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Additional file 3. A3. Classification system for assessment of study methodologies.

Additional file 2. A2. Year of publication of included sources.

Additional file 4. A4. Country of origin of included sources.

Additional file 1. A1. PRISMA 2020 Checklist.

Additional file 6. A6. Dissemination of the prevalence hepatitis C antibodies and the prevalence of people who inject drugs (PWID) within the different studies.

Additional file 5. A5. Included prevalence sources with additional risk factors and the prevalence of HIV coinfection, people who inject drugs and male incarcerated individuals (n=92; 36 countries).

Additional file 3. A multivariate regression model with backward conditional removal of variables.

Additional file 2. . A2. Univariate generalized linear mixed models to investigate the association between different risk factors and hepatitis C antibodies.

Additional file 4. Baseline characteristics of people who use drugs at the Centre for Alcohol and Drug abuse in Limburg.

Additional file 2. Univariate analysis by Chi2 test or Mann-Whitney U test for characteristics of screened, RNA positive, specialist evaluation and treated people who use drugs.

Additional file 1. Changing the landscape of hepatitis C virus infection treatment and services provided to people who use drugs.

Additional file 1.

Background and study aims: Hepatitis C virus (HCV) infection often causes asymptomatic disease and patients are frequently diagnosed at an advanced stage. Oral direct acting antivirals (DAAs) are successful in treating HCV with high sustained virologic response (SVR) and excellent tolerability. The aim of this study is to evaluate cost-effectiveness of a broad screening strategy proposing screening to all undiagnosed members of a population (comprehensive HCV screening), in the general adult population, emergency department (ED) attendees, men who have sex with men (MSM) and people who inject drugs (PWID). Patients and methods: We populated a theoretical model with Belgian data. A decision tree model simulating HCV screening and diagnosis was combined with a Markov state transition model simulating treatment. There was one screening round per year during five years. In the ED population only one screening round was considered. Results: The model calculated that more HCV patients could be detected and treated with comprehensive screening compared to the current situation. Incremental cost per incremental quality adjusted life years (QALY) gained was lower than 10.000€/QALY for one and for five screening rounds in the general population (5.139 and 5.200 respectively), in ED attendees (one screening round 5.967), in MSMs (4.292 and 4.302 respectively) and in PWIDs (3.504 and 3.524 respectively). Conclusion: A broad screening strategy combined with treatment is likely to be a cost-effective strategy to detect and treat HCV infected patients and diminish the HCV burden in Belgium., SCOPUS: ar.j, info:eu-repo/semantics/published

Currently, nucleos(t)ide analogues (NAs) in monotherapy are favored as prophylaxis against Hepatitis B recurrence after liver transplantation. However, in patients at risk for renal failure, renal safety of NAs is of concern. We investigated the safety and efficacy of subcutaneous (SC) Hepatitis B Immunoglobulins (HBIG) in monotherapy. This is a single-arm prospective trial in patients transplanted >1 year. We included 43 Caucasian patients. The majority was treated with calcineurin inhibitors and several patients had other risk factors for renal impairment as well: diabetes mellitus (n=10/43), arterial hypertension (n=11/43) and hyperlipidemia (=10/43). At inclusion, 42% (n=18) had chronic kidney disease ≥grade 3a. All patients were switched from IV HBIG with or without NAs to SC HBIG without NAs. After one year the targeted titer was lowered to ≥150 IU/l in patients with low risk of recurrence. Mean follow-up time was 36±5months. None of the patients had a relapse of HBsAg or HBV DNA. The treatment was well tolerated, safe and the renal function remained unchanged both in patients with (n=18) or without (n=25) renal impairment at baseline. The mean HBsAb titer could be decreased from 343±163IU/l to 199±81 IU/l in the low risk group (n=17) and 218±71 IU/l in the high risk group (n=26). In 86% (n=37) doses reductions were possible, which significantly lowered the cost of treatment. SC HBIG without NAs had a 100% success rate in the long-term prevention of HBsAg and HBV DNA reappearance, without deterioration of renal function. This article is protected by copyright. All rights reserved. ispartof: Transplant International vol:31 issue:5 pages:503-509 ispartof: location:Switzerland status: published

Introduction: Hepatitis C (HCV) remains one of the main causes of chronic liver disease worldwide. The impact of chronic HCV on the long-term ranges widely, from minimal histologic changes to decompensated cirrhosis or hepatocellular carcinoma. These last years, the development of direct acting antivirals have revolutionized HCV care. We present the experience in the KU Leuven affiliated hospitals with the latest generation of direct acting antivirals. These are therapies without concomitant use of interferon, such as simeprevir, sofosbuvir, daclatasvir, and ombitasvir/paritaprevir ritonavir – dasabuvir. Aim Goal of this abstract is to demonstrate the safety and efficacy of the newest generation of direct acting antivirals in the general population in Belgium (the KU Leuven affiliated hospitals). Methods A national retrospective, interventional cohort study conducted between December 2013 and November 2015 in 6 Belgian centers during which patients infected with HCV were treated with the new regimes of DAA. All centers were experienced in treating HCV. In case antiviral treatment was started data were collected in a central database, with main focus on treatment outcome and side effects. Results and discussion In total, 134 patients (age 58 ± 12 years) were treated with one of the newest generation DAAs. All patients had multiple comorbidities, with an average rate of 1.55 ± 1.6. These were highest in the simeprevir/sofosbuvir group. HCV genotype 1b was most prevalent. 45.9% of the patients were treatment naïve, and 38.7% % was once treated before. 59 patients were treated with daclatasvir/sofosbuvir ± ribavirin, 48 with simeprevir/sofosbuvir ± ribavirin, and 27 with ombitasvir/ paritaprevir, ritonavir – dasabuvir ± ribavirin. Treatment is completed in only 60.4% of all patients. Moreover, only 42.5% were treated long enough so they could achieve SVR. From this group, almost everyone obtained SVR (96.5%). Subanalysis showed an SVR-rate of 100% (10/10) in the daclatasvir/sofosbuvir ± ribavirin group, 92.6% (25/27) in the simeprevir/sofosbuvir ± ribavirin group, and 100% (20/20) in the ombitasvir/ paritaprevir, ritonavir – dasabuvir ± ribavirin group. Side effects were present in 49.3 % of the total population, most frequent were an increase in fatigue and skin eruptions. Only in 9.7 %, this required a change in therapy. Ribavirin was lowered in dose or stopped in these cases. These are preliminary results, we will present larger data at the time of the congress. Conclusion Real-life experience with DAAs in Belgium shows comparable excellent results in achieving SVR for the treatment of HCV. Side effects were frequent, but rarely cause a need for therapy change. This study is part of the Limburg Clinical Research Program (LCRP) UHasselt-ZOL-Jessa, supported by the foundation Limburg SterkMerk, Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital.