|
1
|
Chiu I, Cano D, Leathers M, Turner CM, Trujillo D, Sicro S, Arayasirikul S, Taylor KD, Wilson EC, McFarland W. HIV and hepatitis C virus infection and co-infection among trans women in San Francisco, 2020. PLoS One 2024; 19:e0307990. [PMID: 39312538 PMCID: PMC11419358 DOI: 10.1371/journal.pone.0307990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/11/2024] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND Transgender women (hereafter "trans women") face social marginalization, stigma, and discrimination and experience a high burden of HIV. More recently, trans women have been identified as having a high risk for hepatitis C (HCV) infection. The interaction between these two diseases and the risks for HIV/HCV co-infection among trans women are understudied. OBJECTIVE To characterize epidemiological, behavioral, and socio-structural interactions between HIV and HCV infections among trans women. METHODS This cross-sectional study examined data from a community-based survey of trans women in San Francisco recruited through respondent-driven sampling (RDS) in 2019/2020. Face-to-face interviews collected data on demographics, medical history, drug injection practices, sexual behavior, and socio-structural factors (e.g., poverty, housing insecurity, incarceration, social support). HIV and HCV antibodies were detected using oral fluid rapid tests and prior diagnosis and treatment were collected by self-report. Blood specimens were collected to confirm antibodies using ELISA. Multinomial logistic regression analysis characterized factors associated with HIV infection alone, HCV infection alone, and HIV/HCV co-infection compared to neither infection. RESULTS Among 201 trans women recruited, HIV prevalence was 42.3%; HCV infection by history or current seroprevalence was 28.9%; evidence for both HIV and HCV infection was present for 18.9%. Two-thirds of trans women (67.2%) had been incarcerated; 30.8% had ever injected drugs. History of injection drug use and receiving emotional support from family were factors found in common for HIV infection, HCV infection, and HIV/HCV co-infection compared to no infection. Having a sexual partner who injects drugs was associated with HIV infection alone. Not lacking care due to cost and older age were associated with co-infection. Older age was also associated with HCV infection. Of trans women with HIV infection, 91.8% had accessed HIV care, whereas only 62% with HCV had accessed some form of care. CONCLUSIONS Our study found high levels of HIV, HCV, and HIV/HCV co-infection among trans women in San Francisco. We found common associations between HIV and HCV through injection practices and emotional support, but having a sexual partner who injects drugs was not associated with HCV infection alone or co-infection. We note a substantial gap in the treatment of HCV for trans women, including those in HIV care, that needs to be urgently addressed.
Collapse
Affiliation(s)
- Izzy Chiu
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States of America
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, United States of America
| | - Damiana Cano
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, United States of America
- University of California Berkeley, Berkeley, CA, United States of America
| | - Matisse Leathers
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, United States of America
- University of California Berkeley, Berkeley, CA, United States of America
| | - Caitlin M. Turner
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
| | - Dillon Trujillo
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Sofia Sicro
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, United States of America
| | - Sean Arayasirikul
- Department of Health, Society, & Behavior, University of California, Irvine, Irvine, CA, United States of America
| | - Kelly D. Taylor
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
| | - Erin C. Wilson
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, United States of America
| | - Willi McFarland
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
| |
Collapse
|
|
2
|
Cambianica A, Marchese V, Pennati F, Faustinelli A, Migliorati M, Roda F, Spinetti A, Zaltron S, Fiorentini S, Caruso A, Quiros-Roldan E, Castelli F, Focà E. Chronic Hepatitis C Cascade of Care in Prisoners-Is There Still Some Work to Do? Analysis of Two Large Penitentiaries in Northern Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:104. [PMID: 38248566 PMCID: PMC10815604 DOI: 10.3390/ijerph21010104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 01/23/2024]
Abstract
Penitentiaries have a higher burden of communicable diseases compared to the general population. Prisoners should be tested for hepatitis C virus (HCV) and have direct access to treatment. We analysed the HCV cascade of care in two penitentiaries in Brescia, Northern Italy. At admission, prisoners are offered a voluntary screening for HCV, while patients with known infections are tested with an HCVRNA measurement. We performed an observational retrospective study including all the subjects admitted to the penitentiaries from 1 January 2015 to 31 October 2021. We conducted a descriptive analysis. During the study period, 5378 admissions were registered, and 2932 (54.5%) screenings were performed. Hepatitis C virus antibody positivity was found in 269 tests (9.2%). Hepatitis C virus RNA was detectable in 169 people. During the study period, 77 treatments with direct-acting antivirals (DAAs) were administered. Follow-up was available in 45 patients, and sustained virological response (SVR) was documented in 44 of them. Retention in care occurred in less than half of the prisoners after release. Our data demonstrate poor screening adherence that could benefit from educational programs. Treatment rates could be improved with test-and-treat programs. More efforts are needed to eliminate HCV as a public threat by 2030. Dedicated local networks, including infectious diseases (ID) departments, substance abuse services and prisons, could mitigate these issues.
Collapse
Affiliation(s)
- Anna Cambianica
- Department of Clinical and Experimental Sciences, Section of Infectious and Tropical Diseases, University of Brescia, 25123 Brescia, Italy; (F.P.); (A.F.); (M.M.); (E.Q.-R.); (F.C.); (E.F.)
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Hospital, 25123 Brescia, Italy; (V.M.); (A.S.); (S.Z.)
| | - Valentina Marchese
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Hospital, 25123 Brescia, Italy; (V.M.); (A.S.); (S.Z.)
| | - Francesca Pennati
- Department of Clinical and Experimental Sciences, Section of Infectious and Tropical Diseases, University of Brescia, 25123 Brescia, Italy; (F.P.); (A.F.); (M.M.); (E.Q.-R.); (F.C.); (E.F.)
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Hospital, 25123 Brescia, Italy; (V.M.); (A.S.); (S.Z.)
| | - Alessandro Faustinelli
- Department of Clinical and Experimental Sciences, Section of Infectious and Tropical Diseases, University of Brescia, 25123 Brescia, Italy; (F.P.); (A.F.); (M.M.); (E.Q.-R.); (F.C.); (E.F.)
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Hospital, 25123 Brescia, Italy; (V.M.); (A.S.); (S.Z.)
| | - Manuela Migliorati
- Department of Clinical and Experimental Sciences, Section of Infectious and Tropical Diseases, University of Brescia, 25123 Brescia, Italy; (F.P.); (A.F.); (M.M.); (E.Q.-R.); (F.C.); (E.F.)
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Hospital, 25123 Brescia, Italy; (V.M.); (A.S.); (S.Z.)
| | - Fabio Roda
- Unit of Prison Health, ASST Spedali Civili Hospital, 25123 Brescia, Italy;
| | - Angiola Spinetti
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Hospital, 25123 Brescia, Italy; (V.M.); (A.S.); (S.Z.)
| | - Serena Zaltron
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Hospital, 25123 Brescia, Italy; (V.M.); (A.S.); (S.Z.)
| | - Simona Fiorentini
- Unit of Microbiology and Virology, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy; (S.F.); (A.C.)
| | - Arnaldo Caruso
- Unit of Microbiology and Virology, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy; (S.F.); (A.C.)
| | - Eugenia Quiros-Roldan
- Department of Clinical and Experimental Sciences, Section of Infectious and Tropical Diseases, University of Brescia, 25123 Brescia, Italy; (F.P.); (A.F.); (M.M.); (E.Q.-R.); (F.C.); (E.F.)
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Hospital, 25123 Brescia, Italy; (V.M.); (A.S.); (S.Z.)
| | - Francesco Castelli
- Department of Clinical and Experimental Sciences, Section of Infectious and Tropical Diseases, University of Brescia, 25123 Brescia, Italy; (F.P.); (A.F.); (M.M.); (E.Q.-R.); (F.C.); (E.F.)
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Hospital, 25123 Brescia, Italy; (V.M.); (A.S.); (S.Z.)
| | - Emanuele Focà
- Department of Clinical and Experimental Sciences, Section of Infectious and Tropical Diseases, University of Brescia, 25123 Brescia, Italy; (F.P.); (A.F.); (M.M.); (E.Q.-R.); (F.C.); (E.F.)
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Hospital, 25123 Brescia, Italy; (V.M.); (A.S.); (S.Z.)
| |
Collapse
|
|
3
|
Halford R, Christensen L, Cox S, Sheehan J, Brew I, Gillyon‐Powell M, Threadgold G, O'Moore É, Troke PJF, Jones A. Chronic hepatitis C elimination prison initiative: HCV-intensive test and treat, a whole prisoner population HCV test-and-treat program in England. Health Sci Rep 2023; 6:e1724. [PMID: 38125280 PMCID: PMC10730947 DOI: 10.1002/hsr2.1724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 10/11/2023] [Accepted: 11/03/2023] [Indexed: 12/23/2023] Open
Abstract
Background and Aim Prison residents are at high risk for hepatitis C virus (HCV) infection. HCV test-and-treat initiatives within prisons provide an opportunity to engage with prison residents and achieve HCV micro-elimination. The aim of the prison HCV-intensive test and treat initiative was to screen over 95% of all prison residents for HCV infection within a defined number of days determined by the size of the prison population and to initiate treatment within 7-14 days of a positive HCV RNA diagnosis. Methods An HCV-intensive test and treat toolkit was developed based on learnings from pilot HCV-intensive test and treat events. From January 2020 to September 2021, 13 HCV-intensive test and treat events took place at prisons in England selected based on high levels of reception blood-borne virus testing and good access to peers from The Hepatitis C Trust. Results Among a total of 8487 residents, 8139 (95.9%) underwent testing for HCV. Across the 13 prisons included, HCV antibody and RNA prevalence was 8.2% and 1.5%, respectively. The treatment initiation rate among HCV RNA-positive individuals (n = 124) was 79.0%. Conclusion The HCV-intensive test and treat initiative presented here provides a feasible and rapid test-and-treat process to achieve HCV elimination within individual prisons. The HCV-intensive test and treat toolkit can be adapted for rapid HCV testing and treatment events at other prisons in the United Kingdom and worldwide.
Collapse
|
|
4
|
Hosseini-Hooshyar S, Hajarizadeh B, Bajis S, Law M, Janjua NZ, Fierer DS, Chromy D, Rockstroh JK, Martin TCS, Ingiliz P, Hung CC, Dore GJ, Martinello M, Matthews GV. Risk of hepatitis C reinfection following successful therapy among people living with HIV: a global systematic review, meta-analysis, and meta-regression. THE LANCET HIV 2022; 9:e414-e427. [DOI: 10.1016/s2352-3018(22)00077-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/21/2022] [Accepted: 03/14/2022] [Indexed: 12/17/2022]
|
|
5
|
Cheng CY, Ku SY, Lin YC, Chen CP, Cheng SH, Lin IF. Incidence and Risk Factors of Reinfection with HCV after Treatment in People Living with HIV. Viruses 2022; 14:v14020439. [PMID: 35216032 PMCID: PMC8874599 DOI: 10.3390/v14020439] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/08/2022] [Accepted: 02/17/2022] [Indexed: 02/04/2023] Open
Abstract
Infection with hepatitis C virus (HCV) does not induce protective immunity, and re-exposure to HCV can reinfect the population engaging in high-risk behavior. An increasing incidence of acute hepatitis C infection in people living with HIV (PLWH) has been described in recent years. This retrospective cohort study was conducted in PLWH who completed HCV therapy between June 2009 and June 2020 at an HIV care hospital, to analyze their basic characteristics and risky behavior. Of 2419 patients, 639 were diagnosed with HCV infection and 516 completed the HCV therapy with a sustained virologic response. In total, 59 patients (11.4%) were reinfected with acute hepatitis C, and the median time to reinfection was 85.3 weeks (IQR: 57–150). The incidence of reinfection was 6.7 cases/100 person-years. The factors associated with reinfection were being male (AHR, 8.02; 95% CI 1.08–59.49), DAA (direct-acting antiviral) treatment (AHR, 2.23; 95% CI 1.04–4.79), liver cirrhosis (AHR, 3.94; 95% CI 1.09–14.22), heroin dependency (AHR: 7.41; 95% CI 3.37–14.3), and HIV viral loads <50 copies/mL at the follow-up (AHR: 0.47, 95% CI 0.24–0.93) in the subgroup of people who inject drugs (PWID). Amphetamine abuse (AHR: 20.17; 95% CI 2.36–172.52) was the dominant factor in the subgroup of men who have sex with men (MSM). Our study suggests that education and behavioral interventions are needed in this population to prevent reinfection.
Collapse
Affiliation(s)
- Chien-Yu Cheng
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan City 330, Taiwan; (C.-Y.C.); (Y.-C.L.); (C.-P.C.); (S.-H.C.)
- Institute of Public Health, School of Medicine, National Yang-Ming Chiao Tung University, Taipei City 112, Taiwan
| | - Shin-Yen Ku
- Department of Nursing, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan City 330, Taiwan;
| | - Yi-Chun Lin
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan City 330, Taiwan; (C.-Y.C.); (Y.-C.L.); (C.-P.C.); (S.-H.C.)
| | - Cheng-Pin Chen
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan City 330, Taiwan; (C.-Y.C.); (Y.-C.L.); (C.-P.C.); (S.-H.C.)
- School of Clinical Medicine, National Yang-Ming Chiao Tung University, Taipei City 112, Taiwan
| | - Shu-Hsing Cheng
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan City 330, Taiwan; (C.-Y.C.); (Y.-C.L.); (C.-P.C.); (S.-H.C.)
- School of Public Health, Taipei Medical University, Taipei City 110, Taiwan
| | - I-Feng Lin
- Institute of Public Health, School of Medicine, National Yang-Ming Chiao Tung University, Taipei City 112, Taiwan
- Correspondence:
| |
Collapse
|
|
6
|
Liu CH, Peng CY, Kao WY, Yang SS, Shih YL, Lin CL, Tsai MK, Lee CY, Chang CC, Wu JH, Liu CJ, Su TH, Tseng TC, Chen PJ, Kao JH. Hepatitis C virus reinfection in patients on haemodialysis after achieving sustained virologic response with antiviral treatment. Aliment Pharmacol Ther 2022; 55:434-445. [PMID: 34773272 DOI: 10.1111/apt.16697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/12/2021] [Accepted: 10/29/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Data are limited regarding the risk of hepatitis C virus (HCV) reinfection after treatment-induced sustained virologic response (SVR) in patients on haemodialysis. AIMS To assess the risk of HCV reinfection among patients on haemodialysis with treatment-induced SVR. METHODS Patients on haemodialysis patients who achieved SVR12 with interferon (IFN) or direct-acting antiviral (DAA)-based treatment received follow-up at SVR24 and then biannually with HCV RNA measurements. HCV reinfection was defined as the resurgence of viremia by different viral strains beyond SVR12 . The low-risk general population who achieved SVR12 and who underwent the same post-SVR12 surveillance served as the reference group. Crude reinfection rates per 100 person-years (PYs) were calculated. Multivariate Cox regression analysis was performed to estimate the relative risk of HCV reinfection between the two groups. RESULTS We recruited 374 patients on haemodialysis and 1571 reference patients with a mean post-SVR12 follow-up of 4.7 and 6.1 years. All haemodialysis patients who achieved SVR12 also achieved SVR24 . The incidence rates of HCV reinfection were 0.23 per 100 PYs (95% confidence interval [CI]: 0.09-0.59) in haemodialysis patients and 0.16 per 100 PYs (95% CI: 0.10-0.26) in the reference group. The risk of HCV reinfection in patients on haemodialysis was comparable to that in the reference patients (hazard ratio [HR]: 1.39; 95% CI: 0.44-4.38, P = 0.57). CONCLUSIONS The risk of HCV reinfection in patients on haemodialysis who achieve SVR12 is low and comparable to that in the low-risk general population. HCV microelimination in this special population is feasible once universal screening and scaled-up treatment are implemented.
Collapse
|
|
7
|
Cuesta-Sancho S, Márquez-Coello M, Illanes-Álvarez F, Márquez-Ruiz D, Arizcorreta A, Galán-Sánchez F, Montiel N, Rodriguez-Iglesias M, Girón-González JA. Hepatitis C: Problems to extinction and residual hepatic and extrahepatic lesions after sustained virological response. World J Hepatol 2022; 14:62-79. [PMID: 35126840 PMCID: PMC8790402 DOI: 10.4254/wjh.v14.i1.62] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 08/02/2021] [Accepted: 12/10/2021] [Indexed: 02/06/2023] Open
Abstract
Loss of follow-up or reinfections hinder the expectations of hepatitis C eradication despite the existence of highly effective treatments. Moreover, the elimination of the infection does not imply the reversion of those chronic alterations derived from the previous infection by hepatitis C virus (HCV). This review analyzes the risk factors associated with loss to follow-up in diagnosis or treatment, and the possibility of reinfection. Likewise, it assesses the residual alterations induced by chronic HCV infection considering the liver alterations (inflammation, fibrosis, risk of decompensation, hepatocellular carcinoma, liver transplantation) and, on the other hand, the comorbidities and extrahepatic manifestations (cryoglobulinemia, non-Hodgkin lymphoma, peripheral insulin resistance, and lipid, bone and cognitive alterations). Peculiarities present in subjects coinfected with human immunodeficiency virus are analyzed in each section.
Collapse
Affiliation(s)
- Sara Cuesta-Sancho
- Medicina Interna, Hospital Universitario Puerta del Mar, Facultad de Medicina, Universidad de Cádiz, Instituto para la Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Cádiz 11009, Spain
| | - Mercedes Márquez-Coello
- Medicina Interna, Hospital Universitario Puerta del Mar, Facultad de Medicina, Universidad de Cádiz, Instituto para la Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Cádiz 11009, Spain
| | - Francisco Illanes-Álvarez
- Medicina Interna, Hospital Universitario Puerta del Mar, Facultad de Medicina, Universidad de Cádiz, Instituto para la Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Cádiz 11009, Spain
| | - Denisse Márquez-Ruiz
- Medicina Interna, Hospital Universitario Puerta del Mar, Facultad de Medicina, Universidad de Cádiz, Instituto para la Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Cádiz 11009, Spain
| | - Ana Arizcorreta
- Medicina Interna, Hospital Universitario Puerta del Mar, Facultad de Medicina, Universidad de Cádiz, Instituto para la Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Cádiz 11009, Spain
| | - Fátima Galán-Sánchez
- Microbiología, Hospital Universitario Puerta del Mar, Facultad de Medicina, Universidad de Cádiz, Instituto para la Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Cádiz 11009, Spain
| | - Natalia Montiel
- Microbiología, Hospital Universitario Puerta del Mar, Facultad de Medicina, Universidad de Cádiz, Instituto para la Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Cádiz 11009, Spain
| | - Manuel Rodriguez-Iglesias
- Microbiología, Hospital Universitario Puerta del Mar, Facultad de Medicina, Universidad de Cádiz, Instituto para la Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Cádiz 11009, Spain
| | - José-Antonio Girón-González
- Medicina Interna, Hospital Universitario Puerta del Mar, Facultad de Medicina, Universidad de Cádiz, Instituto para la Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Cádiz 11009, Spain
| |
Collapse
|
|
8
|
Rife KM, Lea EJ, Hirsch AA, Falck-Ytter Y. Treating Hepatitis C Virus Reinfection With 8 Weeks of Ledipasvir/Sofosbuvir Achieves Sustained Virologic Response. Fed Pract 2021; 38:282-285. [PMID: 34733076 DOI: 10.12788/fp.0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Three patients reinfected with hepatitis C virus after a sustained virologic response were considered treatment naïve and treated with a short-course direct acting antiviral regimen.
Collapse
Affiliation(s)
- Kelsey M Rife
- is a Hepatology Clinical Pharmacy Specialist, is an Infectious Diseases Clinical Pharmacist, is the Chief of the Gastroenterology and Hepatology Section, and is a Behavioral Health Psychologist, all at US Department of Veterans Affairs Northeast Ohio Healthcare System in Cleveland. Yngve Falck-Ytter is a Professor of Medicine, Erin Lea is an Adjunct Assistant Professor in the Department of Psychological Sciences, and Amy Hirsch is a Senior Clinical Instructor in the College of Medicine, all at Case Western Reserve University. Yngve Falck-Ytter is Faculty for the Gastroenterology Fellowship Program at University Hospitals
| | - Erin J Lea
- is a Hepatology Clinical Pharmacy Specialist, is an Infectious Diseases Clinical Pharmacist, is the Chief of the Gastroenterology and Hepatology Section, and is a Behavioral Health Psychologist, all at US Department of Veterans Affairs Northeast Ohio Healthcare System in Cleveland. Yngve Falck-Ytter is a Professor of Medicine, Erin Lea is an Adjunct Assistant Professor in the Department of Psychological Sciences, and Amy Hirsch is a Senior Clinical Instructor in the College of Medicine, all at Case Western Reserve University. Yngve Falck-Ytter is Faculty for the Gastroenterology Fellowship Program at University Hospitals
| | - Amy A Hirsch
- is a Hepatology Clinical Pharmacy Specialist, is an Infectious Diseases Clinical Pharmacist, is the Chief of the Gastroenterology and Hepatology Section, and is a Behavioral Health Psychologist, all at US Department of Veterans Affairs Northeast Ohio Healthcare System in Cleveland. Yngve Falck-Ytter is a Professor of Medicine, Erin Lea is an Adjunct Assistant Professor in the Department of Psychological Sciences, and Amy Hirsch is a Senior Clinical Instructor in the College of Medicine, all at Case Western Reserve University. Yngve Falck-Ytter is Faculty for the Gastroenterology Fellowship Program at University Hospitals
| | - Yngve Falck-Ytter
- is a Hepatology Clinical Pharmacy Specialist, is an Infectious Diseases Clinical Pharmacist, is the Chief of the Gastroenterology and Hepatology Section, and is a Behavioral Health Psychologist, all at US Department of Veterans Affairs Northeast Ohio Healthcare System in Cleveland. Yngve Falck-Ytter is a Professor of Medicine, Erin Lea is an Adjunct Assistant Professor in the Department of Psychological Sciences, and Amy Hirsch is a Senior Clinical Instructor in the College of Medicine, all at Case Western Reserve University. Yngve Falck-Ytter is Faculty for the Gastroenterology Fellowship Program at University Hospitals
| |
Collapse
|
|
9
|
McNamara KF, Biondi BE, Hernández-Ramírez RU, Taweh N, Grimshaw AA, Springer SA. A Systematic Review and Meta-Analysis of Studies Evaluating the Effect of Medication Treatment for Opioid Use Disorder on Infectious Disease Outcomes. Open Forum Infect Dis 2021; 8:ofab289. [PMID: 34430670 PMCID: PMC8378589 DOI: 10.1093/ofid/ofab289] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/30/2021] [Indexed: 11/12/2022] Open
Abstract
The opioid epidemic has fueled infectious disease epidemics. We determined the impact of medications for opioid use disorder (MOUD) on treatment outcomes of opioid use disorder (OUD)-associated infectious diseases: antiretroviral therapy (ART) adherence, human immunodeficiency virus (HIV) viral suppression, hepatitis C virus (HCV) sustained virologic response, HCV reinfection, new hepatitis B virus infections, and infectious endocarditis-related outcomes. Manuscripts reporting on these infectious disease outcomes in adults with OUD receiving MOUD compared with those with OUD "not" receiving MOUD were included. Initial search yielded 8169 papers; 9 were included in the final review. The meta-analysis revealed that MOUD was associated with greater ART adherence (odds ratio [OR] = 1.55; 95% confidence interval [CI] = 1.12-2.15) and HIV viral suppression (OR = 2.19; 95% CI = 1.88-2.56). One study suggested a positive association between MOUD and HCV sustained virologic response. There is significant support for integrating MOUD with HIV treatment to improve viral suppression among persons with HIV (PWH) and OUD. Treatment of OUD among PWH should be a priority to combat the opioid and HIV epidemics.
Collapse
Affiliation(s)
- Katelyn F McNamara
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Breanne E Biondi
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Raúl U Hernández-Ramírez
- Center for Methods in Implementation and Prevention Science, Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA.,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut, USA
| | - Noor Taweh
- Yale AIDS Program, Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, USA.,University of Connecticut, Storrs, Connecticut, USA
| | - Alyssa A Grimshaw
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, Connecticut, USA
| | - Sandra A Springer
- Yale AIDS Program, Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, USA.,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut, USA
| |
Collapse
|
|
10
|
Crowley D, Avramovic G, Cullen W, Farrell C, Halpin A, Keevans M, Laird E, McHugh T, McKiernan S, Miggin SJ, Murtagh R, Connor EO, O'Meara M, Reilly DO, Lambert JS. New hepatitis C virus infection, re-infection and associated risk behaviour in male Irish prisoners: a cohort study, 2019. ACTA ACUST UNITED AC 2021; 79:97. [PMID: 34103080 PMCID: PMC8186141 DOI: 10.1186/s13690-021-00623-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/30/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prisoners are recognised as a high-risk population and prisons as high-risk locations for the transmission of hepatitis c virus (HCV) infection. Injecting drug use (IDU) is the main driver of HCV infection in prisoners and harm reduction services are often suboptimal in prison settings. HCV prevalence and incident data in prisoners is incomplete which impacts the public health opportunity that incarceration provides in identifying, treating and preventing HCV infection. The aim of this study is to identify new HCV infection and associated risk factors in an Irish male prison. METHODS We conducted a follow up (18-month) cohort study on prisoners who had previously tested negative, self-cleared or had been successfully treated for HCV infection. We conducted the study in a male medium security prison located in Dublin Ireland (Mountjoy Prison) using HCV serology, a review of medical records and a researcher-administered questionnaire. RESULTS 99 prisoners with a mean age of 33.2 yrs. participated in the study and 82(82.8%) completed a research-administered questionnaire. Over half (51%) had a history of drug use from a young age (14.8 yrs.), 49.9% a history of heroin use and 39% a history of IDU. The prevalence of HIV and hepatitis B virus core antibody was 3% and HCV antibody was 22.2%. No new HCV infections were identified in those who had never been infected (n = 77), had self-cleared (n = 9) or achieved sustained virological response (n = 12). Small numbers of prisoners continued to engage in risk-behaviour including, IDU both in the prison (n = 2) and the community (n = 3), sharing syringes (n = 1) and drug taking paraphernalia (n = 6) and receiving non-sterile tattoos (n = 3). CONCLUSION Despite the high numbers of Irish prisoners with a history of IDU and HCV infection, new HCV infection is low or non-existent in this population. Small numbers of prisoners continue to engage in risk behaviour and larger studies are required to further understand HCV transmission in this cohort in an Irish and international context.
Collapse
Affiliation(s)
- Des Crowley
- School of Medicine, University College Dublin, Dublin, Ireland. .,Irish Prison Service, Dublin, Ireland.
| | | | - Walter Cullen
- School of Medicine, University College Dublin, Dublin, Ireland
| | | | | | | | | | - Tina McHugh
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | | | - Ross Murtagh
- School of Medicine, University College Dublin, Dublin, Ireland
| | | | | | | | - John S Lambert
- School of Medicine, University College Dublin, Dublin, Ireland.,Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
| |
Collapse
|
|
11
|
Kwon JA, Chambers GM, Luciani F, Zhang L, Kinathil S, Kim D, Thein HH, Botha W, Thompson S, Lloyd A, Yap L, Gray RT, Butler T. Hepatitis C treatment strategies in prisons: A cost-effectiveness analysis. PLoS One 2021; 16:e0245896. [PMID: 33571196 PMCID: PMC7877645 DOI: 10.1371/journal.pone.0245896] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/08/2021] [Indexed: 02/07/2023] Open
Abstract
In Australian prisons approximately 20% of inmates are chronically infected with hepatitis C virus (HCV), providing an important population for targeted treatment and prevention. A dynamic mathematical model of HCV transmission was used to assess the impact of increasing direct-acting antiviral (DAA) treatment uptake on HCV incidence and prevalence in the prisons in New South Wales, Australia, and to assess the cost-effectiveness of alternate treatment strategies. We developed four separate models reflecting different average prison lengths of stay (LOS) of 2, 6, 24, and 36 months. Each model considered four DAA treatment coverage scenarios of 10% (status-quo), 25%, 50%, and 90% over 2016–2045. For each model and scenario, we estimated the lifetime burden of disease, costs and changes in quality-adjusted life years (QALYs) in prison and in the community during 2016–2075. Costs and QALYs were discounted 3.5% annually and adjusted to 2015 Australian dollars. Compared to treating 10% of infected prisoners, increasing DAA coverage to 25%, 50%, and 90% reduced HCV incidence in prisons by 9–33% (2-months LOS), 26–65% (6-months LOS), 37–70% (24-months LOS), and 35–65% (36-months LOS). DAA treatment was highly cost-effective among all LOS models at conservative willingness-to-pay thresholds. DAA therapy became increasingly cost-effective with increasing coverage. Compared to 10% treatment coverage, the incremental cost per QALY ranged from $497-$569 (2-months LOS), -$280–$323 (6-months LOS), -$432–$426 (24-months LOS), and -$245–$477 (36-months LOS). Treating more than 25% of HCV-infected prisoners with DAA therapy is highly cost-effective. This study shows that treating HCV-infected prisoners is highly cost-effective and should be a government priority for the global HCV elimination effort.
Collapse
Affiliation(s)
- Jisoo A. Kwon
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Georgina M. Chambers
- National Perinatal Epidemiology and Statistics Unit (NPESU), Centre for Big Data Research in Health and School of Women’s and Children’s Health, UNSW Sydney, Sydney, NSW, Australia
- * E-mail:
| | - Fabio Luciani
- School of Medical Sciences, Faculty of Medicine, UNSW, Sydney, NSW, Australia
| | - Lei Zhang
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
- The Melbourne Sexual Health Centre, Alfred Health, Carlton, Melbourne, VIC, Australia
| | | | - Dennis Kim
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Hla-Hla Thein
- Toronto Health Economics and Technology Assessment Collaborative (THETA), Toronto General Hospital Research Institute, University of Toronto and University Health Network, Toronto, ON, Canada
| | - Willings Botha
- RTI Health Solutions, Research Triangle Park, NC, United States of America
| | - Sandra Thompson
- Combined Universities of Rural Health, Geraldton, WA, Australia
| | - Andrew Lloyd
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Lorraine Yap
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | - Tony Butler
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| |
Collapse
|
|
12
|
Mendizabal M, Testa P, Rojas M, Colaci CS, Elías S, Nicolini P, Olguín S, Dunn C, Ronchi C, Barreiro M, Zirpoli M, Piñero F, Arora S, O Flaherty M, Rubinstein F, Silva MO. Pilot study using the ECHO model to enhance linkage to care for patients with hepatitis C in the custodial setting. J Viral Hepat 2020; 27:1430-1436. [PMID: 32813904 DOI: 10.1111/jvh.13374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 12/14/2022]
Abstract
Prisoners in most countries have a higher prevalence of HCV than the general population, but their access to treatment is very limited. Our aim was to evaluate a pilot programme using the ECHO model to enhance linkage to care in patients with HCV in 3 Argentinean prisons between October 2018 and January 2020. All inmates were invited to participate, and data were collected through a personal interview. We then estimated HCV prevalence with dried blood spot and performed a logistic regression analysis to identify risk behaviours associated with HCV infection. Finally, HCV management was assessed and monitored through ECHO. Overall, 1141 inmates agreed to participate, representing 39.7% of the total prison population. Anti-HCV prevalence was estimated at 1.58% (CI 0.93; 2.48), being significantly higher in women 2.98% (CI 1.4;5.6) than in men 1.07% (CI 0.5; 2.0); P = .03. Patients with anti-HCV were significantly older than those who tested negative, 42.3 years (CI 37.6;47.1) vs 30.1 years (CI 30.6;31.2), P < .001, respectively. Multiple logistic regression analysis, identified age OR 1.07 (CI 1.03;1.12, P = .001), history of sexually transmitted disease OR 3.08 (CI 0.97;9.82, P = .057) and intravenous drug use OR 12.6 (CI 3.31;48.53, P < .001) as risk factors associated with anti-HCV. Treatment was initiated in all the patients with specialist physician support utilizing ECHO model. In conclusion, our pilot study reported a low prevalence of anti-HCV in the studied population. Incarceration provides an ideal opportunity for testing and treating HCV. ECHO model arises as a useful tool to support assessment and treatment for inmates with chronic HCV.
Collapse
Affiliation(s)
- Manuel Mendizabal
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina
| | - Pablo Testa
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina
| | - Mercedes Rojas
- Virology laboratory, Hospital Universitario Austral, Pilar, Argentina
| | - Carla S Colaci
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina
| | - Solana Elías
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina
| | - Paula Nicolini
- Servicio Penitenciario Bonaerense, Buenos Aires, Argentina
| | - Soledad Olguín
- Servicio Penitenciario Bonaerense, Buenos Aires, Argentina
| | | | | | - Mariano Barreiro
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina
| | - Mercedes Zirpoli
- Virology laboratory, Hospital Universitario Austral, Pilar, Argentina
| | - Federico Piñero
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina
| | - Sanjeev Arora
- Department of Internal Medicine, University of New Mexico, NM, USA
| | - Martín O Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | | | - Marcelo O Silva
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina
| |
Collapse
|
|
13
|
Seval N, Wurcel A, Gunderson CG, Grimshaw A, Springer SA. The Impact of Medications for Opioid Use Disorder on Hepatitis C Incidence Among Incarcerated Persons: A Systematic Review. Infect Dis Clin North Am 2020; 34:559-584. [PMID: 32782102 PMCID: PMC7437982 DOI: 10.1016/j.idc.2020.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Hepatitis C virus (HCV) is highly prevalent in the criminal justice system and in persons who inject drugs, particularly opioids. Data on the impact of medications for opioid use disorder (MOUD) are abundant for infectious and noninfectious outcomes but are limited for justice-involved settings. This systematic review and meta-analysis focuses on the impact of MOUD on HCV incidence for persons in prisons and jails. Six studies were included in the qualitative synthesis, of which four were included for meta-analysis. A varied MOUD effect on HCV incidence was observed in part due to wide variability in prison and jail risk environments.
Collapse
Affiliation(s)
- Nikhil Seval
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA.
| | - Alysse Wurcel
- Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA
| | - Craig G Gunderson
- Department of Internal Medicine, Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA; Veterans Affairs Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA
| | - Alyssa Grimshaw
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, 333 Cedar Street, New Haven, CT 06510, USA
| | - Sandra A Springer
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA; Veterans Affairs Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA; Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, 135 College Street, Suite 200, New Haven, CT 06510, USA
| |
Collapse
|
|
14
|
Low hepatitis C virus reinfection rate despite ongoing risk following universal access to direct-acting antiviral therapy among people living with HIV. AIDS 2020; 34:1347-1358. [PMID: 32590433 DOI: 10.1097/qad.0000000000002562] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE(S) To evaluate changes in injecting and sexual risk behaviours, and hepatitis C virus (HCV) reinfection incidence among people with HIV/HCV coinfection following unrestricted access to direct-acting antiviral therapy in Australia. DESIGN Prospective observational cohort study (2014-2018). METHODS Among people enrolled in the Control and Elimination of HCV from HIV-infected individuals within Australia study, changes in injecting and sexual behaviour were evaluated, including injecting drug use (IDU) in the last 6 months and last month, frequency of IDU and equipment sharing, condom-less anal intercourse with casual male partner(s), and group sex. HCV reinfection incidence was evaluated with follow-up through May 2018. RESULTS Overall, 272 HIV/HCV antibody-positive participants [median age; 50 years, 96% male, 83% identified as gay and bisexual men (GBM)] had behavioural data at enrolment and follow-up (median 2.91 years) available for analysis. The proportion reporting IDU in the last 6 months remained stable from enrolment (35%) to follow-up (39%). Among GBM, the proportion reporting condom-less anal intercourse with casual partner(s) at enrolment (48%) and follow-up (46%) was also similar. Reinfection was detected in five individuals (all GBM) during total follow-up of 474 person-years for an overall incidence of 1.05 per 100 person-years (95% confidence interval, 0.44-2.53). CONCLUSION No change was observed in levels of injecting or sexual risk behaviour for HCV infection following unrestricted access to direct-acting antiviral therapy in an Australian HIV/HCV cohort. Incidence of HCV reinfection was low potentially reflecting high levels of treatment coverage within this population. Continued screening and rapid retreatment of reinfection will be required to maintain progress towards elimination.
Collapse
|
|
15
|
Crowley D, Lambert JS, Betts-Symonds G, Cullen W, Keevans M, Kelly E, Laird E, McHugh T, McKiernan S, Miggin SJ, Murphy C, Murtagh R, O'Reilly D, Tobin C, Van Hout MC. The seroprevalence of untreated chronic hepatitis C virus (HCV) infection and associated risk factors in male Irish prisoners: a cross-sectional study, 2017. ACTA ACUST UNITED AC 2020; 24. [PMID: 30968825 PMCID: PMC6462789 DOI: 10.2807/1560-7917.es.2019.24.14.1800369] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IntroductionData on chronic hepatitis C (HCV) infection prevalence in European prisons are incomplete and impact the public health opportunity that incarceration provides.AimsWe aimed to estimate the seroprevalence of untreated chronic HCV infection and to identify associated risk factors in an Irish male prison.MethodsWe conducted a cross-sectional study involving a researcher-administered questionnaire, review of medical records and HCV serology.ResultsOf 422 prisoners (78.0% of the study population) who participated in the study, 298 (70.6%) completed the questionnaire and 403 (95.5%) were tested for HCV antibodies. Of those tested, 92 (22.8%) were HCV antibody-positive, and of those, 53 (57.6%) were HCV RNA-positive, 23 (25.0%) had spontaneous clearance, 16 (17.4%) had a sustained viral response, 10 (11.0%) were co-infected with HIV and six (6.0%) with HBV. The untreated chronic HCV seroprevalence estimate was 13.1% and the seroprevalence of HCV among prisoners with a history of injecting drug use (IDU) was 79.7%. Risk factors significantly associated with past HCV infection were IDU (p < 0.0001), having received a prison tattoo (p < 0.0001) or a non-sterile community tattoo (p < 0.0001), sharing needles and other drug-taking paraphernalia (p < 0.0001). Small numbers of prisoners had a history of sharing razors (n=10; 3.4%) and toothbrushes (n=3; 1.0%) while incarcerated. On multivariable analysis, history of receiving a non-sterile community tattoo was the only significant risk factor associated with HCV acquisition (after IDU was removed from the model) (p = 0.005, β = 0.468).ConclusionThe level of untreated chronic HCV infection in Irish prisons is high, with IDU the main associated risk.
Collapse
Affiliation(s)
| | - John S Lambert
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | | | - Walter Cullen
- School of Medicine, University College Dublin, Dublin, Ireland
| | | | | | | | - Tina McHugh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | | | | | - Ross Murtagh
- School of Medicine, University College Dublin, Dublin, Ireland
| | | | - Ciara Tobin
- University of Florida, Gainesville, United States
| | | |
Collapse
|
|
16
|
Akiyama MJ, Lipsey D, Heo M, Agyemang L, Norton BL, Hidalgo J, Lora K, Litwin AH. Low Hepatitis C Reinfection Following Direct-acting Antiviral Therapy Among People Who Inject Drugs on Opioid Agonist Therapy. Clin Infect Dis 2020; 70:2695-2702. [PMID: 31346609 PMCID: PMC7456350 DOI: 10.1093/cid/ciz693] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/19/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Direct-acting antiviral (DAA) therapy is highly effective in people who inject drugs (PWID); however, rates, specific injection behaviors, and social determinants associated with hepatitis C virus (HCV) reinfection following DAA therapy among PWID on opioid agonist therapy (OAT) are poorly understood. METHODS PREVAIL was a randomized controlled trial that assessed models of HCV care for 150 PWID on OAT. Those who achieved sustained virologic response (SVR) (n = 141; 94%) were eligible for this extension study. Interviews and assessments of recurrent HCV viremia occurred at 6-month intervals for up to 24 months following PREVAIL. We used survival analysis to analyze variables associated with time to reinfection. RESULTS Of 141 who achieved SVR, 114 had a least 1 visit in the extension study (62% male; mean age, 52 years). Injection drug use (IDU) was reported by 19% (n = 22) in the extension study. HCV reinfection was observed in 3 participants. Over 246 person-years of follow-up, the incidence of reinfection was 1.22/100 person-years (95% CI, 0.25-3.57). All reinfections occurred among participants reporting ongoing IDU. The incidence of reinfection in participants reporting ongoing IDU (41 person-years of follow-up) was 7.4/100 person-years (95% CI, 1.5-21.6). Reinfection was associated with reporting ongoing IDU in the follow-up period (P < .001), a lack confidence in the ability to avoid contracting HCV (P < .001), homelessness (P = .002), and living with a PWID (P = .007). CONCLUSIONS HCV reinfection was low overall, but more common among people with ongoing IDU following DAA therapy on OAT, as well as those who were not confident in the ability to avoid contracting HCV, homeless, or living with a PWID. Interventions to mediate these risk factors following HCV therapy are warranted.
Collapse
Affiliation(s)
- Matthew J Akiyama
- Divisions of General Internal Medicine, Bronx, New York
- Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Daniel Lipsey
- Divisions of General Internal Medicine, Bronx, New York
| | - Moonseong Heo
- Department of Public Health Sciences, College of Behavioral, Social, and Health Sciences, Clemson University, South Carolina
| | | | - Brianna L Norton
- Divisions of General Internal Medicine, Bronx, New York
- Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | | | - Kiara Lora
- Divisions of General Internal Medicine, Bronx, New York
| | - Alain H Litwin
- Department of Medicine, University of South Carolina School of Medicine–Greenville, Greenville
- Department of Medicine, Prisma Health-Upstate, Greenville
- Clemson University School of Health Research, South Carolina
| |
Collapse
|
|
17
|
Bhandari R, Morey S, Hamoodi A, Thompson C, Jones D, Hewett M, Hunter E, Taha Y, McPherson S. High rate of hepatitis C reinfection following antiviral treatment in the North East England Prisons. J Viral Hepat 2020; 27:449-452. [PMID: 31749225 DOI: 10.1111/jvh.13240] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 10/23/2019] [Accepted: 10/28/2019] [Indexed: 01/17/2023]
Abstract
To achieve elimination of hepatitis C (HCV), a critical group to prioritise for diagnosis and treatment is the prison population, where HCV prevalence is high. A universal offer of blood-borne virus testing (UOBBVT) programme and a new treatment pathway were introduced to seven North East England (NEE) Prisons. Our aim was to assess: (a) the proportion of individuals with active HCV commencing direct-acting antivirals (DAAs); (b) the outcomes following DAA treatment; (3) the reinfection rate following sustained virological response (SVR). Data were collected prospectively on BBVT uptake, HCV positivity, HCV treatment outcomes and reinfection from March 2016 onwards. 8538 individuals had BBV testing. In total, 612 (7.2%) and 374 (4.4%) were HCV antibody positive and HCV RNA positive, respectively. Ultimately, 266 (71%) individuals commenced DAAs. Overall 111 achieved a documented SVR (42%), 17 (6%) failed treatment, 30 (11%) were still on treatment or had not reached 12 weeks post-treatment at time of analysis, and 108 (41%) were lost to follow-up. In those with a known outcome (n = 128), 87% achieved SVR. Worryingly, of those who achieved SVR, 21 (19%) were subsequently identified as having been reinfected (median time from SVR to documented reinfection 13 (range 7-25) months). The reinfection rate was 0.406 cases per person-year follow-up. In conclusion, Implementation of a UOBBVT programme and new treatment pathway resulted in increased diagnosis and treatment of HCV in the NEE prison population. However, the high HCV reinfection rate suggests a need to improve harm reduction approaches.
Collapse
Affiliation(s)
- Rajan Bhandari
- Viral Hepatitis Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK.,Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Morey
- Northumbria University, Newcastle upon Tyne, UK
| | - Abi Hamoodi
- Public Health England, PHE North East, Newcastle upon Tyne, UK
| | | | | | | | - Ewan Hunter
- Viral Hepatitis Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK.,Department of Infection and Tropical Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Yusri Taha
- Viral Hepatitis Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK.,Department of Infection and Tropical Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Stuart McPherson
- Viral Hepatitis Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
|
18
|
Hajarizadeh B, Cunningham EB, Valerio H, Martinello M, Law M, Janjua NZ, Midgard H, Dalgard O, Dillon J, Hickman M, Bruneau J, Dore GJ, Grebely J. Hepatitis C reinfection after successful antiviral treatment among people who inject drugs: A meta-analysis. J Hepatol 2020; 72:643-657. [PMID: 31785345 DOI: 10.1016/j.jhep.2019.11.012] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 10/30/2019] [Accepted: 11/05/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS HCV reinfection following successful treatment can compromise treatment outcomes. This systematic review assessed the rate of HCV reinfection following treatment among people with recent drug use and those receiving opioid agonist therapy (OAT). METHODS We searched bibliographic databases and conference abstracts for studies assessing post-treatment HCV reinfection rates among people with recent drug use (injecting or non-injecting) or those receiving OAT. Meta-analysis was used to cumulate reinfection rates and meta-regression was used to explore heterogeneity across studies. RESULTS Thirty-six studies were included (6,311 person-years of follow-up). The overall rate of HCV reinfection was 5.9/100 person-years (95% CI 4.1-8.5) among people with recent drug use (injecting or non-injecting), 6.2/100 person-years (95% CI 4.3-9.0) among people recently injecting drugs, and 3.8/100 person-years (95% CI 2.5-5.8) among those receiving OAT. Reinfection rates were comparable following interferon-based (5.4/100 person-years; 95% CI 3.1-9.5) and direct-acting antiviral (3.9/100 person-years; 95% CI 2.5-5.9) therapy. In stratified analysis, reinfection rates were 1.4/100 person-years (95% CI 0.8-2.6) among people receiving OAT with no recent drug use, 5.9/100 person-years (95% CI 4.0-8.6) among people receiving OAT with recent drug use, and 6.6/100 person-years (95% CI 3.4-12.7) among people with recent drug use not receiving OAT. In meta-regression analysis, longer follow-up was associated with lower reinfection rate (adjusted rate ratio [aRR] per year increase in mean/median follow-up 0.77; 95% CI 0.69-0.86). Compared with people receiving OAT with no recent drug use, those with recent drug use receiving OAT (aRR 3.50; 95% CI 1.62-7.53), and those with recent drug use not receiving OAT (aRR 3.96; 95% CI 1.82-8.59) had higher reinfection rates. CONCLUSION HCV reinfection risk following treatment was higher among people with recent drug use and lower among those receiving OAT. The lower rates of reinfection observed in studies with longer follow-up suggested higher reinfection risk early post-treatment. LAY SUMMARY Our findings demonstrate that although reinfection by hepatitis C virus occurs following successful treatment in people with recent drug use, the rate of hepatitis C reinfection is lower than the rates of primary infection reported in the literature for this population - reinfection should not be used as a reason to withhold therapy from people with ongoing injecting drug use. The rate of hepatitis C reinfection was lowest among people receiving opioid agonist therapy with no recent drug use. These data illustrate that harm reduction services are required to reduce the reinfection risk, while regular post-treatment hepatitis C assessment is required for early detection and retreatment.
Collapse
Affiliation(s)
| | | | | | | | - Matthew Law
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Håvard Midgard
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | | | - John Dillon
- Ninewells Hospital and Medical School, University of Dundee, Dundee, The United Kingdom
| | - Matthew Hickman
- Population Health Sciences, University of Bristol, Bristol, The United Kingdom
| | - Julie Bruneau
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| |
Collapse
|
|
19
|
Huang MH, Chang SY, Liu CH, Cheng A, Su LH, Liu WC, Su YC, Sun HY, Hung CC, Chang SC. HCV reinfections after viral clearance among HIV-positive patients with recent HCV infection in Taiwan. Liver Int 2019; 39:1860-1867. [PMID: 31343813 DOI: 10.1111/liv.14199] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/14/2019] [Accepted: 07/04/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Higher rates of hepatitis C virus (HCV) reinfection after viral clearance have been well described among HIV-positive men who have sex with men (MSM) in Europe. The epidemiology of HCV reinfection, however, has rarely been investigated among HIV-positive patients in Asia-Pacific region. METHODS We retrospectively identified HIV-positive patients with recent HCV infection who had cleared their primary infection, either spontaneously or via treatment, between January 2011 and May 2018. All included patients were observed until 31 March 2019. HCV reinfection was defined as recurrent HCV viraemia after achieving viral clearance with anti-HCV treatment or after spontaneous clearance. RESULTS During the study period, 219 HIV-positive patients (90.4% MSM) were diagnosed with recent HCV infection. Viral clearance with successful treatment was achieved in 108 patients (49.3%) and spontaneous clearance occurred in 20 (9.1%); of them, 18 (14.1%) acquired HCV reinfections, resulting in an incidence rate of 8.2 per 100 person-years of follow-up (95% CI 5.2-13.1). With the adjusted Cox proportional hazards model, we found a higher reinfection risk in patients with syphilis (adjusted hazard ratio 10.3, 95% CI 1.4-77.8, P = .023) compared to those without syphilis. HCV RNA testing, if performed only following syphilis and elevated aminotransferases, might miss 44.4% and 33.3% of HCV reinfections, respectively. CONCLUSIONS Similar to the findings in Europe, we observed a high incidence of HCV reinfection among HIV-positive Taiwanese with recent HCV infection, which was significantly associated with syphilis. To identify HCV reinfections, annual HCV RNA testing should be instituted instead of testing driven by symptoms, syphilis or elevated aminotransferases.
Collapse
Affiliation(s)
- Miao-Hui Huang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Sui-Yuan Chang
- Department of Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chen-Hua Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Aristine Cheng
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Li-Hsin Su
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Chun Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Ching Su
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- China Medical University, Taichung, Taiwan
| | - Shan-Chwen Chang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| |
Collapse
|
|
20
|
Sacks-Davis R, Doyle JS, Rauch A, Beguelin C, Pedrana AE, Matthews GV, Prins M, van der Valk M, Klein MB, Saeed S, Lacombe K, Chkhartishvili N, Altice FL, Hellard ME. Linkage and retention in HCV care for HIV-infected populations: early data from the DAA era. J Int AIDS Soc 2019; 21 Suppl 2:e25051. [PMID: 29633559 PMCID: PMC5978682 DOI: 10.1002/jia2.25051] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 12/19/2017] [Indexed: 12/17/2022] Open
Abstract
Introduction There is currently no published data on the effectiveness of DAA treatment for elimination of HCV infection in HIV‐infected populations at a population level. However, a number of relevant studies and initiatives are emerging. This research aims to report cascade of care data for emerging HCV elimination initiatives and studies that are currently being evaluated in HIV/HCV co‐infected populations in the context of implementation science theory. Methods HCV elimination initiatives and studies in HIV co‐infected populations that are currently underway were identified. Context, intervention characteristics and cascade of care data were synthesized in the context of implementation science frameworks. Results Seven HCV elimination initiatives and studies were identified in HIV co‐infected populations, mainly operating in high‐income countries. Four were focused mainly on HCV elimination in HIV‐infected gay and bisexual men (GBM), and three included a combination of people who inject drugs (PWID), GBM and other HIV‐infected populations. None were evaluating treatment delivery in incarcerated populations. Overall, HCV RNA was detected in 4894 HIV‐infected participants (range within studies: 297 to 994): 48% of these initiated HCV treatment (range: 21% to 85%; within studies from a period where DAAs were broadly available the total is 57%, range: 36% to 74%). Among studies with treatment completion data, 96% of 1109 initiating treatment completed treatment (range: 94% to 99%). Among those who could be assessed for sustained virological response at 12 weeks (SVR12), 1631 of 1757 attained SVR12 (93%, range: 86% to 98%). Conclusions Early results from emerging research on HCV elimination in HIV‐infected populations suggest that HCV treatment uptake is higher than reported levels prior to DAA treatment availability, but approximately half of patients remain untreated. These results are among diagnosed populations and additional effort is required to increase diagnosis rates. Among those who have initiated treatment, completion and SVR rates are promising. More data are required in order to evaluate the effectiveness of these elimination programmes in the long term, assess which intervention components are effective, and whether they need to be tailored to particular population groups.
Collapse
Affiliation(s)
- Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Andri Rauch
- Department of Infectious Diseases, University Hospital and University of Bern, Bern, Switzerland
| | - Charles Beguelin
- Department of Infectious Diseases, University Hospital and University of Bern, Bern, Switzerland
| | - Alisa E Pedrana
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Gail V Matthews
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Maria Prins
- Public Health Service Amsterdam, Amsterdam, the Netherlands
| | - Marc van der Valk
- International Antiviral Therapy Evaluation Center and Department of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, Amsterdam, the Netherlands
| | - Marina B Klein
- Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
| | - Sahar Saeed
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Karine Lacombe
- Infectious Diseases, AP-HP, Sorbonne Universités and Inserm UMR-S1136, Paris, France
| | | | - Frederick L Altice
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA.,Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.,Centre of Excellence in Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia
| | - Margaret E Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
|
21
|
Marco A, Guerrero RA, Vergara M, Gallego C, Solé C, Planella R, Vaz ME, Teixidó N, Sastre A, Touzón C, da Silva A, Almada G, Ruíz A, Caylà JA, Turu E. Reinfection in a large cohort of prison inmates with sustained virological response after treatment of chronic hepatitis C in Catalonia (Spain), 2002-2016. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:189-194. [PMID: 31160156 DOI: 10.1016/j.drugpo.2019.05.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 04/08/2019] [Accepted: 05/15/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Prisoners and other high-risk patients who show a sustained virological response (SVR) after treatment for hepatitis C virus (HCV) can become reinfected. We aimed to calculate the rate of HCV reinfection in a large cohort of inmates with SVR and to determine factors that predict reinfection. METHODS We included all inmates treated for hepatitis C in Catalonia (Spain) from January 2002 to December 2016 who achieved SVR and in whom viral load was subsequently determined. The incidence rate was calculated per 100 person-years (100 py) of follow up. Risk factors associated with reinfection were evaluated by bivariate log-rank test and multivariate Cox regression. Hazard ratio (HR) and their 95% confidence intervals (CI) were calculated. RESULTS 602 patients were included, with a mean age of 37.9 years: 95% were men, 74.1% had a history of intravenous drug use (IDU) and 28.7% were HIV-infected. Patients were followed for a total of 2154.9 years (average 3.58 ± 3.1 years). 63 (10.5%) had HCV reinfection. 41 (65.1%) presented different genotype/subgenotype, 8 the initial genotype/subgenotype, and in 14 (22.2%) the genotype could not be determined. Of the 21 reinfected patients who were interviewed, 20 (95.2%) reported IDU after antiviral treatment, and 7 (33.3%) during treatment. The overall incidence of reinfection was 2.9 cases per 100 py. All reinfections occurred in patients with IDU history. At multivariate level, HIV infection was associated with reinfection (HR = 3.03; CI:1.82-5.04). CONCLUSION In HIV-infected inmates with IDU history, the rate of reinfection of HCV post-SVR is very high. Prisons play a key role in the detection and treatment of infection and reinfection by HCV and in the post-treatment monitoring in these patients, which should be combined with counseling and the optimization of the harm reduction programs. Effective control of these vulnerable groups favours the elimination of the HCV infection.
Collapse
Affiliation(s)
- Andrés Marco
- Prison Health Program, Catalan Institute of Health, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain.
| | | | - Mercedes Vergara
- Hepatology Unit, Digestive Disease Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain; CIBERehd, Instituto Carlos III, Madrid, Spain.
| | - Carlos Gallego
- Health Services of Quatre Camins Penitentiary Centre, Barcelona, Spain.
| | - Concepció Solé
- Health Services of Puig de les Basses Penitentiary Centre, Girona, Spain.
| | - Ramón Planella
- Health Services of Ponent Penitentiary Centre, Lleida, Spain.
| | - M Elisa Vaz
- Health Services of Mas d'Enric Penitentiary Centre, Tarragona, Spain.
| | - Núria Teixidó
- Health Services of Brians-1 Penitentiary Centre, Barcelona, Spain.
| | - Ana Sastre
- Health Services of Brians-2 Penitentiary Centre, Barcelona, Spain.
| | - Carlos Touzón
- Health Services of Lledoners Penitentiary Centre, Barcelona, Spain.
| | - Antonio da Silva
- Health Services of Quatre Camins Penitentiary Centre, Barcelona, Spain.
| | - Guido Almada
- Health Services of Brians-1 Penitentiary Centre, Barcelona, Spain
| | - Ana Ruíz
- Health Services of Brians-2 Penitentiary Centre, Barcelona, Spain.
| | - Joan A Caylà
- Foundation of Tuberculosis Research Unit of Barcelona, Spain.
| | - Elisabet Turu
- Prison Health Program, Catalan Institute of Health, Spain.
| |
Collapse
|
|
22
|
Schulkind J, Stephens B, Ahmad F, Johnston L, Hutchinson S, Thain D, Ward Z, Vickerman P, Hickman M, Dillon JF. High response and re-infection rates among people who inject drugs treated for hepatitis C in a community needle and syringe programme. J Viral Hepat 2019; 26:519-528. [PMID: 30422370 DOI: 10.1111/jvh.13035] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 10/11/2018] [Indexed: 12/12/2022]
Abstract
To achieve WHO hepatitis C virus (HCV) elimination targets by 2030, mathematical models suggest there needs to be significant scale-up of treatment among people who inject drugs (PWID). We tested whether people who actively inject drugs can be recruited and treated successfully through a community needle and syringe programme (NSP), and assessed rates of re-infection. 105 HCV RNA positive participants were enrolled prospectively. Participants were recruited from the largest NSP in Dundee over 42 months. 94/105 individuals commenced treatment. Genotype 1 (G1) individuals (n = 37) were treated with peg-interferon+ribavirin+Simepravir/Telaprevir. Genotype 2/3 (G2/3) (n = 57) received peg-interferon+ribavirin. Weekly study visits took place within the NSP. Mean age of participants was 34.0 years (SD 6.9), 71.3% (61/94) were male. One in five (20/94) participants were homeless. 68.1% (64/94) were on OST (opiate substitution therapy) at enrolment; participants injected median 6.5 times/wk. In terms of clinical outcomes, >80% treatment adherence was 71.3% (67/94). There was no difference in SVR-12 rates by genotype: 81.0% (30/37) for G1 and 82.5% (47/55) for G2/3. At 18 months post-treatment, 15/77 participants were reinfected, followed up over 69.8 person-years, yielding a re-infection rate of 21.5/100 person-years (95% CI 13.00-35.65). This trial demonstrates that HCV treatment can be delivered successfully to the target population of treatment as prevention strategies. We report higher rates of re-infection than existing estimates among PWID. Scale-up of HCV treatment should be pursued alongside a comprehensive programme of harm reduction interventions to help minimize re-infection and reduce HCV transmission.
Collapse
Affiliation(s)
| | - Brian Stephens
- Department of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Farsana Ahmad
- Department of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Linda Johnston
- Department of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Sharon Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Donna Thain
- NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK
| | - Zoe Ward
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Matt Hickman
- Population Health Sciences, University of Bristol, Bristol, UK
| | - John F Dillon
- Department of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| |
Collapse
|
|
23
|
Martinello M, Dore GJ, Matthews GV, Grebely J. Strategies to Reduce Hepatitis C Virus Reinfection in People Who Inject Drugs. Infect Dis Clin North Am 2019; 32:371-393. [PMID: 29778261 DOI: 10.1016/j.idc.2018.02.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Reinfection after direct-acting antiviral therapy may pose a challenge to hepatitis C virus elimination efforts. Reinfection risk is cited as a reason for not offering treatment to people who inject drugs. As treatment scale-up expands among populations with risks for reacquisition, acknowledgment that reinfection can and will occur is essential. Efforts to prevent and manage reinfection should be incorporated into individual- and population-level strategies. The risk of reinfection after successful treatment emphasises the need for education, harm reduction, and posttreatment surveillance. Reinfection must not be considered an impediment to treatment, if hepatitis C virus elimination is to be achieved.
Collapse
Affiliation(s)
- Marianne Martinello
- Viral Hepatitis Clinical Research Program, Kirby Institute, Level 5, Wallace Wurth Building, High Street, UNSW Sydney, Kensington NSW 2052, Australia.
| | - Gregory J Dore
- Viral Hepatitis Clinical Research Program, Kirby Institute, Level 5, Wallace Wurth Building, High Street, UNSW Sydney, Kensington NSW 2052, Australia
| | - Gail V Matthews
- Viral Hepatitis Clinical Research Program, Kirby Institute, Level 5, Wallace Wurth Building, High Street, UNSW Sydney, Kensington NSW 2052, Australia
| | - Jason Grebely
- Viral Hepatitis Clinical Research Program, Kirby Institute, Level 5, Wallace Wurth Building, High Street, UNSW Sydney, Kensington NSW 2052, Australia
| |
Collapse
|
|
24
|
Moazen B, Saeedi Moghaddam S, Silbernagl MA, Lotfizadeh M, Bosworth RJ, Alammehrjerdi Z, Kinner SA, Wirtz AL, Bärnighausen TW, Stöver HJ, Dolan KA. Prevalence of Drug Injection, Sexual Activity, Tattooing, and Piercing Among Prison Inmates. Epidemiol Rev 2018; 40:58-69. [PMID: 29860343 DOI: 10.1093/epirev/mxy002] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 01/17/2018] [Indexed: 12/14/2022] Open
Abstract
Prisoners engage in a range of risk behaviors that can lead to the transmission of viral infections, such as HIV, hepatitis B and hepatitis C. In this review, we summarize the epidemiologic literature from 2007 to 2017 on 4 key risk behaviors for human immunodeficiency virus and hepatitis C virus among prisoners globally: drug injection, sexual activity, tattooing, and piercing. Of 9,303 peer-reviewed and 4,150 gray literature publications, 140 and 14, respectively, met inclusion criteria covering 53 countries (28%). Regions with high levels of injection drug use were Asia Pacific (20.2%), Eastern Europe and Central Asia (17.3%), and Latin America and the Caribbean (11.3%), although the confidence interval for Latin America was high. Low levels of injection drug use in prison were found in African regions. The highest levels of sexual activity in prison were in Europe and North America (12.1%) and West and Central Africa (13.6%); low levels were reported from the Middle East and North African regions (1.5%). High levels of tattooing were reported from Europe and North America (14.7%), Asia Pacific (21.4%), and Latin America (45.4%). Prisons are burdened with a high prevalence of infectious diseases and risk behaviors for transmission of these diseases, and, commonly, a striking lack of evidence-based infection control measures, even when such measures are available in the surrounding community. Given that most prisoners return to these communities, failure to implement effective responses has repercussions not only prisoner health but also for public health.
Collapse
Affiliation(s)
- Babak Moazen
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Masoud Lotfizadeh
- Social Determinants of Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran.,Department of Community Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Rebecca J Bosworth
- Program of International Research and Training, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Zahra Alammehrjerdi
- Program of International Research and Training, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Stuart A Kinner
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Andrea L Wirtz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Till W Bärnighausen
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Heino J Stöver
- Department of Health and Social Work, Institute of Addiction Research
| | | |
Collapse
|
|
25
|
Cuypers L, Pérez AB, Chueca N, Aldamiz-Echevarría T, Alados JC, Martínez-Sapiña AM, Merino D, Pineda JA, Téllez F, Espinosa N, Salméron J, Rivero-Juarez A, Vivancos MJ, Hontañón V, Vandamme AM, García F. Relapse or reinfection after failing hepatitis C direct acting antiviral treatment: Unravelled by phylogenetic analysis. PLoS One 2018; 13:e0201268. [PMID: 30044871 PMCID: PMC6059487 DOI: 10.1371/journal.pone.0201268] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/11/2018] [Indexed: 12/14/2022] Open
Abstract
Despite high response rates associated to hepatitis C virus (HCV) treatment, no protective immunity is acquired, allowing for reinfection and continued infectiousness. Distinguishing between relapse and reinfection is crucial for patient counselling and to choose the most appropriate retreatment. Here, refined phylogenetic analysis using multiple genes served to assess genotype and reinfection for 53 patients for whom the virus was sampled before start of therapy and at time of sustained virological response evaluation at week 12. At baseline, genotypes were determined as HCV1a (41.5%), HCV1b (24.5%), HCV4 (18.9%) and HCV3a (15.1%), while six cases revealed to be discordantly assigned by phylogeny and commercial assays. Overall, 60.4% was co-infected with HIV. The large majority was classified as people who inject drugs (78.6%), often co-infected with HIV. Transmission was sexual in seven cases, of which five in HIV-positive men-who-have-sex-with-men. Overall, relapse was defined for 44 patients, while no conclusion was drawn for four patients. Five patients were reinfected with a different HCV strain, of which three with a different genotype, showing that phylogeny is needed not only to determine the genotype, but also to distinguish between relapse and intra-subtype reinfection. Of note, phylogenies are more reliable when longer fragments of the viral genome are being sequenced.
Collapse
Affiliation(s)
- Lize Cuypers
- KU Leuven–University of Leuven, Department of Microbiology and Immunology, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Leuven, Belgium
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Ana Belén Pérez
- Clinical Microbiology Department, University Hospital San Cecilio Granada, Instituto de Investigación Ibs. Granada, Spain
| | - Natalia Chueca
- Clinical Microbiology Department, University Hospital San Cecilio Granada, Instituto de Investigación Ibs. Granada, Spain
| | | | | | | | - Dolores Merino
- Clinical Microbiology, Hospital Infanta Elena, Huelva, Spain
| | | | - Francisco Téllez
- UGC Enfermedades Infecciosas y Microbiología, Hospital La Línea, AGS Campo de Gibraltar, Cadiz, Spain
| | - Nuria Espinosa
- Clinical Microbiology, Hospital Virgen del Rocío, Sevilla, Spain
| | - Javier Salméron
- Hepatology Unit, University Hospital San Cecilio Granada, Instituto de Investigación Ibs. CIBERehd, Granada, Spain
| | - Antonio Rivero-Juarez
- Infectious Diseases Unit. Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC). Hospital Universitario Reina Sofía de Córdoba. Universidad de Córdoba, Córdoba, Spain
| | | | - Víctor Hontañón
- Clinical Microbiology, University Hospital La Paz, Madrid, Spain
| | - Anne-Mieke Vandamme
- KU Leuven–University of Leuven, Department of Microbiology and Immunology, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Leuven, Belgium
- Center for Global Health and Tropical Medicine, Microbiology Unit, Institute for Hygiene and Tropical Medicine, University Nova de Lisboa, Lisbon, Portugal
| | - Féderico García
- Clinical Microbiology Department, University Hospital San Cecilio Granada, Instituto de Investigación Ibs. Granada, Spain
| |
Collapse
|
|
26
|
Luo BF, Rao HY, Gao YH, Wei L. Risk factors for familial clustering of hepatitis C virus infection in a Chinese Han population: a cross-sectional study. BMC Public Health 2018; 18:708. [PMID: 29879949 PMCID: PMC5992725 DOI: 10.1186/s12889-018-5592-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 05/23/2018] [Indexed: 01/27/2023] Open
Abstract
Background Hepatitis C is a curable disease, but reinfection from household contact may occur in patients who have achieved sustained viral response (SVR). Methods A total of 997 ethnic Han HCV treatment-naïve adult patients were enrolled in a cross-sectional study with stratified sampling based on the populations of five geographic regions across China to examine the genetic and physiological parameters associated with the phenomenon of HCV familial clustering. Results Of the total 997 patients, there were 59 patients who had at least one family member with HCV infection according to patient self-report. Comparison between patients with and without HCV familial clustering by univariate regression analysis showed that genotype 2, sexual transmission, long-term exposure to HCV patients, monthly family income per person less than 2000 yuan, farming occupation, and the southern and northern regions were associated with HCV familial clustering. Blood transfusion was negatively associated with HCV familial clustering. Multivariate logistic regression analysis suggested that long-term exposure to HCV patients and low family income were correlated with HCV familial clustering, whereas blood transfusion was negatively associated, which meant that blood transfusion was not the main transmission route in HCV familial clustering. Conclusion Long-term exposure to HCV patients and low family income were correlated with HCV familial clustering, whereas blood transfusion was not the main transmission route in HCV familial clustering. To reduce reinfection from household contacts, education and awareness of HCV transmission routes and familial clustering should be strengthened, especially among HCV patients’ family members, low-income families and non-blood transmission hepatitis C patients.
Collapse
Affiliation(s)
- Bi-Fen Luo
- Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Hui-Ying Rao
- Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Ying-Hui Gao
- Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Lai Wei
- Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, No. 11 Xizhimen South Street, Beijing, 100044, China.
| |
Collapse
|
|
27
|
Sohrab SS, Suhail M, Ali A, Qadri I, Harakeh S, Azhar EI. Consequence of HIV and HCV co-infection on host immune response, persistence and current treatment options. Virusdisease 2018; 29:19-26. [PMID: 29607354 PMCID: PMC5877845 DOI: 10.1007/s13337-018-0424-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 01/13/2018] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) is a common opportunistic pathogen especially among Human immunodeficiency virus (HIV) infected patients. Due to incongruous studies, the pathological effect of HCV on HIV induced disease are still not fully understood. While some studies have showed no effect of HCV on HIV infection, others reported a defined role of HCV in aggravating the rates of AIDS-related illnesses and mortality. The explanation of such variances may be due to the host immune response, viral genotypes, sub-type and quasi-species distribution. The factors that complicate the management of HIV/HCV patients are: (1) reduced HCV antibody production, (2) drug interactions, (3) liver disease and (4) different epidemiologic characteristics. However, it is abundantly clear that the morbidity and mortality caused by HCV have increased since the introduction of highly active antiretroviral therapy (HAART) against HIV. In this review, the consequence of HIV/HCV co-infection on host immune response, viral replication, disease progression, mortality and morbidity, viral load, persistence and current treatment options have been discussed. Based on the clinical studies, it is necessary to evaluate the effect of HCV therapy on HIV progression and to provide a fully active HCV treatment for patients receiving HIV treatment. In conclusion, it is recommended to provide fully active HAART therapy in combination with a known HCV therapy.
Collapse
Affiliation(s)
- Sayed Sartaj Sohrab
- Special Infectious Agents Unit (SIAU), King Fahd Medical Research Center, King Abdulaziz University, P.O. Box 80216, Jeddah, 21589 Saudi Arabia
| | - Mohd Suhail
- King Fahd Medical Research Center, King Abdulaziz University, P.O. Box 80216, Jeddah, 21589 Saudi Arabia
| | - Ashraf Ali
- King Fahd Medical Research Center, King Abdulaziz University, P.O. Box 80216, Jeddah, 21589 Saudi Arabia
| | - Ishtiaq Qadri
- King Fahd Medical Research Center, King Abdulaziz University, P.O. Box 80216, Jeddah, 21589 Saudi Arabia
| | - Steve Harakeh
- Special Infectious Agents Unit (SIAU), King Fahd Medical Research Center, King Abdulaziz University, P.O. Box 80216, Jeddah, 21589 Saudi Arabia
| | - Esam I. Azhar
- Special Infectious Agents Unit (SIAU), King Fahd Medical Research Center, King Abdulaziz University, P.O. Box 80216, Jeddah, 21589 Saudi Arabia
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, P. O. Box 80216, Jeddah, 21589 Saudi Arabia
| |
Collapse
|
|
28
|
Montague BT, John B, Sammartino C, Costa M, Fukuda D, Solomon L, Rich JD. Use of viral load surveillance data to assess linkage to care for persons with HIV released from corrections. PLoS One 2018; 13:e0192074. [PMID: 29432472 PMCID: PMC5809020 DOI: 10.1371/journal.pone.0192074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 12/28/2017] [Indexed: 11/18/2022] Open
Abstract
Incarcerated people remain a priority group in efforts to control and reverse the HIV epidemic. Following release, social instability and reengagement in key transmission risk behaviors increase the risk of secondary transmission of HIV. Targeted programs have been developed to facilitate reengagement in care on reentry. Evaluation of the impact of these initiatives requires a systematic, confidential, framework for assessment of linkage to care for persons released from corrections. By linking HIV viral load surveillance data to corrections release data, the time to the first laboratory monitoring service in the community as well as the virologic status can be assessed. Using this method, we linked release data for sentenced individuals released from Massachusetts state correctional facilities in 2012 to HIV surveillance data from the Massachusetts HIV/AIDS Surveillance Program (MHASP) for the years 2012–2013. We identified 41 individuals with HIV released in 2012. Ninety-one percent had identified virologic assessments post release, 41% within 30 days. Thirty-three percent did not have a viral load assessed for more than 90 days and 31% had detectable virus at the time of their initial assessment. Persons with longer incarcerations (> 180 days) were more likely to have suppressed viral load at the time of follow-up (p = 0.05). This work demonstrates the important value of HIV laboratory surveillance data and correctional release data as a tool to assess linkage to care following release from corrections. We encourage jurisdictions to explore utilizing similar methodology to evaluate the effectiveness of the linkage to HIV care after release from incarceration.
Collapse
Affiliation(s)
- Brian T. Montague
- Department of Medicine, Division of Infectious Diseases, University of Colorado Denver School of Medicine, Aurora, Colorado, United States of America
- * E-mail:
| | - Betsey John
- Bureau of Infectious Disease and Laboratory Science, Massachusetts Department of Public Health, Boston, Massachusetts, United States of America
| | - Cara Sammartino
- Department of Health Sciences, Johnson and Wales University, Providence, Rhode Island, United States of America
| | - Michael Costa
- Abt Associates, Cambridge, Massachusetts, United States of America
| | - Dawn Fukuda
- Bureau of Infectious Disease and Laboratory Science, Massachusetts Department of Public Health, Boston, Massachusetts, United States of America
| | - Liza Solomon
- Abt Associates, Cambridge, Massachusetts, United States of America
| | - Josiah D. Rich
- Miriam Hospital, Providence, Rhode Island, United States of America
- Department of Medicine, Division of Infectious Diseases, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, United States of America
| |
Collapse
|
|
29
|
Genotype distribution and treatment response among incarcerated drug-dependent patients with chronic hepatitis C infection. PLoS One 2018; 13:e0191799. [PMID: 29389957 PMCID: PMC5794085 DOI: 10.1371/journal.pone.0191799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/11/2018] [Indexed: 01/15/2023] Open
Abstract
The prevalence of hepatitis C virus (HCV) infection is disproportionately high among prisoners, especially among those who are drug-dependent. However, current screening and treatment recommendations are inconsistent for this population, and appropriate care is not reliably provided. To address these problems, the present study aimed to identify unique characteristics and clinical manifestations of incarcerated patients with HCV infection. We included incarcerated patients who received treatment with pegylated-interferon combined with ribavirin at Mackay Memorial Hospital in Taitung and were serving sentences at either the Taiyuan Skill Training Institute or the Yanwan Training Institute. HCV genotypes 1 (41.4%), 3 (25.9%), and 6 (24.1%) were the most prevalent in the incarcerated patients. During the study period, we analyzed treatment response among 58 incarcerated patients and compared obtained results with treatment response among 52 patients who were living in the community. Higher sustained virological response rate was observed among patients with incarceration and HCV genotype other than 1. The odds ratios (corresponding 95% confidence intervals) for incarceration and genotype 1 were 2.75 (1.06–7.11) and 0.37 (0.14–0.99), respectively. Better treatment compliance among incarcerated patients might partially explain these results. The results of this study suggest that treatment of prisoners with HCV infection is feasible and effective. More appropriate and timely methods are needed to prevent HCV transmission among injection drug users inside prisons.
Collapse
|
|
30
|
Young J, Rossi C, Gill J, Walmsley S, Cooper C, Cox J, Martel-Laferriere V, Conway B, Pick N, Vachon ML, Klein MB. Risk Factors for Hepatitis C Virus Reinfection After Sustained Virologic Response in Patients Coinfected With HIV. Clin Infect Dis 2018; 64:1154-1162. [PMID: 28199495 PMCID: PMC5399935 DOI: 10.1093/cid/cix126] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 02/09/2017] [Indexed: 01/20/2023] Open
Abstract
Background. Highly effective hepatitis C virus (HCV) therapies have spurred a scale-up of treatment to populations at greater risk of reinfection after sustained virologic response (SVR). Reinfection may be higher in HIV–HCV coinfection, but prior studies have considered small selected populations. We assessed risk factors for reinfection after SVR in a representative cohort of Canadian coinfected patients in clinical care. Methods. All patients achieving SVR after HCV treatment were followed with HCV RNA measurements every 6 months in a prospective cohort study. We used Bayesian Cox regression to estimate reinfection rates according to patient reported injection drug use (IDU) and sexual activity among men who have sex with men (MSM). Results. Of 497 patients treated for HCV, 257 achieved SVR and had at least 1 subsequent RNA measurement. During 589 person-years of follow-up (PYFU) after SVR, 18 (7%) became HCV RNA positive. The adjusted reinfection rate (per 1000 PYFU) in the first year after SVR was highest in those who reported high-frequency IDU (58; 95% credible interval [CrI], 18–134) followed by MSM reporting high-risk sexual activity (26; 95% CrI, 6–66) and low-frequency IDU (22; 95% CrI, 4–68). The rate in low-risk MSM (16; 95% CrI, 4–38) was similar to that in reference patients (10; 95% CrI, 4–20). Reinfection rates did not diminish with time. Conclusions. HCV reinfection rates varied according to risk. Measures are needed to reduce risk behaviors and increase monitoring in high-risk IDU and MSM if HCV elimination targets are to be realized.
Collapse
Affiliation(s)
- Jim Young
- Department of Medicine, Division of Infectious Diseases, McGill University Health Centre, Montreal, Canada.,Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Switzerland
| | - Carmine Rossi
- Department of Medicine, Division of Infectious Diseases, McGill University Health Centre, Montreal, Canada
| | - John Gill
- Southern Alberta HIV Clinic, Calgary, Alberta, Canada
| | - Sharon Walmsley
- University Health Network, University of Toronto, Toronto, Canada.,CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - Curtis Cooper
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Joseph Cox
- Department of Medicine, Division of Infectious Diseases, McGill University Health Centre, Montreal, Canada
| | - Valerie Martel-Laferriere
- Department of Microbiology and Infectious Diseases, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada
| | - Brian Conway
- Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada
| | - Neora Pick
- Division of Infectious Diseases, Oak Tree Clinic, BC Women's Hospital, Vancouver, British Columbia, Canada
| | | | - Marina B Klein
- Department of Medicine, Division of Infectious Diseases, McGill University Health Centre, Montreal, Canada.,CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | | |
Collapse
|
|
31
|
Flores-Chávez A, Carrion JA, Forns X, Ramos-Casals M. Extrahepatic manifestations associated with Chronic Hepatitis C Virus Infection. REVISTA ESPANOLA DE SANIDAD PENITENCIARIA 2017; 19:87-97. [PMID: 29364334 PMCID: PMC6241927 DOI: 10.4321/s1575-06202017000300004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 10/10/2017] [Indexed: 12/11/2022]
Abstract
Chronic hepatitis C virus (HCV) infection has been associated with both organ-specific and systemic autoimmune diseases, with cryoglobulinemia being the most frequent associated disease. Experimental, virologic, and clinical evidence have demon-strated a close association between HCV infection and some systemic autoimmune diseases, especially Sjögren's syndrome, but also rheumatoid arthritis and lupus. A higher prevalence of hematological processes has also been described in patients with HCV infection, including cytopenias and lymphoproliferative disorders (B-cell lymphoma). In addition, patients with chronic HCV infection have a higher frequency of other extrahepatic manifestations including endocrine, metabolic and cardiovascular disorders that may worse the prognosis of patients, along with neuropsychiatric manifestations and general symptoms that have a significant influence on the quality of life of the patient. Direct-acting antiviral therapies (DAAs) that have recently begun to be used are providing the opportunity to effectively cure chronic HCV infection and reduce the burden of both hepatic and extrahepatic complications.
Collapse
Affiliation(s)
- A Flores-Chávez
- Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain
| | - J A Carrion
- Department of Hepatology, Hospital del Mar, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), University Autónoma de Barcelona, Barcelona
| | - X Forns
- Department of Hepatology, Hospital Clinic, IDIBAPS y CIBEREHD, University of Barcelona, Barcelona
| | - M Ramos-Casals
- Department of Medicine, University of Barcelona, Barcelona, Spain
| |
Collapse
|
|
32
|
Martinello M, Hajarizadeh B, Grebely J, Dore GJ, Matthews GV. HCV Cure and Reinfection Among People With HIV/HCV Coinfection and People Who Inject Drugs. Curr HIV/AIDS Rep 2017; 14:110-121. [PMID: 28432579 DOI: 10.1007/s11904-017-0358-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Highly effective, well-tolerated interferon-free direct-acting antivirals (DAA) have revolutionised hepatitis C virus (HCV) therapeutics, with the opportunity for broad treatment scale-up among marginalised or "high-risk" populations, including people who inject drugs (PWID) and people with HIV/HCV coinfection. RECENT FINDINGS Concern that HCV reinfection may compromise HCV treatment outcomes is sometimes cited as a reason for not offering treatment to current and former PWID. However, the incidence of reinfection following interferon-based treatment for chronic HCV is low among PWID. Reinfection rates in HIV-positive men-who-have-sex-with-men (MSM) are varied, with high incidence reported in some cohorts. Mathematical modelling suggests that substantial reductions in HCV incidence and prevalence could be achieved with targeted DAA therapy among those at the highest risk of ongoing transmission. This review will summarise the recent literature on DAA efficacy in PWID and people with HIV/HCV coinfection, discuss the individual- and population-level impact of DAA treatment scale-up and reinfection, and highlight ongoing and future research questions in expanding HCV care and treatment to those populations at high risk of ongoing HCV transmission.
Collapse
Affiliation(s)
- Marianne Martinello
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW, 2052, Australia.
| | - Behzad Hajarizadeh
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Jason Grebely
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Gregory J Dore
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW, 2052, Australia.,St Vincent's Hospital, Sydney, NSW, Australia
| | - Gail V Matthews
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW, 2052, Australia.,St Vincent's Hospital, Sydney, NSW, Australia
| |
Collapse
|
|
33
|
Rodriguez-Frias F, Nieto-Aponte L, Gregori J, Garcia-Cehic D, Casillas R, Tabernero D, Homs M, Blasi M, Vila M, Chen Q, Vargas V, Castells L, Viladomiu L, Genesca J, Minguez B, Augustin S, Riveiro-Barciela M, Carbonell J, Perales C, Soria ME, Asensio M, Llorens M, Ordeig L, Godoy C, Buti M, Esteban R, Pumarola T, Esteban JI, Quer J. High HCV subtype heterogeneity in a chronically infected general population revealed by high-resolution hepatitis C virus subtyping. Clin Microbiol Infect 2017; 23:775.e1-775.e6. [PMID: 28192235 DOI: 10.1016/j.cmi.2017.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 02/02/2017] [Accepted: 02/04/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVES This study aimed to characterize the chronically infected general hepatitis C virus (HCV) population in Barcelona using a highly sensitive subtyping method that can identify the 67 recognized HCV subtypes and diagnose mixed infection by various genotypes/subtypes in a single individual. The resulting information has implications for selecting optimal direct-acting antiviral (DAA) treatment for each patient and establishing public healthcare policies in our setting. METHODS Consecutive HCV patients (treatment-naïve or interferon-based failures) attending Vall d'Hebron Hospital outpatient clinics from February 2015 to May 2016 (N=1473) were included in the study. Patient samples were characterized using HCV subtyping by next-generation ultra-deep pyrosequencing. RESULTS The following genotypes (G) were found: G1 (1126/1473 (76.4%)), G4 (145/1473 (9.8%)), G3 (135/1473 (9.2%)), G2 (51/1473 (3.5%)), and G5 (1/1473 (0.1%)). Twenty-two subtypes were seen: 1b (790/1473 (53.6%)), 1a (332/1473 (22.5%)), 3a (133/1473 (9.0%)), 4d (105/1473 (7.1%)), 4a (29/1473 (2.0%)), and 2c (25/1473 (1.7%)), with 16 low-prevalence subtypes accounting for the remaining 3.0% (44/1473). There was a worrisome 1.0% (15/1473) of mixed infections. G2 (51/1473 (3.5%)) showed a high level of heterogeneity. Analyses by age groups showed a predominance of G1b over G1a (428/506 (84.6%) vs. 24/506 (4.7%)) in patients born before 1950 (N=506/1473), and similar percentages of these subtypes in those born between 1951 and 1975 (N=834/1473) (315/834, 37.8% vs. 266/834, 31.9%) and after 1976 (N=133/1473) (47/133, 35.3% vs. 42/133, 31.6%). CONCLUSIONS Subtype distribution showed a higher level of heterogeneity than was expected, particularly for G2. Prevalence of mixed infections was around 1%. HCV subtype distribution related to patient age group suggested that patients born from 1936 to 1975 in our setting should undergo screening for the infection. Next-generation sequencing enabled better classification of candidates for DAA-based treatment.
Collapse
Affiliation(s)
- F Rodriguez-Frias
- Liver Pathology Unit, Department of Biochemistry and Microbiology, Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain; Centro de Investigacion Biomedica en Red (CIBER) de Enfermedades Hepaticas y Digestivas (CIBERehd) del Instituto de Salud Carlos III, Madrid, Spain; Universitat Autonoma de Barcelona, Bellaterra, Barcelona, Spain.
| | - L Nieto-Aponte
- Liver Pathology Unit, Department of Biochemistry and Microbiology, Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain; Clinical Microbiology Department, HUVH, Barcelona, Spain
| | - J Gregori
- Centro de Investigacion Biomedica en Red (CIBER) de Enfermedades Hepaticas y Digestivas (CIBERehd) del Instituto de Salud Carlos III, Madrid, Spain; Roche Diagnostics SL, Sant Cugat del Vall_es, Barcelona, Spain; Liver Unit, Malalties Hepatiques, Internal Medicine Department, Vall d'Hebron Institut Recerca (VHIR)-HUVH), Barcelona, Spain
| | - D Garcia-Cehic
- Centro de Investigacion Biomedica en Red (CIBER) de Enfermedades Hepaticas y Digestivas (CIBERehd) del Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Malalties Hepatiques, Internal Medicine Department, Vall d'Hebron Institut Recerca (VHIR)-HUVH), Barcelona, Spain
| | - R Casillas
- Liver Pathology Unit, Department of Biochemistry and Microbiology, Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain; Clinical Microbiology Department, HUVH, Barcelona, Spain
| | - D Tabernero
- Liver Pathology Unit, Department of Biochemistry and Microbiology, Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain; Centro de Investigacion Biomedica en Red (CIBER) de Enfermedades Hepaticas y Digestivas (CIBERehd) del Instituto de Salud Carlos III, Madrid, Spain
| | - M Homs
- Liver Pathology Unit, Department of Biochemistry and Microbiology, Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain
| | - M Blasi
- Liver Pathology Unit, Department of Biochemistry and Microbiology, Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain
| | - M Vila
- Liver Pathology Unit, Department of Biochemistry and Microbiology, Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain
| | - Q Chen
- Centro de Investigacion Biomedica en Red (CIBER) de Enfermedades Hepaticas y Digestivas (CIBERehd) del Instituto de Salud Carlos III, Madrid, Spain
| | - V Vargas
- Centro de Investigacion Biomedica en Red (CIBER) de Enfermedades Hepaticas y Digestivas (CIBERehd) del Instituto de Salud Carlos III, Madrid, Spain; Universitat Autonoma de Barcelona, Bellaterra, Barcelona, Spain; Liver Unit, Malalties Hepatiques, Internal Medicine Department, Vall d'Hebron Institut Recerca (VHIR)-HUVH), Barcelona, Spain
| | - Ll Castells
- Centro de Investigacion Biomedica en Red (CIBER) de Enfermedades Hepaticas y Digestivas (CIBERehd) del Instituto de Salud Carlos III, Madrid, Spain; Universitat Autonoma de Barcelona, Bellaterra, Barcelona, Spain; Liver Unit, Malalties Hepatiques, Internal Medicine Department, Vall d'Hebron Institut Recerca (VHIR)-HUVH), Barcelona, Spain
| | - Ll Viladomiu
- Universitat Autonoma de Barcelona, Bellaterra, Barcelona, Spain; Liver Unit, Malalties Hepatiques, Internal Medicine Department, Vall d'Hebron Institut Recerca (VHIR)-HUVH), Barcelona, Spain
| | - J Genesca
- Centro de Investigacion Biomedica en Red (CIBER) de Enfermedades Hepaticas y Digestivas (CIBERehd) del Instituto de Salud Carlos III, Madrid, Spain; Universitat Autonoma de Barcelona, Bellaterra, Barcelona, Spain; Liver Unit, Malalties Hepatiques, Internal Medicine Department, Vall d'Hebron Institut Recerca (VHIR)-HUVH), Barcelona, Spain
| | - B Minguez
- Centro de Investigacion Biomedica en Red (CIBER) de Enfermedades Hepaticas y Digestivas (CIBERehd) del Instituto de Salud Carlos III, Madrid, Spain; Universitat Autonoma de Barcelona, Bellaterra, Barcelona, Spain; Liver Unit, Malalties Hepatiques, Internal Medicine Department, Vall d'Hebron Institut Recerca (VHIR)-HUVH), Barcelona, Spain
| | - S Augustin
- Centro de Investigacion Biomedica en Red (CIBER) de Enfermedades Hepaticas y Digestivas (CIBERehd) del Instituto de Salud Carlos III, Madrid, Spain; Universitat Autonoma de Barcelona, Bellaterra, Barcelona, Spain; Liver Unit, Malalties Hepatiques, Internal Medicine Department, Vall d'Hebron Institut Recerca (VHIR)-HUVH), Barcelona, Spain
| | - M Riveiro-Barciela
- Centro de Investigacion Biomedica en Red (CIBER) de Enfermedades Hepaticas y Digestivas (CIBERehd) del Instituto de Salud Carlos III, Madrid, Spain; Universitat Autonoma de Barcelona, Bellaterra, Barcelona, Spain; Liver Unit, Malalties Hepatiques, Internal Medicine Department, Vall d'Hebron Institut Recerca (VHIR)-HUVH), Barcelona, Spain
| | - J Carbonell
- Universitat Autonoma de Barcelona, Bellaterra, Barcelona, Spain; Liver Unit, Malalties Hepatiques, Internal Medicine Department, Vall d'Hebron Institut Recerca (VHIR)-HUVH), Barcelona, Spain
| | - C Perales
- Centro de Investigacion Biomedica en Red (CIBER) de Enfermedades Hepaticas y Digestivas (CIBERehd) del Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Malalties Hepatiques, Internal Medicine Department, Vall d'Hebron Institut Recerca (VHIR)-HUVH), Barcelona, Spain
| | - M E Soria
- Centro de Investigacion Biomedica en Red (CIBER) de Enfermedades Hepaticas y Digestivas (CIBERehd) del Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Malalties Hepatiques, Internal Medicine Department, Vall d'Hebron Institut Recerca (VHIR)-HUVH), Barcelona, Spain
| | - M Asensio
- Liver Pathology Unit, Department of Biochemistry and Microbiology, Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain
| | - M Llorens
- Centro de Investigacion Biomedica en Red (CIBER) de Enfermedades Hepaticas y Digestivas (CIBERehd) del Instituto de Salud Carlos III, Madrid, Spain
| | - L Ordeig
- Centro de Investigacion Biomedica en Red (CIBER) de Enfermedades Hepaticas y Digestivas (CIBERehd) del Instituto de Salud Carlos III, Madrid, Spain
| | - C Godoy
- Liver Pathology Unit, Department of Biochemistry and Microbiology, Hospital Universitari Vall d'Hebron (HUVH), Barcelona, Spain
| | - M Buti
- Centro de Investigacion Biomedica en Red (CIBER) de Enfermedades Hepaticas y Digestivas (CIBERehd) del Instituto de Salud Carlos III, Madrid, Spain; Universitat Autonoma de Barcelona, Bellaterra, Barcelona, Spain; Liver Unit, Malalties Hepatiques, Internal Medicine Department, Vall d'Hebron Institut Recerca (VHIR)-HUVH), Barcelona, Spain
| | - R Esteban
- Centro de Investigacion Biomedica en Red (CIBER) de Enfermedades Hepaticas y Digestivas (CIBERehd) del Instituto de Salud Carlos III, Madrid, Spain; Universitat Autonoma de Barcelona, Bellaterra, Barcelona, Spain; Liver Unit, Malalties Hepatiques, Internal Medicine Department, Vall d'Hebron Institut Recerca (VHIR)-HUVH), Barcelona, Spain
| | - T Pumarola
- Universitat Autonoma de Barcelona, Bellaterra, Barcelona, Spain; Clinical Microbiology Department, HUVH, Barcelona, Spain
| | - J I Esteban
- Centro de Investigacion Biomedica en Red (CIBER) de Enfermedades Hepaticas y Digestivas (CIBERehd) del Instituto de Salud Carlos III, Madrid, Spain; Universitat Autonoma de Barcelona, Bellaterra, Barcelona, Spain; Liver Unit, Malalties Hepatiques, Internal Medicine Department, Vall d'Hebron Institut Recerca (VHIR)-HUVH), Barcelona, Spain
| | - J Quer
- Centro de Investigacion Biomedica en Red (CIBER) de Enfermedades Hepaticas y Digestivas (CIBERehd) del Instituto de Salud Carlos III, Madrid, Spain; Universitat Autonoma de Barcelona, Bellaterra, Barcelona, Spain; Liver Unit, Malalties Hepatiques, Internal Medicine Department, Vall d'Hebron Institut Recerca (VHIR)-HUVH), Barcelona, Spain.
| |
Collapse
|
|
34
|
Hepatitis C cross-genotype immunity and implications for vaccine development. Sci Rep 2017; 7:12326. [PMID: 28951612 PMCID: PMC5615075 DOI: 10.1038/s41598-017-10190-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/02/2017] [Indexed: 01/03/2023] Open
Abstract
While about a quarter of individuals clear their primary hepatitis C (HCV) infections spontaneously, clearance (spontaneous or treatment-induced) does not confer sterilizing immunity against a future infection. Since successful treatment does not prevent future infections either, an effective vaccine is highly desirable in preventing HCV (re)infection. However, development of an effective vaccine has been complicated by the diversity of HCV genotypes, and complexities in HCV immunological responses. Smaller studies on humans and chimpanzees reported seemingly opposing results regarding cross-neutralizing antibodies. We report a lack of cross-genotype immunity in the largest cohort of people to date. In the adjusted Cox proportional hazards model, reinfection with a heterologous HCV genotype (adjusted Hazard Ratio [aHR]: 0.45, 95% CI: 0.25–0.84) was associated with a 55% lower likelihood of re-clearance. Among those who cleared their first infection spontaneously, the likelihood of re-clearance was 49% lower (aHR: 0.51, 95% CI: 0.27–0.94) when reinfected with a heterologous HCV genotype. These findings indicate that immunity against a particular HCV genotype does not offer expanded immunity to protect against subsequent infections with a different HCV genotype. A prophylactic HCV vaccine boosted with multiple HCV genotype may offer a broader and more effective protection.
Collapse
|
|
35
|
Martinello M, Grebely J, Petoumenos K, Gane E, Hellard M, Shaw D, Sasadeusz J, Applegate TL, Dore GJ, Matthews GV. HCV reinfection incidence among individuals treated for recent infection. J Viral Hepat 2017; 24:359-370. [PMID: 28027424 PMCID: PMC5400730 DOI: 10.1111/jvh.12666] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 11/29/2016] [Indexed: 12/15/2022]
Abstract
One challenge to HCV elimination through therapeutic intervention is reinfection. The aim of this analysis was to calculate the incidence of HCV reinfection among both HIV-positive and HIV-negative individuals treated for recent HCV infection (estimated infection duration <18 months). Individuals with recent HCV infection who achieved an end-of-treatment response in four open-label studies between 2004 and 2015 in Australia and New Zealand were assessed for HCV reinfection, confirmed by sequencing of the Core-E2 and/or NS5B regions. Reinfection incidence was calculated using person-time of observation. Exact Poisson regression analysis was used to assess factors associated with HCV reinfection. The cohort at risk for reinfection (n=120; 83% male; median age 36 years) was composed of HIV-positive men-who-have-sex-with-men (53%) and people who inject drugs (current 49%, ever 69%). Total follow-up time at risk was 135 person-years (median 1.08 years, range 0.17, 2.53). Ten cases of HCV reinfection were identified, for an incidence of 7.4 per 100 py (95% CI 4.0, 13.8). Reinfection incidence was significantly higher among participants who reported injection drug use at end of or post-treatment, irrespective of HIV status (15.5 per 100 py, 95% CI 7.8, 31.1). In adjusted analysis, factors associated with reinfection were older age (aIRR 5.3, 95% CI 1.15, 51.5, P=.042) and injection drug use at end of or post-treatment (aIRR 7.9, 95% CI 1.6, 77.2, P=.008). High reinfection incidence following treatment for recent HCV infection in individuals with ongoing risk behaviour emphasizes the need for post-treatment surveillance, harm reduction strategies and education in at-risk populations.
Collapse
Affiliation(s)
- Marianne Martinello
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | - Jason Grebely
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | - Kathy Petoumenos
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | | | - Margaret Hellard
- Centre for Population Health, Burnet Institute, Melbourne, VIC, Australia,Infectious Diseases Unit, Alfred Hospital, Melbourne, VIC, Australia,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - David Shaw
- Infectious Diseases Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Joe Sasadeusz
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Tanya L Applegate
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | - Gregory J Dore
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Australia, Sydney, NSW, Australia,Department of Infectious Disease and Immunology, St Vincent’s Hospital, Sydney, NSW, Australia
| | - Gail V Matthews
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Australia, Sydney, NSW, Australia,Department of Infectious Disease and Immunology, St Vincent’s Hospital, Sydney, NSW, Australia
| |
Collapse
|
|
36
|
Islam N, Krajden M, Shoveller J, Gustafson P, Gilbert M, Buxton JA, Wong J, Tyndall MW, Janjua NZ. Incidence, risk factors, and prevention of hepatitis C reinfection: a population-based cohort study. Lancet Gastroenterol Hepatol 2017; 2:200-210. [DOI: 10.1016/s2468-1253(16)30182-0] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 11/17/2016] [Accepted: 11/17/2016] [Indexed: 02/06/2023]
|
|
37
|
Aspinall EJ, Mitchell W, Schofield J, Cairns A, Lamond S, Bramley P, Peters SE, Valerio H, Tomnay J, Goldberg DJ, Mills PR, Barclay ST, Fraser A, Dillon JF, Martin NK, Hickman M, Hutchinson SJ. A matched comparison study of hepatitis C treatment outcomes in the prison and community setting, and an analysis of the impact of prison release or transfer during therapy. J Viral Hepat 2016; 23:1009-1016. [PMID: 27509844 PMCID: PMC5558600 DOI: 10.1111/jvh.12580] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 07/07/2016] [Indexed: 01/02/2023]
Abstract
Prisoners are a priority group for hepatitis C (HCV) treatment. Although treatment durations will become shorter using directly acting antivirals (DAAs), nearly half of prison sentences in Scotland are too short to allow completion of DAA therapy prior to release. The purpose of this study was to compare treatment outcomes between prison- and community-based patients and to examine the impact of prison release or transfer during therapy. A national database was used to compare treatment outcomes between prison treatment initiates and a matched community sample. Additional data were collected to investigate the impact of release or transfer on treatment outcomes. Treatment-naïve patients infected with genotype 1/2/3/4 and treated between 2009 and 2012 were eligible for inclusion. 291 prison initiates were matched with 1137 community initiates: SVRs were 61% (95% CI 55%-66%) and 63% (95% CI 60%-66%), respectively. Odds of achieving a SVR were not significantly associated with prisoner status (P=.33). SVRs were 74% (95% CI 65%-81%), 59% (95% CI 42%-75%) and 45% (95% CI 29%-62%) among those not released or transferred, transferred during treatment, or released during treatment, respectively. Odds of achieving a SVR were significantly associated with release (P<.01), but not transfer (P=.18). Prison-based HCV treatment achieves similar outcomes to community-based treatment, with those not released or transferred during treatment doing particularly well. Transfer or release during therapy should be avoided whenever possible, using anticipatory planning and medical holds where appropriate.
Collapse
Affiliation(s)
- E J Aspinall
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, NHS National Services Scotland, Glasgow, UK
| | - W Mitchell
- NHS Forth Valley Viral Hepatitis Service, Stirling, UK
| | - J Schofield
- Public Health Protection Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - A Cairns
- Western General Hospital, Edinburgh, UK
| | - S Lamond
- Western General Hospital, Edinburgh, UK
| | - P Bramley
- NHS Forth Valley Viral Hepatitis Service, Stirling, UK
| | | | - H Valerio
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, NHS National Services Scotland, Glasgow, UK
| | - J Tomnay
- Crosshouse Hospital, Kilmarnock, UK
| | - D J Goldberg
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, NHS National Services Scotland, Glasgow, UK
| | - P R Mills
- Gartnavel General Hospital, Glasgow, UK
| | - S T Barclay
- Walton Liver Clinic, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - A Fraser
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - J F Dillon
- Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK
| | - N K Martin
- Division of Global Public Health, University of California San Diego, San Diego, CA, USA
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - M Hickman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - S J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, NHS National Services Scotland, Glasgow, UK
| |
Collapse
|
|
38
|
Structural flexibility at a major conserved antibody target on hepatitis C virus E2 antigen. Proc Natl Acad Sci U S A 2016; 113:12768-12773. [PMID: 27791120 DOI: 10.1073/pnas.1609780113] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Hepatitis C virus (HCV) is a major cause of liver disease, affecting over 2% of the world's population. The HCV envelope glycoproteins E1 and E2 mediate viral entry, with E2 being the main target of neutralizing antibody responses. Structural investigations of E2 have produced templates for vaccine design, including the conserved CD81 receptor-binding site (CD81bs) that is a key target of broadly neutralizing antibodies (bNAbs). Unfortunately, immunization with recombinant E2 and E1E2 rarely elicits sufficient levels of bNAbs for protection. To understand the challenges for eliciting bNAb responses against the CD81bs, we investigated the E2 CD81bs by electron microscopy (EM), hydrogen-deuterium exchange (HDX), molecular dynamics (MD), and calorimetry. By EM, we observed that HCV1, a bNAb recognizing the N-terminal region of the CD81bs, bound a soluble E2 core construct from multiple angles of approach, suggesting components of the CD81bs are flexible. HDX of multiple E2 constructs consistently indicated the entire CD81bs was flexible relative to the rest of the E2 protein, which was further confirmed by MD simulations. However, E2 has a high melting temperature of 84.8 °C, which is more akin to proteins from thermophilic organisms. Thus, recombinant E2 is a highly stable protein overall, but with an exceptionally flexible CD81bs. Such flexibility may promote induction of nonneutralizing antibodies over bNAbs to E2 CD81bs, underscoring the necessity of rigidifying this antigenic region as a target for rational vaccine design.
Collapse
|
|
39
|
Midgard H, Weir A, Palmateer N, Lo Re V, Pineda JA, Macías J, Dalgard O. HCV epidemiology in high-risk groups and the risk of reinfection. J Hepatol 2016; 65:S33-S45. [PMID: 27641987 DOI: 10.1016/j.jhep.2016.07.012] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/08/2016] [Accepted: 07/12/2016] [Indexed: 12/18/2022]
Abstract
Injecting risk behaviours among people who inject drugs (PWID) and high-risk sexual practices among men who have sex with men (MSM) are important routes of hepatitis C virus (HCV) transmission. Current direct-acting antiviral treatment offers unique opportunities for reductions in HCV-related liver disease burden and epidemic control in high-risk groups, but these prospects could be counteracted by HCV reinfection due to on-going risk behaviours after successful treatment. Based on existing data from small and heterogeneous studies of interferon-based treatment, the incidence of reinfection after sustained virological response range from 2-6/100 person years among PWID to 10-15/100 person years among human immunodeficiency virus-infected MSM. These differences mainly reflect heterogeneity in study populations with regards to risk behaviours, but also reflect variations in study designs and applied virological methods. Increasing levels of reinfection are to be expected as we enter the interferon-free treatment era. Individual- and population-level efforts to address and prevent reinfection should therefore be undertaken when providing HCV care for people with on-going risk behaviour. Constructive strategies include acknowledgement, education and counselling, harm reduction optimization, scaled-up treatment including treatment of injecting networks, post-treatment screening, and rapid retreatment of reinfections.
Collapse
Affiliation(s)
- Håvard Midgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute for Clinical Medicine, University of Oslo, Norway; Department of Gastroenterology, Oslo University Hospital, Norway.
| | - Amanda Weir
- School of Health and Life Sciences, Glasgow Caledonian University, United Kingdom; NHS National Services Scotland, Health Protection Scotland, Glasgow, United Kingdom
| | - Norah Palmateer
- School of Health and Life Sciences, Glasgow Caledonian University, United Kingdom; NHS National Services Scotland, Health Protection Scotland, Glasgow, United Kingdom
| | - Vincent Lo Re
- Division of Infectious Diseases, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, United States
| | - Juan A Pineda
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, Spain
| | - Juan Macías
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, Spain
| | - Olav Dalgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute for Clinical Medicine, University of Oslo, Norway
| |
Collapse
|
|
40
|
Weir A, McLeod A, Innes H, Valerio H, Aspinall EJ, Goldberg DJ, Barclay ST, Dillon JF, Fox R, Fraser A, Hayes PC, Kennedy N, Mills PR, Stanley AJ, Aitken C, Gunson R, Templeton K, Hunt A, McIntyre P, Hutchinson SJ. Hepatitis C reinfection following treatment induced viral clearance among people who have injected drugs. Drug Alcohol Depend 2016; 165:53-60. [PMID: 27268294 DOI: 10.1016/j.drugalcdep.2016.05.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/17/2016] [Accepted: 05/17/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Although people who inject drugs (PWID) are an important group to receive Hepatitis C Virus (HCV) antiviral therapy, initiation onto treatment remains low. Concerns over reinfection may make clinicians reluctant to treat this group. We examined the risk of HCV reinfection among a cohort of PWID (encompassing all those reporting a history of injecting drug use) from Scotland who achieved a sustained virological response (SVR). METHODS Clinical and laboratory data were used to monitor RNA testing among PWID who attained SVR following therapy between 2000 and 2009. Data were linked to morbidity and mortality records. Follow-up began one year after completion of therapy, ending on 31st December, 2012. Frequency of RNA testing during follow-up was calculated and the incidence of HCV reinfection estimated. Cox proportional hazards regression was used to examine factors associated with HCV reinfection. RESULTS Among 448 PWID with a SVR, 277 (61.8%) were tested during follow-up, median 4.5 years; 191 (69%) received one RNA test and 86 (31%) received at least two RNA tests. There were seven reinfections over 410 person years generating a reinfection rate of 1.7/100py (95% CI 0.7-3.5). For PWID who have been hospitalised for an opiate or injection related cause post SVR (11%), the risk of HCV reinfection was greater [AHR=12.9, 95% CI 2.2-76.0, p=0.002] and the reinfection rate was 5.7/100py (95% CI 1.8-13.3). CONCLUSION PWID who have been tested, following SVR, for HCV in Scotland appear to be at a low risk of reinfection. Follow-up and monitoring of this population are warranted as treatment is offered more widely.
Collapse
Affiliation(s)
- Amanda Weir
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK.
| | | | - Hamish Innes
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK.
| | - Heather Valerio
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK.
| | - Esther J Aspinall
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK.
| | - David J Goldberg
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK.
| | | | | | - Ray Fox
- Gartnavel General Hospital, Glasgow, UK.
| | | | | | | | | | | | - Celia Aitken
- West of Scotland Specialist Virology Centre, Glasgow, UK.
| | - Rory Gunson
- West of Scotland Specialist Virology Centre, Glasgow, UK.
| | - Kate Templeton
- East of Scotland Specialist Virology Centre, Edinburgh, UK.
| | | | | | - Sharon J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK.
| |
Collapse
|
|
41
|
Midgard H, Bjøro B, Mæland A, Konopski Z, Kileng H, Damås JK, Paulsen J, Heggelund L, Sandvei PK, Ringstad JO, Karlsen LN, Stene-Johansen K, Pettersson JHO, Dorenberg DH, Dalgard O. Hepatitis C reinfection after sustained virological response. J Hepatol 2016; 64:1020-1026. [PMID: 26780289 DOI: 10.1016/j.jhep.2016.01.001] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 12/04/2015] [Accepted: 01/04/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND & AIMS On-going risk behaviour can lead to hepatitis C virus (HCV) reinfection following successful treatment. We aimed to assess the incidence of persistent HCV reinfection in a population of people who inject drugs (PWID) who had achieved sustained virological response (SVR) seven years earlier. METHODS In 2004-2006 we conducted a multicentre treatment trial comprising HCV genotype 2 or 3 patients in Sweden, Norway and Denmark (NORTH-C). Six months of abstinence from injecting drug use (IDU) was required before treatment. All Norwegian patients who had obtained SVR (n=161) were eligible for participation in this long-term follow-up study assessing virological and behavioural characteristics. RESULTS Follow-up data were available in 138 of 161 (86%) individuals. Persistent reinfection was identified in 10 of 94 (11%) individuals with a history of IDU prior to treatment (incidence rate 1.7/100 person-years (PY); 95% CI 0.8-3.1) and in 10 of 37 (27%) individuals who had relapsed to IDU after treatment (incidence rate 4.9/100 PY; 95% CI 2.3-8.9). Although relapse to IDU perfectly predicted reinfection, no baseline factor was associated with reinfection. Relapse to IDU was associated with age <30 years (vs. ⩾40 years) at treatment (adjusted odds ratio [aOR] 7.03; 95% CI 1.78-27.8) and low education level (aOR 3.64; 95% CI 1.44-9.18). CONCLUSIONS Over time, persistent HCV reinfection was common among individuals who had relapsed to IDU after treatment. Reinfection should be systematically addressed and prevented when providing HCV care for PWID.
Collapse
Affiliation(s)
- Håvard Midgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Benedikte Bjøro
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Arild Mæland
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Zbigniew Konopski
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Hege Kileng
- Section of Gastroenterology, University Hospital of North Norway, Tromsø, Norway
| | - Jan K Damås
- Centre of Molecular Inflammation Research, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Infectious Diseases, St. Olav's Hospital, Trondheim, Norway
| | - Jørn Paulsen
- Section of Gastroenterology, Telemark Hospital Trust, Skien, Norway
| | - Lars Heggelund
- Section of Infectious Diseases, Vestre Viken Hospital Trust, Drammen, Norway
| | - Per K Sandvei
- Department of Medicine, Østfold Hospital Trust, Grålum, Norway
| | | | - Lars N Karlsen
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
| | | | - John H-O Pettersson
- Department of Virology, The Norwegian Institute for Public Health, Oslo, Norway
| | - Dagny H Dorenberg
- Department of Virology, The Norwegian Institute for Public Health, Oslo, Norway
| | - Olav Dalgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
|
42
|
Shiffman ML. Universal screening for chronic hepatitis C virus. Liver Int 2016; 36 Suppl 1:62-6. [PMID: 26725899 DOI: 10.1111/liv.13012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 10/27/2015] [Indexed: 02/13/2023]
Abstract
Chronic hepatitis C virus (HCV) infection affects an estimated 123 million persons worldwide and is the leading cause of cirrhosis and hepatocellular carcinoma in most countries. Approximately 75% of persons with chronic HCV were born between the years 1945-1965 and screening of patients in this birth cohort is now advocated. Unfortunately, these recommendations are not readily applied and a sizable population of infected persons who could benefit from treatment fall outside the birth cohort. Universal screening for HCV would be optimal. However, the primary limitation once patients are identified is accessing treatment which remains restricted in most countries.
Collapse
Affiliation(s)
- Mitchell L Shiffman
- Liver Institute of Virginia, Bon Secours Health System, Richmond and Newport News, VA, USA
| |
Collapse
|
|
43
|
Larney S, G Beckwith C, D Zaller N, T Montague B, Rich J. "Seek, test, treat and retain" for hepatitis C in the United States criminal justice system. Int J Prison Health 2015; 10:164-71. [PMID: 25764176 DOI: 10.1108/ijph-11-2013-0051] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE The purpose of this paper is to consider the potential benefits and challenges of applying a strategy of "seek, test, treat and retain" (STTR) to hepatitis C virus (HCV) in the US criminal justice system. DESIGN/METHODOLOGY/APPROACH The authors draw on the published literature to illustrate how each component of STTR could be applied to HCV in the US criminal justice system, and describe challenges to the implementation of this strategy. FINDINGS The burden of morbidity and mortality associated with chronic HCV infection in the USA is increasing and without significantly increased treatment uptake, will likely continue to do so for several decades. The authors argue that the US criminal justice system is an ideal focus for HCV case finding and treatment due to a high prevalence of infection and large volume of individuals in contact with this system. STTR would identify large numbers of HCV infections, leading to opportunities for secondary prevention and primary care. Important challenges to the implementation of STTR include treatment costs and training of prison medical providers. ORIGINALITY/VALUE This paper highlights opportunities to address HCV in the US criminal justice system.
Collapse
Affiliation(s)
- Sarah Larney
- Research Fellow, based at National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia
| | | | | | | | | |
Collapse
|
|
44
|
Zampino R, Coppola N, Sagnelli C, Di Caprio G, Sagnelli E. Hepatitis C virus infection and prisoners: Epidemiology, outcome and treatment. World J Hepatol 2015; 7:2323-2330. [PMID: 26413221 PMCID: PMC4577639 DOI: 10.4254/wjh.v7.i21.2323] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 08/05/2015] [Accepted: 09/07/2015] [Indexed: 02/06/2023] Open
Abstract
The studies on hepatitis C virus (HCV) infection in prison populations are few and mostly cross-sectional. We analyzed prevalently the articles appearing on PubMed in the last ten years. HCV infection is frequent in prisoners, prevalences ranging from 3.1% to 38% according to the HCV endemicity in the geographical location of the prison and in the countries of origin of the foreign prisoners and to the prevalence of intravenous drug use, which is the most important risk factor for HCV infection, followed by an older age of prisoners and previous prison terms. HCV replication in anti-HCV-positive cases varies from 45% to 90% in different studies, and the most common HCV genotypes are generally 1 and 3. The response to antiviral treatment is similar in prisoners to that of the general population. Unfortunately, treatment is administered less frequently to prisoners because of the difficulties in management and follow-up. The new directly acting antivirals offer a good therapy option for inmates because of their good efficacy, short duration of treatment and low incidence of side effects. The efforts of the prison authorities and medical staff should be focused on reducing the spread of HCV infection in prisons by extending the possibility of follow-up and treatment to more prisoners with chronic hepatitis C.
Collapse
Affiliation(s)
- Rosa Zampino
- Rosa Zampino, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Internal Medicine, Second University Naples, 80135 Naples, Italy
| | - Nicola Coppola
- Rosa Zampino, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Internal Medicine, Second University Naples, 80135 Naples, Italy
| | - Caterina Sagnelli
- Rosa Zampino, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Internal Medicine, Second University Naples, 80135 Naples, Italy
| | - Giovanni Di Caprio
- Rosa Zampino, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Internal Medicine, Second University Naples, 80135 Naples, Italy
| | - Evangelista Sagnelli
- Rosa Zampino, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Internal Medicine, Second University Naples, 80135 Naples, Italy
| |
Collapse
|
|
45
|
Marco A, Antón JJ, Trujols J, Saíz de la Hoya P, de Juan J, Faraco I, Caylà JA. Personality disorders do not affect treatment outcomes for chronic HCV infection in Spanish prisoners: the Perseo study. BMC Infect Dis 2015; 15:355. [PMID: 26286450 PMCID: PMC4545785 DOI: 10.1186/s12879-015-1102-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 08/12/2015] [Indexed: 12/26/2022] Open
Abstract
Background The link between infection with hepatitis C virus (HCV) and personality disorders (PD) has not been investigated in detail. The aim of this study was to compare the effectiveness of HCV treatment in prisoners with and without PD. Methods We performed a prospective multicentre study in inmates from 25 Spanish prisons who had been treated with pegylated interferon alfa-2a plus ribavirin in 2011. PD diagnosis was based on the Personality Diagnostic Questionnaire-4+. We calculated adjusted Odds Ratios (AOR) and 95 % confidence intervals (95 % CI) using logistic regression. Results The sample included 236 patients (mean age: 40.3 years, 92.8 % male, 79.2 % intravenous drug users, and 26.3 % HIV-coinfected). The prevalence of PD was 72.5 %. 32.2 % of patients discontinued treatment; this percentage was higher in patients with HCV genotypes 1/4 (AOR = 3.55; CI:1.76–7.18) and those without PD (AOR = 2.51; 1.23–5.11). Treatment discontinuation was mainly for penitentiary reasons (40.3 %): release or transfer between prisons. The rate of sustained viral response (SVR) was 52.1 % by ITT and 76.9 % by observed treatment (OT). SVR was higher among patients with genotype 2 or 3, and those with low baseline HCV-RNA. We did not observe any differences between individuals with and without PD in term of SVR, HCV genotype or HIV infection. Conclusions Our results support the safety and clinical effectiveness of the treatment of chronic HCV infection in correctional facilities, both in prisoners with PD and those without. Our data support non-discrimination between patients with and without PD when offering treatment for HCV infection to prison inmates. Trial registration Trial registration number (TRN) NCT01900886. Date of registration: July 8, 2013
Collapse
Affiliation(s)
- Andrés Marco
- Barcelona Men's Penitentiary Health Services, Barcelona, Spain. .,CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
| | - José J Antón
- Albolote Penitentiary Health Services, Granada, Spain.
| | - Joan Trujols
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), CIBER Salud Mental (CIBERSAM), Barcelona, Spain.
| | | | - José de Juan
- Córdoba Penitentiary Health Services, Córdoba, Spain.
| | | | - Joan A Caylà
- CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain. .,Epidemiology Service, Barcelona Public Health Agency, Plaza Lesseps 1, 08023, Barcelona, Spain.
| | | |
Collapse
|
|
46
|
Kong L, Kadam RU, Giang E, Ruwona TB, Nieusma T, Culhane JC, Stanfield RL, Dawson PE, Wilson IA, Law M. Structure of Hepatitis C Virus Envelope Glycoprotein E1 Antigenic Site 314-324 in Complex with Antibody IGH526. J Mol Biol 2015; 427:2617-28. [PMID: 26135247 PMCID: PMC4523428 DOI: 10.1016/j.jmb.2015.06.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 06/17/2015] [Accepted: 06/18/2015] [Indexed: 01/19/2023]
Abstract
Hepatitis C virus (HCV) is a positive-strand RNA virus within the Flaviviridae family. The viral "spike" of HCV is formed by two envelope glycoproteins, E1 and E2, which together mediate viral entry by engaging host receptors and undergoing conformational changes to facilitate membrane fusion. While E2 can be readily produced in the absence of E1, E1 cannot be expressed without E2 and few reagents, including monoclonal antibodies (mAbs), are available for study of this essential HCV glycoprotein. A human mAb to E1, IGH526, was previously reported to cross-neutralize different HCV isolates, and therefore, we sought to further characterize the IGH526 neutralizing epitope to obtain information for vaccine design. We found that mAb IGH526 bound to a discontinuous epitope, but with a major component corresponding to E1 residues 314-324. The crystal structure of IGH526 Fab with this E1 glycopeptide at 1.75Å resolution revealed that the antibody binds to one face of an α-helical peptide. Single mutations on the helix substantially lowered IGH526 binding but did not affect neutralization, indicating either that multiple mutations are required or that additional regions are recognized by the antibody in the context of the membrane-associated envelope oligomer. Molecular dynamics simulations indicate that the free peptide is flexible in solution, suggesting that it requires stabilization for use as a candidate vaccine immunogen.
Collapse
Affiliation(s)
- Leopold Kong
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Rameshwar U Kadam
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Erick Giang
- Department of Immunology and Microbial Science, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Tinashe B Ruwona
- Department of Immunology and Microbial Science, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Travis Nieusma
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Jeffrey C Culhane
- Department of Chemistry, The Scripps Research Institute, La Jolla, CA 92037, USA; Department of Cell and Molecular Biology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Robyn L Stanfield
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Philip E Dawson
- Department of Chemistry, The Scripps Research Institute, La Jolla, CA 92037, USA; Department of Cell and Molecular Biology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Ian A Wilson
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA 92037, USA; The Skaggs Institute for Chemical Biology, The Scripps Research Institute, La Jolla, CA 92037, USA.
| | - Mansun Law
- Department of Immunology and Microbial Science, The Scripps Research Institute, La Jolla, CA 92037, USA.
| |
Collapse
|
|
47
|
Pineda JA, Núñez-Torres R, Téllez F, Mancebo M, García F, Merchante N, Pérez-Pérez M, Neukam K, Macías J, Real LM. Hepatitis C virus reinfection after sustained virological response in HIV-infected patients with chronic hepatitis C. J Infect 2015. [PMID: 26212868 DOI: 10.1016/j.jinf.2015.07.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To assess the incidence of hepatitis C virus (HCV) reinfections after therapy-induced clearance in HIV-coinfected patients with prior chronic hepatitis C. METHODS Eighty-four HIV-infected subjects, who had previously achieved sustained virological response (SVR) after being treated of chronic hepatitis C, were analyzed. In all of them, at least yearly HCV RNA determinations were carried out during a median (range) of 34 (12-146) months. RESULTS Seventy-two (86%) subjects had been people who inject drugs (PWID), of whom 11 (15%) continued to use snorted or injected drugs during the follow-up. Four (4.76%) patients showed HCV reinfection (incidence 1.21 [95% confidence interval: 0.3-3.09] cases per 100 person-years). These patients maintained risk factors for HCV infection. In three cases, HCV genotype switched. Phylogenetic analysis of the remaining case suggested reinfection from his sexual partner. CONCLUSION The incidence of HCV reinfection in the overall population of HIV-coinfected patients who achieved SVR after being treated against chronic hepatitis C is low. A low frequency of risk behavior is the main factor accounting for this modest rate of reinfection. The possibility of reinfection should not be considered a reason against treatment of HCV infection with direct acting antivirals in PWID.
Collapse
Affiliation(s)
- Juan A Pineda
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Avda. de Bellavista s/n, 41014 Sevilla, Spain.
| | - Rocio Núñez-Torres
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Avda. de Bellavista s/n, 41014 Sevilla, Spain
| | - Francisco Téllez
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital La Línea, AGS Campo de Gibraltar, Avda. Menéndez Pelayo 103, 11300 La Línea de la Concepción, Cádiz, Spain
| | - María Mancebo
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Avda. de Bellavista s/n, 41014 Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Campus Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Sevilla, Spain
| | - Federico García
- Servicio de Microbiología, Complejo Hospitalario Universitario de Granada, Centro San Cecilio-PTS, C. Dr. Oloriz, 18012 Granada, Spain
| | - Nicolás Merchante
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Avda. de Bellavista s/n, 41014 Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Campus Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Sevilla, Spain
| | - Montserrat Pérez-Pérez
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital La Línea, AGS Campo de Gibraltar, Avda. Menéndez Pelayo 103, 11300 La Línea de la Concepción, Cádiz, Spain
| | - Karin Neukam
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Avda. de Bellavista s/n, 41014 Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Campus Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Sevilla, Spain
| | - Juan Macías
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Avda. de Bellavista s/n, 41014 Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Campus Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Sevilla, Spain
| | - Luis M Real
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Avda. de Bellavista s/n, 41014 Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Campus Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Sevilla, Spain
| | | |
Collapse
|
|
48
|
Abstract
The majority of new and existing cases of HCV infection in high-income countries occur among people who inject drugs (PWID). Ongoing high-risk behaviours can lead to HCV re-exposure, resulting in mixed HCV infection and reinfection. Assays used to screen for mixed infection vary widely in sensitivity, particularly with respect to their capacity for detecting minor variants (<20% of the viral population). The prevalence of mixed infection among PWID ranges from 14% to 39% when sensitive assays are used. Mixed infection compromises HCV treatment outcomes with interferon-based regimens. HCV reinfection can also occur after successful interferon-based treatment among PWID, but the rate of reinfection is low (0-5 cases per 100 person-years). A revolution in HCV therapeutic development has occurred in the past few years, with the advent of interferon-free, but still genotype-specific regiments based on direct acting antiviral agents. However, little is known about whether mixed infection and reinfection has an effect on HCV treatment outcomes in the setting of new direct-acting antiviral agents. This Review characterizes the epidemiology and natural history of mixed infection and reinfection among PWID, methodologies for detection, the potential implications for HCV treatment and considerations for the design of future studies.
Collapse
|
|
49
|
Abstract
The advent of potent and safe direct-acting antivirals against the hepatitis C virus has the potential of fulfilling the dream of eliminating this infection and its impact on global public health. However, even if effective drugs are at hand, most patients remain unaware of their infection, which may be recognized only in late stages when dire complications have occurred. Europe is not spared by this scourge, with its estimated 19,000,000 persons infected, and knowledge of the epidemiology of HCV and its drivers is a critical tool in fighting this virus. A thorough review is provided on the extent of the HCV epidemic across Europe, with a discussion of the most important subgroups affected, and of the risk factors of infection, both traditional and new.
Collapse
|
|
50
|
Alanko Blomé M, Björkman P, Molnegren V, Höglund P, Widell A. Hepatitis C viremia patterns in incident hepatitis C infection and one year later in 150 prospectively tested persons who inject drugs. PLoS One 2014; 9:e97022. [PMID: 24830647 PMCID: PMC4022632 DOI: 10.1371/journal.pone.0097022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 04/15/2014] [Indexed: 12/15/2022] Open
Abstract
Objectives To assess HCV viremia levels just before, during and one year after anti-HCV seroconversion in people who inject drugs (PWID). Methods PWID enrolling into a needle exchange program in Malmö, Sweden, 1997–2005 constituted the source population. Sera were obtained at enrolment and at approximately 3–4 monthly intervals afterwards, and were initially tested for anti-HIV, HBsAg/anti-HBc and anti-HCV and thereafter for markers previously negative. Seroconversion to anti-HCV had occurred during the study period in 186 out of 332 seronegative subjects. In these anti-HCV seroconverters, quantitative HCV RNA PCR was retrospectively performed on frozen sera to determine viremia levels in the last anti-HCV negative, the first anti-HCV positive and in one year follow-up samples. Results Among 150 subjects seroconverting to anti-HCV with samples available from all three defined time-points, eight different patterns of viremia were observed. Spontaneous clearance at one year was noted in 48 cases (32%) and was associated with female gender (p = 0.03, CI 0.17–1.00). In 13 cases HCV-RNA was not detected in any study sample. Among 61 subjects with pre-seroconversion viremia, viral load was significantly higher in the pre-seroconversion samples compared to subsequent samples. For the whole group, viral load declined to undetectable levels at seroconversion in 28% of cases (but with recurrent viremia in 15%). Conclusions Different patterns of HCV RNA kinetics were observed among PWID with documented seroconversion to anti-HCV. The frequently observed absence of detectable HCV RNA in the first anti-HCV positive sample (irrespective of subsequent viremia) demonstrates the importance of repeated sampling and RNA testing for determination of the outcome of acute infection.
Collapse
Affiliation(s)
- Marianne Alanko Blomé
- Infectious Disease Unit, Division of Clinical Sciences, Lund University, Malmö, Sweden
| | - Per Björkman
- Infectious Disease Unit, Division of Clinical Sciences, Lund University, Malmö, Sweden
| | - Vilma Molnegren
- Department of Clinical Microbiology, Division of Laboratory Sciences, Lund University, Malmö, Sweden
| | - Peter Höglund
- Medical Statistics and Epidemiology Unit, Research and Development Centre Skåne, Lund, Sweden
| | - Anders Widell
- Department of Clinical Microbiology, Division of Laboratory Sciences, Lund University, Malmö, Sweden
- * E-mail:
| |
Collapse
|