Expanding treatment indications in chronic hepatitis B: Should we treat all patients?

Hepatology International, Год журнала: 2025, Номер unknown

Опубликована: Фев. 17, 2025

Abstract Nucleos(t)ide analogues (NUCs) are first-line agents for chronic hepatitis B (CHB). Current guidelines provide recommendations NUC initiation, yet the complex and restrictive. Accumulating data on virus (HBV) replication HBV integration suggests that there no real quiescent disease phases in CHB, treatment-ineligible patients current still have substantial risks of cirrhosis hepatocellular carcinoma. Expanding CHB treatment indications can effectively reduce liver-related complications. Furthermore, indication expansion be cost-effective, simplify care pathways to remove barriers. Potential caveats include non-compliance, long-term side effects from NUCs, poor patient acceptability. Nonetheless, these not insurmountable, benefits outweigh disadvantages. There is consensus among hepatologists supporting expansion, although expert panels varying strategies. A treat-all approach, which involves treating all patients, has also been proposed. strategy straightforward, should yield greatest a population health perspective. However, feasibility new strategies, especially influenced by multiple factors including local epidemiology, healthcare resource availability, socioeconomic factors. one-size-fits-all approach optimal, strategies tailored based impact toward elimination.

Язык: Английский

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Peer-delivered point-of-care testing and linkage to treatment for hepatitis C virus infection among marginalized populations through a mobile clinic in Copenhagen, Denmark

International Journal of Drug Policy, Год журнала: 2023, Номер 121, С. 104185 - 104185

Опубликована: Сен. 27, 2023

Globally, many people with hepatitis C virus (HCV) infection are marginalized and have very limited access to traditional healthcare services, including HCV testing treatment. Models of care attuned the needs population at risk needed. This study aimed evaluate treatment uptake a community-based, peer-led model offering point-of-care testing.In this interventional cohort study, were recruited between May 2019 December 2021 mobile clinic. During single visit, participants offered antibody test, and, if antibodies detected, an additional RNA test. Participants detectable linked peer-assisted referral 'fast-track' clinic major hospital. The primary outcomes number engaged in proportion who initiated achieved sustained virologic response (SVR).We tested 728 individuals. Of those, 208 (29%) positive for antibodies, 114 (15%) detectable. 114, 80 (70%) treatment, 79 (99%) SVR. main reason not initiating was non-Danish citizenship no legal health care.This found that service is can engage groups linkage

Язык: Английский

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Real‐world economic burden of hepatitis C and impact of direct‐acting antivirals in France: A nationwide claims data analysis

Liver International, Год журнала: 2024, Номер 44(5), С. 1233 - 1242

Опубликована: Фев. 20, 2024

The economic impact of managing patients with hepatitis C virus (HCV) infection remains unknown. This study aimed to assess the burden chronic HCV from a national health insurance perspective and direct-acting antivirals (DAAs) using nationwide real-world data. Patients were identified French Health Insurance Claims Databases (SNDS) matched for age sex general population. resource utilization reimbursements summarized according healthcare expenditure items 2012 2021. attributable was evaluated over 10-year period. Finally, DAAs estimated data derived SNDS. A total 145 187 identified. Among eligible DAA therapy, 81.5% had received by end Over period, resulted in an additional cost €9.71 billion (95% confidence interval [CI]: €9.66-€9.78 billion) or €9191 CI: €9134-€9252) per patient year compared After higher than population, €5781 €5540-€6028) at fifth-year post-DAA therapy. significant persists among after treatment. high proportion not treated therapy supports reinforcing policies universal access.

Язык: Английский

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Changing global epidemiology of chronic hepatitis C virus-related outcomes from 2010 to 2019: cirrhosis is the growing burden of hepatitis C virus-related disease

European Journal of Cancer Prevention, Год журнала: 2024, Номер unknown

Опубликована: Март 22, 2024

Background Chronic infection with hepatitis C virus (HCV) has a long-term impact on hepatic consequences. A comprehensive evaluation of the global burden HCV-related health outcomes can help to develop HCV prevention and treatment program. Methods We used 2019 Global Burden Disease (GBD) Study comprehensively investigate temporal trends in incidence, mortality disability-adjusted life-years (DALYs) diseases, including liver cancer cirrhosis other diseases across 264 countries territories from 2010 2019. Results Globally, there were 152 225 incident cases, 141 811 deaths approximately 2.9 million DALYs because cancer, 551 668 395 022 about 12.2 Worldwide, during 2010–2019 period, incidence declined, however, was 62% increase incidence. In 2019, Eastern Mediterranean region highest rates both cirrhosis. Africa fastest-growing trend period [annual percentage change (APC) = 2.09, 95% confidence interval (CI): 1.93–2.25], followed by Western Pacific (APC 1.17, CI: 1.09–1.22). Americas only observing increased 0.70 0.12, respectively). identified three patterns that reported rates. Conclusion Urgent measures are required for diagnosis, research at global, regional country levels, particularly Africa, Mediterranean.

Язык: Английский

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World Hepatitis Day 2023: Are we close to the target?

The Indian Journal of Medical Research, Год журнала: 2023, Номер 158(1), С. 1 - 1

Опубликована: Янв. 1, 2023

Viral hepatitis is a major global health challenge. In particular, chronic B virus (HBV) and C (HCV) infections are causes of cirrhosis hepatocellular carcinoma1, these two viruses account for 96 per cent viral hepatitis-related mortality2. 2016, the World Health Organization (WHO) called elimination as public threat by 2030, aiming 90 reduction in incidence 65 mortality due to HBV or HCV3. Since target was established, extensive policy changes campaigns have been implemented worldwide2. HCV treatment success rates dramatically risen we entered direct-acting antivirals (DAAs) era4, whereas management has also evolved with increasing availability nucleos(t)ide analogues5 emergence novel drugs6. As stand at halfway mark between 2016 it good opportunity evaluate our progress. Are close target? Hepatitis Through rigorous data collection from 200 countries regions, WHO estimated prevalence 3.84 (295.9 million patients) 2019, which increased 3.5 2015. The HBV-related 0.821 decreased seven since 20152. These numbers failed reach 2020 Interim Goals set WHO7. vaccine developed almost four decades ago, well documented reduce transmission long-term complications HBV8. However, coverage remained suboptimal, timely administration birth dose this only 43 85 three doses vaccine7. Vaccination low African region, region that accounts 64.9 new globally, forming vicious cycle infections2. Barriers vaccination multifactorial. Interventions such accessibility, providing outreach services education will be required enhance coverage9. Most patients do not know about their diagnosis they symptoms early-stage disease. 10.3 knew were infected2, number fell far short interim 30 diagnosis7. Large discrepancies noted European, western Pacific American regions all achieving >18.5 cent, while southeast Asian had 2.2 2.1 respectively2. screening supported various international societies. latest 2023 guidelines US Centers Disease Control recommend universal adults panel surface antigen (HBsAg), antibody (anti-HBs) core antigen10. Modelling studies demonstrated can cost-effective11, yet efficacy programmes may affected existing knowledge gaps social barriers12. Tailoring interventions at-risk populations warranted uptake programmes. Aside carriers, linkage care equally important. A streamlined programme transition newly diagnosed would paramount lost follow up13. current first line analogues unable reliably induce HBsAg seroclearance; yet, highly effective suppressing replication reducing complications5. 21.8 eligible received therapy globally; high regional discrepancy noted. accounted 84.2 receiving worldwide, 1.6 on-treatment patients2. Generic tenofovir disoproxil fumarate entecavir now available, costs USD year. most require lifelong treatment, economic impact multiple more prominent low-to-middle-income countries14. recent years, many drugs being entering clinical trials6. If effectively seroclearance, obviate provide boost elimination. infection 57.8 (0.75% prevalence) caused 0.287 deaths dropped 2015 figures one 400 thousand mortalities. This large improvement primarily driven successful DAAs2. approval sofosbuvir 2013, officially all-oral DAA era. DAAs tolerated, pangenotypic cure over 95 patients4. costly than HBV. encompasses single course established cost-effective15. Allocating lump sum challenging, worthwhile investment. For example, Egypt highest world before implementing assistance Bank, national 2.3 20192. Among 66 burden, eight on track eliminate 203016. With challenge lies case finding coverage. 21 worldwide status. patients, 9.4 Globally, Eastern Mediterranean reached targets coverage, efforts Egypt2. predominantly spread through intravenous injections modern era, resulting disproportionately marginalized people who inject (PWID)17. Screening targeting general population may, hence, ineffective HCV. Even if diagnosed, default clinic appointments, poor adherence up main reason coverage4. Dedicated micro-elimination thus improve control17. Micro-elimination influenced economic, geographical cultural factors. There no one-size-fits-all programme, each nation must tailor own effectiveness. Unlike HBV, anti-HCV does offer seroprotection. Reinfection is, unique among treated Education behavioural critical risks reinfection. Multidisciplinary involving addiction specialists, mental sexual role reinfection18. elimination? shown 2030 target2,16. hurdle healthcare inequity. While some made strides towards elimination, able implement basic policies16. level, collaborative necessary tackle inequities, levels, further acceleration scaling necessary. study16 showed policies did correlate progress move closer simply pushing out sufficient. It perhaps, important consider granular details quality implementation, clinician patient high-risk groups. Outcome assessment necessary, should aim achieve tangible outcomes sustainable benefit patients16. COVID-19 pandemic an unforeseen All facets including screening, referral delayed least 20 countries19. year delay result 44000 carcinoma cases 72000 liver related mortalities20. undoubtedly short-term care, lessons learnt applicable long run. development therapeutics highlighted potential collaborations expedite drug provision. Other concepts self-testing telehealth popularized, applied efforts. pace Nonetheless, massive made, remain optimistic. July 28th Day, annual event observed 2010. Day perfect us reflect progress, raise awareness concentrate time push it. Financial support & sponsorship: None. Conflicts Interest:

Язык: Английский

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Knowledge of, and attitude towards, the treatment of hepatitis C in people who inject drugs

Harm Reduction Journal, Год журнала: 2024, Номер 21(1)

Опубликована: Авг. 28, 2024

Direct acting antivirals (DAAs) as a curative treatment of hepatitis C have been available for several years and replaced interferon-containing therapies. However, rates people who inject drugs (PWID) are declining in Germany, putting the elimination by 2030 at risk. This study aimed elucidating knowledge of, attitude towards, clinical sample PWID.

Язык: Английский

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Progression of the FIB-4 index among patients with chronic HCV infection and early liver disease

BMJ Open Gastroenterology, Год журнала: 2023, Номер 10(1), С. e001209 - e001209

Опубликована: Дек. 1, 2023

Background and aims Historical paired liver biopsy studies are likely to underestimate current progression of disease in patients with chronic hepatitis C virus (HCV) infection. We aimed assess according the non-invasive Fibrosis-4 (FIB-4) index HCV early disease. Methods results Patients diagnosed FIB-4 <3.25 from four international clinics were included a retrospective cohort study. Follow-up ended at start antiviral therapy resulting sustained virological response, time transplantation or death. Primary outcome advanced was defined as >3.25 during follow-up. Survival analyses used >3.25. In total, 4286 followed for median 5.0 (IQR 1.7–9.4) years, which 41 071 measurements collected. At baseline, age 47 39–55) 2529 (59.0%) male, 2787 (65.0%) had <1.45. Advanced developed 821 patients. Overall, 10-year cumulative incidence 32.1% (95% CI 29.9% 34.3%). who showed an exponential increase. Among presumed date infection, increased 7.7-fold 20 40 years opposed first after Conclusions The rate is high among HCV-infected diagnosis, whom accelerated over time. These emphasise need overcome any limitations respect diagnosing treating all across globe.

Язык: Английский

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Editorial: Revisit the causes and long‐term outcomes in cirrhosis patients—Authors' reply

Alimentary Pharmacology & Therapeutics, Год журнала: 2024, Номер 60(2), С. 286 - 287

Опубликована: Май 23, 2024

LINKED CONTENT This article is linked to Tran et al papers. To view these articles, visit https://doi.org/10.1111/apt.18024 and https://doi.org/10.1111/apt.18046 .

Язык: Английский

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Bioequivalence Study of Velpatasvir/Sofosbuvir Oral Coated Tablets in Healthy Volunteers Under Fasting Conditions

Clinical Pharmacology in Drug Development, Год журнала: 2024, Номер 13(10), С. 1123 - 1129

Опубликована: Июнь 16, 2024

This study was conducted as a single-site, open-label, randomized, replicated crossover trial with 4 treatment periods. The aim to evaluate the bioequivalence of generic test drug containing velpatasvir and sofosbuvir compared an established brand-name medication in healthy White subjects under fasting conditions. Blood samples were collected at specified intervals up 72 hours after dosing measure concentrations using certified high-performance liquid chromatography tandem mass spectrometry method. 2 formulations confirmed when statistical analysis showed that confidence for log-transformed peak concentration area concentration-time curve from time 0 last quantifiable sample within acceptable range 80% 125%. Criteria met both until parameters. No adverse effects reported during this groups.

Язык: Английский

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Towards risk-based surveillance for hepatocellular carcinoma after HCV cure?

Hepatology, Год журнала: 2024, Номер unknown

Опубликована: Авг. 13, 2024

Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, The Netherlands Manuscript type editorial Correspondence Adriaan J. van der Meer, & Hepatology. Email: [email protected]

Язык: Английский

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