Role of primary T‐cell immunodeficiency and hepatitis B coinfection on spontaneous clearance of hepatitis C: The BC Hepatitis Testers Cohort

Islam, Nazrul; Krajden, Mel; Gilbert, Mark; Gustafson, Paul; Yu, Amanda; Kuo, Margot; Chong, Mei; Alvarez, Maria; Wong, Jason; Tyndall, Mark W.; Janjua, Naveed Z.

doi:10.1111/jvh.12650

Cited by 8 publications

(8 citation statements)

References 42 publications

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“…Number of chronically infected individuals in BC was estimated for 2012 to 2018 using the sum of: (a) the number of untreated individuals with at least an HCV RNA test on record, whose last HCV RNA test on record is positive; (b) 75% of those who were positive by antibody testing only (had no HCV RNA test or genotype on record); (c) 75% of the untested and undiagnosed estimate; (d) those treated individuals determined to have failed to achieve SVR (the SVR rate calculated for treated individuals with available RNA test after treatment was used to estimate how many treated individuals with no available RNA test after treatment would fail to achieve SVR).…”

Section: Methodsmentioning

confidence: 99%

The population level care cascade for hepatitis C in British Columbia, Canada as of 2018: Impact of direct acting antivirals

Bartlett

Chapinal

et al. 2019

Liver International

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Background: Population-level monitoring of hepatitis C virus (HCV) infected people across cascades of care identifies gaps in access and engagement in care and treatment. We characterized the population-level care cascade for HCV in British Columbia (BC), Canada before and after introduction of Direct Acting Antiviral (DAA) treatment. Methods: BC Hepatitis Testers Cohort (BC-HTC) includes 1.7 million individuals tested for HCV, HIV, reported cases of hepatitis B, and active tuberculosis in BC from 1990 to 2018 linked to medical visits, hospitalizations, cancers, prescription drugs and mortality data. We defined six HCV care cascade stages: (a) antibody diagnosed; (b) RNA tested; (c) RNA positive; (d) genotyped; (e) initiated treatment; and (f) achieved sustained virologic response (SVR). Results:We estimated 61 127 people were HCV antibody positive in BC in 2018 (undiagnosed: 7686, 13%; diagnosed: 53 441, 87%). Of those diagnosed, 83% (44 507) had HCV RNA testing, and of those RNA positive, 90% (28 716) were genotyped. Of those genotyped, 61% (17 441) received therapy, with 90% (15 672) reaching SVR.Individuals from older birth cohorts had lower progression to HCV RNA testing.While people who currently inject drugs had the highest proportional progression to RNA testing, this group had the lowest proportional treatment uptake. Conclusions: Although gaps in HCV RNA and genotype testing after antibody diagnosis exist, the largest gap in the care cascade is treatment initiation, despite introduction of DAA treatment and removal of treatment eligibility restrictions. Further interventions are required to ensure testing and treatment is equitably accessible in BC.

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Section: Methodsmentioning

confidence: 99%

The population level care cascade for hepatitis C in British Columbia, Canada as of 2018: Impact of direct acting antivirals

Bartlett

Chapinal

et al. 2019

Liver International

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“…We used data from the BC Hepatitis Testers Cohort (BC‐HTC). Details of the cohort creation and epidemiological characteristics have been reported previously . Briefly, the BC‐HTC includes all individuals tested for HCV or HIV, or reported as a case of HBV, HCV, HIV or active TB in BC between 1990 and 2013 linked with data on medical visits, hospitalizations, cancers, prescription drugs and deaths (Table ).…”

Section: Methodsmentioning

confidence: 99%

Shift in disparities in hepatitis C treatment from interferon to DAA era: A population‐based cohort study

Janjua

Islam

Wong

et al. 2017

Journal of Viral Hepatitis

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We evaluated the shift in the characteristics of people who received interferon-based hepatitis C virus (HCV) treatments and those who received recently introduced direct-acting antivirals (DAAs) in British Columbia (BC), Canada. The BC Hepatitis Testers Cohort includes 1.5 million individuals tested for HCV or HIV, or reported cases of hepatitis B and active tuberculosis in BC from 1990 to 2013 linked to medical visits, hospitalization, cancer, prescription drugs and mortality data. This analysis included all patients who filled at least one prescription for HCV treatment until 31 July 2015. HCV treatments were classified as older interferon-based treatments including pegylated interferon/ribavirin (PegIFN/RBV) with/without boceprevir or telaprevir, DAAs with RBV or PegIFN/RBV, and newer interferon-free DAAs. Of 11 886 people treated for HCV between 2000 and 2015, 1164 (9.8%) received interferon-free DAAs (ledipasvir/sofosbuvir: n=1075; 92.4%), while 452 (3.8%) received a combination of DAAs and RBV or PegIFN/RBV. Compared to those receiving interferon-based treatment, people with HIV co-infection (adjusted odds ratio [aOR]: 2.96, 95% CI: 2.31-3.81), cirrhosis (aOR: 1.77, 95% CI: 1.45-2.15), decompensated cirrhosis (aOR: 1.72, 95% CI: 1.31-2.28), diabetes (aOR: 1.30, 95% CI: 1.10-1.54), a history of injection drug use (aOR: 1.34, 95% CI: 1.09-1.65) and opioid substitution therapy (aOR: 1.30, 95% CI: 1.01-1.67) were more likely to receive interferon-free DAAs. Socio-economically marginalized individuals were significantly less likely (most deprived vs most privileged: aOR: 0.71, 95% CI: 0.58-0.87) to receive DAAs. In conclusion, there is a shift in prescription of new HCV treatments to previously excluded groups (eg HIV-co-infected), although gaps remain for the socio-economically marginalized populations.

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“…Worldwide, about 71 million people are chronically infected with hepatitis C virus (HCV) . About 25% of people with HCV infection clear the virus spontaneously within the first 6 months without receiving any treatment . However, the majority of people with HCV develop chronic infection (CHC), which if left untreated, increases the risk of progressive liver disease including cirrhosis and hepatocellular carcinoma (HCC)…”

Section: Introductionmentioning

confidence: 99%

“…To estimate the relative impact of earlier HCV treatment, the risk of HCC among individuals who cleared the virus spontaneously could be used as a real‐world control group relative to untreated HCV‐infected patients, as well as in individuals who cleared or failed to clear the virus after treatment. The spontaneously cleared group is defined as individuals who were exposed to the HCV, but resolved their infection spontaneously within a few months after the infection . Therefore, this group provides a unique control comparator to assess the impact of early viral clearance on HCV‐related outcomes since (a) they were exposed to the virus, (b) they cleared the virus in a short period of time after the infection and were not at risk of HCV viral sequelae (eg HCC and liver‐related mortality), and (c) they may had similar HCV acquisition risks (eg injecting drug use) as patients who developed chronic infection …”

Section: Introductionmentioning

confidence: 99%

Estimating the impact of early hepatitis C virus clearance on hepatocellular carcinoma risk

Darvishian

Janjua

Chong

et al. 2018

Journal of Viral Hepatitis

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Although achieving sustained virological response (SVR) through antiviral therapy could reduce the risk of hepatocellular carcinoma (HCC) attributable to hepatitis C virus (HCV) infection, the impact of early viral clearance on HCC is not well defined. In this study, we compared the risk of HCC among individuals who spontaneously cleared HCV (SC), the referent population, with the risk in untreated chronic HCV (UCHC), those achieved SVR, and those who failed interferon-based treatment (TF). The BC Hepatitis Testers Cohort (BC-HTC) includes individuals tested for HCV between 1990-2013, integrated with medical visits, hospitalizations, cancers, prescription drugs and mortality data. This analysis included all HCV-positive patients with at least one valid HCV RNA by PCR on or after HCV diagnosis. Of 46 666 HCV-infected individuals, there were 12 527 (26.8%) SC; 24 794 (53.1%) UCHC; 5355 (11.5%) SVR and 3990 (8.5%) TF. HCC incidence was lowest (0.3/1000 person-years (PY)) in the SC group and highest in the TF group (7.7/1000 PY). In a multivariable model, compared to SC, TF had the highest HCC risk (hazard ratio (HR):14.52, 95% confidence interval (CI): 9.83-21.47), followed by UCHC (HR: 5.85; 95% CI: 4.07-8.41). Earlier treatment-based viral clearance similar to SC could decrease HCC incidence by 69.4% (95% CI: 57.5-78.0), 30% (95% CI: 10.8-45.1) and 77.5% (95% CI: 69.4-83.5) among UCHC, SVR and TF patients, respectively. In conclusion, using SC as a real-world comparator group, it showed that substantial reduction in HCC risk could be achieved with earlier treatment initiation. These analyses should be replicated in patients who have been treated with direct acting antiviral therapies.

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Role of primary T‐cell immunodeficiency and hepatitis B coinfection on spontaneous clearance of hepatitis C: The BC Hepatitis Testers Cohort

Cited by 8 publications

References 42 publications

The population level care cascade for hepatitis C in British Columbia, Canada as of 2018: Impact of direct acting antivirals

The population level care cascade for hepatitis C in British Columbia, Canada as of 2018: Impact of direct acting antivirals

Shift in disparities in hepatitis C treatment from interferon to DAA era: A population‐based cohort study

Estimating the impact of early hepatitis C virus clearance on hepatocellular carcinoma risk

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