Territory‐wide population‐based study of chronic hepatitis C infection and implications for hepatitis elimination in Hong Kong

Hui, Yee Tak; Wong, Grace Lai–Hung; Fung, James; Chan, Henry Lik‐Yuen; Leung, Nancy; Liu, Sienna D.; Liu, Ken; Keung, Yiu; But, David; Mak, W; Chan, Jts; Lai, Kin Bon; Loo, Ching Kong; Ng, Annie C. Y.; Lai, Moon Sing; Chan, C. W.; Lau, Joulen Y. L.; Fan, Tina T. T.; Hui, Aric Josun; Lam, Belsy C Y; Cheung, Wing I.; Tsang, Owen Tak‐Yin; Lam, Karen Siu Ling; Lai, Lawrence S. W.; Luk, Wai Fan; Li, Michael K K; Lao, Wai Cheung; Lam, Jodis Ting Wa; Tsang, Steven Woon–Choy; Kung, Kam Ngai; Chow, Wai Hung; Tong, Ronald K. N.; Lui, Thomas Ka-Luen; Shan, Edwin Hok Shing; Yuen, Man Fung; Wong, Vincent Wai‐Sun

doi:10.1111/liv.13926

Cited by 17 publications

(23 citation statements)

References 28 publications

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“…All 16 patients were chronically infected with HCV and had been followed up for a median duration (interquartile range) of 6 (2.75–9.25) years. Half the patients were infected with genotype 1 HCV, and 5/16 (31.25%) patients were infected with genotype 6, which is the second most common HCV genotype in Hong Kong [16]. HBsAg positivity was documented in 4/16 (25%) cases, whereas 1 patient was known to be co-infected with HIV.…”

Section: Resultsmentioning

confidence: 99%

Epidemiological and Clinical Characteristics of Human Hepegivirus 1 Infection in Patients With Hepatitis C

Sridhar

Yip

Chew

et al. 2019

Open Forum Infectious Diseases

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Background Transmission of human hepegivirus 1 (HHpgV-1), a novel human pegivirus, is closely associated with hepatitis C virus (HCV). The impact of HHpgV-1 viremia on HCV infection is unknown. This study aimed to (a) evaluate the impact of HHpgV-1 viremia on HCV viral load and liver injury and (b) elucidate the clinical and molecular epidemiology of HHpgV-1 infection. Methods Individuals with HHpgV-1 viremia (cases) were identified by screening plasma from 655 HCV-infected adults. HHpgV-1 isolates were sequenced for phylogenetic analysis, and viral load was quantified. Cases were age- and sex-matched to HCV-infected individuals without HHpgV-1 viremia (controls) in a 1:3 ratio. A retrospective case–control analysis was performed to identify differences in HCV viral load and parameters of liver injury. Results Among HCV-infected adults, 16/655 (2.4%) had HHpgV-1 viremia. Risk groups for HHpgV-1 infection included intravenous drug users, blood product recipients, tattoo recipients, and men who have sex with men. Viral sequences clustered into 2 distinct HHpgV-1 genogroups. Cases had a higher mean HCV viral load than controls, with difference between means of 0.58 log10 IU/mL (P = .009). Cases were more likely to have an HCV viral load >5 log10 IU/mL (P = .028). Multiple regression demonstrated the impact of HHpgV-1 viral load and infection status on HCV viral load. HHpgV-1 infection was not associated with higher liver function tests, fibrosis scores, or imaging abnormalities. Conclusions HHpgV-1 viremia is associated with a higher HCV viral load in co-infected patients. HHpgV-1 infection does not affect progression of HCV-related liver disease.

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Section: Resultsmentioning

confidence: 99%

Epidemiological and Clinical Characteristics of Human Hepegivirus 1 Infection in Patients With Hepatitis C

Sridhar

Yip

Chew

et al. 2019

Open Forum Infectious Diseases

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“…In Hong Kong, 40-50% of injection drug users are chronically infected with hepatitis C virus [3,26]. Although the diagnosis rate is 50% in the overall community [27], the diagnosis rate among injection drug users is much lower, and only a quarter of patients diagnosed to have CHC would eventually receive antiviral therapy. It is also noteworthy that the proportion of patients with other psychiatric illnesses who had CHC (0.9-3.3%) was still much higher than the population prevalence of positive anti-hepatitis C virus Fig.…”

Section: Discussionmentioning

confidence: 99%

High incidence of hepatocellular carcinoma and cirrhotic complications in patients with psychiatric illness: a territory-wide cohort study

et al. 2020

Self Cite

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Background: Because of high-risk behaviours, sedentary lifestyle and side effects of medications, psychiatric patients are at risk of viral hepatitis, alcohol-related liver disease and non-alcoholic fatty liver disease. We aimed to study the incidence of hepatocellular carcinoma (HCC) and cirrhotic complications in psychiatric patients. Methods: We identified consecutive adult patients in all public hospitals and clinics in Hong Kong with psychiatric diagnoses between year 2003 and 2007 using the Clinical Data Analysis and Reporting System, which represents inpatient and outpatient data of approximately 80% of the 7.4-million local population. The patients were followed for liver-related events (HCC and cirrhotic complications) and deaths until December 2017. Age-and sex-standardized incidence ratio (SIR) of HCC in psychiatric patients to the general population was estimated by Poisson model. Results: We included 105,763 psychiatric patients without prior liver-related events in the final analysis. During a median (interquartile range) follow-up of 12.4 (11.0-13.7) years, 1461 (1.4%) patients developed liver-related events; 472 (0.4%) patients developed HCC. Compared with the general population, psychiatric patients had increased incidence of HCC (SIR 1.42, 95% confidence interval [CI] 1.28-1.57, P < 0.001). The SIR was highest in patients with drug-induced (SIR 3.18, 95% CI 2.41-4.11, P < 0.001) and alcohol-induced mental disorders (SIR 2.98, 95% CI 2.30-3.81, P < 0.001), but was also increased in patients with psychotic disorders (SIR 1.39, 95% CI 1.16-1.65, P < 0.001) and mood disorders (SIR 1.16, 95% CI 1.00-1.34, P = 0.047). Liver disease was the fifth most common cause of death in this population, accounting for 595 of 10,614 (5.6%) deaths. Importantly, 569 (38.9%) patients were not known to have liver diseases at the time of liver-related events. The median age at HCC diagnosis (61 [range 26-83] years) was older and the median overall survival (8.0 [95% CI 5.0-10.9] months) after HCC diagnosis was shorter in this cohort of psychiatric patients than other reports from Hong Kong.

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“…Furthermore, increased public and private funding is essential to support care and treatment services . In a territory‐wide population‐based study from Hong Kong the authors concluded that the reduction in the diagnostic, treatment and mortality rates was low, especially since treatment with peg‐IFN was still used in some cases making make it difficult to reach the WHO hepatitis elimination target . The authors concluded that generalized use of new DAAs was also urgently needed in this region.…”

Section: Mathematical Modellingmentioning

confidence: 99%

Hepatitis C elimination – Macro‐elimination

Kåberg

Weiland

2020

Liver International

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In 2016 the WHO set a goal to obtain an 80% reduction in new chronic HCV cases, requiring a level of diagnosis of 90%, treatment coverage of 80% and resulting in a 65% reduction in HCV‐related deaths by 2030. This goal is easier to reach in specific populations such as people who inject drugs (PWID), men who have sex with men (MSM) or blood‐transfusion recipients before screening for HCV became mandatory and in high‐income regions. It is much more difficult to achieve macro‐elimination throughout the population especially in low‐income areas with underdeveloped infrastructures, a high prevalence of HCV and limited economic resources. To achieve the WHO goals by 2030, awareness of HCV must increase and the cascade of care must be improved and implemented. Diagnostic procedures and treatment should be affordable and universally available. At the end of 2017 fewer than 15 countries were on track to reach these goals by 2030.

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Territory‐wide population‐based study of chronic hepatitis C infection and implications for hepatitis elimination in Hong Kong

Abstract: Our diagnosis rate, treatment rate and mortality rate reduction were still low, particularly the Peg-IFN outcomes, making it difficult to meet the WHO hepatitis elimination targets. A more generalized use of DAAs is urgently needed to improve the situation.

Cited by 17 publications

References 28 publications

Epidemiological and Clinical Characteristics of Human Hepegivirus 1 Infection in Patients With Hepatitis C

Epidemiological and Clinical Characteristics of Human Hepegivirus 1 Infection in Patients With Hepatitis C

High incidence of hepatocellular carcinoma and cirrhotic complications in patients with psychiatric illness: a territory-wide cohort study

Hepatitis C elimination – Macro‐elimination

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