Journal of Viral Hepatitis最新文献

Dental health professionals (DHPs) are at risk for bloodborne viruses. We evaluated hepatitis B and hepatitis C seroprevalence and knowledge, attitudes and practices regarding viral hepatitis in Georgia. We randomly selected 214 dental facilities. DHPs underwent face-to-face interviews and provided blood samples. High knowledge and practice were defined as correctly responding to 70% or more of the questions. Samples were tested for antibodies against hepatitis C virus (anti-HCV) and, if reactive, for HCV RNA; total hepatitis B core antibodies (anti-HBc) and, if reactive, for hepatitis B surface antigen (HBsAg). Specimens reactive for HBsAg were tested for antibody to hepatitis D virus (anti-HDV). Among 519 participants, 6.6% and 7.9% correctly identified all HBV and HCV transmission modes, respectively. Approximately half had high knowledge scores for hepatitis B and hepatitis C. Nurses had lower odds than dentists to have high scores. While 56% agreed that the hepatitis B vaccine is essential for healthcare workers, only 23.9% reported being vaccinated. Overall, 89.4% had high practice scores; 41.6% experienced a blood splash on their face, 43.7% a needle-stick injury and 20.6% an injury with a contaminated instrument. Practice scores were lower among those who had not been screened or vaccinated for hepatitis B. Among 517 blood samples tested, 0.8% were anti-HCV reactive, but none had detectable HCV RNA; 12.2% were anti-HBc reactive and 0.6% were HBsAg reactive. None tested reactive for anti-HDV. Enhanced training and policy reforms are critical to improve hepatitis knowledge, vaccination uptake and infection control practices among DHPs in Georgia.

NéoVie primary objective was to describe the care pathway of patients with HCV infection treated in addiction centres in France, by evaluating the rate of treatments initiated among these patients and to identify obstacles to treatment initiation. Multicentric, prospective, non-interventional study conducted in France from May 2020 to July 2022. Inclusion criteria were age > 18 years, positive HCV RNA, follow up in a participating addiction centre. Direct-acting antiviral (DAA) treatment was initiated at the discretion of the investigators. Patients initiating glecaprevir/pibrentasvir (G/P) treatment were followed for up to 11 months after treatment initiation. Data were collected through specific questionnaires. 32 centres participated in the study and 18 were active. Among the 93 patients included, 89 (95.7%) were treated with a DAA (77 (82.8%) with G/P). After G/P treatment initiation, all but 2 (which were reinfections) achieved SVR 12 and maintained virological response 6 months later. No AEs with a frequency > 3% were reported. Significant improvements were observed between inclusion and 11 months after in terms of quality of life (mean improvement of 6.78 ± 21.53 pts (VAS)) and anxiety and depression (10/37; 27.0% of the patients). These results suggest that once efforts are made in the centre to apply the simplified pathway, it is possible to treat and cure patients with DAA. In order to achieve HCV elimination goal, efforts to promote treatment should continue focusing on training and motivating addiction centres.

Despite long-standing national vaccination recommendations targeting high-risk groups, hepatitis B vaccination (HepB) coverage among US adults remains low. To inform efforts following the 2022 recommendation for universal adult HepB vaccination, we analysed data from the National Health Interview Survey (2000–2018) to estimate national HepB vaccination coverage and identify factors associated with vaccine uptake. We used Poisson regression and a health behaviour framework to examine associations across four domains: Sociodemographic characteristics, healthcare access, health-seeking behaviours, and access to health information. Among 532,168 non-institutionalised US adults aged ≥ 18 years, the self-reported HepB vaccination rate was 27.9% (95% CI 27.6–29.7), increasing from 22% in 2000 to 35% in 2018. Health-related behaviours showed the strongest association with HepB vaccination, including prior hepatitis A vaccination (AOR 11.17, 95% CI 10.51–11.87), prior hepatitis B testing (AOR 4.70, 95% CI 4.47–4.93), and prior hepatitis C testing (AOR 1.28, 95% CI 1.21–1.35). Conversely, older age, lower educational level, and recent unemployment were associated with lower odds of HepB vaccination. Additionally, Black and Hispanic adults had lower odds of vaccination compared to white adults. These findings highlight persistent gaps in HepB vaccine coverage among particular segments of the US population and underscore the importance of vaccination efforts that focus on these communities to mitigate existing disparities and achieve the goal of universal HepB vaccination.

Occult hepatitis B infection (OBI) represents a unique diagnostic and clinical challenge due to undetectable HBsAg despite HBV DNA presence. Genetic mutations, particularly in the HBV S gene, play a crucial role in immune evasion and diagnostic failures associated with OBI. This cross-sectional study investigated the genetic mutations in the S gene of HBV among family members of chronically infected patients. This study enrolled 243 family members from 62 HBV-infected index cases. Serological assays were used to identify HBsAg and anti-HBc positivity. HBV DNA was amplified and sequenced in 12 cases, focusing on the S gene. The impact of mutations in the S gene was assessed through in silico analyses, including epitope prediction and secondary structure modelling. Of the household contacts, 9.05% were HBsAg-positive and 37.03% were suspected OBI due to anti-HBc positivity. Out of the suspected OBI, 20% of individuals had detectable HBV DNA. Mutations like R122K and V194A were found to be enriched among OBI sequences and were shown to alter immune epitopes without affecting protein structure. Genotype D was predominant in chronic cases, while genotype A was more frequent in OBI. The adw2 serotype was commonly observed in OBI cases. Thus, this study highlights the role of S gene mutations in OBI's diagnostic and immune escape mechanisms. The findings underline the importance of genotype-specific diagnostic approaches and further investigations into the pre-S regions to enhance understanding of HBV pathogenesis.

Whether combining non-alcoholic fatty liver disease (NAFLD) affects the efficacy of pegylated interferon alpha (PEG-IFN-α) for patients with chronic hepatitis B (CHB) remains unknown; hence, we aimed to conduct a retrospective cohort study to investigate the impact of NAFLD on the HBsAg loss rate of CHB treated with PEG-IFN-α. A total of 279 adult CHB patients receiving antiviral therapy with PEG-IFN-α were included in the study, of which 94 (33.7%) patients had combined NAFLD. The median treatment duration in the overall population was 37 (23, 59) weeks, and 79 (28.3%) patients achieved serum HBsAg loss during treatment. Compared to patients without NAFLD, patients with NAFLD had lower baseline HBsAg levels prior to treatment with PEG-IFN-α (438.05 [152.77, 978.60] vs. 296.60 [54.20, 647.15] IU/mL, p = 0.004). Propensity score matching (PSM) was applied to rectify the baseline characteristics between the two groups, including age, gender and quantitative HBsAg level. After PSM, 84 CHB with NAFLD and 84 CHB without NAFLD were included in the matched cohort. With a comparable treatment duration in both groups, the patients with NAFLD had a lower cumulative HBsAg loss rate (Log-rank p = 0.007). Multivariable analysis suggested that NAFLD was independently associated with a decrease in HBsAg loss rates (risk ratio HR = 0.505; 95% CI, 0.283–0.902; p = 0.021), which was consistent in sensitivity analyses that included only nucleos(t)ide analogue (NA)–treated patients. In conclusion, CHB with NAFLD demonstrated a lower HBsAg loss rate during PEG-IFN-α treatment, suggesting that more optimal therapeutic strategies need to be further explored.

The degree to which alcohol use is associated with the risk of all-cause mortality and hepatic decompensation after hepatitis C (HCV) diagnosis, treatment, and cure remains unknown. We sought to address this question among patients achieving sustained virologic response (SVR) after direct-acting antiviral treatment in the largest HCV health system in the United States. We extracted data on alcohol use, HCV treatment, SVR, HIV co-infection, demographics, risk behaviours, hepatic decompensation, and mortality from all patients in the 1945 to 1965 VA Birth Cohort. Alcohol use categories were generated using responses to the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) questionnaire and diagnostic codes for alcohol use disorder (AUD): abstinent without a history of AUD, abstinent with a history of AUD, current lower-risk consumption, current moderate-risk consumption, and current high-risk consumption with or without AUD. Cox proportional hazard models were used to examine associations between alcohol category and the risk of hepatic decompensation and all-cause mortality. Among 50,581 patients in the analytic cohort, compared to current drinkers exhibiting lower risk alcohol consumption (referent), current high-risk consumption with or without AUD was associated with increased risk of all-cause mortality (aHR: 1.40, 95% CI: 1.21–1.63) and hepatic decompensation (HR: 2.15, 95% CI: 1.60–2.89) as was abstinence with a history of AUD diagnosis (mortality aHR: 1.63, 95% CI: 1.41–1.89; hepatic decompensation aHR: 1.85, 95% CI: 1.36–2.51). AUD and high-risk alcohol consumption are associated with the risk of hepatic decompensation and all-cause mortality among Veterans who have achieved SVR, including those categorised as being currently abstinent. Interventions for alcohol consumption and use disorder among individuals treated for HCV infection may reduce morbidity and mortality in this population.