Treatment Of Viral Hepatitis Research Articles

Exploring Perceptions and Treatment-Seeking Behaviors for Viral Hepatitis Among the Ethnic Irula Tribe in Tamil Nadu, India: A Qualitative Study on Health Disparities.

Qualitative research was undertaken to determine the perceptions and treatment-seeking behaviors of the Irula tribal populations in Tamil Nadu, India, and to explore the depth, diversity, and complexity of viral hepatitis. An in-depth interview (IDI) was conducted among the eligible respondents. A purposive sampling technique was used to obtain the study subjects. The IDI was conducted among the community leader, male and female participants, and other representatives, e.g., ward members (Panchayat). We gathered data regarding the perceptions of viral hepatitis and behavioral intentions. Thematic analysis was used to generate the results of the qualitative research. Four themes emerged from the codes of the current qualitative study: (1) the general perception, transmission, and treatment of viral hepatitis; (2) stigma and discrimination; (3) health-seeking behavior towards viral hepatitis; and (4) morbidity patterns were significant themes. Most of the nomadic tribes hold incorrect perceptions regarding viral hepatitis and liver cancer risk, and women were reported to have a higher perceived risk than men. The participants displayed high hope and confidence, which motivated them to participate actively in viral hepatitis prevention activities. Programs and policies geared towards enhancing viral hepatitis prevention in this sub-population may consider sociocultural factors observed to influence prevention behaviors.

Interaction Between Hepatitis B, Hepatitis C and Alcohol in the Development of Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis.

The objective of this report is to provide clarification on the interaction among hepatitis B virus (HBV), hepatitis C virus (HCV) and alcohol in the development of hepatocellular carcinoma (HCC). A systematic search was performed in PubMed, Web of Science and Scopus databases up to July 18, 2023. The inclusion criteria involved observational studies that examined the relationship between HBV, HCV, alcohol use and the development of HCC. To assess between-study heterogeneity, the I2 statistics were employed. Publication bias was evaluated using the Begg and Egger tests. The effect sizes were estimated as odds ratios (ORs) with 95% confidence intervals (CIs) utilising a random-effects model. Among the initial pool of 31,021 studies identified, 28 studies involving 42,406 participants met the inclusion criteria. Through our meta-analysis, we found that the combined effect of HBV and alcohol was associated with an OR of 14.56 (95% CI: 9.80, 21.65). The combined impact of HCV and alcohol showed an OR of 42.44 (95% CI: 20.11, 89.56). Coinfection with both HBV and HCV was associated with an OR of 32.58 (95% CI: 20.57, 51.60). These results emphasising the importance of reducing alcohol consumption and implementing effective viral hepatitis prevention and treatment.

Rheumatoid arthritis and viral hepatitis. Tactics of a rheumatologist. Literature review

Rheumatoid arthritis (RA) is an autoimmune disease that can be accompanied by complex liver involvement. The diagnosis and differentiation of these conditions are often complicated by the rarity of liver biopsies and the similarity of symptoms to other liver diseases. Viral hepatitis B and C in the context of rheumatoid arthritis can mimic rheumatological manifestations, further complicating timely diagnosis and worsening the prognosis for patients with rheumatoid arthritis. This literature review aims to systematize knowledge and assess the risks associated with the treatment of rheumatoid arthritis in patients with viral hepatitis B and C. Additionally, the article aims to provide recommendations for screening and treatment of viral hepatitis in these patients. The review is based on the analysis of available literature for the last ten years, including clinical trials, meta‑analyses, systematic reviews, and recommendations for the treatment of viral hepatitis in patients with rheumatoid arthritis. According to the literature, liver involvement in patients with rheumatoid arthritis can be caused by the disease itself, its treatment, or viral infections. Research results emphasize the importance of regular monitoring of liver function and screening for viral hepatitis B and C before starting rheumatoid arthritis treatment and during the use of immunosuppressive drugs. The integration of screening for viral hepatitis B and C into standard medical protocols for patients with rheumatoid arthritis before starting immunosuppressive therapy is essential. The timely detection of these infections is crucial because the treatment of hepatitis and immunosuppressive therapy for rheumatoid arthritis are interconnected and require a comprehensive approach. Adaptation of treatment depending on the status of viral infection is necessary to minimize liver risks and optimize the outcomes of rheumatoid arthritis treatment.

A Qualitative Systematic Review of Barriers and Facilitators to Hepatitis B and C Programmes in Prisons.

The prevalence of viral hepatitis among people in prisons is higher than in the general population. Screening, treatment and vaccination programmes exist within prisons to reduce the incidence of hepatitis, although lower uptake has often been reported compared to similar programmes outside of prisons. We conducted a systematic review of qualitative evidence to explore the barriers and facilitators to hepatitis B and C reduction programmes in prisons from the perspectives of people in prison, custodial staff and prison healthcare staff. Comprehensive searches of five databases (to November 2023) yielded 28 studies for review inclusion. Four synthesised findings were identified: (i) accurate, up-to-date knowledge of viral hepatitis disease and treatment among people in prison and staff is a facilitator to programme uptake, particularly when imparted by a trusted source; (ii) personal subjective and relative views have a bearing on participation with the programme; (iii) social interactions and relationships both within the community of people in prison and between them and staff groups influence participation in the programmes; and (iv) the organisational structure of the prison and healthcare services within it affect programme participation. Based on these findings, we make recommendations for the adaptation of viral hepatitis programmes to individual custodial settings thereby improving equitable programme access and hepatitis B and C reduction in this complex environment.

Эффективность препарата Ремаксол в комплексной терапии хронического вирусного гепатита С

Эффективность препарата Ремаксол в комплексной терапии хронического вирусного гепатита С

Bifidumbacterin forte in the treatment of acute viral hepatitis

Relevance. In patients with acute viral hepatitis A and B, favorable conditions are created for the development of dysbacteriosis. As a result, the toxic load on the liver increases. For effective treatment of acute viral hepatitis A and B, it is necessary to examine for intestinal dysbiosis before and after treatment and subsequent correction of identified disorders. Aim. To study the clinical course, functional state of the liver, intestinal microflora in patients with acute viral hepatitis A and B and the effectiveness of using bifidumbacterin forte for the correction of intestinal microflora. Materials and methods. The work used clinical and laboratory data from 54 patients with acute viral hepatitis A and B. The main group of patients received bifidumbacterin forte against the background of basic therapy. Patients in the comparison group were on traditional therapy. Clinical, biochemical, bacteriological parameters were observed before the start of therapy and 15 days after its start, serological markers - upon admission. Results. During the therapy, in patients of the main group, the disappearance of intoxication, lethargy, weakness, pain, and normalization of liver size were observed earlier in comparison with the control group. Symptoms of pigment metabolism disorders disappeared significantly earlier: yellowness of the skin, itching of the skin, changes in the color of urine and feces. A dynamic study of liver tests demonstrated a more rapid reverse development of biochemical disorders of the functional state of the liver in patients who received bifidumbacterin forte as part of complex treatment. Conclusion. The use of bifidumbacterin forte in patients with acute viral hepatitis A and B against the background of basic treatment has a positive effect on some clinical manifestations, biochemical parameters, and individual components of the intestinal microflora.

Toward Universal Health Coverage: What Socioeconomic and Clinical Factors Influence Health Insurance Coverage and Restrictions in Access to Viral Hepatitis Services in Nasarawa State, Nigeria?

Background: Viral hepatitis B and C (HBV and HCV) pose significant public health concern in Nigeria, where access to healthcare and treatment affordability are limited. This study investigated sociodemographic and clinical predictors of health insurance coverage and access to care among patients with HBV and HCV in Nasarawa State, Nigeria. Methods: A cross-sectional facility-based study was conducted at two secondary hospitals in Nasarawa State, Nigeria. Participants included patients diagnosed with HBV, HCV, or both who were ≥18 years old. Data were collected using a structured questionnaire covering sociodemographic and clinical information, health insurance details, and economic impact. Binary logistic regression was used to analyze the relationship between sociodemographic/clinical factors and health insurance status. Results: Out of 303 participants, 68% had health insurance, which mostly covered hepatitis screening and vaccination. Significant predictors of health insurance coverage included being aged 36-40 years (adjusted odds ratio [aOR]: 11.01, 95% confidence interval [CI]: 2.38-50.89, p = 0.002), having post-secondary education (aOR: 25.2, 95% CI: 9.67-65.68, p < 0.001), being employed (aOR: 27.83, 95% CI: 8.85-87.58, p < 0.001), and being HIV-positive (aOR: 4.06, 95% CI: 1.55-10.61, p = 0.004). Nearly all those insured (99%) faced restrictions in insurance coverage for viral hepatitis services. Conclusions: This study reveals that while health insurance coverage is relatively high among viral hepatitis patients in Nasarawa State, significant restrictions hinder access to comprehensive services, especially for vulnerable groups like younger adults, the unemployed, and PLHIV. Key factors influencing coverage include age, education, employment, and HIV status. Expanding benefit packages to include viral hepatitis diagnosis and treatment, raising awareness about viral hepatitis as part of insurance strategy, improving access for underserved populations, and integrating hepatitis services into existing HIV programs with strong policy implementation monitoring frameworks are crucial to advancing universal health coverage and meeting the WHO's 2030 elimination goals.

Acute toxicity and anti-inflammatory activity of an improved traditional medicine developed in Burkina Faso

An Improved Traditional Medicine (ITM) in capsule form presented by traditional health practitioners in Burkina Faso as used for hepatoprotective and hepatocurative treatment for viral hepatitis B. The study's main objective was to investigate the anti-inflammatory properties of this ITM, which is used in treating viral hepatitis B in traditional medicine in Burkina Faso. Phytochemical screening revealed the presence of flavonoids, saponins, tannins, coumarins, alkaloids, sterols and triterpenes. The in vitro anti-inflammatory assay inhibited LOX by 15.69 ± 0.50% at a 100 µg/mL concentration. The LD50 was estimated to be greater than 5000 mg/kg. In vivo activity using the carrageenan anti-oedema test showed good dose-dependent anti-inflammatory activity of ITM at 30, 65 and 130 mg/kg bw. After 3 hours, the extract at various doses reduced edema to over 50% inhibition. After 5 h, oedema was reduced to 85.209% at the 130 mg/kg. However, the reference acetylsalicylic acid (ASA) at 100 mg/kg bw showed a percentage of 85.048% at 5 h. The IC50 obtained after the ABTS, FRAP and LPO antioxidant tests of the phytomedicine were 351.00 µg/mL, 353.20 mM EAA/L and 81.13%. However, the IC50 with the DPPH method was higher than 104 mg/mL. The phytomedicine would have anti-inflammatory and antioxidant properties due to the presence of bioactive phytochemicals on inflammation and free radicals. Keywords: ITM, Phytochemical, Acute toxicity, Anti-inflammatory, Antioxidants

Comparative efficacy and safety of tenofovir amibufenamide vs tenofovir alafenamide in the initial 48-week treatment of high viral load chronic hepatitis B: A single-centre retrospective study.

Tenofovir amibufenamide (TMF) employs innovative ProTide technology and a methylation strategy to enhance the lipid solubility and plasma stability of the amide bond, providing advantages over tenofovir alafenamide (TAF). Despite promising Phase III clinical trial results demonstrating its antiviral efficacy, real-world data on TMF remains scarce. This study evaluates the antiviral efficacy and safety of TMF compared to TAF as the initial treatment in patients with high viral loads of chronic hepatitis B (CHB). We retrospectively collected clinical data from March 1 2022 to June 30 2022 for highly viremic CHB patients who received either TMF (n = 58) or TAF (n = 32) as their initial monotherapy at Beijing YouAn Hospital. To understand the efficacy and safety of TMF over 48 weeks, we compared the virological response rates and HBeAg/HBsAg serological clearance rates between TMF and TAF groups. Also, the changes in serum creatinine, eGFR and serum lipid levels were assessed. Baseline median HBV DNA levels were 7.85 (6.89, 8.36) IgIU/ml for TMF and 7.44 (6.89, 8.03) IgIU/ml for TAF. Median ALT levels were 102.0 (56.0, 210.0) U/L for TMF and 195.0 (73.5, 371.0) U/L for TAF, with HBeAg positivity rates of 70.7% and 75.0%, respectively. At 48 weeks, virological response rates (HBV DNA <10 IU/ml) were 43.5% (20/46) for TMF and 42.9% (12/28) for TAF (p = 1.000). ALT normalization rates were 87.9% for TMF and 90.6% for TAF (p = .969), and HBeAg serological clearance rates were 21.1% and 18.2%, respectively (p = 1.000). No patients achieved HBsAg clearance. Compared with the baseline, LDL-C levels increased, while eGFR decreased, with no significant differences in serum creatinine, triglycerides and total cholesterol levels noted at week 48 for both TMF and TAF groups. TMF demonstrates comparable antiviral efficacy to TAF when used as initial therapy in highly viremic CHB patients, with similar impacts on renal function and lipid profiles.

Evaluation of Antioxidant and Anti-inflammatory Activities of a Medicinal Plant Recipe from Burkina Faso

&amp;lt;i&amp;gt;Background:&amp;lt;/i&amp;gt; Oxidative stress and chronic inflammation are crucial factors in the development of various diseases, such as hepatitis and cancer. In the case of hepatitis, persistent inflammation of the liver contributes to cellular damage and progression to more severe stages of the disease. &amp;lt;i&amp;gt;Objective:&amp;lt;/i&amp;gt; The aim of this study is to evaluate the antioxidant and anti-inflammatory activity of a recipe, &amp;lt;i&amp;gt;Hepatib tiben,&amp;lt;/i&amp;gt; traditionally used in the treatment of viral hepatitis B, and often associated with &amp;lt;i&amp;gt;Momordica charantia&amp;lt;/i&amp;gt; in the treatment of liver cancer in Burkina Faso. &amp;lt;i&amp;gt;Material and Methods:&amp;lt;/i&amp;gt; The recipe and associated plants were infused, macerated and the yields were evaluated and being freeze-dried. The extracts obtained were used to determine the total content of phenolic and flavonoid compounds by measuring the antioxidant activity through the FRAP, DPPH and ABTS methods and then the evaluation of the anti-inflammatory properties by inhibition of 15-LOX and COX 1 &amp; 2. &amp;lt;i&amp;gt;Results: &amp;lt;/i&amp;gt;The aqueous infusion of &amp;lt;i&amp;gt;Hepatib tiben&amp;lt;/i&amp;gt; had the best yield, the highest content of phenolic compounds and flavonoids, an antioxidant activity comparable to that of Rutin, by the FRAP method, DPPH and ABTS method. But the best antioxidant activity by FRAP method was observed with the DCM fraction. It is on the other hand the hydroalcoholic extract which had the best anti-inflammatory activity by the inhibition of the 15-LOX. Both Aqueous and Hydroalcoholic Extracts inhibited COX 1 &amp; 2. &amp;lt;i&amp;gt;Momortica charantia&amp;lt;/i&amp;gt; had high phenolic content and significant antioxidant activity by FRAP, DPPH and ABTS methods. &amp;lt;i&amp;gt;Conclusion:&amp;lt;/i&amp;gt; These observations suggest that the recipe of traditional medicinal plants used in Burkina Faso could be beneficial in the treatment of inflammatory conditions and oxidative stress. Further studies are needed to identify the active compounds responsible for these activities and to assess their safety and clinical effectiveness.

Effects of Schisandrae Fructus alone or in combination in viral hepatitis treatment: A systematic review and meta-analysis of randomized controlled trials

Abstract Background Viral hepatitis causes annual deaths of 1.4 million people. Antiviral therapy rarely cures the disease, and patients are usually required to maintain lifelong medication, leading to cumulative drug toxicity. Schisandrae Fructus (SF) is efficacious in the treatment of viral hepatitis. Objective The systematic review and meta-analysis aim to examine the efficacy and safety of SF alone or in combination with specific and nonspecific treatments for treating viral hepatitis by analyzing the clinical trials performed up to date. Methods An extensive literature was searched in 7 databases from inception to May 2023. Final outcomes were divided into the primary outcomes containing the total effective rate and virological responses, as well as the secondary outcomes containing liver biochemical functions and frequencies of adverse events. RevMan 5.3 and GRADE pro 3.6 software were used for meta-analysis and assessment of evidence quality. Subgroup analysis was conducted to explore the source of the heterogeneity. Results Twenty-nine randomized controlled trials were included in the meta-analysis. SF treatment was comparable with western medicines or other traditional Chinese treatments in terms of primary and secondary outcomes. In combination with specific treatments with antiviral medicines, SF group reduced 18.45 U/L of alanine aminotransferase levels [weighted mean difference: 18.45, 95% confidence interval (CI): (16.12, 20.78), p &lt; 0.000 01] and 8.37 U/L of aspartate aminotransferase levels [weighted mean difference: 8.37, 95% CI: (1.25, 15.48), p = 0.02], and it decreased the levels of hyaluronic acid (HA) [standard mean difference (SMD): 0.92, 95% CI: (0.58, 1.27), p &lt; 0.000 01], laminin (LN) [SMD: 0.64, 95% CI: (0.38, 0.90), p &lt; 0.000 01], and procollagen type III [SMD: 0.48, 95% CI: (0.28, 0.67), p &lt; 0.000 01] while increasing the total effective rate by 24% [risk ratio: 1.24, 95% CI: (1.15, 1.32), p &lt; 0.000 01]. There were no severe adverse events during treatment. Conclusions SF was a potential adjuvant for antiviral therapy in restoring liver function. However, the poor quality of the included randomized controlled trials limited the recommendations. More long-term, randomized, and double-blind studies should be performed to assess the efficacy and safety of combination therapy.

Parenteral chronic viral hepatitis in the Arctic zone of the Republic of Sakha (Yakutia) as the most important medical and social problem

Background. The severe course of parenteral viral hepatitis and their further chronicity are associated with the presence of immunodeficiency disorders, frequency of which increases significantly in harsh climate. The article discusses the spread of parenteral viral hepatitis in the Arctic zone of the Republic of Sakha (Yakutia) and the issues of organizing medical care for patients with chronic viral hepatitis at the regional level.The aim of the study. To analyze the incidence rates of parenteral viral hepatitis in the Arctic regions of Yakutia in order to improve the health care system using the example of remote areas of hard access.Methods. The work uses materials from official statistics of the territorial department of Rospotrebnadzor for the Republic of Sakha (Yakutia) for 2000–2022 and information from the “Chronic viral hepatitis in the Republic of Sakha (Yakutia)” register. Results. In the Arctic regions of Yakutia, problems are observed in chronic forms of viral hepatitis B, C and D, as well as in their outcomes, such as cirrhosis and liver cancer, leading to early disability and mortality. In the general structure, hepatitis B infection prevails, which indicates the presence of family foci of infection. All this requires a complex of not only therapeutic, but also advanced anti-epidemiological measures.Conclusion. The difficult epidemiological situation regarding parenteral viral hepatitis, caused by extreme natural and climatic conditions, genetic characteristics of the indigenous population and the lack of medical institutions specializing in the treatment of chronic viral hepatitis, dictates the need to strengthen systematic on-site monitoring studies and telemedicine consultations in the Arctic zone of Yakutia. Thanks to this, residents of hard-to-reach areas of the Arctic zone of the Republic of Sakha (Yakutia) will be able to receive targeted subsidized care for the treatment of chronic hepatitis without traveling to Yakutsk.

Diagnostik und Therapie der Virushepatitis in der Schwangerschaft

Diagnostik und Therapie der Virushepatitis in der Schwangerschaft

Integrated policy of medical expense subsidies and clinical registry for patients with liver cancer and decompensated cirrhosis in Japan.

Chronic hepatitisB and C are among the most significant infectious diseases worldwide, and are major risk factors for liver cirrhosis and liver cancer. In Japan, comprehensive hepatitis measures are implemented for the testing and treatment of viral hepatitis, thus enabling the early diagnosis of liver cancer. Nevertheless, patients with decompensated cirrhosis and liver cancer often have unfavorable prognoses and require repetitive long-term treatment. In fiscal year 2018, an integrated policy of medical expense subsidies and research was established in Japan that aimed to alleviate patients' financial burden and launch the clinical registry of advanced liver disease. Over time, updates to the eligibility for the subsidy increased access to patients and has led to an increased number of beneficiaries. Additionally, the accumulation of clinical data in the registry has revealed the treatment choices for these diseases. However, the disparities in efforts across prefectures have also become evident. Raising public awareness of the policy and tightening the multisector healthcare network are keys to success in supporting qualifying patients with advanced liver disease.

Metabolic Dysfunction-Associated Steatotic Liver Disease in People Living with HIV-Limitations on Antiretroviral Therapy Selection.

Chronic liver disease is one of the main causes of morbidity and mortality in people living with HIV (PLWH). The increasing life expectancy of PLWH, effective treatment for viral hepatitis, and Western dietary patterns as well as the adverse effects of antiretroviral therapy (ART) have rendered metabolic dysfunction-associated steatotic liver disease (MASLD) the most common chronic liver disease in PLWH. The risk factors for MASLD in PLWH include traditional MASLD risk factors and additional virus-specific factors, including the adverse effects of ART. The management of patients suffering from HIV and MASLD is often challenging. Apart from the conventional management of MASLD, there are also certain limitations concerning the use of ART in this patient population. In general, the appropriate combination of antiretroviral drugs should be chosen to achieve the triad of effective viral suppression, avoidance of mitochondrial dysfunction, and deterrence of worsening the patient's metabolic profile. In the current review, we discuss the epidemiology of MASLD in PLWH, the risk factors, and the disease pathogenesis, as well as the limitations in the use of ART in this patient population, while practical recommendations on how to overcome these limitations are also given.

Barriers and facilitators to viral hepatitis testing in Uzbekistan: scoping qualitative study among key stakeholders, healthcare workers, and the general population

IntroductionIn the World Health Organization European Region, an estimated 14 million people live with a chronic hepatitis B virus infection (HBV), and 12 million are affected by a hepatitis C virus infection (HCV). Uzbekistan bears a major burden of HBV and has one of the highest HCV prevalence in the region. Following a presidential decree in May 2022, significant funds were allocated to the viral hepatitis (VH) elimination program in Uzbekistan. The program expands VH testing to reach 500,000 people annually during 2022–2025 as part of the VH elimination strategy that includes the provision of free testing and affordable treatment. Exploring the existing barriers and facilitators to VH testing is pivotal for informing these interventions.MethodsThis study uses a cross-sectional qualitative design to identify and explore the barriers and facilitators to VH testing among the general population in Uzbekistan. We collected data during October-November 2022 through semi-structured interviews with 12 key informants (KIs) and 7 focus group discussions with two target populations: the general population and healthcare workers (HCW) in Tashkent, Uzbekistan.ResultsFollowing the capability-opportunity-motivation-behavior model (COM-B model) as a framework for the analysis, we identified major capability barriers to VH testing primarily linked to low health literacy and limited knowledge about VH types, symptoms, transmission, testing and treatment. Physical opportunity barriers included the time and financial costs associated with testing, diagnostics, and treatment. Sociocultural opportunity barriers involved anticipated negative reactions and stigmatization, particularly affecting women. Motivational barriers included a reluctance to be tested when asymptomatic and a general fear of receiving positive test results. The involvement of healthcare workers in promoting VH awareness and motivating the general population emerged as a facilitator.ConclusionsA multi-pronged approach is recommended to achieve VH testing goals among the general population, focusing on raising awareness and health literacy and creating an enabling environment that ensures easy accessibility and minimizing VH testing-associated costs.

Treatment results of our patients with acute viral hepatitis C

Aim: The diagnosis of acute hepatitis C virus (HCV) infection can be made during follow-up in patients with a generally known risk contact, as it is mostly asymptomatic. The earliest indicator of acute HCV infection is increased HCV-RNA. Anti-HCV seroconversion is also the strongest evidence of acute infection. The risk of chronicity is at least 80%. Treatment of acute HCV infection is recommended because of the high rate of chronicity. Spontaneous recovery can be seen after 8-12 weeks in acute viral hepatitis C. Therefore, 8-12 weeks should be waited to start specific treatment. The aim of this study is to evaluate the data of the patients we follow up with the diagnosis of acute HCV in our clinic, to determine the most appropriate time to start treatment in acute viral hepatitis C and to evaluate the effectiveness of Peg-interferon alfa 2a treatment.&#x0D; Materials and Methods: The data of patients diagnosed with acute viral hepatitis C in our clinic between 2005 and 2015 were evaluated.&#x0D; Results: Twelve patients with acute viral hepatitis C were followed in our clinic. Twelve of the cases were male, and the mean age was 38.83 ± 6.75 (range, 25-50) years. Spontaneous clearance was observed in three patients at the third month. Three months after the acute diagnosis of HCV, pegylated-interferon alpha 2a 180 mcg (1x1 / week sc) was started in nine patients without spontaneous improvement and treatment was performed for six months. Treatment response was 100% at 6-month and 2-year follow-ups.&#x0D; Conclusion: Acute viral hepatitis C is a disease that should not be overlooked.&#x0D; After diagnosis, 8-12 weeks should be waited for spontaneous viral clearance. Patients who do not develop spontaneous viral clearance after 8-12 weeks can be largely treated with interferon alfa 2a therapy.&#x0D; Spontaneous recovery was observed in three of our patients after 8-12 weeks of follow-up (HCV-RNA was negative by PCR, AST-ALT values were normal).

Viral hepatitis testing and treatment in community pharmacies: a systematic review and meta-analysis

The World Health Organization seeks to eliminate viral hepatitis as a public health threat by 2030. This review and meta-analysis aims to evaluate the effectiveness of programs for hepatitis B and C testing and treatment in community pharmacies. Medline, Embase, Cochrane CENTRAL, and Global Health were searched from database inception until 12 November 2023. Comparative and single arm intervention studies were eligible for inclusion if they assessed delivery of any of the following interventions for hepatitis B or C in pharmacies: (1) pre-testing risk assessment, (2) testing, (3) pre-treatment assessment or (4) treatment. Primary outcomes were proportions testing positive and reaching each stage in the cascade. Random effects meta-analysis was used to estimate pooled proportions stratified by recruitment strategy and setting where possible; other results were synthesised narratively. This study was pre-registered (PROSPERO: CRD42022324218). Twenty-seven studies (4 comparative, 23 single arm) were included, of which 26 reported hepatitis C outcomes and four reported hepatitis B outcomes. History of injecting drug use was the most identified risk factor from pre-testing risk assessments. The pooled proportion hepatitis C antibody positive from of 19 studies testing 5096 participants was16.6% (95% CI 11.0%-23.0%; heterogeneity I2=96.6%). The pooled proportion antibody positive was significantly higher when testing targeted people with specified risk factors (32.5%, 95% CI 24.8%-40.6%; heterogeneity I2=82.4%) compared with non-targeted or other recruitment methods 4.0% (95% CI 2.1%-6.5%; heterogeneity I2=83.5%). Meta-analysis of 14 studies with 813 participants eligible for pre-treatment assessment showed pooled attendance rates were significantly higher in pharmacies (92.7%, 95% CI 79.1%-99.9%; heterogeneity I2=72.4%) compared with referral to non-pharmacy settings (53.5%, 95% CI 36.5%-70.1%; heterogeneity I2=92.3%). The pooled proportion initiating treatment was 85.6% (95% CI 74.8%-94.3%; heterogeneity I2=75.1%). This did not differ significantly between pharmacy and non-pharmacy settings. These findings add pharmacies to the growing evidence supporting community-based testing and treatment for hepatitis C. Few comparative studies and high degrees of statistical heterogeneity were important limitations. Hepatitis B care in pharmacies presents an opportunity for future research. None.

Treatment of chronic viral hepatitis c in perm Krai

Objective. To analyze the effectiveness of etiotropic antiviral therapy with direct antiviral drugs against chronic viral hepatitis C in the adult population of the Perm Krai.&#x0D; Materials and methods. In the regional register of Perm Krai, 20095 patients with chronic viral hepatitis C were registered. In 2019–2021, antiviral therapy with direct antiviral drugs, registered in the Russian Federation, and included in the list of vital and essential medicines for medical use was prescribed to 282 patients with chronic hepatitis C. There were 137 men (48.6 %), 145 (51.4 %) – women. The age of the patients ranged from 26 to 82 years, the duration of the disease – from 3 to 25 years.&#x0D; Results. All the therapy regimes we used showed 100 % effectiveness in the population of patients suffering from chronic hepatitis C associated with mild liver fibrosis regardless of genotype, whereas in the population of patients with grade 3 fibrosis or liver cirrhosis, 100 % effectiveness was achieved only after the use of sofosbuvir-containing schemes. The pangenotypic schemes resulted in 100 % achievement of a stable virological response among patients with genotype 1 regardless of the stage of liver fibrosis and previous therapy experience. In the treatment of patients infected with genotype 3 of hepatitis C virus with severe fibrosis, the effectiveness of 100 % was noted after the use of sofosbuvir-containing regimes.&#x0D; Conclusions. Among the adult population of Perm Krai, the overall effectiveness of therapy in patients with chronic hepatitis C, who used direct antiviral drugs, was 97.8 %.

Inequities in primary liver cancer in Europe: The state of play

The liver cancer burden in Europe is increasing and to improve health outcomes equitably, it is crucial to investigate how social determinants of health (SDoH) affect liver cancer risk factors and access to care. This paper summarises the available evidence on the differential distribution of liver cancer risk factors, incidence, and health outcomes in the European Economic Area and the United Kingdom from an SDoH perspective. Vulnerable and marginalised populations have low socio-economic and educational backgrounds and are the most affected by liver cancer risk factors. Reasons for this include that access to hepatitis B virus vaccination varies, while viral hepatitis screening, harm reduction, and treatment access are limited. Additionally, alcohol-related liver disease remains prevalent among individuals with low education, insecure employment, economic instability, migrants, and deprived populations. Moreover, significant variation exists across Europe in the proportion of adults with steatotic liver disease, overweight/obesity, and diabetes, based on geographical area, gender, socio-economic, educational background, and density of ultra-processed foods outlets. Inequities in cirrhosis mortality rates have been reported, with the highest death rates among individuals living in socio-economically disadvantaged areas and those with lower educational levels. Furthermore, insufficient healthcare access for key populations with primary liver cancer is influenced by complex healthcare systems, stigmatisation, discrimination, low education, language barriers, and fear of disclosure. These challenges contribute to the liver cancer care pathway inequities. Future studies are needed to explore the different SDoH-interlinked effects on liver cancer incidence and outcomes in European countries. The ultimate goal is to develop evidence-based multilevel public health interventions that reduce the SDoH impact in precipitating and perpetuating a disproportionate liver cancer level among specific populations.