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Micro-Elimination of HCV—The David's Strategy against Goliath

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (31 January 2022) | Viewed by 12616

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Special Issue Editors

Prof. Dr. Jose Luis Calleja

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Guest Editor

Department of Gastroenterology, Hospital Universitario Puerta de Hierro, Madrid, Spain
Interests: gastroenterology; hepatology; viral hepatitis; cirrhosis; liver disease

Prof. Dr. Javier Crespo

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Guest Editor

Gastroenterology and Hepatology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain. Institute Valdecilla (IDIVAL), School of Medicine, University of Cantabria, Santander, Spain
Interests: liver diseases; infection; treatment; HBV replication; viral hepatitis; hepatitis C; hepatology; gastroenterology

Dr. Joaquín Cabezas

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Guest Editor

Gastroenterology and Hepatology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain. Institute Valdecilla (IDIVAL), Santander, Spain
Interests: gastroenterology; Hepatology; liver diseases; oral direct-acting antivirals; hepatitis C; viral hepatitis; Alcoholic Liver Disease (ALD); molecular targets; Hepatitis C epidemiology; management of hepatitis C; multidiciplinary team; model of care

Special Issue Information

Dear Colleagues,

Hepatitis C virus (HCV) infection is a major global disease burden, and the leading cause of liver cirrhosis and hepatocellular carcinoma in those infected. The introduction of direct-acting antivirals (DAAs) for the treatment of hepatitis C virus (HCV) infection in 2013 is one of the greatest advances of the current biomedical era. However, eradicate hepatitis C requires more than high antiviral efficacy. In 2017, the International Liver Foundation's European Association for the Study of the Liver suggested eliminating HCV would be less complex by setting micro-elimination goals. This Special Issue will focus to collect the best care practices in micro-elimination, the efforts that many research groups are making to reduce the prevalence, incidence and mortality of HCV in specific populations, using a micro-elimination strategy with novel model of care.

This issue will include papers that analyze the implementation of diagnostic methods that allow point-of-care diagnosis, one-step infection diagnosis and, of course, one-step comprehensive evaluation of HCV disease. The organization of healthcare systems that facilitate micro-elimination in different high-risk or vulnerable groups will be especially welcome, as well as the practice based on telemedicine, telepharmacy and home-delivery. Undoubtedly, the integration of the care cascade and the monitoring of treatment: from dispensing to adherence and treatment completion; they are key elements of micro-elimination that should be collected in this monograph. The concept of treatment as prevention is to successfully treat an HCV-infected person who is at a risk of transmitting the virus on to others and eliminate the possibility of further transmission, thereby achieving “prevention.” Demonstration of the effectiveness of this approach is also welcome.

In conclusion, we want to develop a special issue able to teach us the efforts to eliminate HCV through micro-elimination tools. The publication of the results of the different elimination strategies in different parts of the world will allow the combination of different healthcare processes and contribute to the elimination of HCV in 2030. The victory of the small against the big, of the helpless against the powerful; micro-elimination reminds us of David's strategy against Goliath. There will always be chances of being successful.

Prof. Dr. Jose Luis Calleja
Prof. Dr. Javier Crespo
Dr. Joaquín Cabezas
Guest Editors

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Keywords

Hepatitis C virus
Direct-acting antivirals
HCV Infection
Liver cirrhosis
Therapy
Diagnostic methods
Micro-elimination goals
Novel model of care
DAAs
DBS
Elimination
Simplification Targeting people who inject drugs
PWID
Incarcerated people

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Published Papers (6 papers)

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Research

9 pages, 610 KiB

Open AccessArticle

Pan-Genotypic Direct-Acting Antiviral Agents for Undetermined or Mixed-Genotype Hepatitis C Infection: A Real-World Multi-Center Effectiveness Analysis

by Hsu-Heng Yen, Yang-Yuan Chen, Jun-Hung Lai, Hung-Ming Chen, Chih-Ta Yao, Siou-Ping Huang, I-Ling Liu, Ya-Huei Zeng, Fang-Chi Yang, Fu-Yuan Siao, Mei-Wen Chen and Pei-Yuan Su

J. Clin. Med. 2022, 11(7), 1853; https://doi.org/10.3390/jcm11071853 - 27 Mar 2022

Cited by 4 | Viewed by 2277

Abstract

Although the pan-genotypic direct-acting antiviral regimen was approved for treating chronic hepatitis C infection regardless of the hepatitis C virus (HCV) genotype, real-world data on its effectiveness against mixed-genotype or genotype-undetermined HCV infection are scarce. We evaluated the real-world safety and efficacy of two pan-genotypic regimens (Glecaprevir/Pibrentasvir and Sofosbuvir/Velpatasvir) for HCV-infected patients with mixed or undetermined HCV genotypes from the five hospitals in the Changhua Christian Care System that commenced treatment between August 2018 and December 2020. This retrospective study evaluated the efficacy and safety of pan-genotypic direct-acting antiviral (DAA) treatment in adults with HCV infection. The primary endpoint was the sustained virological response (SVR) observed 12 weeks after completing the treatment. Altogether, 2446 HCV-infected patients received the pan-genotypic DAA regimen, 37 (1.5%) patients had mixed-genotype HCV infections and 110 (4.5%) patients had undetermined HCV genotypes. The mean age was 63 years and 55.8% of our participants were males. Nine (6.1%) patients had end-stage renal disease and three (2%) had co-existing hepatomas. We lost one patient to follow-up during treatment and one more patient after treatment. A total of four patients died. However, none of these losses were due to treatment-related side effects. The rates of SVR12 for mixed-genotype and genotype-undetermined infections were 97.1% and 96.2%, respectively, by per-protocol analyses, and 91.9% and 92.7% respectively, by intention-to-treat population analyses. Laboratory adverse events with grades ≥3 included anemia (2.5%), thrombocytopenia (2.5%), and jaundice (0.7%). Pan-genotypic DAAs are effective and well-tolerated for mixed-genotype or genotype-undetermined HCV infection real-world settings. Full article

(This article belongs to the Special Issue Micro-Elimination of HCV—The David's Strategy against Goliath)

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11 pages, 977 KiB

Open AccessArticle

Against All Odds? Addiction History Associated with Better Viral Hepatitis Care: A Dutch Nationwide Claims Data Study

by Daan W. Von den Hoff, Floor A. C. Berden, Femke Atsma, Arnt F. A. Schellekens and Joost P. H. Drenth

J. Clin. Med. 2022, 11(4), 1146; https://doi.org/10.3390/jcm11041146 - 21 Feb 2022

Cited by 2 | Viewed by 1740

Abstract

The elimination of viral hepatitis in target populations is crucial in reaching WHO viral hepatitis elimination goals. Several barriers for the treatment of viral hepatitis in people with addictive disorders have been identified, yet nationwide data on hepatitis healthcare utilization (HCU) in these patients are limited. We investigated whether a history of addictive disorder is associated with suboptimal hepatitis HCU, indicating failure to receive diagnostic care or treatment. We identified all newly referred viral hepatitis patients in the Netherlands between 2014 and 2019 by query of the Dutch national hospital claims database. Each patient’s first year of HBV or HCV care activities was collected and clustered in two categories, ‘optimal’ or ‘suboptimal’ hepatitis HCU. Optimal HCU includes antiviral therapy. We tested the association between addiction history and HCU, adjusted for sex, age, migrant status, and comorbidity. In secondary analyses, we explored additional factors affecting hepatitis HCU. We included 10,513 incident HBV and HCV patients, with 13% having an addiction history. Only 47% of all patients achieved optimal hepatitis HCU. Addiction history was associated with less suboptimal HCU (adjusted OR = 0.73, 95% CI = 0.64–0.82). Migration background was associated with suboptimal HCU (OR = 1.62, 95% CI = 1.50–1.76). This study shows that addiction history is associated with higher viral hepatitis HCU; thus, this population performs better compared to non-addicted patients. However, less than 50% of all patients received optimal hepatitis care. This study highlights the need to improve hepatitis HCU in all patients, with a focus on migrant populations. Linkage to care in the addicted patients is not studied here and may be a remaining obstacle to be studied and improved to reach WHO viral hepatitis elimination goals. Full article

(This article belongs to the Special Issue Micro-Elimination of HCV—The David's Strategy against Goliath)

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9 pages, 1444 KiB

Open AccessArticle

Micro-Elimination of Hepatitis C among Patients with Kidney Disease by Using Electronic Reminder System—A Hospital-Based Experience

by Pei-Yuan Su, Wei-Wen Su, Yu-Chun Hsu, Shu-Yi Wang, Ping-Fang Chiu and Hsu-Heng Yen

J. Clin. Med. 2022, 11(2), 423; https://doi.org/10.3390/jcm11020423 - 14 Jan 2022

Cited by 2 | Viewed by 1546

Abstract

Background: Little is known about the use of an electronic reminder system for HCV screening among patients with kidney disease. In this study, we tried to determine whether reminder systems could improve the HCV screening rate in patients with kidney disease. Methods: Patients with kidney disease were enrolled from August 2019 to December 2020 to automatically screen and order HCV antibody and RNA testing in outpatient departments. Results: A total of 19,316 outpatients with kidney disease were included, and the mean age was 66.5 years. The assessment rate of HCV antibody increased from 53.1% prior to the reminder system to 79.8% after the reminder system (p < 0.001), and the assessment rate of HCV RNA increased from 71% to 82.9%. The anti-HCV seropositivity rate decreased from 7.3% at baseline to 2.5% after the implementation of the reminder system (p < 0.001), and the percentage of patients with detectable HCV RNA among those with anti-HCV seropositivity decreased from 69.1% at baseline to 46.8% (p < 0.001). Conclusions: The feasibility of an electronic reminder system for HCV screening among patients with kidney disease in a hospital-based setting was demonstrated. Full article

(This article belongs to the Special Issue Micro-Elimination of HCV—The David's Strategy against Goliath)

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14 pages, 2460 KiB

Open AccessArticle

Pangenotypic and Genotype-Specific Antivirals in the Treatment of HCV Genotype 4 Infected Patients with HCV Monoinfection and HIV/HCV Coinfection

by Dorota Zarębska-Michaluk, Jerzy Jaroszewicz, Anna Parfieniuk-Kowerda, Małgorzata Pawłowska, Ewa Janczewska, Hanna Berak, Justyna Janocha-Litwin, Jakub Klapaczyński, Krzysztof Tomasiewicz, Anna Piekarska, Rafał Krygier, Jolanta Citko, Olga Tronina, Krystyna Dobrowolska and Robert Flisiak

J. Clin. Med. 2022, 11(2), 389; https://doi.org/10.3390/jcm11020389 - 13 Jan 2022

Cited by 5 | Viewed by 1926

Abstract

The introduction of the direct-acting antivirals (DAA) has substantially improved the effectiveness of the therapy in patients with chronic hepatitis C. We aimed to compare the efficacy of pangenotypic and genotype-specific DAA in the cohort of genotype (GT) four patients with HCV monoinfection and HIV coinfection. A total of 662 GT4-infected patients treated in 2015–2020—of whom 168 (25.3%) were coinfected with HIV, selected from the retrospective EpiTer-2 database—were enrolled in the analysis. Among HIV-coinfected patients, 54% (90) were treated with genotype-specific regimens and 46% (78) with pangenotypic options, while among HCV-monoinfected patients, the rates were 72% and 28%, respectively. Significantly higher rate of males (67.9% vs. 57.7%, p = 0.01), a lower rate of liver cirrhosis (10.2% vs. 18.1%, p = 0.02), and higher of treatment-naïve patients (87.5% vs. 76.7%, p = 0.003) were documented in the HIV coinfected population. The overall sustained virologic response after exclusion of non-virologic failures was achieved in 98% with no significant difference between HIV-positive and HIV-negative patients, 96.2% vs. 98.5%, respectively. While the genotype-specific regimens resulted in a similar cure rate regardless of the HIV status, the pangenotypic options were more efficacious in patients with HCV monoinfection (99.3% vs. 94.4%, p = 0.05). Hereby, we demonstrated the high effectiveness and good safety profile of the DAA therapy in the population of HCV GT4 infected patients with HIV coinfection supporting the current recommendations to treat HCV/HIV coinfected patients with the same options as those with HCV monoinfection. Full article

(This article belongs to the Special Issue Micro-Elimination of HCV—The David's Strategy against Goliath)

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10 pages, 485 KiB

Open AccessArticle

Real-World Experience of Chronic Hepatitis C-Related Compensated Liver Cirrhosis Treated with Glecaprevir/Pibrentasvir: A Multicenter Retrospective Study

by Pei-Yuan Su, Yang-Yuan Chen, Jun-Hung Lai, Hung-Ming Chen, Chih-Ta Yao, I-Ling Liu, Ya-Huei Zeng, Siou-Ping Huang, Yu-Chun Hsu, Shun-Sheng Wu, Fu-Yuan Siao and Hsu-Heng Yen

J. Clin. Med. 2021, 10(22), 5236; https://doi.org/10.3390/jcm10225236 - 10 Nov 2021

Cited by 6 | Viewed by 2103

Abstract

Background: Glecaprevir/pibrentasvir is a protease inhibitor-containing pangenotypic direct-acting antiviral regimen that has been approved for the treatment of chronic hepatitis C. The present study aimed to evaluate the safety and efficacy of glecaprevir/pibrentasvir in patients with compensated cirrhosis in a real-world setting. Methods: We evaluated the real-world safety and efficacy of glecaprevir/pibrentasvir in patients with compensated cirrhosis from five hospitals in the Changhua Christian Care System, who underwent treatment between August 2018 and October 2020. The primary endpoint was a sustained virological response observed 12 weeks after completion of the treatment. Results: Ninety patients, including 70 patients who received the 12-week therapy and 20 patients who received the 8-week therapy, were enrolled. The mean age of the patients was 65 years, and 57.8% of the patients were males. Sixteen (17.8%) patients had end-stage renal disease, and 15 (16.7%) had co-existing hepatoma. The hepatitis C virus genotypes 1 (40%) and 2 (35.6%) were most common. The common side effects included anorexia (12.2%), pruritus (7.8%), abdominal discomfort (7.8%), and malaise (7.8%). Laboratory adverse grade ≥3 events included anemia (6.3%), thrombocytopenia (5.1%), and jaundice (2.2%). The overall sustained virological response rates were 94.4% and 97.7% in the intention-to-treat and per-protocol analyses, respectively. Conclusions: the glecaprevir/pibrentasvir treatment regimen was highly effective and well tolerated among patients with compensated cirrhosis in the real-world setting. Full article

(This article belongs to the Special Issue Micro-Elimination of HCV—The David's Strategy against Goliath)

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11 pages, 1937 KiB

Open AccessArticle

Micro-Elimination: Updated Pathway to Global Elimination of Hepatitis C in Small Communities and Industrial Settings during the COVID 19 Pandemic

by Anca Elena Butaru, Dan Ionuț Gheonea, Ion Rogoveanu, Mircea Diculescu, Ancuța-Ramona Boicea, Marius Bunescu, Costin-Teodor Streba and Carmen Nicoleta Oancea

J. Clin. Med. 2021, 10(21), 4976; https://doi.org/10.3390/jcm10214976 - 27 Oct 2021

Cited by 5 | Viewed by 2303

Abstract

Background: In response to the goal of the World Health Organisation to eliminate hepatitis C virus infections by 2030, Romania is striving for national elimination. An already successful micro-elimination project was expanded to test-and-treat specific populations and at-risk groups. The aim of this project was to identify the individuals with HCV infection in disadvantaged regions who do not have proper medical care access. Materials and Methods: Our two-arm interventional cross-sectional study used rapid anti-HCV antibody testing on two population groups from the Romanian southwestern region of Oltenia, approached between September 2020 and May 2021. The first group consisted of predominantly over 40 years old individuals, recruited through five family doctors from two medium-sized towns (community lot—CL). We approached a second group, aged 18–65, through 11 medical offices of five large factories in the same region (industry lot, IL). A 12-items questionnaire was given to each participant, to determine risk factors and record demographic data. Eligible patients initiated antiviral therapy using direct-acting antivirals (DAAs). Results: We enrolled 15,383 individuals between all 16 locations. The overall prevalence by antibody testing was 0.77% (119 cases). Of these, 57 subsequently received treatment with DAAs. We identified blood transfusions as a risk factor within the CL. Participants in the IL reported a relatively high risk for the following situations: sharing of personal hygiene belongings with another person, performing previous blood transfusions, dental interventions and previous surgery. Conclusions: In this global context, the use of micro-elimination allows interventions to be faster and more efficient. This is possible by targeting smaller and specific HCV risk groups. Full article

(This article belongs to the Special Issue Micro-Elimination of HCV—The David's Strategy against Goliath)

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