scholarly journals Micro-elimination of Chronic Hepatitis C by Universal Screening plus Direct Acting Antivirals for Incarcerated Persons in Taiwan

2020 ◽  
Author(s):  
Tsung-Hua Yang ◽  
Yu-Jen Fang ◽  
Shih-Jer Hsu ◽  
Ji-Yuh Lee ◽  
Min-Chin Chiu ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Universal Screening ◽  
Virologic Response ◽  
Hcv Rna ◽  
Direct Acting Antiviral ◽  
Hcv Antibody ◽  
Hcv Screening ◽  
Direct Acting

Abstract Background Incarcerated persons are a special population with higher hepatitis C virus (HCV) prevalence and should be prioritized for micro-elimination. This study aimed to investigate the seroprevalence and to evaluate the effectiveness and safety of direct acting antiviral (DAA) therapy in the custodial settings. Methods Incarcerated persons in Yunlin Prison were recruited to receive anti-HCV antibody screening. Patients with positive HCV ribonucleic acid (HCV RNA) were treated with glecaprevir/pibrentasvir (GLE/PIB) in our special chronic hepatitis C (CHC) clinic in prison. The primary endpoint was sustained virologic response at week 12 off therapy (SVR12). Results A total of 1402 incarcerated persons were invited to anti-HCV screening and 824 (58.7%) accepted. The prevalence of anti-HCV positivity was 33.5% (276/824) and the viremic rate (detectable HCV RNA) was 69.2% (191/276). According to FIB-4 index, patients with F3 stage were six (3.1%), but none met the criteria of F4 stage. However, six (3.1%) had liver cirrhosis with splenomegaly, confirmed by findings of ultrasonography. The median log10 HCV RNA level at baseline was 6.235 (2.394-7.403). Genotype (GT) 6 was predominant (39.3%), followed by GT 1a (22.0%) and 1b (14.1%). Mixed genotype HCV infection accounted for 3.6% of total infections. In total, 165 patients received GLE/PIB therapy. The overall SVR12 rates were 100%. Conclusions DAA therapy is highly effective and safe for incarcerated patients in Taiwan. Our special prison-based CHC clinic, linking universal screening to medical care, can serve as a model for micro-elimination of HCV in custodial settings.

scholarly journals Metabolic Changes in Chronic Hepatitis C Patients Who Carry IFNL4-ΔG and Achieve Sustained Virologic Response With Direct-Acting Antiviral Therapy

2019 ◽  
Vol 221 (1) ◽  
pp. 102-109 ◽  
Author(s):  
Benjamin Emmanuel ◽  
Samer S El-Kamary ◽  
Laurence S Magder ◽  
Kristen A Stafford ◽  
Man E Charurat ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Sustained Virologic Response ◽  
Density Lipoprotein ◽  
Virologic Response ◽  
Direct Acting Antiviral ◽  
Hiv Coinfection ◽  
The Mean ◽  
Direct Acting

Abstract Background Clearance of hepatitis C virus (HCV) results in rapid changes in metabolic parameters early in direct-acting antiviral (DAA) therapy. Long-term changes after sustained virologic response (SVR) remain unknown. Methods We investigated longitudinal changes in metabolic and inflammatory outcomes in chronic hepatitis C (CHC) patients: low-density lipoprotein (LDL), high-density lipoprotein, triglycerides, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) using a general linear model for repeated measurements at 5 clinical time points and by human immunodeficiency virus (HIV) coinfection and IFNL4 genotype. Results The mean LDL increased markedly during DAA therapy (pre-DAA, 86.6 to DAA, 107.4 mg/dL; P < .0001), but then it decreased to 97.7 mg/dL by post-SVR year 1 (P < .001 compared with DAA; P = .0013 compared with SVR). In patients who carry the IFNL4-ΔG allele, mean LDL increased during treatment, then decreased at post-SVR year 1; however, in patients with TT/TT, genotype did not change during and after DAA treatment. The mean ALT and AST normalized rapidly between pre-DAA and DAA, whereas only mean ALT continued to decrease until post-SVR. Metabolic and inflammatory outcomes were similar by HIV-coinfection status. Conclusions Changes in LDL among CHC patients who achieved SVR differed by IFNL4 genotype, which implicates the interferon-λ4 protein in metabolic changes observed in HCV-infected patients.

scholarly journals Ineffective Absorption? Failure of Direct-Acting Therapy for Chronic Hepatitis C in Cirrhotic Patients With Roux-en-Y Gastric Bypass

2019 ◽  
Vol 7 ◽  
pp. 232470961985812
Author(s):  
Clara Y. Tow ◽  
John F. Reinus
Keyword(s):  
Gastric Bypass ◽  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Virologic Response ◽  
Response To Therapy ◽  
Direct Acting Antiviral ◽  
Cirrhotic Patients ◽  
Direct Acting ◽  
Short Courses

In this era of direct-acting antiviral (DAA) therapy for chronic hepatitis C virus (HCV) infection, treated patients have extremely high rates of sustained virologic response to short courses of therapy regardless of stage of fibrosis. Treatment failure is uncommon and often attributed to medication noncompliance or viral resistance to drug. This report describes 2 Child-Pugh-A cirrhotic patients who failed to clear HCV in response to therapy with DAAs. Each patient had Roux-en-Y gastric bypass (RYGB) surgery preceding DAA therapy. RYGB may create multiple barriers to adequate DAA absorption as a result of changes in gastrointestinal physiology. Treatment monitoring and duration should be carefully considered in this unique patient population.

scholarly journals Sustained Virologic Response for Chronic Hepatitis C Infection After 27 Days of Treatment with Sofosbuvir and Ribavirin

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Eric G. Meissner ◽  
Amy Nelson ◽  
Miriam Marti ◽  
Henry Masur ◽  
Anu Osinusi ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Sustained Virologic Response ◽  
Antiviral Agents ◽  
Virologic Response ◽  
Hepatitis C Infection ◽  
Direct Acting Antiviral ◽  
Direct Acting ◽  
Direct Acting Antiviral Agents

Abstract Successful treatment of chronic hepatitis C virus infection can now be achieved using direct-acting antiviral agents without interferon. In this report, we present a patient who achieved a sustained virologic response after 27 days of treatment with sofosbuvir and ribavirin. It is imperative to identify factors that allow for shorter treatment times in some individuals.

scholarly journals PATIENTS WITH HAEMOGLOBINOPATHIES AND CHRONIC HEPATITIS C: A REALLY DIFFICULT TO TREAT POPULATION IN 2016?

2016 ◽  
Vol 9 (1) ◽  
pp. e2017003 ◽  
Author(s):  
Kalliopi Zachou ◽  
Pinelopi Arvaniti ◽  
Nikolaos K. Gatselis ◽  
Kalliopi Azariadis ◽  
Georgia Papadamou ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Antiviral Treatment ◽  
Response To Treatment ◽  
Hcv Rna ◽  
Severe Liver Disease ◽  
Hcv Screening ◽  
The Stability ◽  
Direct Acting

Background & objectives: In the past, patients with haemoglobinopathies were at high risk for acquiring hepatitis C virus (HCV) due to multiple transfusions before HCV screening. In these patients the coexistence of haemochromatosis and chronic hepatitis C (CHC) often leads to more severe liver disease. We assessed the HCV prevalence, clinical characteristics and outcome in this setting with particular attention to the response to treatment including therapies with the new direct acting antivirals (DAAs).Methods: The medical records of 81 consecutive patients followed the last 15 years were reviewed retrospectively.Results: 43/81 (53%) patients were anti-HCV positive including 31/43 (72.1%) with CHC (HCV-RNA positive; age 25±7 years; 45.2% with genotype 1b; 19.4% cirrhotics; baseline ferritin 887 ng/ml; range: 81-10.820).  Thirty patients received IFN-based therapy with or without ribavirin with sustained virological response (SVR) in 14/30 (46.7%).   Eleven patients (9 non-responders to IFN-based therapies, 1 relapser and 1 naïve) received treatment with DAAs (SVR: 100%). 3/11 patients increased their transfusion needs while 1/11 reported mild arthralgias. No drug-drug interactions between DAAs and chelation agents were observed as attested by the stability of ferritin levels during treatment. Conclusions: More than 1/3 of patients with haemoglobinopathies suffered from CHC. Response rates to antiviral treatment seem to be similar to other patients with CHC, while treatment with DAAs was very effective and safe even in difficult to treat patients (most null responders with severe fibrosis) suggesting that this group of HCV patients should no longer be regarded as a difficult to treat.

scholarly journals THE USE OF DIRECT-ACTING ANTIVIRALS FOR THE TREATMENT OF CHRONIC HEPATITIS C IN PATIENTS WITH HEMOPHILIA

2020 ◽  
Vol 4 (2) ◽  
pp. 184-188
Author(s):  
D. E. Danilau ◽  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Hematological Parameters ◽  
Antiviral Treatment ◽  
Virologic Response ◽  
Direct Acting Antiviral ◽  
Number Of Patients ◽  
Direct Acting ◽  
Alt Activity

Background. Worldwide, prior to 1990, a large number of patients with hemophilia were infected with the hepatitis C virus due to substitution therapy. The mortality rate from chronic liver disease and HCC in patients with HCV and hemophilia is signifcantly higher than in general population. Objective. To assess the results of direct-acting antiviral therapy in patients with hemophilia and chronic hepatitis C. Material and methods. The rate of sustained virologic response after DAA treatment and the dynamics of clinical and laboratory parameters during antiviral treatment were evaluated. Results. All 14 patients achieved sustained virological response after 12 / 24 weeks of treatment. During antiviral treatment, some patients showed an increase in blood urea nitrogen, a decrease in leukocyte count, and increase of ALT activity. All these phenomena were reversible and resolved spontaneously. Conclusion. The DAA regimens available in Belarus are highly effective for the treatment of chronic hepatitis C in patients with hemophilia. These regimens do not signifcantly affect hematological parameters, are well tolerated, and have acceptable safety profle.

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