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Zhu L, Kim EJ, González E, Fraser MA, Zhu S, Rubio-Torio N, Ma GX, Yeh MC, Tan Y. Reducing Liver Cancer Risk through Dietary Change: Positive Results from a Community-Based Educational Initiative in Three Racial/Ethnic Groups. Nutrients 2022; 14:4878. [PMID: 36432564 PMCID: PMC9698707 DOI: 10.3390/nu14224878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/28/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022] Open
Abstract
Dietary behaviors and alcohol consumption have been linked to liver disease and liver cancer. So far, most of the liver cancer awareness campaigns and behavioral interventions have focused on preventive behaviors such as screening and vaccination uptake, while few incorporated dietary aspects of liver cancer prevention. We implemented a community-based education initiative for liver cancer prevention among the African, Asian, and Hispanic populations within the Greater Philadelphia and metropolitan New York City areas. Data from the baseline and the 6-month follow-up surveys were used for the assessment of changes in dietary behaviors and alcohol consumption among participants. In total, we recruited 578 participants through community-/faith-based organizations to participate in the educational workshops. The study sample included 344 participants who completed both baseline and follow-up survey. The Hispanic subgroup was the only one that saw an overall significant change in dietary behaviors, with the Mediterranean dietary score increasing significantly from 30.000 at baseline survey to 31.187 at 6-month follow-up assessment (p < 0.05), indicating a trend towards healthier dietary habit. In the African Americans participants, the consumption scores of fruits and poultry increased significantly, while vegetables and red meats decreased. In Asian Americans, the consumption of non-refined cereals, red meats, and dairy products decreased. Alcohol consumption decreased significantly among Hispanics while it did not change significantly among the other two communities. This community-based educational initiative generated different impacts in the three populations, further highlighting the needs for more targeted, culturally tailored efforts in health promotion among these underprivileged communities.
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Affiliation(s)
- Lin Zhu
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
- Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Ellen Jaeseon Kim
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Evelyn González
- Office of Community Outreach, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA 19111, USA
| | | | - Steven Zhu
- Pennsylvania United Chinese Coalition, Philadelphia, PA 19107, USA
| | | | - Grace X. Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
- Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Ming-Chin Yeh
- Nutrition Program, Hunter College, City University of New York, New York, NY 10017, USA
| | - Yin Tan
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
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2
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Low Rates of Hepatitis B Virus Treatment Among Treatment-Eligible Patients in Safety-Net Health Systems. J Clin Gastroenterol 2022; 56:360-368. [PMID: 33780210 DOI: 10.1097/mcg.0000000000001530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/10/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Timely initiation of antiviral therapy in chronic hepatitis B virus (CHB) reduces risk of disease progression. We evaluate overall treatment rates and predictors of treatment among treatment-eligible safety-net CHB patients. METHODS We retrospectively evaluated adults with CHB from 2010 to 2018 across 4 large safety-net health systems in the United States. CHB was identified with ICD-9/10 diagnosis coding and confirmed with laboratory data. Treatment eligibility was determined using American Association for the Study of Liver Diseases (AASLD) guidelines. Comparison of CHB treatment rates among treatment-eligible patients were performed using χ2 testing, Kaplan Meier methods and log-rank testing. Adjusted multivariate Cox proportional hazards models evaluated independent predictors of receiving treatment among eligible patients. RESULTS Among 5157 CHB patients (54.7% male, 34.6% African American, 22.3% Asian), 46.8% were treatment-eligible during the study period. CHB treatment rates were 48.4% overall and 37.3% among CHB patients without human immunodeficiency virus. Significantly lower odds of treatment were observed in females versus males (odds ratio: 0.40, 95% confidence interval: 0.33-0.49, P<0.001) and patients age 65 years or above versus age below 45 years (odds ratio: 0.68, 95% confidence interval: 0.51-0.92, P=0.012). Conversely, significantly greater odds of treatment were observed in African American and Asians versus non-Hispanic whites, CHB patients with indigent care versus commercially insured patients, and non-English speaking versus English speaking patients. CONCLUSION Among a large multicentered, safety-net cohort of CHB patients, 46.8% of treatment-eligible CHB patients overall and 37.3% of treatment-eligible CHB patients without human immunodeficiency virus received antiviral therapy. Improving CHB treatment rates among treatment-eligible patients represents "low hanging fruit," given the clear benefits of antiviral therapy in mitigating disease progression.
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3
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Szpakowski JL, Tucker LY, Baer DM, Pauly MP. Hepatotoxicity during legacy cancer chemotherapy in patients infected with hepatitis C virus: A retrospective cohort study. CANADIAN LIVER JOURNAL 2022; 5:43-60. [PMID: 35990784 PMCID: PMC9231429 DOI: 10.3138/canlivj-2021-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/13/2021] [Indexed: 11/04/2023]
Abstract
BACKGROUND The rates and causes of significant hepatotoxicity with cancer chemotherapy (CCT) in patients infected with hepatitis C virus (HCV) are incompletely characterized. METHODS We compared rates of grade 3 or 4 hepatotoxicity, defined as elevated transaminases, during CCT in patients who are mono-infected with HCV compared with rates in controls matched on demographics, diagnosis, and rituximab use. We excluded patients with hepatobiliary cancers, hepatitis B virus or human immunodeficiency virus infection. Hepatotoxicity was attributed to a medical cause, cancer progression, or CCT, including HCV flare. RESULTS Patients with HCV (n = 196) had a higher rate of cirrhosis than the 1,130 matched controls (21.9% versus 4%; P <0.001). Their higher rate of overall hepatotoxicity (8.7% versus 4.5% of controls, P = 0.01) was due to higher rate of CCT-related hepatotoxicity (4.1% versus 1.2%, P = 0.01). On multivariable analysis, the largest risk factor for overall hepatotoxicity was cirrhosis, and the only risk factor for CCT-related hepatotoxicity was HCV infection. Among those with HCV, the only significant risk factor for hepatotoxicity was rituximab use. Hepatotoxicity caused by CCT delayed or altered treatment in only 3 HCV patients and 1 control (1.5% versus 0.1%, P = 0.01). CONCLUSIONS Most patients with HCV can safely be treated with cancer chemotherapy. Cirrhosis and HCV infection contributed to increased hepatotoxicity in subjects on CCT. Among HCV patients, rituximab use was the major risk factor for increased hepatotoxicity. Hepatotoxicity due to CCT itself rarely altered or delayed CCT. Nonetheless, HCV-positive patients should be monitored carefully during CCT.
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Affiliation(s)
| | - Lue-Yen Tucker
- Division of Research, Kaiser Permanente, Oakland, California, USA
| | - David M Baer
- Kaiser Permanente Medical Center, Oakland, California, USA
| | - Mary Pat Pauly
- Kaiser Permanente Medical Center, Sacramento, California, USA
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4
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Mohareb AM, Patel NJ, Fu X, Kim AY, Wallace ZS, Hyle EP. Screening for Hepatitis B Virus Prior to Initiating Tocilizumab and Tofacitinib in Patients With Rheumatic Diseases: A Cross-sectional Study. J Rheumatol 2022; 49:104-109. [PMID: 34334359 PMCID: PMC8724454 DOI: 10.3899/jrheum.210257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Hepatitis B virus (HBV) can reactivate among rheumatology patients initiating tocilizumab (TCZ) or tofacitinib (TOF). HBV screening is recommended by the Centers for Disease Control and Prevention (CDC), the American Association for the Study of Liver Diseases (AASLD), and the Canadian Rheumatology Association, but it is not explicitly recommended by the American College of Rheumatology. METHODS We conducted a cross-sectional study to characterize HBV screening practices for adult rheumatology patients initiating TCZ or TOF before December 31, 2018, in the Greater Boston area. We classified appropriate HBV screening patterns prior to TCZ or TOF (i.e., HBV surface antigen [HBsAg], total core antibody [anti-HBcAb], and surface antibody [HBsAb]) as follows: complete (all 3 tested), partial (any 1 or 2 tests), or none. We determined the frequency of inappropriate HBV testing (HBV e-antigen, anti-HBcAb IgM, or HBV DNA without a positive HBsAg or total anti-HBcAb) and used multivariable regression to assess factors associated with complete HBV screening. RESULTS Among 678 subjects initiating TCZ, 194 (29%) completed appropriate HBV screening, 307 (45%) had partial screening, and 177 (26%) had none. Among 391 subjects initiating TOF, 94 (24%) completed appropriate HBV screening, 195 (50%) had partial screening, and 102 (26%) had none. Inappropriate testing was performed in 22% of subjects. Race was associated with complete HBV screening (White vs non-White: OR 0.74, 95% CI 0.57-0.95), whereas prior immunosuppression was not (conventional synthetic disease-modifying antirheumatic drugs [DMARDs]: OR 1.05, 95% CI 0.72-1.55; biologic DMARDs: OR 0.73, 95% CI 0.48-1.12). CONCLUSION Patients initiating TCZ or TOF are infrequently screened for HBV despite recommendations from the AASLD and CDC.
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Affiliation(s)
- Amir M. Mohareb
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA,Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston MA USA
| | - Naomi J. Patel
- Harvard Medical School, Boston MA USA,Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Xiaoqing Fu
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Arthur Y. Kim
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston MA USA
| | - Zachary S. Wallace
- Harvard Medical School, Boston MA USA,Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, MA, USA,Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Emily P. Hyle
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA,Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston MA USA
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Sowah L, Chiou C. Impact of Coronavirus Disease 2019 Pandemic on Viral Hepatitis Elimination: What Is the Price? AIDS Res Hum Retroviruses 2021; 37:585-588. [PMID: 33913731 DOI: 10.1089/aid.2020.0301] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
In 2016, the World Health Organization developed a plan for viral hepatitis elimination by 2030. Globally, control of hepatitis B virus (HBV) and hepatitis C virus (HCV) are the most challenging aspects of viral hepatitis elimination. In many developed countries elimination of HBV could be targeted to special populations mostly immigrants from low resource settings. Elimination of HCV, however, remains a challenge globally. Barriers to HCV elimination include high cost of medications and the ability to engage specific at-risk populations as well as individuals who are out of medical care. In the context of the coronavirus disease 2019 (COVID-19) pandemic, treatment access and screening have been further negatively impacted by social distancing rules and COVID-19-related anxieties. This threatens to throw most countries off course in their elimination efforts. Before the pandemic, some states in the United States had scaled up their elimination efforts with plans to ramp up testing and treatment using Netflix-like payment models for HCV direct acting antiviral drugs. Most of these efforts have stalled on account of the health system's focus on COVID-19 control. To prevent further delays in achieving elimination targets, programs would need to explore new models of care that address COVID-19-related access hurdles. Systems that leverage technologies such as telemedicine and self-testing could help maintain treatment levels. Mathematical models estimate that COVID-19-related delays in 2020 could lead to 44,800 hepatocellular cancers and 72,300 liver-related deaths for the next decade.
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Affiliation(s)
- Leonard Sowah
- Division of AIDS, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, USA
| | - Christine Chiou
- Division of AIDS, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, USA
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Wong RJ, Brosgart CL, Welch S, Block T, Chen M, Cohen C, Kim WR, Kowdley KV, Lok AS, Tsai N, Ward J, Wong SS, Gish RG. An Updated Assessment of Chronic Hepatitis B Prevalence Among Foreign-Born Persons Living in the United States. Hepatology 2021; 74:607-626. [PMID: 33655536 PMCID: PMC8453838 DOI: 10.1002/hep.31782] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Although prevalence of chronic hepatitis B (CHB) in the USA includes 0.42 million (range, 0.28-0.67) U.S.-born persons, foreign-born (FB) persons contribute a substantially larger number to the burden of CHB in the USA. Over the past decade, patterns of U.S. immigration have changed and many countries have implemented HBV prevention programs. This study aims to estimate the number of FB persons with CHB in the USA by country of origin, updating our 2011 study. APPROACH AND RESULTS We performed systematic searches for articles published in 2009-2019 reporting HBsAg seroprevalence in emigrants and in-country populations of 117 countries. Data meeting inclusion criteria were combined with data from our 2011 study to calculate pooled prevalence estimates for 99 countries using meta-analyses (total 2,800 surveys involving 112 million subjects). Combining country-specific CHB rate estimates with the number of FB in the USA in 2018, by country of origin from the U.S. Census Bureau, we estimate that the number of FB with CHB in the USA in 2018 was 1.47 million (95% CI, 1.21-1.73), substantially higher than previously reported. The weighted average CHB prevalence for all FB in the USA in 2018 was 3.07%. Approximately 59% of FB with CHB in the USA in 2018 emigrated from Asia, 19% from the Americas, and 15% from Africa. Subgroup analyses found that for many countries, CHB rates are higher in males than females and have declined over the past three decades, but no consistent pattern is observed between emigrant and in-country rates. CONCLUSIONS Including FB and U.S.-born persons, the total prevalence of CHB in the USA may be as high as 2.4 million.
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Affiliation(s)
- Robert J Wong
- Division of Gastroenterology and HepatologyStanford University School of MedicineStanfordCA.,Division of Gastroenterology and HepatologyVeterans Affairs Palo Alto Healthcare SystemPalo AltoCA
| | - Carol L Brosgart
- Department of Medicine, Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCA
| | | | - Tim Block
- Hepatitis B FoundationDoylestownPA.,Baruch S Blumberg InstituteDoylestownPA
| | | | - Chari Cohen
- Hepatitis B FoundationDoylestownPA.,Baruch S Blumberg InstituteDoylestownPA
| | - W Ray Kim
- Division of Gastroenterology and HepatologyStanford University School of MedicineStanfordCA
| | | | - Anna S Lok
- Division of Gastroenterology and HepatologyUniversity of MichiganAnn ArborMI
| | | | - John Ward
- Coalition for Global Hepatitis EliminationTask Force for Global HealthDecaturGA
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Abstract
Hepatitis B virus (HBV) core protein (Cp) can be found in the nucleus and cytoplasm of infected hepatocytes; however, it preferentially segregates to a specific compartment correlating with disease status. Regulation of this intracellular partitioning of Cp remains obscure. In this paper, we report that cellular compartments are filled and vacated by Cp in a time- and concentration-dependent manner in both transfections and infections. At early times after transfection, Cp, in a dimeric state, preferentially localizes to the nucleolus. Later, the nucleolar compartment is emptied and Cp progresses to being predominantly nuclear, with a large fraction of the protein in an assembled state. Nuclear localization is followed by cell-wide distribution, and then Cp becomes exclusively cytoplasmic. The same trend in Cp movement is seen during an infection. Putative nucleolar retention signals have been identified and appear to be structure dependent. Export of Cp from the nucleus involves the CRM1 exportin. Time-dependent flux can be recapitulated by modifying Cp concentration, suggesting transitions are regulated by reaching a threshold concentration.
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Mukhtar NA, Evon DM, Yim C, Lok AS, Lisha N, Lisker-Melman M, Hassan M, Janssen HL, Khalili M. Patient Knowledge, Beliefs and Barriers to Hepatitis B Care: Results of a Multicenter, Multiethnic Patient Survey. Dig Dis Sci 2021; 66:434-441. [PMID: 32239377 PMCID: PMC7529692 DOI: 10.1007/s10620-020-06224-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/18/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND A greater understanding of the determinants of health behavior among those with and at-risk of chronic hepatitis B virus (HBV) infection is needed for effective design and implementation of public health initiatives. AIMS To determine factors associated with (1) willingness to accept HBV antiviral treatment and (2) satisfaction with provider communication regarding HBV care in a diverse cohort of HBV-infected patients. METHODS Using a multifaceted model of health behavior, the Health Behavior Framework, we conducted a comprehensive assessment of knowledge, attitudes, beliefs, and barriers to HBV care. RESULTS We enrolled 510 patients, with mean age 46 years; 53.1% men; and 71.6% Asian or Hawaiian/Pacific Islander. Patients were knowledgeable about HBV infection, but one-fifth did not think that HBV was a treatable disease; over a quarter felt it was so common among family and friends that it did not concern them, and less than half of patients believed they were likely to have liver problems or transmit HBV to others during their lifetime. Perceived susceptibility to disease risk was the only independent predictor of willingness to accept HBV treatment (β = 0.23, p = 0.0005), and contrary to expectations, having a doctor that speaks the same language was predictive of lower patient satisfaction with provider communication about their HBV care (β = - 0.65, p < 0.0001). CONCLUSIONS Patients with greater perceived susceptibility to the health consequences of HBV infection are more likely to accept treatment, and patient-provider language concordance impacts patient satisfaction with communication regarding HBV care in an unexpected direction.
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Affiliation(s)
- Nizar A. Mukhtar
- Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, 2350 Geary Blvd., 2 Floor, San Francisco, CA 94115
| | - Donna M. Evon
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, 8010 Burnett-Womack Building, 101 Manning Drive, Chapel Hill, NC 27599
| | - Colina Yim
- Toronto Centre for Liver Disease, University Health Network, University of Toronto, 585 University Ave., Norman Urquhart Building, 13 floor, Toronto, ON, M5G 2N2
| | - Anna S. Lok
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, 3912 Taubman Center, 1500 E. Medical Center Dr., Ann Arbor, MI 48109
| | - Nadra Lisha
- Department of Medicine, University of California San Francisco, 530 Parnassus Ave., Rm 363, San Francisco, CA 94143
| | - Mauricio Lisker-Melman
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8124, St. Louis, MO 63110
| | - Mohamed Hassan
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Minnesota, 420 Delaware Street SE, MMC 36, Minneapolis, MN 55455
| | - Harry L.A. Janssen
- Toronto Centre for Liver Disease, University Health Network, University of Toronto, 585 University Ave., Norman Urquhart Building, 13 floor, Toronto, ON, M5G 2N2
| | - Mandana Khalili
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, 1001 Potrero Ave., Ward 3D-4, San Francisco, CA 94110
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9
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Hiva S, Negar K, Mohammad-Reza P, Gholam-Reza G, Mohsen A, Ali-Asghar NG, Mohammed-Jafar S. High level of vaccination and protection against hepatitis B with low rate of HCV infection markers among hospital health care personnel in north of Iran: a cross-sectional study. BMC Public Health 2020; 20:920. [PMID: 32532228 PMCID: PMC7291184 DOI: 10.1186/s12889-020-09032-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/03/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND hepatitis B virus (HBV) and C virus (HCV) are among the leading causes of mortality worldwide. Health care personnel (HCP) are subjected to increased risk of these infections. Therefore, HBV vaccination and post-vaccination serologic testing (PVST) are recommended for them. Our objectives in this study were investigate how well the vaccination guidelines for hospital HCPs were implemented. Moreover, the prevalence rates of HBV and HCV infections were calculated. To determine the presence of immunological memory, vaccinated personnel negative to antibody against HB surface antigen with one dose of HB vaccine were boosted. METHODS From 1 July to 30 November 2017, a cross-sectional study among HCPs working in public hospitals were conducted. All HCPs from various professional categories potentially at risk of exposure to contaminated sources were included. The information was gathered via interview and self-administered questionnaire. The questions were focused on the demographic characteristics, HB vaccination and immunity status and time elapsed since initial vaccination series, and frequency of needelstick injuries during the past 12 months of their work. Moreover, the prevalence rate of HBV and HCV infections were calculated. To determine the presence of immunological memory, subjects negative to HBV seromarkers received a booster dose of the vaccine. RESULTS A total of 186 out of 766 participants were male and nurses comprised 71% of personnel. Although all HCP were vaccinated, 84% of them completed the course and less than 5% of them received PVST. According to the results, 0.78, 4.6, and 83% were serologically positive to HBV surface antigen, antibodies against HBV core, and S antigens, respectively. Approximately, 91% of seronegative participants responded to a booster dose and only 0.91% of the personnel was anti-HCV positive. CONCLUSION Most HCP received full HBV vaccination course. Although a minority did PVST, the HBV vaccine-induced long-term protection and HB vaccine booster were not required. Therefore, policies should be made to increase the rate PVST after immunization. According to the results, the HCV infection rate was low and thus pre-recruitment screening was not necessary.
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Affiliation(s)
- Saffar Hiva
- Department of Pathology, Shariati Hospital, Teheran University of Medical Sciences, Tehran, Iran
| | - Khoshayand Negar
- Resident of Pathology, Shariati Hospital, Teheran University of Medical Sciences, Tehran, Iran
| | | | | | - Aarabi Mohsen
- Mazandaran University of Medical Sciences, Sari, Iran
| | - Nadi Ghara Ali-Asghar
- Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Saffar Mohammed-Jafar
- Research Center for Pediatric Infectious Diseases, Department of Pediatric Infectious Diseases, Bu-Ali Sina Hospital, Mazandaran University of Medical Sciences, Pasdaran Bolv, Sari, Iran
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10
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Le MH, Yeo YH, Cheung R, Henry L, Lok AS, Nguyen MH. Chronic Hepatitis B Prevalence Among Foreign-Born and U.S.-Born Adults in the United States, 1999-2016. Hepatology 2020; 71:431-443. [PMID: 31228279 DOI: 10.1002/hep.30831] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 06/18/2019] [Indexed: 12/20/2022]
Abstract
Hepatitis B virus (HBV) infection remains a major global health problem, exacerbated by poor linkage to care. We aimed to determine the prevalence of HBV infection, exposure, self-reported vaccination, vaccine-induced immunity, disease awareness, and treatment in the United States by birthplace and race/ethnicity during 1999-2016. A total of 47,628 adult participants in the National Health and Nutrition Examination Survey who completed HBV core antibody (anti-HBc) and surface antigen (HBsAg) tests and 47,618 adults who completed HBV surface antibody (anti-HBs) and anti-HBc tests were included in the analysis. HBV infection was defined by positive HBsAg and past exposure by positive anti-HBc. Vaccine-mediated immunity was defined by positive anti-HBs and negative anti-HBc. No significant change in the prevalence of HBV infection was observed between 1999 and 2016 (P = 0.442), affecting 0.35% (95% confidence interval [CI], 0.28-0.45) or 0.84 million adults. In contrast, a significant decrease in HBV exposure and increase in vaccine-mediated immunity was observed. U.S.-born persons had significantly lower prevalence of HBV infection and exposure as well as higher prevalence of vaccine-mediated immunity and self-reported vaccination than foreign-born persons. Prevalence of HBV infection was highest in non-Hispanic Asians in both foreign- (3.85%; 95% CI, 2.97-4.97) and U.S.-born (0.79%; 95% CI, 0.17-3.59) persons during 2011-2016. Among infected persons, liver disease awareness was only 15.19%, and treatment rate was only 4.60%. Conclusion: This study revealed disparities of HBV infection among ethnic/racial groups and between U.S.-born and foreign-born persons. Awareness of liver disease and treatment rate among infected persons was dismal.
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Affiliation(s)
- Michael H Le
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA
| | - Yee Hui Yeo
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA.,Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care, Palo Alto, CA
| | - Linda Henry
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA
| | - Anna S Lok
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA
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11
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Moscoso CG, Steer CJ. "Let my liver rather heat with wine" - a review of hepatic fibrosis pathophysiology and emerging therapeutics. Hepat Med 2019; 11:109-129. [PMID: 31565001 PMCID: PMC6731525 DOI: 10.2147/hmer.s213397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 08/17/2019] [Indexed: 12/12/2022] Open
Abstract
Cirrhosis is characterized by extensive hepatic fibrosis, and it is the 14th leading cause of death worldwide. Numerous contributing conditions have been implicated in its development, including infectious etiologies, medication overdose or adverse effects, ingestible toxins, autoimmunity, hemochromatosis, Wilson’s disease and primary biliary cholangitis to list a few. It is associated with portal hypertension and its stigmata (varices, ascites, hepatic encephalopathy, combined coagulopathy and thrombophilia), and it is a major risk factor for hepatocellular carcinoma. Currently, orthotopic liver transplantation has been the only curative modality to treat cirrhosis, and the scarcity of donors results in many people waiting years for a transplant. Identification of novel targets for pharmacologic therapy through elucidation of key mechanistic components to induce fibrosis reversal is the subject of intense research. Development of robust models of hepatic fibrosis to faithfully characterize the interplay between activated hepatic stellate cells (the principal fibrogenic contributor to fibrosis initiation and perpetuation), hepatocytes and extracellular matrix components has the potential to identify critical components and mechanisms that can be exploited for targeted treatment. In this review, we will highlight key cellular pathways involved in the pathophysiology of fibrosis from extracellular ligands, effectors and receptors, to nuclear receptors, epigenetic mechanisms, energy homeostasis and cytokines. Further, molecular pathways of hepatic stellate cell deactivation are discussed, including apoptosis, senescence and reversal or transdifferentiation to an inactivated state resembling quiescence. Lastly, clinical evidence of fibrosis reversal induced by biologics and small molecules is summarized, current compounds under clinical trials are described and efforts for treatment of hepatic fibrosis with mesenchymal stem cells are highlighted. An enhanced understanding of the rich tapestry of cellular processes identified in the initiation, perpetuation and resolution of hepatic fibrosis, driven principally through phenotypic switching of hepatic stellate cells, should lead to a breakthrough in potential therapeutic modalities.
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Affiliation(s)
- Carlos G Moscoso
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition
| | - Clifford J Steer
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition.,Department of Genetics, Cell Biology and Development, University of Minnesota Medical School, Minneapolis, MN 55455, USA
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12
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Gomes C, Wong RJ, Gish RG. Global Perspective on Hepatitis B Virus Infections in the Era of Effective Vaccines. Clin Liver Dis 2019; 23:383-399. [PMID: 31266615 DOI: 10.1016/j.cld.2019.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hepatitis B virus (HBV) infection is a global health burden. The chronicity of this infection leads to complication such as cirrhosis and hepatocellular carcinoma, making it a leading cause of morbidity and mortality worldwide. Chronic infection commonly develops among those who acquire infection during childhood, hence the importance of effective implementation of HBV vaccination policies designed to eradicate chronic HBV. This article provides updated estimates of worldwide HBV disease prevalence and discusses how implementation of vaccination policies has affected HBV epidemiology.
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Affiliation(s)
- Chantal Gomes
- Department of Medicine, Division of Gastroenterology and Hepatology, Endoscopy Unit, Alameda Health System, Highland Hospital, Highland Hospital Campus, Highland Care Pavilion 5th Floor, 1411 East 31st Street, Oakland, CA 94602, USA
| | - Robert J Wong
- Department of Medicine, Division of Gastroenterology and Hepatology, Endoscopy Unit, Alameda Health System, Highland Hospital, Highland Hospital Campus, Highland Care Pavilion 5th Floor, 1411 East 31st Street, Oakland, CA 94602, USA.
| | - Robert G Gish
- Division of Gastroenterology and Hepatology, Stanford Health Care, 300 Pasteur Drive, Palo Alto, CA 94304, USA
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Lu M, Zhou Y, Holmberg SD, Moorman AC, Spradling PR, Teshale EH, Boscarino JA, Daida YG, Schmidt MA, Li J, Rupp LB, Trudeau S, Gordon SC, Chronic Hepatitis Cohort Study Investigators. Trends in Diagnosed Chronic Hepatitis B in a US Health System Population, 2006-2015. Open Forum Infect Dis 2019; 6:ofz286. [PMID: 31341929 PMCID: PMC6641786 DOI: 10.1093/ofid/ofz286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/13/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Trends in the epidemiology of chronic hepatitis B (CHB) among routine clinical care patients in the United States are not well documented. We used data from the Chronic Hepatitis Cohort Study to investigate changes in prevalence and newly recorded cases of CHB from 2006 to 2015. METHODS Annual percentage changes (APCs) were estimated using join point Poisson regression. Analyses were adjusted by study site; when an interaction with the trend was observed, APCs were estimated by subgroups. Differences in rates based on race, age, and sex were calculated with rate ratios. RESULTS We identified 5492 patients with CHB within select health systems with total populations that ranged from 1.9 to 2.4 million persons. From 2006 to 2014, the prevalence of diagnosed CHB increased from 181.3 to 253.0 per 100 000 persons in the health system population; from 2014 to 2015, it declined to 237.0 per 100 000 persons. APC was +3.7%/y through 131 December 2014 (P < .001) and -15.0%/y (P < .001) thereafter. The rate of newly reported cases of CHB did not change significantly across the study period (APC, -1.1%/y; P = .07). The rates of newly reported cases were 20.5 times higher among patients in the Asian American/American Indian/Pacific Islander (ASINPI) category, compared with white patients, and 2.8 times higher among African American patients. The ratio of male to female patients was roughly 3:2. CONCLUSIONS The prevalence of diagnosed CHB in this US patient population increased from 2006 to 2014, after which it decreased significantly. Rates declined most rapidly among patients ≤40 or 61-70 years old, as well as among ASINPI patients. The rate of newly reported cases remained steady over the study period.
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Affiliation(s)
- Mei Lu
- Department of Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan
| | - Yueren Zhou
- Department of Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan
| | - Scott D Holmberg
- Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta Georgia
| | - Anne C Moorman
- Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta Georgia
| | - Philip R Spradling
- Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta Georgia
| | - Eyasu H Teshale
- Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta Georgia
| | - Joseph A Boscarino
- Department of Epidemiology and Health Services Research, Geisinger Clinic, Danville, Pennsylvania
| | - Yihe G Daida
- Center for Health Research, Kaiser Permanente Hawaii, Honolulu, Hawai’i
| | - Mark A Schmidt
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Jia Li
- Department of Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan
| | - Loralee B Rupp
- Center for Health Policy and Health Services Research, Wayne State University School of Medicine, Detroit, Michigan
| | - Sheri Trudeau
- Department of Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan
| | - Stuart C Gordon
- Division of Gastroenterology and Hepatology, Henry Ford Health System, and Wayne State University School of Medicine, Detroit, Michigan
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Hyun Kim B, Ray Kim W. Epidemiology of Hepatitis B Virus Infection in the United States. Clin Liver Dis (Hoboken) 2018; 12:1-4. [PMID: 30988901 PMCID: PMC6385902 DOI: 10.1002/cld.732] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/07/2018] [Accepted: 05/22/2018] [Indexed: 02/04/2023] Open
Affiliation(s)
- Bo Hyun Kim
- Center for Liver CancerNational Cancer CenterGoyangRepublic of Korea,Division of Gastroenterology and HepatologyStanford University School of MedicineStanfordCA
| | - W. Ray Kim
- Center for Liver CancerNational Cancer CenterGoyangRepublic of Korea
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15
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Flamm SL. Complications of Cirrhosis in Primary Care: Recognition and Management of Hepatic Encephalopathy. Am J Med Sci 2018; 356:296-303. [PMID: 30286824 DOI: 10.1016/j.amjms.2018.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/24/2018] [Accepted: 06/08/2018] [Indexed: 12/13/2022]
Abstract
Approximately 3.7% of patients in primary care settings have chronic liver disease, and 18% with chronic liver disease in the specialty care setting have cirrhosis. For cirrhotic patients without complications, prognosis is generally favorable; increased morbidity and mortality are observed when complications (i.e., hepatic encephalopathy [HE]) occur. HE occurs in up to 70% of patients with cirrhosis. Neurologic signs in HE span a wide spectrum, from those not easily apparent (covert) to more clinically obvious signs (overt). Providers should consider overt HE in patients with cirrhosis and signs of impaired cognition, confusion, consciousness and/or personality changes, and/or impaired memory. Overt HE treatment includes identifying and treating precipitating factors and reducing bacterial-derived toxin loads. For acute overt HE, lactulose is first-line treatment. To prevent HE recurrence, lactulose plus rifaximin is recommended. Patients with cirrhosis and HE often present in primary care; recognizing and properly managing HE are important in this setting.
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Affiliation(s)
- Steven L Flamm
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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16
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Barriers in Hepatitis C Treatment in Somali Patients in the Direct Acting Antiviral Therapy Era. J Natl Med Assoc 2018; 110:556-559. [PMID: 30129499 DOI: 10.1016/j.jnma.2018.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/12/2018] [Accepted: 02/14/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS Hepatitis C virus (HCV) treatment has changed dramatically in the last few years. Our observations suggest that a minority of HCV infected Somalis are treated. In this study, we aimed to evaluate for treatment and health outcome disparities between Somali and non-Somali patients during the direct acting antiviral (DAA) era. METHODS Patients with HCV seen in the gastroenterology clinic in 2015 were included in the study. Patients were identified using ICD9 and 10 codes. Electronic medical records were analyzed to evaluate for treatment candidacy, acceptance and reasons for refusal of treatment. RESULTS Genotype 4 followed by 3 were the most common genotypes in the Somalis while genotype 1 was the most common in the non-Somalis. Majority of patients were offered treatment, active alcohol and substance abuse was a common reason for not offering treatment in non-Somalis while the presence of hepatocellular carcinoma was the most common reason in Somalis. Somalis had higher rates of declining treatment given the asymptomatic nature of their disease and the feeling that treatment is not needed. Sustained virologic response rates were comparable in both groups. CONCLUSIONS Disparities in acceptance of HCV treatment persist in the DAA era. The asymptomatic nature of the infection and potential cultural mistrust makes patients hesitant to undergo treatment. Healthcare providers must find interventions aimed at reducing barriers to treatment and increasing acceptance of HCV treatment.
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Dusheiko G. Current and future directions of management of hepatitis B: steps toward a cure. Future Virol 2018. [DOI: 10.2217/fvl-2017-0103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Universal hepatitis B virus vaccination has been effective in reducing incident chronic hepatitis B but will not have the requisite effect on the prevalence of end-stage liver disease in chronically infected persons. The natural history and immunological stages of hepatitis B virus infection are still being defined. Over three decades, current therapies have reduced morbidity from chronic hepatitis B. The majority require nucleoside analog maintenance therapy. The preferential preservation of covalently closed circular DNA (cccDNA), and capsid reverse transcriptase–cccDNA interactions currently precludes cure in most. A functional cure in the host may require several synergistic antiviral and immunological intercessions. The correct sequencing and combinations of treatment with either host or viral targeting agents have yet to be determined. Proven surrogates for cccDNA for clinical trials are required. Different strategies may become apparent for patients at different stages of the disease. Curative therapies will require affordability. This review focuses on steps toward a cure.
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Affiliation(s)
- Geoffrey Dusheiko
- Kings College Hospital & University College London Medical School, Denmark Hill, London SE5 9RS, UK
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Block TM, Alter H, Brown N, Brownstein A, Brosgart C, Chang KM, Chen PJ, Cohen C, El-Serag H, Feld J, Gish R, Glenn J, Greten TF, Guo JT, Hoshida Y, Kowdley KV, Li W, Lok AS, McMahon B, Mehta A, Perrillo R, Rice CM, Rinaudo J, Schinazi RF, Shetty K. Research priorities for the discovery of a cure for chronic hepatitis B: Report of a workshop. Antiviral Res 2017; 150:93-100. [PMID: 29248746 PMCID: PMC6309822 DOI: 10.1016/j.antiviral.2017.12.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 12/08/2017] [Indexed: 02/09/2023]
Abstract
In early 2017, the Hepatitis B Foundation invited 30 experts in the fields of hepatitis B and liver cancer research to identify projects they deemed important to the goal of finding a cure for chronic hepatitis B and D and the diseases with which these viral infections are associated. They were also asked to identify general categories of research and to prioritize sub-project topics within those areas. The experts generally agreed on broadly defined areas of research, but there was usually little difference between the highest and lowest scoring projects; for the most part, all programs described in this document were considered valuable and necessary. An executive summary of this discussion was recently published (Alter et al., Hepatology 2017). The present manuscript reports the areas of research identified by the workshop participants, provides a brief rationale for their selection, and attempts to express differences among the priorities assigned to each area of research, when such distinctions were expressed.
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Affiliation(s)
- Timothy M Block
- Hepatitis B Foundation, Doylestown, PA, USA; Baruch S Blumberg Institute, Doylestown, PA, USA.
| | - Harvey Alter
- Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Nathaniel Brown
- Hepatitis B Foundation, Doylestown, PA, USA; Baruch S Blumberg Institute, Doylestown, PA, USA
| | | | - Carol Brosgart
- U. California San Francisco School of Medicine and U. California at Berkeley School of Public Health, National Viral Hepatitis Roundtable, USA
| | - Kyong-Mi Chang
- University of Pennsylvania School of Medicine and the Philadelphia Veterans Hospital, Philadelphia, PA, USA
| | | | - Chari Cohen
- Hepatitis B Foundation, Doylestown, PA, USA; Baruch S Blumberg Institute, Doylestown, PA, USA
| | | | | | - Robert Gish
- Hepatitis B Foundation, Doylestown, PA, USA; Stanford University Medical Center and Hospital, Palo Alto, CA, USA
| | - Jeffrey Glenn
- Stanford University School of Medicine, Palo Alto, CA, USA
| | - Tim F Greten
- National Cancer Institute, NIH, Bethesda, MD, USA
| | | | | | | | - Wenhui Li
- National Institute of Biological Sciences, Beijing, China
| | - Anna S Lok
- University of Michigan School of Medicine, Ann Arbor, MI, USA
| | | | - Anand Mehta
- Medical University of South Carolina, Charleston, SC, USA
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Carter W, Connelly S, Struble K. Reinventing HCV Treatment: Past and Future Perspectives. J Clin Pharmacol 2016; 57:287-296. [PMID: 27654843 DOI: 10.1002/jcph.830] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 09/15/2016] [Indexed: 12/13/2022]
Abstract
This review paper summarizes the epidemiology of hepatitis C virus (HCV) and chronic HCV infection, including HCV virology and treatment regimens. Specifically, we focus on the evolution of past, current, and future HCV treatment options, the reasons for treatment failure, and the impact of resistance-associated variants on treatment success.
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Affiliation(s)
- Wendy Carter
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of New Drugs, Division of Antiviral Products, Silver Spring, MD, USA
| | - Sarah Connelly
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of New Drugs, Division of Antiviral Products, Silver Spring, MD, USA
| | - Kimberly Struble
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of New Drugs, Division of Antiviral Products, Silver Spring, MD, USA
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20
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Block TM, Zhou T, Anbarasan N, Gish R. Evolving New Strategies for the Medical Management of Chronic Hepatitis B Virus Infection. Gastroenterol Hepatol (N Y) 2016; 12:679-689. [PMID: 28035197 PMCID: PMC5193088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Is a cure for chronic hepatitis B virus (HBV) infection possible? Hepatitis C virus infection is now routinely cured medically. There is a growing expectation that new drugs for the management of chronic HBV infection should provide substantial benefit over and above that of current chronic HBV medications, if not be curative. Although the definition of medically induced cure for chronic HBV infection varies, most include sustained off-drug absence of viremia and negativity for other virologic markers. There are currently more than 29 drugs in the pipeline being tested for the management of chronic HBV infection. This article discusses the potential drugs with respect to their possible contributions to achieving medically induced cure.
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Affiliation(s)
- Timothy M Block
- Dr Block and Dr Zhou are professors and project leaders at the Baruch S. Blumberg Institute in Doylestown, Pennsylvania. Mr Anbarasan was affiliated with the Baruch S. Blumberg Institute at the time of this article but is now a third-year medical student affiliated with Flushing Hospital and Medical Center in Flushing, New York. Dr Gish is a professor consultant in the Department of Medicine in the Division of Gastroenterology and Hepatology at Stanford University in Stanford, California; principal of Robert G. Gish Consultants, LLC, in San Diego, California; senior medical director at St Joseph's Hospital and Medical Center in Phoenix, Arizona; and chief medical advisor of the Hepatitis B Foundation in Doylestown, Pennsylvania
| | - Tianlun Zhou
- Dr Block and Dr Zhou are professors and project leaders at the Baruch S. Blumberg Institute in Doylestown, Pennsylvania. Mr Anbarasan was affiliated with the Baruch S. Blumberg Institute at the time of this article but is now a third-year medical student affiliated with Flushing Hospital and Medical Center in Flushing, New York. Dr Gish is a professor consultant in the Department of Medicine in the Division of Gastroenterology and Hepatology at Stanford University in Stanford, California; principal of Robert G. Gish Consultants, LLC, in San Diego, California; senior medical director at St Joseph's Hospital and Medical Center in Phoenix, Arizona; and chief medical advisor of the Hepatitis B Foundation in Doylestown, Pennsylvania
| | - Nikhil Anbarasan
- Dr Block and Dr Zhou are professors and project leaders at the Baruch S. Blumberg Institute in Doylestown, Pennsylvania. Mr Anbarasan was affiliated with the Baruch S. Blumberg Institute at the time of this article but is now a third-year medical student affiliated with Flushing Hospital and Medical Center in Flushing, New York. Dr Gish is a professor consultant in the Department of Medicine in the Division of Gastroenterology and Hepatology at Stanford University in Stanford, California; principal of Robert G. Gish Consultants, LLC, in San Diego, California; senior medical director at St Joseph's Hospital and Medical Center in Phoenix, Arizona; and chief medical advisor of the Hepatitis B Foundation in Doylestown, Pennsylvania
| | - Robert Gish
- Dr Block and Dr Zhou are professors and project leaders at the Baruch S. Blumberg Institute in Doylestown, Pennsylvania. Mr Anbarasan was affiliated with the Baruch S. Blumberg Institute at the time of this article but is now a third-year medical student affiliated with Flushing Hospital and Medical Center in Flushing, New York. Dr Gish is a professor consultant in the Department of Medicine in the Division of Gastroenterology and Hepatology at Stanford University in Stanford, California; principal of Robert G. Gish Consultants, LLC, in San Diego, California; senior medical director at St Joseph's Hospital and Medical Center in Phoenix, Arizona; and chief medical advisor of the Hepatitis B Foundation in Doylestown, Pennsylvania
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Kohli A, Alshati A, Georgie F, Manch R, Gish RG. Direct-acting antivirals for the treatment of chronic hepatitis C in patients with chronic kidney disease. Therap Adv Gastroenterol 2016; 9:887-897. [PMID: 27803742 PMCID: PMC5076774 DOI: 10.1177/1756283x16665254] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
All-oral, direct-acting antivirals (DAAs) have significantly improved the efficacy and safety of chronic hepatitis C (CHC) treatment but their effectiveness and safety among patients with chronic kidney disease (CKD) remains poorly understood. Our aim was to assess the efficacy and safety of DAAs for treatment of CKD patients. The National Library of Medicine through PubMed was searched for studies evaluating the efficacy of DAAs for the treatment of patients with CKD stages 4 or 5, as defined by the Kidney Disease Outcomes Quality Initiative guidelines [i.e. glomerular filtration rate (GFR) 15-29 ml/min per 1.73 m2 and GFR <15 ml/min per 1.73 m2, respectively, or hemodialysis or peritoneal dialysis]. Randomized clinical trials (RCTs) and relevant cohort studies were included if they were published in English and included sustained viral response after 12 weeks (SVR12) as a primary or secondary endpoint. After applying inclusion and exclusion criteria, eight studies (one RCT and seven cohort studies) following 350 patients were selected. For patients with CKD stage 4 or 5, ± hemodialysis, the overwhelming majority of DAA regimens were well-tolerated and resulted in SVR12 rates of 90-100%. Most studies were small, with the exception of one RCT evaluating elbasvir and grazoprevir. Overall, treatment of CHC in patients with CKD is highly effective with SVR12 rates similar to those seen in patients without CKD and with acceptable adverse event profiles. In patients with hepatitis C virus (HCV) genotype (GT) 1a, 1b or 4 and Stage 4 or 5 CKD, the best evidence available is for the use of elbasvir and grazoprevir. This combination as well as the combination of paritaprevir/ritonavir/ombitasvir/dasabuvir for HCV GT-1b are recommended. More studies are needed to assess efficacy and adverse effects of DAAs and their impact on CKD patients and to fully elucidate the effect of curing CHC on the natural history and sequelae of renal disease in CHC patients with CKD.
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Affiliation(s)
- Anita Kohli
- Dignity Health, St. Joseph’s Hospital and Medical Center, Division of Hepatology and Division of Infectious Disease, Phoenix, AZ, USA
| | - Ali Alshati
- Dignity Health, St. Joseph’s Hospital and Medical Center, Division of Hepatology, Phoenix, AZ, USA
| | - Fawaz Georgie
- Dignity Health, St. Joseph’s Hospital and Medical Center, Division of Hepatology, Phoenix, AZ, USA
| | - Richard Manch
- Dignity Health, St. Joseph’s Hospital and Medical Center, Division of Hepatology, Phoenix, AZ, USA
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Levin JM, Dabirshahsahebi S, Bauer M, Huckins E. Retrospective analysis of hepatitis C infected patients treated through an integrated care model. World J Gastroenterol 2016; 22:8558-8567. [PMID: 27784968 PMCID: PMC5064037 DOI: 10.3748/wjg.v22.i38.8558] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 07/27/2016] [Accepted: 08/23/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To determine if our health system's integrated model reflects sustained virologic response (SVR) outcomes similar to those in clinical trial data, maximizes adherence, and averts drug interactions. METHODS Subjects with chronic hepatitis C had their medical records reviewed from November 1st, 2014 through March 1st, 2016. Patients eligible for treatment were entered into an integrated care model therapy algorithm. The primary outcome was SVR12 based on intention to treat (ITT) analysis. Inclusion criteria consisted of both treatment naïve and experienced patients over the age of 18 who were at least twelve weeks post-therapy completion with any genotype (GT) or METAVIR score. Secondary outcomes included adherence, adverse events, and number of drug interaction interventions. RESULTS At the time of analysis, 133 patients had reached twelve weeks post therapy with ITT. In the ITT analysis 70 patients were GT 1a, 26 GT 1b, 23 could not be differentiated between GT 1a or 1b, 8 GT 2, 4 GT 3, and 2 patients with multiple genotypes. The ITT treatment regimens consisted of 97 sofosbuvir (SOF)/ledipasvir (LDV), 8 SOF/LDV and ribavirin (RBV), 7 SOF and Simeprevir (SMV), 6 3D and RBV, 1 3D, 11 SOF and RBV, and 1 SOF, peg interferon alpha, and RBV. The overall SVR12 rate was 93% in the ITT analysis with a total of 6 patients relapsing. In patients with cirrhosis, 89% obtained SVR12. All 33 patients who were previous treatment failures achieved SVR12. Drug-drug interactions were identified in 56.4% of our patient population, 69 of which required interventions made by the pharmacist. The most common side effects were fatigue (41.4%), headache (28.6%), nausea (18.1%), and diarrhea (8.3%). No serious adverse effects were reported. CONCLUSION Dean Health System's integrated care model successfully managed patients being treated for hepatitis C virus (HCV). The integrated care model demonstrates high SVR rates amongst patients with different levels of fibrosis, genotypes, and HCV treatment history.
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Zhu J, Khemichian S, Nghiem D, Zhang SR, Limurti J, Saito T, Fong TL. Comparison of Demographic and Clinical Characteristics of Hispanic and Asian Chronic Hepatitis B Patients in Southern California. J Clin Gastroenterol 2016; 50:602-7. [PMID: 26890328 DOI: 10.1097/mcg.0000000000000486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES There are few data regarding the clinical and serologic features of chronic hepatitis B (CHB) infection among Hispanics in the United States. The aims of this study were to compare and contrast clinical characteristics of Hispanic and Asian CHB patients. METHODS Demographic, clinical, and laboratory data were collected from Hispanic and Asian CHB patients seen between January 2013 and May 2014 at Los Angeles County Hepatitis Clinic. RESULTS A total of 55 Hispanic and 342 Asian CHB patients were identified. Almost all were foreign-born. Compared with Asians, Hispanics were more likely to report heterosexual transmission (P<0.0001) and blood transfusion history (P<0.0001) as risk factors. Overall, 31% of Hispanics had HBV>2000 IU/mL compared with 54% of Asians (P=0.004).Significantly more Asian HBeAg-negative/anti-HBe-positive CHB patients had high HBV DNA levels (>2000 IU/mL) with elevated ALT compared with Hispanic patients (P=0.04). Compared with Asians, Hispanic CHB patients were more likely to have elevated ALT and low HBV DNA levels (P=0.001). Among CHB patients who received antiviral therapy, response was comparable among Hispanics and Asians. There were no Hispanic CHB patients who experienced spontaneous reactivation or developed hepatocellular carcinoma. CONCLUSIONS There were important differences in the clinical, demographic, and serologic characteristics between Hispanic and Asian CHB. Response rate to antiviral therapy was comparable. Further studies of Hispanic CHB patients in the United States are warranted.
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Affiliation(s)
- Jiaming Zhu
- Departments of *Medicine, Division of Gastrointestinal and Liver Diseases ‡Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA †Bristol-Myers Squibb, Plainsboro, NJ
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Sarpel D, Baichoo E, Dieterich DT. Chronic hepatitis B and C infection in the United States: a review of current guidelines, disease burden and cost effectiveness of screening. Expert Rev Anti Infect Ther 2016; 14:511-21. [DOI: 10.1586/14787210.2016.1174066] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Nyberg AH. The Association of Extrahepatic Cancers With Chronic Hepatitis C Virus Infection. Gastroenterol Hepatol (N Y) 2016; 12:185-187. [PMID: 27231448 PMCID: PMC4872847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Anders H Nyberg
- Hepatology Division of Gastroenterology/Hepatology Kaiser Permanente Southern California San Diego, California
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Allison RD, Hale SA, Harvey BJ, Hudson TML, Livingston CJ, Sherin KM, Uduhiri KA, Niebuhr DW. The American College of Preventive Medicine Position Statement on Hepatitis C Virus Infection. Am J Prev Med 2016; 50:419-426. [PMID: 26897344 DOI: 10.1016/j.amepre.2015.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 12/01/2015] [Accepted: 12/02/2015] [Indexed: 01/25/2023]
Abstract
The American College of Preventive Medicine Prevention Practice Committee contributes to policy guidelines and recommendations on preventive health topics for clinicians and public health decision makers. After review of the currently available evidence, the College is providing a consensus-based set of recommendations designed to increase screening for and prevention of hepatitis C virus infection, increase linkage to care, improve access to treatment, and encourage development of hepatitis C virus-related quality measures.
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Affiliation(s)
- Robert D Allison
- Department of Preventive Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Steven A Hale
- Department of Family Medicine & Rural Health, University of Central Florida College of Medicine, Orlando, Florida; Florida Department of Health in Orange County, Orlando, Florida
| | - Bart J Harvey
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Kevin M Sherin
- Department of Family Medicine & Rural Health, University of Central Florida College of Medicine, Orlando, Florida; Florida Department of Health in Orange County, Orlando, Florida; Florida State University College of Medicine, Tallahassee, Florida
| | - Kelechi A Uduhiri
- Department of Family Medicine, Providence Hospital, Washington, District of Columbia
| | - David W Niebuhr
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of Health Sciences, Bethesda, Maryland.
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Demma S, Dusheiko G. The current treatment situation and definitions of a cure for chronic HBV infection. Future Virol 2016. [DOI: 10.2217/fvl.15.93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
HBV vaccination, while effective in reducing incident chronic disease in endemic regions, will not have the desired impact on the rates of end-stage liver disease in chronically infected persons. Over three decades, IFN-α and nucleoside analogs have reduced the morbidity from the disease. A large reservoir of chronic infection remains. The natural history of HBV infection is still being defined. Understanding the interactions between HBV and the host will be fundamental to achieving higher rates of cure. Curing hepatitis B will require several steps for either eradication, or a functional cure in the host. It is unclear whether covently closed circular DNA chromatin would need to be cleared to cure hepatitis B, or whether low threshold levels would slow the disease.
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Affiliation(s)
- Shirin Demma
- UCL institute of Liver & Digestive Health & Royal Free NHS Foundation Trust, London, UK
- Hepatology Unit, Department of Medical & Pediatric Sciences, University of Catania, Policlinic, Via S. Sofia No 78, 95123 Catania, Italy
| | - Geoffrey Dusheiko
- UCL institute of Liver & Digestive Health & Royal Free NHS Foundation Trust, London, UK
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