Hepatitis C virus micro-elimination: Where do we stand?

Mangia, Alessandra; Cotugno, Rosa; Cocomazzi, Giovanna; Squillante, Maria Maddalena; Piazzolla, Valeria

doi:10.3748/wjg.v27.i16.1728

Cited by 18 publications

(11 citation statements)

References 36 publications

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“…The European Union has prioritized organizing attention based on epidemiological data that subsidize referencing and creating services that offer focal actions to specific populations and risk groups to achieve microelimination. 28 …”

Section: Discussionmentioning

confidence: 99%

Aspects that facilitate access to care for viral hepatitis: An evaluative research

Gleriano,

Krein,

Chaves

2024

Sao Paulo Med. J.

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BACKGROUND: Viral hepatitis is a major public health concern worldwide. OBJECTIVES: This study aimed to analyze the factors that facilitate access to care for viral hepatitis. DESIGN AND SETTING: Using a sequential mixed method, this evaluation research was conducted in the state of Mato Grosso, Brazil. METHODS: Mapping of references and selection of regions were made based on the quantity and heterogeneity of services. The stakeholders, including the managers of the State Department of Health and professionals from reference services, were identified. Nine semi-structured interviews were conducted using content analysis and discussions guided by the dimensions of the analysis model of universal access to health services. RESULTS: In the political dimension, decentralizing services and adhering to the Intermunicipal Health Consortium are highly encouraged. In the economic-social dimension, a commitment exists to allocate public funds for the expansion of referral services and subsidies to support users in their travel for appointments, medications, and examinations. In the organizational dimension, the availability of inputs for testing, definition of user flow, ease of scheduling appointments, coordination by primary care in testing, collaboration following the guidelines and protocols, and engagement in extramural activities are guaranteed. In the technical dimension, professionals actively commit to the service and offer different opening hours, guarantee the presence of an infectious physician, expand training opportunities, and establish intersectoral partnerships. In the symbolic dimension, professionals actively listen to the experiences of users throughout their care trajectory and demonstrate empathy. CONCLUSIONS: The results are crucial for improving comprehensiveness, but necessitate managerial efforts to enhance regional governance.

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Section: Discussionmentioning

confidence: 99%

Aspects that facilitate access to care for viral hepatitis: An evaluative research

Gleriano,

Krein,

Chaves

2024

Sao Paulo Med. J.

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“…In low-and middle-income countries, such as India, Cambodia, and Indonesia with limited infrastructure, recent efforts to eliminate HCV infection included political support and decentralized programs. These approaches have enabled intensive low-cost screening and a reduction in the cost of medication and have resulted in a cure rate exceeding 90% in 120 individuals (52) In European countries, such as France, plans to eliminate HCV infection include the availability of oral antivirals to members of various 'high-risk 'populations, such as HIV-infected patients and men who have sex with men for the years 2015 and 2016 respectively. Universal HCV treatment, with full coverage by French National Health Care, was introduced in 2017.…”

Section: Discussionmentioning

confidence: 99%

Seroprevalence and Genotype Diversity of Hepatitis C Virus in the Caribbean - A Review

Brown¹,

Lindo²,

Nelson³

et al. 2023

Preprint

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INTRODUCTION There have been several advances in the treatment of hepatitis C virus (HCV) infection which have resulted in major reductions in the morbidity and mortality from liver-associated disease. These are not widely available in the Caribbean, due in part, to lack of knowledge of the epidemiology of infections with HCV. As efforts are made to eliminate HCV from the region, these and other existing barriers such as lack of an established database on HCV must be addressed. This review seeks to identify gaps in the knowledge of HCV in the Caribbean with respect to seroprevalence, genotype distribution and general epidemiologic characteristics. MATERIALS AND METHODS The literature for the period January 1, 2005, to October 2022, was reviewed to gather country specific data on HCV across the Caribbean. References were identified through indexed journals accessed through established databases. The usage pattern of HCV drugs was determined from data obtained from Pharmacists and Infectious Diseases Specialists across the region. RESULTS The prevalence of HCV in the Caribbean was 1.5%; the region should therefore be considered an area of moderate prevalence. Notably, data from specific countries were limited. The prevalence of HCV among intravenous drug users (21.9-58.8%); persons living with HIV/AIDS (0.8 to 58.5%); prisoners (32.8-64%) and men who have sex with men (MSM) (0.8-6.9%) was generally higher than in the general population (0.8-2.3%). Genotype 1 (83% was most prevalent followed by genotypes 2 (7.2%) and 3(2.1%), respectively. Drugs currently being used for treatment of HCV infections across the Caribbean include Epclusa (Sofosbuvir/velpatasvir), and Harvoni (Ledipasvir/sofosbuvir). Some of these drugs, are only available in the private sector and are sourced externally whenever needed. CONCLUSION There is a paucity of current data on the seroprevalence of HCV in the Caribbean and well-designed prospective studies are indicated to drive the implementation of treatment and control programs for HCV in the region. Barriers which need to be first overcome include unavailability and high cost of drugs used to treat HCV infections, injecting drug use and limited access to medical care and laboratory testing.

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“…PWH enrolled in the ANRS CO4 FHDH cohort with HCV infection, without cirrhosis, and cured with oral DAAs have worse survival outcomes than participants with HIV monoinfection, despite HIV viral suppression, after adjusting for confounding factors, with no significant difference in the first 12 months, and a significant difference from 12 to 60 months. Tailoring health services to reach WHO targets for HCV micro-elimination in the HIV population is one component of the strategy to defeat HCV as a public health threat [31,32]. In addition, it is paramount to address the issue of mortality in PWH with cured HCV, even in those who do not have cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

Mortality in hepatitis C virus-cured vs. hepatitis C virus-uninfected people with HIV

Requena

Grabar

Lanoy

et al. 2023

Aids

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Objective: It is unknown whether hepatitis C virus (HCV)-cured people with HIV (PWH) without cirrhosis reached the same mortality risk as HCV-uninfected PWH. We aimed to compare mortality in PWH cured of HCV by direct-acting antivirals (DAAs) to mortality in individuals with HIV monoinfection.Design: Nationwide hospital cohort.Methods: HIV-controlled participants without cirrhosis and HCV-cured by DAAs started between September 2013 and September 2020, were matched on age (AE5 years), sex, HIV transmission group, AIDS status, and body mass index (BMI) (AE1 kg/m 2 ) to up to 10 participants with a virally suppressed HIV monoinfection followed at the time of HCV cure AE6 months. Poisson regression models with robust variance estimates were used to compare mortality in both groups after adjusting for confounders.Results: The analysis included 3961 HCV-cured PWH (G1) and 33 872 HCV-uninfected PWH (G2). Median follow-up was 3.7 years in G1 [interquartile range (IQR): 2.0-4.6], and 3.3 years (IQR: 1.7-4.4) in G2. Median age was 52.0 years (IQR: 47.0-56.0), and 29 116 (77.0%) were men. There were 150 deaths in G1 [adjusted incidence rate (aIR): 12.2/ 1000 person-years] and 509 (aIR: 6.3/1000 person-years) in G2, with an incidence rate ratio (IRR): 1.9 [95% confidence interval (CI), 1.4-2.7]. The risk remained elevated 12 months post HCV cure (IRR: 2.4 [95% CI, 1.6-3.5]). Non-AIDS/non-liver-related malignancy was the most common cause of death in G1 (28 deaths).Conclusions: Despite HCV cure and HIV viral suppression, after controlling on factors related to mortality, DAA-cured PWH without cirrhosis remain at higher risk of allcause mortality than people with HIV monoinfection. A better understanding of the determinants of mortality is needed in this population.

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Hepatitis C virus micro-elimination: Where do we stand?

Cited by 18 publications

References 36 publications

Aspects that facilitate access to care for viral hepatitis: An evaluative research

Aspects that facilitate access to care for viral hepatitis: An evaluative research

Seroprevalence and Genotype Diversity of Hepatitis C Virus in the Caribbean - A Review

Mortality in hepatitis C virus-cured vs. hepatitis C virus-uninfected people with HIV

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