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1.
Dtsch Med Wochenschr ; 149(16): 955-961, 2024 Aug.
Article in German | MEDLINE | ID: mdl-39094600

ABSTRACT

Chronic infection with hepatitis C virus (HCV) is a common cause of complications such as liver cirrhosis and hepatocellular carcinoma (HCC). It is one of the most significant infectious diseases worldwide, posing a substantial health burden. Since the introduction of direct-acting antiviral agents (DAAs), the treatment landscape has undergone a revolution. HCV infection is curable, and the treatment is safe and well tolerated. Due to the availability of this effective therapeutic option, the World Health Organization (WHO) set an ambitious goal in 2015 to eliminate Hepatitis C by 2030, a goal that the German government also embraced in 2016. The key tasks involve identifying previously undiagnosed cases and ensuring they receive antiviral treatment. Addressing at-risk populations through specific measures, including micro-elimination projects and population-wide campaigns, is essential to achieving the WHO's target both in Germany and globally.


Subject(s)
Antiviral Agents , Humans , Antiviral Agents/therapeutic use , Germany , Hepatitis C, Chronic/drug therapy , Hepatitis C, Chronic/diagnosis , World Health Organization , Global Health , Disease Eradication , Hepatitis C/drug therapy , Hepatitis C/diagnosis
2.
Euro Surveill ; 29(30)2024 Jul.
Article in English | MEDLINE | ID: mdl-39056200

ABSTRACT

IntroductionA national study from 2006 to 2008 showed a high antibody prevalence of 3.2% against hepatitis C virus (HCV) in Romania, but more recent epidemiological data on hepatitis C prevalence are lacking.AimWe aimed to estimate the current prevalence of HCV antibodies (anti-HCV) and chronic HCV infection in the general adult population in Romania, as a crucial element in monitoring progress towards eliminating hepatitis C.MethodsWe used anonymised leftover sera from a SARS-CoV-2 survey conducted between July and October 2020 (n = 2,100), supplemented with sera collected prospectively between July 2022 and March 2023 (n = 574). These included sera collected from adults visiting laboratories for routine medical check-ups. Sera were tested for anti-HCV and HCV core antigen and classified according to anti-HCV and chronic infection status.ResultsOf the total 2,674 specimens tested, 44 were anti-HCV-positive with a weighted anti-HCV prevalence of 1.4% (95% CI: 1.0-1.9), and 29 were HCV core antigen-positive with a weighted prevalence of chronic infection of 0.9% (95% CI: 0.5-1.2). The prevalence of chronic infection did not differ significantly between men and women. It was higher in persons 60 years and older (2.0%; 95% CI: 1.1-3.0) and in specimens from the North-East region (2.2%; 95% CI: 0.8-3.7).ConclusionAlthough the overall HCV prevalence in Romania is currently low, targeted screening, prevention measures and treatment scale-up are needed especially for the population 60 years and older and in the north-eastern part of the country to achieve the goal of ending the hepatitis C epidemic.


Subject(s)
Hepacivirus , Hepatitis C Antibodies , Hepatitis C, Chronic , Humans , Romania/epidemiology , Male , Female , Hepatitis C, Chronic/epidemiology , Hepatitis C, Chronic/diagnosis , Middle Aged , Prevalence , Adult , Aged , Hepacivirus/immunology , Hepacivirus/isolation & purification , Hepatitis C Antibodies/blood , Young Adult , Adolescent , SARS-CoV-2/immunology , COVID-19/epidemiology , Seroepidemiologic Studies , Surveys and Questionnaires
3.
Acta Med Indones ; 56(2): 185-190, 2024 Apr.
Article in English | MEDLINE | ID: mdl-39010767

ABSTRACT

BACKGROUND: Point of care is laboratory testing conducted close to the site of the patient. Point of care assessment is essential to detect and treat the hepatitis C virus in a single visit. The potential use of Genedrive extends to remote areas and key populations Therefore, there is a need for a simple, and cost-effective examination of methods, such as Genedrive. Genedrive is a rapid and low-cost diagnostic tool for the identification and treatment selection of infectious diseases. The World Health Organization targets to eliminate hepatitis by 2030, which decreases infections by 90%, and decreases deaths by 65%. Point of care could play a significant role in contributing to the elimination of hepatitis C. Chronic kidney disease (CKD) patients on hemodialysis are among the population at risk of hepatitis C due to nosocomial transmission. This study aimed to assess the role of Genedrive in measuring hepatitis C in chronic hepatitis C patients with chronic kidney disease on hemodialysis. METHODS: This study used a cross-sectional design. There were 64 CKD on Hd patients in Cipto Mangunkusumo Hospital tested by Genedrive. ROC analysis was conducted to assess significant hepatitis C among chronic kidney disease on hemodialysis. RESULTS: The calculated detection limit of Genedrive was 3.1x103 IU/mL. Genedrive HCV assay showed 90.6% sensitivity, 96.8% specificity, 92% negative predictive value, and 97% positive predictive value to detect HCV, 10.36 positive likelihood ratio, and 0.09 negative likelihood ratio. CONCLUSION: Genedrive could be a simple and reliable point of care method to detect hepatitis C with chronic kidney disease on hemodialysis.


Subject(s)
Point-of-Care Systems , Renal Dialysis , Humans , Female , Male , Cross-Sectional Studies , Middle Aged , Renal Insufficiency, Chronic/therapy , Renal Insufficiency, Chronic/complications , Adult , Hepacivirus/isolation & purification , Sensitivity and Specificity , ROC Curve , Indonesia , Aged , Hepatitis C/diagnosis , Hepatitis C/complications , Hepatitis C, Chronic/complications , Hepatitis C, Chronic/diagnosis
4.
BMC Cardiovasc Disord ; 24(1): 344, 2024 Jul 08.
Article in English | MEDLINE | ID: mdl-38977993

ABSTRACT

BACKGROUND: The link between diabetes mellitus and chronic hepatitis C infection remains well established. It is estimated that up to one third of chronic hepatitis C patients have type II diabetes mellitus. Hepatitis C virus infection is one of the main global health burdens. Sofosbuvir and Daclatasvir are used as effective antiviral inhibitors of hepatitis C virus. The cardiovascular effects of those drugs are not well studied. We used electrocardiography and echocardiography with global longitudinal strain assessment by speckle tracking to detect their effect on cardiac function. METHODS AND RESULTS: One hundred diabetic patients with hepatitis C infection were included in the study. Abdominal ultrasound and laboratory work up were carried out for all participants. Left ventricular systolic and diastolic function were assessed by 2D-echocardiography and global longitudinal strain, before and 3 months after treatment. Results showed significant decrease in global longitudinal strain 3 months after therapy (-21 ± 4 vs. -18 ± 7; P < 0.001) but other echocardiographic findings showed no significant changes. CONCLUSIONS: Sofosbuvir and Daclatasvir were associated with early left ventricular systolic dysfunction as assessed by global longitudinal strain in diabetic patients. More deterioration in left ventricular systolic function was detected among those with Child-Pough class B. Further long-term follow-up may be required.


Subject(s)
Antiviral Agents , Carbamates , Diabetes Mellitus, Type 2 , Hepatitis C, Chronic , Imidazoles , Pyrrolidines , Sofosbuvir , Valine , Ventricular Dysfunction, Left , Ventricular Function, Left , Humans , Antiviral Agents/therapeutic use , Antiviral Agents/adverse effects , Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/complications , Male , Female , Middle Aged , Sofosbuvir/therapeutic use , Sofosbuvir/adverse effects , Valine/analogs & derivatives , Valine/therapeutic use , Pyrrolidines/therapeutic use , Imidazoles/therapeutic use , Treatment Outcome , Hepatitis C, Chronic/drug therapy , Hepatitis C, Chronic/complications , Hepatitis C, Chronic/diagnosis , Carbamates/therapeutic use , Ventricular Function, Left/drug effects , Ventricular Dysfunction, Left/physiopathology , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Dysfunction, Left/drug therapy , Ventricular Dysfunction, Left/etiology , Ventricular Dysfunction, Left/diagnosis , Time Factors , Aged , Electrocardiography , Adult
5.
Euro Surveill ; 29(29)2024 Jul.
Article in English | MEDLINE | ID: mdl-39027939

ABSTRACT

BackgroundActive follow-up of chronic hepatitis C notifications to promote linkage to care is a promising strategy to support elimination.AimThis pilot study in Victoria, Australia, explored if the Department of Health could follow-up on hepatitis C cases through their diagnosing clinicians, to assess and support linkage to care and complete data missing from the notification.MethodsFor notifications received between 1 September 2021 and 31 March 2022 of unspecified hepatitis C cases (i.e. acquired > 24 months ago or of unknown duration), contact with diagnosing clinicians was attempted. Data were collected on risk exposures, clinical and demographic characteristics and follow-up care (i.e. HCV RNA test; referral or ascertainment of previous negative testing or treatment history). Reasons for unsuccessful doctor contact and gaps in care provision were investigated. Advice to clinicians on care and resources for clinical support were given on demand.ResultsOf 513 cases where information was sought, this was able to be obtained for 356 (69.4%). Reasons for unsuccessful contact included incomplete contact details or difficulties getting in touch across three attempts, particularly for hospital diagnoses. Among the 356 cases, 307 (86.2%) had received follow-up care. Patient-management resources were requested by 100 of 286 contacted diagnosing clinicians.ConclusionsMost doctors successfully contacted had provided follow-up care. Missing contact information and the time taken to reach clinicians significantly impeded the feasibility of the intervention. Enhancing system automation, such as integration of laboratory results, could improve completeness of notifications and support further linkage to care where needed.


Subject(s)
Hepatitis C , Humans , Pilot Projects , Male , Female , Middle Aged , Adult , Victoria , Hepatitis C/diagnosis , Disease Notification , Aged , Hepacivirus/isolation & purification , Hepacivirus/genetics , Population Surveillance/methods , Contact Tracing/methods , Hepatitis C, Chronic/diagnosis
6.
Sex Transm Infect ; 100(5): 321-324, 2024 Jul 26.
Article in English | MEDLINE | ID: mdl-38960601

ABSTRACT

OBJECTIVES: To eliminate hepatitis B and C virus (HBV/HCV) as a public health threat by 2030, the WHO focuses on screening key populations, including men who have sex with men (MSM).This study aims to assess HBV and HCV knowledge and awareness and HCV prevalence in MSM in Belgium. METHODS: First, a questionnaire was designed to assess MSM's knowledge of HBV and HCV infection (disease process, vaccination, treatment and transmission routes). This questionnaire was conducted online, and by means of a tablet-based face-to-face questionnaire at the Antwerp and Belgian Pride. Second, HCV and HIV prevalence data were collected during outreach projects and office screening for sexually transmitted infections (STIs) organised by Sensoa and Exaequo, a Flemish and Walloon sexual health organisation. RESULTS: 300 MSM completed the questionnaire (median age 36 years; 7.7% HIV+). Mean overall survey scores were low (HBV: 41.1%; HCV: 39.8%). Few participants identified all transmission routes correctly (HBV: 15%; HCV 1%).The degree of education was significantly correlated with HBV knowledge and showed a trend towards correlation with HCV knowledge. HCV knowledge was significantly correlated with high-risk sexual behaviour.The prevalence of HCV and HIV was 0.3% and 1.0%, respectively, in MSM attending commercial gay venues and 0% and 1.9% in MSM attending office STI screening. CONCLUSIONS: Knowledge of HBV and HCV infection in MSM is poor. More awareness campaigns are needed, focusing on frequent HCV risk factors (group sex, chemsex, receptive fisting, and sharing of anal toys and anal douching devices), especially targeting low-educated MSM. HBV vaccination of MSM requires continued attention.The prevalence of HCV and HIV was remarkably low in commercial gay venues and may be higher in older MSM or in subcultures where risk factors coexist (eg, chemsex). The cost-effectiveness of internet-based approaches with subsequent at-home testing needs to be evaluated in the future.


Subject(s)
Health Knowledge, Attitudes, Practice , Homosexuality, Male , Mass Screening , Humans , Male , Belgium/epidemiology , Homosexuality, Male/statistics & numerical data , Adult , Surveys and Questionnaires , Prevalence , Hepatitis B, Chronic/epidemiology , Hepatitis B, Chronic/prevention & control , Hepatitis B, Chronic/diagnosis , Hepatitis C, Chronic/epidemiology , Hepatitis C, Chronic/diagnosis , Hepatitis C, Chronic/prevention & control , Middle Aged , Young Adult , HIV Infections/epidemiology , HIV Infections/prevention & control , HIV Infections/diagnosis , Sexual and Gender Minorities/statistics & numerical data , Sexual Behavior
7.
Liver Int ; 44(7): 1548-1563, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38804727

ABSTRACT

In 2016, the Global Health Sector Strategy, ratified by the 69th World Health Assembly, set the ambitious goal of eliminating hepatitis C virus (HCV) and hepatitis B virus infections by 2030, emphasizing the importance of national screening programmes. Achieving this goal depends on each country's ability to identify and treat 80% of chronic hepatitis C cases, a critical threshold set by the World Health Organization. Traditionally, estimates of HCV prevalence have been based on interferon era studies that focused on high-risk subgroups rather than the general population. In addition, the incomplete data available from national registries also limited the understanding of HCV prevalence. The 2016 report from the European Centre for Disease Prevention and Control highlighted that HCV rates varied across European counties, ranging from .1% to 5.9%. However, data were only available for 13 countries, making the overall picture less clear. Additionally, the epidemiological data may have underestimated the true burden of HCV due to lack of awareness among those with chronic infection. The main objective of this review is to provide a comprehensive summary of HCV epidemiology in Europe in the current era of direct-acting antivirals (DAAs). The data included in the analysis range from the end of 2013 to December 2023 and have been categorised according to the United Nations Geoscheme. The resulting synthesis underscores the noteworthy impact of DAA treatment on the epidemiological situation.


Subject(s)
Antiviral Agents , Hepatitis C, Chronic , Humans , Europe/epidemiology , Prevalence , Antiviral Agents/therapeutic use , Hepatitis C, Chronic/epidemiology , Hepatitis C, Chronic/drug therapy , Hepatitis C, Chronic/diagnosis , Hepacivirus/drug effects
8.
J Natl Compr Canc Netw ; 22(2D)2024 May 10.
Article in English | MEDLINE | ID: mdl-38729204

ABSTRACT

BACKGROUND: The prevalence of chronic hepatitis C virus (HCV) infection in the United States is ≤1%. Universal HCV screening is recommended nationwide. Here we describe our experience implementing universal HCV screening at a cancer center. METHODS: In October 2016, universal HCV screening with HCV antibody (anti-HCV) was initiated for all new outpatients. Universal screening was promoted through widespread provider education, orders in the Epic electronic health records (EHRs), SmartSets, and automated EHR reminders. The effort focused on patients with solid tumors, because universal screening in patients with hematologic malignancies was already standard practice. Primary outcomes were the proportion of patients screened and the proportion of patients with reactive anti-HCV test results linked to HCV care. The secondary outcome was the incidence of HCV-associated hepatocellular carcinoma as a second primary malignancy (HCC-SPM) in patients with a history of other cancers before HCC diagnosis. Epic's Reporting Workbench Business Intelligence tools were used. Statistical significance was defined as P<.05 on chi-square analysis. RESULTS: From April 2016 through April 2023, 56,075 patients with solid tumors were screened for HCV, of whom 1,300 (2.3%) had reactive anti-HCV test results. The proportion of patients screened was 10.1% in the 6 months before study implementation and 34.4% in the last 6 months of the study (P<.001). HCV screening was ordered using SmartSets in 39,332 (45.8%) patients and in response to automated EHR reminders in 10,972 (12.8%) patients. Most patients with reactive anti-HCV test results were linked to care (765/1,300; 59%), most with proven HCV infection were treated (425/562; 76%), and most treated patients achieved sustained virologic response (414/425; 97%). The incidence of HCC-SPMs was 15% in historical controls treated from 2011 to 2017 and 5.7% following implementation of universal screening (P=.0002). CONCLUSIONS: Universal HCV screening can be successfully implemented in cancer hospitals using an EHR-based multipronged approach to eliminate HCV and prevent HCV-associated HCC-SPMs.


Subject(s)
Mass Screening , Tertiary Care Centers , Humans , Male , Mass Screening/methods , Female , Middle Aged , Hepacivirus/isolation & purification , Hepacivirus/immunology , Aged , Hepatitis C, Chronic/epidemiology , Hepatitis C, Chronic/diagnosis , Hepatitis C, Chronic/virology , Hepatitis C, Chronic/complications , Hepatitis C/epidemiology , Hepatitis C/diagnosis , Hepatitis C/virology , Hepatitis C Antibodies/blood , Liver Neoplasms/epidemiology , Liver Neoplasms/diagnosis , Liver Neoplasms/virology , Incidence , Carcinoma, Hepatocellular/epidemiology , Carcinoma, Hepatocellular/diagnosis , Carcinoma, Hepatocellular/virology , Electronic Health Records
9.
J Viral Hepat ; 31(7): 416-422, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38749911

ABSTRACT

Chronic hepatitis C Virus (HCV) infection presents a global health challenge, with significant morbidity and mortality worldwide. Despite remarkable progress in treatment options, achieving elimination targets by 2030, as set by the World Health Organization, remains elusive. Our study aimed to address this gap by integrating HCV screening into a national breast cancer screening program. Between March 2022 and March 2023, a prospective cross-sectional multicenter study was conducted in four radiology centers in Montpellier, France. We proposed HCV screening to consecutive women undergoing mammography, targeting 1,500 participants aged 50-74 years. A rapid diagnostic test (RDT) for HCV antibodies (HCV Ab) was performed on capillary whole blood, with positive cases undergoing serological and RNA confirmation. Participants also completed a questionnaire on demographic data and risk factors. Acceptance rates, HCV prevalence, and linkage to care were assessed. The acceptance rate for this integrated screening approach was 82.4%. Notably, the seroprevalence of HCV was found to be 0.65%. Linkage to care was prompt, and the cascade of care demonstrated successful treatment outcomes. Importantly, the majority of detected infections were successfully resolved. These findings underscore the feasibility and acceptability of integrating HCV screening with breast cancer screening programs providing updated prevalence data and valuable insights for refining future screening strategies.


Subject(s)
Early Detection of Cancer , Hepatitis C Antibodies , Mammography , Humans , Female , Middle Aged , Aged , Cross-Sectional Studies , Prospective Studies , Mammography/methods , Mammography/statistics & numerical data , Hepatitis C Antibodies/blood , Early Detection of Cancer/methods , Mass Screening/methods , France/epidemiology , Hepacivirus/immunology , Hepacivirus/genetics , Breast Neoplasms/diagnosis , Breast Neoplasms/epidemiology , Hepatitis C, Chronic/diagnosis , Hepatitis C, Chronic/epidemiology , Diagnostic Tests, Routine/methods , Diagnostic Tests, Routine/statistics & numerical data , Seroepidemiologic Studies , Prevalence , Hepatitis C/diagnosis , Hepatitis C/epidemiology , Rapid Diagnostic Tests
10.
Pathol Res Pract ; 258: 155327, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38692084

ABSTRACT

PURPOSE: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death worldwide. Although alpha-fetoprotein (AFP) has been used for 60+ years as an HCC diagnostic serum marker, its accuracy is debated. Notably, the role of interleukin 10 (IL-10) in cancer development and metastasis is elevated in various tumor types, including HCC and chronic HCV infection. Our study aimed to investigate the diagnostic performance of IL-10 and AFP as biomarkers for HCV-induced HCC in an Egyptian population. METHODS: Eighty participants were recruited and categorized into three groups: HCV-related HCC (n=40), HCV-related cirrhosis (n=40), and control (n=20).The collected blood samples were analyzed to evaluate liver function, AFP levels, and IL-10 levels. RESULTS: Our analysis showed that AFP demonstrated low sensitivity (40% false-negative) and low specificity (33% false-positive).IL-10 levels were significantly higher (P < 0.001) in patients with HCC than in the cirrhosis and control groups. The serum AFP and IL-10 combination revealed significantly increased sensitivity (97.5%), diagnostic accuracy (71.1%), AUC (0.798), PPV (73.3%), and NPV ( 69.5%) when compared with either of them alone. CONCLUSION: the reliability of AFP as a major HCC marker was poor. However, IL-10 levels are a novel biomarker for the degree of HCC inflammation, considering IL-10's potential role in HCV-HCC development. We suggest combining AFP with IL-10 to improve the diagnostic and prognostic value of HCC considerably. Future research on these biomarkers should prioritize their clinical validity, prognostic usefulness, and compatibility with other therapeutic approaches as immunotherapy.


Subject(s)
Biomarkers, Tumor , Carcinoma, Hepatocellular , Interleukin-10 , Liver Neoplasms , alpha-Fetoproteins , Humans , Carcinoma, Hepatocellular/blood , Carcinoma, Hepatocellular/diagnosis , Carcinoma, Hepatocellular/virology , alpha-Fetoproteins/analysis , alpha-Fetoproteins/metabolism , Liver Neoplasms/blood , Liver Neoplasms/diagnosis , Liver Neoplasms/virology , Interleukin-10/blood , Male , Middle Aged , Female , Egypt , Biomarkers, Tumor/blood , Hepatitis C, Chronic/blood , Hepatitis C, Chronic/diagnosis , Hepatitis C, Chronic/complications , Adult , Aged , Sensitivity and Specificity , North African People
11.
Expert Rev Pharmacoecon Outcomes Res ; 24(5): 687-695, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38716801

ABSTRACT

BACKGROUND: The treatment of chronic hepatitis C virus (HCV) infection using directly acting antivirals was recently adopted in the treatment guidelines of Zimbabwe. The objectives of this study were to design a simplified model of HCV care and estimate the cost of screening and treatment of hepatitis C infection at a tertiary hospital in Zimbabwe. METHODS: We developed a model of care for HCV using WHO 2018 guidelines for the treatment of HCV infection and expert opinion. We then performed a micro-costing to estimate the costs of implementing the model of care from the healthcare sector perspective. Deterministic and probabilistic sensitivity analyses were performed to explore the impact of uncertainty in input parameters on the estimated total cost of care. RESULTS: The total cost of screening and treatment was estimated to be US$2448 (SD=$290) per patient over a 12-week treatment duration using sofosbuvir/velpatasvir. The cost of directly acting antivirals contributed 57.5% to the total cost of care. The second largest cost driver was the cost of diagnosis, US$819, contributing 34.6% to the total cost of care. CONCLUSION: Screening and treatment of HCV-infected individuals using directly acting antivirals at a tertiary hospital in Zimbabwe may require substantial financial resources.


Subject(s)
Antiviral Agents , Health Care Costs , Hepatitis C, Chronic , Mass Screening , Tertiary Care Centers , Humans , Zimbabwe , Tertiary Care Centers/economics , Antiviral Agents/economics , Antiviral Agents/administration & dosage , Antiviral Agents/therapeutic use , Mass Screening/economics , Mass Screening/methods , Hepatitis C, Chronic/drug therapy , Hepatitis C, Chronic/economics , Hepatitis C, Chronic/diagnosis , Health Care Costs/statistics & numerical data , Practice Guidelines as Topic , Costs and Cost Analysis , Models, Economic
12.
World J Gastroenterol ; 30(14): 1949-1957, 2024 Apr 14.
Article in English | MEDLINE | ID: mdl-38681127

ABSTRACT

In Japan, liver biopsies were previously crucial in evaluating the severity of hepatitis caused by the hepatitis C virus (HCV) and diagnosing HCV-related hepatocellular carcinoma (HCC). However, due to the development of effective antiviral treatments and advanced imaging, the necessity for biopsies has significantly decreased. This change has resulted in fewer chances for diagnosing liver disease, causing many general pathologists to feel less confident in making liver biopsy diagnoses. This article provides a comprehensive overview of the challenges and potential solutions related to liver biopsies in Japan. First, it highlights the importance of considering steatotic liver diseases as independent conditions that can coexist with other liver diseases due to their increasing prevalence. Second, it emphasizes the need to avoid hasty assumptions of HCC in nodular lesions, because clinically diagnosable HCCs are not targets for biopsy. Third, the importance of diagnosing hepatic immune-related adverse events caused by immune checkpoint inhibitors is increasing due to the anticipated widespread use of these drugs. In conclusion, pathologists should be attuned to the changing landscape of liver diseases and approach liver biopsies with care and attention to detail.


Subject(s)
Antiviral Agents , Hepacivirus , Liver , Humans , Antiviral Agents/therapeutic use , Biopsy , Carcinoma, Hepatocellular/pathology , Carcinoma, Hepatocellular/virology , Fatty Liver/pathology , Fatty Liver/virology , Fatty Liver/diagnosis , Hepacivirus/isolation & purification , Hepacivirus/immunology , Hepatitis C/diagnosis , Hepatitis C/pathology , Hepatitis C/drug therapy , Hepatitis C, Chronic/pathology , Hepatitis C, Chronic/drug therapy , Hepatitis C, Chronic/complications , Hepatitis C, Chronic/diagnosis , Immune Checkpoint Inhibitors/therapeutic use , Immune Checkpoint Inhibitors/adverse effects , Japan , Liver/pathology , Liver/virology , Liver/diagnostic imaging , Liver Neoplasms/pathology , Liver Neoplasms/virology
13.
J Virol Methods ; 327: 114937, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38614281

ABSTRACT

Quantification of hepatitis C virus (HCV)-RNA in serum or plasma samples is an essential parameter in HCV diagnostics. Here, the NeuMoDx™Molecular System (Qiagen) was tested for the most common HCV genotypes and compared to the cobas c6800 system (Roche). HCV-RNA from 131 plasma/serum samples from chronically infected patients was determined in parallel on the NeuMoDx and c6800 systems. Linearity was analysed using the four most common HCV genotypes (1-4) in our cohort. The coefficient of variation (CV) within (intra-assay) and between (inter-assay) runs was calculated based on HCV-RNA concentration. Quantitative HCV-RNA results were highly correlated on both test systems (R2 = 0.7947; y = 0.94 x + 0.37). On average, the NeuMoDx and c6800 HCV RNA levels showed a mean difference of only 0.05 log10 IU/mL but with a broad distribution (±1.2 2 x SD). The NeuMoDx demonstrated very good linearity across all HCV genotypes tested at concentrations between 1.7 and 6.2 log10 IU/mL (R2 range: 0.9257-0.9991) with the highest mean coefficient of determination for genotype 1 (R2 = 0.9909). The mean intra- and inter-assay CV for both serum and plasma samples was <5 %. The NeuMoDx HCV-RNA Assay demonstrates high subtype-independent comparability, linearity, and reproducibility for the quantification of HCV-RNA in serum and plasma samples from chronically infected patients.


Subject(s)
Genotype , Hepacivirus , RNA, Viral , Viral Load , Humans , Hepacivirus/genetics , Hepacivirus/isolation & purification , RNA, Viral/blood , RNA, Viral/genetics , Viral Load/methods , Reproducibility of Results , Hepatitis C, Chronic/virology , Hepatitis C, Chronic/diagnosis , Hepatitis C, Chronic/blood , Sensitivity and Specificity , Hepatitis C/diagnosis , Hepatitis C/virology , Hepatitis C/blood , Molecular Diagnostic Techniques/methods , Molecular Diagnostic Techniques/standards , Reagent Kits, Diagnostic/standards
14.
Swiss Med Wkly ; 154: 3352, 2024 Feb 29.
Article in English | MEDLINE | ID: mdl-38579293

ABSTRACT

BACKGROUND: To eliminate chronic hepatitis C virus (HCV) infection by 2030, 90% of those infected must be diagnosed and 80% treated. In Switzerland, >40% of the estimated 32,000 infected people are still undiagnosed. In the canton of St Gallen, HCV prevalence and cascade of care have only been studied in the centralised opioid agonist therapy (OAT) setting (institutions), although about 80% of OAT patients are treated decentrally (general practitioner [GP] or pharmacy). AIM: To describe HCV prevalence and cascade of care among patients in the decentralised OAT programme of the canton of St Gallen, Switzerland, and compare it to contemporaneous data from the centralised setting. METHODS: For each patient receiving his/her OAT from a GP or pharmacy on 1 April 2021, the cantonal medical office sent a questionnaire to the prescribing GP. Patient characteristics, HCV antibody (Ab)/RNA screening uptake, HCV Ab/RNA prevalence and HCV treatment uptake were obtained and compared to those of patients of the Medizinisch-soziale Hilfsstelle 1 in St Gallen (centralised setting). RESULTS: Of the 563 OAT patients under the care of 127 GPs, 107 patients from 41 GPs could be analysed (median age: 48 years [IQR: 40-56]; ongoing intravenous drug use: 25%; OAT provider: 66% GP, 34% pharmacy). HCV Ab screening uptake was 68% (73/107) with an HCV Ab prevalence of 68% (50/73) among those tested. Of the HCV Ab-positive patients, 84% (42/50) were HCV RNA-tested, among whom 57% (24/42) were viraemic. HCV treatment uptake was 83% (20/24), with 95% (19/20) achieving a sustained virological response. Non-uptake of HCV screening and treatment tended to be higher among patients receiving OAT at the pharmacy vs at the GP's office: 37% vs 26% (p = 0.245) for screening and 30% vs 7% (p = 0.139) for treatment. The proportion never HCV Ab-tested and the proportion of HCV Ab-positives never HCV RNA-tested was significantly higher in the decentralised compared to the centralised setting: 32% vs 3% (p <0.001) never Ab-tested and 16% vs 0% (p = 0.002) never RNA-tested. In contrast, HCV treatment uptake (83% vs 78%), sustained virological response rate (95% vs 100%) and residual HCV RNA prevalence among the HCV Ab-positive (12% vs 14%) were comparable for both settings. CONCLUSION: In the decentralised OAT setting of the canton of St Gallen, HCV Ab prevalence is high. Since HCV Ab and RNA screening uptake are markedly lower than in the centralised setting, potentially >40% of patients with chronic HCV are not diagnosed yet. HCV screening in the decentralised setting needs improvement, e.g. by increasing awareness and simplifying testing. High HCV treatment uptake and cure rates are possible in centralised and decentralised settings.


Subject(s)
Hepatitis C, Chronic , Hepatitis C , Substance Abuse, Intravenous , Humans , Male , Female , Middle Aged , Analgesics, Opioid/therapeutic use , Hepatitis C, Chronic/diagnosis , Hepatitis C, Chronic/drug therapy , Hepatitis C, Chronic/epidemiology , Cross-Sectional Studies , Switzerland/epidemiology , Prevalence , Antiviral Agents/therapeutic use , Hepatitis C/diagnosis , Hepatitis C/drug therapy , Hepatitis C/epidemiology , Hepacivirus/genetics , Substance Abuse, Intravenous/epidemiology , RNA
15.
Liver Int ; 44(6): 1383-1395, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38445848

ABSTRACT

BACKGROUND: Patients with chronic hepatitis C (CHC) can be cured with the new highly effective interferon-free combination treatments (DAA) that were approved in 2014. However, CHC is a largely silent disease, and many individuals are unaware of their infections until the late stages of the disease. The impact of wider access to effective treatments and improved awareness of the disease on the number of infections and the number of patients who remain undiagnosed is not known in Canada. Such evidence can guide the development of strategies and interventions to reduce the burden of CHC and meet World Health Organization's (WHO) 2030 elimination targets. The purpose of this study is to use a back-calculation framework informed by provincial population-level health administrative data to estimate the prevalence of CHC and the proportion of cases that remain undiagnosed in the three most populated provinces in Canada: British Columbia (BC), Ontario and Quebec. METHODS: We have conducted a population-based retrospective analysis of health administrative data for the three provinces to generate the annual incidence of newly diagnosed CHC cases, decompensated cirrhosis (DC), hepatocellular carcinoma (HCC) and HCV treatment initiations. For each province, the data were stratified in three birth cohorts: individuals born prior to 1945, individuals born between 1945 and 1965 and individuals born after 1965. We used a back-calculation modelling approach to estimate prevalence and the undiagnosed proportion of CHC. The historical prevalence of CHC was inferred through a calibration process based on a Bayesian Markov chain Monte Carlo (MCMC) algorithm. The algorithm constructs the historical prevalence of CHC for each cohort by comparing the model-generated outcomes of the annual incidence of the CHC-related health events against the data set of observed diagnosed cases generated in the retrospective analysis. RESULTS: The results show a decreasing trend in both CHC prevalence and undiagnosed proportion in BC, Ontario and Quebec. In 2018, CHC prevalence was estimated to be 1.23% (95% CI: .96%-1.62%), .91% (95% CI: .82%-1.04%) and .57% (95% CI: .51%-.64%) in BC, Ontario and Quebec respectively. The CHC undiagnosed proportion was assessed to be 35.44% (95% CI: 27.07%-45.83%), 34.28% (95% CI: 26.74%-41.62%) and 46.32% (95% CI: 37.85%-52.80%) in BC, Ontario and Quebec, respectively, in 2018. Also, since the introduction of new DAA treatment in 2014, CHC prevalence decreased from 1.39% to 1.23%, .97% to .91% and .65% to .57% in BC, Ontario and Quebec respectively. Similarly, the CHC undiagnosed proportion decreased from 38.78% to 35.44%, 38.70% to 34.28% and 47.54% to 46.32% in BC, Ontario and Quebec, respectively, from 2014 to 2018. CONCLUSIONS: We estimated that the CHC prevalence and undiagnosed proportion have declined for all three provinces since the new DAA treatment has been approved in 2014. Yet, our findings show that a significant proportion of HCV cases remain undiagnosed across all provinces highlighting the need to increase investment in screening. Our findings provide essential evidence to guide decisions about current and future HCV strategies and help achieve the WHO goal of eliminating hepatitis C in Canada by 2030.


Subject(s)
Antiviral Agents , Carcinoma, Hepatocellular , Hepatitis C, Chronic , Humans , Hepatitis C, Chronic/epidemiology , Hepatitis C, Chronic/drug therapy , Hepatitis C, Chronic/diagnosis , Antiviral Agents/therapeutic use , Prevalence , Male , Female , Retrospective Studies , Middle Aged , Carcinoma, Hepatocellular/epidemiology , Aged , Adult , Quebec/epidemiology , Ontario/epidemiology , Liver Neoplasms/epidemiology , British Columbia/epidemiology , Liver Cirrhosis/epidemiology , Incidence
16.
J Viral Hepat ; 31(6): 320-323, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38483043

ABSTRACT

Hepatitis C core antigen (HCVcAg) is becoming increasingly recognized as an alternative to molecular testing for the confirmation of chronic hepatitis C. However, there are limited data on the performance of this assay in a genotype 3 (GT3) predominant country like Pakistan. We conducted a study to evaluate the diagnostic performance of HCVcAg against the HCV polymerase chain reaction (PCR) molecular test. HCV antibody-positive patients requiring confirmatory testing were recruited from August to October 2018 at the Pakistan Kidney and Liver Institute and Research Center (PKLI&RC), Lahore, Pakistan. Patients with previously known diagnoses or treatment histories were excluded. The Abbott HCV Ag assay was used for HCVcAg testing. Results ≥3.00 fmol/L were considered positive for HCVcAg. The Abbott RealTime HCV assay was used for PCR testing with a lower detection limit of ≥12 IU/mL. We computed the sensitivity, specificity and correlation of HCVcAg against HCV PCR. A total of 394 patients were recruited. The median age of the patients was 42 years. Most participants were females (51.5%, n = 203), 30.7% (n = 121) had HTN, 10.4% DM (n = 41) and 5% had APRI ≥2. The overall sensitivity was 98.0% and the specificity was 98.6%. The lowest detection limit of cAg was an HCV RNA value of 4657 IU/mL. The levels of cAg were highly correlated with those of HCV RNA by Spearman's rank correlation test (r = 0.935, p < .001). HCVcAg represents a suitable alternative with high sensitivity and specificity compared with HCV PCR in the GT3-predominant population and can be incorporated into algorithms to improve linkage to care.


Subject(s)
Genotype , Hepacivirus , Hepatitis C Antigens , Hepatitis C, Chronic , Polymerase Chain Reaction , Sensitivity and Specificity , Viral Core Proteins , Humans , Female , Male , Pakistan , Hepacivirus/genetics , Hepacivirus/immunology , Adult , Middle Aged , Hepatitis C, Chronic/diagnosis , Hepatitis C, Chronic/virology , Viral Core Proteins/genetics , Viral Core Proteins/immunology , Hepatitis C Antigens/blood , Polymerase Chain Reaction/methods , Young Adult , Aged , RNA, Viral
17.
BMC Infect Dis ; 24(1): 362, 2024 Mar 29.
Article in English | MEDLINE | ID: mdl-38553731

ABSTRACT

This comprehensive retrospective data-linkage study aimed at evaluating the impact of Direct-Acting Antivirals (DAAs) on Hepatitis C Virus (HCV) testing, treatment trends, and access to care in Tuscany over six years following their introduction. Utilizing administrative healthcare records, our work reveals a substantial increase in HCV tests in 2017, attributed to the decision to provide universal access to treatment. However, despite efforts to eradicate chronic HCV through a government-led plan, the target of treating 6,221 patients annually was not met, and services contracted after 2018, exacerbated by the COVID-19 pandemic. Key findings indicate a higher prevalence of HCV screening among females in the 33-53 age group, influenced by pregnancy-related recommendations, while diagnostic tests and treatment uptake were more common among males. Problematic substance users constituted a significant proportion of those tested and treated, emphasizing their priority in HCV screening. Our paper underscores the need for decentralized HCV models and alternative testing strategies, such as point-of-care assays, especially in populations accessing harm reduction services, communities, and prisons. The study acknowledges limitations in relying solely on administrative records, advocating for improved data access and timely linkages to accurately monitor HCV care cascades and inform regional plans. Despite challenges, the paper demonstrates the value of administrative record linkages in understanding the access to care pathway for hard-to-reach populations. The findings emphasize the importance of the national HCV elimination strategy and the need for enhanced data collection to assess progress accurately, providing insights for future regional and national interventions.


Subject(s)
Hepatitis C, Chronic , Hepatitis C , Substance Abuse, Intravenous , Male , Pregnancy , Female , Humans , Hepacivirus , Hepatitis C, Chronic/diagnosis , Hepatitis C, Chronic/drug therapy , Hepatitis C, Chronic/epidemiology , Retrospective Studies , Antiviral Agents/therapeutic use , Pandemics , Hepatitis C/diagnosis , Hepatitis C/drug therapy , Hepatitis C/epidemiology , Substance Abuse, Intravenous/epidemiology
18.
Hepatology ; 80(2): 440-450, 2024 Aug 01.
Article in English | MEDLINE | ID: mdl-38478751

ABSTRACT

BACKGROUND AND AIMS: Despite the availability of highly effective direct-acting antiviral therapy, chronic hepatitis C (CHC) continues to cause a major public health burden. In many high-income countries, treatment rates have been declining, which was exacerbated by the impact of the COVID-19 pandemic, threatening the ability to meet the World Health Organization (WHO)'s targets for eliminating HCV as a public health threat by 2030. We sought to model the impact of CHC in Canada, a resource-rich country with ongoing immigration from HCV-endemic regions; which relies exclusively on risk-based screening for case identification. APPROACH AND RESULTS: We developed an agent-based model to characterize the HCV epidemic in a high-income country with ongoing immigration. Combinations of prevention such as harm reduction, screening, and treatment strategies were considered. Model parameters were estimated from the literature and calibrated against historical HCV data. Sensitivity analyses were performed to assess uncertainty. Under the current status quo of risk-based screening, we predict the incidence of CHC-induced decompensated cirrhosis, HCC, and liver-related deaths would decrease by 79.4%, 76.1%, and 62.1%, respectively, between 2015 and 2030, but CHC incidence would only decrease by 11.1%. The results were sensitive to HCV transmission rate and an annual number of people initiating treatment. CONCLUSIONS: Current risk-based screening, and subsequent treatment, will be inadequate to achieve WHO goals. With extensive scale-up in screening, and treatment, the mortality target may be achievable, but the target for preventing new CHC cases is unlikely reachable, highlighting the importance of developing enhanced harm-reduction strategies for HCV elimination.


Subject(s)
Antiviral Agents , Feasibility Studies , Hepatitis C, Chronic , Mass Screening , Humans , Mass Screening/methods , Antiviral Agents/therapeutic use , Canada/epidemiology , Hepatitis C, Chronic/diagnosis , Hepatitis C, Chronic/epidemiology , Hepatitis C, Chronic/drug therapy , Hepatitis C, Chronic/prevention & control , COVID-19/epidemiology , COVID-19/prevention & control , Developed Countries/statistics & numerical data , Disease Eradication/methods , Female , Male , Incidence , SARS-CoV-2 , Middle Aged , Adult
19.
J Viral Hepat ; 31(5): 240-247, 2024 May.
Article in English | MEDLINE | ID: mdl-38385850

ABSTRACT

Widespread screening for hepatitis C virus (HCV) is necessary for Canada to meet its HCV elimination goals by 2030. People who currently or previously injected drugs are at high risk for HCV. Opioid agonist therapy (OAT, such as methadone and buprenorphine) has been shown to help stabilize the lives of people who are opioid-dependent. The distribution of OAT in North America typically requires daily, weekly, or monthly clinic visits and presents an opportunity for engagement, screening and treatment for those at high-risk of HCV. In this study, HCV screening was conducted by staff at OAT clinics in Ontario from 2016 to 2020 and those with chronic infections were treated on-site with direct-acting antivirals. Point-of-care or dried blood spot (DBS) testing was used for antibodies, DBS or serum for HCV RNA and serum for HCV RNA at SVR12 (sustained virological response). Clinics screened 1954 people (mean age 40 years ±12, 63% male). Forty-five percent were antibody positive, of whom 64% were HCV RNA+. Eighty percent of those RNA+ set an appointment in which 99% attended. Ninety-six percent started treatment with 87% completing treatment. Sixty-eight percent of people who completed treatment submitted a sample for SVR12 testing of which 97% achieved a virological cure. Results suggest that HCV screening and treatment at OAT clinics is feasible, effective and warrants expansion. Data suggest strong treatment adherence due to high rates of SVR12 comparable with other OAT-based HCV treatment programs. The lack of SVR12 sampling could be addressed by either on-site phlebotomy or incentivizing SVR12 sampling.


Subject(s)
Hepatitis C, Chronic , Hepatitis C , Substance Abuse, Intravenous , Humans , Male , Adult , Female , Hepacivirus/genetics , Analgesics, Opioid/therapeutic use , Antiviral Agents , Ontario/epidemiology , Prevalence , Hepatitis C, Chronic/diagnosis , Hepatitis C, Chronic/drug therapy , Hepatitis C, Chronic/epidemiology , Hepatitis C/diagnosis , Hepatitis C/drug therapy , Hepatitis C/epidemiology , RNA , Substance Abuse, Intravenous/complications , Substance Abuse, Intravenous/epidemiology , Substance Abuse, Intravenous/drug therapy
20.
J Viral Hepat ; 31(4): 208-215, 2024 04.
Article in English | MEDLINE | ID: mdl-38326936

ABSTRACT

Hepatitis C virus (HCV) represents a formidable menace to human health, necessitating urgent attention. The objective of this study was to assess the efficacy and safety of HCV health management in the city of Guigang which consists of five districts, employing a comprehensive multi-modal approach. The study systematically carried out HCV screening in Guigang city which consists of five districts, such as Gangbei District, Gangnan District, Guiping District, Qintang District, and Pingnan District from 1 January 2016 to 30 December 2022. The target population consisted of individuals residing in these aforementioned districts, falling within the age range of 30-75 years. A multidisciplinary HCV management team was established to deliver anti-HCV screening, diagnosis, and direct-acting antiviral (DAA) therapy. The primary outcome of interest was the achievement of sustained virologic response (SVR). A total of 2489 individuals were included as the target population, with 1694 individuals residing in Gangbei District, 202 in Gangnan District, 111 in Qintang District, 167 in Pingnan District, and 315 in Guiping District. Out of these individuals, 2478 were subjected to anti-HCV screening. The screening rates varied across the districts, ranging from a peak of 99.55% in Guigang City to a nadir of 98.41% in Guiping District. Remarkably, within Guigang City, a noteworthy enhancement was observed in the HCV-RNA diagnosis rate from 23.4% prior to program implementation to a remarkable 100% following 7 years of intervention and management. Furthermore, the diagnosis and treatment coordination rate experienced a substantial improvement, rising from 26.8% before program inception to 80%. Importantly, a total of 1180 individuals affected by hepatitis C were successfully cured, equating to a 100% cure rate. Logistic regression analysis revealed a significant association between serological status and factors such as Aging, bilirubin, and glutamic oxalacetic transaminase. The findings from our investigation unveil a pioneering HCV management model, exemplified by the Guigang model, which has contributed crucially to HCV microclearance efforts and serves as an invaluable reference for future initiatives.


Subject(s)
Hepatitis C, Chronic , Hepatitis C , Telemedicine , Humans , Adult , Middle Aged , Aged , Hepatitis C, Chronic/diagnosis , Hepatitis C, Chronic/drug therapy , Hepatitis C, Chronic/epidemiology , Antiviral Agents/therapeutic use , Hepatitis C/diagnosis , Hepatitis C/drug therapy , Hepatitis C/epidemiology , Hepacivirus/genetics , Sustained Virologic Response
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