Hepatitis C Virus Transmission Research Articles

Economic and epidemiological evaluation of interventions to reduce the burden of hepatitis C in Yunnan province, China.

BackgroundThe paradigm shift in hepatitis C virus (HCV) treatment options in the last five years has raised the prospect of eliminating the disease as a global health threat. This will require a step-change in the number being treated with the new direct-acting antivirals (DAAs). Given constrained budgets and competing priorities, policy makers need information on how to scale-up access to HCV treatment. To inform such decisions, we examined the cost effectiveness of screening and treatment interventions in Yunnan, China.Methods and findingsWe simulated the HCV epidemic using a previously published model of HCV transmission and disease progression, calibrated to Yunnan data, and implemented a range of treatment and screening interventions from 2019. We incorporated treatment, diagnosis, and medical costs (expressed in 2019 US Dollars, USD) to estimate the lifetime benefits and costs of interventions. Using this model, we asked: is introducing DAAs cost effective from a healthcare sector perspective; what is the optimal combination of screening interventions; and what is the societal return on investment of intervention? The incremental cost-effectiveness ratio (ICER) of switching to DAAs with a median cost of 7,400 USD (50,000 Chinese Yuan) per course is 500 USD/disability adjusted life year (DALY) averted; at a threshold of 50% of Yunnan gross domestic product (2,600 USD), switching to DAAs is cost effective 94% of the time. At this threshold, the optimal, cost-effective intervention comprises screening people who inject drugs, those in HIV care, men who have sex with men, and ensuring access to DAAs for all those newly diagnosed with HCV. For each USD invested in this intervention, there is an additional 0·80 USD (95% credible interval: 0·17–1·91) returned through reduced costs of disease or increased productivity. Returns on investment are lower (and potentially negative) if a sufficiently long-term horizon, encompassing the full stream of future benefits, is not adopted. The study had two key limitations: costing data were not always specific to Yunnan province but were taken from China-level studies; and modelled interventions may require more operational research to ensure they can be effectively and efficiently rolled-out to the entire province.ConclusionsIntroducing DAAs is cost effective, the optimal package of screening measures is focussed on higher risk groups, and there are likely to be positive returns from investing in such HCV interventions. Our analysis shows that targeted investment in HCV interventions will have net benefits to society; these benefits will only increase as DAA costs fall.

Hepatitis C Virus Transmission Clusters in Public Health and Correctional Settings, Wisconsin, USA, 2016-20171.

Ending the hepatitis C virus (HCV) epidemic requires stopping transmission among networks of persons who inject drugs. Identifying transmission networks by using genomic epidemiology may inform community responses that can quickly interrupt transmission. We retrospectively identified HCV RNA–positive specimens corresponding to 459 persons in settings that use the state laboratory, including correctional facilities and syringe services programs, in Wisconsin, USA, during 2016–2017. We conducted next-generation sequencing of HCV and analyzed it for phylogenetic linkage by using the Centers for Disease Control and Prevention Global Hepatitis Outbreak Surveillance Technology platform. Analysis showed that 126 persons were linked across 42 clusters. Phylogenetic clustering was higher in rural communities and associated with female sex and younger age among rural residents. These data highlight that HCV transmission could be reduced by expanding molecular-based surveillance strategies to rural communities affected by the opioid crisis.

Microelimination or Not? The Changing Epidemiology of Human Immunodeficiency Virus-Hepatitis C Virus Coinfection in France 2012-2018.

The arrival of highly effective, well-tolerated, direct-acting antiviral agents (DAA) led to a dramatic decrease in hepatitis C virus (HCV) prevalence. Human immunodeficiency virus (HIV)-HCV-coinfected patients are deemed a priority population for HCV elimination, while a rise in recently acquired HCV infections in men who have sex with men (MSM) has been described. We describe the variations in HIV-HCV epidemiology in the French Dat'AIDS cohort. This was a retrospective analysis of a prospective cohort of persons living with HIV (PLWH) from 2012 to 2018. We determined HCV prevalence, HCV incidence, proportion of viremic patients, treatment uptake, and mortality rate in the full cohort and by HIV risk factors. From 2012 to 2018, 50 861 PLWH with a known HCV status were followed up. During the period, HCV prevalence decreased from 15.4% to 13.5%. HCV prevalence among new HIV cases increased from 1.9% to 3.5% in MSM but remained stable in other groups. Recently acquired HCV incidence increased from 0.36/100 person-years to 1.25/100 person-years in MSM. The proportion of viremic patients decreased from 67.0% to 8.9%. MSM became the first group of viremic patients in 2018 (37.9%). Recently acquired hepatitis represented 59.2% of viremic MSM in 2018. DAA treatment uptake increased from 11.4% to 61.5%. More treatments were initiated in MSM in 2018 (41.2%) than in intravenous drug users (35.6%). In MSM, treatment at the acute phase represented 30.0% of treatments in 2018. A major shift in HCV epidemiology was observed in PLWH in France from 2012 to 2018, leading to a unique situation in which the major group of HCV transmission in 2018 was MSM. Clinical Trials Registration. NCT02898987.

Oral Prescription Opioids as a High-Risk Indicator for Hepatitis C Infection: Another Step Toward HCV Elimination.

BackgroundThe opioid epidemic across the U.S. poses an array of public health concerns, especially HCV transmission. HCV is now widely curable, yet incident rates are increasing due to the opioid epidemic. Despite the established trajectory from oral prescription opioids (OPOs) to opioid use disorder (OUD), OUD to injection drug use (IDU), and IDU to hepatitis C virus (HCV), OPOs are not a defined risk factor (RF) for HCV infection. The objective of this study was to observe rates of HCV testing and Ab reactivity (HCVAb+) in patients receiving OPOs to substantiate them as a RF, ultimately contributing to HCV elimination.MethodsData from MedStar Health patients receiving OPOs from 1/2017 to 12/2018 were collected and analyzed using chi-squared or student t-tests and logistic regression for uni- or multi-variable analyses, respectively. Statistical significance was defined as P < .05; Epi Info and SAS v 9·4 were used for statistical analyses; IRB approval was received.ResultsThere were 115 415 individuals prescribed OPOs over the study period. In this population, 8.6% (932) were HCVAb+ when tested and not previously diagnosed (10 900); 3.4% (3893) had an OUD diagnosis, 20.6% (803) of whom were HCV tested; 25.4% (361) of all HCVAb+ (1421) had an OUD diagnosis. OUD (ORadj 8.53 [7.22-10.07]) was an independent predictor of HCVAb+ in this population.Conclusions(1) In a large population prescribed oral opioids, HCVAb+ was 8.6%, higher than our previously published data (2.5%) and the US rate (1.7%); (2) only 20% of patients diagnosed with OUD were tested; and (3) only 25% of HCVAb+ patients were classified with OUD; this suggests underreporting of OUD in this population. Primary Care and Community Health Recommendations: (1) Re-testing for HCV in patients taking OPOs; (2) increased HCV testing among OUD patients; and (3) improved surveillance and reporting of OUD.

Detection of Hepatitis C Virus Genotype 1a among Patients from Al-Nasiriya City and Determining its Transmission Risk Factors

Background: Hepatitis C virus (HCV) genotypes have been shown to be differently distributed between distinct geographical areas. Information regarding hepatitis C genotypes and subtypes distribution in Al-Nasiriya city is not well-known. Objectives: The objectives of this study were to determine the frequency of various HCV genotypes in Al-Nasiriya City and the demographic and risk factors associated with HCV transmission among the Al-Nasiriya City population. Materials and Methods: Blood samples were collected from 200 patients with chronic HCV infection who were referred from Al-Nasiriya City to the Digestive Disease Department of Al-Yarmouk Hospital during February 2019–December 2020. Patients were screened for HCV antibodies using an enzyme-linked immunosorbent assay test. Quantitation of the HCV viral load and genotype were assessed using a polymerase chain reaction. Results: This study revealed that the most common HCV genotype was 1a (HCV-1a) with a rate of 63%, while HCV-1d showed 1.5% and HCV-4 was 35.5%. Furthermore, the frequency of infection among females was more than among males at 37.5% and 25.5%, respectively, while the hemodialysis process among other transmission risk factors increased the transmission of HCV-1a infection. Conclusions: HCV-1a is the most predominant genotype in these patients, with more prevalent in females than males over 20 years old, and hemodialysis is the most risk factor in their transmission.

Mother-to-Child Transmission of Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) Among Pregnant Women with Dual or Triplex Infections of HIV, HBV and HCV in Nigeria: A Systematic Review

Background: There is no previous systemic review on mother-to-child transmission (MTCT) rate of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) among pregnant women with dual or triplex infections of HIV, HBV and HCV. The aim of this study was to systematically review the literature and identify MTCT rates and factors associated with MTCT of HIV, HBV and HCV among pregnant women and their infant pairs with dual or triplex infections of HIV, HBV and HCV in Nigeria. Methods: A systematic review was done using PRISMA guidelines. Searches were conducted on 19th February 2021 in PubMed, Google Scholar and CINAHL to identify studies published from 1st February 2001 until 31st January 2021 using keywords including ‘MTCT,’ ‘co-infection,’ ‘dual infection,’ ‘triplex infection,’ ‘HIV,’ ‘HBV,’ and ‘HCV’. Studies that reported MTCT rate of at least any of HIV, HBV and HCV and/or its associated factors with them among pregnant women and their infant pairs with dual and triplex infections of HIV, HBV and HCV in Nigeria irrespective of publication status or language were eligible. If there was no eligible study, studies on mono-infection (HIV or HBV or HCV) population were eligible for narrative synthesis only. Studies were excluded if they were abstracts only or published prior to February 2001. The data from these studies were extracted independently by two authors with disagreements resolved by a third author and consensus reached. The protocol was prospectively registered in the PROSPERO database, ID: CRD42020202070. Findings: The search identified 891 reports. After screening titles and abstracts, 25 full-text articles were assessed for eligibility and none of the studies was included for quantitative synthesis in the systematic review. We identified one relevant large national ongoing study. We have included a comprehensive narrative account of 18 studies where we identified a MTCT rate analysis of HIV (median MTCT rate at birth: 2.18%; range: 0.0% to 9.6%; 5,863 participants; 15 studies) and HBV (median MTCT rate at birth: 51.6%; range: 42.86% to 72.0%; 433 participants; three studies) among mother-infant pairs with mono-infection of HIV and HBV respectively, as this forms the only evidence base in this area. Interpretation: Currently, we found no reliable evidence to inform decisions on the rate of MTCT transmission of HIV, HBV and HCV among mother-infant pairs with dual or triplex infection of HIV, HBV and HCV in Nigeria since the only present study is ongoing. This important topic has been addressed in few studies involving an entirely mono-infection population for HIV or HBV but not HCV. Future research needs to focus on the MTCT rates among mother-infant pairs with dual or triplex infections of HIV, HBV and HCV. Funding: TETFund National Research Fund 2019 (Grant number TETFund/DR&D/CE/NRF/STI/33). Declaration of Interest: We declare no competing interests.

Sociodemographic features associated with Hepatitis C Virus (HCV) in pregnant females: A tertiary care centre study from Malwa region of Punjab (North India).

Background:Hepatitis C virus (HCV) infection is high in state of Punjab, however very few studies have been done till date. We all know that pregnant females are a most important section of our community and are usually screened for HCV, HIV, and Hepatitis B at time of presentation. HCV is capable of causing chronic infections and having long-term implications on a person's health. Vertical transmission of HCV can be one of the major route of transmission of this virus to the neonate and there have been various sociodemographic factors like age, literacy, socioeconomic status, occupational status, associated with the disease causation and transmission.Methods:All pregnant females attending Obstetrics and gynecology department of our institute were included in study. All the sociodemographic characters and socioeconomic records were retrieved and analyzed.Results:In our study also a lower socioeconomic status, illiteracy have been significantly associated with the HCV-positive group, thus emphasizing the role of education so as to impart education to the masses as regard to mode of transmission and its effects on the disease. Higher age of conceiving is also significant associated with the increased maternal risk.Conclusions:The more involvement of health care officials and even persons not related to health care set up is required who can educate masses so as to protect the community.

Changes in the Distribution Pattern of Hepatitis C Virus Genotypes Among Chronic Hepatitis Patients: a Cross-Sectional Study

Hepatitis C virus (HCV) is a major cause of liver diseases. It has been determined that HCV genotypes have a distinct geographical distribution, clinical outcome, and response to antiviral therapy. Over the past years, many studies have reported that HCV genotype 1a is the dominant genotype in Ahvaz city. In recent years, changes in the distribution pattern of HCV genotypes of different geographical regions have attracted a great deal of attention; hence, the aim of this study was to accurately evaluate such probable changes in Ahvaz in southwestern Iran. This is a cross-sectional study conducted from September 2017 to August 2020, including 262 patients suffering from chronic hepatitis C. HCV-RNA was extracted, and HCV genotyping was performed by PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism) method. To evaluate the association between HCV genotype, age, gender, and viral load, statistical analyses were done by SPSS software. HCV genotyping was done on 260 patients where genotype 3a had the highest prevalence over the period of 4 years with an average of 48.1%, followed by genotype 1a (46.5%). HCV genotype of two patients was not typeable. Although the difference between the two genotypes is currently small, the main result was finding an increasing trend in the prevalence of genotype 3a in recent years. The present study showed that the distribution pattern of HCV genotypes is gradually changing among chronic hepatitis C patients in Ahvaz city. The most important cause of such changes could be the alteration in HCV transmission routes and the increase in migration from areas where genotype 3 is dominant.

Accidental Exposures to Biological Products – A Risk for Medical Staff and Patients

"Hypothesis: While performing professional activities, the healthcare workers (HCW) can be exposed to blood and other potentially infectious materials from the patients they are taking care of. In order to minimize the risk of Hepatitis B virus (HBV), Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) transmission, these accidental exposures should be reported and followed by post-exposure prophylaxis. If seroconversion of the injured person occurs, the healthcare unit intervenes by various methods to ensure that the infected HCW does not represent a source of infection for other patients [1]. Objective: Through this study we aimed to assess the perception of different categories of healthcare personnel about their testing for their carrying of HBV, HCV and HIV at the time of employment in a healthcare facility and their right to confidentiality regarding their health status. We also wanted to evaluate the opinion of the medical staff about the patient’s right to be informed about the risk of HBV, HCV and HIV transmission, if there is an infected person in the medical team. Method: A multicentric cross-sectional study was performed, by applying an original pre-tested questionnaire to different professional categories of medical staff from different categories of healthcare facilities. Results: Over 20% of respondents declared they were not tested at the time of employment, but almost 40% claimed that they were tested every year since employment. Only 20% of the participants considered they have the right to confidentiality regarding the state of viral carrying, but ⅓ consider that there is no discrimination if a healthcare facility refuses to hire a HBV, HCV, HIV carrier. Out of all participants questioned, ½ of the respondents agree that the medical staffs who are a carrier for a transmissible virus can be detached in a less dangerous healthcare department in order to avoid the transmission of the virus to patients. Almost equally, there were participants who believed that they could not be compelled to reveal their carrier status to the patient, and those who would have no hesitation in informing their patient about their status Keywords: Blood and other potentially infectious materials, exposure, healthcare workers, patient, confidentiality. "

Micro-elimination of HIV and HCV co-infection

More than 2 million people are co-infected with HIV and hepatitis C virus (HCV). 1 Platt L Easterbrook P Gower E et al. Prevalence and burden of HCV co-infection in people living with HIV: a global systematic review and meta-analysis. Lancet Infect Dis. 2016; 16: 797-808 Summary Full Text Full Text PDF PubMed Scopus (379) Google Scholar Co-infection with these persistent virus infections poses a threat: over the past decade an increased prevalence of HCV infection has occurred in men who have sex with men (MSM) with HIV in Europe. 2 van Santen DK van der Helm JJ Del Amo J et al. Lack of decline in hepatitis C virus incidence among HIV-positive men who have sex with men during 1990–2014. J Hepatol. 2017; 67: 255-262 Summary Full Text Full Text PDF PubMed Scopus (44) Google Scholar Historically, shared transmission occurred in people who inject drugs (PWID); transfusions of infected blood products caused devastating outcomes for co-infected haemophiliacs. 3 Darby SC Ewart DW Giangrande PL et al. Mortality from liver cancer and liver disease in haemophilic men and boys in UK given blood products contaminated with hepatitis C. Lancet. 1997; 350: 1425-1431 Summary Full Text Full Text PDF PubMed Scopus (497) Google Scholar Early reports indicated an increased risk of progressive liver disease after dual infection. Effective antiretroviral therapy reduced mortality from HIV, but the poor effectiveness of interferon-α treatment on HCV and HIV co-infection accentuated a relative increase in liver-related morbidity. 4 Martin-Carbonero L Soriano V Valencia E Garcia-Samaniego J Lopez M Gonzalez-Lahoz J Increasing impact of chronic viral hepatitis on hospital admissions and mortality among HIV-infected patients. AIDS Res Hum Retroviruses. 2001; 17: 1467-1471 Crossref PubMed Scopus (205) Google Scholar , 5 Sulkowski MS Mehta SH Torbenson MS et al. Rapid fibrosis progression among HIV/hepatitis C virus-co-infected adults. AIDS. 2007; 21: 2209-2216 Crossref PubMed Scopus (158) Google Scholar Highly effective direct-acting antiviral (DAA) treatments now effect high rates of HCV cure in co-infected patients. 6 Wyles D Saag M Viani RM et al. TURQUOISE-I part 1b: ombitasvir/paritaprevir/ritonavir and dasabuvir with ribavirin for hepatitis c virus infection in hiv-1 coinfected patients on darunavir. J Infect Dis. 2017; 215: 599-605 Crossref PubMed Scopus (21) Google Scholar The concept of micro-elimination uses testing and treatment strategies in defined populations to decrease incidence. Thus, micro-elimination of HCV in people living with HIV is an obvious objective as these individuals in HIV care are an easy to reach group and because of the risk of onward transmission and the potentially deleterious outcomes of unrecognised coinfection. 7 Bischoff J Rockstroh JK Are there any challenges left in hepatitis C virus therapy of HIV-infected patients?. Int J Antimicrob Agents. 2020; 56105527 Crossref PubMed Scopus (3) Google Scholar HCV micro-elimination in individuals with HIV in the Netherlands 4 years after universal access to direct-acting antivirals: a retrospective cohort studyThe sharp decline in HCV incidence in MSM with HIV shortly after restrictions on DAAs were lifted suggests a treatment-as-prevention effect. HCV incidence was already low in PWID and other groups before unrestricted access. Ongoing HCV transmission is occurring in MSM, as illustrated by a declining but high rate of reinfection, stressing the need for additional preventive measures. Full-Text PDF

HCV micro-elimination in individuals with HIV in the Netherlands 4 years after universal access to direct-acting antivirals: a retrospective cohort study

In the Netherlands, access to direct-acting antivirals (DAAs) against hepatitis C virus (HCV) has been unrestricted for chronic infection since 2015. We evaluated whether the nationwide incidence of HCV infections in individuals with HIV has changed since 2015. In this retrospective cohort study, data from the ATHENA cohort of people with HIV aged 18 years or older attending any of the 24 HIV treatment centres in the Netherlands between 2000 and 2019 were assessed. We used parametric proportional hazards models with a piecewise exponential survival function to model HCV primary infection and reinfection incidence per 1000 person-years. Of the 23 590 individuals without previous HCV infection, 1269 cases of HCV primary infection were documented (incidence 5·2 per 1000 person-years [95% CI 5·0-5·5]). The highest incidence was observed in men who have sex with men (MSM; 7·7 per 1000 person-years [7·3-8·2]) and was lower in people who inject drugs (PWID; 1·7 per 1000 person-years [0·7-4·1]) and other key populations (1·0 per 1000 person-years [0·8-1·2]). In MSM, incidence increased in 2007 to 14·3 per 1000 person-years and fluctuated between 8·7 and 13·0 per 1000 person-years from 2008 to 2015. In 2016, incidence declined to 6·1 cases per 1000 person-years and remained steady between 4·1 and 4·9 per 1000 person-years from 2017 to 2019. Of the 1866 individuals with a previous HCV infection, 274 reinfections were documented (incidence 26·9 per 1000 person-years [95% CI 23·9-30·3]). The highest incidence rate was observed in MSM (38·5 per 1000 person-years [33·9-43·7]) and was lower in PWID (10·9 per 1000 person-years [3·5-33·8]) and other key populations (8·9 per 1000 person-years [6·3-12·5]). In MSM, reinfection incidence fluctuated between 38·0 and 88·9 per 1000 person-years from 2006 to 2015, reaching 55·6 per 1000 person-years in 2015. In 2016, reinfection incidence declined to 41·4 per 1000 person-years, followed by further decreases to 24·4 per 1000 person-years in 2017 and 11·4 per 1000 person-years in 2019. The sharp decline in HCV incidence in MSM with HIV shortly after restrictions on DAAs were lifted suggests a treatment-as-prevention effect. HCV incidence was already low in PWID and other groups before unrestricted access. Ongoing HCV transmission is occurring in MSM, as illustrated by a declining but high rate of reinfection, stressing the need for additional preventive measures. Dutch Ministry of Health, Welfare, and Sport.

Hepatitis C outbreak in a respiratory care ward associated with frequent injections: Taiwan, 2017.

Healthcare-associated outbreaks of hepatitis C virus (HCV) infection pose serious risks of harm to patients. During May-July 2017, the Taiwan Centers for Disease Control were notified of four patients with acute HCV infection in a respiratory care ward (RCW). To prevent further infection, an investigation was conducted to identify the transmission route and risk factors for infection. We tested patients and staff members of the RCW for HCV, reviewed medical records, observed infection control practices on-site, and undertook a case-control study. We defined cases as individuals who had stayed in the RCW 2 weeks to 6 months prior to the laboratory diagnosis date of the first case and were infected with HCV after admission. Patients who were hospitalized during the same period but whose HCV tests were negative were selected as controls. We used Mann-Whitney U test to compare the frequency of injections among cases and controls. Of 19 staff and 29 patients, we identified four case-patients and one patient with chronic hepatitis C whose HCV RNA similarity was >98%. Compared to the 12 controls, the case-patients received more injections per day (4.4 vs. 0.1; p=0.01). The RCW lacked designated areas and standardized workflows for injection preparation. Disinfection of the environment and equipment was inadequate, which could possibly lead to blood contamination of the environment and parenteral medications. HCV infection was associated with frequent injections and infection control lapses. Healthcare workers should follow safe injection practices and reduce injection frequency to prevent HCV transmission.

Hepatitis C Virus Transmission Among Men Who Have Sex With Men in Amsterdam: External Introductions May Complicate Microelimination Efforts.

It is unclear whether unrestricted access and high uptake of direct-acting antivirals (DAAs) is sufficient to eliminate hepatitis C virus (HCV) in high-risk populations such as men who have sex with men (MSM). This study presents historic trends and current dynamics of HCV transmission among MSM in Amsterdam based on sequence data collected between 1994 and 2019. Hypervariable region 1 sequences of 232 primary HCV infections and 56 reinfections were obtained from 244 MSM in care in Amsterdam. Maximum-likelihood phylogenies were constructed for HCV genotypes separately, and time-scaled phylogenies were constructed using a Bayesian coalescent approach. Transmission clusters were determined by Phydelity and trends in the proportion of unclustered sequences over time were evaluated using logistic regression. Seventy-six percent (218/288) of sequences were part of 21 transmission clusters and 13 transmission pairs. Transmission cluster sizes ranged from 3 to 44 sequences. Most clusters were introduced between the late 1990s and early 2010s and no new clusters were introduced after 2012. The proportion of unclustered sequences of subtype 1a, the most prevalent subtype in this population, fluctuated between 0% and 20% in 2009-2012, after which an increase occurred from 0% in 2012 to 50% in 2018. The proportion of external introductions of HCV infections among MSM in Amsterdam has recently increased, coinciding with high DAA uptake. Frequent international transmission events will likely complicate local microelimination efforts. Therefore, international collaboration combined with international scale-up of prevention, testing, and treatment of HCV infections (including reinfections) is warranted, in particular for local microelimination efforts.

Violence and hepatitis C transmission in prison-A modified social ecological model.

Transmission of hepatitis C virus (HCV) among the prisoner population is most frequently associated with sharing of non-sterile injecting equipment. Other blood-to-blood contacts such as tattooing and physical violence are also common in the prison environment, and have been associated with HCV transmission. The context of such non-injecting risk behaviours, particularly violence, is poorly studied. The modified social-ecological model (MSEM) was used to examine HCV transmission risk and violence in the prison setting considering individual, network, community and policy factors. The Australian Hepatitis C Incidence and Transmission Study in prisons (HITS-p) cohort enrolled HCV uninfected prisoners with injecting and non-injecting risk behaviours, who were followed up for HCV infection from 2004-2014. Qualitative interviews were conducted within 23 participants; of whom 13 had become HCV infected. Deductive analysis was undertaken to identify violence as risk within prisons among individual, network, community, and public policy levels. The risk context for violence and HCV exposure varied across the MSEM. At the individual level, participants were concerned about blood contact during fights, given limited scope to use gloves to prevent blood contamination. At the network level, drug debt and informing on others to correctional authorities, were risk factors for violence and potential HCV transmission. At the community level, racial influence, social groupings, and socially maligned crimes like sexual assault of children were identified as possible triggers for violence. At the policy level, rules and regulations by prison authority influenced the concerns and occurrence of violence and potential HCV transmission. Contextual concerns regarding violence and HCV transmission were evident at each level of the MSEM. Further evidence-based interventions targeted across the MSEM may reduce prison violence, provide opportunities for HCV prevention when violence occurs and subsequent HCV exposure.

Hepatitis C Virus Treatment as Prevention: Challenges and Opportunities in Men Who Have Sex With Men.

Since 2002, a global epidemic of acute hepatitis C virus (HCV) infection has been noted in men who have sex with men (MSM). Transmission of HCV, particularly in the context of traumatic sex practices that increase the risk of blood-blood contacts (eg, anal sex and fisting), was initially found in human immunodeficiency virus (HIV)-coinfected and more recently in HIV-uninfected MSM, especially those receiving pre-exposure prophylaxis (PrEP). Early HCV treatment with all-oral direct-acting antiviral combination therapy has been associated with very high HCV cure rates of up to 100%. Indeed, immediate treatment of recently acquired HCV directly after new HCV diagnosis, or after 4 weeks if no 2-log10 drop in HCV RNA level occurs, promises rapid HCV elimination. Reports from the Netherlands, Switzerland, and the United Kingdom all show that with increased treatment uptake in this particular patient group, dramatic reductions in new HCV infections can be achieved. A general consensus on how to best screen for and manage acute HCV infections, along with broad access to rapid HCV therapy initiation, is crucial to attaining HCV elimination, a goal that is challenged by high HCV reinfection rates among MSM.

Prevalence and incidence of hepatitis C virus infection in men who have sex with men: a systematic review and meta-analysis

WHO has set targets for hepatitis C virus (HCV) elimination by 2030. We did a global systematic review of HCV prevalence and incidence in men who have sex with men (MSM) to provide updated estimates that can guide community education and public health policy. We did a systematic review and meta-analysis of studies published and listed on MEDLINE or Embase between Jan 1, 2000, and Oct 31, 2019, including conference proceedings. Studies were eligible if they reported measures of HCV prevalence or HCV incidence (or both) among MSM. Studies that relied on participants' self-reported HCV status with no laboratory confirmation were excluded. Pooled HCV estimates in MSM were stratified by HIV status and by injecting drug use, then by WHO region and by income level. Random-effects meta-analysis was done to account for between-study heterogeneity and examined using the I2 statistic. Pooled HCV prevalence was also compared with HCV estimates in the general population and presented as prevalence ratios (PRs). In HIV-negative MSM, incidence estimates were stratified by use of HIV pre-exposure prophylaxis (PrEP). The systematic review was registered with PROSPERO, number CRD42020156262. Of 1221 publications identified, 194 were deemed to be eligible and included in the systematic review and meta-analysis. Overall, the pooled HCV prevalence in MSM was 3·4% (95% CI 2·8-4·0; I2=98·0%) and was highest in Africa (5·8%, 2·5-10·4) and South-East Asia (5·0%, 0·0-16·6). Globally, HCV prevalence was 1·5% (1·0-2·1) in HIV-negative MSM and 6·3% (5·3-7·5) in HIV-positive MSM. Compared with the general population, HCV prevalence was slightly higher in HIV-negative MSM (PR 1·58, 95% CI 1·14-2·01) and markedly higher (6·22, 5·14-7·29) in HIV-positive MSM. Pooled HCV prevalence was substantially higher in MSM who had ever injected drugs (30·2%, 22·0-39·0) or currently injected drugs (45·6%, 21·6-70·7) than in those who never injected drugs (2·7%, 2·0-3·6). In HIV-negative MSM, the pooled HCV incidence was 0·12 per 1000 person-years (95% CI 0·00-0·72) in individuals not on PrEP and 14·80 per 1000 person-years (9·65-20·95) in individuals on PrEP. HCV incidence in HIV-positive MSM was 8·46 per 1000 person-years (6·78-10·32). HIV-positive MSM are at substantially increased risk of HCV. Overall, HIV-negative MSM had a slightly higher prevalence of HCV than the general population but had a lower prevalence than HIV-positive MSM. High HCV incidence in more recent PrEP studies suggests that as PrEP use increases, greater HCV transmission might occur. HCV burden in MSM varies considerably by region, which is likely to be associated with variation in the prevalence of injecting drug use and HIV. World Health Organization.

The cost of a late-detected outbreak among people who inject drugs. A modeling study

BackgroundPeople who inject drugs (PWID) are at risk for human immunodeficiency virus (HIV) and hepatitis C virus (HCV). In 2009 and 2011, Athens, Greece experienced an HCV and an HIV outbreak among PWID, respectively. Of these, only the 2011 HIV outbreak was detected. However, the public health interventions implemented in response to the HIV outbreak tackled also indirectly the undetected HCV outbreak. The aim of this study is to highlight the potential benefits of an efficient notification system using as a case study the undetected 2009 HCV outbreak among PWID of Athens. More specifically, the study assesses whether an earlier implementation of the same public responses could diminish the scale of the HCV outbreak and estimates the potential cost-savings. MethodsA previous dynamic, stochastic, individual‐based model was used to simulate HCV transmission among PWID of Athens, Greece. We calibrated the model to reproduce the observed HCV prevalence. We examined the effect of the non-detection scenario, the 1- or 2-years earlier detection scenarios and compared them to the status quo scenario. ResultsUnder the non-detection scenario, 2800 additional PWID would have been infected with HCV compared to the status quo by 2019. On the contrary, if the outbreak was detected 1- or 2- years earlier with immediate interventions, 440 and 970 HCV cases could be averted by 2019, respectively. Non-detection of the outbreak would cost an additional 43.2 (95% Credible interval: 2.7, 59.4) million euros to the healthcare system, compared to the status quo. On the other hand, if there was an efficient notification system to detect the HCV outbreak 1 or 2 years earlier, 6.8–15.6 million euros could have been saved by 2019. ConclusionsAn efficient notification system among PWID is a cost-saving investment that could detect on time and contain future outbreaks, and save valuable resources of the healthcare system.

Prevalence of Transfusion Transmissible Infections in Beta-Thalassemia Major Patients of Pakistan: A Systematic Review

Introduction: β-thalassemia major (TM) is one of the most prevalent inherited hemoglobinopathies in Pakistan. It has one of the highest prevalence of transfusion-dependent TM patients globally, with an estimated greater than 100,000 active cases. Each year, an estimated 5000-9000 new cases of TM are being diagnosed in the country. Blood transfusions (BT) are essential in the management of severe TM; it is critical to have a safe BT to reduce the risk of transfusion transmissible infections (TTIs). Frequent blood transfusions in these patients increase their risk of acquiring TTIs compared to the general population. In this systematic review, we aimed to identify the prevalence of TTIs in transfusion-dependent β -thalassemia major patients in Pakistan. Methods &amp; Material: We performed a systematic literature search to identify studies related to the TTIs and transfusion-related infections in Pakistan from January 1, 2010, to January 31, 2020. The search was conducted using PubMed and PakMediNet (Largest medical database of Pakistan), with initial search retrieved 981 studies. Among these, 166 studies met the inclusion criteria. After further screening by reviewing the articles for relevance and availability of full-length articles, only 14 studies met the final criteria for qualitative synthesis. Results Analysis of 14 studies (n=3786) showed that the seroprevalence of Hepatitis B virus (HBV) of 3.13% (0.66 % to 7.4%) and Hepatitis C virus (HCV) of 26 % (5.56% to 68.2%). There were only two studies reported HIV seroprevalence of 0 % &amp; 0.5% (n=6). The rate of seropositivity for HBV and HCV was directly related to the number of transfusions, higher ferritin levels, and older age groups. There was an increase in the HCV rate with the increasing age of patients. Thalassemia patients who were older than ten years of age had a greater HCV compared to those who were less than ten years of age, i.e., 22% vs. 8.4%, p:0.005, respectively. The mean age was higher in HCV reactive children than non-reactive children. A comparison of HCV in healthy donors vs. thalassemia patients showed a rate of 1.9% vs. 13.1% for T.M. patients. There was HCV infection rate of 74% in the group with greater than 100 BTs compared to 33 % in a group with fewer than 35 BTs. The rate of HCV increased to 75% for the patients who had more than 100 BTs. The majority of the patients were males (51% to 88%). The seroprevalence of TTIs was higher in males than in females (73.4% vs. 26.6%). On average, a single TM patient is exposed to at least 17 different donors annually, requiring 1-2 transfusions every month. The free BT is accessible only in 1 out of 4 thalassemia centers. The majority of patients either need to bring their donors or are dependent on an external source of financial aid as they could not afford the cost of BT treatment. More than half of thalassemia patients (57.2%) need to contact multiple BT centers to search for required blood products. About 42.1% of parents of TM patients did not know about TTIs, whereas 31.6% of them did not know about the bloodborne transmission of HBV and HCV. The majority of parents of TM children had a low income, with 75% of them having income less than 10,000 Pakistani rupees (PKR) per month. The prevalence of TTIs in TM patients was significantly higher (96% vs. 4%) compared to the patients requiring multiple transfusions due to other causes such as leukemia, aplastic anemia, and thrombocytopenia. Conclusion: Our data highlights that the prevalence of transfusion-transmitted infections, especially HCV, is alarmingly higher (26%) in the TM population than in the general population. This is because of a lack of resources, inadequate safety measures, and a fragmented blood transfusion system. These findings warrant the urgent need for better public health measures, safe blood transfusion practices, voluntary remunerated blood-based transfusions, and universal quality-assured donor screening. Without these positive interventions, the current transfusion system can lead to a further worsening of the situation. Large prospective multi-centered clinical trials are required to understand better the high prevalence of TTIs in patients with TM. Disclosures Anwer: Incyte, Seattle Genetics, Acetylon Pharmaceuticals, AbbVie Pharma, Astellas Pharma, Celegene, Millennium Pharmaceuticals.:Honoraria, Research Funding, Speakers Bureau.

A Systematic Review of Transfusion-Transmissible Infections Among Blood Donors and Associated Safety Challenges in Pakistan.

The blood transfusion (BT) system in Pakistan is fragmented, demand-driven and depends on weakly regulated transfusion practices. There is a considerable possibility that transfusion-transmissible infections (TTIs) are contributing to the current epidemic of hepatitis B virus (HBV) and hepatitis C virus (HCV) (affecting 7.4% of the general population) in the country. To study this issue, we conducted a systematic review to identify articles related to TTIs and transfusion safety in Pakistan from January 1, 2010 to January 31, 2020. A review of 33 articles met the final criteria for qualitative synthesis. Analysis of these studies showed a cumulative frequency of HBV 2.04%, HCV 2.44%, HIV 0.038%, syphilis 1.1% and malaria 0.11%. The frequency of coinfections among blood donors varied from 0.0099% to 0.35%. The highest number of coinfections were HCV and syphilis, followed by HCV and HBV infections. Syphilis and malaria were tested in only 38% and 46% of all the blood donations in one study. The rate of voluntary non-remunerated donations (VNRDs) was less than 13%, and male donors were 95% to 100% in these studies. There was a significant difference in the frequency of HBV and HCV in VNRDs (0.48%) as compared to replacement donors (RDs) (4.15%). In short, this review shows a high frequency of TTIs, especially HBV, HCV and syphilis in the blood donor population in Pakistan. There is a high dependency on RDs, minimal use of healthy voluntary blood donation practices, inadequate screening of high-risk donors, repeated collections of the blood from RDs, poor quality of screening methods and limited knowledge of donor health. Without standardized safe transfusion practices, there will be an ongoing increase in transmission of TTIs, especially HBV, HCV, syphilis, and HIV leading to a significant adverse public health impact.

Update on Hepatitis C Epidemiology: Unaware and Untreated Infected Population Could Be the Key to Elimination.

Globally, the World Health Organization (WHO) estimates that 71 million people have chronic hepatitis C virus (HCV) infection. A significant number of these will develop cirrhosis or liver cancer. Currently, during the COVID-19 outbreak, a high mortality rate has been found in patients with COVID-19 and cirrhosis. New direct-acting antiviral agents can cure more than 90% of HCV-infected patients. The new WHO strategy has introduced global goals against viral hepatitis, including a 30% reduction in new HCV cases and a 10% reduction in mortality by 2020. HCV transmission has changed considerably, reflecting both the evolution of medicine and health and social changes. The HCV is usually spread through blood-to-blood contact. After the discovery of HCV in 1989, antibody screening has drastically decreased the incidence of post-transfusion hepatitis. Nowadays, routine blood donor screening by nucleic acid amplification testing for the presence of HCV RNA has been introduced in many countries. It is conceivable that HCV screening could be offered to people born between 1946 and 1964 in the developed world and to people at high risk for HCV infection such as those who have received blood transfusions, blood products or organ donations before the 1990s, prisoners, health care workers, drug users and infants born to HCV-infected women. To achieve HCV elimination, health programmes should include improvement to access to health care services, increased screening and new projects to identify a submerged portion of patients with HCV infection. Submerged people with HCV infection are both people who are unaware of their condition and people diagnosed with HCV but not yet treated. Based on these premises, this review will examine and discuss the epidemiological changes in contracting HCV, highlighting the ways in which to identify a submerged portion of patients with HCV infection.