Background Rapid improvements in hepatitis C virus (HCV) therapy have led to the approval of multiple oral direct-acting antiviral (DAA) regimens by the U.S. Food and Drug Administration (FDA) for treatment of chronic HCV infection. Purpose To summarize published literature on the efficacy and safety of oral DAAs for treatment of persons with chronic HCV infection. Data Sources MEDLINE and EMBASE from inception through 1 November 2016. Study Selection 42 English-language studies from controlled and single-group registered clinical trials of adults with HCV infection that evaluated at least 8 weeks of an FDA-approved interferon-free HCV regimen that included at least 2 DAAs. Data Extraction Two investigators abstracted data on study design, patient characteristics, and virologic and safety outcomes sequentially and assessed quality independently. Data Synthesis Six DAA regimens showed high sustained virologic response (SVR) rates (>95%) in patients with HCV genotype 1 infection without cirrhosis, including those with HIV co-infection. Effective treatments for HCV genotype 3 infection are limited (2 DAA regimens). Patients with hepatic decompensation, particularly those with Child–Turcotte–Pugh class C disease, had lower SVR rates (78% to 87%) than other populations. The addition of ribavirin was associated with increased SVR rates for certain DAA regimens and patient groups. Overall rates of serious adverse events and treatment discontinuation were low (<10% in the general population); regimens that included ribavirin had more mild or moderate adverse events than those without. Limitations Twenty-three studies had moderate risk of bias (10 were open-label single-group trials, 11 had limited information on concealment of the allocation scheme, and 5 had selective outcome reporting). All but 1 of the studies were industry-funded. Heterogeneity of interventions precluded pooling. Conclusion Multiple oral DAA regimens show high rates of safety, tolerability, and efficacy for treatment of HCV genotype 1 infection, particularly among persons without cirrhosis. Primary Funding Source Patient-Centered Outcomes Research Institute. (PROSPERO: CRD42014009711)

Recognizing the importance of timely guidance regarding the rapidly evolving field of hepatitis C management, the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) developed a web-based process for the expeditious formulation and dissemination of evidence-based recommendations. Launched in 2014, the hepatitis C virus (HCV) guidance website undergoes periodic updates as necessitated by availability of new therapeutic agents and/or research data. A major update was released electronically in September 2017, prompted primarily by approval of new direct-acting antiviral agents and expansion of the guidance's scope. This update summarizes the latest release of the HCV guidance and focuses on new or amended recommendations since the previous September 2015 print publication. The recommendations herein were developed by volunteer hepatology and infectious disease experts representing AASLD and IDSA and have been peer reviewed and approved by each society's governing board.

Summary Triazole and imidazole antifungal agents inhibit metabolism of vincristine, leading to excess vinca alkaloid exposure and severe neurotoxicity. Recent reports of debilitating interactions between vincristine and itraconazole, as well as posaconazole, voriconazole and ketoconazole underscore the need to improve medical awareness of this adverse combination. We therefore undertook a comprehensive analysis of reports of adverse drug interactions (ADIs) with the combination of vincristine and azole antifungal agents, established a new classification, and provided a detailed summary of these toxicities. In patients who had sufficient data for analysis, forty-seven individuals were identified who had an ADI with the combination of vincristine and antifungal azoles. Median age was 8 years (1.3–68 years) with 33(70%) having a diagnosis of acute lymphoblastic leukemia. Median time to ADI with vincristine was 9.5 days with itraconazole, 13.5 days posaconazole, and 30 days voriconazole. The median number of vincristine doses preceding the ADI was 2 doses with itraconazole, 3 doses posaconazole, and 2 doses voriconazole. The most common severe ADIs included gastrointestinal toxicity, peripheral neuropathy, hyponatremia/SIADH, autonomic neuropathy, and seizures. Recovery from these ADIs occurred in 80.6% of patients. We recommend using alternative antifungal agents if possible in patients receiving vincristine to avoid this serious and potentially life-threatening drug interaction.

The availability of effective, simple, well-tolerated oral direct-acting antiviral (DAA) hepatitis C regimens has raised optimism for hepatitis C virus (HCV) elimination at the population level. HCV reinfection in key populations such as people who inject drugs (PWID) and HIV-infected men who have sex with men (MSM) however threatens the achievement of this goal from a patient, provider and population perspective. The goal of this review was to synthesize our current understanding of estimated rates and factors associated with HCV reinfection. This review also proposes interventions to aid understanding of and reduce hepatitis C reinfection among PWID and HIV-infected MSM in the oral direct-acting antiviral era.

Background Testing and linkage to care are important determinants of hepatitis C virus (HCV) treatment effectiveness. Public health clinics serve populations at high risk for HCV. We investigated their potential to serve as sites for HCV testing, initiation of and linkage to HCV care. Methods Cross-sectional study of patients accessing Sexually Transmitted Infections (STI) care at the Baltimore City Health Department (BCHD) STI clinics, from June 2013 through April 2014. Logistic regression was used to assess factors associated with HCV infection and specialist linkage to care. Results Between June 24, 2013 and April 15, 2014, 2681 patients were screened for HCV infection. Overall, 189 (7%) were anti-HCV positive, of whom 185 (98%) received follow-up HCV RNA testing, with 155 (84%) testing RNA positive. Of 155 RNA positive individuals, 138 (89%) returned to the STI clinic for HCV RNA results and initial HCV care including counseling regarding transmission and harm reduction for alcohol, and 132 (85%) were referred to a specialist for HCV care. With provision of patient navigation services, 81(52%) attended an offsite HCV specialist appointment. Alcohol use and lack of insurance coverage were associated with lower rates of specialist linkage (OR 0.4 [95% CI 0.1–0.9] and OR 0.4 [95% CI 0.1–0.9] respectively). Conclusion We identified a high prevalence of HCV infection in BCHD STI clinics. With availability of patient navigation services a large proportion of HCV infected patients linked to off-site specialist care.

Background: Hepatitis C virus (HCV) infection is a major public health issue among people who inject drugs (PWID) with prevalence of 50–80% in the United States. Effective, simple, oral direct acting agents (DAA) of short duration with minimal side effects have been associated with cure rates > 95%. However, HCV treatment uptake among PWID remains low. We characterized the HCV care continuum, HCV treatment knowledge, as well as barriers and facilitators to HCV treatment uptake among PWID enrolled in two opioid treatment programs (OTPs) in Baltimore, Maryland, USA. Methods: Between July and November 2016, 124 HCV infected PWID were recruited from two opioid treatment programs in Baltimore through convenience sampling. Participants completed a 50-item questionnaire to assess HCV treatment knowledge, attitudes, and practices. Progress through the HCV care continuum was assessed based on a series of questions assessing evaluation for HCV treatment, recommendation for HCV treatment by a provider, and HCV treatment initiation. HCV status was assessed based on participant self-report. Results: The median age was 52 years (IQR 44–58), 56% were male, the majority were African American (69%), and 19% reported HIV coinfection. Participants had been tested for HCV at their primary care provider’s (PCP’s) office (34%), drug treatment center (20%), emergency room (11%), or prison (9%), and most (60%) had been diagnosed with HCV over 5 years prior. The majority reported that HCV was a major health concern for them (91%), were aware there were new treatments for HCV (89%), and that the new treatments cure most people (69%). More than half (60%) had seen a health professional who could treat HCV, 40% had HCV therapy recommended by their HCV specialist, and 20% had started or completed treatment. In univariable analysis, PWID were significantly more likely to have been treated if they were HIV co-infected (OR 3.4 (95% CI 1.3–9.2)) or had a partner or friend concerned about their HCV (OR 3.4 (95% CI 1.2–9.7)), and were significantly less likely to have been treated if they had used any illicit drugs in the preceding 6 months (OR 0.4 (95% CI 0.2–0.99). In multivariable analysis, having a friend or partner concerned about their HCV remained significantly associated with HCV treatment (OR 5.0 (95% CI 1.4–17.7)). When questioned about what would facilitate HCV treatment, the majority (85%) reported that a friend telling them that HCV treatment had helped them and having HCV treatment provided at their opioid treatment program would make them more likely to engage in HCV treatment. Conclusion: Despite a high prevalence of HCV among opioid treatment program patients and the availability of effective treatments, uptake remains low. We identified several key barriers and facilitators that can affect HCV treatment uptake.

Viremic controllers (VC) and elite controllers/suppressors (ES) maintain control over HIV-1 replication. Some studies suggested that control is a result of infection with a defective viral strain while others suggested host immune factors play a key role. Here we document two HIV-1 transmission pairs: one consisting of a patient with progressive disease and an individual who became an ES, and the second consisting of a patient with progressive disease and a VC. In contrast to another ES transmission pair, virus isolated from all patients was fully replication competent. These data suggests that some VC and ES are infected with HIV-1 isolates that replicate vigorously in vitro and are able to cause progressive disease in vivo. These data suggest that host factors play a dominant role in control of HIV-1 infection, thus it may be possible to control fully pathogenic HIV-1 isolates with therapeutic vaccination.

evolution of the virus but also the fundamental mechanisms by which control measures affected its epidemic spread. These efforts complement the information provided by the rapidly growing public databases of SARS-CoV-2 sequences by focusing the collection of genomic data in settings where we can access extensive current and past clinical data to investigate fundamental questions about this evolving virus's changing relationship with human health. MethodsData availability. Raw nanopore and Illumina data are deposited at SRA (BioProject PRJNA629390). Consensus sequences are deposited at GISAID and Genbank (MT509452-MT509493, and MT646048-MT646120) under BioProject PRJNA650037 (accession numbers available in Supplemental Table 3).Specimens and patient data. Clinical specimens used for genetic characterization were remnant nasopharyngeal swabs available at the completion of standard of care testing at the Johns Hopkins Hospital clinical virology laboratory. In total, 143 samples were selected for analysis based on their distribution throughout March 2020 and representation of the range of disease severity observed during this period. During this period, automated patient metadata extraction was limited to the date a sample was confirmed positive; all other data required patient chart reviews. Samples were sequenced in 2 phases, with the first phase enriched for patients admitted to the ICU (14 of 55 samples collected March 11-21), and the second a convenience sample that captured as many samples as possible for sequencing, irrespective of disease severity or ICU admission (10 of 88 samples collected March 13 -31).Clinical data analysis. Data including patient demographics, symptoms, comorbidities, COVID-19 exposure, recent travel history, and results of chest imaging at presentation were abstracted from the electronic medical record (EMR). COVID-19 treatment (medication, supplemental oxygen, and invasive mechanical ventilation) and outcomes (home observation without inpatient admission, discharge after admission, ongoing admission, and death) were also abstracted from the EMR. Race as self-reported by the patient and documented in the EMR was collected in prespecified categories. Patients who reported (a) contact with an individual known to be COVID-19-infected or (b) high-risk exposure (e.g., healthcare worker) were classified as COVID-19-exposed. Comorbidities were assessed based on diagnoses in the EMR (i.e., diabetes, obesity, or alcohol use disorder) and further categorized for lung disease (e.g., asthma, COPD), cardiac disease (e.g., valvular heart disease, arrhythmias, hypertension), and immunocompromised (e.g., HIV positive, hematologic malignancy, solid organ transplant).Nucleic acid extraction. Automated nucleic acid extraction was performed using either the NucliSENS easy-Mag or eMAG instruments (bioMérieux) using software version 2.1.0.1. easyMag or eMAG lysis buffer (2 mL) was added to 500 μL of aliquoted viral transport media in a biosafety cabinet in either a BSL-3 or BSL-2 facility using BSL-3 biosafe...