Search

Diagnostic overshadowing refers to a phenomenon whereby people with mental health conditions encounter inadequate or delayed medical attention and misdiagnosis. This occurs when physical symptoms are mistakenly attributed to their mental health condition. This paper presents a scoping review focusing on direct causes and background factors of diagnostic overshadowing in the context of hepatitis C infection in people who inject drugs and have concurrent mental health conditions. Despite significant strides in hepatitis C treatment with direct‐acting antiviral drugs, the complex interplay of mental health conditions and physical symptoms necessitates a nuanced approach for accurate diagnosis and effective screening. This review was conducted using Joanna Briggs Institute's methodology for scoping reviews. The databases searched included Medline, Embase, PsycInfo, Global Health, CINAHL and Scopus. This review followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews (PRISMA‐ScR). The search strategies identified 1995 records. Overall, 166 studies were excluded. Forty‐two (42) studies met the inclusion criteria. Three (n = 3) studies represented direct causes, and 39 (n = 39) with background factors related to diagnostic overshadowing. Studies highlighted six key themes encompassing diagnostic overshadowing, with communication barriers, stigma and knowledge deficiencies being the most prominent. Recognising and addressing diagnostic overshadowing in chronic hepatitis C will lead to increased screening, diagnosis and timely administration of life‐saving antiviral therapy, resulting in profound enhancements in well‐being and health outcomes. Moreover, this proactive approach will play a pivotal role in advancing the global effort towards eliminating hepatitis C by 2030. [ABSTRACT FROM AUTHOR]

This document is a reply to a critique of a paper on the prevalence of hepatitis C virus (HCV) infections in Switzerland. The authors of the reply address the criticisms made by the critique and defend their estimates of HCV prevalence in Switzerland. They argue that the critique's assumptions and methodology are flawed and provide evidence to support their own estimates. They also mention positive feedback they received from other scientists in the field. The authors conclude that Switzerland has reached the World Health Organization's elimination targets for HCV and that prevalence estimates should be revised. [Extracted from the article]

Modern health‐care systems have customarily approached hepatitis C in ways that resemble the public health approach to HIV/AIDS known as 'HIV exceptionalism'. HIV exceptionalism describes the unusual emphasis on privacy, confidentiality and consent in approaches to HIV and was partly developed to address HIV/AIDS‐related stigma. In the case of hepatitis C, exceptionalist approaches have included diagnosis and treatment by specialist physicians and other 'boutique' public health strategies. The recent availability of highly effective, direct‐acting antivirals alongside goals to eliminate hepatitis C have heralded dramatic changes to hepatitis C health care, including calls for its 'normalisation'. The corollary to exceptionalism, normalisation aims to bring hepatitis C into routine, mainstream health care. This article draws on interviews with stakeholders (n = 30) who work with hepatitis C‐affected communities in policy, community, legal and advocacy settings in Australia, alongside Fraser et al.'s (2017, International Journal of Drug Policy, 44, 192–201) theorisation of stigma, and Rosenbrock et al.'s (1999, The AIDS policy cycle in Western Europe: from exceptionalism to normalisation. WZB Discussion Paper, No. P 99‐202) critique of normalisation to consider the perceived effects of hepatitis C normalisation. Stakeholders described normalisation as a stigma‐reducing process. However, they also expressed concerns about the ongoing stigma and discrimination that is not ameliorated by normalisation. We suggest that in centring normalisation, changes in health care may exaggerate the power of technological solutions to transform the meanings of hepatitis C. [ABSTRACT FROM AUTHOR]

Introduction: Early diagnosis is key to achieving the goal of eliminating transmission of HIV and hepatitis B and C. We assessed the uptake, acceptability and interpretability of self‐testing using a 3‐in‐1 rapid diagnostic test (RDT) in facility‐based services. Methods: Stand‐alone testing services were provided free of charge to consenting individuals aged ≥15 years in five facilities in northern Thailand. Clients were invited to choose between self‐testing by fingerprick or venepuncture by a healthcare worker (HCW). In each facility, several clients could simultaneously self‐test in separate private areas using TriQuik™ (Genlantis, San Diego, CA, USA), a single immunochromatographic cassette detecting HIV‐1/2 antibody, hepatitis B surface antigen (HBsAg) and hepatitis C antibody (HCAb). An interactive program on a tablet computer was developed to collect socio‐demographic, behavioural and satisfaction data and provide information to guide the self‐test process, including video instructions, results interpretation and a picture of the cassette for immediate remote review by the HCW. When the HCW interpreted an HIV self‐test as positive, the HCW collected blood by venepuncture for immediate confirmation. Results: Between October 2020 and April 2022, 4119 clients presented for testing for the first time as part of the project. Of them, 3462 (84.0%) opted for self‐testing. Among self‐testers, 1801 (52.0%) were born female, the median age was 27 years (interquartile range, 22–36), 661 (19.1%) belonged to at least one key population and 2124 (61.4%) had never been tested for HIV; 3329 (99.8% of those who answered) reported being "very satisfied" or "satisfied" with the testing process. The proportions of test results interpreted as positive by self‐testers among those interpreted as positive by HCWs were 95% for HIV‐1/2 antibody, 95% for HBsAg and 78% for HCAb. Conclusions: These proportions were higher than those observed in a previous study evaluating another 3‐in‐1 RDT for HIV, HBsAg and HCAb, possibly due to the use of video instructions instead of paper‐based instructions, lower prevalence and co‐infection rates, or lower percentages of clients with low education level. Multiplex self‐testing simplified and streamlined the service delivery process and was well accepted. HCW assistance proved to be essential in a limited number of cases. [ABSTRACT FROM AUTHOR]

In recent years, early detection of hepatitis C virus (HCV) disease has been a vital task in the medical science field. HCV became the main health concern to the public, as it was noticed to have more blood donors in Egypt equated to other nationalities. The WHO assessed that in 2019, around 290 000 individuals died from hepatitis C, which says the seriousness of the HCV disease. So, early prediction, preventions, and curing the disease are vital components to save individuals from HCV. In this paper, we propose and investigate experimental results of the five machine learning (ML) models and probabilistic neural network (PNN) based approach to detect the HCV utilizing University of Califonia Irvine (UCI) ML Egyptian HCV dataset. We also analyze the statistical reports of HCV stages and their features. As per result analysis, the random forest (RF) ML model performs superiorly to other traditional ML algorithms with 97.5% of accuracy. The PNN (incremental hidden layer [HL] neurons) based proposal model shows a very high performance (99.6% of accuracy) at 30‐HL neurons of PNN. As per comparative analysis, the proposed model is superior to experimental basic ML models, and early HCV disease works are related to this area. This research focuses on early detection, prevention, and challenges of handling HCV. [ABSTRACT FROM AUTHOR]

Background and aim: People who inject drugs are at high risk of contracting hepatitis C (HCV). The introduction of direct acting antiviral (DAA) drugs to treat HCV has the potential to transform care; however, uptake of DAAs has been slower than anticipated. The strong link between HCV and injecting drug use frames HCV as a shameful, stigmatising disease, reinforcing an 'addict' identity. Linking HCV care to a recovery journey, 'clean' identity and social redemption may provide compelling encouragement for people to engage with treatment and re‐evaluate risk and behaviours, reducing the incidence of HCV re‐infection. The aim of this review was to identify actions, interventions and treatments that provide an opportunity for a change in identity and support a recovery journey and the implications for HCV care. Methods: Databases (MEDLINE, EMBASE, PsycINFO, ProQuest Public Health, ProQuest Sociological Abstracts, CINAHL and Web of Science) were searched following our published strategy and a grey literature search conducted. A narrative synthesis was undertaken to collate themes and identify common threads and provide an explanation of the findings. Results: Thirty‐two studies fulfilled the inclusion criteria. The narrative synthesis of the studies identified five over‐arching analytical themes: social factors in substance use and recovery, therapeutic communities, community treatment, online communities, and finally women and youth subsets. The change from an 'addict' identity to a 'recovery' identity is described as a key aspect of a recovery journey, and this process can be supported through social support and turning point opportunities. Conclusions: Recovery from addiction is a socially mediated process. Actions, interventions and treatments that support a recovery journey provide social connections, a recovery identity and citizenship (reclaiming a place in society). There is a gap in current literature describing how pathways of care with direct acting antivirals can be designed to promote recovery, as part of hepatitis C care. [ABSTRACT FROM AUTHOR]

Objective: To formalize comparative interrupted time series (CITS) using the potential outcomes framework; compare two version of CITS--a standard linear version and one that adds postperiod group-by-time parameters--to two versions of difference-in-differences (DID)--a standard version with time fixed effects and one that adds group-specific pretrends; and reanalyze three previously published papers using these models. Data Sources: Outcome data for reanalyses come from two counties' jail booking and release data, Medicaid prescription drug rebate data from the Centers for Medicare and Medicaid Services (CMS), and acute hepatitis C incidence from the Centers for Disease Control and Prevention. Study Design: DID and CITS were compared using potential outcomes, and reanalyses were conducted using the four described pre--post study designs. Data Collection/Extraction Methods: Data from county jails were provided by sheriffs. Data from CMS are publicly available. Data for the third reanalysis were provided by the authors of the original study. Principal Findings: Though written differently and preferred by different research communities, the general version of CITS and DID with group-specific pretrends are the same: they yield the same counterfactuals and identify the same treatment effects. In a reanalysis with evidence of divergent preperiod trends, failing to account for this in standard DID led to an 84% smaller effect estimate than the more flexible models. In a second reanalysis with evidence of nonlinear outcome trends, failing to account for this in linear CITS led to a 28% smaller effect estimate than the more flexible models. Conclusion: We recommend detailing a causal model for treatment selection and outcome generation and the required counterfactuals before choosing an analytical approach. The more flexible versions of DID and CITS can accommodate features often found in real data, namely, nonlinearities and divergent preperiod outcome trends. [ABSTRACT FROM AUTHOR]

Background: People experiencing homelessness have an increased risk of hepatitis C virus (HCV) infection, with rates higher than the general population. However, their access to HCV diagnosis is limited and treatment uptake is low. Objectives: To identify and describe the barriers and facilitators for HCV screening and treatment for adults with lived experience of homelessness in highly developed countries. Methods: Bibliographic databases (Embase, MEDLINE, CINAHL and SocINDEX) and grey literature (Google, EThOS, the Health Foundation, Social Care Online, the World Health Organisation, Shelter, Crisis and Pathway) were searched. Two reviewers independently screened and appraised all studies. The Critical Appraisal Skills Programme tool and the Joanna Briggs Institute checklist were used. The analysis involved a three‐stage process: coding, theme generation and theme mapping under Penchansky and Thomas's modified access model. Results: Twelve papers/reports were included in the review. Several interacting factors influence access of people with lived experience of homelessness to HCV testing and treatment. Some mirror those identified for the general population. The precarious conditions associated with the lived experience of homelessness along with the rigidity of hospital settings and lack of awareness emerged as dominant barriers. Flexibility, outreach, effective communication, tailoring and integration of services were found to be important facilitators. Evidence from Black, Asian and minority ethnic groups is limited. Conclusions: People experiencing homelessness face multiple barriers in accessing and completing HCV treatment, relating to both their lived experience and characteristics of health systems. Although some barriers are readily amenable to change, others are more difficult to modify. The facilitators identified could inform future targeted measures to improve HCV diagnosis and treatment for people experiencing homelessness. Research is warranted into successful models to promote screening, diagnosis and treatment. Patient or Public Contribution: Our team includes a peer advocate, a hepatology nurse and a community volunteer, all with significant experience in promoting and engaging in HCV care and outreach for people experiencing homelessness. They contributed to the protocol, interpretation and reporting of the review findings. [ABSTRACT FROM AUTHOR]

Hepatitis C virus infection causes chronic diseases such as cirrhosis and hepatocellular carcinoma. Metabolomics research has been shown to be linked to pathophysiologic pathways in liver illnesses. The aim of this study was to investigate the serum metabolic profile of patients with chronic hepatitis C (CHC) infection and to identify underlying mechanisms as well as potential biomarkers associated with the disease. Nuclear magnetic resonance (NMR) was used to evaluate the sera of 83 patients with CHC virus and 52 healthy control volunteers (NMR). Then, multivariate statistical analysis was used to find distinguishing metabolites between the two groups. Sixteen out of 40 metabolites including include 3‐HB, betaine, carnitine, creatinine, fucose, glutamine, glycerol, isopropanol, lysine, mannose, methanol, methionine, ornithine, proline, serine, and valine—were shown to be significantly different between the CHC and normal control (NC) groups (variable importance in projection >1 and p < 0.05). All the metabolic perturbations in this disease are associated with pathways of Glycine, serine, and threonine metabolism, glycerolipid metabolism, arginine and proline metabolism, aminoacyl‐tRNA biosynthesis, cysteine and methionine metabolism, alanine, aspartate, and glutamate metabolism. Multivariate statistical analysis constructed using these expressed metabolites showed CHC patients can be discriminated from NCs with high sensitivity (90%) and specificity (99%). The metabolomics approach may expand the diagnostic armamentarium for patients with CHC while contributing to a comprehensive understanding of disease mechanisms. [ABSTRACT FROM AUTHOR]

Background: With the introduction of direct‐acting antiviral therapies (DAAs), the non‐use rate of hepatitis C virus (HCV)‐positive donor organs (D+) has decreased significantly. We present the donor, recipient, and transplant allograft characteristics, along with recipient outcomes, in one of the largest cohorts of HCV‐D+ transplants into HCV‐naïve recipients (R−). Methods: Charts of HCV D+/R− kidney (KT), liver (LT), and simultaneous liver‐kidney (SLKT) transplant recipients between January 2019 and July 2022 were reviewed. Primary outcomes of interest included waitlist times and 1‐year graft failure. Secondary outcomes included hospital and intensive care unit length of stay, post‐transplant complications, effectiveness of DAA therapy, and characteristics of patients who relapsed from initial DAA therapy. Results: Fifty‐five HCV D+/R− transplants at our center [42 KT (26 nucleic acid testing positive [NAT+], 16 NAT−), 12 LT (eight NAT+, four NAT−), and one SLKT (NAT+)] had a median waitlist time of 69 days for KT, 87 days for LT, and 15 days for SLKT. There were no graft failures at 1 year. All viremic recipients were treated with a 12‐week course of DAAs, of which 100% achieved end of treatment response (EOTR)—85.7% (n = 30) achieved sustained virologic response (SVR) and 14.3% relapsed (n = 5; four KT, one LT). All relapsed recipients were retreated and achieved SVR. The most common post‐transplantation complications include BK virus infection (n = 9) for KT and non‐allograft infections (n = 4) for LT. Conclusions: Our study has demonstrated no graft failures or recipient deaths at 1 year, and despite a 14.3% relapse rate, we achieved 100% SVR. Complications rates of D+/R− appeared comparable to national D−/R− complication rates. Further studies comparing D+/R− to D−/R− outcomes are needed. [ABSTRACT FROM AUTHOR]

This document contains a collection of articles and case reports related to liver diseases. The articles cover a range of topics, including predictive models for liver-related outcomes in primary biliary cholangitis (PBC) patients, the effects of ancient Chinese herbal remedies on liver health, health-related quality of life outcomes in hepatocellular carcinoma (HCC) patients, and the prevalence of intestinal failure-associated liver disease (IFALD) in patients on long-term home parenteral nutrition (HPN). The case reports discuss the development of IFALD in patients on HPN, a predictive model for portal hypertension-related decompensation events in cirrhosis patients, a quality improvement project for assessing non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes, and a case of hepatosplenic candidiasis following endoscopic cholangiopancreatography (ERCP). These reports provide valuable insights into the diagnosis, management, and outcomes of various liver diseases. [Extracted from the article]

Backgrounds: The success of direct‐acting antiviral (DAA) therapy provides a cure for patients chronically infected with hepatitis C virus (HCV); however, outcomes after hepatectomy for HCV‐associated hepatocellular carcinoma (HCC) before and after DAA introduction remain poorly studied. Methods: Patients who underwent R0/R1 hepatectomy for HCV‐associated HCC were retrospectively analyzed. Two time periods were defined: Pre‐DAA (2007–2011, December 2013 was defined as the end of follow‐up) and Post‐DAA groups (2014–2018, December 2020 was defined as the end of follow‐up). Propensity score matching (PSM) analyses were performed to highlight the effect of DAA therapy. Results: A total of 155 patients with HCV‐associated HCC were included in this study (Pre‐DAA group, n = 103 and post‐DAA group, n = 52). In the Post‐DAA group, DAA therapy was performed in 26 patients (50.0%), and all of these patients achieved sustained virologic response (SVR) (preoperative SVR, n = 7; postoperative SVR, n = 19). There was no significant difference between the two groups regarding surgical settings and tumor pathology. There was no significant difference in the 5‐year overall survival (OS) rate (61.1% and 64.8%, pre‐ and post‐DAA group, respectively, p = 0.441); meanwhile, the 5‐year recurrence‐free survival (RFS) rate in the post‐DAA group was better than the pre‐DAA group (21.1% and 40.2%, p = 0.073) with a trend toward significance. After PSM except for the postoperative SVR status, there were no significant differences in OS (p = 0.586) and RFS (p = 0.888). Conclusions: This study showed that survival outcomes were not changed in hepatectomized cases of HCV‐associated HCC before and after the introduction of DAA therapy. [ABSTRACT FROM AUTHOR]

This article discusses the transfer of data from the Thai haemophilia treatment center registry to the Annual Global Survey (AGS) of the World Federation of Hemophilia (WFH). The data collection aims to improve care for patients with hereditary bleeding disorders by identifying available treatment resources, evaluating their effectiveness, and advocating for better care. The Thai Society of Haematology (TSH) initiated the Haemostasis Registry, which includes the Hereditary Bleeding Disorders Registry (HBDR) and Thrombosis. The data from the HBDR is transferred to the World Bleeding Disorders Registry (WBDR) and the AGS of the WFH. This data transfer reduces redundancy and improves the reliability, accuracy, cost-effectiveness, and efficiency of data collection. The article highlights the importance of the AGS in collecting data on patients with hereditary bleeding disorders and the treatments used worldwide. The data collected through the AGS is used for resource planning, advocacy, research, and development activities to improve the management of patients with these disorders. The authors emphasize the need for collaboration between clinicians and information technology personnel to ensure accurate data input and output. The dataset of the World Bleeding Disorders Registry and the questionnaire of the AGS are recommended as useful templates for data collection and reporting. The study was conducted ethically and the data is available upon request. [Extracted from the article]

Background & Aims: The aim of this study was to assess the effect of treatment with sofosbuvir/velpatasvir (SOF/VEL) on the health‐related quality of life (HRQL) of children with chronic hepatitis C. Methods: In the non‐commercial, non‐randomized, open‐label PANDAA‐PED study, 50 children aged 6–18 years with chronic hepatitis C were treated with a fixed dose of SOF/VEL. All patients achieved sustained virologic response 12 weeks after the end of treatment (SVR12). Evaluation of HRQL was performed twice: at baseline (before the treatment) and during the SVR12 analysis using the KIDSCREEN‐27 questionnaires, which included 5 dimensions of HRQL, for child self‐reporting and parent proxy reporting. The normal range for the population was set to T values of 50 ± 10 points. Child–parent agreement was analysed using the intra‐class correlation coefficient (ICC) and Bland–Altman test. Results: Mean T values were within the normal range for all dimensions, both before and after treatment. There was a significant improvement in physical well‐being based on the children's self‐assessment (from 48.53 to 51.21, p =.03). In addition, a trend towards better scores in the 'social support & peers' part of the parent proxy evaluation (from 45.98 to 48.66, p =.06) was noticed. After the treatment, the proportion of children self‐assessing their physical well‐being as below normal significantly decreased from 17% to 5% (p =.007). HRQL scores were not associated with patients' sex, but in most cases, younger age correlated with better HRQL. Evaluation of the ICC for child self‐reports versus parent proxy reports revealed poor to moderate agreement for most single measures. Bland–Altman analysis showed that in all dimensions, both before and after treatment, the limits of agreement (LoAs) exceeded ±5 points (half of the SD and considered a maximum allowed difference). Conclusions: A significant proportion of children with chronic hepatitis C have decreased HRQL in all dimensions, but effective treatment with SOF/VEL leads to an improvement in some areas of well‐being. As the effect of HCV on HRQL is more pronounced in older patients, treatment of younger children should be indicated to prevent them from experiencing decreased HRQL due to ongoing HCV infection in the future. [ABSTRACT FROM AUTHOR]

Background: Despite advancements in liver transplantation (LT) over the past two decades, liver re‐transplantation (re‐LT) presents challenges. This study aimed to assess improvements in re‐LT outcomes and contributing factors. Methods: Data from the United Network for Organ Sharing database (2002–2021) were analyzed, with recipients categorized into four‐year intervals. Trends in re‐LT characteristics and postoperative outcomes were evaluated. Results: Of 128,462 LT patients, 7254 received re‐LT. Graft survival (GS) for re‐LT improved (91.3%, 82.1%, and 70.8% at 30 days, 1 year, and 3 years post‐LT from 2018 to 2021). However, hazard ratios (HRs) for GS remained elevated compared to marginal donors including donors after circulatory death (DCD), although the difference in HRs decreased in long‐term GS. Changes in re‐LT causes included a reduction in hepatitis C recurrence and an increase in graft failure post‐primary LT involving DCD. Trends identified included recent decreased cold ischemic time (CIT) and increased distance from donor hospital in re‐LT group. Meanwhile, DCD cohort exhibited less significant increase in distance and more marked decrease in CIT. The shortest CIT was recorded in urgent re‐LT group. The highest Model for End‐Stage Liver Disease score was observed in urgent re‐LT group, while the lowest was recorded in DCD group. Analysis revealed shorter time interval between previous LT and re‐listing, leading to worse outcomes, and varying primary graft failure causes influencing overall survival post‐re‐LT. Discussion: While short‐term re‐LT outcomes improved, challenges persist compared to DCD. Further enhancements are required, with ongoing research focusing on optimizing risk stratification models and allocation systems for better LT outcomes. [ABSTRACT FROM AUTHOR]

Hepatitis C virus infection (HCV) is prevalent in prisons. Therefore, effective prison HCV services are critical for HCV elimination programmes. We aimed to evaluate the efficacy of a regional HCV prison testing and treatment programme. Between July 2017 and June 2022, data were collected prospectively on HCV test offer and uptake rates, HCV Antibody (HCV‐Ab) and HCV‐RNA positivity, treatment starts and outcomes for new inmates incarcerated in three prisons. Rates of HCV‐Ab and RNA positivity at reception, incidence of new HCV infections and reinfection following treatment were determined. From a total of 39,652 receptions, 33,028 (83.3%) were offered HCV testing and 20,394 (61.7%) completed testing. Including all receptions, 24.5% of tests (n = 4995) were HCV‐Ab positive and 8.4% of tests (n = 1713) were HCV‐RNA positive. When considering the first test for each individual (median age 34 years; 88.1% male), 14.8% (n = 1869) and 7.2% (n = 905) were HCV‐Ab and HCV‐RNA positive, respectively. The incidence of new HCV‐Ab and RNA positivity was 5.1 and 3.3 per 100 person‐years, respectively. Of 1145 HCV viraemic individuals, 18 died within 6 months and 150 were rapidly transferred out of area, leaving 977 individuals with outcomes. Of these, 835 (85.5%) received antivirals and 47 spontaneously cleared the infection, leaving 95 (9.7%) untreated. 607 (72.7%) achieved SVR. 95 patients had reinfection post‐treatment (rate 10.1 cases per 100 person‐years). Testing for HCV has increased in our prisons and the majority with viraemia are initiated on antiviral treatment. Reassuringly, a significant fall in frequency of HCV‐RNA positivity at prison reception was observed suggesting progress towards HCV elimination. [ABSTRACT FROM AUTHOR]

Background & Aims: Detecting hepatitis C virus (HCV) reinfection among key populations helps prevent ongoing transmission. This systematic review aims to determine the association between different testing intervals during post‐SVR follow‐up on the detection of HCV reinfection among highest risk populations. Methods: We searched electronic databases between January 2014 and February 2023 for studies that tested individuals at risk for HCV reinfection at discrete testing intervals and reported HCV reinfection incidence among key populations. Pooled estimates of reinfection incidence were calculated by population and testing frequency using random‐effects meta‐analysis. Results: Forty‐one single‐armed observational studies (9453 individuals) were included. Thirty‐eight studies (8931 individuals) reported HCV reinfection incidence rate and were included in meta‐analyses. The overall pooled estimate of HCV reinfection incidence rate was 4.13 per 100 per person‐years (py) (95% confidence interval [CI]: 3.45–4.81). The pooled incidence estimate among people who inject drugs (PWID) was 2.84 per 100 py (95% CI: 2.19–3.50), among men who have sex with men (MSM) 7.37 per 100 py (95% CI: 5.09–9.65) and among people in custodial settings 7.23 per 100 py (95% CI: 2.13–16.59). The pooled incidence estimate for studies reporting a testing interval of ≤6 months (4.26 per 100 py; 95% CI: 2.86–5.65) was higher than studies reporting testing intervals >6 months (5.19 per 100 py; 95% CI: 3.92–6.46). Conclusions: HCV reinfection incidence was highest in studies of MSM and did not appear to change with retesting interval. Shorter testing intervals are likely to identify more reinfections, help prevent onward transmission where treatment is available and enable progress towards global HCV elimination, but additional comparative studies are required. [ABSTRACT FROM AUTHOR]

Background and Aim: Prison residents are at high risk for hepatitis C virus (HCV) infection. HCV test‐and‐treat initiatives within prisons provide an opportunity to engage with prison residents and achieve HCV micro‐elimination. The aim of the prison HCV‐intensive test and treat initiative was to screen over 95% of all prison residents for HCV infection within a defined number of days determined by the size of the prison population and to initiate treatment within 7−14 days of a positive HCV RNA diagnosis. Methods: An HCV‐intensive test and treat toolkit was developed based on learnings from pilot HCV‐intensive test and treat events. From January 2020 to September 2021, 13 HCV‐intensive test and treat events took place at prisons in England selected based on high levels of reception blood‐borne virus testing and good access to peers from The Hepatitis C Trust. Results: Among a total of 8487 residents, 8139 (95.9%) underwent testing for HCV. Across the 13 prisons included, HCV antibody and RNA prevalence was 8.2% and 1.5%, respectively. The treatment initiation rate among HCV RNA‐positive individuals (n = 124) was 79.0%. Conclusion: The HCV‐intensive test and treat initiative presented here provides a feasible and rapid test‐and‐treat process to achieve HCV elimination within individual prisons. The HCV‐intensive test and treat toolkit can be adapted for rapid HCV testing and treatment events at other prisons in the United Kingdom and worldwide. [ABSTRACT FROM AUTHOR]

Data on the acceptability and usability of hepatitis C virus self‐testing (HCVST) remain scarce. We estimated the pooled rates of acceptability/feasibility and re‐reading/re‐testing agreement of HCVST using oral fluid tests (PROSPERO‐CRD42022349874). We searched online databases for studies that evaluated acceptability, usability and inter‐reader/operator variability for HCVST using oral fluid tests. Pooled estimates of feasibility, agreement and post‐testing perspectives were analysed. Sensitivity analyses were performed in men who have sex with men (MSM) and people who inject drugs (PWID). Heterogeneity was assessed using the I2 statistics. A total of six studies comprising 870 participants were identified: USA (n = 95 with liver disease), Kenya (n = 150 PWID), Egypt (n = 116 from the general population), Vietnam (n = 104 MSM and n = 105 PWID), China (n = 100 MSM) and Georgia (n = 100 MSM and n = 100 PWID)]. All studies used OraQuick® HCV Rapid Antibody Test. The pooled overall estimates for correct sample collection and for people who performed HCVST without needing assistance in any step (95% confidence interval [CI]) were 87.2% [76.0–95.3] (n = 755; I2 = 93.7%) and 62.6% [37.2–84.8] (n = 755; I2 = 98.0%), respectively. The pooled estimate of agreement for re‐reading was 95.0% [95% CI 91.5–97.6] (n = 831; I2 = 74.0%) and for re‐testing was 94.4% [90.3–97.5] (n = 726; I2 = 77.1%). The pooled estimate of those who would recommend HCVST was 94.4% [84.7–99.6] (n = 625; I2 = 93.7%). Pooled estimates (95% CI) of correct sample collection (72.8% [63.3–81.5] vs. 90.8% [85.9–94.8]) and performance of HCVST without needing assistance (44.1% [14.1–76.7] vs. 78.1% [53.4–95.3]) was lower in PWID compared to MSM. In summary, HCV testing with oral fluid HCVST was feasible and well‐accepted. Oral fluid HCVST should be considered in key populations for uptake HCV testing. [ABSTRACT FROM AUTHOR]

Summary: Hepatocellular carcinoma (HCC) is a leading cause of cancer‐related death worldwide, and is increasing in incidence in Australia.For most people with cirrhosis and chronic hepatitis B, HCC screening and surveillance is recommended with 6‐monthly ultrasound. However, most patients with HCC are still diagnosed outside of surveillance with incurable disease.While HCC surveillance almost certainly reduces cancer‐related mortality, the potential harms of surveillance are incompletely understood.Surveillance uptake remains suboptimal in many contexts, and stems from a combination of patient, clinician and system level barriers.Improved case‐finding strategies may be required to identify high risk individuals in need of surveillance, as cirrhosis and viral hepatitis are often asymptomatic.HCC prediction models and novel surveillance tools such as biomarker panels, computed tomography and magnetic resonance imaging may have a future role in personalised HCC surveillance.Analyses suggest surveillance may be cost‐effective, but Australian data remain limited.A centralised HCC surveillance program may ultimately have a role in delivering improved and more equitable care. [ABSTRACT FROM AUTHOR]

In their paper, the authors quantified liver iron concentration (LIC) and hepatic steatosis (HS) using MRI‐T2* technology in transfusion‐dependent thalassaemia (TDT) patients and healthy controls and found that the prevalence of HS among patients with TDT was 36.4%. In comparison with healthy controls, the hepatic fat fraction (FF) was significantly higher in the TDT population (p = 0.013). Active hepatitis C virus infection, body mass index (BMI) and LIC were independent predictors of HS. An inverse correlation between hepatic FF and high‐density lipoprotein cholesterol (p = 0.042) and a significant association of high glycaemia level (p = 0.037) with higher hepatic FF and a significant relationship (p = 0.026) between HS and higher BMI (though in a 'lean' group of patients) in TDT patients indicated that 'metabolic syndrome' was present in this subset with TDT. The impact of metabolic syndrome on TDT, including cardiac disease unrelated to iron overload, needs further study. Commentary on: Ricchi et al. Liver steatosis in patients with transfusion‐dependent thalassaemia. Br J Haematol 2024;204:2458–2467. [ABSTRACT FROM AUTHOR]

The article presents abstracts on medical topics which include a study on Acute lymphoblastic leukemia progression and various treatment options for it, hepatitis C treatment and its progression and treatment, and triple negative breast cancer and the cellular sensitivity of drug response to it.

Regarding patient cohorts, 13 studies only included patients with decompensated cirrhosis, including three studies specifically of patients with hepatic encephalopathy. B I Conclusion: i b We found that the kinetics of quantitative HBsAg levels in treatment-naive patients with phase 3 CHB, as well as HBeAg-negative patients receiving NA treatment, decrease over time but were numerically similar between the treatment-naïve Phase 3 CHB group and the HBeAg-negative treatment-experienced patients. All five compensated patients were Child-Pugh A, and four of the five decompensated patients were Child-Pugh B. Median Model for End-Stage Liver Disease score was 8.0 ± 0.8 for the compensated group and 14.0 ± 3.6 in decompensated patients. B I Results: i b A total of 269 patients with CHD were included; 64 and 115 patients were treated with BLV 2 or 10 mg, respectively, 51 were control patients, and 39 patients were treated with peg-IFN . B I Methods: i b The predictive utility of end-of-treatment (EOT) and off-treatment HBcrAg level was evaluated among patients previously enrolled in the published HBV-STOP study (non-cirrhotic HBeAg-negative patients with CHB). SP 1 sp All patients were followed for 96 weeks after stopping NA therapy. [Extracted from the article]

The World Health Organization (WHO) aims to reduce HCV mortality, but estimates are difficult to obtain. We aimed to identify electronic health records of individuals with HCV infection, and assess mortality and morbidity. We applied electronic phenotyping strategies on routinely collected data from patients hospitalized at a tertiary referral hospital in Switzerland between 2009 and 2017. Individuals with HCV infection were identified using International Classification of Disease (ICD)‐10 codes, prescribed medications and laboratory results (antibody, PCR, antigen or genotype test). Controls were selected using propensity score methods (matching by age, sex, intravenous drug use, alcohol abuse and HIV co‐infection). Main outcomes were in‐hospital mortality and attributable mortality (in HCV cases and study population). The non‐matched dataset included records from 165,972 individuals (287,255 hospital stays). Electronic phenotyping identified 2285 stays with evidence of HCV infection (1677 individuals). Propensity score matching yielded 6855 stays (2285 with HCV, 4570 controls). In‐hospital mortality was higher in HCV cases (RR 2.10, 95%CI 1.64 to 2.70). Among those infected, 52.5% of the deaths were attributable to HCV (95%CI 38.9 to 63.1). When cases were matched, the fraction of deaths attributable to HCV was 26.9% (HCV prevalence: 33%), whilst in the non‐matched dataset, it was 0.92% (HCV prevalence: 0.8%). In this study, HCV infection was strongly associated with increased mortality. Our methodology may be used to monitor the efforts towards meeting the WHO elimination targets and underline the importance of electronic cohorts as a basis for national longitudinal surveillance. [ABSTRACT FROM AUTHOR]

Introduction: Eastern Europe is facing major HIV and hepatitis C (HCV) epidemics, with many people living with HIV (PLHIV) and HIV/HCV coinfection living in Ukraine. Despite the previous progress towards care quality improvement, the ongoing war in Ukraine is disrupting HIV and HCV care. Methods: We described an HIV cascade of care (CoC) in PLHIV from two clinical sites and an HCV CoC for anti‐HCV‐positive PLHIV from six sites in Ukraine, enrolled in the CARE cohort between 1 January 2019 and 1 June 2020. The cross‐sectional HIV CoC and HCV CoC are described at study enrolment. Results: Of 1028 PLHIV, 1014 (98.6%, 95% confidence interval [CI] 97.7–99.3) were on antiretroviral therapy (ART), and 876 (86.4% of those on ART, 95% CI 84.1–88.4) were virologically suppressed. Of 894 participants on ART >6 months, 90.8% (95% CI 88.7–92.6) were virologically suppressed (HIV‐RNA <200 copies/ml). Of 2040 anti‐HCV‐positive PLHIV, 417 (20.4%, 95% CI 18.7–22.3) were ever tested for HCV‐RNA prior to enrolment, ranging from 4.9% to 54.4% across sites, and 13.5% were currently HCV‐RNA positive. One hundred and eighteen persons (7.3% of ever chronically infected) had received HCV treatment, and 25 persons (1.6% of ever chronically infected) were cured, with variations across sites (0%–7.5%). The site diagnosing 54.4% of people with chronic HCV was the only one providing free RNA testing for all anti‐HCV‐positive persons, while the intra‐country differences in treatment coverage were driven by the number of available direct‐acting antiviral (DAA) courses. Conclusions: Over 98% of PLHIV in care in both CARE sites in Ukraine were receiving ART, and the target of 90% virally suppressed was achieved in persons >6 months on ART. Only one of six HIV/HCV study sites tested over 50% anti‐HCV‐positive PLHIV for HCV‐RNA and treated over 25% of eligible persons. While free HCV‐RNA testing and DAA treatment are paramount to achieving HCV elimination targets, they remained a challenge in Ukraine in 2019–2020. The extent of the HIV and HCV care disruption during the war will be further assessed in the CARE cohort and compared with the pre‐war findings. [ABSTRACT FROM AUTHOR]

Hepatitis D viral infection in humans is a disease that requires the establishment of hepatitis B, relying on hepatitis B surface Ag and host cellular machinery to replicate and propagate the infection. Since its discovery in 1977, substantial progress has been made to better understand the hepatitis D viral life cycle, pathogenesis and modes of transmission along with expanding on clinical knowledge related to prevention, diagnosis, monitoring and treatment. The availability of serologic diagnostic assays for hepatitis D infection has evolved over time with current widespread availability, improved detection and standardized reporting. With human migration, the epidemiology of hepatitis D infection has changed over time. Thus, the ability to use diagnostic assays remains essential to monitor the global impact of hepatitis D infection. Separately, while liver biopsy remains the gold standard for the staging of this rapidly progressive and severe form of chronic viral hepatitis, there is an unmet need for clinical monitoring of chronic hepatitis D infection for management of progressive disease. Thus, exploration of the utility of non‐invasive fibrosis markers in hepatitis D is ongoing. In this review, we discuss the virology, the evolution of diagnostics and the development of non‐invasive markers for the detection and monitoring of fibrosis in patients with hepatitis D infection. [ABSTRACT FROM AUTHOR]

Hepatitis C virus (HCV) infection is still a significant global health problem despite therapeutic advancements. Ribavirin and interferon therapy have been the sole available treatments for HCV infection for a number of years with low efficacy. Thus, currently, a number of therapeutic strategies are being used, including nanoparticles (NPs), micro‐RNAs such as small interfering RNA (siRNA), RNAi‐based gene silencing and antisense oligonucleotide‐based microRNA‐122, microRNA‐155, and short hairpin RNAs (shRNAs), and immunotherapeutic approaches such as anti‐programmed cell death 1(PD‐1), monoclonal antibodies (mAb or moAb), and monocyte‐derived dendritic cells (Mo‐DCs). Furthermore, direct‐acting antivirals (DAAs) and host‐targeting agents (HTA) were also the current therapeutic approaches with great efficacy. In spite of different clinical trials on HCV vaccine developments, nowadays there is no effective HCV vaccine in opposition to virus due to various challenges including genetic diversity, lack of immunocompetent small animal models, shortage of HCV vaccination testing alternatives, lack of an effective tissue culture method for replicating HCV, and inadequate knowledge regarding to immune responses against HCV infection. Nowadays, mRNA vaccine, recombinant viral vector, peptides vaccine, virus‐like particles, DNA vaccine, rational designed vaccine, and recombinant polyantigenic T‐cell‐based vaccine are novel promising candidates for HCV vaccine based on various clinical trials. This review summarizes the different therapeutic approaches and the advancements of vaccine candidates for HCV infection. [ABSTRACT FROM AUTHOR]

In this multi‐method study, we investigated the prevalence of chronic infections with the hepatitis C virus (HCV) in Switzerland in 2020, and assessed Switzerland's progress in eliminating HCV as a public health problem by 2030 with regard to the World Health Organization (WHO) criteria targeting infections acquired during the preceding year ('new transmissions') and HCV‐associated mortality. Based on a systematic literature review, the reappraisal of a 2015 prevalence analysis assuming 0.5% prevalence among the Swiss population and data from many additional sources, we estimated the prevalence among subpopulations at increased risk and the general population. For new transmissions, we evaluated mandatory HCV notification data and estimated unreported new transmissions based on subpopulation characteristics. For the mortality estimate, we re‐evaluated a previous mortality estimate 1995–2014 based on new data on comorbidities and age. We found a prevalence of ≤0.1% among the Swiss population. Discrepancies to the 2015 estimate were explained by previous (i) underestimation of sustained virologic response numbers, (ii) overestimation of HCV prevalence among PWID following bias towards subgroups at highest risk, (iii) overestimation of HCV prevalence among the general population from inclusion of high‐risk persons and (iv) underestimation of spontaneous clearance and mortality. Our results suggest that the WHO elimination targets have been met 10 years earlier than previously foreseen. These advancements were made possible by Switzerland's outstanding role in harm‐reduction programmes, the longstanding micro‐elimination efforts concerning HIV‐infected MSM and nosocomial transmissions, little immigration from high‐prevalence countries except Italian‐born persons born before 1953, and wealth of data and funding. [ABSTRACT FROM AUTHOR]

Background and aims: The future development of hepatocellular carcinoma (HCC) in patients after sustained virologic response (SVR) is an important issue. The purposes of this study were to investigate pathological alterations in organelle of the liver of SVR patients and to characterize organelle abnormalities that may be related to carcinogenesis after SVR. Methods: The ultrastructure of liver biopsy specimens from patients with chronic hepatitis C (CHC) and SVR were compared to cell and mouse models and assessed semi‐quantitatively using transmission electron microscopy. Results: Hepatocytes in patients with CHC showed abnormalities in the nucleus, mitochondria, endoplasmic reticulum, lipid droplet, and pericellular fibrosis, comparable to those seen in hepatitis C virus (HCV)‐infected mice and cells. DAA treatment significantly reduced organelle abnormalities such as the nucleus, mitochondria, and lipid droplet in the hepatocytes of patients and mice after SVR, and cured cells, but it did not change dilated/degranulated endoplasmic reticulum and pericellular fibrosis in patients and mice after SVR. Further, samples from patients with a post‐SVR period of >1 year had significantly larger numbers of abnormalities in the mitochondria and endoplasmic reticulum than those of <1 year. A possible cause of organelle abnormalities in patients after SVR could be oxidative stress of the endoplasmic reticulum and mitochondria associated with abnormalities of the vascular system due to fibrosis. Interestingly, abnormal endoplasmic reticulum was associated with patients with HCC for >1 year after SVR. Conclusions: These results indicate that patients with SVR exhibit a persistent disease state and require long‐term follow‐up to detect early signs of carcinogenesis. [ABSTRACT FROM AUTHOR]

A draft UK Parliamentary Bill sought to criminalize assaults on emergency workers through biting and spitting. This seemed to be based on a fear of bloodborne virus transmission. We undertook a literature search to clarify the risk of hepatitis infection from such exposures. We identified 245 possible papers and then reduced these to those relevant to HBV and HCV transmission through biting or spitting and the scientific plausibility. Nine papers were identified, reporting 16 possible cases of HBV (15 bites, 1 spitting) and 2 of HCV transmission (both bites). Only 3 HBV transmissions by bites and 1 by spitting and both HCV transmissions were felt to be plausible. Although both HBV DNA and HCV RNA can be found in the saliva of infected patients, it seems unlikely that there is enough to transmit infection unless there is blood contamination. In conclusion, the risk of acquiring HCV through spitting is negligible and is very low for HBV. The risk is also low for acquiring HBV and HCV through biting, especially if no blood is apparent in the saliva. [ABSTRACT FROM AUTHOR]

Objective. We systematically identified the prevalence of triplex infections (combined human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV)) in pregnancy. Methods. To gather information on the frequency of triplex infections, we searched the databases of PubMed, CINAHL, and Google Scholar. Without regard to language, we utilized search terms that covered HIV, HBV, HCV, and pregnancy. Pregnant women with triplex infections of HIV, HBV, and HCV were included in studies that also examined the prevalence of triplex infections. Review Manager 5.4.1 was employed to conduct the meta-analysis. Critical appraisal and bias tool risk data were provided as percentages with 95% confidence intervals (95% CIs), and I2 was used as the statistical measure of heterogeneity. The checklist was created by Hoy and colleagues. The study protocol was registered on PROSPERO, under the registration number CRD42020202583. Results. Eight studies involving 5314 women were included. We identified one ongoing study. Pooled prevalence of triplex infections was 0.03% (95% CI: 0.02–0.04%) according to meta-analysis. Subgroup analysis demonstrated a significantly high prevalence of 0.08% (95% CI: 0.06–0.10%; 3863 women) in HIV-positive population than 0.00% (95% CI:−0.00-0.00; 1451 women; P < 0.001) in general obstetric population. Moreover, there was a significant difference in the pooled prevalence between studies published between 2001 and 2010 and between 2011 and 2021 (0.14% (95% CI: 0.12 to 0.16 versus 0.03% (95% CI: 0.02 to 0.04%; P < 0.001))) and participants recruited in the period between 2001 and 2011 and between 2012 and 2021 (0.13% (95% CI: 0.05 to 0.21; p = 0.002 versus 0.00% (95% CI: −0.00 to 0.00%; p = 1.00))), respectively. Conclusion. The combined prevalence of prenatal triplex infections was 0.03%, with rates notably higher among the group of pregnant women who were HIV-positive and during the recruitment period that took place before 2012. This prevalence still necessitates screening for these infections as necessary. [ABSTRACT FROM AUTHOR]

Co‐administration of hepatitis C virus (HCV) direct‐acting antivirals (DAAs) with anti‐epileptics or mood stabilizers with cytochrome P450 (CYP) and/or drug transport‐inducing properties is contraindicated due to concerns of subtherapeutic DAA levels that can lead to treatment failure and viral resistance. The recommended strategy is to change the interacting medication to a different agent that does not have inducing properties, but this is not always possible depending on the clinical scenario. We report on three patients who received DAAs for their HCV infection while remaining on the contraindicated anti‐epileptic or mood stabilizer by utilizing CYP and drug transport inhibitors as pharmacokinetic enhancers to attempt to overcome the induction effects and maximize chances of achieving sustained virologic response (SVR). All patients achieved SVR despite the drug–drug interactions and there were no safety concerns. In patients facing this unique clinical quandary, the use of CYP and drug transport inhibitors appears to be a safe and possible strategy. [ABSTRACT FROM AUTHOR]

Background: Global data on the treatment rate with direct‐acting antivirals (DAAs) for chronic hepatitis C (CHC) are sparse. We aimed to evaluate the CHC treatment rate and barriers to treatment in the DAA era. Methods: We searched PubMed, EMBASE and Cochrane from inception to 5 August 2021, for relevant articles. Patients treated with DAAs without interferon (IFN) therapy were categorized as IFN‐free DAAs. Patients receiving DAA with IFN or unclear IFN status were categorized as DAA/IFN. Results: We identified and analysed data from 146 studies (1 760 352 CHC patients). DAA/IFN treatment rate was 16.0% (95% CI: 9.9–23.3, 49 studies, 886 535 patients). IFN‐free DAA treatment rate was 52.3% (95% CI: 46.2–58.4, 123 studies, 1 276 754 patients): 45.4% in North America, 64.2% in South America (1 study), 90.4% in Africa (most data from Egypt), 54.4% in Europe, 60.7% in Australia and 60.5% in Asia, (p <.0001); 49% with hepatitis B co‐infection and 32.3% with hepatocellular carcinoma (HCC). Treatment was not a priority in 22.8% of patients in Europe and 16.7% in Australia, compared to only 4.8% in North America and 2.1% in Asia (p <.0001). Poor adherence to clinical follow‐up was the cause of no treatment in 74.7% of patients in Australia, 37.0% in North America, 7.9% in Europe and 14.3% in Asia (p <.0001). Conclusion: Though a marked improvement from IFN/DAA, the treatment rate with IFN‐free DAA remains suboptimal (52.3% overall, 32.3% in HCC patients). Non‐adherence to clinical follow‐up and lack of disease awareness were treatment barriers. [ABSTRACT FROM AUTHOR]

P005 Dupilumab treatment normalizes skin barrier function in children aged 6 to 11 years with mode... Michael J. Cork 1, Donald Y.M. Leung 2, Peck Ong 3, Simon G. Danby 1, Marco Ramirez-Gama... 1 Sheffield Dermatology Research University of Sheffield, Department of Infection Immunity an... B Objectives: b To report the effect of dupilumab treatment in paediatric patients aged 6-11 years with moderate-to-severe atopic dermatitis (AD) on skin barrier function, clinician- and patient-reported outcomes. The lesions affected the upper leg (2 patients), neck (1 patient), shoulder (1 patient) and forehead (1 patient). P020 Dupilumab significantly improves patient reported outcomes in pediatric AD patients < 12 y... Michele Ramien 1,2, Danielle Marcoux 3,4, Eulalia Baselga 5, Marlies de Graaf 6, Alan D.... 1 Alberta Children's Hospital, Pediatrics and Medicine, Calgary, Canada; 2 University of Calg... B Objectives: b Dupilumab has proven to be effective in improving patient-reported outcomes for atopic dermatitis (AD) in paediatric patients in clinical trials. Comparison of epicardial adipose tissue thickness of paediatric patients with concomitant mod... Eduard Ambarchian 1, Vladislav Ivanchikov 1, Anastasia Kuzminova 1, Anna Shandra 1, Nikol... 1 Pediatrics and Child Health Research Institute in Petrovsky National Research Centre of Sur... B Objectives: b to identify the difference in the thickness of epicardial adipose tissue (EA) in the groups of patients with and without psoriasis B Method: b a total of 30 patients in the age between 8 and 16 years were separated in 2 groups of 15 people. The epidemiological, clinical and radiological characteristics of the patients are described, as well as their treatment and clinical course during the years of follow-up. B Results: b 8 paediatric patients and 1 adult patient with cerebral/spinal arteriovenous malformations or fistulas were identified. [Extracted from the article]

Aboriginal and Torres Strait Islander peoples experience a disproportionate burden of hepatitis C virus (HCV) infection. This study assessed the effectiveness of direct‐acting antiviral (DAA) therapy among Aboriginal peoples in the three years following universal access in Australia. REACH‐C, a national multicentre prospective cohort study, evaluated HCV treatment outcomes from sequential DAA initiations across 33 health services between March 2016 and June 2019. DAA effectiveness was assessed by sustained virological response (SVR) in the total (full analysis set) and effectiveness (modified analysis set excluding those lost to follow‐up) populations. Overall, 915 (10%) Aboriginal and 8095 (90%) non‐Indigenous people commenced DAA therapy, of whom 30% and 16% reported current injecting drug use and 73% and 42% were treated in primary care, respectively. SVR in the total and effectiveness populations was 74% and 94% among Aboriginal people and 82% and 94% among non‐Indigenous people, with loss to follow‐up contributing to lower SVR in the total population analysis (22% Aboriginal, 13% non‐Indigenous). Among Aboriginal people, returning for follow‐up was positively associated with older age (aOR 1.20; 95% CI 1.04, 1.39) and SVR was negatively associated with cirrhosis (aOR 0.39; 95% CI 0.19, 0.80) and prior DAA treatment (aOR 0.14; 95% CI 0.04, 0.49). Factors reflecting higher vulnerability or inequity were not associated with returning for testing or SVR. DAA therapy was highly effective among Aboriginal peoples with HCV treated through primary and tertiary services. Tailored community‐led interventions are necessary to optimize follow‐up and engagement. Sustained DAA uptake and equitable access to care, treatment and prevention are required for HCV elimination. [ABSTRACT FROM AUTHOR]

To evaluate the safety and tolerability of the fixed‐dose, single‐tablet regimen sofosbuvir/velpatasvir (SOF/VEL) for the treatment of hepatitis C virus (HCV) infection in three Phase 3 studies in patients with and without compensated cirrhosis. Data from three registrational trials (ASTRAL‐1, NCT02201940; ASTRAL‐2, NCT02220998; ASTRAL‐3, NCT02201953) were pooled by treatment regimen. Researchers assessed treatment‐emergent adverse events (TEAEs) and laboratory abnormalities in patients randomized to SOF/VEL or placebo for 12 weeks in ASTRAL‐1 and SOF/VEL for 12 weeks in ASTRAL‐2 and ASTRAL‐3. Overall, 1035 patients were treated with SOF/VEL, and 116 patients received placebo. Rates of any TEAE were generally similar between patients receiving SOF/VEL (79.4%) and those receiving placebo (76.7%). The majority of TEAEs were mild to moderate, with 23 (2.2%) treatment‐emergent serious AEs in patients treated with SOF/VEL. Of these treatment‐emergent serious AEs, none led to premature study discontinuation, nor were they considered related to treatment. Presence of compensated cirrhosis, greater age and mild renal impairment did not impact incidence or severity of TEAEs with SOF/VEL treatment. The most common TEAEs (incidence ≥10%) were headache, fatigue, nausea and nasopharyngitis in patients receiving SOF/VEL; similar rates were observed in placebo‐treated patients. Three deaths (<1%) were reported in patients treated with SOF/VEL, all posttreatment and none assessed as related to study treatment. Similar to that of placebo, SOF/VEL treatment of HCV infection had a safety/tolerability profile that was not affected by baseline factors, such as the presence of compensated cirrhosis, mild renal impairment or advanced age. [ABSTRACT FROM AUTHOR]

Background and Aim: Burden of hepatitis C in India is not known. We therefore conducted a systematic review of the available data on anti‐hepatitis C virus (HCV) seroprevalence in the Indian population. Methods: We searched several publication databases for English language papers that reported data on anti‐HCV seroprevalence from India and also identified other unpublished sources of such data. Data on groups likely to represent seroprevalence in general population and in selected high‐risk groups were extracted and subjected to meta‐analysis. Results: Of the 3995 published papers and 94 additional data sources identified, 327 were selected; these provided 414 anti‐HCV seroprevalence data points. Pooled anti‐HCV seroprevalence rates in community‐based studies, blood donors, and pregnant women were 0.85% (95% confidence interval: 0.00–3.98%), 0.44% (0.40–0.49), and 0.88% (0.21–1.90), respectively. Among groups considered at high risk of HCV, pooled anti‐HCV seroprevalence rates were as follows: people living with HIV (40 studies from 17 states: 3.51% [2.43–4.76]), persons on maintenance hemodialysis (37, 13; 19.23% [13.52–25.65]), people who inject drugs (46, 14; 44.71% [37.50–52.03]), multi‐transfused persons (38, 12; 24.06% [20.00–28.36]), persons with sexually transmitted diseases (7, 5; 4.10% [0.98–9.04]), and those with high‐risk sex behavior (6, 5; 4.06% [1.79–7.10]). Conclusions: Community‐based data on HCV seroprevalence in India were limited. Large amount of data on blood donors and pregnant women were identified, with pooled anti‐HCV seroprevalence rates of 0.44% and 0.88%, respectively. Among high‐risk groups, anti‐HCV prevalence was higher among people living with HIV, those with sexually transmitted diseases, high‐risk sex behavior or injection drug use, and those receiving hemodialysis or frequent transfusions. [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Vutien et al papers. To view these articles, visit https://doi.org/10.1111/apt.17802 and https://doi.org/10.1111/apt.17818 [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Vutien et al papers. To view these articles, visit https://doi.org/10.1111/apt.17802 and https://doi.org/10.1111/apt.17841 [ABSTRACT FROM AUTHOR]

Over 70 million individuals are infected with hepatitis C virus (HCV) worldwide. Yet most prevalence data are in the adult population, with little focus on paediatrics, partially due to the scarcity of public data. The objective of this paper is to examine HCV prevalence in children by estimating prevalence rates among women, given the assumption that most cases are vertically transmitted. Between 2001 and 2017, maternal HCV infection affected ~ 0.24% of all births, with prevalence increasing by at least 261%. On average, approximately 0.01% of the total number of live births were infected with HCV, with a 245% increase in the number of children born with the infection. HCV epidemiology has evolved, with women of childbearing age representing a greater proportion of infected individuals in the United States, and infants born to infected mothers being at risk. We therefore recommend a greater public health focus of HCV on the paediatric population. [ABSTRACT FROM AUTHOR]

The article presents abstracts of medical research related to liver cancer. They include "Surgery of hepatocellular carcinoma - current status and future prospects," by Zhao-You Tang, "Natural history of hepatitis C virus," Harvey J. Alter and "The history of viral hepatitis: a tale of dogmas and misinterpretations," by Rudi Schmid.

The aim of this study was to examine the cost-effectiveness of adding nucleic acid testing (NAT) to serological (antibody and antigen) screening protocols for donated blood in the United States (US) with the purpose of reducing the risks of transfusion-transmission of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). The costs, health consequences and cost-effectiveness of adding either minipool or individual-donor NAT to serological screening (SS) testing were estimated using a decision-analysis model. With the given modelling assumptions, adding minipool NAT would avoid an estimated 37, 128 and eight cases of HBV, HCV and HIV, respectively, and save ≈ 53 additional years of life and 102 additional quality adjusted life years (QALYs) compared with SS, at a net cost of $154 million. SS + minipool NAT − p24 compared with SS alone resulted in an incremental cost-effectiveness ratio of $1·5 million per QALY gained (range in sensitivity analysis $1·0–2·1 million per QALY gained) in this US analysis. The cost effectiveness of adding NAT screening is outside the typical range for most healthcare interventions, but not for established blood safety measures. [ABSTRACT FROM AUTHOR]

Contrary to the zero results that Schwarzer et al.2 report, the pooled HCV infections per 1000 observations are similar across methods with the IVhet model values being most conservative at 1.91 (95% CI 1.18, 2.80) infections per 1000 observations. We then generated 10,000 sample proportions using each true proportion and a beta distribution as above and then computed its confidence interval on the FTT scale, which was then back-transformed to the natural scale. Pooling of proportions in meta-analysis are used to get better and more precise estimates of disease frequency, including cumulative incidence or prevalence. [Extracted from the article]

This case report describes a pharmacokinetic drug–drug interaction between crizotinib, a tyrosine kinase inhibitor, and sofosbuvir/velpatasvir, a direct-acting antiviral drug, leading to cardiac toxicity. A 75-year-old man, with no cardiovascular history but a diagnosis of metastatic nonsmall cell lung cancer with mesenchymal–epithelial transition exon-14 deletion and hepatitis C virus infection genotype 1A, received both crizotinib and sofosbuvir/velpatasvir. Crizotinib was well tolerated, but 1 week after sofosbuvir/velpatasvir initiation, the patient experienced bilateral lower-limb oedema and class III New York Heart Association dyspnoea. We assumed that increased exposure to crizotinib could account for this cardiac toxicity. Drug causality was probable according to the Naranjo scale. We hypothesized a reciprocal interaction between crizotinib and velpatasvir, mediated by both cytochrome 3A4 (CYP3A4) and P-glycoprotein (P-gp). Clinicians should be aware of the risk of drug–drug interactions between direct-acting antiviral agents that inhibit CYP3A4 (glecaprevir) and/or P-gp (voxilaprevir, velpatasvir) and anticancer tyrosine kinase inhibitors that are mostly CYP3A4 and/or P-gp substrates (gefitinib, afatinib, erlotinib, crizotinib, ceritinib, lorlatinib, brigatinib, capmatinib etc.). [ABSTRACT FROM AUTHOR]

It is well‐established that prevalence of Hepatitis C (HCV) infection in prisoners is disproportionately higher than in the general population. While developments in screening and treatment for HCV have enabled greater detection and treatment in prison, release is a high‐risk time for HCV infected prisoners returning to the challenges of community living. A scoping review was conducted to examine the evidence on individual, provider and system level factors that influence compliance with HCV treatment in patients transitioning from prison to community. Retrieved articles were screened and those eligible were selected for data extraction. Quantitative and qualitative studies were included. Electronic peer‐reviewed databases were searched in February 2022: 140 articles were initially identified of which seven were included in the final review. Six key themes characterized the literature: education, case management and discharge planning, hepatology in‐reach nurses, transition clinics, primary care providers and system wide approach. This summary scoping review highlights the paucity of research in this area. There is a need for experimental research to investigate specific interventions, and to understand HCV care‐specific barriers and facilitators. A multi‐pronged approach is needed to address barriers to healthcare services in general but also specific barriers relating to HCV. Factors that facilitate compliance should also be recognized and amplified across regional HCV elimination strategies. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the feasibility of testing and treating people who inject drugs at a supervised injecting facility for hepatitis C virus (HCV) infection. Design: Retrospective cohort study. Setting, participants: People who inject drugs who attended the Melbourne supervised injecting facility, 30 June 2018 – 30 June 2020. Main outcome measures: Proportion of people tested for hepatitis C; proportions of people positive for anti‐HCV antibody and HCV RNA, and of eligible people prescribed direct‐acting antiviral (DAA) treatment; sustained virological response twelve weeks or more after treatment completion. Results: Of 4649 people who attended the supervised injecting facility during 2018–20, 321 were tested for hepatitis C (7%); 279 were anti‐HCV antibody‐positive (87%), of whom 143 (51%) were also HCV RNA‐positive. Sixty‐four of 321 had previously been treated for hepatitis C (20%), 21 had clinically identified cirrhosis (7%), eight had hepatitis B infections (2%), and four had human immunodeficiency virus infections (1%). In multivariate analyses, people tested for hepatitis C were more likely than untested clients to report psychiatric illness (adjusted odds ratio [aOR], 9.65; 95% confidence interval [CI], 7.26–12.8), not have a fixed address (aOR, 1.59; 95% CI, 1.18–2.14), and to report significant alcohol use (aOR, 1.57; 95% CI, 1.06–2.32). The median number of injecting facility visits was larger for those tested for hepatitis C (101; interquartile range [IQR], 31–236) than for those not tested (20; IQR, 3–90). DAA treatment was prescribed for 126 of 143 HCV RNA‐positive clients (88%); 41 of 54 with complete follow‐up data were cured (76%). Conclusions: People who attend supervised injecting facilities can be tested and treated for hepatitis C on site. Models that provide streamlined, convenient hepatitis C care promote engagement with treatment in a group in which the prevalence of hepatitis C is high. [ABSTRACT FROM AUTHOR]

Background: Direct‐acting antiviral agents (DAAs) have transformed chronic hepatitis C (CHC) treatment. Continued affordable access to DAAs requires updated cost‐effectiveness analyses (CEA). Utility is a preference‐based measure of health‐related quality of life (HRQoL) used in CEA. This study evaluated the impact of DAAs on utilities for patients with CHC in two clinical settings. Methods: This prospective longitudinal study included patients aged ≥18 years, diagnosed with CHC and scheduled to begin DAA treatment, from two tertiary care hospital clinics and four community clinics in Toronto, Calgary, and Montreal. Patients completed two utility instruments (EQ‐5D‐5L and Health Utilities Index 2/3 (HUI2/3)) before treatment, 6 weeks after treatment initiation, and 12 weeks and 1 year after treatment completion. We measured utilities for all patients, and for hospital‐based and community‐based groups. Results: Between 2017 and 2020, 209 patients (126 hospital‐based, 83 community‐based; average age 53 years; 65% male) were recruited, and 143 completed the 1‐year post‐treatment assessment. Pre‐treatment, utilities were (mean ± standard deviation) 0.77 ± 0.21 (EQ‐5D‐5L), 0.69 ± 0.24 (HUI2) and 0.58 ± 0.34 (HUI3). The mean changes at 1‐year post‐treatment were 0.035, 0.038 and 0.071, respectively. While utilities for hospital‐based patients steadily improved, utilities for the community‐based cohort improved between baseline and 12‐weeks post‐treatment, but decreased thereafter. Discussion: This study suggests that utilities improve after DAA treatment in patients with CHC in a variety of settings. However, community‐based patients may face challenges related to comorbid health and social conditions that are not meaningfully addressed by treatment. Our study is essential for valuing health outcomes in CHC‐related CEA. [ABSTRACT FROM AUTHOR]

Background and Aims: Screening strategies for undiagnosed infections are fundamental for hepatitis C virus (HCV) elimination. We previously investigated HCV prevalence and screening strategies in an urban primary care setting. IV drug abuse, blood transfusion before 1992, immigration, or elevated ALT were identified as risk factors in a post hoc analysis and diagnosed 83% of unknown HCV‐RNA‐positive cases by screening only 26% of the population. We aimed to validate prospectively the proposed screening algorithm in two independent urban and rural cohorts and to analyse for potential differences. Methods: Anti‐HCV and ALT were included in a routine check‐up together with a questionnaire covering risk factors. HCV‐RNA was analysed in anti‐HCV‐positive individuals. Results: In urban and rural areas, 4323 and 9321 individuals were recruited. The anti‐HCV prevalence was 0.56% and 0.49%, and 0.1% of patients were HCV‐RNA‐positive in both regions. Fifty‐two anti‐HCV positive patients including eight HCV‐RNA‐positive cases were unaware of the infection (number needed to screen to detect one unknown anti‐HCV‐positive individual: 262). At least one of the three aforementioned risk factors or elevated serum ALT was present in 3000 patients (22%). Restricting HCV screening to only those with risk factors, 52% and 75% of all anti‐HCV and HCV‐RNA‐positive undiagnosed patients were identified (number needed to screen: 111). Conclusions: We confirm prospectively the efficiency of a risk‐based HCV screening. The risk‐based algorithm should be evaluated in other countries with similarly low HCV prevalence as in Germany to achieve WHO HCV elimination goals. [ABSTRACT FROM AUTHOR]

Purpose: As drug‐related epidemics have expanded from cities to rural areas, syringe service programs (SSPs) and other harm reduction programs have been slow to follow. The recent implementation of SSPs in rural areas demands attention to program fidelity based on core components of SSP success. Methods: Semistructured interviews conducted with clients and staff at 5 SSPs in 5 counties within 2 Central Appalachian health districts. Interviews covered fidelity of SSP implementation to 6 core components: (1) meet needs for harm reduction supplies; (2) education and counseling for sexual, injection, and overdose risks; (3) cooperation between SSPs and local law enforcement; (4) provide other health and social services; (5) ensure low threshold access to services; and (6) promote dignity, the impact of poor fidelity on vulnerability to drug‐related harms, and the risk environment's influence on program fidelity. We applied thematic methods to analyze the data. Findings: Rural SSPs were mostly faithful to the 6 core components. Deviations from core components can be attributed to certain characteristics of the local rural risk environment outlined in the risk environment model, including geographic remoteness, lack of resources and underdeveloped infrastructure, and stigma against people who inject drugs (PWID) Conclusions: As drug‐related epidemics continue to expand outside cities, scaling up SSPs to serve rural PWID is essential. Future research should explore whether the risk environment features identified also influence SSP fidelity in other rural areas and develop and test strategies to strengthen core components in these vulnerable areas. [ABSTRACT FROM AUTHOR]

The occurrence of hepatocellular carcinoma (HCC) is one of the most serious complications of hepatitis C virus (HCV) infection. Recently, effective antiviral medications have made sustained viral response (SVR) or cure a realistic therapeutic goal for most chronic HCV patients. Given HCV's tumorigenic propensity, it is not surprising that achieving SVR is helpful in preventing HCC. This review briefly summarizes and discusses the existing evidence on the relationship between hepatic carcinogenesis and viral eradication by antivirals, which is mainly divided into interferon‐based and direct‐acting antivirals (DAAs) based therapy. DAAs have changed the treatment landscape of chronic HCV, reaching high rates of SVR even in patients with advanced cirrhosis, with few contraindications and little side effects. Although some early reports suggested that DAA treatment increased the chance of HCC occurrence, more subsequent observational studies have refuted this theory. The probability of HCC recurrence after HCV eradication appears to be decreasing over time following SVR. Despite virological suppression/cure, individuals with liver cirrhosis are still at risk of HCC and should be monitored. There is a considerable need for markers/scores to predict the long‐term risk of HCC in patients with HCV‐related liver disease who attain SVR with direct‐acting antivirals. [ABSTRACT FROM AUTHOR]