Journal of Viral Hepatitis最新文献

The World Health Organisation targeted the Hepatitis B virus (HBV) for elimination as a public health threat by 2030. To achieve this goal, equitable access to HBV testing and treatment services is critical. Migrants usually experience multiple barriers to accessing HBV services. Understanding HBV prevalence among this population can support planning for HBV elimination. This systematic review aimed to estimate HBV prevalence among migrants in high-income countries with low/intermediate HBV prevalence. PubMed, Scopus, PsycINFO and Cochrane Library were searched for peer-reviewed studies published between 2015 and 2025 in English. The Joanna Briggs Institute (JBI) Critical Appraisal Tools were used for methodological quality assessment. A proportional meta-analysis was used to estimate HBV prevalence. We also estimated the prevalence of HBV surface antibody (anti-HBs) positive from the included studies. Forty-four studies were included in this review. The pooled HBV surface antigen (HBsAg) and anti-HBs prevalence were 4.4% (95% CI: 3.4%–5.5%) and 35.2% (95% CI: 26.9%–44.0%), respectively. HBsAg prevalence was higher in males (5.8%) than in females (2.4%). Migrants aged 18 years and over had higher HBsAg prevalence than those aged less than 18 years (3.5% vs. 2.1%). Among refugees and asylum seekers, HBsAg and anti-HBs prevalence were 4.2% and 31.2%, respectively. The HBV prevalence among migrants was comparable to the global level, but higher than that in the general population of countries included in this study. To improve equity in HBV elimination strategies, migrants, especially refugees and asylum seekers' access to HBV information, testing, and treatment should be facilitated.

Despite advances in hepatitis C virus (HCV) treatments, diagnostic gaps and linkage-to-care hinder elimination efforts. We evaluated an electronic medical record (EMR)-based automated alert system to improve HCV care at tertiary referral centers. We have screened 1,303,578 patients who were tested for anti-HCV, and analyzed 8291 patients positive for anti-HCV antibody (Ab) across four tertiary hospitals between July 2009 and December 2023. The EMR alert system, implemented in June 2021, identified patients with positive anti-HCV antibody results who had not undergone HCV ribonucleic acid (RNA) testing. We compared HCV RNA testing rates, linkage-to-care and time intervals between testing before and after system implementation. The HCV RNA test prescription rate increased from 60.5% in the pre-alert period to 66.9% in the post-alert period. In non-hepatology departments, the prescription rate increased from 47.1% to 60.5%. The interval between HCV Ab positivity to HCV RNA test prescription in patients without initial HCV RNA order decreased significantly from 1208.9 to 244.5 days. Among 732 previously HCV RNA untested patients who were followed up after alert implementation, 43.4% received HCV RNA testing, leading to 62 new HCV diagnoses. The referral rate to hepatology departments remained stable (83.3% pre-alert vs. 80.9% post-alert). In conclusion, implementation of an EMR-based alert system effectively improved HCV diagnostic rates and reduced testing delays, particularly in non-hepatology departments. This system represents a promising strategy for hospital-based HCV micro-elimination, but additional interventions might be needed to achieve optimal testing rates and linkage-to-care.

In 2015, Georgia launched a hepatitis C elimination programme with free screening and treatment. However, a large number of persons were lost to follow up after screening for, or diagnosis with, hepatitis C virus (HCV) infection. During February 2023–September 2024, we conducted active outreach to reengage persons who were lost to follow-up in care and assess barriers to hepatitis C care and treatment through questionnaires covering pre- and post-outreach perceptions. Among 18,034 persons who tested HCV antibody (anti-HCV) reactive but were not tested for HCV viremia and had valid contact information, 14,252 (79%) could be reached, among whom 64% were unaware of their test result. After outreach, 4593 (32%) completed HCV viremia testing, among whom 2440 (53%) tested positive and 1577 (65%) initiated treatment. Main reasons for not seeking care after active outreach were having another chronic illness (33%) and being unaware they were screened for anti-HCV (23%). Among 13,151 persons diagnosed with HCV infection who did not initiate treatment and had valid contact information, 6982 (53%) were reached, among whom 2267 (33%) initiated treatment. The main reason for not initiating treatment before outreach was lack of information (62%) and after outreach was distrust in the hepatitis C elimination programme (79%). Treatment initiation was more common among those first tested in recent years. Active outreach successfully identified new infections and nearly 40% of those diagnosed initiated treatment. Educating patients about their test results and promptly linking them to care and treatment is essential to achieve hepatitis C elimination.

This study investigates the impact of the indirect bilirubin percentage-to-albumin ratio (iBAR) on the prognosis of patients with acute-on-chronic liver failure (ACLF), as defined by the Chinese Group on the Study of Severe Hepatitis B-ACLF (COSSH ACLF) criteria, who were treated with an artificial liver support system (ALSS). In a retrospective cohort of 258 eligible patients, restricted cubic splines, linear regression, and Cox proportional hazards models were used to analyse the association of iBAR with disease severity and 28-day and 90-day outcomes. The 28-day transplant-free and overall survival rates were 76.4% and 82.2%, respectively, while the 90-day rates were 58.5% and 66.3%. The iBAR was significantly lower in 28-day transplant-free survivors compared to those who underwent transplantation or died (6.47 ± 2.95 vs. 8.87 ± 2.49, p < 0.001), with similar findings for 90-day outcomes (6.09 ± 2.75 vs. 8.38 ± 2.88, p < 0.001). A positive association was observed between iBAR and COSSH ACLF score (adjusted β = 0.14, 95% CI: 0.11–0.18, p < 0.001). Furthermore, iBAR was independently associated with higher risks of 28-day transplant-free mortality (adjusted HR = 1.21, 95% CI: 1.10–1.34, p < 0.001), 28-day overall mortality (adjusted HR = 1.26, 95% CI: 1.12–1.42, p < 0.001), 90-day transplant-free mortality (adjusted HR = 1.13, 95% CI: 1.06–1.22, p < 0.001), and 90-day overall mortality (adjusted HR = 1.14, 95% CI: 1.05–1.23, p = 0.002). Patients with an iBAR > 6.13 had significantly poorer 28-day and 90-day prognoses compared to those with iBAR ≤ 6.13 (all adjusted HR > 1, p < 0.05). In conclusion, iBAR is positively associated with disease severity and adverse prognosis in COSSH ACLF patients receiving ALSS therapy, suggesting its potential as a prognostic biomarker that warrants validation in future prospective, multicenter studies.

Hepatitis B virus (HBV)–related hepatocellular carcinoma (HCC) poses significant health challenges globally, particularly in regions with considerable HBV prevalence such as Egypt. Despite immunisation programmes, HBV remains a leading cause of liver cancer in Egypt, often diagnosed at advanced stages, complicating management and worsening prognosis. This retrospective multicentre study included 365 Egyptian patients diagnosed with HBV-related HCC between February 2007 and July 2023 from six tertiary care centres across Egypt. Clinical, laboratory, tumour characteristics, treatment outcomes and overall survival were collected and analysed. Diagnosis was confirmed according to international guidelines using triphasic CT or dynamic MRI. Treatment responses were assessed using modified RECIST criteria, and survival was analysed using Kaplan–Meier curves. Patients had a median age of 59 years, predominantly male (76.4%), and most (98.4%) presented with cirrhosis at diagnosis. The majority were not receiving antiviral treatment (76.71%) at presentation. Intermediate and advanced BCLC stages (B-D) comprised over 75% of cases. Trans-arterial chemoembolization was the primary treatment modality (34.5%), followed by sorafenib (24.1%) and best supportive care (28.8%). Median overall survival was 13.1 months. Independent factors associated with mortality included high ALBI score, positive HBV DNA at diagnosis, and advanced Child–Pugh classification. In conclusion: this study underscores the advanced stage at which HBV-related HCC is typically diagnosed in Egypt and the resulting poor survival outcomes. Strengthening early detection through surveillance programmes, increasing antiviral therapy coverage and adherence to treatment protocols are critical strategies to enhance patient prognosis.

Chronic hepatitis C (CHC) continues to be a significant public health issue in the United States, but comprehensive analysis of its epidemiological characteristics is limited. This analysis used data from the National Notifiable Diseases Surveillance System to examine patterns and changes in newly reported CHC. During 2016–2023, 895,522 CHC cases were newly reported among adults aged ≥ 18 years in the United States. The rate of newly reported cases during 2020–2023 was significantly lower (47.8 cases per 100,000), compared with the rate during 2016–2019 (75.8 cases per 100,000). A distinct bimodal age distribution was observed with age peaks centered at approximately 33.9 and 59.5 years, which corresponds to millennials (born during 1981–1996) and baby boomers (born during 1945–1965), respectively. While the bimodal age distribution persisted, over time, fewer cases contributed to the older peak relative to the younger peak. Males had a significantly higher rate of newly reported CHC than females, as did individuals residing in rural areas compared to urban areas, particularly within the younger peak. Variations in the transition from the older peak to the younger peak were observed across states during 2016–2023. These findings provide valuable insights into the evolving CHC epidemiology and the implications for the efforts to eliminate the disease.