Effective Treatment of Injecting Drug Users With Recently Acquired Hepatitis C Virus Infection

Dore, Gregory J.; Hellard, Margaret; Matthews, Gail V.; Grebely, Jason; Haber, Paul S.; Petoumenos, Kathy; Yeung, Barbara; Marks, Philippa; Beek, Ingrid van; McCaughan, Geoffrey W.; White, Peter A.; French, Rosemary; Rawlinson, William D.; Lloyd, Andrew R.; Kaldor, John

doi:10.1053/j.gastro.2009.09.019

Cited by 133 publications

(166 citation statements)

References 25 publications

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“…In both group of patients, the resolution was significantly higher in the treated group, suggesting that even patients with a low viremia also get benefit with treatment. A trend toward better response in IDU patients with AHC and a low baseline viral load (< 400.000 IU/mL) was also found in the Australian trial (32).…”

Section: Discussionmentioning

confidence: 76%

Acute hepatitis C in Spain: a retrospective study of 131 cases

Pérez-Álvarez¹,

García-Samaniego

Solá

et al. 2012

Rev. esp. enferm. dig.

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Background and aims: the management of acute hepatitis C (AHC) is controversial. We have conducted a retrospective study to determine the epidemiological and biochemical aspects, the genotypes, the spontaneous clearance of HCV (SVC), and the treatment responses in patients with AHC.Methods: we have retrospectively collected data from 131 patients with AHC from 18 Spanish hospitals.Results: the mean age was 43 ± 16 years (17-83), 69% were symptomatic. The causes of infection were nosocomial in 40% and intravenous drug users in 20%. Eighty two percent had genotype 1. The delay from symptoms-onset to HCV-RNA confirmation was 50 ± 68 days (range, 11-350 days) and to treatment (in 59%) 14 ±1 3 weeks (range, 2-58 days). In the treated group, 80% achieved sustained virological response (SVR) versus 57% SVC in untreated patients (p = 0.004). Up to 96% of those treated within the first 12 weeks had SVR versus 86% of those treated later (p = 0.04). Patients with HCV-RNA(-) at week 4 resolved with or without treatment more frequently than those HCV-RNA(+) (98% versus 69%, p = 0.005). The treatment was not beneficial if HCV-RNA was undetectable at week 12. No differences in SVR were found in genotype 1 patients treated for 24 or 48 weeks. Patients with low baseline viral load achieved higher SVC and SVR. The SVC in patients with bilirubin > 5 mg/dL was 78 versus 40% in those with lower values (p = 0.004).Conclusions: the most common transmission route was nosocomial. SVR was higher in patients treated than SVC in non-treated. Early treatment (before week 12) achieved the highest response rate. SVC and SVR were more common in patients with a low baseline viral load. Undetectable HCV-RNA at week 4 was associated with high SVR and SVC rates. Jaundice was related with SVC.

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Section: Discussionmentioning

confidence: 76%

Acute hepatitis C in Spain: a retrospective study of 131 cases

Pérez-Álvarez¹,

García-Samaniego

Solá

et al. 2012

Rev. esp. enferm. dig.

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“…The samples came from clinics run by community addition services. Group 4 consisted of 65 DBS taken from known chronic patients (tested anti-HCV and HCV PCR positive for >1 year) and group 5 consisted of 68 DBS from resolved patients (tested anti-HCV and HCV PCR negative for an average of 6 years, range [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. The patients chosen for each group had had previous HCV results from plasma samples on record at WoSSVC.…”

Section: Patient Dbs Samplesmentioning

confidence: 99%

“…[5][6][7] Treatment of early HCV infection is associated with higher sustained virological response rates, including among PWID. [8][9][10] The ability to distinguish between a recently acquired and a past infection is important to help guide the clinical management of patients with HCV and direct prevention initiatives. 6 A recently acquired HCV infection is often asymptomatic.…”

Section: Introductionmentioning

confidence: 99%

A hepatitis C avidity test for determining recent and past infections in both plasma and dried blood spots

Shepherd

Kean

Hutchinson

et al. 2013

Journal of Clinical Virology

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This version is available at https://strathprints.strath.ac.uk/42887/ Strathprints is designed to allow users to access the research output of the University of Strathclyde. Unless otherwise explicitly stated on the manuscript, Copyright © and Moral Rights for the papers on this site are retained by the individual authors and/or other copyright owners. Please check the manuscript for details of any other licences that may have been applied. You may not engage in further distribution of the material for any profitmaking activities or any commercial gain. You may freely distribute both the url (https://strathprints.strath.ac.uk/) and the content of this paper for research or private study, educational, or not-for-profit purposes without prior permission or charge.Any correspondence concerning this service should be sent to the Strathprints administrator: strathprints@strath.ac.ukThe Strathprints institutional repository (https://strathprints.strath.ac.uk) is a digital archive of University of Strathclyde research outputs. It has been developed to disseminate open access research outputs, expose data about those outputs, and enable the management and persistent access to Strathclyde's intellectual output. a b s t r a c tBackground: DBS testing has been used successfully to detect HCV antibody positive individuals. Determining how long someone has been infected is important for surveillance initiatives. Antibody avidity is a method that can be used to calculate recency of infection. Objectives: A HCV avidity assay was evaluated for both plasma and DBS. Study design: To measure antibody avidity a commercial HCV ELISA was modified using 7 M urea. The plasma samples were split into: group 1 (recently infected N = 19), group 2 (chronic carrier N = 300) and group 3 (resolved infection N = 82). Mock DBS made from group 1 (N = 12), group 2 (N = 50), group 3 (N = 25) and two seroconverter panels were evaluated. 133 DBS taken from patients known to have a resolved infection or be a chronic carrier were also tested.Results: The avidity assay cut-off was set at AI ≤ 30 for a recent infection. Using sequential samples the assay could detect a recent infection in the first 4-5 months from the point of infection. Most of the false positive results (AI < 30 among cases known not to have had recent infection) were detected among known resolved infections, in both the plasma and DBS; as a result, a testing algorithm has been designed incorporating both PCR and two dilution factors. The sensitivity and specificity of the assay on plasma was 100% and 99.3%, respectively, while DBS had 100% sensitivity and 98.3% specificity. Conclusion:The HCV avidity assay can be used to distinguish between chronic and recent infection using either plasma or DBS as the sample type.

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“…Most studies in the HIV-infected population initiated treatment between 12 and 24 weeks after diagnosis, and the length of time between the start of acute hepatitis and treatment initiation does not appear to influence treatment response. In the Australian Trial in Acute HCV (ATAHC) there appeared little difference in SVR in individuals commenced on therapy prior to 27 weeks, 27 to 52 weeks and > 52 weeks: 67% (10 of 15), 73% (11 of 15), and 100% (5 of 5), respectively [116]. This finding has been confirmed by other studies with SVRs of 76% (13/17) versus 76% (25/33) in those commenced on therapy less than 24 weeks or greater than and equal to 24 weeks after estimated HCV infection [117].…”

Section: Rationalementioning

confidence: 99%

“…Cohort studies in AHC have varied widely in duration of therapy administered, with the most common durations being either 24 or 48 weeks [116,117,121,122,[125][126][127][128][129][130][131][132]. In the treatment of chronic HCV, viral kinetics are used to determine treatment duration.…”

Section: Rationalementioning

confidence: 99%