Journal of Viral Hepatitis最新文献

This study aimed to evaluate the effectiveness of direct-acting antivirals (DAAs) on hepatitis C virus (HCV) hospitalisation trends in Italy, the country with not only the highest burden of HCV-related disease but also the highest number of patients treated for chronic HCV infection in Europe. Incident hospital discharge records in Italy from 2012 to 2019 that included a liver cirrhosis diagnosis without mention of alcohol, hepatocellular carcinoma (HCC), HCV and liver cirrhosis without mention of alcohol and/or HCC, cirrhosis with mention of alcohol, as defined by the International Classification of Diseases (ICD-9-CM) were reviewed. An interrupted time series analysis compared the incidence of cirrhosis and HCC before and after the introduction of DAAs (Year 2015). Overall, non-alcoholic cirrhosis significantly decreased after the introduction of DAAs (β₃ = 0.03) and for those 40–59 years of age (β₃ = 0.025). HCV with cirrhosis and/or HCC significantly reduced overall for those aged 40–59 and older than 60 ($��{\beta }_3�=�0.002�$). HCC-related hospitalisation rates significantly decreased in patients younger than 60 ($��{\beta }_3�=�0.03�$). Cirrhosis-related hospitalisations with mention of alcohol did not differ during the study period before and after the year 2015 ($��{\beta }_3�=�0.4�$). There was a significant reduction in HCV-related hospitalisations throughout Italy after introducing DAAs.

Steatotic liver disease is prevalent among people with hepatitis C virus (HCV). The new definition of metabolic dysfunction–associated steatotic liver disease (MASLD) emphasises the metabolic drivers of steatosis and recognises its frequent coexistence with other chronic liver diseases, including HCV. We aimed to evaluate the association of coexisting MASLD and HCV with liver fibrosis. Individuals with HCV who underwent transient elastography (TE) with associated controlled attenuation parameter (CAP) were included from two clinical centres. MASLD and significant liver fibrosis were defined as the presence of steatosis (CAP ≥ 275 dB/m) with at least one cardiometabolic risk factor, and liver stiffness measurement (LSM) ≥ 7.1 kPa measured by TE, respectively. Associated cofactors of significant liver fibrosis were determined using stepwise regression and cross-validation by LASSO models to select confounders. Among 590 participants, 31% were diagnosed with MASLD. The prevalence of significant liver fibrosis was the highest among people with MASLD (58%) followed by HCV-related steatosis (45%) and the non-steatosis group (39%). After adjusting for potential confounders, MASLD was associated with significant liver fibrosis (adjusted odds ratio [aOR] 2.29, 95% confidence interval [CI] 1.07–4.87). Furthermore, specific MASLD phenotypes including diabetes, hypertension and overweight were associated with significant liver fibrosis, with aORs of 4.76 (95% CI 2.16–10.49), 3.44 (95% CI 1.77–6.68) and 2.54 (95% CI 1.27–5.07), respectively. In conclusion, MASLD is associated with liver fibrosis in people with HCV, specifically the diabetes, overweight and hypertensive phenotypes. Beyond pursuing a virological cure, healthcare providers should prioritise managing metabolic conditions, particularly diabetes, hypertension and obesity.

Hepatitis B virus (HBV)–hepatitis delta virus (HDV) coinfection is the most severe form of chronic viral hepatitis, but the factors that determine disease progression and severity are incompletely characterised. This long-term follow-up study aims to identify risk factors for severe liver-related outcomes. In this multicentre national cohort study, data from admission until the last visit between 2001 and 2023 was retrospectively collected from 162 HBV-HDV coinfected patients. The inclusion criteria were HBsAg or HBV DNA positivity, anti-HDV or HDV RNA positivity, and at least one follow-up visit. The median follow-up was 6.2 years (IQR 3.3–10.2). At baseline, 68/152 (44.7%) patients were diagnosed with advanced liver fibrosis. Forty patients (24.7%) had at least one severe liver-related outcome during follow-up. HDV viremia was detectable in 92 patients (64.3%) at last evaluation and was more frequently detectable in patients of European origin (p < 0.001). HDV RNA-positive patients had a 4.7-fold higher risk for severe liver-related outcomes (p < 0.001) and were more frequently diagnosed with advanced fibrosis at baseline (p = 0.007) compared to HDV RNA-negative patients. Multivariate analyses identified HDV RNA positivity, as well as several markers for liver disease severity, such as INR, platelet count, and advanced fibrosis at baseline, and age at admission as independent risk factors for severe liver-related outcomes. In conclusion, almost one in four HBV-HDV coinfected patients developed a severe liver-related outcome during follow-up. Several markers for liver disease severity and HDV RNA positivity were the strongest predictors for outcomes.

The World Health Organisation (WHO) has set goals to eliminate hepatitis C (HCV) as a global health threat by 2030. To meet this goal, Australia must increase testing and diagnosis, including expanding access to care through community pharmacists. This study aims to explore community pharmacists' preparedness to discuss and offer HCV testing and treatment. Australian community pharmacists from four states completed an online anonymous quantitative survey between August and October 2023. Pharmacists were asked about their experiences of, comfort discussing and willingness to host outreach HCV testing or treatment. Predictors of each outcome were examined using logistic regression. In total, 530 pharmacists participated in the study. One in five pharmacists stocked HCV medications (22%), half (48%) were willing/somewhat willing to host an outreach HCV testing and treatment team, while 36% strongly agreed/agreed they were comfortable discussing HCV testing and treatment. Willingness to host an outreach HCV team was associated with pharmacists working in rural/remote settings (95% CI: 1.04–2.35, p = 0.032), providing opioid agonist treatment (95% CI: 1.16–2.49, p = 0.006) and comfort discussing overdose prevention (95% CI: 1.31–2.80, p = 0.001). Pharmacists with ≥ 15 years' experience (95% CI: 0.44–0.94, p = 0.022) were less willing to host outreach HCV testing. Females were significantly less comfortable discussing HCV testing (95% CI: 0.45–0.98, p = 0.039) compared to males. This is the first Australian study to explore community pharmacists' preparedness to discuss and offer HCV testing and treatment. In light of research showing that community pharmacy models of care can help meet HCV elimination targets, ongoing engagement with pharmacists is needed to increase their preparedness to provide this care.

Hepatitis B virus (HBV) remains a critical public health issue in low- and middle-income countries (LMICs), particularly among pregnant women in Nigeria. Routine screening using rapid diagnostic kits is common in antenatal care, yet the accuracy of these tests can vary. This study aimed to determine the seroprevalencwe of HBV among pregnant women who had previously undergone screening using rapid diagnostic kits at Obafemi Awolowo Teaching Hospital, Ilesa, Osun State, Nigeria, to assess the effectiveness of initial screening and identify any missed cases. A cross-sectional study was conducted, involving 263 pregnant women. Blood samples were tested for HBV markers (HBsAg, HBsAb, and HBcAb) using ELISA. Sociodemographic data and potential risk factors were also analysed. The study found that 7.6% of women were HBsAg positive, indicating active HBV infection, and 49.6% were susceptible to HBV. There was a significant association between higher education levels and HBV seropositivity. Employment status also correlated with HBV prevalence, with self-employed women showing higher seroprevalence. Additionally, a history of blood transfusions was linked to higher HBV seropositivity. The findings highlight the limitations of rapid diagnostic kits in detecting HBV and underscore the need for enhanced infection prevention and control measures, including confirmatory testing, robust vaccination programmes and safe delivery practices to reduce HBV transmission in high-burden regions like Nigeria.

Chronic hepatitis C virus (HCV) infection is associated with significant morbidity, mortality and health economic burden. Over 90% of HCV cases in England occur in people who inject drugs (PWID). Current treatments for HCV are effective but do not protect against reinfection. This research characterised HCV infection and reinfection risk in PWID in England using 2011–2021 data from the annual, cross-sectional, bio-behavioural survey of PWID, Unlinked Anonymous Monitoring. Risk factors for HCV infection were explored using multivariable logistic regression. Shared frailty models for the force of infection (FOI) were used to estimate the risk of HCV infection throughout injecting career with unmeasured risk variation modelled using gamma-shaped frailty distributions. HCV reinfection rates were derived using the frailty distributions of FOI models fitted to UAM data. Infection rates were highest in the first year of injecting (24 per 100 person-years) but fell to between 5 and 8 infections per 100 person-years subsequently. The estimated average annual risks of HCV primary infection and reinfection were 10.0% and 14.2%, indicating a 42% higher risk of reinfection compared to primary infection. Even those with no a priori risk factors were predicted to have high rates of reinfection if previously infected. These findings support the recognition of primary HCV infection as an independent risk factor for reinfection in PWID and emphasise the importance of reducing high-risk behaviours to prevent HCV reinfection following treatment of primary infection. Public health policies must recognise the importance of preventing reinfection in efforts to reduce HCV infection prevalence.

As the second most populated country in Africa, Ethiopia needs public health measures to control diseases that impact its population. The goal of this study is to analyse disease burdens of HBV and HCV, while also highlighting their estimated associated costs for the country. A literature review and a Delphi process reflecting input of Ethiopian experts and the National Viral Hepatitis Technical Working Group were used to complement mathematical modelling to estimate HBV and HCV disease and economic burdens. Two scenarios were created for HCV: 2023 base and WHO elimination. For HBV, three scenarios were created: 2023 base, WHO elimination and universal birth dose. Using current country costs, each scenario was also examined through an economic lens. There were an estimated 7.6 million HBV infections in 2023. To impact transmission, a universal birth dose and pregnant women screening program would allow Ethiopia to vaccinate approximately 3.9 million infants annually, with a budget of $4.68 million USD, meeting the WHO prevalence elimination target (≤ 0.1% in ≤ 5-year-olds) by 2043. Ethiopia had an estimated 690,000 HCV infections in 2023. To achieve HCV elimination, the country would need to expand screening and treatment to 74,000 individuals annually with a peak budget of $12 million USD per year until 2032, decreasing to less than $2 million USD in 2035. Ethiopia can begin making steps towards elimination of HBV through expansion of birth dose vaccination. However, larger investments will be needed to scale-up treatment and diagnosis interventions for both diseases.