Treatment Of HCV Infection Research Articles

HCV infection characteristics, treatment uptake and outcomes in patient with diabetes mellitus

BackgroundThe interplay between HCV, DM, and DAA therapy is poorly understood. We compared HCV infection characteristics, treatment uptake, and treatment outcomes in patients with and without DM. MethodsA retrospective cohort study was conducted using data from The Ottawa Hospital Viral Hepatitis Program. Statistical comparisons between diabetes and non-diabetes were made using χ2 and t-tests. Logistic regression analyses were performed to assess predictors of DM and SVR.ResultsOne thousand five hundred eighty-eight HCV patients were included in this analysis; 9.6% had DM. Patients with DM were older and more likely to have cirrhosis. HCC and chronic renal disease were more prevalent in the DM group. Treatment uptake and SVR were comparable between groups. Regression analysis revealed that age and employment were associated with achieving SVR. Post-SVR HCC was higher in DM group.ConclusionThe high prevalence of DM in our HCV cohort supports screening. Further assessment is required to determine if targeted, early DAA treatment reduces DM onset, progression to cirrhosis and HCC risk. Further studies are needed to determine if optimization of glycemic control in this population can lead to improved liver outcomes.

Antimicrobial peptides: natural or synthetic defense peptides against HBV and HCV infections.

According to the literature, treatment of HCV and HBV infections faces challenges due to problems such as the emergence of drug-resistant mutants, the high cost of treatment, and the side effects of current antiviral therapy. Antimicrobial peptides (AMPs), a group of small peptides, are a part of the immune system and are considered as an alternative treatment for microbial infections. These peptides are water-soluble with amphiphilic (hydrophilic and hydrophobic surfaces) characteristics. AMPs are produced by a wide range of organisms including both prokaryotic and eukaryotic cells. The antiviral mechanisms of AMPs include inhibiting virus entry, inhibiting intracellular virus replication, inhibiting intracellular viral packaging, and inducing immune responses. In addition, AMPs are a new generation of antiviral biomolecules that have very low toxicity for human host cells, particularly liver cell lines. AMPs can be considered as one of the most important strategies for developing new adjuvant drugs in the treatment of HBV and HCV infections. In the present study, several groups of AMPs (with a net positive charge) such as Human cathelicidin, Claudin-1, Defensins, Hepcidin, Lactoferrin, Casein, Plectasin, Micrococcin P1, Scorpion venom, and Synthetic peptides were reviewed with antiviral properties against HBV and HCV.

Quick diagnosis, staging, and treatment of HCV infection among people living in prison: Opinion expert panel.

Quick diagnosis, staging, and treatment of HCV infection among people living in prison: Opinion expert panel.

Correlation of host factor with virological response to direct-acting antiviral treatment in hepatitis C patients

BackgroundHepatitis C virus (HCV) infection is the global epidemic of this century, affecting almost 100 million people, and it is now the leading cause of liver-related mortality and liver transplantation. Interferon (IFN)-α was introduced as the first treatment for chronic hepatitis C but had several limitations, including factors that cause unresponsiveness to therapy, such as viral and host factors. The availability of non-interferon antiviral agents, direct-acting antivirals (DAAs), has led to a major paradigm shift in the treatment of HCV infection. This therapy has been shown to achieve higher cure rates and minimal side effect profiles in clinical trials. This study is aimed to determine the correlation between host factors, such as age, gender, and body mass index (BMI) with virological response to DAA treatment in hepatitis C patients.ResultObservational research with a retrospective cohort approach was conducted at Wahidin Sudirohusodo Hospital, Makassar, Indonesia, from April 2021 to October 2021. The virological response was assessed using HCV-RNA quantitative and sustained virological response (SVR) 12 weeks after therapy. The research was conducted on 86 subjects consisting of 57 men and 29 women with a mean age of 48.69±13.94 years and mean BMI of 23.17±3.71 kg/m2, with SVR12 up to 90.7%. Study analysis did not find a significant correlation between age, gender, and BMI, with virological response SVR12 of chronic hepatitis C patients with direct-acting antiviral (p>0.05).ConclusionAge, gender, and body mass index do not influence the success of DAA therapy.

Detection of Occult Hepatitis C Virus Infection in Egyptian Patients Who Achieved a Sustained Virologic Response to Direct-Acting Antiviral Agents.

Occult hepatitis C virus (HCV) infection (OCI) is diagnosed based on the detection of HCV-RNA in non-serum reservoirs, such as peripheral blood mononuclear cells (PBMCs) and/or hepatocytes with undetectable HCV-RNA in the serum. The current study was designed to shed more light on the presence of occult HCV in a population of cases who achieved an SVR after receiving treatments for HCV-infection and its significance. This cross-sectional study evaluated 111 chronic HCV patients treated at Theodor Bilharz Research Institute, Egypt and achieved a sustained virological response (SVR) 12 -24 weeks after treatment with Direct acting antiviral drugs (DAAs). The treatment lasted 12 or 24 weeks using generic medications including Sofosbuvir (SOF) 400 mg/day and Daclatasvir (DCV) 60 mg/day ± weight-based Ribavirin (RBV) 600-1000 mg/day. After achieving the SVR 12 -24 weeks, all patients were subjected to clinical examination and full laboratory investigations. All the candidates were assessed for fibrosis pre/post-treatment by transient elastography (Fibroscan©). Eighty-seven patients (78.4%) received dual therapy (SOF/DCV) and 24 patients (21.6%) received triple therapy (SOF/DCV/RBV). One hundred and seven patients received the regimen for 12 weeks (96.4%) and only four patients received the regimen for 24 weeks (3.6%). All patients were examined in terms of HCV RNA in plasma and PBMCs. Nine patients (8.1%) were positive for PBMCs HCV RNA. The presence of Occult HCV infection (OCI) was significantly correlated with age, level of AFP, and the degree of liver stiffness. The OCI was present in 8.1% of the patients who achieved an SVR 12 - 24 weeks. These patients were mostly aged and with elevated AFP and advanced fibrosis. Monitoring and follow-up of those patients may help to assess the outcomes.

Effects of Achieving Sustained Virologic Response after Direct-Acting Antiviral Agents on Long-Term Liver Fibrosis in Diabetics vs. in Non-Diabetic Patients with Chronic Hepatitis C Infection.

Because of the prevalence of HCV worldwide as well as its undiagnosed population due to a lack of screening, HCV can be considered a modern pandemic disease. In 2016, the World Health Organization (WHO) set goals for HCV’s elimination that included a 65 percent reduction in mortality and an 80 percent reduction in newly infected cases by 2030. This study is a follow-up evaluation of 80 patients who received interferon-free treatment with direct-acting agents (DAA) for chronic HCV infection between the second half of 2017 and the end of 2018. They were assessed using a FibroMax test prior to DAA administration. Two pills/day of Ombitasvir 12.5 mg/Paritaprevir 75 mg/Ritonavir 50 mg and two pills/day of Dasabuvir 250 mg were given to the patients for 8 weeks. After treatment, all 80 patients in this study achieved an SVR (sustained virologic response), and the FibroMax test was performed three years later. Our study found that successfully treating HCV infection can play a significant role in reducing fibrosis in T2DM patients. In comparison to those of ActiTest and SteatoTest, FibroMax scores showed a significantly greater reduction in T2DM patients than in treatment-naive patients.

Treatment of Hepatitis C Infection in an Internal Medicine Residency Continuity Clinic: Resident Perspectives and Patient Outcomes.

IntroductionStudies have demonstrated that primary care clinicians can achieve the same excellent outcomes in treatment of hepatitis C (HCV) infection as specialist physicians but there is a dearth of literature on experiences and outcomes of treatment of HCV infection in residency clinics. We sought to describe the perspectives of internal medicine resident physicians in one community-based residency program toward treating HCV infection before and after launching treatment of HCV infection within the residency clinic. Further, this study examined outcomes of patients treated by the resident physicians.MethodsTreatment of HCV infection was initiated in 2019. Residents were invited to complete a baseline survey. Residents who treated at least one patient with HCV infection were invited to complete a subsequent survey. Comparative analysis was performed using Fisher’s Exact test. Sustained virologic response at least 12 weeks (SVR-12) after completion of treatment in patients initiated on therapy in the residency clinic was assessed.ResultsResidents (n = 12) who treated patients for HCV infection reported significantly greater knowledge in evaluating and treating patients with HCV infection and preparedness to provide this care after residency than residents (n = 34) who completed the baseline survey (p < 0.001). Twenty-six patients were initiated on direct-acting antiviral (DAA) therapy. All 21 patients who were tested achieved SVR-12.ConclusionsTraining resident physicians to evaluate and treat HCV infection can improve outcomes for underserved patients in residency clinics while preparing a pool of physicians to provide this care after residency.

Declining prevalence of current HCV infection and increased treatment uptake among people who inject drugs: The ETHOS Engage study.

Evaluating trends in HCV treatment and prevalence is crucial for monitoring elimination. We evaluated the change in current infection and treatment among people who inject drugs (PWID) between 2018-2019 and 2019-2021. ETHOS Engage is an observational cohort study of PWID attending drug treatment clinics and needle and syringe programs in Australia. Participant enrolment occurred over two periods, Wave 1 (May 2018-September 2019, 25 sites) and Wave 2 (November 2019-June 2021, 21 sites), with baseline questionnaire completion and point-of-care HCV RNA testing (Xpert®HCV Viral Load Fingerstick). Logistic regression wasused to identify factors associated with current HCV infection and historic HCV treatment. 2,395 individuals were enrolledacross the two recruitment waves (66% male, median age 43, 72% current opioid agonist therapy, and 65% injecting in the previousmonth). HCV prevalence decreased from 24% to 17% between 2018-2019 and 2019-2021, respectively (p=0.003). HCVtreatment increased from 66% to 74% between 2018-2019 and 2019-2021, respectively (p<0.001). After adjusting, there was a reduction in current HCV infection in 2019-2021 (adjusted odds ratio [aOR] 0.62; 95% CI, 0.50, 0.77) compared to 2018-2019. Other factors associated with currentinfection included homelessness (aOR, 1.70; 1.26, 2.30), incarceration (vs. never; historic: aOR 1.69; 95%CI 1.31, 2.19; recent: aOR 1.85; 95%CI, 1.35, 2.54), and recentlyinjecting drugs(vs. >12 months ago;previous month <daily: aOR 2.03; 95%CI, 1.37, 3.02;≥daily: aOR 2.90; 95%CI, 1.94, 4.32). The increase in HCV treatment and decrease in prevalence among PWID provides evidence of further progress towards HCV elimination; however, sub-populations may require additional support to enhance elimination. PWID are a priority population to facilitate HCV elimination and temporal data are crucial to understand trends in HCV infection and treatment in this group. Among a cohort of PWID recruited during two different waves and in an era of unrestricted DAA therapy, prevalence of HCV infection decreased and the proportion who had received HCV treatment increased. Sub-populations of PWID-including people who are homeless, people who have been incarcerated, people who frequently inject drugs, younger people, women, and people not engaged in OAT-may require additional support to enhance HCV elimination efforts.

FRI403 - Sofosbuvir/Velpatasvir (S/V) for the treatment of HCV infection among vulnerable inner-city residents: extending the results of clinical trial

FRI403 - Sofosbuvir/Velpatasvir (S/V) for the treatment of HCV infection among vulnerable inner-city residents: extending the results of clinical trial

FRI324 - Use of Glecaprevir/Pibrentasvir (G/P) for the treatment of HCV infection among fentanyl users: an interim analysis of the GRAND PLAN study

FRI324 - Use of Glecaprevir/Pibrentasvir (G/P) for the treatment of HCV infection among fentanyl users: an interim analysis of the GRAND PLAN study

Kidney Transplantation From Hepatitis-C Viraemic Donors:Considerations for Practice in the United Kingdom.

Background: Donor hepatitis-C (HCV) infection has historically represented a barrier to kidney transplantation (KT). However, direct-acting antiviral (DAA) medications have revolutionised treatment of chronic HCV infection. Recent American studies have demonstrated that DAA regimes can be used safely peri-operatively in KT to mitigate HCV transmission risk. Methods: To formulate this narrative review, a comprehensive literature search was performed to analyse results of existing clinical trials examining KT from HCV-positive donors to HCV-negative recipients with peri-operative DAA regimes. Results: 13 studies were reviewed (11 single centre, four retrospective). Outcomes for 315 recipients were available across these studies. A sustained virological response at 12 weeks (SVR12) of 100% was achieved in 11 studies. One study employed an ultra-short DAA regime and achieved an SVR12 of 98%, while another achieved SVR12 of 96% due to treatment of a missed mixed genotype. Conclusion: HCV+ KT is safe and may allow increased utilisation of organs for transplantation from HCV+ donors, who often have other favourable characteristics for successful donation. Findings from US clinical trials can be applied to the United Kingdom transplant framework to improve organ utilisation as suggested by the NHSBT vision strategy “Organ Donation and Transplantation 2030: meeting the need”.

ՔՐՈՆԻԿ ՎԻՐՈՒՍԱՅԻՆ C ՀԵՊԱՏԻՏ. ՀԱԿԱՎԻՐՈՒՍԱՅԻՆ ԲՈՒԺՄԱՆ ՓՈՒԼԵՐԸ (ՎԵՐԼՈՒԾՈՒԹՅՈՒՆ)

All over the world, liver diseases occupy a significant place among the causes of disability and mortality, particularly, in patients with chronic liver lesions, which are common in people of working age. Chronic hepatitis C has a special place among liver diseases. A distinctive feature of chronic HCV infection is its long-term latent course due to which it remains unrecognized for a long time. At the same time, it gradually progresses with further development of liver cirrhosis and/or hepatocellular carcinoma. WHO estimates that about 290,000 people died from hepatitis C in 2019, mostly as a result of cirrhosis of the liver or hepatocellular carcinoma. In the 90s of the twentieth century, recombinant interferons were used in mono mode, dosages were selected, treatment periods were increased, and the significance of HCV genotypes and viral load was established in predicting the results and duration of treatment. In the late XX – early XXI centuries, pegylated interferons (PIFN-α-2a and PIFN-α-2b) began to be introduced into clinical practice. The use of these drugs in combination with ribavirin made it possible to make a qualitative breakthrough in the treatment of chronic HCV infection. The WHO updated guidelines released in 2018 recommend therapy based on pangenotypic direct-acting antiviral drugs, which guarantees treatment for almost all patients with chronic hepatitis C. It is important that treatment be initiated before the patient develops liver cirrhosis and/or hepatocellular carcinoma.

Incidence of hepatocellular carcinoma one year after direct acting antiviral therapy for treatment of HCV infection in patients with decompensated liver cirrhosis; A multicenter study

Incidence of hepatocellular carcinoma one year after direct acting antiviral therapy for treatment of HCV infection in patients with decompensated liver cirrhosis; A multicenter study

The Efficacy and Safety of Treatment of Chronic HCV Infection by Ombitasvir/Paritaprevir/Ritonavir with Ribavirin and its Effect on Complement C3 and C4 Levels

The Efficacy and Safety of Treatment of Chronic HCV Infection by Ombitasvir/Paritaprevir/Ritonavir with Ribavirin and its Effect on Complement C3 and C4 Levels

HCV Elimination in Central Europe with Particular Emphasis on Microelimination in Prisons.

In 2016, the WHO announced a plan to eliminate viral hepatitis as a public health threat by 2030. In this narrative review, experts from Bulgaria, Croatia, the Czech Republic, Hungary, Latvia, Lithuania, Poland and Slovakia assessed the feasibility of achieving the WHO 2030 target for HCV infections in Central Europe. They focused mainly on HCV micro-elimination in prisons, where the highest incidence of HCV infections is usually observed, and the impact of the COVID-19 pandemic on the detection and treatment of HCV infections. According to the presented estimates, almost 400,000 people remain infected with HCV in the analyzed countries. Interferon-free therapies are available ad libitum, but the number of patients treated annually in the last two years has halved compared to 2017–2019, mainly due to the COVID-19 pandemic. None of the countries analyzed had implemented a national HCV screening program or a prison screening program. The main reason is a lack of will at governmental and prison levels. None of the countries analyzed see any chance of meeting the WHO targets for removing viral hepatitis from the public threat list by 2030, unless barriers such as a lack of political will and a lack of screening programs are removed quickly.

Application of different spectrophotometric methods for quantitative analysis of direct acting antiviral drugs simeprevir and sofosbuvir

Simeprevir and sofosbuvir are direct-acting antiviral drugs approved for the treatment of chronic HCV infection. Reports demonstrate the similarities between HCV and SARS-CoV-2 in terms of structure and replication mechanism. Therefore, it is suggested that a combination of simeprevir and sofosbuvir may be considered for COVID-19 patients. To date, no spectrophotometric methods have been published for quantitative analysis of simeprevir and sofosbuvir in combination. In this work, two simple spectrophotometric methods allowed quantitative analysis of the studied drugs in the mixed form. The zero-order direct method allowed quantitative analysis of simeprevir at 333 nm, with sofosbuvir showing zero absorbance values. The dual wavelength method allowed quantitative analysis of sofosbuvir by measuring the difference in absorbance values at 259.40 and 276 nm, where the difference in absorbance values of simeprevir was zero. With the applied methods, the investigated drugs in the mixtures and tablets prepared in the laboratory were successfully analyzed quantitatively with acceptable results.

Echocardiographic assessment of ventricular function in chronic HCV patients receiving direct antiviral therapy

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Hepatitis C virus (HCV) infection is still a major public health burden in many parts of the world (1). Globally, an estimated 58 million people have chronic hepatitis C virus infection, with about 1.5 million new infections occurring per year (2). Treatment for chronic HCV infection has evolved from interferon (IFN)-based therapy to direct-acting antivirals (DAAs) (3,4). With the development of DAA, treatment of HCV became better-tolerated and highly effective (5,6). Several studies have attempted to explore their cardiac side effects, especially their impact of left ventricular (LV) function; however, these studies were limited by their design and the methods of assessment (7-10). Aim In this prospective study we aimed at evaluating the short effects of DAAs on left ventricular functions using 3D Echocardiography. Methods Patients with HCV infection planned to receive combination therapy of Sofosbuvir 400 mg daily plus Daclatasvir 60 mg daily for 12 weeks were assessed by echocardiography before starting and after 3 months after completion of treatment. Patients with other systemic or cardiac conditions or structural heart disease were excluded. Assessment of LV volume and EF was performed by 3D quantification and global longitudinal strain (GLS). Right ventricle size was assessed by 2D and systolic function was evaluated by TAPSE, S` and FAC. Results In 102 patients who were followed up at 3 months after DAA therapy, We found an increase in increase in both LV end diastolic dimensions and volumes (p∼0.02 &amp; p∼0.045 respectively) as well as end systolic volumes (p∼0.005). There was no significant difference in neither LV systolic function as assessed by EF and GLS (62.25 ± 5.15 vs. 62.35 ± 5.77, p∼0.850, -22.97 ± 2.93 vs. -22.83 ± 2.59, p∼0.546 respectively), nor in diastolic function (p∼0.546). However, subgroup analyses revealed a significant negative correlation between age and GLS (P∼0.022) as well as the number of cardiovascular risk factors (P∼0.039). Hypertension was found to be the only predictor of the decrease in GLS in the regression analysis of risk factors (p∼0.001). There was no significant change in RV size and systolic function at follow up. Conclusions There was no significant change in LV systolic or diastolic function before and after DAA therapy as measured by EF and GLS. Nonetheless, subgroup analysis suggests a drop in GLS in older patients and those with more cardiovascular risk factors. An increase in LV size was also noted while no significant effect was noted with regards to RV size and function.

Cartilage Oligomeric Matrix Protein As A Serological Biomarker for the Assessment of Liver Fibrosis Before and After Treatment of HCV Infection

Cartilage Oligomeric Matrix Protein As A Serological Biomarker for the Assessment of Liver Fibrosis Before and After Treatment of HCV Infection

Favorable impact in hepatitis C-related mortality following free access to direct-acting antivirals in Spain.

Free treatments for HCV infection with direct-acting antivirals became widespread in Spain in April 2015. We aimed to test whether, after this intervention, there was a more favorable change in population mortality from HCV-related than from non-HCV-related causes. Postintervention changes in mortality were assessed using uncontrolled before-after and single-group interrupted time series designs. All residents in Spain during 2001-2018 were included. Various underlying death causes were analyzed: HCV infection; other HCV-related outcomes (HCC, liver cirrhosis, and HIV disease); and non-C hepatitis, other liver diseases, and nonhepatic causes as control outcomes. Changes in mortality after the intervention were first assessed by rate ratios (RRs) between the postintervention and preintervention age-standardized mortality rates. Subsequently, using quasi-Poisson segmented regression models, we estimated the annual percent change (APC) in mortality rate in the postintervention and preintervention periods. All mortality rates were lower during the postintervention period, although RRs were much lower for HCV (0.53; 95% CI, 0.51-0.56) and HIV disease than other causes. After the intervention, there was a great acceleration of the downward mortality trend from HCV, whose APC went from -3.2% (95% CI, -3.6% to -2.8%) to -18.4% (95% CI, -20.6% to -16.3%). There were also significant accelerations in the downward trends in mortality from HCC and HIV disease, while they remained unchanged for cirrhosis and slowed or reversed for other causes. These results suggest that the favorable changes in HCV-related mortality observed for Spain after April 2015 are attributable to scaling up free treatment with direct-acting antivirals and reinforce that HCV eradication is on the horizon.

Effects of direct-acting antiviral therapy for patients with advanced hepatocellular carcinoma and concomitant hepatitis C-A population-based cohort study.

We analyzed real-world data to elucidate the effects of anti-Hepatitis C virus (HCV) direct-acting antiviral (DAA) therapy on survival in patients with advanced hepatocellular carcinoma (HCC) and concomitant HCV infection treated with sorafenib. This population-based retrospective cohort study used the Taiwan National Health Insurance Research Database and the Registration System for Patients Treated with Oral Hepatitis C Antivirals to identify patients with advanced HCC and concomitant HCV infection who received initial targeted therapy (sorafenib) in 2018-2019. The overall survival (OS) of the DAA and non-DAA groups were compared using the Kaplan-Meier survival analysis. Propensity score matching was performed using a ratio of 1:4 to reduce confounding between the DAA and non-DAA groups. The study included 1,684 patients (122 DAA and 1,562 non-DAA users) with HCC and concomitant HCV infection who used sorafenib for the first time in 2018-2019. The Kaplan-Meier survival analysis indicated that advanced HCC patients who used DAAs had longer OS compared to non-DAA patients. The mean survival times were 20.7 months for DAA and 12.5 months for non-DAA. Results obtained after propensity matching indicated a significant difference in OS between the DAA and non-DAA groups. The analysis of big data from the Taiwan National Health Insurance Research Database revealed that advanced HCC patients on sorafenib benefited from DAAs as a treatment for HCV infection. Patients whose HCV infection was cured had better OS.