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1.
J Viral Hepat ; 28(2): 420-430, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33073452

RESUMEN

The first clinical case of persistent HEV infection in England was reported in 2009. We describe the demography, virology and outcomes of patients identified with persistent HEV infection in England and Wales between 2009 and 2017. A series of 94 patients with persistent HEV infection, defined by HEV viraemia of more than 12 weeks, was identified through routine reference laboratory testing. Virology, serology and clinical data were recorded through an approved PHE Enhanced Surveillance System. Sixty-six cases (70.2%) were transplant recipients, 16 (17.0%) had an underlying haematological malignancy without stem cell transplantation, six (6.4%) had advanced HIV infection, five (5.3%) were otherwise immunosuppressed, and one patient (1.1%) had no identified immunosuppression. Retrospective analysis of 46 patients demonstrated a median 38 weeks of viraemia before diagnostic HEV testing. At initial diagnosis, 16 patients (17.0%) had no detectable anti-HEV serological response. Of 65 patients treated with ribavirin monotherapy, 11 (16.9%) suffered virological relapse despite undetectable RNA in plasma or stool at treatment cessation. Persistent HEV infection remains a rare diagnosis, but we demonstrate that a broad range of immunocompromised patients are susceptible. Both lack of awareness and the pauci-symptomatic nature of persistent HEV infection likely contribute to significant delays in diagnosis. Diagnosis should rely on molecular testing since anti-HEV serology is insufficient to exclude persistent HEV infection. Finally, despite treatment with ribavirin, relapses occur even after cessation of detectable faecal shedding of HEV RNA, further emphasising the requirement to demonstrate sustained virological responses to treatment.


Asunto(s)
Infecciones por VIH , Virus de la Hepatitis E , Hepatitis E , Demografía , Hepatitis E/diagnóstico , Hepatitis E/epidemiología , Virus de la Hepatitis E/genética , Humanos , Huésped Inmunocomprometido , Recurrencia Local de Neoplasia , ARN Viral , Estudios Retrospectivos , Gales/epidemiología
2.
Value Health ; 23(3): 309-318, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32197726

RESUMEN

BACKGROUND: Despite potentially severe and fatal outcomes, recent studies of solid organ transplant (SOT) recipients in Europe suggest that hepatitis E virus (HEV) infection is underdiagnosed, with a prevalence of active infection of up to 4.4%. OBJECTIVES: To determine the cost-effectiveness of introducing routine screening for HEV infection in SOT recipients in the UK. METHODS: A Markov cohort model was developed to evaluate the cost-utility of 4 HEV screening options over the lifetime of 1000 SOT recipients. The current baseline of nonsystematic testing was compared with annual screening of all patients by polymerase chain reaction (PCR; strategy A) or HEV-antigen (HEV-Ag) detection (strategy B) and selective screening of patients who have a raised alanine aminotransferase (ALT) value by PCR (strategy C) or HEV-Ag (strategy D). The primary outcome was the incremental cost per quality-adjusted life-year (QALY). We adopted the National Health Service (NHS) perspective and discounted future costs and benefits at 3.5%. RESULTS: At a willingness-to-pay of £20 000/QALY gained, systematic screening of SOT patients by any method (strategy A-D) had a high probability (77.9%) of being cost-effective. Among screening strategies, strategy D is optimal and expected to be cost-saving to the NHS; if only PCR testing strategies are considered, then strategy C becomes cost-effective (£660/QALY). These findings were robust against a wide range of sensitivity and scenario analyses. CONCLUSIONS: Our model showed that routine screening for HEV in SOT patients is very likely to be cost-effective in the UK, particularly in patients presenting with an abnormal alanine aminotransferase.


Asunto(s)
Costos de la Atención en Salud , Hepatitis E/diagnóstico , Hepatitis E/economía , Tamizaje Masivo/economía , Trasplante de Órganos/economía , Medicina Estatal/economía , Pruebas Enzimáticas Clínicas/economía , Ahorro de Costo , Análisis Costo-Beneficio , Hepatitis E/mortalidad , Humanos , Cadenas de Markov , Modelos Económicos , Trasplante de Órganos/efectos adversos , Trasplante de Órganos/mortalidad , Reacción en Cadena de la Polimerasa/economía , Valor Predictivo de las Pruebas , Prevalencia , Años de Vida Ajustados por Calidad de Vida , Medición de Riesgo , Factores de Riesgo , Pruebas Serológicas/economía , Factores de Tiempo , Resultado del Tratamiento , Reino Unido/epidemiología
3.
Euro Surveill ; 25(14)2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32290904

RESUMEN

Healthcare workers (HCW) are potentially at increased risk of infection with coronavirus disease (COVID-19) and may transmit severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to vulnerable patients. We present results from staff testing at Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom. Between 16 and 29 March 2020, 1,533 symptomatic HCW were tested, of whom 282 (18%) were positive for SARS-CoV-2. Testing HCW is a crucial strategy to optimise staffing levels during this outbreak.


Asunto(s)
Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Coronavirus/aislamiento & purificación , Guías como Asunto , Personal de Salud , Neumonía Viral/diagnóstico , Betacoronavirus , COVID-19 , Prueba de COVID-19 , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Brotes de Enfermedades , Humanos , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/virología , Prevalencia , SARS-CoV-2 , Síndrome Respiratorio Agudo Grave/diagnóstico , Síndrome Respiratorio Agudo Grave/epidemiología , Síndrome Respiratorio Agudo Grave/virología , Medicina Estatal , Reino Unido/epidemiología
4.
J Viral Hepat ; 30(1): 82, 2023 01.
Artículo en Inglés | MEDLINE | ID: mdl-36081342
7.
Lancet Infect Dis ; 23(3): e115-e120, 2023 03.
Artículo en Inglés | MEDLINE | ID: mdl-36470282

RESUMEN

The 2022 monkeypox outbreak has affected 110 countries worldwide, outside of classic endemic areas (ie, west Africa and central Africa). On July 23, 2022, the outbreak was classified by WHO as a public health emergency of international concern. Clinical presentation varies from mild to life-changing symptoms; neurological complications are relatively uncommon and there are few therapeutic interventions for monkeypox disease. In this Grand Round, we present a case of monkeypox with encephalitis complicated by transverse myelitis in a previously healthy woman aged 35 years who made an almost complete recovery from her neurological symptoms after treatment with tecovirimat, cidofovir, steroids, and plasma exchange. We describe neurological complications associated with orthopoxvirus infections and laboratory diagnosis, the radiological features in this case, and discuss treatment options.


Asunto(s)
Encefalitis , Mpox , Mielitis Transversa , Femenino , Humanos , África Occidental , Benzamidas
8.
Transplantation ; 102(1): 15-20, 2018 01.
Artículo en Inglés | MEDLINE | ID: mdl-28795981

RESUMEN

The incidence and prevalence of hepatitis E virus (HEV) infection has increased in many developed countries over the last decade, predominantly due to infection with genotype 3 (G3) HEV. Infection with HEV G3 is important in transplant recipients because it can persist in immunosuppressed individuals, leading, if untreated, to the development of chronic hepatitis and significant liver fibrosis. The British Transplantation Society (BTS) has developed Guidelines for "Hepatitis E and Solid Organ Transplantation" to inform clinical teams and patients about hepatitis E, to help increase the recognition of persistent hepatitis E infection, and to provide clear guidance on its management. This guideline was published on the BTS website in June 2017 and aims to review the evidence relating to the diagnosis and management of persistent hepatitis E in solid organ transplant recipients and the methods of prevention of HEV infection. In line with previous guidelines published by the BTS, the guideline has used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system to rate the strength of evidence and recommendations. This article includes a summary overview of hepatitis E and transplantation with key references, and the statements of recommendation contained within the guideline. It is recommended that the full guideline document is consulted for complete details of the relevant references and evidence base. This may be accessed at https://bts.org.uk/guidelines-standards/.


Asunto(s)
Hepatitis E/epidemiología , Trasplante de Órganos/efectos adversos , Guías de Práctica Clínica como Asunto , Hepatitis E/diagnóstico , Hepatitis E/tratamiento farmacológico , Humanos , Ribavirina/uso terapéutico , Sociedades Médicas , Reino Unido
9.
Transplantation ; 102(7): 1139-1147, 2018 07.
Artículo en Inglés | MEDLINE | ID: mdl-29953421

RESUMEN

BACKGROUND: Persistent hepatitis E virus genotype 3 (HEV G3) infections affect solid organ transplant (SOT) recipients and hematopoietic stem cell transplant (HSCT) recipients, but the burden in these cohorts in the United Kingdom is unknown. We established an audit to determine the point prevalence of HEV viremia in SOT and HSCT patients in the United Kingdom and compare different testing approaches to inform screening strategies. METHODS: Between January 5, 2016, and September 21, 2016, 3044 patients undergoing therapeutic drug monitoring at a single transplant center were screened for HEV ribonucleic acid (RNA) in minipools. A total of 2822 patients who could be characterized included 2419 SOT patients, 144 HSCT patients and 259 patients with no available transplant history. HEV RNA-positive samples were characterized by serology and genomic phylogeny. HEV antigen (HEV-Ag) testing was performed on RNA-positive samples, 420 RNA-negative samples and 176 RNA-negative blood donor samples. RESULTS: Nineteen of 2822 patients were viremic with G3 HEV giving a prevalence of 0.67%. The median alanine aminotransferase was significantly higher in the HEV viremic patients (P < 0.0001); however, 2 viremic patients had an alanine aminotransferase value within the normal range at the time of screening. The HEV-Ag assay identified 18/19 viremic patients and all those patients with proven viremia longer than 4 weeks. CONCLUSIONS: Transplant recipients in the United Kingdom are at a low but significant risk of HEV infection. HEV-Ag detection could be an alternative to RNA detection where the goal is to identify established persistent HEV infection, particularly where expertise, facilities, or cost prohibit RNA testing.


Asunto(s)
Virus de la Hepatitis E/aislamiento & purificación , Hepatitis E/diagnóstico , Tamizaje Masivo/estadística & datos numéricos , Trasplante de Órganos/efectos adversos , Complicaciones Posoperatorias/diagnóstico , Viremia/epidemiología , Adulto , Anciano , Costo de Enfermedad , Femenino , Antígenos de la Hepatitis/aislamiento & purificación , Hepatitis E/epidemiología , Hepatitis E/virología , Virus de la Hepatitis E/genética , Virus de la Hepatitis E/inmunología , Humanos , Masculino , Tamizaje Masivo/economía , Tamizaje Masivo/métodos , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/virología , Prevalencia , Estudios Prospectivos , ARN Viral/aislamiento & purificación , Receptores de Trasplantes/estadística & datos numéricos , Reino Unido/epidemiología , Viremia/virología , Adulto Joven
13.
AIDS ; 27(1): 139-41, 2013 Jan 02.
Artículo en Inglés | MEDLINE | ID: mdl-22874516

RESUMEN

This study evaluated the outcome of first-line antiretroviral therapy among 35 Ghanaians with occult HBV/HIV co-infection, comparing them over 2 years to 120 patients with HBsAg+ HBV/HIV co-infection and 230 patients without HBV co-infection. Increases in CD4 cell count and BMI were similar, whereas elevations of hepatic transaminases were more frequent in both the occult HBV and HBsAg+ patients. Occult HBV/HIV co-infection appears not to impact adversely on response to antiretroviral therapy in Ghana.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Hepatitis B/tratamiento farmacológico , Lamivudine/uso terapéutico , Inhibidores de la Transcriptasa Inversa/uso terapéutico , Índice de Masa Corporal , Recuento de Linfocito CD4 , Coinfección , Progresión de la Enfermedad , Femenino , Ghana/epidemiología , Infecciones por VIH/epidemiología , Infecciones por VIH/inmunología , Hepatitis B/epidemiología , Hepatitis B/inmunología , Antígenos de Superficie de la Hepatitis B/sangre , Humanos , Masculino , Prevalencia , Resultado del Tratamiento , Carga Viral/efectos de los fármacos
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