Chronic Hepatitis C Virus Patients Research Articles

The Diagnostic Performance of Serum Hyaluronic Acid and Collagen III in Differentiating Liver Fibrosis in HCV-Induced Patients

Abstract Introduction/Objective Chronic liver diseases may lead to inflammation and progressive scarring, causing irreversible hepatic damage (cirrhosis). To avoid the complications of liver puncture biopsy, Collagen III and Hyaluronic acid are studied as non-invasive markers of liver fibrosis in chronic liver diseases. Aim of the work: Discovering the diagnostic role of serum Hyaluronic acid and Collagen III in liver fibrosis associated with chronic HCV patients. Methods/Case Report The study was performed on 118 patients with liver fibrosis associated with chronic HCV (60 males and 58 females) and 50 age-matched healthy subjects (27 males and 23 females). Liver function tests were measured, including ALT, AST, [AST/ ALT] ratio, albumin, total bilirubin, and platelets counts. APRI was also calculated as [AST/ (upper limits of normal)/ platelets count 109/L]×100. Serum levels of Collagen III (ng/ml) and hyaluronic acid (µg/L) were determined. Plotted receiver-operating characteristic (ROC) curves were used to assess and compare the diagnostic accuracy of biomarkers. Results (if a Case Study enter NA) The area under ROC curve of collagen III in discriminating liver fibrosis in patients associated with chronic HCV infection and healthy ones was 0.805; P< 0.0001. The Sensitivity and Specificity were 62% and 96%, respectively. While the area under ROC curve of hyaluronic acid in discriminating liver fibrosis patients associated with chronic HCV infection from healthy volunteers was 0.832; P < 0.0001. The Sensitivity and Specificity were 72% and 94%, respectively. Also, there was no significant correlation between levels of collagen III and hyaluronic acid; (r=0.01 & P=0.714). Conclusion Collagen III and Hyaluronic acid can identify patients with liver fibrosis with a detection rate of 62% and 72%, respectively. So, both biomarkers are considered powerful non-invasive methods in discriminating and diagnosing liver fibrosis in chronic HCV patients.

Chi phí chẩn đoán và điều trị cho người bệnh Viêm gan vi rút C mạn tính tại bệnh viện A Thái Nguyên, năm 2021

Objective: To calculate the average cost of outpatient chronic hepatitis C diagnosis and treatment from the view of Vietnam Social Security (VSS), A Thai Nguyen Hospital, in 2021; Methods: Cross-sectional descriptive study. Study is based on retrospective billing data from hospital discharge records with 257 Hepatitis C outpatients who completed treatment from May 2021 to Dec 2021 at Thai Nguyen A Hospital. Main findings: The average cost per case of diagnosis and treatment for chronic HCV patients in the non-cirrhotic stage or compensated cirrhosis is 30 million VND and 58 million VND for patients with decompensated cirrhosis. Drug costs account for more than 90% of the total cost of diagnosis and treatment of chronic HCV. Conclusions: The study provided evidence on the cost of diagnosis and treatment for VGC outpatients from the point of view of Vietnam Social Security at A Thai Nguyen hospital. The average total cost of diagnosis and treatment for 01 patient in the late stage with decompensated cirrhosis is double price for 01 patient in the early stages (no cirrhosis/compensated cirrhosis). In addition, drug costs account for more than 90% of the cost of diagnosis and treatment. Thai Nguyen province promote screening and treatment programs for HCV at an early stage such as without cirrhosis or with compensated cirrhosis. At the same time, implementing methods of drug procurement to reduce prices and continue to lobby for funding for the diagnosis and treatment of HCV to help reduce the burden of HCV in the locality. Keywords: Costing, Hepatities C, A Thai Nguyen Hospital

Impact of Treatment of Chronic HCV Patients by Direct Acting Antiviral Drugs (DAADs) on COVID -19 Disease Frequency and Severity

Impact of Treatment of Chronic HCV Patients by Direct Acting Antiviral Drugs (DAADs) on COVID -19 Disease Frequency and Severity

Impact of IL28B (rs8099917) gene polymorphism on treatment response to Sovaldi, Daklinza, and Ribavirin in Egyptian patients with HCV infection

ABSTRACT Infection by the hepatitis C virus (HCV) is a big threat to human health all over the world. Many host factors could affect the treatment response in HCV infection. One of these factors is IL28B gene polymorphism. This research study investigated the association of IL28B (rs8099917) gene polymorphism with treatment response in patients with chronic hepatitis C virus (HCV) infection receiving a combination of Sovaldi, Daklinza, and Ribavirin in Egypt. The study included 100 patients, divided into three groups based on treatment outcomes: responders, relapsers, and non-responders. Biochemical and hematological analyses were performed, and HCV genotypes were determined using PCR. IL28B genotyping was done using real-time PCR. The results showed a high prevalence of HCV genotype 4 and a few patients with genotype 1. The G allele of IL28B was associated with a higher risk of developing relapse and non-response, while the TT genotype was significantly associated with treatment success. Viral load levels were lower in responders compared to relapsers and non-responders. The study suggests that IL28B genotype may be a valuable predictor of treatment response in chronic HCV patients treated with the specified combination therapy. Further research is needed to confirm and fully understand these findings.

Study of Serum Chemerin Level in Chronic Hepatitis C Virus Patients with and without Nonalcoholic Fatty Liver Disease

Abstract Background Chronic hepatitis C (CHC) has a number of features that suggest that it should be recognized not only as a viral disease but also as a metabolic liver disease that encompasses insulin resistance (IR), liver steatosis, impaired glucose tolerance or type 2 diabetes mellitus (T2DM) and disturbances in lipid metabolism. Objective To evaluate the role of serum Chemerin as a biomarker in patients with chronic hepatitis C virus with and without Non Alcoholic Fatty Liver Disease and its correlation to disease progress and activity and to evaluate its relationship with various laboratory parameters of the disease. Patients and Methods Type of study: A case control study. Study setting: outpatient clinics and inpatient wards at King Fahd hospital, Medina, Saudi Arabia & outpatient clinics at Ain Shams university hospitals, Egypt. Study Period: 6 months. Study Population: The study was conducted on normal populations, chronic HCV patients with NAFLD, and chronic HCV patients without NAFLD. Results In the present study the mean chemerin level was found to be statistically higher in chronic hepatitis C virus patients with NAFLD group compared to chronic hepatitis C virus patients without NAFLD group and was found to be statistically higher in both previous groups than in control group (p value <0.05). There was significant positive correlation between serum chemerin with ALT (p value <0.01), AST (p value<0.01), BMI (P value<0.01), INR (p value<0.01), triglyceride (p value<0.01), FIB4 index (p value <0.01) and NAFLD fibrosis score (p value <0.01). There was significant negative correlation between serum chemerin with serum ALBUMIN (p value <0.01). Conclusion The results obtained in the current study demonstrate that the serum chemerin level increased in parallel with the worsening liver functional reserves in CHC patients and serum chemerin level incrased in patients with CHC associated with NAFLD. It could be concluded that chemerin may be considered as additional tools for assessment of prognosis of CHC and monitoring the virally derived metabolic abnormality.

Incidence of Hepatocellular Carcinoma in Hepatitis C Patients Treated with Direct-Acting Antivirals and Its Relation to Hepatic Fibrosis Stage

Abstract Introduction Significant advances in understanding of the molecular virology, life cycle, and pathogenesis of Hepatitis C Virus (HCV) led to the Direct-Acting Anti-viral (DAA) era of HCV therapy in 2011 (Hezode et al.,2015). It can be expected that rates of HCV-associated hepatocellular carcinoma (HCC) will decrease significantly after the widespread adoption of DAAs, However Hepatitis C patients with cirrhosis who were treated with direct-acting antivirals had increased likelihood of developing HCC (Tayyab et al., 2020) (Kozbial et al., 2016). HCC was also associated with greater liver stiffness according to transient elastography and lower platelet counts (Conti et al., 2016). The aim of this study is to investigate incidence of HCC in Egyptian HCV patients in whom other predominant HCV genotypes are prevalent and different treatment protocols followed. Methods This was a retrospective study including 400 chronic HCV patients who were following up their medical condition at Kobri El-Koba Military Hospital hepatology outpatient clinic from January 2018 to September 2019. Patients were divided into two main equal groups regarding either received HCV direct acting antivirals or not. Incidence of HCC after 18 months of follow up were compared between two groups. Its relation to hepatic fibrosis stage was calculated in both groups. Results DAA receiving group had significantly lower incidence of HCC than non DAA receiving group (control group). Eleven patients in DAA receiving group developed HCC (5.5%) compared to twenty-two patients in control group (11%) with P- value 0.04. Although there was no significant difference between two groups regarding pre-treatment prevalence of ascites, splenomegaly, or esophageal varices, DAA receiving group had statistically significant advanced hepatic fibrosis when compared to control group. Before starting treatment, DAA Receiving group shows (4.5% F0, 14% F1, 7% F2, 11.5% F3 and 63% F4) versus (20.5% F0, 14% F1, 18.5% F2, 6.5% F3 and 40.5% F4) in control group with highly significant P value 0.00. Conclusion Incidence of HCC decreased significantly after DAA in chronic HCV patients. Decreased incidence occurred despite advanced hepatic fibrosis in this group of patients.

Impact of Direct Acting Antiviral (DAA) Agents on Hematological and Hepatic Statuses of Patients with Chronic Hemolytic Anemias and Chronically Infected with Hepatitis C Virus (HCV)

Abstract Background Different combinations of Direct Antiviral Agents (DAAs) have been used against different Hepatitis C Virus (HCV) genotypes and in different types of patients. Aim and objectives To investigate the impact of DAA-based regimens on hematological and hepatic statuses of patients with chronic hemolytic anemias and chronically infected with HCV. Subjects and Methods This is a cross sectional study, was carried out at viral hepatitis research and treatment center of Ain Shams University Hospitals, on 50 patients with chronic hemolytic anemias and has HCV infection, from December 2019 till June 2020. Result There was high statistically significant difference before treatment, first month, third month and sixth month follow up in chronic liver disease group as regard HGB, statistically significant in Hemolytic anemia group (no splenectomy) as regard HGB and there was high statistically significant difference between the studied groups as regard HGB. Conclusion DAAs therapy is effective and tolerable in patients with chronic HCV patients. It improves liver necro-inflammatory changes in patients, evidenced by decreased liver enzymes' level, but still require careful observation during DAAs therapy for being more susceptible for hemolytic anemia.

Effect of Direct Acting Anti-Viral Drugs on Myostatin Level among CRF Egyptian Patients with Chronic HCV Infection and Its Correlation with Sarcopenia

Background Chronic kidney disease (CKD) is a progressive condition that might negatively affect musculoskeletal health. Secondary sarcopenia due to chronic kidney disease may be accompanied with elevated fall risk and mobility limitations. The loss of muscle mass, in addition to the impact of poor body composition on muscle strength and mobility status are necessary for classification and staging of sarcopenia. Aim of the Work The main aim of this study was to assess the effect of direct anti-viral drugs on myostatin level and its correlation with sarcopenia in CRF patient with chronic HCV. Patients and Methods This was a case control study was conducted at gastroenterology outpatients’ clinics and internal medicine and nephrology department Ain Shams university hospital and om elmasryeen general hospital including 50 chronic renal failure patients with chronic HCV infection and normal persons; they were divided into: Group A: 20 chronic HCV patient received direct acting anti-viral drugs. Group B: 20 chronic HCV patients didn’t receive direct acting antiviral drugs. Group C: 10 normal persons without chronic renal failure or hepatitis C virus. The duration of the study ranged from 6-12 months. Results There was no statistically significant difference between the studied groups as regard demographic data, there was high statistically significant difference between the studied groups as regard weight, lean body mass and BMI, there was high statistically significant difference between the studied groups as regard Hb, there was high statistically significant difference between the studied groups as regard history of ALT and AST and significant difference between the two studied groups as regards Alpha fetoprotein, there was high statistically significant difference between the studied groups as regard history of BUN and significant difference between the two studied groups as regards Creatinine, there was statistically significant difference between the studied groups as regard Serum myostatin. Conclusion The serum myostatin level was significantly lower in chronic HCV patients didn’t receive direct acting anti-viral drugs than those who received direct acting anti-viral drugs and control groups.

Hepatocellular Carcinoma in Hepatitis C Virus Patients after Treatment by Directly Acting Antiviral Drugs Compared to Hepatitis C Virus Non Treated Patients

Background Hepatocellular carcinoma (HCC) is one of the most prevalent cancers globally. It is considered as leading cause of cancer related death that occurs mostly in patients with underlying significant liver fibrosis and cirrhosis. Objective to compare characteristics and behavior of de novo Hepatocellular carcinoma (HCC) in chronic HCV patients who received direct acting antiviral treatment with those who didn't receive DAAs. Patients and Methods The study was conducted on patients with de novo HCC presented at HCC Clinic and Tropical medicine department at Ain Shams University Hospitals from January 2019 to January 2020. Total number of HCC cases visited the HCC clinic was 382 patients. 196 patients with de novo HCC were enrolled in the study according to inclusion criteria and divided into two groups: Group (A): included 79 patients with de novo HCC that received DAAs according to NCCVH. 64 males (81%), 15 females (19%) with mean age of 60 years. Group (B): included 117 patients with de novo HCC that didn’t receive DAAs treatment before; 82 males (70.1%) 35 females (29.9%) with a mean age of 61.9 years. Results In the current study we found there was no difference in tumor aggressiveness between patients with de novo HCC following DAA and patients with HCC that didn’t receive DAA regarding different scoring system except for Child pugh score was significantly higher in group (A), and for BCLC staging was significantly more advanced in group(A). The Current study revealed 69 patients (87.3%) of Group (A) achieved SVR with DAAs. with no significant statistical value between different regimens of DAAs regarding relapsing rate or behavior of HCC. Conclusion Despite the great advance in HCV treatment in the era of DAA drugs, HCC remains to be a great risk for cirrhotic patients. Moreover, patients with a history of HCC have to be closely monitored before and after treatment with DAA. There were no difference between studied group regarding tumor size, tumor number, tumor site, tumor extension, tumor metastasis, vascular invasion or AFP. but lymph node invasion was more significant in group (A). There were no difference between studied group regarding Child grade, FIB-4 score or PST. Patients of group (A) showed more advanced liver disease regarding BCLC stage than those of group (B).

Angiopoietin-2 as a Predictor of Fibrosis Regression in Hepatitis C Virus-Patients after Direct Acting Antiviral Drugs

Abstract Background Hepatitis C virus (HCV) infection is the major cause of liver cirrhosis and hepatocellular carcinoma (HCC); thus, effective and safe treatment is crucial. Aim of the Work to evaluate the serum angiopoietin-2 as non-invasive marker of fibrosis regression in patients with Hepatitis C Virus receiving DAA drugs. Patients and Methods This study was conducted on 40 chronic HCV-patients who received DAA therapy in the Hepatic Virology Unit and the gastroenterology department of Ain Shams University hospitals. All patients were subjected to the following: Full history taking with stress concerning the hepatology system, clinical evaluation, laboratory investigations, Routine investigations: Abdominal and Pelvic ultrasonography and Transient elastography (Fibroscan) to measure liver stiffness measurement (LSM) for detection the degree of liver fibrosis in the chronic HCV-patients. Results Hematological findings, biochemical liver profile and liver fibrosis indices except hemoglobin level and platelets counts were significantly improved after DAA therapy. There was a significant improvement concerning the fibrosis stage after the treatment fibrosis staging at SVR12. The liver size, the spleen size and portal vein diameter were also significant after DAA therapy. There was improvement in the Child-Pugh score after successful HCV eradication by DAAs but the difference was no statistically significant. There was a statistically significant higher mean of Ang-2 levels in higher stages of liver fibrosis stages. Overall, serum Ang-2 levels significantly decrease after DAA therapy. In F0, F1, F2 & F3 fibrosis stage; the mean Ang2 levels decrease after DAA therapy but in F4 fibrosis stage; the mean Ang2 levels did not change almost. Baseline Ang-2 and WBCs, AST, ALT, total bilirubin, INR, serum albumin, alpha-fetoprotein, serum creatinine, LSM, FIB-4 index, APRI score, liver size and portal vein diameter were significantly correlated. There were also a significant correlation between Ang-2 and all the fibrosis stages (from F0 to F4) before DAA treatment. Ang-2 levels were significantly associated with LSM based liver fibrosis stage regression after successful DAA therapy. Ang-2 levels did not correlate with hemoglobin, platelets and spleen size at baseline. Ang-2 levels did not correlate with hemoglobin, platelets, WBCs, INR, spleen size and portal vein diameter after DAA therapy. Ang-2 levels did not show significant correlation with the Child-Pugh score after DAA therapy. Conclusion Liver fibrosis stage after successful HCV eradication by DAAs. But in stage F4 (cirrhosis), mean Ang-2 remained almost unchanged after DAA therapy. Significant decrease of Serum Ang-2 could suggest its use as a predictor of liver fibrosis regression in Hepatitis C Virus-patients after Direct Acting Antiviral drugs after DAA therapy.

Impaired health-related quality of life in the HCV cure era: who is concerned? (ANRS CO22 HEPATHER French cohort).

Hepatitis C virus (HCV) cure after treatment with direct-acting antivirals (DAAs) can improve health-related quality of life (HRQoL). However, specific groups with chronic HCV may still exhibit worse post-cure HRQoL because of persisting severe liver fibrosis or social vulnerability factors (e.g. unhealthy alcohol use, living in poverty). We assessed the effect of such factors on longitudinal measures of HRQoL in chronic HCV patients. ANRS CO22 HEPATHER is a prospective cohort of chronic HCV patients receiving DAAs, which included notably patients with social vulnerability factors, a population usually under-represented in clinical trials. Multivariable mixed-effects linear regression models helped identify factors associated with longitudinal measures of HRQoL (PROQOL-HCV scores). At enrolment, 52.4% of the 2740 participants were men, median age was 56years [interquartile range 50-64], and 21.5% had severe liver fibrosis (FIB-4 > 3.25). Twenty-eight per cent reported current or past unhealthy alcohol use [> 2(3) alcohol units per day for women (men)], and 28.1% were living in poverty (standard of living under 1015€/month per household consumption unit). At first PROQOL-HCV completion, 54.0% of patients were HCV-cured. After multivariable adjustment, people with current or past unhealthy alcohol use, individuals living in poverty, those with severe liver fibrosis, and women had worse HRQoL in the dimensions explored. Conversely, HCV cure was associated with better HRQoL. Specific socially vulnerable groups of patients with chronic HCV infection still experience impaired HRQoL, independently of HCV cure. Patient-centred interventions, including social support and referral for comorbidities, should be prioritized for them. Trial registration with ClinicalTrials.gov NCT01953458.

Performance of Albumin-Bilirubin (ALBI) score in comparison to other non-invasive markers in the staging of liver fibrosis in chronic HCV patients

BackgroundThe prognostic ability of albumin-bilirubin score (ALBI) to assess the hepatic dysfunction in patients with hepatocellular carcinoma (HCC) was previously studied. Its role in the staging of liver fibrosis post chronic hepatitis C Virus (HCV) infection needs to be investigated.Aimto assess the diagnostic value of the ALBI score compared to other non-invasive fibrosis scores in chronic HCV patients.MethodsThis cross-sectional study included consecutive chronic HCV patients from January 2015 till December 2018. Liver stiffness measurement (LSM) by transient elastography (TE) is currently one of the most validated noninvasive methods for liver fibrosis staging and is used in daily practice as a reference for fibrosis assessment. ALBI grade as well as Fibrosis-4 (FIB-4), Aspartate aminotransferase to platelet ratio index (APRI), LOK index and Göteborg University Cirrhosis (GUCI) scores were calculated for all of the patients.ResultsA total of 781 chronic HCV patients were included. Around 54% of them had compensated cirrhosis. GUCI score was the most sensitive one to difference between early fibrosis stages, F0 vs. F1. LOK index and ALBI score did not differ significantly between F1 and F2 stages unlike the other study markers. ROC curves revealed good diagnostic capability of FIB-4 (AUROC: 0.85, 0.84), APRI (AUROC: 0.83, 0.83) and GUCI score (AUROC: 0.83, 0.83) for detecting advanced fibrosis and cirrhosis, respectively. ALBI score had a moderate diagnostic role for diagnosing advanced fibrosis and cirrhosis, AUROC of 0.73 and 0.74 respectively. At a cutoff value of -2.95, the sensitivity of ALBI score approached 79%, the specificity was 53% for advanced fibrosis.ConclusionALBI score has a moderate diagnostic power score in the diagnosis of HCV-associated advanced liver fibrosis and cirrhosis; however, FIB-4, APRI and GUCI scores outperformed the ALBI score.

KIR Genotypes Impact Progression to Hepatocellular Carcinoma in Patients with Chronic Hepatitis C Infection

In Egypt, hepatocellular carcinoma (HCC) is the most prevalent cancer in men and the second most prevalent cancer in women. In addition, Egypt has one of the highest prevalences of hepatitis C infection in the world. The aim of the present work was to study the potential role of the 16 KIR genes in the outcome of individuals with chronic hepatitis C virus (HCV) infection in Egypt. The study was carried out under an IRB-approved protocol. Sequence-Specific-Primer-PCR (SSP-PCR) was used for KIR genotyping of germline DNA extracted from peripheral blood leukocytes or from the non-tumor liver of 83 HCC patients, 100 patients with chronic HCV infection without HCC, and 120 matched healthy controls. Out of the 83 HCC patients, only 7 (8.4%) were treated by interferon and/or interferon Ribavirin combination, while for the remaining patients 50 (60.2%) received no prior HCV therapy and 26 (31.3%) were treated with direct-acting antiviral (DAA). Our results showed that KIR haplotype AA that contains more inhibitory KIR genes and fewer activating genes was observed with a significantly lower frequency in HCC patients (6/83, 7.2%) compared to chronic HCV (27/100, 27.0%) (p = 0.0005, OR = 0.21 [0.08–0.53]) and healthy controls (29/119, 24.4%) (p = 0.001, OR = 0.24 [0.09–0.61]). In addition, the frequency of genotype 6 (G6) which contains all the KIR genes was significantly high in the HCC patients (16/83, 19.3%) compared to chronic HCV (8/100, 8.0%) (p = 0.02, OR = 2.7 [1.11–6.79]) and healthy controls (8/119, 6.7%) (p = 0.006, OR = 3.31 [1.35–8.16]). Activating KIR genes 2DS1 and 3DS1 were significantly higher in HCC patients (48/83, 57.83% and 45/83, 54.22%) compared to the chronic HCV patients (36/100, 36% and 34/100, 34%), p = 0.028, 0.027, respectively. Our results are contrary to a prior work on HCC from patients with HCV who were mostly treated by interferon-based therapies. In conclusion, KIR haplotype AA has an important role in host defense against HCC progression especially in patients treated by DAA, suggesting an important role of the KIR genotype status on the outcome of chronic HCV infection.

Prevalence and clinical outcomes in subtypes of metabolic associated fatty liver disease

In 2020, metabolic Associated Fatty Liver Disease (MAFLD) was proposed to replace non-alcoholic fatty liver disease (NAFLD) with new diagnostic criteria. The prevalence and clinical outcomes of MAFLD subtypes remained unclear. The participants from Taiwan bio-bank cohort were included. MAFLD was defined as the presence of fatty liver, plus any of the following three conditions: overweight/obesity, diabetes mellitus (DM), or metabolic dysfunction. The patients with positive HBsAg or anti-HCV were considered as chronic HBV or HCV infection. NAFLD fibrosis score (NFS)>0.676 plus fibrosis 4 (FIB-4) score > 2.67 was defined as advanced liver fibrosis. Atherosclerosis was diagnosed as having carotid plaques on duplex ultrasounds. The clinical outcomes were assessed among four subtypes of MAFLD including DM, obesity, chronic HBV infection, and chronic HCV infection. A total of 21,885 participants (mean age 55.34±10.31; 35.69% males) were included in the final analysis. Among them, 38.83% were diagnosed with MAFLD. The prevalence of MAFLD was 66.95% in DM patients, 65.07% in obese participants, 33.74% in chronic HBV patients, and 30.23% in chronic HCV patients. Logistic regression analysis showed that the subtypes of DM and chronic HCV infection were associated with an increased risk of advanced liver fibrosis in MAFLD patients. Additionally, the subtypes of DM and lean were associated with an increased risk of atherosclerosis, but a decreased risk of atherosclerosis in the subtype of chronic HBV infection. This population-based study proves the concept that subtypes of MAFLD can help risk stratification of clinical outcomes.

Direct‑acting antiviral treatment is safe and effective for chronic HCV patients with psychiatric disorders.

Although most patients with hepatitis C virus (HCV) infection have been cured since the introduction of direct-acting antiviral (DAA) treatments, whether patients with psychiatric disorders and chronic HCV infection receive benefits from DAA treatments remain unclear. The efficacy and safety of DAA treatment were compared between patients with and without psychiatric disorders. Data were retrospectively collected from medical records at the Suzuka General Hospital (Japan) between September 2014 and December 2021. The study was an observational, single-center study. Fisher's exact test, Mann-Whitney U test and Friedman's test were used for the comparisons between groups. Patients with HCV infection who had been started on DAA treatments were included. In total, 15 HCV cases with psychiatric disorders (P) and 209 HCV cases with nonpsychiatric disorders (NP) were started on DAA treatments for HCV infection. Patients in group P were younger (55±13.9 years) compared with those in group NP (68±13.0 years). A total of 12 patients (80%) in group P achieved and 188 patients (90%) in group NP achieved sustained virologic response (SVR), with no significant difference between the two groups. The remaining three patients in group P who did not achieve SVR included two drop-out cases. Regarding the laboratory data at the end of DAA treatments and SVR, there were no significant differences between the two groups. There were no cases of discontinuation or reduction of medication due to psychiatric disorders during DAA treatment. DAA treatment for HCV infection is effective, tolerable and safe for psychiatric patients, as well as patients without psychiatric disorders. Psychiatric patients with HCV infection should undergo DAA treatment to prevent progression to liver failure and/or cancer.

A Comparative Study on the Presence and Reversibility of Subclinical Arterial Damage in HCV-Infected Individuals and Matched Controls.

Background: The arterial pathology and mechanisms of increased cardiovascular disease (CVD) risk in HCV-infected individuals are not yet clear. The aim of this study was to identify types of arterial pathology in treatment-naive chronic HCV patients and to test their reversibility after successful treatment. Methods: Consecutive, never-treated, HCV-infected patients were compared with age and CVD-related risk factors, matched controls, healthy individuals (HI), patients with rheumatoid arthritis (RA) and people living with HIV (PLWH), in terms of arterial stiffening by pulse wave velocity, arterial atheromatosis/hypertrophy by carotid plaques/intima-media thickness and impaired pressure wave reflections by augmentation index. After three months of sustained virological response (SVR) administered using direct-acting antivirals, vascular examination was repeated in HCV-infected patients to test drug and viral-elimination effect in subclinical CVD. Results: Thirty HCV patients were examined at baseline; fourteen of them were re-examined post-SVR. Compared with HI, HCV patients had significantly more plaques, which is similar to that of RA patients and the PLWH group. No other differences were found in all other vascular biomarkers, and regression among HCV patients also revealed no differences 3 months post-SVR. Conclusions: Accelerated atheromatosis, rather than arterial stiffening, arterial remodeling and peripheral impaired hemodynamics is the underlying pathology leading to increased CVD risk in HCV patients.

Recent Insights into the Role of B Cells in Chronic Hepatitis B and C Infections.

Chronic viral hepatitis infections, caused by the hepatitis B or C virus, are a major global health problem causing an estimated one million deaths each year. Immunological studies have classically focused on T cells, while B cells have largely been neglected. Emerging evidence, however, highlights a role for B cells in the immunopathogenesis of chronic hepatitis B and C infections. B cell responses appear to be altered across different clinical phases of chronic HBV infection and across stages of disease in chronic HCV infection. These B cell responses show signs of a more activated state with a simultaneous enrichment of phenotypically exhausted atypical memory B cells. Despite the fact that studies show an activating B cell signature in chronic viral hepatitis infection, antibody responses to HBsAg remain impaired in chronic HBV infection, and glycoprotein E2-specific neutralizing antibody responses remain delayed in the acute phase of HCV infection. At the same time, studies have reported that a subset of HBV- and HCV-specific B cells exhibit an exhausted phenotype. This may, at least in part, explain why antibody responses in chronic HBV and HCV patients are suboptimal. Here, we summarize recent findings and discuss upcoming research questions while looking forward to how new single-cell technologies could provide novel insights into the role of B cells in chronic viral hepatitis infections.

Efficacy and Safety of Generic (Velpatasvir containing regimen) among Adult Chronic HCV Patients Non-responders to Treatment by Sofosbuvir Plus Daclatasvir Regimen in Egypt

Efficacy and Safety of Generic (Velpatasvir containing regimen) among Adult Chronic HCV Patients Non-responders to Treatment by Sofosbuvir Plus Daclatasvir Regimen in Egypt

Efficacy and Safety of Generic (Velpatasvir containing regimen) among Adult Chronic HCV Patients Non-responders to Treatment by Sofosbuvir Plus Daclatasvir Regimen in Egypt

Efficacy and Safety of Generic (Velpatasvir containing regimen) among Adult Chronic HCV Patients Non-responders to Treatment by Sofosbuvir Plus Daclatasvir Regimen in Egypt

Effect of HCV treatment with DAAs on serum intestinal fatty acid binding protein (I-FABP) as a marker of intestinal permeability in HCV/HIV co-infected patients

BackgroundHCV and HIV co-infected patients develop cirrhosis more rapidly than HCV mono-infection. Intestinal injury and microbial translocation are postulated mechanisms for the rapid progression of cirrhosis.AimStudy the effect of HCV treatment with DAAs on serum intestinal fatty acid binding protein (I-FABP) as a marker of intestinal injury in HCV/HIV co-infected patients and its relation to hepatic fibrosis. Comparing the level of I-FABP in HCV mono-infection and HCV/HIV co-infection was a secondary aim.MethodsI-FABP levels were measured in 50 non-cirrhotic HCV/HIV co-infected patients pre- and post-HCV treatment (SVR 12) (25 patients were HIV treatment naive, and 25 patients were on HAART) and in 25 chronic HCV patients as a control group. Hepatic fibrosis was assessed by FIB4 score, APRI score, and transient elastography.ResultsHCV/HIV co-infected patients had significantly higher levels of I-FABP compared to the HCV-mono-infected patients (P = 0.001). After HCV treatment in HCV/HIV co-infected patients, I-FABP level was significantly elevated (P < 0.001) and was positively correlated with baseline FIB4 values and serum ALT levels (r = 0.283, P-value = 0.047) and (r = 0.340, P-value = 0.016), respectively.ConclusionHCV/HIV co-infection is associated with significantly higher intestinal injury and subsequent hepatic fibrosis than HCV mono-infection. HIV infection is associated with intestinal epithelial injury and microbial translocation and may play a role in the persistence of systemic inflammation after HCV eradication.