Journal of Viral Hepatitis最新文献

Chronic hepatitis B (CHB) is a major cause of liver-related morbidity and mortality in the United States. Patients with CHB require long-term antiviral treatment and consistent follow-up, but often face numerous barriers to accessing care and medications. In this study, we used the Medicare Part D database and the Rural–Urban Continuum code to explore specialty and geographic characteristics of healthcare providers that manage Medicare patients with CHB. Between 2013 and 2021, more than 7000 prescribers prescribed over 2.4 million 30-day prescriptions of these CHB therapies, of which 2 million (85%) were in metropolitan counties. The number of 30-day prescriptions increased by 5.4% annually. The number of prescriptions by GI increased by 12.5% a year and prescriptions by APPs increased by 12.2% a year, while prescriptions by ID decreased by 14.0% annually. In non-metropolitan counties, APPs experienced −5% APC between 2013 and 2021, and PCPs experienced −12.5% APC between 2016 and 2021. In this study, we found that there has been a noticeable shift in the specialties prescribing medications for patients with hepatitis B. Gastroenterologists and APPs became significantly more involved as prescribers. The increase in APP management of patients with CHB is a welcoming development, especially in light of the physician workforce shortage. It is important to create solutions such as co-management to ensure that patients with CHB receive consistent care without further contributing to supply–demand mismatch in gastroenterology.

Discontinuing antivirals in chronic hepatitis B virus (HBV) ‘e’ antigen negative infection can enhance HBV surface antigen (HBsAg) loss but risks complications. We modelled the clinical impact of discontinuing antivirals in chronic HBV. We developed a Markov state model with Monte Carlo simulation of chronic HBV to compare continuation of antiviral therapy with 3 strategies of cessation and reinitiation for: (1) virologic relapse, (2) clinical relapse, or (3) hepatitis flare. We simulated the probability of virologic relapse as an exponential decay function from the time of antiviral cessation. We used literature-based estimates for input probabilities following virologic relapse: clinical relapse (60%, conditional on virologic relapse), hepatitis flare (57%, conditional on clinical relapse) and HBsAg-loss (6%–8%). We projected HBsAg loss, cirrhosis, HCC, and survival. In 10 years, cessation strategies would increase cumulative incidence of HBsAg loss from 4.6% to 12.9%–17.3% but would not appreciably change survival (from 90.6% with continuation to 88.1%–89.0%). In an undifferentiated population, continuation would be a preferred strategy to increase average life expectancy (by 0.75–1.05 years) unless HBsAg loss following treatment cessation was > 46%. Sensitivity analyses showed that the decision to continue or stop antivirals would depend on the off-treatment rates of cirrhosis and HCC for people who remain HBsAg-positive but do not fulfil retreatment criteria. Careful selection of people for antiviral cessation using quantitative HBsAg levels could improve survival compared with continuation. Clinical practice guidelines should emphasise selective application of antiviral cessation to persons most likely to lose HBsAg without experiencing liver-related complications.

To assess the efficacy and safety of the Velpatasvir (VEL)/Sofosbuvir (SOF) with or without Ribavirin (RBV) in treating patients with decompensated hepatitis C cirrhosis. We searched multiple databases for studies published from October 2010 to September 2024. Outcomes of interest were sustained viral response at 12 weeks (SVR12) and the safety of VEL/SOF with and without RBV regimens in patients with decompensated hepatitis C virus (HCV) cirrhosis. All statistical analyses were performed using R Statistics (4.4.1). We included 13 studies that enrolled 872 adult patients with decompensated cirrhosis due to HCV. The addition of RBV to the VEL/SOF regimen neither significantly improved SVR12 after the last dose of treatment [95.0% (366/391, 95% CI: 89.0–99.0) vs. 94.0% (442/481, 95% CI: 90.0–97.0); p = 0.92] nor decreased virologic relapse [1.0% (2/158, 95% CI: 0.0–8.0) vs. 6.0% (12/197, 95% CI: 3.0–10.0); p = 0.15]. VEL/SOF plus RBV therapy had a significantly higher rate of adverse events [92.0% (261/287, 95% CI: 88.0–95.0) vs. 47.0% (167/348, 95% CI: 24.0–71.0); p < 0.01] and death [7.0% (20/287, 95% CI: 2.0–16.0) vs. 2.0% (8/366, 95% CI: 1.0–4.0); p = 0.05]. However, for patients with genotype 3, adding RBV to the VEL/SOF regimen significantly improved SVR12 [87.0% (26/30, 95% CI: 71.0–98.0) vs. 45% (7/15, 95% CI: 13.0–79.0); p < 0.01] and decreased virologic relapse [0.0% (0/10, 95% CI: 0.0–31.0) vs. 100% (1/1, 95% CI: 2.0–100.0); p = 0.02]. VEL/SOF based therapy is a safe and effective treatment for patients with decompensated cirrhosis due to HCV. The addition of RBV to VEL/SOF may increase toxicity without achieving improved efficacy overall. However, the addition of RBV significantly increased the SVR12 rate and reduced the virologic relapse in genotype 3 patients.

Trial Registration: PROSPERO database: CRD42023491852

Chronic liver disease (CLD) is a leading cause of global morbidity and mortality, necessitating effective preventive strategies. Growing evidence is linking coffee consumption with reduced risk of disease progression in various CLDs, including metabolic dysfunction associated steatotic liver disease (MASLD), alcoholic liver disease, hepatitis B and C, autoimmune hepatitis, and a reduction in the risk of hepatocellular carcinoma development. Coffee, a globally consumed beverage, contains bioactive compounds like caffeine, chlorogenic acids, diterpenes, and polyphenols, which may offer hepatoprotective benefits through anti-inflammatory, antioxidant, and metabolic regulatory effects. This narrative review discusses the current evidence demonstrating an inverse correlation between regular coffee intake and CLD progression, highlighting dose-dependent benefits with optimal consumption at three to four cups per day. Potential mechanisms for hepatoprotective effects of coffee involve modulation of the gut-liver axis, epigenetic regulation, and improving liver transaminitis. Additionally, the current review explores the effects of different coffee processing methods, such as roasting levels and brewing techniques, on these protective properties. Coffee's role as an affordable, culturally accepted intervention to mitigate the burden of CLD offers a compelling avenue for future public health strategies. Despite promising evidence, there is a need for further proof to establish the most beneficial coffee preparation methods.

Persons co-infected with hepatitis C virus and hepatitis B virus (HCV-HBV) are at increased risk of developing liver disease compared with mono-infected individuals. In Georgia, all patients undergoing hepatitis C treatment are eligible for free testing for hepatitis B surface antigen (HBsAg). However, further hepatitis B evaluations and treatment are not free. We explored demographic and clinical characteristics associated with HCV-HBV co-infection among persons treated for HCV infection. Persons aged ≥ 18 years with HCV infection who initiated HCV treatment during 2017–2023 were included. Patients were grouped as HCV mono-infected, HCV-HBV co-infected (HBsAg positive), and HBV exposed (total HBV core antibody positive, HBsAg negative). We present descriptive analysis and adjusted prevalence ratios (aPR) with 95% confidence intervals (95% CI). Of 54,994 adults treated for hepatitis C, 68.1% had HCV mono-infection, 29.3% were previously exposed to HBV, and 2.6% had HCV-HBV co-infection. Persons who were aged 18–45 years (aPR: 1.75, 95% CI: 1.48–2.08), male (aPR: 1.38, 95% CI: 1.11–1.71), reported ever injecting drugs (aPR: 1.40, 95% CI: 1.19–1.66), had end-of-HCV treatment, alanine transaminase (ALT) levels > 80 IU/L (aPR: 2.14, 95% CI: 1.40–3.29) and did not achieve hepatitis C cure after treatment (aPR: 1.83, 95% CI: 1.13–2.95) were more likely to have HCV-HBV co-infection vs. HCV mono-infection. Patients who did not achieve cure and had persistently higher ALT levels after hepatitis C treatment were more likely to have HCV-HBV co-infection. Expanded access to hepatitis B care and treatment, and co-management of HBV infection along with HCV treatment in co-infected persons are needed to improve clinical outcomes.

Acute hepatitis E (AHE) disproportionately affects regions with diverse socioeconomic conditions. This study aims to assess the trends in AHE burden and health inequalities from 1990 to 2021. Utilising data from the Global Burden of Disease 2021, joinpoint regression was employed to identify significant trends. Cross-country inequality analysis was conducted to quantify the distributive inequalities in the burden of AHE. The trends of AHE incidence, prevalence, deaths and disability-adjusted life years (DALYs) rate have experienced a marked decrease from 1990 to 2021, reaching the lowest recorded in 2021. However, the numbers of those continued to increase. An inverse relationship was found between AHE disease rate and sociodemographic index (SDI) levels. The joinpoint regression analysis confirmed a downward trend of AHE globally and in the five SDI levels. Notably, incidence and prevalence rates in high-middle SDI increased from 2015, while those in high SDI slowed down from 2001. Mortality and DALYs rates showed a deceleration in high-middle SDI and a rebound in high SDI from 2009 to 2021. Cross-country inequality analysis disclosed that lower SDI countries disproportionately bear a higher AHE burden, with the magnitude of these inequalities decreasing over time. The study uncovered an inverse correlation between the AHE disease rate and SDI level. Despite a consistent decline in hepatitis E virus disease rate across the five SDI levels, the disparity in burden persists, with developing regions retaining a relatively elevated load. Meanwhile, developed regions exhibit a resurgence, characterised by an upward trend. This dynamic epidemiological shift underscores the ongoing need for vigilant monitoring and adaptable approaches in the management of the disease.

Rapid point-of-care tests for hepatitis C virus (HCV) provide results in 20 min and allow linkage to care, particularly for difficult-to-reach populations. Prior work suggested an early reading time of the OraQuick (OQ) rapid HCV antibody lateral flow immunoassay identified people with HCV viremia; however, these observations were not externally validated. We conducted a prospective cohort study at Penn Presbyterian Medical Center from June 2021 to August 2023 to evaluate the performance of OQ early reading times for HCV viremia among participants with reactive HCV antibody. Following test device insertion for whole blood substrate, the OQ assay was evaluated every minute from 5 to 10 min, then at 20 and 40 min. Early read time performance was evaluated against the standard of care HCV RNA. 175 participants (120 [68.6%] with detectable HCV viremia) completed the OQ assay. Among HCV viremic participants, 119 had a positive whole blood OQ by 7 min (sensitivity: 99.2% [95% confidence interval, CI: 95.4–100]; positive predictive value: 82.1% [95% CI: 74.8–87.9]); 1 viremic participant with severe immunosuppression was not identified at this early reading time. No time interval accurately identified only those with HCV viremia, yet a negative OQ test at 7 min excluded HCV viremia (negative predictive value: 96.3% [95% CI: 81.0–99.9]). A 7-min reading time for a whole blood OQ assay may reduce the need for HCV RNA testing and improve screening efficiency by identifying people without HCV viremia. Early read time results cannot be used to exclusively identify HCV viremia and should be used with caution in those with severe immunosuppression or if acute HCV infection is suspected.