世界病毒学杂志(英文版)最新文献

Hepatitis C virus (HCV) infection, traditionally regarded as a hepatotropic disease, is increasingly recognized as a systemic condition with significant thrombotic implications. Chronic HCV induces a persistent proinflammatory and prothrombotic state that substantially elevates the risk of both venous and arterial events. Mechanistically, HCV drives endothelial dysfunction, enhances platelet activation, disrupts coagulation and fibrinolytic balance, and promotes immune-mediated vascular injury through cryoglobulinemia and chronic systemic inflammation. Clinical manifestations range from portal vein thrombosis and venous thromboembolism to coronary artery disease and ischemic stroke, highlighting the far-reaching consequences of virus-driven coagulopathy. Emerging evidence challenges the historical view of cirrhosis as a "naturally anticoagulated" state, instead describing a fragile hemostatic balance prone to both bleeding and thrombosis. Direct-acting antiviral therapy has transformed outcomes, not only achieving sustained virological response but also reversing systemic inflammation, improving endothelial function, and reducing thrombotic complications. However, patients with advanced fibrosis and comorbidities remain at elevated risk despite viral clearance, underscoring the need for ongoing surveillance. This minireview highlights the interplay between hepatic dysfunction, viral-induced inflammation, and cardiovascular sequelae in chronic HCV, emphasizing the importance of integrating thrombotic risk assessment into clinical care and research frameworks.

Background: Current antiviral treatment for chronic hepatitis B can suppress viral replication and reduce the risk of cirrhosis and liver cancer. It requires lifelong daily medication, and long-term adherence is often cited as a concern when initiating treatment. Hepatitis B treatment adherence in the context of the patient's medical and life experiences remains underexplored.

Aim: To evaluate factors associated with adherence to hepatitis B oral antiviral treatment.

Methods: A global online survey was administered anonymously to adults (aged 18 years or older) living with chronic hepatitis B. A subsample of 614 individuals who reported being on hepatitis B treatment was included in the analysis. Indices for treatment affordability, healthcare service acceptability, and individual physical, psychological, and emotional functioning were constructed (Cronbach's alpha = 0.71-0.83). Data analysis was conducted using Stata/BE 17.0.

Results: Overall, 81% of respondents reported high adherence to hepatitis B treatment. Lower adherence was observed among individuals who identified as African or African American (P = 0.008). Among participants with low adherence, 60% cited affordability as a challenge (P = 0.068), 53% identified healthcare service acceptability as a challenge (P = 0.04), 79% described physical functioning as a challenge (P = 0.002), and 40.5% reported difficulties with psychological functioning (P = 0.55).

Conclusion: Findings demonstrate high treatment adherence, although access to and acceptability of healthcare services, as well as an individual's physical functioning challenges, appear to be related to low adherence.

This article discusses the evolving real-world practice using nitazoxanide, non-steroidal anti-inflammatory drugs (NSAIDs) and/or azithromycin (Kelleni's protocol) to manage the evolving manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron EG.5.1, its descendant HV.1 as well as BA.2.86 and its descendant JN.1 subvariants in Egypt in 2024. These subvariants are well-known for their highly evolved immune-evasive properties and the manifestations include some peculiar manifestations as persistent cough besides high fever in young children as well as high fever, persistent severe cough, change of voice, loss of taste and smell, epigastric pain, nausea, vomiting, diarrhea, generalized malaise and marked bone aches in adults including the high-risk groups. It's suggested that the ongoing SARS-CoV-2 evolution is continuing to mostly affect the high-risk groups of patients, to some of whom we've also successfully prescribed nitazoxanide and/or NSAIDs for post-exposure prophylaxis of all household contacts. We also continue to recommend starting the immune-modulatory antiviral Kelleni's protocol as soon as possible in the course of infection and adjusting it in a personalized manner to be more aggressive from the beginning for the high risk patients, at least until the currently encountered surge of infections subsides.

Background: Hepatitis C virus (HCV) affects millions of individuals globally and is linked to dilated cardiomyopathy and hypertrophic cardiomyopathy via complex direct viral, immune, and metabolic mechanisms, often exacerbated by cirrhosis, increasing cardiovascular morbidity.

Aim: To review the pathogenesis of cardiomyopathy in patients infected with HCV and investigate its clinical implications.

Methods: A narrative literature review (PubMed, Scopus, Google Scholar; 1990-2024) focused on English-language studies examining the HCV-cardiomyopathy link, pathophysiology, and treatment. The findings were qualitatively synthesized.

Results: HCV drives cardiomyopathy through direct viral toxicity, immune damage, genetic factors, and apoptosis. The associated cirrhosis contributes via cirrhotic cardiomyopathy mechanisms. Clinically, HCV increases cardiovascular events. Direct-acting antivirals (DAAs) generally improve cardiovascular outcomes by reducing adverse events and enhancing cardiac function.

Conclusion: HCV is a significant cardiomyopathy risk factor involving diverse pathways, including cirrhosis. DAA therapy offers cardiovascular benefits. Further research on the underlying mechanisms, biomarkers (e.g., M2BPGi, Ang-2), and global DAA access is warranted.

Background: People living with human immunodeficiency virus (HIV) are aging as a result the benefits of combination antiretroviral therapy.

Aim: To provide descriptions of eligible existing studies on demographics, methodologies, and outcome measures related to health-related quality of life (HRQoL) in the context of HIV and aging.

Methods: The MEDLINE, CINAHL, Scopus, and PsycINFO databases were systematically searched using the terms HIV, age, and HRQoL to find studies published between January 1995 and June 2022. Key variables of the eligible studies were identified and categorized into demographics (e.g., study sites, study year), methodologies (e.g., use of conceptual frameworks, measures used), and outcome measures [e.g., HRQoL, quality of life (QoL)]. The PRISMA 2009 checklist was followed.

Results: A total of 68 published studies involving 53504 participants were included. The majority of the studies (55.88%) were conducted in North America, with relatively few studies conducted in Africa. The median age of participants was 51.0 years (IQR = 11.0). Over one-third (32.56%) of all participants were older people living with HIV aged 50 years and older Four studies included only older female participants, and six studies included only men who have sex with men. Outcome measures were assessed as HRQoL (26.47%) or QoL (36.76%). Overall, data from African studies, older women living with HIV, socioeconomic status (e.g., employment, income, education), sexual behavioral risks, theoretical frameworks used, and follow-up studies were limited.

Conclusion: This narrative review highlights imbalances and gaps in research on HRQoL in the context of HIV and aging, providing direction for future studies in this area.

A knowledge of the epidemiology and clinical aspects of non-hepatotropic viruses is becoming increasingly important in lieu of the rising incidence of acute liver injury caused by them in various circumstances. Broadly, they include the Herpesviridae group, the hemorrhagic fever viruses and certain respiratory viruses that infect the liver. They can affect both the immunocompetent and the immunocompromised individual, more commonly the latter as part of disseminated systemic infection with symptoms ranging from self-limited transaminitis to acute liver failure Various reasons for their rising importance are increased exposure to these viruses by way of: (1) Overcrowding, climatic and environmental changes, increasing tourism and settlement in hitherto unexplored areas where they are endemic and spread either by direct contact or through local fauna which serve as their reservoir host; and (2) Tampering with the normal protective human immunity by using immunomodulator drugs in scenarios of organ transplants, immune and non-immune related inflammatory disorders and various cancers, all of which are rising in incidence due to the aging world population living longer with many comorbidities. As such infections are relatively rare with non-specific presentation, and self-limited clinical course, they are seldom thought of or investigated for in the early disease stages which lead to the development of complications. This review of the most common non-hepatotropic viruses focusses on their epidemiology, etiopathogenesis, clinical manifestations, and management. They should be listed in the differential diagnosis of acute liver injury in appropriate clinical setting like recent travel to endemic areas, immunocompromised state, or exposure to these viruses.

Background: Proton pump inhibitors (PPIs) are among the most commonly prescribed medications globally. While concerns exist regarding their association with adverse infection-related outcomes, their impact on coronavirus disease 2019 (COVID-19) severity remains uncertain. Emerging preclinical data suggest immunomodulatory and antiviral properties of PPIs, yet clinical evidence is conflicting.

Aim: To investigate whether chronic pre-hospital PPI use is associated with improved outcomes in patients hospitalized with COVID-19.

Methods: We conducted a retrospective case-control study of adult inpatients with severe acute respiratory syndrome coronavirus 2 infection admitted to a racially and ethnically diverse community hospital in Massachusetts from July 2021 to March 2022. Patients were stratified by documented pre-hospital PPI use. The primary outcomes were intensive care unit (ICU) admission, need for invasive mechanical ventilation, and in-hospital mortality. Multivariable logistic regression was used to adjust for demographics, comorbidities, and treatment variables. Significance was set at P < 0.05.

Results: Among 248 patients, 83 (33.4%) were on PPIs prior to hospitalization. Compared to non-users, PPI users had significantly lower rates of ICU admission (13.3% vs 24.8%, P = 0.034), mechanical ventilation (13.3% vs 25.5%, P = 0.027), and in-hospital mortality (6.0% vs 17.6%, P = 0.013). Multivariable analysis confirmed these associations: ICU admission [adjusted odds ratios (aOR): 0.462, 95%CI: 0.223-0.955], mechanical ventilation (aOR: 0.447, 95%CI: 0.216-0.923), and mortality (aOR: 0.144, 95%CI: 0.031-0.677). Findings were consistent across demographic and comorbidity strata.

Conclusion: In this diverse, real-world United States cohort, chronic pre-hospital PPI use was independently associated with lower odds of intensive care unit admission, mechanical ventilation, and mortality among COVID-19 inpatients. These findings highlight a potentially protective role of PPIs and support continued therapy in eligible patients.

Background: Sustained viral load (VL) suppression is an important indicator of successful treatment among people living with human immunodeficiency virus (HIV).

Aim: To assess trends of different VL outcomes before and after adoption of the Treat All policy among people living with HIV in Rwanda.

Methods: Between 2014 and 2017, VL suppression [VL suppression (VLS) < 200 copies/mL] was measured among people living with HIV from 28 healthcare facilities in Rwanda. Participant VL was measured at 6 months, 18 months, and 30 months. The unit of analysis was visit-pair, with subjects across four visit-pair categories: (1) Sustained VL suppression (VL < 200 copies/mL at two consecutive visits); (2) Persistent viremia (VL ≥ 200 copies/mL at two consecutive visits); (3) Viral rebound (VL < 200 copies/mL at prior visit only); and (4) Newly suppressed (VL < 200 copies/mL at subsequent visit only). Poisson regression models with generalized estimating equations were used to estimate adjusted incidence risk ratio (aIRR) and 95% confidence intervals (CIs) for factors associated with sustained VLS. To handle missing data, multiple imputations was performed.

Results: A total of 634 participants contributed 973 visit-pairs (295 single pairs and 339 double pairs). The median age was 37 years (interquartile range: 32-43 years). The incidence rates of sustained VLS, persistent viremia, viral rebound, and new suppression were 85.2%, 4.3%, 4.6%, and 5.7%, respectively. Young individuals aged 18-24 years had higher incidence of viral rebound compared to those 25 years or older (14.8% vs 4.3%; P = 0.011). Of the visit-pairs that had sustained VLS during the first two visits (49.8%; n = 485), 56.7% exhibited sustained VLS throughout follow-up. Compared to having no education, having at least primary education was associated with an increased likelihood of sustained VLS (aIRR = 1.09; 95%CI: 1.01-1.17). Those who presented with advanced HIV disease at baseline had a 12% reduced likelihood of sustained VLS (aIRR = 0.88; 95%CI: 0.79-0.99). Achieving sustained VLS did not differ before or after adoption of the Treat All policy. When the analysis was repeated on imputed datasets, similar results were found.

Conclusion: Although most people living with HIV have sustained VLS in Rwanda, individuals without formal education, those presenting with advanced HIV, and younger individuals were lagging on multiple outcomes. Interventions tailored to these individuals would improve treatment outcomes to achieve epidemic control.

Lassa fever (LF) is a serious acute viral hemorrhagic illness that is endemic to West Africa where it affects an estimated two million people and results in up to 10000 deaths each year. The disease is caused by the Lassa virus (LASV), part of the Arenaviridae family, and is primarily transmitted through contact with urine or feces of infected Mastomys natalensis rodents. Human-to-human transmission, particularly in healthcare and community settings, further amplifies the risk of spread. Since its discovery in 1969, LF continues to be a neglected tropical disease with significant health impacts, especially in vulnerable populations such as pregnant females and those with weakened immune systems. The clinical spectrum of LF varies from mild, flu-like symptoms to severe complications including bleeding, brain inflammation, and multiple organ dysfunction with neonates and pregnant female showing the highest fatality rates. Accurate diagnosis is hindered by symptom overlap with common regional illnesses such as malaria and typhoid, underlining the urgent need for strengthened diagnostic infrastructure and rapid testing methods. While ribavirin remains the main antiviral treatment, its effectiveness depends heavily on early administration. Currently, no approved vaccine exists; however, promising candidates like vesicular stomatitis virus (VSV)ΔG-LASVGPC, INO-4500, and measles virus-based (MV)-LASV are undergoing preclinical and early-phase clinical evaluation, exhibiting encouraging immune responses in animal and human studies. A comprehensive strategy combining public health education, rodent control measures, robust infection prevention in clinical settings, and international cooperation in vaccine and drug research is essential to curb the impact of LF.

An estimated 3%-4% of people are living with the hepatitis B virus (HBV), and without treatment, the risk of developing cirrhosis and hepatocellular cancer (HCC) is an omnipresent threat. Prevention of HCC is a major challenge, as the association between viral suppression and HCC risk reduction is multifactorial, involving the progressive depletion of hepatocytes through covalently closed circular DNA integration, as well as the prevention of liver fibrosis and cirrhosis. Despite effective and cheap antiviral treatment capable of suppressing HBV replication and thereby cirrhosis and HCC, the current indications for therapy need revision and more research to expand the gamut and treat more infected people. In this review, we discuss the possible expansion of antiviral treatment in chronic hepatitis B to prevent cirrhosis and, importantly, HCC.