Journal of Viral Hepatitis最新文献

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.

Systematic screening for hepatitis C virus (HCV) by serology once in a lifetime is recommended by the French Association for the Study of the Liver, but not by the French National Authority for Health. Screening focused on subjects aged over 40 years would seem more appropriate, as the prevalence of hepatitis C increases with age. The aim of this study was to assess the feasibility (number of serologies proposed) and acceptability (number of serologies performed) of HCV screening prior to endoscopy in people aged 40 years and over seen in gastroenterology consultations in non-university hospitals; and to determine whether the prevalence after age 40 is higher than in the general population (0.86%). As of 1 June 2023, 490 patients were included in eight different hospitals in six regions of metropolitan France; 97.4% of patients accepted the prescription of HCV serology and 97.6% of prescribed serologies were performed; 55.5% were men and 44.4% women with a mean age of 58 years (range, 40–90). The HCV serology positivity rate was 6% (29 patients). No previous HCV serology was known. Risk exposures associated with positive HCV serology were drug use in 19 patients, a history of transfusion in six patients and origin from an endemic country in five patients; 90% of positive serologies concerned men and the mean age was 65 years (range, 49–85). Mean hepatic elastometry was 8.7 kPa; 11 out of 28 patients tested had a positive HCV viral load and were treated. Systematic screening for hepatitis C after the age of 40 years and before digestive endoscopy is feasible, well accepted and enables a high number of patients to be managed.

The objective of this study is to analyse the prevalence and clinical characteristics of HCV/HBV coinfection in Guizhou, and evaluate the rate of HBV reactivation during and after anti-HCV treatment in a real-world study. This retrospective study included 1652 patients with hepatitis C virus (HCV) infection who received direct-acting antiviral (DAA) therapy at the Guiyang Public Health Clinical Center between January 2018 and December 2022 Baseline, on-treatment and posttreatment data were collected, including HCV RNA, HCV genotypes, liver function, hepatitis B virus (HBV) markers (HBsAg, HBcAb) and HBV DNA levels. The HCV/HBV coinfection rate was analysed, and the risk of HBV reactivation and disease progression following DAA therapy was assessed. Among the 1652 HCV-infected patients, the HCV/HBV coinfection rate was 49.88% (824/1652). Of these, 5.08% (84/1652) were HBsAg-positive, while 44.79% (740/1652) were HBsAg-negative/HBcAb-positive with HBV DNA < 20 IU/mL. Compared to patients with HCV monoinfection, HBsAg-positive patients had a higher proportion of males, compensated and decompensated cirrhosis, hepatocellular carcinoma (HCC) and lower platelet (PLT) counts (χ² = 15.482, 46.101; F = 7.292; all p < 0.05). Differences in HCV genotype distribution were observed among various HBV immune status groups (χ² = 32.529, p < 0.05). The cumulative incidence of HBV reactivation in HCV/HBV coinfected patients treated with DAAs was 1.2% (10/824). Among these, the reactivation rate was 16.67% (9/54) in HBsAg-positive patients without prophylactic anti-HBV therapy and 0.1% (1/740) in HBsAg-negative/HBcAb-positive patients. Baseline HBsAg levels were significantly higher in patients with HBV reactivation than in those without reactivation (Z = −4.291, p < 0.05). No significant changes were observed in liver function or PLT levels after HBV reactivation compared to baseline (p > 0.05), and no cases of liver failure were reported. In Guizhou, a relatively high prevalence of HBsAg-positivity and a large proportion of past HBV exposure (HBsAg-negative/HBcAb-positive, HBV DNA < 20 IU/mL) were observed among HCV-infected patients. While HBV reactivation can occur in HCV/HBV coinfected patients undergoing DAA therapy, the overall risk is low. A baseline HBsAg level > 185 IU/mL is a significant risk factor for HBV reactivation.