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1.
Sci Rep ; 12(1): 330, 2022 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-35013390

RESUMO

We conducted a systematic review and meta-analysis of studies assessing HCV infection rates in haemodialysis patients in Brazil (Prospero CRD #42021275068). We included studies on patients under haemodialysis, comprising both convenience samples and exhaustive information from selected services. Patients underwent HCV serological testing with or without confirmation by HCV RNA PCR. Exclusion criteria were the following: absence of primary empirical information and studies without information on their respective settings, study year, accurate infection rates, or full specification of diagnostic tests. Studies with samples ≤ 30 and serial assessments with repeated information were also excluded. Reference databases included PubMed, LILACS, Scopus, and Web of Science for the period 1989-2019. A systematic review was carried out, followed by two independent meta-analyses: (i) studies with data on HCV prevalence and (ii) studies with a confirmatory PCR (i.e., active infection), respectively. A comprehensive set of different methods and procedures were used: forest plots and respective statistics, polynomial regression, meta-regression, subgroup influence, quality assessment, and trim-and-fill analysis. 29 studies and 11,290 individuals were assessed. The average time patients were in haemodialysis varied from 23.5 to 56.3 months. Prevalence of HCV infection was highly heterogeneous, with a pronounced decrease from 1992 to 2001, followed by a plateau and a slight decrease in recent years. The summary measure for HCV prevalence was 34% (95% CI 26-43%) for studies implemented before 2001. For studies implemented after 2001, the corresponding summary measure was 11% (95% CI 8-15%). Estimates for prevalence of active HCV infection were also highly heterogeneous. There was a marked decline from 1996 to 2001, followed by a plateau and a slight increase after 2010. The summary measure for active HCV infection was 19% (95% CI 15-25%) in studies carried out before 2001. For studies implemented after 2001, the corresponding summary measure was 9% (95% CI 6-13%). Heterogeneity was pervasive, but different analyses helped to identify its underlying sources. Besides the year each study was conducted, the findings differed markedly between geographic regions and were heavily influenced by the size of the studies and publication biases. Our systematic review and meta-analysis documented a substantial decline in HCV prevalence among Brazilian haemodialysis patients from 1992 to 2015. CKD should be targeted with specific interventions to prevent HCV infection, and if prevention fails, prompt diagnosis and treatment. Although the goal of HCV elimination by 2030 in Brazil remains elusive, it is necessary to adopt measures to achieve micro-elimination and to launch initiatives towards targeted interventions to curb the spread of HCV in people with CKD, among other high-risk groups. This is of particular concern in the context of a protracted COVID-19 pandemic and a major economic and political crisis.


Assuntos
COVID-19/diagnóstico , Hepacivirus/genética , Hepatite C/diagnóstico , Diálise Renal/estatística & dados numéricos , SARS-CoV-2/genética , Brasil/epidemiologia , COVID-19/epidemiologia , COVID-19/virologia , Hepacivirus/fisiologia , Hepatite C/epidemiologia , Hepatite C/virologia , Humanos , Técnicas de Amplificação de Ácido Nucleico/métodos , Pandemias , Prevalência , RNA Viral/genética , Diálise Renal/métodos , SARS-CoV-2/fisiologia
2.
Internist (Berl) ; 63(1): 118-128, 2022 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-34988607

RESUMO

Antiviral drugs inhibit viral replication by interaction with specific elements of the viral replication cycle. Directly acting antiviral agents have revolutionized the therapeutic options for chronic infections with human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV). Pharmacological developments constantly improve therapeutic and prophylactic options for diseases caused by herpes viruses, which is of particular relevance for immunocompromised patients. While infections with persistent viruses, such as HIV, HBV or herpes viruses principally so far cannot be cured, complete elimination of viruses that cause acute infections is possible; however, acute infections, such as influenza or coronavirus disease 2019 (COVID-19) offer only a small therapeutic window for antiviral strategies due to their pathophysiological dynamics. The optimal time point for antiviral agents is immediately after exposure to the virus, which frequently limits its application in practice. An effective pre-exposure or postexposure prophylaxis has been established for infections with HIV and influenza A/B and also gains relevance for infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).


Assuntos
COVID-19 , Antivirais/uso terapêutico , Hepacivirus , Humanos , SARS-CoV-2
3.
BMC Infect Dis ; 22(1): 58, 2022 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-35038987

RESUMO

BACKGROUND: Although an increase in hepatitis C virus (HCV) prevalence from Northern to Southern Italy has been reported, the burden of asymptomatic individuals in different Italian regions is currently unknown. METHODS: A probabilistic approach, including a Markov chain for liver disease progression, was applied to estimate current HCV viraemic burden. The model defined prevalence by geographic area using an estimated annual historical HCV incidence by age, treatment rate, and migration rate from the Italian National database. Viraemic infection by age group was estimated for each region by main HCV transmission routes of individuals for stage F0-F3 (i.e. patients without liver cirrhosis and thus potentially asymptomatic) and F4 (patients with liver cirrhosis, thus potentially symptomatic). RESULTS: By January 2020, it was estimated that there were 409,184 Italian individuals with HCV (prevalence of 0.68%; 95% CI: 0.54-0.82%), of which 300,171 (0.50%; 95% CI: 0.4-0.6%) were stage F0-F3. Considering all individuals with HCV in stage F0-F3, the geographical distributions (expressed as the proportion of HCV infected individuals by macroarea within the overall estimated number of F0-F3 individuals and prevalence values, expressed as the percentage of individuals with HCV versus the overall number of individuals for each macroarea) were as follows: North 42.1% (0.45%; 95% CI: 0.36-0.55%), Central 24.1% (0.61%; 95% CI: 0.48-0.74%), South 23.2% (0.50%; 95% CI: 0.4-0.61%), and the Isles 10.6% (0.49%; 95% CI: 0.39-0.59%). The population of people who inject drugs accounted for 50.4% of all individuals infected (F0-F3). Undiagnosed individuals (F0-F3) were ~ 15 years younger (⁓ 50 years) compared with patients with stage F4 (⁓ 65 years), with similar age distributions across macroareas. In contrast to what has been reported on HCV epidemiology in Italy, an increasing trend in the proportion of potentially undiagnosed individuals with HCV (absolute number within the F0-F3) from South (23.2%) to North (42.1%) emerged, independent of similar regional prevalence values. CONCLUSION: This targeted approach, which addresses the specific profile of undiagnosed individuals, is helpful in planning effective elimination strategies by region in Italy and could be a useful methodology for other countries in implementing their elimination plans.


Assuntos
Hepatite C Crônica , Hepatite C , Antivirais/uso terapêutico , Hepacivirus/genética , Hepatite C/diagnóstico , Hepatite C/tratamento farmacológico , Hepatite C/epidemiologia , Hepatite C Crônica/tratamento farmacológico , Humanos , Cirrose Hepática/tratamento farmacológico , Cirrose Hepática/epidemiologia , Modelos Teóricos
4.
Int J Infect Dis ; 115: 171-177, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34902582

RESUMO

BACKGROUND: Hepatitis C virus (HCV) is a global public health problem. Second-generation direct-acting antivirals targeting non-structural regions on the viral genome are the cornerstone for treatment of chronic infection. However, resistance-associated variants (RAVs) have been reported to be associated with therapeutic failure. The aim of this study was to assess the frequency of variants, including RAVs, in the NS3, NS5A and NS5B regions at baseline in Brazilian patients with chronic hepatitis C with HCV genotypes 1a, 1b and 3a. METHODS: Serum samples from 13 patients were used to obtain viral RNA. Massively parallel sequencing was performed using genotype-specific amplicons and a panel of Ampliseq technology for all genotypes. RESULTS: Several non-synonymous substitutions were detected at baseline for 11 responders and pre-/post-treatment for two non-responders. HCV genotype 3a was found to have significantly more non-synonymous substitutions than HCV genotype 1 in the NS3 and NS5A regions. Analyses were conducted using quantitative and qualitative inter- and intrapatient comparisons. Variants that confer resistance to the treatment used by the patients were found in both responders and non-responders. CONCLUSIONS: A wide frequency distribution of RAVs was found at baseline, and this did not interfere with the achievement of a sustained response. Evaluation of the presence of RAVs requires additional study in order to determine clinical relevance.


Assuntos
Hepatite C Crônica , Hepatite C , Antivirais/farmacologia , Antivirais/uso terapêutico , Farmacorresistência Viral/genética , Genótipo , Hepacivirus/genética , Hepatite C/tratamento farmacológico , Hepatite C Crônica/tratamento farmacológico , Humanos , Proteínas não Estruturais Virais/genética
5.
Emerg Infect Dis ; 28(1): 256-259, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34932463

RESUMO

During 2017-2019, a total of 88/753 (11.7%) of patients 5-90 years of age in hospitals in Saravan Province, Laos, were seropositive for hepatitis C virus antibodies. Viral RNA was found in 44 samples. Sequencing showed high diversity within genotype 6. We recommend exposure-risk investigations and targeted testing and treatment.


Assuntos
Hepacivirus , Hepatite C , Hepacivirus/genética , Hepatite C/epidemiologia , Humanos , Laos/epidemiologia , Prevalência , RNA Viral/genética
6.
J Med Virol ; 94(1): 7-10, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34506635

RESUMO

Hepatitis, a significant cause of mortality worldwide, results in around 1.34 million deaths each year globally. Africa is not exempt from the plague of Hepatitis. Around 100 million estimated individuals are infected with Hepatitis B or C. Egypt has the highest prevalence of cases of Hepatitis followed by Cameroon and Burundi. The continent is severely affected by the onset of the COVID-19 pandemic, as the virus has added an additional burden on the already fragile continent. With the pandemic, it is presumable that Hepatitis like other viral diseases will pose a threat to collapsing healthcare system. Therefore, for Africa to become more resilient in the face of such menaces, including Hepatitis, further prevention policies are required to be implemented.


Assuntos
COVID-19/epidemiologia , Acesso aos Serviços de Saúde , Hepatite B Crônica/epidemiologia , Hepatite C Crônica/epidemiologia , Países em Desenvolvimento , Egito/epidemiologia , Hepacivirus/patogenicidade , Vírus da Hepatite B/patogenicidade , Hepatite B Crônica/prevenção & controle , Hepatite B Crônica/terapia , Hepatite C Crônica/prevenção & controle , Hepatite C Crônica/terapia , Humanos , Fígado/lesões , Fígado/patologia , Fígado/virologia , Prevalência , SARS-CoV-2
7.
Biosens Bioelectron ; 196: 113719, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-34706315

RESUMO

Coinfection of HIV/HCV is a significant public health issue globally, as it increases the risk of liver cancer in co-infected individuals. The point-of-care testing (POCT) device for HIV/HCV DNA detection is promptly needed for diagnosis and monitoring of the disease progression. Here, the alternating-current electroluminescence (ACEL) technique is proposed as a sensitive POCT sensing platform for HIV/HCV cDNA detection. A conductance-based light emission modulated by the hybridization between a pyrrolidinyl PNA probe and the DNA target enabled the DNA detection in a label-free format. Enhanced electroluminescence was observed in the presence of the target DNA due to the increased proton conductivity. Under the optimal conditions, the linearity range from 1 nM to 1 µM was achieved for HIV and HCV cDNA with LODs of 1.86 pM (HIV cDNA) and 1.96 pM (HCV cDNA). The spiked HIV/HCV cDNA in healthy human serum was successfully detected, demonstrating the feasibility of the developed device for the detection of cDNA in real biological samples. Additionally, simultaneous HIV/HCV cDNA detection on a single ACEL device employing a 2x2-array detection zone design. The cross-reactivity with other viral DNA was shown to be minimal due to the high specificity of the PNA probes used. Finally, the negative and positive samples from the patient's serum were tested and the results were in 100% agreement with the commercial kit based-on real-time PCR method, thus illustrating the high sensitivity and specificity of the developed sensor.


Assuntos
Técnicas Biossensoriais , Coinfecção , Infecções por HIV , Hepatite C , DNA Viral/genética , HIV/genética , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Hepacivirus/genética , Hepatite C/diagnóstico , Humanos
8.
Pan Afr Med J ; 40: 158, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34970400

RESUMO

Hepatitis C is a leading cause of chronic hepatitis and causes severe health problems in areas where prevalence is high. Ghana is noted for a relatively high sero-prevalence of hepatitis C virus infection. However, there is very little data on prevalence of hepatitis C virus (HCV) among children in Ghana, and what data is available indicates very low prevalence rate. We conducted a cross-sectional study to determine the sero-prevalence and associated pre-disposing risk factor for HCV infection among children attending the Princes Marie Louis Children´s Hospital in Accra. Two hundred archived blood samples from a previous study were retrieved and tested for the presence of HCV antibodies using a dipstick test kit. Out of the 200 samples tested, one (1) tested positive for HCV antibodies giving a prevalence of 0.5% among the study group. The results show that there is potentially a very low prevalence of hepatitis C among Ghanaian children. Hence, the higher prevalence among adults usually seen is often due to infection later in life. Obtaining an appropriate vaccine early in life could thus help prevent people from getting infected in later life.


Assuntos
Hepacivirus , Hepatite C , Adulto , Criança , Estudos Transversais , Gana/epidemiologia , Hepacivirus/genética , Hepatite C/epidemiologia , Anticorpos Anti-Hepatite C , Hospitais , Humanos , Prevalência , Estudos Soroepidemiológicos
9.
PLoS One ; 16(12): e0261155, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34914773

RESUMO

BACKGROUND & AIMS: Kazakhstan has implemented comprehensive programs to reduce the incidence of Hepatitis B and Hepatitis C. This study aims to assess seroprevalence and risk factors for HBsAg and anti-HCV positivity in three large regions of Kazakhstan. METHODS: A cross-sectional study was conducted in three regions geographically remote from each other. Participants were randomly selected using a two-stage stratified cluster sampling and were surveyed by a questionnaire based on the WHO STEP survey instrument. Blood samples were collected for HBsAg and anti-HCV testing. RESULTS: A total of 4,620 participants were enrolled. The seroprevalence was 5.5% (95%CI: 3.6%-8.4%) for HBsAg and 5.1% (95%CI: 3.5%-7.5%) for anti-HCV antibodies. Both were more prevalent in the western and northern regions than in the southern. A history of blood transfusion was significantly associated with anti-HCV presence, with odds ratios (ORs) of 2.10 (95%CI: 1.37-3.21) and was borderline associated with HBsAg 1.39 (95%CI: 0.92-2.10), respectively. Having a family member with viral hepatitis was also borderline associated (2.09 (95%CI: 0.97-4.50)) with anti-HCV positivity. CONCLUSIONS: This study found a high-intermediate level of endemicity for HBsAg and a high level of endemicity for anti-HCV antibodies in three large regions of Kazakhstan. We found that history of surgery was not associated with HbsAg neither with anti-HCV seropositivity rates. Blood transfusion was associated with anti-HCV seropositivity, however, to investigate effectiveness of the introduced comprehensive preventive measures in health care settings, there is a need to conduct further epidemiological studies.


Assuntos
Hepacivirus/isolamento & purificação , Vírus da Hepatite B/isolamento & purificação , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Seguimentos , Hepatite B/sangue , Hepatite B/diagnóstico , Hepatite B/virologia , Hepatite C/sangue , Hepatite C/diagnóstico , Hepatite C/virologia , Humanos , Cazaquistão/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Estudos Soroepidemiológicos , Adulto Jovem
10.
Am Fam Physician ; 104(6): 626-635, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34913652

RESUMO

Screening recommendations and treatment guidelines for hepatitis C virus (HCV) infection have been updated. People at the greatest risk of HCV infection are those between 18 and 39 years of age and those who use injection drugs. Universal screening with an anti-HCV antibody test with follow-up reflex HCV RNA polymerase chain reaction testing for positive results to confirm active disease is recommended at least once for all adults 18 years and older and during each pregnancy. Any person with ongoing risk factors should be screened periodically as long as the at-risk behavior persists. One-time screening is recommended for patients younger than 18 years with risk factors. For treatment-naive adults without cirrhosis or with compensated cirrhosis, a simplified treatment regimen consisting of eight weeks of glecaprevir/pibrentasvir or 12 weeks of sofosbuvir/velpatasvir results in greater than 95% cure rates. Undetectable HCV RNA 12 weeks after completing therapy is considered a virologic cure (i.e., sustained virologic response). A sustained virologic response is associated with lower all-cause mortality and improves hepatic and extrahepatic manifestations, cognitive function, physical health, work productivity, and quality of life. In patients with compensated cirrhosis, posttreatment surveillance for hepatocellular carcinoma and esophageal varices should include abdominal ultrasonography (with or without alpha fetoprotein) every six months and upper endoscopy every two to three years. In the absence of cirrhosis, no liver-related follow-up is recommended.


Assuntos
Hepatite C/diagnóstico , Hepatite C/terapia , Hepacivirus/efeitos dos fármacos , Hepacivirus/patogenicidade , Hepatite C/fisiopatologia , Humanos , Cirrose Hepática/etiologia , Cirrose Hepática/psicologia , Programas de Rastreamento/métodos , Programas de Rastreamento/tendências , Qualidade de Vida/psicologia
11.
J Med Case Rep ; 15(1): 627, 2021 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-34924025

RESUMO

INTRODUCTION: Treatment of hepatitis C infection has evolved dramatically since 2011. Previous conventional therapy with interferon and ribavirin used to have a low sustained virological response rate of less than 40%. In the new direct-acting antiviral therapy era, a sustained virological response can be achieved in more than 90% of cases. CASE PRESENTATION: We report a rare case of severe reversible acute rhabdomyolysis in a 31-year-old Saudi male patient with very long-chain acyl-coenzyme A dehydrogenase deficiency and chronic hepatitis C infection. The patient was clinically asymptomatic with no signs of decompensated liver disease. The patient received new direct-acting antiviral agents: sofosbuvir and daclatasvir. Fourteen days after initiation of direct-acting antiviral agents, the patient was found to have asymptomatic rhabdomyolysis. His creatine kinase peaked at 2572 IU/l, and he was treated conservatively; the direct-acting antiviral agents were discontinued and within 7 days, the patient's creatine kinase levels normalized. CONCLUSION: This case highlights possible direct-acting antiviral agent-induced rhabdomyolysis in a patient with very-long-chain acyl-CoA dehydrogenase deficiency, presumably through alteration of mitochondrial membrane potential. Further studies are required to assess the possible impact and associations.


Assuntos
Hepatite C Crônica , Rabdomiólise , Adulto , Antivirais/efeitos adversos , Hepacivirus , Hepatite C Crônica/complicações , Hepatite C Crônica/tratamento farmacológico , Humanos , Masculino , Rabdomiólise/induzido quimicamente
12.
Zhonghua Gan Zang Bing Za Zhi ; 29(11): 1046-1052, 2021 Nov 20.
Artigo em Chinês | MEDLINE | ID: mdl-34933421

RESUMO

Objective: To study the real-world outcome of China FDA-approved Sofosbuvir (SOF)/Velpatasvir (VEL) in Northwest China. Methods: In this multicenter, prospective, real-world cohort study, we recruited patients from 10 sites from Northwest China, who were chronically infected with HCV GTs 1-6 from 06/2018 to 09/2019. Patients received SOF (400mg)/VEL (100mg) for 12 weeks, and with ribavirin 900-1200 mg for GT3 cirrhosis and for any genotype decompensated cirrhosis. The primary endpoint was sustained virological response at 12-weeks post-treatment (SVR12) and safety. The secondary endpoint was the change of liver function after the achievement of SVR12. Results: Totally, 143 patients were enrolled in the study, four patients were lost to follow-up and one died during the follow-up, 138 patients were included in per-protocol analysis. Of the 138 patients, the mean age 53 years, 53.6% male, 94.2% Han nationality, 53.6% liver cirrhosis, 10.1% HBsAg(+), 6.5% renal dysfunction, 5.1% treatment-experienced, and 16.7% patients received ribavirin treatment. The genotype distribution was as follows: 35.5% GT1, 42.8% GT2, 15.9% GT3, and 5.8% un-typed. The SVR12 rate was 96.5% (138/143, 95%CI: 93.5%-99.6%) for intention-to-treat analysis, and in per-protocol analysis, all 138 patients obtained SVR12 (100%). Compared with baseline, the serum total bilirubin, ALT and AFP levels decreased (all P < 0.05), as well as increased ALB and platelet count (all P < 0.001) at post-treatment 12-weeks. Overall adverse events (AEs) rate is 29.0%, and the most common AEs were anemia (14.5%) and fatigue (8.0%). Severe side effects (edema and fatigue) occurred in 2 patients, one of whom needed a short-term interruption of treatment due to fatigue. Conclusion: In this real-world cohort study, 12-week SOF/VEL regimen with or without ribavirin achieved high SVR12 rates (96.5%-100% overall) with excellent safety profile among patients with HCV GT1/2/3 infection including patients with GT3 and cirrhosis, and led to improvement of liver function.


Assuntos
Hepatite C Crônica , Sofosbuvir , Antivirais/uso terapêutico , Carbamatos , Estudos de Coortes , Quimioterapia Combinada , Feminino , Genótipo , Hepacivirus/genética , Hepatite C Crônica/tratamento farmacológico , Compostos Heterocíclicos de 4 ou mais Anéis , Humanos , Cirrose Hepática/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ribavirina/uso terapêutico , Sofosbuvir/uso terapêutico , Resultado do Tratamento
13.
Zhonghua Gan Zang Bing Za Zhi ; 29(11): 1053-1058, 2021 Nov 20.
Artigo em Chinês | MEDLINE | ID: mdl-34933422

RESUMO

Objective: To understand the current status of screening, diagnosis, and treatment and analyze the factors influencing micro-elimination strategy, so as to achieve hepatitis C elimination in hospital. Methods: Anti-HCV and HCV RNA test results of patients from October 2017 to September 2020 were retrospectively analyzed. Anti-HCV positive rates and factors influencing different genders, ages, places of residence and departments were analyzed. After comparing anti-HCV-positive patients with HCV RNA-positive patients with duplicate entries in "Name" and "Date of birth", the data were divided into three categories: anti-HCV positive without HCV RNA test, HCV RNA positive in single test, and HCV RNA positive many times in multiple tests. The above three types of patients were followed-up by telephone. According to the hospital follow-up results, current status of diagnosis and treatment and the factors influencing the micro-elimination strategy of hepatitis C were studied and analyzed. The comparison of data between groups were performed using χ(2) or χ(2) continuity-correction test. Results: Anti-HCV positive detection rate was 1.34% (899/66 866). The positive rate of male patients aged 40 and over residing in cities was significantly higher than female patients under 40 years old residing in rural areas, and the difference was statistically significant (χ(2) = 55.178, 264.11, 36, 351, P < 0.05). There were 90 (10.02%) and 809 cases (89.98%) in outpatient and inpatient departments, respectively, with no statistically significant difference between the two (χ(2) = 0.002, P > 0.05). The total number of anti-HCV positive cases were 196 in Gastroenterology (22.0%), 75 in Respiratory and Critical Care Medicine (8.3%), 74 in Neurology (8.2%), 63 in Orthopedics (7.0%) and 55 in Endocrinology departments (6.1%), and the difference in the positive rate among different departments were also statistically significant (χ(2) = 271.585, P < 0.05). Among the 480 cases who were followed-up, 215 (44.79%) were lost to follow-up, 84 cases (39.07%) were unregistered, 77 cases (16.04%) were untreated, 15 cases (19.48%) were unaware of their state of illness, 46 cases (59.74%) were diagnosed without concern, 16 cases (20.78%) were diagnosed but did not take medicine, 60 cases were under treatment, and 29 cases were mostly on counterfeit drugs (48.33%). Conclusion: Comprehensive diagnosis and treatment education to non-specialist clinicians and timely manner regular follow-up of patients is a key factor and an important link to formulate a simple, easy and sustainable model to improve the efficiency of screening, diagnosis, and treatment of hepatitis C micro-elimination strategy in hospital. In addition, it will also play an important role in achieving the strategic goal of "eliminating hepatitis C as a public health threat by 2030".


Assuntos
Hepacivirus , Hepatite C , Adulto , Feminino , Hepacivirus/genética , Hepatite C/diagnóstico , Hepatite C/tratamento farmacológico , Hepatite C/epidemiologia , Anticorpos Anti-Hepatite C , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
14.
Braz J Biol ; 83: e252610, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34909837

RESUMO

Although increased response rates concomitant in hepatitis C virus but relapse after treatment is threatened. Therefore, it is terrible requirement to evaluate the response of Pegylated interferon and direct acting antivirals in Punjab Pakistan. The study was conducted to find the rate of recurrence of HCV infection after treatment with Pegylated Interferon and Direct Acting Antivirals in Punjab Pakistan. This study was conducted at Department of Pathology, Nawaz Sharif Medical College Gujrat, while treatment effects monitored in different Government and Private Hospitals of Punjab, Pakistan. Total 973 patients who administered the recommended dose and divided in two groups (i) Interferon based therapy (ii) direct acting antivirals (DAAs).Other parameters like ALT and viral load studied. The rate of recurrence was higher in female infected with genotype 2b and in male with mixed genotype 3a/2b after six month of antiviral therapy. Genotype 3a showed significant response to therapy after three month. 32 among 374 (8.5%) were positive after 24 weeks of treatment with interferon, 29 (7.7%) patients have same genotype while 3 patients were re-infected with different HCV strains. With DAAs, only 27 (4.8%) patients were positive among 558 after 2 weeks and one patient re-infected with different genotype. Early and sustained virological response noted in DAAs. ALT and viral load decreased faster with DAAs that not achieved after 4 weeks with pegylated interferon. Sustained virological response appears in DAAs and recurrence rate is high in interferon therapy compared to DAAs. Therefore, reinfection has implications for correct treatment efficiency and to select strategies for retreatment cases.


Assuntos
Hepatite C Crônica , Hepatite C , Antivirais/uso terapêutico , Feminino , Genótipo , Hepacivirus/genética , Hepatite C/tratamento farmacológico , Hepatite C/epidemiologia , Hepatite C Crônica/tratamento farmacológico , Humanos , Interferons/uso terapêutico , Masculino , Paquistão/epidemiologia , Polietilenoglicóis/uso terapêutico , Resultado do Tratamento
15.
Arq Gastroenterol ; 58(4): 419-423, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34909843

RESUMO

BACKGROUND: Hepatocarcinogenesis is a multistep process that lead to genetic changes in hepatocytes resulting in neoplasia. However, the mechanisms of malignant transformation seem to differ widely. To know carcinogenesis mechanisms is essential to develop new treatment and prevention methods. OBJECTIVE: The aim of this study is to analyze B-Raf protein immunoexpression in explants with hepatocellular carcinoma (HCC) related to hepatitis C (HCV), in adjacent cirrhotic tissue and in normal livers. We also associated the immunoexpression with known HCC related histopathogical prognostic features. METHODS: Livers from 35 patients with HCV related cirrhosis and HCC that underwent liver transplantation or hepatectomy at Clinical Hospital – UFMG and 25 normal livers from necropsy archives were studied. Tumors were classified according to: tumor size, vascular invasion and differentiation grade. B-Raf protein expression was determined by immunohistochemistry. RESULTS: B-Raf was strongly expressed in the HCV cirrhotic parenchyma cytoplasm of 17.1% cases and in 62.9% of HCC samples. Strong B-Raf protein staining was associated with tumor tissue (P<0.0001; OR=8.18 (2.62–26.63)). All normal livers showed weak or negative expression for B-Raf. There was no significant association among B-Raf scores and tumor differentiation grade (P=0.9485), tumor size (P=0.4427) or with vascular invasion (P=0.2666). CONCLUSION: We found B-Raf protein immunostaining difference in normal livers, in the areas of HCV cirrhosis and in the hepatocarcinoma. We did not find association between B-Raf expression and histopathological markers of tumor progression. Our data suggests that B-Raf may play an important role in initial HCC carcinogenesis. Larger studies are needed to validate these observations.


Assuntos
Carcinoma Hepatocelular , Hepatite C , Neoplasias Hepáticas , Hepacivirus , Hepatite C/complicações , Humanos , Cirrose Hepática
16.
Arq Gastroenterol ; 58(4): 456-460, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34909850

RESUMO

BACKGROUND: In Brazil, since 2015, the treatment of hepatitis C is provided by SUS (Public Health System) with direct-acting antiviral (DAA). OBJECTIVE: To describe the rate of non-adherence patients to hepatitis C treatment by DAA, investigating the epidemiological data in a large database from Curitiba, Brazil. METHODS: Retrospective study with patients treated between January 2015 and June 2019. Patients were considered adherent when received all medication doses during their treatment. The following data were evaluated: gender, age, type of treatment, period of treatment, presence of diabetes or HIV, previous therapy, originated from SUS or private medicine, fibrosis grade and HCV genotype. RESULTS: 1248 patients (56.8% males) were studied and 102/1248 (8.2%) were non-adherent to treatment. Age or gender not influenced significantly; 10.2% patients from SUS and 3.7% individuals from private medicine were non-adherent (P<0.0001; OR=2.9; CI95%=1.6-9.1); 13.1% patients were co-infected with HIV and among them, 15.9% abandoned treatment. Individuals without co-infection presented 7.0% of non-adherence (P<0.0001; OR=2.5; CI=1.5-4.1). All the other variables showed no differences in the adhesion rate. CONCLUSION: Our study showed that 8.2% of patients were non-adherent to HCV treatment, and that patients from the Public Health System and co-infected with HIV were significantly less adherent.


Assuntos
Coinfecção , Infecções por HIV , Hepatite C Crônica , Hepatite C , Antivirais/uso terapêutico , Brasil/epidemiologia , Coinfecção/tratamento farmacológico , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Hepacivirus/genética , Hepatite C/tratamento farmacológico , Hepatite C Crônica/tratamento farmacológico , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
17.
Rev Assoc Med Bras (1992) ; 67(12): 1821-1824, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34909956

RESUMO

OBJECTIVE: To review data regarding the effects of hepatitis C virus eradication on glycemic control and insulin resistance. METHODS: This is an integrative literature review, carried out in the PubMed, SciELO, and Lilacs databases. Studies published in the past five years that were fully available, written in English or Portuguese, and have addressed the effects of eradication of the hepatitis C virus on glycemic control and insulin resistance were selected. RESULTS: Nine studies were selected. Among the results found, it was observed that there is no consensus on the effects of viral eradication on glycemic control and IR, as some authors show an eventual improvement in insulin resistance and glycemic control, while other studies indicate that there are no significant differences between the parameters evaluated after viral eradication. CONCLUSIONS: Although there is a relationship between hepatitis C virus infection and the development of insulin resistance and type 2 diabetes mellitus and recent advances in research, it was observed that there is no consensus on improving insulin resistance and glycemic control after antiviral treatment, probably due to methodological differences between studies. However, it emphasizes the need to guide people diagnosed with hepatitis C, regarding changes in lifestyle, encouragement of multidisciplinary monitoring, and control of other risk factors.


Assuntos
Diabetes Mellitus Tipo 2 , Hepatite C , Resistência à Insulina , Glicemia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Controle Glicêmico , Hepacivirus , Hepatite C/tratamento farmacológico , Humanos , Insulina
18.
Acta Gastroenterol Belg ; 84(4): 637-656, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34965046

RESUMO

Hepatitis C virus (HCV) is one of the leading causes of chronic liver disease, cirrhosis, and hepatocellular carcinoma, resulting in major global public health concerns. The HCV infection is unevenly distributed worldwide, with variations in prevalence across and within countries. The studies on molecular epidemiology conducted in several countries provide an essential supplement for a comprehensive knowledge of HCV epidemiology, genotypes, and subtypes, along with providing information on the impact of current and earlier migratory flows. HCV is phylogenetically classified into 8 major genotypes and 57 subtypes. HCV genotype and subtype distribution differ according to geographic origin and transmission risk category. Unless people with HCV infection are detected and treated appropriately, the number of deaths due to the disease will continue to increase. In 2015, 1.75 million new viral infections were mostly due to unsafe healthcare procedures and drug use injections. In the same year, access to direct-acting antivirals was challenging and varied in developing and developed countries, affecting HCV cure rates based on their availability. The World Health Assembly, in 2016, approved a global strategy to achieve the elimination of the HCV public health threat by 2030 (by reducing new infections by 90% and deaths by 65%). Globally, countries are implementing policies and measures to eliminate HCV risk based on their distribution of genotypes and prevalence.


Assuntos
Hepatite C Crônica , Hepatite C , Neoplasias Hepáticas , Antivirais/uso terapêutico , Genótipo , Hepacivirus/genética , Hepatite C/tratamento farmacológico , Hepatite C/epidemiologia , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/epidemiologia , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Prevalência
19.
BMC Med Inform Decis Mak ; 21(1): 347, 2021 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-34903225

RESUMO

BACKGROUND: Patients with hepatitis C virus (HCV) frequently remain at risk for cirrhosis after sustained virologic response (SVR). Existing cirrhosis predictive models for HCV do not account for dynamic antiviral treatment status and are limited by fixed laboratory covariates and short follow up time. Advanced fibrosis assessment modalities, such as transient elastography, remain inaccessible in many settings. Improved cirrhosis predictive models are needed. METHODS: We developed a laboratory-based model to predict progression of liver disease after SVR. This prediction model used a time-varying covariates Cox model adapted to utilize longitudinal laboratory data and to account for antiretroviral treatment. Individuals were included if they had a history of detectable HCV RNA and at least 2 AST-to-platelet ratio index (APRI) scores available in the national Veterans Health Administration from 2000 to 2015, Observation time extended through January 2019. We excluded individuals with preexisting cirrhosis. Covariates included baseline patient characteristics and 16 time-varying laboratory predictors. SVR, defined as permanently undetectable HCV RNA after antiviral treatment, was modeled as a step function of time. Cirrhosis development was defined as two consecutive APRI scores > 2. We predicted cirrhosis development at 1-, 3-, and 5-years follow-up. RESULTS: In a national sample of HCV patients (n = 182,772) with a mean follow-up of 6.32 years, 42% (n = 76,854) achieved SVR before 2016 and 16.2% (n = 29,566) subsequently developed cirrhosis. The model demonstrated good discrimination for predicting cirrhosis across all combinations of laboratory data windows and cirrhosis prediction intervals. AUROCs ranged from 0.781 to 0.815, with moderate sensitivity 0.703-0.749 and specificity 0.723-0.767. CONCLUSION: A novel adaptation of time-varying covariates Cox modeling technique using longitudinal laboratory values and dynamic antiviral treatment status accurately predicts cirrhosis development at 1-, 3-, and 5-years among patients with HCV, with and without SVR. It improves upon earlier cirrhosis predictive models and has many potential population-based applications, especially in settings without transient elastography available.


Assuntos
Hepatite C Crônica , Hepatite C , Hepacivirus , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/epidemiologia , Humanos , Cirrose Hepática , Modelos de Riscos Proporcionais
20.
Arch Microbiol ; 204(1): 69, 2021 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-34951685

RESUMO

Hepatitis C virus is still a global challenge affecting millions of carriers worldwide with the more devastating situation in developing countries. Present-day clinical manifestations are insufficient to tackle the increasing disease burden unaffordable cost, viral resistance and adverse effects of treatment. In this research, indigenous medicinal plants from Pakistan tested in bioassay guided manner on Huh-7 cell lines for their antiviral effect, synergism of purified fraction with interferon FDA approved drug regime, as the receptor for developing transfection model. The methanol extract of Syzgium cumine was observed against HCV through serum titter reduction in Quantitative Real Time PCR assay and the gene expression system, NS3protease inhibition was 76% and 51% against genotype 1a and 3a, respectively. More precisely the most active fraction SC14 was assessed in dose response assay and synergistic potential resulted in 50% reduction (EC50 Value) in HCV titer of genotype 1a and 3a at a concentration of 71.96 ± 8.67 µg and 31.75 ± 3.28 µg, respectively, at a concentration of 100 µg. As per our research work, the S. cumine extract has shown a promising effect on HCV genotypes 1a and 3a. Moreover the purified fraction S. cumine SC14 has a potential synergistic effect and ability to suppress the gene effect of NS3 during transfection in Huh-7 cells and GC/MS analysis reports the presence of Di-n-octyl phthalate (C24H38O4) which can be future direct-acting antiviral therapy against Hepatitis C virus.


Assuntos
Hepatite C Crônica , Hepatite C , Antivirais/farmacologia , Antivirais/uso terapêutico , Bioensaio , Genótipo , Hepacivirus/genética , Hepatite C Crônica/tratamento farmacológico , Hepatócitos , Humanos , Proteínas não Estruturais Virais/genética
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