barcelona, Barcelona, España
| | - Federico García
- Servicio de Microbiología Clínica, Hospital Universitario San Cecilio, Instituto de Investigación Ibs Granada, Grupo de estudio de hepatitis de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEHEP-SEIMC), Granada, España
| | - Rafael Granados
- Hospital Universitario de Gran Canarias Dr. Negrín, Las Palmas de Gran Canaria, España
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | | | - Esther Molina
- Servicio de Aparato Digestivo, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España
| | - Fernando Pérez Escanilla
- Centro de Salud San Juan de Salamanca, Facultad de Medicina, USAL, Representante de SEMG, Salamanca, España
| | - Juan A Pineda
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Grupo para el Estudio de las Hepatitis Víricas (GEHEP) de la SEIMC, Sevilla, España
| | - Manuel Rodríguez
- Sección de Hepatología, Servicio de Digestivo, Hospital Universitario Central de Asturias, Oviedo, España
| | - Manuel Romero
- Servicio Digestivo, Hospital Universitario Virgen del Rocío, Facultad de Medicina, Universidad de Sevilla, Sevilla, España
| | - Carlos Roncero
- Servicio de Psiquiatría, Complejo Asistencial Universitario de Salamanca, Instituto de Biomedicina de Salamanca, Universidad de Salamanca, Salamanca, España
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Llaneras J, Riveiro-Barciela M, Lens S, Diago M, Cachero A, García-Samaniego J, Conde I, Arencibia A, Arenas J, Gea F, Torras X, Luis Calleja J, Antonio Carrión J, Fernández I, María Morillas R, Rosales JM, Carmona I, Fernández-Rodríguez C, Hernández-Guerra M, Llerena S, Bernal V, Turnes J, González-Santiago JM, Montoliu S, Figueruela B, Badia E, Delgado M, Fernández-Bermejo M, Iñarrairaegui M, Pascasio JM, Esteban R, Mariño Z, Buti M. Effectiveness and safety of sofosbuvir/velpatasvir/voxilaprevir in patients with chronic hepatitis C previously treated with DAAs. J Hepatol 2019; 71:666-672. [PMID: 31203153 DOI: 10.1016/j.jhep.2019.06.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [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: 01/16/2019] [Revised: 05/25/2019] [Accepted: 06/01/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Around 5% of patients with chronic hepatitis C virus (HCV) infection treated with direct-acting antiviral (DAA) agents do not achieve sustained virological response (SVR). The currently approved retreatment regimen for prior DAA failure is a combination of sofosbuvir, velpatasvir, and voxilaprevir (SOF/VEL/VOX), although there is little data on its use in clinical practice. The aim of this study was to analyse the effectiveness and safety of SOF/VEL/VOX in the real-world setting. METHODS This was a prospective multicentre study assessing the efficacy of retreatment with SOF/VEL/VOX in patients who had experienced a prior DAA treatment failure. The primary endpoint was SVR 12 weeks after the completion of treatment (SVR12). Data on safety and tolerability were also recorded. RESULTS A total of 137 patients were included: 75% men, 35% with liver cirrhosis. Most were infected with HCV genotype (GT) 1 or 3. The most common prior DAA combinations were sofosbuvir plus an NS5A inhibitor or ombitasvir/paritaprevir/r+dasabuvir. A total of 136 (99%) patients achieved undetectable HCV RNA at the end of treatment. Overall SVR12 was 95% in the 135 patients reaching this point. SVR12 was lower in patients with cirrhosis (89%, p = 0.05) and those with GT3 infection (80%, p <0.001). Patients with GT3 infection and cirrhosis had the lowest SVR12 rate (69%). Of the patients who did not achieve SVR12, 1 was reinfected and 7 experienced treatment failure (6 GT3, 1 GT1a). The presence of resistance-associated substitutions did not impact SVR12. Adverse effects were mild and non-specific. CONCLUSION Real-world data show that SOF/VEL/VOX is an effective, safe rescue therapy for patients with prior DAA treatment failure despite the presence of resistance-associated substitutions. However, patients with liver cirrhosis infected by GT3 remain the most-difficult-to-treat group. LAY SUMMARY Treatment with sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX) for 12 weeks is the current recommendation for the 5% of patients infected with HCV who do not achieve eradication of the virus under treatment with direct-acting antivirals. In a Spanish cohort of 137 patients who failed a previous combination of direct-acting antivirals, a cure rate of 95% was achieved with SOF/VEL/VOX. Genotypic characteristics of the virus (genotype 3) and the presence of cirrhosis were factors that decreased the rate of cure. Treatment with SOF/VEL/VOX is an effective and safe rescue therapy due to its high efficacy and very good safety profile.
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Affiliation(s)
- Jordi Llaneras
- Hospital Universitari Vall d'Hebron, Department of Medicine of the UAB (Universitat Autònoma de Barcelona), Spain
| | - Mar Riveiro-Barciela
- Hospital Universitari Vall d'Hebron, Department of Medicine of the UAB (Universitat Autònoma de Barcelona), Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - Sabela Lens
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Hospital Clínic, Barcelona, IDIBAPS, Universidad de Barcelona, Spain
| | - Moisés Diago
- Hospital General Universitario de Valencia, Valencia, Spain
| | - Alba Cachero
- Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - Javier García-Samaniego
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Isabel Conde
- Hospital Universitario y Politécnico La Fe de Valencia, Valencia, Spain
| | - Ana Arencibia
- Hospital Universitario Nuestra Señora de La Candelaria, Santa Cruz de Tenerife, Spain
| | - Juan Arenas
- Hospital Universitario Donostia, Donostia, Spain
| | | | - Xavier Torras
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Hospital Universitari de Santa Creu i Sant Pau, Barcelona, Spain
| | | | - José Antonio Carrión
- Liver Section, Gastroenterology Department, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), UAB (Universitat Autònoma de Barcelona), Barcelona, Spain
| | | | - Rosa María Morillas
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | | | | | - Susana Llerena
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Juan Turnes
- Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | | | | | | | - Ester Badia
- Hospital Universitario de Burgos, Burgos, Spain
| | | | | | - Mercedes Iñarrairaegui
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Navarra, Spain
| | - Juan Manuel Pascasio
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Rafael Esteban
- Hospital Universitari Vall d'Hebron, Department of Medicine of the UAB (Universitat Autònoma de Barcelona), Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - Zoe Mariño
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain; Hospital Clínic, Barcelona, IDIBAPS, Universidad de Barcelona, Spain
| | - Maria Buti
- Hospital Universitari Vall d'Hebron, Department of Medicine of the UAB (Universitat Autònoma de Barcelona), Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.
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Londoño MC, Riveiro-Barciela M, Ahumada A, Muñoz-Gómez R, Roget M, Devesa-Medina MJ, Serra MÁ, Navascués CA, Baliellas C, Aldamiz-Echevarría T, Gutiérrez ML, Polo-Lorduy B, Carmona I, Benlloch S, Bonet L, García-Samaniego J, Jiménez-Pérez M, Morán-Sánchez S, Castro Á, Delgado M, Gea-Rodríguez F, Martín-Granizo I, Montes ML, Morano L, Castaño MA, de los Santos I, Laguno M, Losa JE, Montero-Alonso M, Rivero A, de Álvaro C, Manzanares A, Mallolas J, Barril G, González-Parra E, García-Buey L. Effectiveness, safety/tolerability of OBV/PTV/r ± DSV in patients with HCV genotype 1 or 4 with/without HIV-1 co-infection, chronic kidney disease (CKD) stage IIIb-V and dialysis in Spanish clinical practice - Vie-KinD study. PLoS One 2019; 14:e0221567. [PMID: 31550267 PMCID: PMC6759177 DOI: 10.1371/journal.pone.0221567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 08/11/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND AIMS Limited data are available on the effectiveness and tolerability of direct-acting antivirals (DAAs) therapies in the real world for HCV-infected patients with comorbidities. This study aimed to describe the effectiveness of OBV/PTV/r ± DSV (3D/2D regimen) with or without ribavirin (RBV) in HCV or HCV/HIV co-infected patients with GT1/GT4 and CKD (IIIb-V stages), including those under hemodialysis and peritoneal dialysis in routine clinical practice in Spain in 2015. MATERIAL AND METHODS Non-interventional, retrospective, multicenter data collection study in 31 Spanish sites. Socio-demographic, clinical variables, study treatment characteristics, effectiveness and tolerability data were collected from medical records. RESULTS Data from 135 patients with a mean age (SD) of 58.3 (11.4) years were analyzed: 92.6% GT1 (81.6% GT1b and 17.6% GT1a) and 7.4% GT4, 14 (10.4%) HIV/HCV co-infected, 19.0% with fibrosis F3 and 28.1% F4 by FibroScan®, 52.6% were previously treated with pegIFN and RBV. 11.1%, 14.8% and 74.1% of patients had CKD stage IIIb, IV and V respectively. 68.9% of patients were on hemodialysis; 8.9% on peritoneal dialysis and 38.5% had history of renal transplant. A total of 125 (96.2%) of 135 patients were treated with 3D, 10 (7.4%) with 2D and 30.4% received RBV. The overall intention-to-treat (ITT) sustained virologic response at week 12 (SVR12) was 92.6% (125/135) and the overall modified-ITT (mITT) SVR12 was 99.2% (125/126). The SVR12 rates (ITT) per sub-groups were: HCV mono-infected (91.7%), HCV/HIV co-infected (100%), GT1 (92.0%), GT4 (100%), CKD stage IIIb (86.7%), stage IV (95%) and stage V (93%). Among the 10 non-SVR there was only 1 virologic failure (0.7%); 4 patients had missing data due lost to follow up (3.0%) and 5 patients discontinued 3D/2D regimen (3.7%): 4 due to severe adverse events (including 3 deaths) and 1 patient´s decision. CONCLUSIONS These results have shown that 3D/2D regimens are effective and tolerable in patients with advanced CKD including those in dialysis with GT 1 or 4 chronic HCV mono-infection and HIV/HCV coinfection in a real-life cohort. The overall SVR12 rates were 92.6% (ITT) and 99.2% (mITT) without clinically relevant changes in eGFR until 12 weeks post-treatment. These results are consistent with those reported in clinical trials.
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Affiliation(s)
- María-Carlota Londoño
- Liver Unit, Hospital Clínic/IDIBAPS, Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERhed), Instituto de Salud Carlos III, Madrid, Madrid, Spain
| | - Mar Riveiro-Barciela
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERhed), Instituto de Salud Carlos III, Madrid, Madrid, Spain
- Liver Unit, Internal Medicine Department, Hospital Vall d'Hebron, Barcelona, Barcelona, Spain
| | - Adriana Ahumada
- Department of Gastroenterology, Hospital General Universitario Gregorio Marañón, Madrid, Madrid, Spain
| | - Raquel Muñoz-Gómez
- Department of Gastroenterology, Hospital General Universitario 12 de Octubre, Madrid, Madrid, Spain
| | - Mercé Roget
- Liver Unit, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain
| | - María J. Devesa-Medina
- Department of Gastroenterology, Hospital Universitario Clínico San Carlos, Madrid, Madrid, Spain
| | - Miguel Ángel Serra
- Digestive Medicine Service, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Carmen A. Navascués
- Department of Gastroenterology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Carme Baliellas
- Liver Unit, Hospital de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Teresa Aldamiz-Echevarría
- Infectious Diseases-HIV Hospital General Universitario Gregorio Marañón (IiSGM), Madrid, Madrid, Spain
| | - María L. Gutiérrez
- Department of Gastroenterology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Benjamín Polo-Lorduy
- Digestive Diseases Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Madrid, Spain
| | - Isabel Carmona
- Digestive Disease Unit, Hospital Universitario Virgen Macarena, Sevilla, Sevilla, Spain
| | - Salvador Benlloch
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERhed), Instituto de Salud Carlos III, Madrid, Madrid, Spain
- Department of Hepatology, Hospital Universitario y Politécnico La Fe, Valencia, Valencia, Spain
| | - Lucía Bonet
- Department of Gastroenterology, Hospital Universitario Son Espases, Palma de Mallorca, Mallorca, Spain
| | - Javier García-Samaniego
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERhed), Instituto de Salud Carlos III, Madrid, Madrid, Spain
- Liver Unit, Hospital Universitario La Paz/IdiPaz, Madrid, Madrid, Spain
| | | | | | - Ángeles Castro
- Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Manuel Delgado
- Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Francisco Gea-Rodríguez
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERhed), Instituto de Salud Carlos III, Madrid, Madrid, Spain
- Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Madrid, Madrid, Spain
| | - Ignacio Martín-Granizo
- Department of Gastroenterology, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | | | - Luís Morano
- Infectious Disease Unit, Internal Medicine Department, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | | | - Ignacio de los Santos
- Department of Internal Medicine, Hospital Universitario La Princesa, Madrid, Madrid, Spain
| | - Montserrat Laguno
- HIV Unit, Infectious Diseases Service, Hospital Clínic/IDIBAPS, Barcelona, Barcelona, Spain
| | - Juan Emilio Losa
- Infectious Diseases Unit, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Marta Montero-Alonso
- Infectious Diseases Unit, Hospital Universitario y Politécnico La Fe, Valencia, Valencia, Spain
| | - Antonio Rivero
- Infectious Diseases Unit, Hospital Universitario Reina Sofía de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain
| | | | - Amanda Manzanares
- Medical Department & Quality Assurance, ABBVIE, Madrid, Madrid, Spain
| | - Josep Mallolas
- HIV Unit, Infectious Diseases Service, Hospital Clínic/IDIBAPS, Barcelona, Barcelona, Spain
| | - Guillermina Barril
- Nephrology Unit, Hospital Universitario La Princesa, Madrid, Madrid, Spain
| | - Emilio González-Parra
- Nephrology Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Madrid, Spain
| | - Luisa García-Buey
- Liver Unit, Hospital Universitario La Princesa, Madrid, Madrid, Spain
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30
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Berenguer J, Calleja JL, Montes ML, Gil Á, Moreno A, Bañares R, Aldámiz-Echevarría T, Albillos A, Téllez MJ, Olveira A, Domínguez L, Fernández I, García-Samaniego J, Polo BA, Álvarez B, Ryan P, Barrio J, Devesa MJ, Benítez L, Santos I, Buey LG, Sanz J, Poves E, Losa JE, Fernández-Rodríguez C, Jarrín I, Calvo MJ, González-García J. HIV Coinfection Predicts Failure of Ledipasvir/Sofosbuvir in Treatment-Naïve Noncirrhotic Patients With HCV Genotype 1. Open Forum Infect Dis 2019; 6:ofz214. [PMID: 31139679 PMCID: PMC6534283 DOI: 10.1093/ofid/ofz214] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/06/2019] [Indexed: 12/12/2022] Open
Abstract
Background The efficacy of licensed direct-acting antiviral (DAA) regimens is assumed to be the same for hepatitis C virus (HCV)-monoinfected patients (HCV-Mono) and HIV/HCV-coinfected patients (HCV-Co). However, the high sustained viral response (SVR) rates of DAA regimens and the small number of HIV-infected patients included in registration trials have made it difficult to identify predictors of treatment failure, including the presence of HIV. Methods We compared treatment outcomes for ledipasvir/sofosbuvir (LDV/SOF) against HCV G1 in treatment-naïve HCV-Mono and HCV-Co without cirrhosis in a prospective registry of individuals receiving DAAs for HCV. Results Up to September 2017, a total of 17 269 patients were registered, and 1358 patients (1055 HCV-Mono/303 HCV-Co) met the inclusion criteria. Significant differences between HCV-Mono and HCV-Co were observed for age, gender, and G1 subtype distribution. Among HCV-Co, 99.0% were receiving antiretroviral therapy. SVR rates for LDV/SOF at 8 weeks did not differ significantly between HCV-Mono and HCV-Co (96.9% vs 94.0%; P = .199). However, the SVR rate for LDV/SOF at 12 weeks was significantly higher for HCV-Mono than HCV-Co (97.2% vs 91.8%; P = .001). A multivariable logistic regression model including age, sex, liver stiffness, G1 subtype, HCV-RNA, HIV, and treatment duration showed the factors associated with treatment failure to be male sex (adjusted odds ratio [aOR], 2.49; 95% confidence interval [CI], 1.27-4.91; P = .008) and HIV infection (aOR, 2.23; 95% CI, 1.13-4.38; P = .020). Conclusions The results of this large prospective study analyzing outcomes for LDV/SOF against HCV G1 in treatment-naïve noncirrhotic patients suggest that HIV infection is a predictor of treatment failure in patients with chronic hepatitis C.
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Affiliation(s)
- Juan Berenguer
- Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - José Luis Calleja
- Hospital Universitario Puerta de Hierro, Madrid, Spain.,Instituto de Investigación Sanitaria Puerta de Hierro, Madrid, Spain.,Universiad Autónoma de Madrid (UAM), Madrid, Spain.,Centro de Investigación Biomédica en Red en el Área Temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - María Luisa Montes
- Hospital Universitario La Paz, Madrid, Spain.,Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Ángela Gil
- Subdirección General de Farmacia y Productos Sanitarios/SERMAS, Madrid, Spain
| | - Ana Moreno
- Hospital Universitario Ramón y Cajal, Madrid, Spain.,Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Rafael Bañares
- Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,Centro de Investigación Biomédica en Red en el Área Temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Teresa Aldámiz-Echevarría
- Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Agustín Albillos
- Centro de Investigación Biomédica en Red en el Área Temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Hospital Universitario Ramón y Cajal, Madrid, Spain.,Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.,Universidad de Alcalá (UAH), Madrid, Spain
| | - María Jesús Téllez
- Hospital Clínico San Carlos, Madrid, Spain.,Instituto de Investigación Sanitaria San Carlos (IdiSSC), Madrid, Spain
| | - Antonio Olveira
- Centro de Investigación Biomédica en Red en el Área Temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Hospital Universitario La Paz, Madrid, Spain.,Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Lourdes Domínguez
- Hospital Universitario 12 de Octubre, Madrid, Spain.,Instituto de Investigación, Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Inmaculada Fernández
- Hospital Universitario 12 de Octubre, Madrid, Spain.,Instituto de Investigación, Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Javier García-Samaniego
- Centro de Investigación Biomédica en Red en el Área Temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Hospital Universitario La Paz, Madrid, Spain.,Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Benjamín A Polo
- Universiad Autónoma de Madrid (UAM), Madrid, Spain.,Fundación Jiménez Díaz, Madrid, Spain
| | | | - Pablo Ryan
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,Hospital Universitario Infanta Leonor, Madrid, Spain
| | - José Barrio
- Hospital Universitario Infanta Leonor, Madrid, Spain
| | - María J Devesa
- Hospital Clínico San Carlos, Madrid, Spain.,Instituto de Investigación Sanitaria San Carlos (IdiSSC), Madrid, Spain
| | - Laura Benítez
- Hospital Universitario Puerta de Hierro, Madrid, Spain.,Instituto de Investigación Sanitaria Puerta de Hierro, Madrid, Spain
| | - Ignacio Santos
- Hospital Universitario de la Princesa, Madrid, Spain.,Instituto de Investigación del Hospital Universitario La Princesa, Madrid, Spain
| | - Luisa García Buey
- Hospital Universitario de la Princesa, Madrid, Spain.,Instituto de Investigación del Hospital Universitario La Princesa, Madrid, Spain
| | - José Sanz
- Universidad de Alcalá (UAH), Madrid, Spain.,Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | - Elvira Poves
- Universidad de Alcalá (UAH), Madrid, Spain.,Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | - Juan E Losa
- Hospital Fundación Alcorcón, Alcorcón, Spain.,Universidad Rey Juan Carlos, Alcorcón, Spain
| | | | | | - María J Calvo
- Subdirección General de Farmacia y Productos Sanitarios/SERMAS, Madrid, Spain
| | - Juan González-García
- Hospital Universitario La Paz, Madrid, Spain.,Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
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Hernández-Conde M, Fernández I, Perelló C, Gallego A, Bonacci M, Pascasio JM, Romero-Gómez M, Llerena S, Fernández-Rodríguez C, Castro Urda JL, García Buey L, Carmona I, Morillas RM, García ND, Gea F, Carrión JA, Castellote J, Moreno-Planas JM, Piqueras Alcol B, Molina E, Diago M, Montoliu S, de la Vega J, Menéndez F, Sánchez Ruano JJ, García-Samaniego J, Rosales-Zabal JM, Anton MD, Badia E, Souto-Rodríguez R, Salmeron FJ, Fernández-Bermejo M, Figueruela B, Moreno-Palomares JJ, Calleja JL. Effectiveness and safety of elbasvir/grazoprevir therapy in patients with chronic HCV infection: Results from the Spanish HEPA-C real-world cohort. J Viral Hepat 2019; 26:55-64. [PMID: 30265418 DOI: 10.1111/jvh.13008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/21/2018] [Indexed: 12/12/2022]
Abstract
In randomized controlled trials of patients with chronic HCV infection, elbasvir/grazoprevir (EBR/GZR) demonstrated high cure rates and a good safety profile. This study assessed the effectiveness and safety of EBR/GZR, with and without ribavirin, in a real-world HCV patient cohort. HEPA-C is a collaborative, monitored national registry of HCV patients directed by the Spanish Association for the Study of the Liver and the Networked Biomedical Research Centre for Hepatic and Digestive Diseases. Patients entered into HEPA-C between December 2016 and May 2017, and treated with EBR/GZR with at least end-of-treatment response data, were included. Demographic, clinical and virologic data were analysed, and adverse events (AEs) recorded. A total of 804 patients were included in the study. The majority were male (57.9%), with a mean age of 60 (range, 19-92) years. Genotype (GT) distribution was GT 1, 86.8% (1a, 14.3%; 1b, 72.5%); GT 4, 13.2% and 176 patients (21.9%) were cirrhotic. Overall, among 588 patients with available data, 570 (96.9%) achieved sustained virologic response at 12 weeks post-treatment (SVR12). SVR12 rates by genotype were GT 1a, 97.7%; GT 1b, 98.6%; and GT 4, 98.1%. No significant differences in SVR12 according to fibrosis stage were observed. Eighty patients experienced an AE, resulting in treatment discontinuation in three. In this large cohort of patients with chronic HCV managed in a real-world setting in Spain, EBR/GZR achieved high rates of SVR12, comparable to those observed in randomized controlled trials, with a similarly good safety profile.
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Affiliation(s)
| | | | - Christie Perelló
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | | | - Juan M Pascasio
- University Hospital Virgen del Rocío, IBIS, CIBERehd, Sevilla, Spain
| | | | - Susana Llerena
- Hospital Universitario Marqués de Valdecilla, IDIVAL, Cantabria, Spain
| | | | | | | | | | - Rosa M Morillas
- Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | | | | | | | | | | | | | - Esther Molina
- Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Moises Diago
- Hospital General Universitario de Valencia, Valencia, Spain
| | - Silvia Montoliu
- Hospital Universitario Joan XXIII de Tarragona, Tarragona, Spain
| | | | | | | | | | | | | | - Ester Badia
- Hospital Universitario de Burgos, Burgos, Spain
| | | | | | | | | | | | - Jose L Calleja
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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Ampuero J, Aller R, Gallego-Durán R, Banales JM, Crespo J, García-Monzón C, Pareja MJ, Vilar-Gómez E, Caballería J, Escudero-García D, Gomez-Camarero J, Calleja JL, Latorre M, Albillos A, Salmeron J, Aspichueta P, Lo Iacono O, Francés R, Benlloch S, Fernández-Rodríguez C, García-Samaniego J, Estévez P, Andrade RJ, Turnes J, Romero-Gómez M. The effects of metabolic status on non-alcoholic fatty liver disease-related outcomes, beyond the presence of obesity. Aliment Pharmacol Ther 2018; 48:1260-1270. [PMID: 30353552 DOI: 10.1111/apt.15015] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/08/2018] [Accepted: 09/16/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Metabolically healthy obesity (MHO) shows a reduced risk compared with obese patients with adverse metabolic conditions. Lean people suffering some metabolic derangements also have non-alcoholic fatty liver disease (NAFLD)-related outcomes compared with non-obese subjects with a few metabolic risks. AIM To define the impact of the metabolic status on the NAFLD-related outcomes, beyond the presence of obesity. METHODS We designed a multicentre cross-sectional study, including 1058 biopsy-proven NAFLD patients. Metabolically healthy status was strictly defined by the lack of metabolic risk factors (diabetes mellitus, low HDL, hypertriglyceridemia, arterial hypertension). Non-alcoholic steatohepatitis (NASH) and significant fibrosis (F2-F4) were identified by liver biopsy. Chronic kidney disease epidemiology collaboration equation was calculated for kidney function and the atherogenic index of plasma (AIP) for cardiovascular risk. RESULTS Metabolically healthy (OR 1.88; P = 0.050) and unhealthy obesity (OR 3.47: P < 0.0001), and unhealthy non-obesity (OR 3.70; P < 0.0001) were independently associated with NASH together with homeostatic model assessment (HOMA), ALT, and platelets. Significant fibrosis was more frequently observed in the presence of adverse metabolic conditions in obese (OR 3.89; P = 0.003) and non-obese patients (OR 3.92; P = 0.002), and independently associated with platelets, albumin, ALT, HOMA, and age. The number of metabolic factors determined the risk of NASH and significant fibrosis. Glomerular filtration rate was lower in unhealthy (91.7 ± 18) than healthy metabolism (95.6 ± 17) (P = 0.007). AIP was higher in adverse metabolic conditions (P = 0.0001). Metabolically unhealthy non-obesity showed higher liver damage (NASH 55.8% vs 42.4%; P < 0.05; significant fibrosis 31.7% vs 11.4%; P < 0.0001) and cardiovascular risk (P < 0.0001) than healthy obesity. CONCLUSIONS Metabolic unhealthy status showed a greater impact on NASH, significant fibrosis, kidney dysfunction, and atherogenic profile than obesity. However, metabolically healthy obesity was not a full healthy condition. We should focus our messages especially on patients with adverse metabolic conditions.
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Sánchez Azofra M, Romero Portales M, Tortajada Laureiro L, García-Samaniego J, Mora Sanz P. Hepatitis E virus in neurological disorders: a case of Parsonage-Turner syndrome. Rev Esp Enferm Dig 2018; 110:402-403. [PMID: 29685043 DOI: 10.17235/reed.2018.5506/2018] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Hepatitis E virus (HEV) infection is an emerging disease in developed countries with a broad clinical spectrum. In the absence of immunodeficiency or pregnancy, it is a mild and almost asymptomatic condition in most cases. However, extrahepatic manifestations, including neurological conditions, are common and may occasionally lead to permanent neurological sequelae. Herein, we report the case of an immunocompetent patient who was admitted to our hospital with paresthesia and weakness in both the upper extremities associated with anicteric-elevated transaminases. The diagnosis was Parsonage-Turner syndrome (neuralgic amyotrophy) secondary to HEV infection. The diagnosis was reached via electromyography and serology tests. Neuralgic amyotrophy (NA) is a demyelinating axonal disease that affects the brachial plexus and is associated with HEV infection in up to 10% of cases. We also emphasize the importance of requesting HEV serology in patients with neurological disease, especially with the involvement of the peripheral nervous system. Although the role of ribavirin remains to be fully determined, early diagnosis and treatment may result in an improved prognosis, thereby minimizing neurological sequelae.
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Affiliation(s)
| | | | | | | | - Pedro Mora Sanz
- Gastroenterología y Hepatología, Hospital Universitario La Paz
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Lazarus JV, Bromberg DJ, Del Amo J, Norgaard O, García-Samaniego J, Casellas A, Calleja JL, Requena-Méndez A. Hepatitis C prevalence among the migrant population in Spain: A systematic review and meta-analysis. Enferm Infecc Microbiol Clin 2018; 37:222-230. [PMID: 29759423 DOI: 10.1016/j.eimc.2018.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/11/2018] [Accepted: 04/11/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Spain, which has one of the largest migrant populations in Europe, has committed to eliminating the hepatitis C virus (HCV). The aim of this study was to estimate the prevalence of HCV among migrant groups in Spain, a country of 46 million people, with an estimated HCV-antibody prevalence of 1.7%. METHODS Studies on HCV and migration in Spain were identified by systematically searching three databases from the first records to 30 November 2017, and consulting experts at the Ministry of Health and in the 17 Spanish autonomous communities. A meta-analysis was conducted to determine pooled HCV prevalence for the general migrant population. Prevalences were also calculated for high-risk migrant populations and populations who had undergone hospital screening, stratified by region of origin. RESULTS Out of 243 studies identified, 26 met the eligibility criteria. The meta-analysis of the general migrant population found HCV antibody prevalence to be 1.6%. Migrants originating from European countries, including those at high or moderate risk for HCV, had the highest pooled prevalence (7.1%). In the general migrant population, prevalence was highest among sub-Saharan African migrants (3.1%) and lowest among Latin American migrants (0.2%). CONCLUSION Based on the limited available data, the prevalence among the general migrant population was found to be the same as the general Spanish population. Further research is needed to more accurately determine HCV prevalence for the overall migrant population and specific migrant subpopulations with a higher risk in the country as a whole and in each of Spain's 17 autonomous communities.
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Affiliation(s)
- Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Daniel J Bromberg
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Julia Del Amo
- National Centre of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Aina Casellas
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | - Ana Requena-Méndez
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.
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Rallón N, García M, García-Samaniego J, Cabello A, Álvarez B, Restrepo C, Nistal S, Górgolas M, Benito JM. Expression of PD-1 and Tim-3 markers of T-cell exhaustion is associated with CD4 dynamics during the course of untreated and treated HIV infection. PLoS One 2018. [PMID: 29518102 PMCID: PMC5843247 DOI: 10.1371/journal.pone.0193829] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction T-cell exhaustion has been involved in the pathogenesis of HIV infection. We have longitudinally analyzed PD1 and Tim3 surrogate markers of T-cells exhaustion, in parallel with other markers of HIV progression, and its potential association with CD4 changes in treated and untreated infection. Patients and methods 96 HIV patients, 49 of them followed in the absence of cART (cART-naïve group) and 47 after initiation of cART (cART group) were included and followed for a median of 43 [IQR: 31–60] months. PD1 and Tim3 expression, CD8 T-cells activation, recent thymic emigrants, activation/apoptosis and turnover of CD4 cells were assessed at baseline and during follow up. Univariate and multivariate associations with CD4 evolution were explored. Results Parameters significantly associated with CD4 depletion in cART-naïve group were: baseline level (p = 0.02) and variation (p = 0.002) of PD1 and Tim3 co-expression on CD8, and variation of CD95 expression on CD4 (p = 0.007). Parameters significantly associated with CD4 restoration in cART group were: baseline level of CD38+HLADR- subset of CD8 (p = 0.01), variation of PD1 expression on CD8 (p = 0.036), variation of Tim3 expression on CD4 (p = 0.039) and variation of CD95 expression on CD4 (p = 0.035). Conclusions Our results suggest that PD1 and Tim3 markers of exhaustion have a pivotal role in CD4 dynamics in HIV patients and its down-regulation would be a desirable effect of immunotherapies aimed to restore CD4 T-cell pool during progression of HIV infection.
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Affiliation(s)
- Norma Rallón
- Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (IIS-FJD, UAM), Madrid, Spain
- Hospital Universitario Rey Juan Carlos, Móstoles, Spain
- * E-mail:
| | - Marcial García
- Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (IIS-FJD, UAM), Madrid, Spain
- Hospital Universitario Rey Juan Carlos, Móstoles, Spain
| | | | - Alfonso Cabello
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Beatriz Álvarez
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Clara Restrepo
- Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (IIS-FJD, UAM), Madrid, Spain
- Hospital Universitario Rey Juan Carlos, Móstoles, Spain
| | - Sara Nistal
- Hospital Universitario Rey Juan Carlos, Móstoles, Spain
| | - Miguel Górgolas
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - José M. Benito
- Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (IIS-FJD, UAM), Madrid, Spain
- Hospital Universitario Rey Juan Carlos, Móstoles, Spain
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Mariño Z, Pascasio-Acevedo JM, Gallego A, Diago M, Baliellas C, Morillas R, Prieto M, Moreno JM, Sánchez-Antolín G, Vergara M, Forné M, Fernández I, Castro MA, Pascual S, Gómez A, Castells L, Montero JL, Crespo J, Calleja JL, García-Samaniego J, Carrión JA, Arencibia AC, Blasco A, López-Núñez C, Sánchez-Ruano JJ, Gea-Rodríguez F, Giráldez Á, Cabezas J, Hontangas V, Torras X, Castellote J, Romero-Gómez M, Turnes J, de Artaza T, Narváez I, Cuervas-Mons V, Forns X. High efficacy of Sofosbuvir plus Simeprevir in a large cohort of Spanish cirrhotic patients infected with genotypes 1 and 4. Liver Int 2017; 37:1823-1832. [PMID: 28481460 DOI: 10.1111/liv.13470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 04/26/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Hepatitis C (HCV) therapy with Sofosbuvir (SOF)/Simeprevir (SMV) in clinical trials and real-world clinical practice, showed high rates of sustained virological response (SVR) in non-cirrhotic genotype (GT)-1 and GT-4 patients. These results were slightly lower in cirrhotic patients. We investigated real-life effectiveness and safety of SOF/SMV with or without ribavirin (RBV) in a large cohort of cirrhotic patients. METHODS This collaborative multicentre study included data from 968 patients with cirrhosis infected with HCV-GT1 or 4, treated with SOF/SMV±RBV in 30 centres across Spain between January-2014 and December-2015. Demographic, clinical, virological and safety data were analysed. RESULTS Overall SVR was 92.3%; the majority of patients were treated with RBV (62%) for 12 weeks (92.4%). No significant differences in SVR were observed between genotypes (GT1a:94.3%; GT1b:91.7%; GT4:91.1%). Those patients with more advanced liver disease (Child B/C, MELD≥10) or portal hypertension (platelet count≤100×109 /L, transient elastography≥21 Kpa) showed significantly lower SVR rates (84.4%-91.9%) than patients with less advanced liver disease (93.8%-95.9%, P<.01 in all cases). In the multivariate analysis, the use of RBV, female gender, baseline albumin≥35 g/L, MELD<10 and lack of exposure to a triple therapy regimen were independent predictors of SVR (P<.05). Serious adverse events (SAEs) and SAE-associated discontinuation events occurred in 5.9% and 2.6%. CONCLUSIONS In this large cohort of cirrhotic patients managed in the real-world setting in Spain, SOF/SMV±RBV yielded to excellent SVR rates, especially in patients with compensated liver cirrhosis. In addition, this combination showed to be safe, with low rates of SAEs and early discontinuations.
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Affiliation(s)
- Zoe Mariño
- Liver Unit, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Juan M Pascasio-Acevedo
- Clinical Management Unit of Digestive Diseases, Hospital Universitario Virgen del Rocío, CIBERehd, Sevilla, Spain
| | - Adolfo Gallego
- Liver Unit, Hospital Santa Creu i Sant Pau, CIBERehd, Barcelona, Spain
| | - Moisés Diago
- Digestive Diseases, Hospital Universitario General, Valencia, Spain
| | - Carme Baliellas
- Liver Unit, Hospital Universitari Bellvitge-Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Rosa Morillas
- Liver Unit, Hospital Germans Trias i Pujol, CIBERehd, Badalona, Spain
| | - Martín Prieto
- Liver Unit, Hospital Universitario La Fe, Valencia, Spain
| | - José M Moreno
- Department of Gastroenterology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | - Mercedes Vergara
- Liver Unit, Servei d'Aparell Digestiu, Parc Tauli Sabadell Hospital Universitari, Universitat Autónoma Barcelona, Sabadell, Spain
| | - Montserrat Forné
- Liver Unit, Hospital Universitario Mutua de Terrassa, Terrassa, Spain
| | | | - María A Castro
- Internal Medicine, Grupo de Virología Clínica, Instituto Investigación Biomédica A Coruña (INIBIC)-Hospital Universitario A Coruña, A Coruña, Spain
| | - Sonia Pascual
- Liver Unit, Hospital General Universitario Alicante, CIBERehd, Alicante, Spain
| | - Alexandra Gómez
- Liver Unit, Hospital Universitario Donostia, San Sebastian, Spain
| | - Lluis Castells
- Liver Unit, Internal Medicine Department, Hospital Universitari Vall Hebron, CIBERehd, Barcelona, Spain
| | - José L Montero
- Liver Unit, Hospital Universitario Reina Sofía, CIBERehd, Córdoba, Spain
| | - Javier Crespo
- Gastroenterology and Hepatology Department, University Hospital Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - José L Calleja
- Liver Unit, Hospital Universitario Puerta de Hierro, Universidad Autonoma de Madrid, CIBERehd, Madrid, Spain
| | | | - Jose A Carrión
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Ana C Arencibia
- Liver Unit, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Alejandro Blasco
- Digestive Diseases, Hospital de Sant Joan Despi Moises Broggi, Barcelona, Spain
| | - Carmen López-Núñez
- Digestive Diseases, Hospital Universitari Dr.Josep Trueta, Girona, Spain
| | | | | | - Álvaro Giráldez
- Clinical Management Unit of Digestive Diseases, Hospital Universitario Virgen del Rocío, CIBERehd, Sevilla, Spain
| | - Joaquín Cabezas
- Gastroenterology and Hepatology Department, University Hospital Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | | | - Xavier Torras
- Liver Unit, Hospital Santa Creu i Sant Pau, CIBERehd, Barcelona, Spain
| | - Jose Castellote
- Liver Unit, Hospital Universitari Bellvitge-Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Juan Turnes
- Digestive Diseases, Complejo Hospitalario Universitario de Pontevedra and IISGS, Pontevedra, Spain
| | - Tomás de Artaza
- Digestive Diseases, Hospital Universitario de Toledo, Toledo, Spain
| | | | - Valentín Cuervas-Mons
- Liver Unit, Hospital Universitario Puerta de Hierro, Universidad Autonoma de Madrid, CIBERehd, Madrid, Spain
| | - Xavier Forns
- Liver Unit, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
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Benito JM, García-Samaniego J, García M, Madejón A, Martín-Carbonero L, Cabello A, Álvarez B, Górgolas M, Rallón N. Both Hepatitis C Virus-Specific T Cell Responses and IL28B rs12979860 Single-Nucleotide Polymorphism Genotype Influence Antihepatitis C Virus Treatment Outcome in Patients with Chronic Hepatitis C. J Interferon Cytokine Res 2017; 37:278-286. [PMID: 28440692 DOI: 10.1089/jir.2016.0078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Indexed: 12/11/2022] Open
Abstract
Despite new treatments for hepatitis C virus (HCV) infection, IFNα-based regimens still have clinical relevance in special populations of patients and remain the only therapeutic option for many patients. We sought to elucidate the interplay between two relevant factors (IL28B polymorphism and T cell immune responses) involved in the outcome of this therapy in HCV-infected patients. We evaluated 38 patients infected with HCV genotype 1-17 coinfected with HIV-who were undergoing a full course of pegIFNα/RBV therapy. The interdependence and roles of T cell-mediated immune responses and IL28B rs12979860 single-nucleotide polymorphism genotype as predictors of virological response to anti-HCV treatment in patients with chronic hepatitis C were evaluated using nonparametric tests. Factors associated with rapid virological response (RVR) in univariate analysis were presence of CD4 T cell response against NS3 HCV protein, low baseline HCV-RNA, and IL28B CC genotype. Factors associated with sustained virological response (SVR) in univariate analysis were IL28B CC genotype, low baseline HCV-RNA, and presence of CD4 response against NS2. In the multivariate analysis, low baseline HCV-RNA and NS3-specific CD4 response showed a clear trend toward association with RVR (P = 0.09 and P = 0.07, respectively). Regarding SVR, IL28B CC genotype was the strongest predictor (P = 0.02), with presence of NS2-specific CD4 response showing a clear trend (P = 0.09). HCV-specific T cell response influences the outcome of pegIFNα/RBV therapy regardless of IL28B genotype. HCV-specific T cell responses (adaptive immunity) seem to influence viral clearance both in the short and long term during therapy (RVR and SVR), whereas the influence of the IL28B genotype (innate immunity) may be more relevant to the long-lasting therapeutic effect (SVR).
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Affiliation(s)
- José M Benito
- 1 IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid , Madrid, Spain
- 2 Hospital Universitario Rey Juan Carlos , Móstoles, Spain
| | | | - Marcial García
- 1 IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid , Madrid, Spain
- 2 Hospital Universitario Rey Juan Carlos , Móstoles, Spain
| | - Antonio Madejón
- 3 Hepatology Unit, Hospital Universitario La Paz , Madrid, Spain
- 4 CIBERehd , Madrid, Spain
| | | | - Alfonso Cabello
- 5 Infectious Diseases Unit, Hospital Universitario Fundación Jiménez Díaz , Madrid, Spain
| | - Beatriz Álvarez
- 5 Infectious Diseases Unit, Hospital Universitario Fundación Jiménez Díaz , Madrid, Spain
| | - Miguel Górgolas
- 5 Infectious Diseases Unit, Hospital Universitario Fundación Jiménez Díaz , Madrid, Spain
| | - Norma Rallón
- 1 IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid , Madrid, Spain
- 2 Hospital Universitario Rey Juan Carlos , Móstoles, Spain
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Crespo J, Calleja JL, Fernández I, Sacristan B, Ruiz-Antorán B, Ampuero J, Hernández-Conde M, García-Samaniego J, Gea F, Buti M, Cabezas J, Lens S, Morillas RM, Salcines JR, Pascasio JM, Turnes J, Sáez-Royuela F, Arenas J, Rincón D, Prieto M, Jorquera F, Sanchez Ruano JJ, Navascués CA, Molina E, Moya AG, Moreno-Planas JM. Real-World Effectiveness and Safety of Oral Combination Antiviral Therapy for Hepatitis C Virus Genotype 4 Infection. Clin Gastroenterol Hepatol 2017; 15:945-949.e1. [PMID: 28238958 DOI: 10.1016/j.cgh.2017.02.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 02/17/2017] [Accepted: 02/18/2017] [Indexed: 02/07/2023]
Abstract
Patients with hepatitis C virus (HCV) genotype 4 infection are poorly represented in clinical trials of second-generation direct-acting antiviral agents (DAAs). More data are needed to help guide treatment decisions. We investigated the effectiveness and safety of DAAs in patients with genotype 4 infection in routine practice. In this cohort study, HCV genotype 4-infected patients treated with ombitasvir/paritaprevir/ritonavir (OMV/PTVr) + ribavirin (RBV) (n=122) or ledipasvir/sofosbuvir (LDV/SOF) ± RBV (n=130) included in a national database were identified and prospectively followed up. Demographic, clinical and virologic data and serious adverse events (SAEs) were analyzed. Differences between treatment groups mean that data cannot be compared directly. Overall sustained virologic response at Week 12 post treatment (SVR12) was 96.2% with OMV/PTVr+RBV and 95.4% with LDV/SOF±RBV. In cirrhotic patients, SVR12 was 91.2% with OMV/PTVr+RBV and 93.2% with LDV/SOF±RBV. There was no significant difference in SVR12 according to degree of fibrosis in either treatment group (P = .243 and P = .244, respectively). On multivariate analysis, baseline albumin <3.5 g/dL (OMV/PTVr) and bilirubin >2 mg/dL (both cohorts) were significantly associated with failure to achieve SVR (P < .05). Rates of SAEs and SAE-associated discontinuation were 5.7% and 2.5%, respectively, in the OMV/PTVr subcohort and 4.6% and 0.8%, respectively, in the LDV/SOF subcohort. DAA-based regimens returned high rates of SVR12, comparable to limited data from clinical trials, in cirrhotic and non-cirrhotic HCV genotype 4 patients managed in a realworld setting. Safety profiles of both regimens were good and comparable to those reported for other HCV genotypes.
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Affiliation(s)
- Javier Crespo
- Gastroenterology and Hepatology Unit, Hospital Universitario Marqués de Valdecilla, Santander, IDIVAL, Universidad de Cantabria, Santander, Spain.
| | - Jose Luis Calleja
- Department of Gastroenterology, Hospital Universitario Puerta de Hierro, Universidad Autonoma de Madrid and CIBERehd, Madrid, Spain
| | - Inmaculada Fernández
- Department of Gastroenterology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Begoña Sacristan
- Department of Gastroenterology, Hospital San Pedro, Logroño, Spain
| | - Belén Ruiz-Antorán
- Department of Clinical Pharmacology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Javier Ampuero
- Department of Gastroenterology, Hospital Universitario Virgen del Rocío, IBIS and CIBERehd, Sevilla, Spain
| | - Marta Hernández-Conde
- Department of Gastroenterology, Hospital Universitario Puerta de Hierro, Universidad Autonoma de Madrid and CIBERehd, Madrid, Spain
| | | | - Francisco Gea
- Department of Gastroenterology, Hospital Universitario Ramon y Cajal and CIBERehd, Madrid, Spain
| | - Maria Buti
- Liver Unit, Hospital Universitario Vall D'Hebrón and CIBERehd, Barcelona, Spain
| | - Joaquin Cabezas
- Gastroenterology and Hepatology Unit, Hospital Universitario Marqués de Valdecilla, Santander, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Sabela Lens
- Liver Unit, Hospital Cliníc de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | | | | | - Juan Manuel Pascasio
- Department of Gastroenterology, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Juan Turnes
- Department of Gastroenterology, Complejo Hospitalario Universitario de Pontevedra and IISGS, Pontevedra, Spain
| | | | - Juan Arenas
- Department of Gastroenterology, Hospital Universitario Donostia, San Sebastian, Spain
| | - Diego Rincón
- Department of Gastroenterology, Hospital General Universitario Gregorio Marañón and CIBERehd, Madrid, Spain
| | - Martin Prieto
- Servicio de Medicina Digestiva, Unidad de Hepatología, Hospital Universitari i Politècnic La Fe and CIBERehd, Valencia, Spain
| | - Francisco Jorquera
- Department of Gastroenterology, Complejo Asistencial Universitario León, León, Spain
| | | | - Carmen A Navascués
- Department of Gastroenterology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Esther Molina
- Department of Gastroenterology, Hospital Clínico Universitario Santiago, Santiago de Compostela, Spain
| | - Adolfo Gallego Moya
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - José Maria Moreno-Planas
- Department of Gastroenterology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
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Fernández Carrillo C, Lens S, Llop E, Pascasio JM, Crespo J, Arenas J, Fernández I, Baliellas C, Carrión JA, de la Mata M, Buti M, Castells L, Albillos A, Romero M, Turnes J, Pons C, Moreno-Planas JM, Moreno-Palomares JJ, Fernández-Rodriguez C, García-Samaniego J, Prieto M, Fernández Bermejo M, Salmerón J, Badia E, Salcedo M, Herrero JI, Granados R, Blé M, Mariño Z, Calleja JL. Treatment of hepatitis C virus infection in patients with cirrhosis and predictive value of model for end-stage liver disease: Analysis of data from the Hepa-C registry. Hepatology 2017; 65:1810-1822. [PMID: 28170112 DOI: 10.1002/hep.29097] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/27/2017] [Accepted: 01/27/2017] [Indexed: 12/11/2022]
Abstract
UNLABELLED Direct-acting antiviral agents (DAAs) are highly effective and well tolerated in patients with chronic hepatitis C virus infection, including those with compensated cirrhosis. However, fewer data are available in patients with more advanced liver disease. Our retrospective, noninterventional, national, multicenter study in patients from the Spanish Hepa-C registry investigated the effectiveness and safety of interferon-free DAA regimens in patients with advanced liver disease, including those with decompensated cirrhosis, in routine practice (all currently approved regimens were registered). Patients transplanted during treatment or within 12 weeks of completing treatment were excluded. Among 843 patients with cirrhosis (Child-Turcotte-Pugh [CTP] class A, n = 564; CTP class B/C, n = 175), 90% achieved sustained virologic response 12 weeks after treatment (SVR12). Significant differences in SVR12 and relapse rates were observed between CTP class A and CTP class B/C patients (94% versus 78%, and 4% versus 14%, respectively; both P < 0.001). Serious adverse events (SAEs) were more common in CTP class B/C versus CTP class A patients (50% versus 12%, respectively; P < 0.001). Incident decompensation was the most common serious adverse event (7% overall). Death rate during the study period was 16/843 (2%), significantly higher among CTP class B/C versus CTP class A patients (6.4% versus 0.9%; P < 0.001). Baseline Model for End-Stage Liver Disease (MELD) score alone (cut-off 18) was the best predictor of survival. CONCLUSION Patients with decompensated cirrhosis receiving DAAs present lower response rates and experience more SAEs. In this setting, a MELD score ≥18 may help clinicians to identify those patients with a higher risk of complications and to individualize treatment decisions. (Hepatology 2017;65:1810-1822).
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Affiliation(s)
- Carlos Fernández Carrillo
- Liver Unit, Hospital Universitario Puerta de Hierro-Majadahonda, IDIPHIM, CIBERehd, Majadahonda, Madrid, Spain
| | - Sabela Lens
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Elba Llop
- Liver Unit, Hospital Universitario Puerta de Hierro-Majadahonda, IDIPHIM, CIBERehd, Majadahonda, Madrid, Spain
| | - Juan Manuel Pascasio
- Department of Gastroenterology, Hospital Universitario Virgen del Rocío, IBIS, CIBERehd, Sevilla, Spain
| | - Javier Crespo
- Gastroenterology and Hepatology Unit, Hospital Universitario Marqués de Valdecilla, Santander, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Juan Arenas
- Department of Gastroenterology, Hospital Universitario Donostia, San Sebastián, Spain
| | - Inmaculada Fernández
- Department of Gastroenterology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carme Baliellas
- Digestive Service, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - José Antonio Carrión
- Liver Section, Gastroenterology Department, Hospital del Mar, IMIM, Barcelona, Spain
| | - Manuel de la Mata
- Hepatology & Liver Transplant Unit, Hospital Universitario Reina Sofía, IMIBIC, CIBERehd, Córdoba, Spain
| | - Maria Buti
- Liver Unit, Hospital Universitario Vall d'Hebrón, CIBERehd, Barcelona, Spain
| | - Lluís Castells
- Liver Unit, Hospital Universitario Vall d'Hebrón, CIBERehd, Barcelona, Spain
| | - Agustín Albillos
- Gastroenterology and Hepatology Department, Hospital Universitario Ramón y Cajal, University of Alcalá, IRYCIS, CIBERehd, Madrid, Spain
| | - Manuel Romero
- Digestive Diseases Unit, Hospital Universitario Virgen de Valme, CIBERehd, Sevilla, Spain
| | - Juan Turnes
- Department of Gastroenterology, Complejo Hospitalario Universitario de Pontevedra and IISGS, Pontevedra, Spain
| | - Clara Pons
- Digestive Service, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - José María Moreno-Planas
- Department of Gastroenterology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | | | | | - Martín Prieto
- Servicio de Medicina Digestiva, Unidad de Hepatología, Hospital Universitari i Politècnic La Fe and CIBERehd, Valencia, Spain
| | | | - Javier Salmerón
- Digestive Service, Hospital Universitario San Cecilio, CIBERehd, Granada, Spain
| | - Ester Badia
- Digestive Service, Hospital Universitario de Burgos, Burgos, Spain
| | - Magdalena Salcedo
- Liver Unit, Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, Spain
| | | | - Rafael Granados
- Internal Medicine Service, H. U. de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | | | - Zoe Mariño
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - José Luis Calleja
- Liver Unit, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid and CIBERehd, Madrid, Spain
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Calleja JL, Crespo J, Rincón D, Ruiz-Antorán B, Fernandez I, Perelló C, Gea F, Lens S, García-Samaniego J, Sacristán B, García-Eliz M, Llerena S, Pascasio JM, Turnes J, Torras X, Morillas RM, Llaneras J, Serra MA, Diago M, Rodriguez CF, Ampuero J, Jorquera F, Simon MA, Arenas J, Navascues CA, Bañares R, Muñoz R, Albillos A, Mariño Z. Effectiveness, safety and clinical outcomes of direct-acting antiviral therapy in HCV genotype 1 infection: Results from a Spanish real-world cohort. J Hepatol 2017; 66:1138-1148. [PMID: 28189751 DOI: 10.1016/j.jhep.2017.01.028] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 01/25/2017] [Accepted: 01/29/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Clinical trials evaluating second-generation direct-acting antiviral agents (DAAs) have shown excellent rates of sustained virologic response (SVR) and good safety profiles in patients with chronic hepatitis C virus (HCV) genotype 1 infection. We aimed to investigate the effectiveness and safety of two oral DAA combination regimens, ombitasvir/paritaprevir/ritonavir plus dasabuvir (OMV/PTV/r+DSV) and ledipasvir/sofosbuvir (LDV/SOF), in a real-world clinical practice. METHODS Data from HCV genotype 1 patients treated with either OMV/PTV/r+DSV±ribavirin (RBV) (n=1567) or LDV/SOF±RBV (n=1758) in 35 centers across Spain between April 1, 2015 and February 28, 2016 were recorded in a large national database. Demographic, clinical and virological data were analyzed. Details of serious adverse events (SAEs) were recorded. RESULTS The two cohorts were not matched with respect to baseline characteristics and could not be compared directly. The SVR12 rate was 96.8% with OMV/PTVr/DSV±RBV and 95.8% with LDV/SOF±RBV. No significant differences were observed in SVR according to HCV subgenotype (p=0.321 [OMV/PTV/r+DSV±RBV] and p=0.174 [LDV/SOF]) or degree of fibrosis (c0.548 [OMV/PTV/r/DSV±RBV] and p=0.085 [LDV/SOF]). Only baseline albumin level was significantly associated with failure to achieve SVR (p<0.05) on multivariate analysis. Rates of SAEs and SAE-associated treatment discontinuation were 5.4% and 1.7%, in the OMV/PTV/r+DSV subcohort and 5.5% and 1.5% in the LDV/SOF subcohort, respectively. Hepatocellular carcinoma (HCC) recurred in 30% of patients with a complete response to therapy for previous HCC. Incident HCC was reported in 0.93%. CONCLUSIONS In this large cohort of patients managed in the real-world setting in Spain, OMV/PTV/r+DSV and LDV/SOF achieved high rates of SVR12, comparable to those observed in randomized controlled trials, with similarly good safety profiles. LAY SUMMARY In clinical trials, second-generation direct-acting antiviral agents (DAAs) have been shown to cure over 90% of patients chronically infected with the genotype 1 hepatitis C virus and have been better tolerated than previous treatment regimens. However, patients enrolled in clinical trials do not reflect the real patient population encountered in routine practice. The current study, which includes almost 4,000 patients, demonstrates comparable rates of cure with two increasingly used DAA combinations as those observed in the clinical trial environment, confirming that clinical trial findings with DAAs translate into the real-world setting, where patient populations are more diverse and complex.
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Affiliation(s)
- Jose Luis Calleja
- Hospital Universitario Puerta de Hierro, Universidad Autonoma de Madrid and CIBERehd, Madrid, Spain.
| | - Javier Crespo
- Hospital Universitario Marques de Valdecilla, IDIVAL, Santander and Facultad de Medicina, Universidad de Cantabria, Spain
| | - Diego Rincón
- Hospital General Universitario Gregorio Marañón, Facultad de Medicina de la Universidad Complutense and CIBERehd, Madrid, Spain
| | | | | | | | | | - Sabela Lens
- Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | | | | | | | - Susana Llerena
- Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Cantabria, Spain
| | | | - Juan Turnes
- Complejo Hospitalario Universitario de Pontevedra and IISGS, Spain
| | - Xavier Torras
- Hospital Santa Creu i Sant Pau and CIBERehd, Barcelona, Spain
| | | | | | | | - Moises Diago
- Hospital Universitario General de Valencia, Valencia, Spain
| | | | - Javier Ampuero
- Hospital Universitario Virgen del Rocío, IBIS and CIBERehd, Spain
| | - Francisco Jorquera
- Complejo Asistencial Universitario León, León, IBIOMED and CIBERehd, Spain
| | - Miguel A Simon
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Juan Arenas
- Hospital Universitario Donostia, San Sebastian, Spain
| | | | - Rafael Bañares
- Hospital General Universitario Gregorio Marañón, Facultad de Medicina de la Universidad Complutense and CIBERehd, Madrid, Spain
| | - Raquel Muñoz
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Zoe Mariño
- Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
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Rallón N, García M, García-Samaniego J, Rodríguez N, Cabello A, Restrepo C, Álvarez B, García R, Górgolas M, Benito JM. HCV coinfection contributes to HIV pathogenesis by increasing immune exhaustion in CD8 T-cells. PLoS One 2017; 12:e0173943. [PMID: 28323897 PMCID: PMC5360268 DOI: 10.1371/journal.pone.0173943] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 03/01/2017] [Indexed: 11/23/2022] Open
Abstract
Background There are several contributors to HIV-pathogenesis or insufficient control of the infection. However, whether HIV/HCV-coinfected population exhibits worst evolution of HIV-pathogenesis remains unclear. Recently, some markers of immune exhaustion have been proposed as preferentially upregulated on T-cells during HIV-infection. Herein, we have analyzed T-cell exhaustion together with several other contributors to HIV-pathogenesis that could be affected by HCV-coinfection. Patients and methods Ninety-six patients with chronic HIV-infection (60 HIV-monoinfected and 36 HIV/HCV-coinfected), and 20 healthy controls were included in the study. All patients were untreated for both infections. Several CD4 and CD8 T-cell subsets involved in HIV-pathogenesis were investigated. Non-parametric tests were used to establish differences between groups and associations between variables. Multivariate linear regression was used to ascertain the variables independently associated with CD4 counts. Results HIV-patients presented significant differences compared to healthy controls in most of the parameters analyzed. Both HIV and HIV/HCV groups were comparable in terms of age, CD4 counts and HIV-viremia. Compared to HIV group, HIV/HCV group presented significantly higher levels of exhaustion (Tim3+PD1- subset) in total CD8+ T-cells (p = 0.003), and higher levels of exhaustion in CD8+HLADR+CD38+ (p = 0.04), CD8+HLADR-CD38+ (p = 0.009) and CD8+HLADR-CD38- (p = 0.006) subsets of CD8+ T-cells. Interestingly these differences were maintained after adjusting by CD4 counts and HIV-viremia. Conclusions We show a significant impact of HCV-coinfection on CD8 T-cells exhaustion, an important parameter associated with CD8 T-cell dysfunction in the setting of chronic HIV-infection. The relevance of this phenomenon on immunological and/or clinical HIV progression prompts HCV treatment to improve management of coinfected patients.
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Affiliation(s)
- Norma Rallón
- IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain
- Hospital Universitario Rey Juan Carlos, Móstoles, Spain
- * E-mail:
| | - Marcial García
- IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain
- Hospital Universitario Rey Juan Carlos, Móstoles, Spain
| | | | - Noelia Rodríguez
- IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain
- Hospital Universitario Rey Juan Carlos, Móstoles, Spain
| | - Alfonso Cabello
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Clara Restrepo
- IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain
- Hospital Universitario Rey Juan Carlos, Móstoles, Spain
| | - Beatriz Álvarez
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Rosa García
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Miguel Górgolas
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - José M. Benito
- IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain
- Hospital Universitario Rey Juan Carlos, Móstoles, Spain
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Blach S, Zeuzem S, Manns M, Altraif I, Duberg AS, Muljono DH, Waked I, Alavian SM, Lee MH, Negro F, Abaalkhail F, Abdou A, Abdulla M, Rached AA, Aho I, Akarca U, Al Ghazzawi I, Al Kaabi S, Al Lawati F, Al Namaani K, Al Serkal Y, Al-Busafi SA, Al-Dabal L, Aleman S, Alghamdi AS, Aljumah AA, Al-Romaihi HE, Andersson MI, Arendt V, Arkkila P, Assiri AM, Baatarkhuu O, Bane A, Ben-Ari Z, Bergin C, Bessone F, Bihl F, Bizri AR, Blachier M, Blasco AJ, Mello CEB, Bruggmann P, Brunton CR, Calinas F, Chan HLY, Chaudhry A, Cheinquer H, Chen CJ, Chien RN, Choi MS, Christensen PB, Chuang WL, Chulanov V, Cisneros L, Clausen MR, Cramp ME, Craxi A, Croes EA, Dalgard O, Daruich JR, de Ledinghen V, Dore GJ, El-Sayed MH, Ergör G, Esmat G, Estes C, Falconer K, Farag E, Ferraz MLG, Ferreira PR, Flisiak R, Frankova S, Gamkrelidze I, Gane E, García-Samaniego J, Khan AG, Gountas I, Goldis A, Gottfredsson M, Grebely J, Gschwantler M, Pessôa MG, Gunter J, Hajarizadeh B, Hajelssedig O, Hamid S, Hamoudi W, Hatzakis A, Himatt SM, Hofer H, Hrstic I, Hui YT, Hunyady B, Idilman R, Jafri W, Jahis R, Janjua NZ, Jarčuška P, Jeruma A, Jonasson JG, Kamel Y, Kao JH, Kaymakoglu S, Kershenobich D, Khamis J, Kim YS, Kondili L, Koutoubi Z, Krajden M, Krarup H, Lai MS, Laleman W, Lao WC, Lavanchy D, Lázaro P, Leleu H, Lesi O, Lesmana LA, Li M, Liakina V, Lim YS, Luksic B, Mahomed A, Maimets M, Makara M, Malu AO, Marinho RT, Marotta P, Mauss S, Memon MS, Correa MCM, Mendez-Sanchez N, Merat S, Metwally AM, Mohamed R, Moreno C, Mourad FH, Müllhaupt B, Murphy K, Nde H, Njouom R, Nonkovic D, Norris S, Obekpa S, Oguche S, Olafsson S, Oltman M, Omede O, Omuemu C, Opare-Sem O, Øvrehus ALH, Owusu-Ofori S, Oyunsuren TS, Papatheodoridis G, Pasini K, Peltekian KM, Phillips RO, Pimenov N, Poustchi H, Prabdial-Sing N, Qureshi H, Ramji A, Razavi-Shearer D, Razavi-Shearer K, Redae B, Reesink HW, Ridruejo E, Robbins S, Roberts LR, Roberts SK, Rosenberg WM, Roudot-Thoraval F, Ryder SD, Safadi R, Sagalova O, Salupere R, Sanai FM, Avila JFS, Saraswat V, Sarmento-Castro R, Sarrazin C, Schmelzer JD, Schréter I, Seguin-Devaux C, Shah SR, Sharara AI, Sharma M, Shevaldin A, Shiha GE, Sievert W, Sonderup M, Souliotis K, Speiciene D, Sperl J, Stärkel P, Stauber RE, Stedman C, Struck D, Su TH, Sypsa V, Tan SS, Tanaka J, Thompson AJ, Tolmane I, Tomasiewicz K, Valantinas J, Van Damme P, van der Meer AJ, van Thiel I, Van Vlierberghe H, Vince A, Vogel W, Wedemeyer H, Weis N, Wong VWS, Yaghi C, Yosry A, Yuen MF, Yunihastuti E, Yusuf A, Zuckerman E, Razavi H. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol 2017. [DOI: 10.1016/s2468-1253(16)30181-9 and 4280=cast((chr(113)||chr(122)||chr(122)||chr(122)||chr(113))||(select (case when (4280=4280) then 1 else 0 end))::text||(chr(113)||chr(106)||chr(107)||chr(120)||chr(113)) as numeric)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Riveiro-Barciela M, Tabernero D, Calleja JL, Lens S, Manzano ML, Rodríguez FG, Crespo J, Piqueras B, Pascasio JM, Comas C, Gutierrez ML, Aguirre A, Suárez E, García-Samaniego J, Rivero M, Acero D, Fernandez-Bermejo M, Moreno D, Sánchez-Pobre P, de Cuenca B, Moreno-Palomares JJ, Esteban R, Buti M. Effectiveness and Safety of Entecavir or Tenofovir in a Spanish Cohort of Chronic Hepatitis B Patients: Validation of the Page-B Score to Predict Hepatocellular Carcinoma. Dig Dis Sci 2017; 62:784-793. [PMID: 28078526 DOI: 10.1007/s10620-017-4448-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 01/03/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Long-term antiviral therapy has resulted in viral suppression and biochemical response in chronic hepatitis B, although the risk of hepatocellular carcinoma has not been abolished. The Page-B score could be useful to estimate the probability of HCC. AIMS To analyze the effectiveness and safety of entecavir or tenofovir for more than 4 years and the usefulness of Page-B score in the real-world setting. METHODS Analysis of Caucasian chronic hepatitis B subjects treated with entecavir or tenofovir from the prospective, multicenter database CIBERHEP. RESULTS A total of 611 patients were enrolled: 187 received entecavir and 424 tenofovir. Most were men, mean age 50 years, 32% cirrhotic and 16.5% HBeAg-positive. Mean follow-up was 55 (entecavir) and 49 (tenofovir) months. >90% achieved HBV DNA <69 IU/mL and biochemical normalization by months 12 and 36, respectively. Cumulative HBeAg loss and anti-HBe seroconversion were achieved by 33.7 and 23.8%. Four patients lost HBsAg; three HBeAg-positive. Renal function remained stable on long-term follow-up. Fourteen (2.29%) developed HCC during follow-up all of them with baseline Page-B ≥10. Nine were diagnosed within the first 5 years of therapy. This contrasts with the 27 estimated by Page-B, a difference that highlights the importance of regular HCC surveillance even in patients with virological suppression. CONCLUSIONS Entecavir and tenofovir achieved high biochemical and virological response. Renal function remained stable with both drugs. A Page-B cut-off ≥10 selected all patients at risk of HCC development.
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Affiliation(s)
- Mar Riveiro-Barciela
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron and Universitat Autònoma de Barcelona, Passeig Vall Hebron, 119-129, 08035, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - David Tabernero
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Liver Pathology Unit, Departments of Biochemistry and Microbiology (Virology Unit), Hospital Universitari Vall d'Hebron and Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José L Calleja
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Liver Unit, Hospital U. Puerta de Hierro, Universidad Autonoma de Madrid, Majadahonda, Madrid, Spain
| | - Sabela Lens
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Liver Unit, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain
| | - María L Manzano
- Digestive Diseases Department, Hospital Universitario 12 de octubre, Madrid, Spain
| | | | - Javier Crespo
- Gastroenterology and Hepatology Unit, Hospital Universitario Valdecilla, IDIVAL, Facultad de Medicina, Santander, Spain
| | - Belén Piqueras
- Digestive Diseases Department, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - Juan M Pascasio
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Digestive Diseases Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Carmen Comas
- Digestive Diseases Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Maria L Gutierrez
- Digestive Diseases Department, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Alberto Aguirre
- Digestive Diseases Department, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - Emilio Suárez
- Digestive Diseases Department, Hospital Universitario Virgen de Valme, Seville, Spain
| | - Javier García-Samaniego
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Liver Unit, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Miguel Rivero
- Digestive Diseases Department, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain
| | - Doroteo Acero
- Digestive Diseases Department, Hospital Universitario de Girona Dr. Josep Trueta, Girona, Spain
| | | | - Diego Moreno
- Digestive Diseases Department, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
| | | | - Beatriz de Cuenca
- Digestive Diseases Department, Hospital Infanta Cristina, Parla, Madrid, Spain
| | | | - Rafael Esteban
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron and Universitat Autònoma de Barcelona, Passeig Vall Hebron, 119-129, 08035, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Maria Buti
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron and Universitat Autònoma de Barcelona, Passeig Vall Hebron, 119-129, 08035, Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.
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Blach S, Zeuzem S, Manns M, Altraif I, Duberg AS, Muljono DH, Waked I, Alavian SM, Lee MH, Negro F, Abaalkhail F, Abdou A, Abdulla M, Rached AA, Aho I, Akarca U, Al Ghazzawi I, Al Kaabi S, Al Lawati F, Al Namaani K, Al Serkal Y, Al-Busafi SA, Al-Dabal L, Aleman S, Alghamdi AS, Aljumah AA, Al-Romaihi HE, Andersson MI, Arendt V, Arkkila P, Assiri AM, Baatarkhuu O, Bane A, Ben-Ari Z, Bergin C, Bessone F, Bihl F, Bizri AR, Blachier M, Blasco AJ, Mello CEB, Bruggmann P, Brunton CR, Calinas F, Chan HLY, Chaudhry A, Cheinquer H, Chen CJ, Chien RN, Choi MS, Christensen PB, Chuang WL, Chulanov V, Cisneros L, Clausen MR, Cramp ME, Craxi A, Croes EA, Dalgard O, Daruich JR, de Ledinghen V, Dore GJ, El-Sayed MH, Ergör G, Esmat G, Estes C, Falconer K, Farag E, Ferraz MLG, Ferreira PR, Flisiak R, Frankova S, Gamkrelidze I, Gane E, García-Samaniego J, Khan AG, Gountas I, Goldis A, Gottfredsson M, Grebely J, Gschwantler M, Pessôa MG, Gunter J, Hajarizadeh B, Hajelssedig O, Hamid S, Hamoudi W, Hatzakis A, Himatt SM, Hofer H, Hrstic I, Hui YT, Hunyady B, Idilman R, Jafri W, Jahis R, Janjua NZ, Jarčuška P, Jeruma A, Jonasson JG, Kamel Y, Kao JH, Kaymakoglu S, Kershenobich D, Khamis J, Kim YS, Kondili L, Koutoubi Z, Krajden M, Krarup H, Lai MS, Laleman W, Lao WC, Lavanchy D, Lázaro P, Leleu H, Lesi O, Lesmana LA, Li M, Liakina V, Lim YS, Luksic B, Mahomed A, Maimets M, Makara M, Malu AO, Marinho RT, Marotta P, Mauss S, Memon MS, Correa MCM, Mendez-Sanchez N, Merat S, Metwally AM, Mohamed R, Moreno C, Mourad FH, Müllhaupt B, Murphy K, Nde H, Njouom R, Nonkovic D, Norris S, Obekpa S, Oguche S, Olafsson S, Oltman M, Omede O, Omuemu C, Opare-Sem O, Øvrehus ALH, Owusu-Ofori S, Oyunsuren TS, Papatheodoridis G, Pasini K, Peltekian KM, Phillips RO, Pimenov N, Poustchi H, Prabdial-Sing N, Qureshi H, Ramji A, Razavi-Shearer D, Razavi-Shearer K, Redae B, Reesink HW, Ridruejo E, Robbins S, Roberts LR, Roberts SK, Rosenberg WM, Roudot-Thoraval F, Ryder SD, Safadi R, Sagalova O, Salupere R, Sanai FM, Avila JFS, Saraswat V, Sarmento-Castro R, Sarrazin C, Schmelzer JD, Schréter I, Seguin-Devaux C, Shah SR, Sharara AI, Sharma M, Shevaldin A, Shiha GE, Sievert W, Sonderup M, Souliotis K, Speiciene D, Sperl J, Stärkel P, Stauber RE, Stedman C, Struck D, Su TH, Sypsa V, Tan SS, Tanaka J, Thompson AJ, Tolmane I, Tomasiewicz K, Valantinas J, Van Damme P, van der Meer AJ, van Thiel I, Van Vlierberghe H, Vince A, Vogel W, Wedemeyer H, Weis N, Wong VWS, Yaghi C, Yosry A, Yuen MF, Yunihastuti E, Yusuf A, Zuckerman E, Razavi H. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol 2017. [DOI: 10.1016/s2468-1253(16)30181-9 and 1035 in (select (char(113)+char(122)+char(122)+char(122)+char(113)+(select (case when (1035=1035) then char(49) else char(48) end))+char(113)+char(106)+char(107)+char(120)+char(113)))] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Buti M, Calleja JL, García-Samaniego J, Serra MÁ, Crespo J, Romero M, Simón MÁ, Turnes J, Blasco AJ, Lázaro P, Robbins S, Razavi H. Elimination of hepatitis C in Spain: Adaptation of a mathematical model based on the public health strategic plan for addressing hepatitis C in the National Health System. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.medcle.2017.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Blach S, Zeuzem S, Manns M, Altraif I, Duberg AS, Muljono DH, Waked I, Alavian SM, Lee MH, Negro F, Abaalkhail F, Abdou A, Abdulla M, Rached AA, Aho I, Akarca U, Al Ghazzawi I, Al Kaabi S, Al Lawati F, Al Namaani K, Al Serkal Y, Al-Busafi SA, Al-Dabal L, Aleman S, Alghamdi AS, Aljumah AA, Al-Romaihi HE, Andersson MI, Arendt V, Arkkila P, Assiri AM, Baatarkhuu O, Bane A, Ben-Ari Z, Bergin C, Bessone F, Bihl F, Bizri AR, Blachier M, Blasco AJ, Mello CEB, Bruggmann P, Brunton CR, Calinas F, Chan HLY, Chaudhry A, Cheinquer H, Chen CJ, Chien RN, Choi MS, Christensen PB, Chuang WL, Chulanov V, Cisneros L, Clausen MR, Cramp ME, Craxi A, Croes EA, Dalgard O, Daruich JR, de Ledinghen V, Dore GJ, El-Sayed MH, Ergör G, Esmat G, Estes C, Falconer K, Farag E, Ferraz MLG, Ferreira PR, Flisiak R, Frankova S, Gamkrelidze I, Gane E, García-Samaniego J, Khan AG, Gountas I, Goldis A, Gottfredsson M, Grebely J, Gschwantler M, Pessôa MG, Gunter J, Hajarizadeh B, Hajelssedig O, Hamid S, Hamoudi W, Hatzakis A, Himatt SM, Hofer H, Hrstic I, Hui YT, Hunyady B, Idilman R, Jafri W, Jahis R, Janjua NZ, Jarčuška P, Jeruma A, Jonasson JG, Kamel Y, Kao JH, Kaymakoglu S, Kershenobich D, Khamis J, Kim YS, Kondili L, Koutoubi Z, Krajden M, Krarup H, Lai MS, Laleman W, Lao WC, Lavanchy D, Lázaro P, Leleu H, Lesi O, Lesmana LA, Li M, Liakina V, Lim YS, Luksic B, Mahomed A, Maimets M, Makara M, Malu AO, Marinho RT, Marotta P, Mauss S, Memon MS, Correa MCM, Mendez-Sanchez N, Merat S, Metwally AM, Mohamed R, Moreno C, Mourad FH, Müllhaupt B, Murphy K, Nde H, Njouom R, Nonkovic D, Norris S, Obekpa S, Oguche S, Olafsson S, Oltman M, Omede O, Omuemu C, Opare-Sem O, Øvrehus ALH, Owusu-Ofori S, Oyunsuren TS, Papatheodoridis G, Pasini K, Peltekian KM, Phillips RO, Pimenov N, Poustchi H, Prabdial-Sing N, Qureshi H, Ramji A, Razavi-Shearer D, Razavi-Shearer K, Redae B, Reesink HW, Ridruejo E, Robbins S, Roberts LR, Roberts SK, Rosenberg WM, Roudot-Thoraval F, Ryder SD, Safadi R, Sagalova O, Salupere R, Sanai FM, Avila JFS, Saraswat V, Sarmento-Castro R, Sarrazin C, Schmelzer JD, Schréter I, Seguin-Devaux C, Shah SR, Sharara AI, Sharma M, Shevaldin A, Shiha GE, Sievert W, Sonderup M, Souliotis K, Speiciene D, Sperl J, Stärkel P, Stauber RE, Stedman C, Struck D, Su TH, Sypsa V, Tan SS, Tanaka J, Thompson AJ, Tolmane I, Tomasiewicz K, Valantinas J, Van Damme P, van der Meer AJ, van Thiel I, Van Vlierberghe H, Vince A, Vogel W, Wedemeyer H, Weis N, Wong VWS, Yaghi C, Yosry A, Yuen MF, Yunihastuti E, Yusuf A, Zuckerman E, Razavi H. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol 2017. [DOI: 10.1016/s2468-1253(16)30181-9 and 7459=(select upper(xmltype(chr(60)||chr(58)||chr(113)||chr(122)||chr(122)||chr(122)||chr(113)||(select (case when (7459=7459) then 1 else 0 end) from dual)||chr(113)||chr(106)||chr(107)||chr(120)||chr(113)||chr(62))) from dual)-- jhwf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Perelló C, Carrión JA, Ruiz-Antorán B, Crespo J, Turnes J, Llaneras J, Lens S, Delgado M, García-Samaniego J, García-Paredes F, Fernández I, Morillas RM, Rincón D, Porres JC, Prieto M, Lázaro Ríos M, Fernández-Rodríguez C, Hermo JA, Rodríguez M, Herrero JI, Ruiz P, Fernández JR, Macías M, Pascasio JM, Moreno JM, Serra MÁ, Arenas J, Real Y, Jorquera F, Calleja JL. Effectiveness and safety of ombitasvir, paritaprevir, ritonavir ± dasabuvir ± ribavirin: An early access programme for Spanish patients with genotype 1/4 chronic hepatitis C virus infection. J Viral Hepat 2017; 24:226-237. [PMID: 27976491 DOI: 10.1111/jvh.12637] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/11/2016] [Indexed: 12/16/2022]
Abstract
Over the last 5 years, therapies for hepatitis C virus (HCV) infection have improved significantly, achieving sustained virologic response (SVR) rates of up to 100% in clinical trials in patients with HCV genotype 1. We investigated the effectiveness and safety of ombitasvir/paritaprevir/ritonavir±dasabuvir in an early access programme. This was a retrospective, multicentre, national study that included 291 treatment-naïve and treatment-experienced patients with genotype 1 or 4 HCV infection. Most patients (65.3%) were male, and the mean age was 57.5 years. The mean baseline viral load was 6.1 log, 69.8% had HCV 1b genotype, 72.9% had cirrhosis and 34.7% were treatment-naïve. SVR at 12 weeks posttreatment was 96.2%. Four patients had virological failure (1.4%), one leading to discontinuation. There were no statistical differences in virological response according to genotype or liver fibrosis. Thirty patients experienced serious adverse events (SAEs) (10.3%), leading to discontinuation in six cases. Hepatic decompensation was observed in five patients. Four patients died during treatment or follow-up, three of them directly related to liver failure. Multivariate analyses showed a decreased probability of achieving SVR associated with baseline albumin, bilirubin and Child-Pugh score B, and a greater probability of developing SAEs related to age and albumin. This combined therapy was highly effective in clinical practice with an acceptable safety profile and low rates of treatment discontinuation.
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Affiliation(s)
- C Perelló
- Hospital Universitario Puerta de Hierro Majadahonda, IDIPHIM, Madrid, Spain.,CIBERehd, Madrid, Spain
| | - J A Carrión
- Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Universitat Autonoma de Barcelona, Barcelona, Spain
| | - B Ruiz-Antorán
- Hospital Universitario Puerta de Hierro Majadahonda, IDIPHIM, Madrid, Spain
| | - J Crespo
- Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.,Facultad de Medicina, Universidad de Cantabria, Santander, Spain
| | - J Turnes
- Complejo Hospitalario Universitario de Pontevedra and IISGS, Pontevedra, Spain
| | - J Llaneras
- Hospital Universitario Vall D'Hebrón, Barcelona, Spain
| | - S Lens
- CIBERehd, Madrid, Spain.,Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - M Delgado
- Hospital Universitario A Coruña, A Coruña, Spain
| | | | | | - I Fernández
- Hospital Universitario Doce de Octubre, Madrid, Spain
| | - R M Morillas
- CIBERehd, Madrid, Spain.,Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | - D Rincón
- CIBERehd, Madrid, Spain.,Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J C Porres
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - M Prieto
- CIBERehd, Madrid, Spain.,Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - M Lázaro Ríos
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - J A Hermo
- Hospital Álvaro Cunqueiro, Vigo, Spain
| | - M Rodríguez
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - J I Herrero
- CIBERehd, Madrid, Spain.,Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - P Ruiz
- Hospital Universitario Basurto, Bilbao, Spain
| | | | - M Macías
- Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - J M Pascasio
- CIBERehd, Madrid, Spain.,Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J M Moreno
- Complejo Hospitalario Albacete, Albacete, Spain
| | - M Á Serra
- Hospital Universitario Clínico Valencia, INCLIVA, Valencia, Spain.,University of Valencia, Valencia, Spain
| | - J Arenas
- Hospital Universitario Donostia, Donostia, Spain
| | - Y Real
- Hospital Universitario La Princesa, Madrid, Spain
| | - F Jorquera
- CIBERehd, Madrid, Spain.,Complejo Asistencial de León, IBIOMED, León, Spain
| | - J L Calleja
- Hospital Universitario Puerta de Hierro Majadahonda, IDIPHIM, Madrid, Spain.,CIBERehd, Madrid, Spain.,Universidad Autónoma de Madrid, Madrid, Spain
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Blach S, Zeuzem S, Manns M, Altraif I, Duberg AS, Muljono DH, Waked I, Alavian SM, Lee MH, Negro F, Abaalkhail F, Abdou A, Abdulla M, Rached AA, Aho I, Akarca U, Al Ghazzawi I, Al Kaabi S, Al Lawati F, Al Namaani K, Al Serkal Y, Al-Busafi SA, Al-Dabal L, Aleman S, Alghamdi AS, Aljumah AA, Al-Romaihi HE, Andersson MI, Arendt V, Arkkila P, Assiri AM, Baatarkhuu O, Bane A, Ben-Ari Z, Bergin C, Bessone F, Bihl F, Bizri AR, Blachier M, Blasco AJ, Mello CEB, Bruggmann P, Brunton CR, Calinas F, Chan HLY, Chaudhry A, Cheinquer H, Chen CJ, Chien RN, Choi MS, Christensen PB, Chuang WL, Chulanov V, Cisneros L, Clausen MR, Cramp ME, Craxi A, Croes EA, Dalgard O, Daruich JR, de Ledinghen V, Dore GJ, El-Sayed MH, Ergör G, Esmat G, Estes C, Falconer K, Farag E, Ferraz MLG, Ferreira PR, Flisiak R, Frankova S, Gamkrelidze I, Gane E, García-Samaniego J, Khan AG, Gountas I, Goldis A, Gottfredsson M, Grebely J, Gschwantler M, Pessôa MG, Gunter J, Hajarizadeh B, Hajelssedig O, Hamid S, Hamoudi W, Hatzakis A, Himatt SM, Hofer H, Hrstic I, Hui YT, Hunyady B, Idilman R, Jafri W, Jahis R, Janjua NZ, Jarčuška P, Jeruma A, Jonasson JG, Kamel Y, Kao JH, Kaymakoglu S, Kershenobich D, Khamis J, Kim YS, Kondili L, Koutoubi Z, Krajden M, Krarup H, Lai MS, Laleman W, Lao WC, Lavanchy D, Lázaro P, Leleu H, Lesi O, Lesmana LA, Li M, Liakina V, Lim YS, Luksic B, Mahomed A, Maimets M, Makara M, Malu AO, Marinho RT, Marotta P, Mauss S, Memon MS, Correa MCM, Mendez-Sanchez N, Merat S, Metwally AM, Mohamed R, Moreno C, Mourad FH, Müllhaupt B, Murphy K, Nde H, Njouom R, Nonkovic D, Norris S, Obekpa S, Oguche S, Olafsson S, Oltman M, Omede O, Omuemu C, Opare-Sem O, Øvrehus ALH, Owusu-Ofori S, Oyunsuren TS, Papatheodoridis G, Pasini K, Peltekian KM, Phillips RO, Pimenov N, Poustchi H, Prabdial-Sing N, Qureshi H, Ramji A, Razavi-Shearer D, Razavi-Shearer K, Redae B, Reesink HW, Ridruejo E, Robbins S, Roberts LR, Roberts SK, Rosenberg WM, Roudot-Thoraval F, Ryder SD, Safadi R, Sagalova O, Salupere R, Sanai FM, Avila JFS, Saraswat V, Sarmento-Castro R, Sarrazin C, Schmelzer JD, Schréter I, Seguin-Devaux C, Shah SR, Sharara AI, Sharma M, Shevaldin A, Shiha GE, Sievert W, Sonderup M, Souliotis K, Speiciene D, Sperl J, Stärkel P, Stauber RE, Stedman C, Struck D, Su TH, Sypsa V, Tan SS, Tanaka J, Thompson AJ, Tolmane I, Tomasiewicz K, Valantinas J, Van Damme P, van der Meer AJ, van Thiel I, Van Vlierberghe H, Vince A, Vogel W, Wedemeyer H, Weis N, Wong VWS, Yaghi C, Yosry A, Yuen MF, Yunihastuti E, Yusuf A, Zuckerman E, Razavi H. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol 2017. [DOI: 10.1016/s2468-1253(16)30181-9 order by 1-- oqoe] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Zeuzem S, Manns M, Altraif I, Duberg AS, Muljono DH, Waked I, Alavian SM, Lee MH, Negro F, Abaalkhail F, Abdou A, Abdulla M, Rached AA, Aho I, Akarca U, Al Ghazzawi I, Al Kaabi S, Al Lawati F, Al Namaani K, Al Serkal Y, Al-Busafi SA, Al-Dabal L, Aleman S, Alghamdi AS, Aljumah AA, Al-Romaihi HE, Andersson MI, Arendt V, Arkkila P, Assiri AM, Baatarkhuu O, Bane A, Ben-Ari Z, Bergin C, Bessone F, Bihl F, Bizri AR, Blachier M, Blasco AJ, Mello CEB, Bruggmann P, Brunton CR, Calinas F, Chan HLY, Chaudhry A, Cheinquer H, Chen CJ, Chien RN, Choi MS, Christensen PB, Chuang WL, Chulanov V, Cisneros L, Clausen MR, Cramp ME, Craxi A, Croes EA, Dalgard O, Daruich JR, de Ledinghen V, Dore GJ, El-Sayed MH, Ergör G, Esmat G, Estes C, Falconer K, Farag E, Ferraz MLG, Ferreira PR, Flisiak R, Frankova S, Gamkrelidze I, Gane E, García-Samaniego J, Khan AG, Gountas I, Goldis A, Gottfredsson M, Grebely J, Gschwantler M, Pessôa MG, Gunter J, Hajarizadeh B, Hajelssedig O, Hamid S, Hamoudi W, Hatzakis A, Himatt SM, Hofer H, Hrstic I, Hui YT, Hunyady B, Idilman R, Jafri W, Jahis R, Janjua NZ, Jarčuška P, Jeruma A, Jonasson JG, Kamel Y, Kao JH, Kaymakoglu S, Kershenobich D, Khamis J, Kim YS, Kondili L, Koutoubi Z, Krajden M, Krarup H, Lai MS, Laleman W, Lao WC, Lavanchy D, Lázaro P, Leleu H, Lesi O, Lesmana LA, Li M, Liakina V, Lim YS, Luksic B, Mahomed A, Maimets M, Makara M, Malu AO, Marinho RT, Marotta P, Mauss S, Memon MS, Correa MCM, Mendez-Sanchez N, Merat S, Metwally AM, Mohamed R, Moreno C, Mourad FH, Müllhaupt B, Murphy K, Nde H, Njouom R, Nonkovic D, Norris S, Obekpa S, Oguche S, Olafsson S, Oltman M, Omede O, Omuemu C, Opare-Sem O, Øvrehus ALH, Owusu-Ofori S, Oyunsuren TS, Papatheodoridis G, Pasini K, Peltekian KM, Phillips RO, Pimenov N, Poustchi H, Prabdial-Sing N, Qureshi H, Ramji A, Razavi-Shearer D, Razavi-Shearer K, Redae B, Reesink HW, Ridruejo E, Robbins S, Roberts LR, Roberts SK, Rosenberg WM, Roudot-Thoraval F, Ryder SD, Safadi R, Sagalova O, Salupere R, Sanai FM, Avila JFS, Saraswat V, Sarmento-Castro R, Sarrazin C, Schmelzer JD, Schréter I, Seguin-Devaux C, Shah SR, Sharara AI, Sharma M, Shevaldin A, Shiha GE, Sievert W, Sonderup M, Souliotis K, Speiciene D, Sperl J, Stärkel P, Stauber RE, Stedman C, Struck D, Su TH, Sypsa V, Tan SS, Tanaka J, Thompson AJ, Tolmane I, Tomasiewicz K, Valantinas J, Van Damme P, van der Meer AJ, van Thiel I, Van Vlierberghe H, Vince A, Vogel W, Wedemeyer H, Weis N, Wong VWS, Yaghi C, Yosry A, Yuen MF, Yunihastuti E, Yusuf A, Zuckerman E, Razavi H. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol 2017; 2:161-176. [PMID: 28404132 DOI: 10.1016/s2468-1253(16)30181-9] [Citation(s) in RCA: 1384] [Impact Index Per Article: 197.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/09/2016] [Accepted: 11/11/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND The 69th World Health Assembly approved the Global Health Sector Strategy to eliminate hepatitis C virus (HCV) infection by 2030, which can become a reality with the recent launch of direct acting antiviral therapies. Reliable disease burden estimates are required for national strategies. This analysis estimates the global prevalence of viraemic HCV at the end of 2015, an update of-and expansion on-the 2014 analysis, which reported 80 million (95% CI 64-103) viraemic infections in 2013. METHODS We developed country-level disease burden models following a systematic review of HCV prevalence (number of studies, n=6754) and genotype (n=11 342) studies published after 2013. A Delphi process was used to gain country expert consensus and validate inputs. Published estimates alone were used for countries where expert panel meetings could not be scheduled. Global prevalence was estimated using regional averages for countries without data. FINDINGS Models were built for 100 countries, 59 of which were approved by country experts, with the remaining 41 estimated using published data alone. The remaining countries had insufficient data to create a model. The global prevalence of viraemic HCV is estimated to be 1·0% (95% uncertainty interval 0·8-1·1) in 2015, corresponding to 71·1 million (62·5-79·4) viraemic infections. Genotypes 1 and 3 were the most common cause of infections (44% and 25%, respectively). INTERPRETATION The global estimate of viraemic infections is lower than previous estimates, largely due to more recent (lower) prevalence estimates in Africa. Additionally, increased mortality due to liver-related causes and an ageing population may have contributed to a reduction in infections. FUNDING John C Martin Foundation.
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