120 results found
Lemoine M, Cooke GS, Thursz M, et al., 2021, Cuts to UK official development assistance budget jeopardise global viral hepatitis elimination goals., Lancet Gastroenterol Hepatol, Vol: 6, Pages: 527-528
Post G, Howell J, Sow A, et al., 2021, Clinical utility of quantifying hepatitis B surface antigen in African patients with chronic hepatitis B, JOURNAL OF VIRAL HEPATITIS, Vol: 28, Pages: 1003-1010, ISSN: 1352-0504
Kim JU, Ingiliz P, Shimakawa Y, et al., 2021, Improving care of migrants is key for viral hepatitis elimination in Europe, Bulletin of the World Health Organization, Vol: 99, Pages: 280-286, ISSN: 0042-9686
By 2040, deaths from chronic viral hepatitis worldwide are projected to exceed those from human immunodeficiency virus infection,tuberculosis and malaria combined. The burden of this disease is predominantly carried by low-resource countries in Africa and Asia. Inresource-rich countries, the epidemiological spread of viral hepatitis is partially driven by migrant movements from areas of high endemicity.In the last decade, Member States of the European Union and the European Economic Area have experienced an unprecedented influxof migrants, which has resulted in the polarization of political views about migration. In addition, the coronavirus disease 2019 pandemichas worsened the economic and health conditions of migrants and contributed to hostility to ensuring their health rights. Moreover, theimplementation of hostile laws in some host nations has increased the vulnerability of marginalized migrant subgroups, such as asylumseekers and undocumented individuals. These developments have complicated the historical challenge of identifying high-risk migrantgroups for screening and treatment. However, if European countries can apply the simplified assessment tools and diagnostic tests for viralhepatitis that have been used for decentralized screening and monitoring in resource-poor countries, the uptake of care by migrants couldbe dramatically increased. Given the global calls for the elimination of viral hepatitis, European nations should recognize the importance oftreating this vulnerable migrant population. Political and health strategies need to be adapted to meet this challenge and help eliminateviral hepatitis globally
Scott N, Mohamed Z, Rwegasha J, et al., 2021, Upscaling prevention, testing and treatment to control hepatitis C as a public health threat in Dar es Salaam, Tanzania: A cost-effectiveness model, INTERNATIONAL JOURNAL OF DRUG POLICY, Vol: 88, ISSN: 0955-3959
Yoshida K, Desbiolles A, Feldman SF, et al., 2021, Hepatitis B Core-Related Antigen to Indicate High Viral Load: Systematic Review and Meta-Analysis of 10,397 Individual Participants, CLINICAL GASTROENTEROLOGY AND HEPATOLOGY, Vol: 19, Pages: 46-+, ISSN: 1542-3565
Lemoine M, Kim JU, Ndow G, et al., 2020, Effect of the COVID-19 pandemic on viral hepatitis services in sub-Saharan Africa, LANCET GASTROENTEROLOGY & HEPATOLOGY, Vol: 5, Pages: 966-967
Shimakawa Y, Lemoine M, 2020, Reply to: "Validation of the TREAT-B score for hepatitis B treatment eligibility in a large Asian cohort: TREAT-B improves with age", JOURNAL OF HEPATOLOGY, Vol: 73, Pages: 1284-1285, ISSN: 0168-8278
Kim JU, Majid A, Judge R, et al., 2020, Effect of COVID-19 lockdown on alcohol consumption in patients with pre-existing alcohol use disorder, LANCET GASTROENTEROLOGY & HEPATOLOGY, Vol: 5, Pages: 886-+
Maurice JB, Goldin R, Hall A, et al., 2020, Increased BMI and Type 2 diabetes are the main predictors of NAFLD and advanced fibrosis in liver biopsies of patients with HIV mono-infection., Clinical Infectious Diseases, ISSN: 1058-4838
BACKGROUND: Liver disease is an important cause of morbidity and mortality in people living with HIV (PLWH), of which non-alcoholic fatty liver disease (NAFLD) is an increasingly recognised cause. There is limited data investigating NAFLD in HIV mono-infection and histologically defined disease. We aimed to identify who is at risk of fibrosis, NAFLD and NASH among PLWH, and explore the diagnostic accuracy of non-invasive markers of fibrosis. METHODS: Retrospective cross-sectional international multicentre study including patients with HIV mono-infection, without chronic viral hepatitis or other known causes of chronic liver disease, who underwent liver biopsy for abnormal liver biochemistry and/or clinical suspicion of liver fibrosis. RESULTS: One hundred and sixteen patients from 5 centres were included. Sixty-three (54%) had NAFLD, of whom 57 (92%) had NASH. Overall, 36 (31%) had advanced fibrosis (≥F3) and 3 (3%) cirrhosis. Of the 53 cases without NAFLD, 15 (28%) had advanced fibrosis. Collagen proportionate area (CPA) was similar between cases with and without NAFLD (3% vs 2%). Body mass index (BMI) was independently associated with NAFLD (aOR 1.2 95% CI 1.08-1.34), and type 2 diabetes was independently associated with advanced fibrosis (aOR 3.42 95% CI 1.00-11.71)). The area under the curve for advanced fibrosis was 0.65 and 0.66 for both NAFLD Fibrosis Score (NFS) and FIB-4. Cut-off values of -1.455 (NFS) and 1.3 (FIB-4) have negative predictive values of 0.80 and 0.82, respectively. CONCLUSION: Advanced fibrosis is strongly associated with type 2 diabetes in PLWH. Serological markers require further optimisation.
Baudoin M, Woode ME, Nishimwe ML, et al., 2020, Long-term clinical benefits of Sofosbuvir-based direct antiviral regimens for patients with chronic hepatitis C in Central and West Africa, LIVER INTERNATIONAL, Vol: 40, Pages: 2643-2654, ISSN: 1478-3223
Mohamed Z, Scott N, Al-Kurdi D, et al., 2020, Cost-effectiveness of strategies to improve HCV screening, linkage-to-care and treatment in remand prison settings in England., Liver International, Vol: 40, Pages: 2950-2960, ISSN: 1478-3223
BACKGROUND: A simplified cascade-of-care may improve screening and treatment uptake among incarcerated individuals. We assessed the cost-effectiveness of traditional and simplified screening and treatment in a London remand prison. METHODS: Using empirical data from Her Majesty's Prison (HMP) Wormwood Scrubs, London, we designed a decision tree and Markov transition state model using national average data for HCV screening and treatment for the base-case scenario. This was compared two alternative strategies; (1) general prison population screening and treatment and (2) prioritising screening and treatment among people who inject drugs (PWID) combined with general prison population screening and treatment. Strategies varied the rates of screening (47-90%), linkage-to-care (60-86%) and treatment (21-85%). Cost, utility and disease transition rates were obtained from existing literature. Outcome measures were; screening, treatment and disease-related costs per admitted individual, quality-adjusted life years (QALYs). Incremental cost-effectiveness ratios (ICERs) were calculated for each intervention. All costs and utilities were discounted at a rate of 3.5% per annum. Both univariate and probabilistic sensitivity analyses have been conducted. RESULTS: In our cohort of 5,239 incarcerated individuals with an estimated chronic HCV prevalence of 2.6%, all strategy ICER values (£3,565-10,300) fell below the national willingness to pay threshold (£30,000). Increased successful treatment (7-54%) was observed by an optimising cascade-of-care. A robust sensitivity analysis identified treatment cost of, QALY for mild liver disease and probability of completing treatment as important factors that impact the ICER value. CONCLUSION: In our remand setting, optimising adherence to the cascade-of-care is cost-effective. Where universal screening is not practical, a stratified approach focused on intensive screening and treatment of PWID also results in increased treatment
Cox AL, El-Sayed MH, Kao J-H, et al., 2020, Progress towards elimination goals for viral hepatitis, Nature Reviews Gastroenterology and Hepatology, Vol: 17, Pages: 533-542, ISSN: 1759-5045
The global burden of viral hepatitis is substantial; in terms of mortality, hepatitis B virus and hepatitis C virus infections are on a par with HIV, malaria and tuberculosis, among the top four global infectious diseases. In 2016, the 194 Member States of the World Health Organization committed to eliminating viral hepatitis as a public health threat by 2030, with a particular focus on hepatitis B virus and hepatitis C virus infection. With only 10 years to go until the 2030 deadline is reached, and although much progress has been made towards elimination, there are still some important gaps in terms of policy and progress. In this Viewpoint, we asked a selection of scientists and clinicians working in the viral hepatitis field for their opinions on whether elimination of viral hepatitis by 2030 is feasible, what the key areas of progress are and what the focus for the next 10 years and beyond should be for viral hepatitis elimination.
Nathwani R, Mukherjee S, Forlano R, et al., 2020, Letter: liver disease and COVID-19 - not the perfect storm, Alimentary Pharmacology and Therapeutics, Vol: 52, Pages: 572-574, ISSN: 0269-2813
This article is linked to Garrido et al papers. To view these articles, visit https://doi.org/10.1111/apt.15813 and https://doi.org/10.1111/apt.15886.
Maurice J, Lemoine M, 2020, Are separate clinical trials still required in NASH for patients with and without HIV?, Clin Infect Dis
Bassoum O, Kimura M, Dia AT, et al., 2020, Coverage and timeliness of birth dose vaccination in Sub-Saharan Africa: a systematic review and meta-analysis, Vaccines, Vol: 8, Pages: 1-16, ISSN: 2076-393X
Background: Depending on the epidemiological context of each country, three vaccines are recommended by the World Health Organization (WHO) to be administered as soon as possible after birth (birth vaccines); namely, BCG, zero dose of oral polio vaccine (OPV0), and birth dose of hepatitis B vaccine (HepB-BD). The timely administration of these vaccines immediately after birth might pose significant challenges in sub-Saharan Africa, where about half of childbirths occur outside health facilities. We therefore conducted a systematic review and meta-analysis to estimate the coverage rate of these vaccines at a specific timing in neonates in sub-Saharan Africa. Methods: We searched PubMed, Embase, CINAHL, and Web of Science for studies conducted in sub-Saharan Africa and published up to March 31, 2017, which provided a coverage rate of the birth vaccines at any specific time points within 28 days after birth. Two investigators independently screened the titles and abstracts and extracted data from the eligible full-text articles. This study was registered in PROSPERO (CRD42017071269). Results: Of 7283 articles identified, we finally included 31 studies with 204,111 infants in the meta-analysis. The pooled coverage rates at day 0–1 after birth were 14.2% (95% CI: 10.1–18.9) for BCG and 1.3% (0.0–4.5) for HepB-BD. No data were available for OPV0 at day 0–1. The coverage at day 28 was 71.7% (63.7–79.2) for BCG, 60.8% (45.8–74.7) for HepB-BD, and 76.1% (67.1–84.0) for OPV0. No significant difference in the vaccine coverage was observed between infants born in healthcare facilities and those born outside facilities. Conclusions: The rates of vaccine coverage immediately after birth were very low for BCG and HepB-BD, and no data for OPV0. We need additional data to better define barriers and facilitators for the timely administration of the birth vaccines in sub-Saharan Africa, since the delay in its provision may increase the burden
Sonderup MW, Dusheiko G, Desalegn H, et al., 2020, Hepatitis B in sub-Saharan Africa-How many patients need therapy?, Journal of Viral Hepatitis, Vol: 27, Pages: 560-567, ISSN: 1345-2533
Hepatitis B is endemic in sub‐Saharan Africa with ~60 million people chronically infected. While prevention, through vaccination, is central to elimination strategies, only 11 countries have birth dose vaccination and full vaccine coverage remains at suboptimal levels. Furthermore, to fully realize elimination, those chronically infected need to be identified, assessed for therapy and then linked to care. Given current treatment criteria, the precise quantum of people warranting therapy, according to criteria, is essentially unknown. The issue is further complicated by data to suggest differences in the numbers of people requiring treatment when applying WHO as compared to European Association for the Study of the Liver, EASL, criteria. Optimal determination of treatment eligibility is further hindered by the lack of available tools to adequately assess individual patients. It is conceivable that accurately determining the number of those requiring treatment, given the heterogeneity of hepatitis B in Africa, is difficult. Better studies and data are required. More signifcantly, improved access and availability to the diagnostic tools needed to assess patients in additon to access to drugs are as, if not more important, to achieve elimination.
Guaraldi G, Maurice JB, Marzolini C, et al., 2020, New Drugs for NASH and HIV Infection: Great Expectations for a Great Need, HEPATOLOGY, Vol: 71, Pages: 1831-1844, ISSN: 0270-9139
Shimakawa Y, Ndow G, Njie R, et al., 2020, Hepatitis B core-related antigen (HBcrAg): an alternative to HBV DNA to assess treatment eligibility in Africa, Clinical Infectious Diseases, Vol: 70, Pages: 1442-1452, ISSN: 1058-4838
BACKGROUND: To eliminate hepatitis B virus (HBV) infection, it is essential to scale up testing and treatment. However, conventional tools to assess treatment eligibility, particularly nucleic acid testing (NAT) to quantify HBV DNA, are hardly available and affordable in resource-limited countries. We therefore assessed the performance of novel immunoassay, hepatitis B core-related antigen (HBcrAg), as an inexpensive (US$ <10-15/assay) alternative to NAT to diagnose clinically important HBV DNA thresholds (≥2,000; ≥20,000; and ≥200,000 IU/ml), and select patients for antiviral therapy in Africa. METHODS: Using well-characterized cohort of treatment-naïve patients with chronic HBV infection in The Gambia, we evaluated the accuracy of serum HBcrAg to diagnose HBV DNA levels, and to indicate treatment eligibility determined by the American Association for the Study of Liver Diseases, based on the reference tests (HBV DNA, HBV e antigen (HBeAg), alanine transaminase (ALT), liver histopathology and/or FibroScan). RESULTS: A total of 284 treatment-naïve patients were included in the analysis. The area under the receiver operating characteristic curve (AUROC), sensitivity and specificity of serum HBcrAg were: 0.88 (95% CI: 0.82-0.93), 83.3% and 83.9% to diagnose HBV DNA ≥2,000 IU/ml; and 0.94 (0.88-0.99), 91.4% and 93.2% for ≥200,000 IU/ml. A simplified treatment algorithm using HBcrAg without HBV DNA showed high AUROC (0.91 (95% CI: 0.88-0.95)) with a sensitivity of 96.6% and specificity of 85.8%. CONCLUSIONS: HBcrAg might be an accurate alternative to HBV DNA quantification as a simple and inexpensive tool to identify HBV-infected patients in need of antiviral therapy in low- and middle-income countries.
Nayagam S, Shimakawa Y, Lemoine M, 2020, Mother-to-child transmission of hepatitis B: What more needs to be done to eliminate it around the world?, Journal of Viral Hepatitis, Vol: 27, Pages: 342-349, ISSN: 1345-2533
Mother‐to‐child transmission (MTCT) of hepatitis B virus (HBV) is a key component of the hepatitis B burden worldwide. Despite its efficacy to prevent HBV transmission, infant vaccination is not enough to control HBV MTCT. Additional efforts are urgently needed to evaluate and scale‐up preventive strategies especially in endemic countries, which are most affected. This review highlights the efficacy and barriers of the currently validated measures for the prevention of HBV MTCT and proposes alternatives adapted to resource‐limited settings to eventually achieve HBV elimination worldwide.
Kim JU, Mohamed Z, Mbwambo J, et al., 2020, Hepatitis C virus infection in people who inject drugs in Africa, LANCET INFECTIOUS DISEASES, Vol: 20, Pages: 283-284, ISSN: 1473-3099
Shah R, Boucheron P, Mandaliya K, et al., 2020, Hepatitis C virus infection in people who inject drugs in Africa, LANCET INFECTIOUS DISEASES, Vol: 20, Pages: 282-283, ISSN: 1473-3099
Mohamed Z, Mbwambo J, Rwegasha J, et al., 2020, In-field evaluation of Xpert® HCV viral load fingerstick assay in people who inject drugs in Tanzania, Liver International, Vol: 40, Pages: 514-521, ISSN: 1478-3223
BackgroundAlthough novel hepatitis C (HCV) RNA point-of-care technology has the potential to enhance diagnosis in resource-limited settings, very little real-world validation of their utility exists. We evaluate the performance of HCV RNA quantification using the Xpert® HCV Viral Load Fingerstick assay (Xpert® HCV VL Fingerstick assay) as compared to the WHO pre-qualified plasma Xpert® HCV viral load assay among people who inject drugs (PWID) attending an opioid agonist therapy (OAT) clinic in Dar-es-Salaam, Tanzania. MethodsBetween December 2018 and February 2019 consecutive HCV seropositive PWID attending the OAT clinic provided paired venous and finger-stick samples for HCV RNA quantification. These were processed on-site using the GeneXpert® platform located at the Central tuberculosis reference laboratory. ResultsA total of 208 out of 220 anti-HCV positive participants recruited (94.5%) had a valid Xpert® HCV VL result available; 126 (61%; (95% CI 53.8-67.0) had detectable and quantifiable HCV RNA. 188 (85%) had paired plasma and finger-stick whole blood samples; the sensitivity and specificity for the quantification of HCV RNA levels were 99.1% and 98.7% respectively. There was an excellent correlation (R2=0.95) and concordance (mean difference 0.13 IU/mL, (95% CI -0.9 to 0.16 IU/mL) in HCV RNA levels between plasma samples and finger-stick samples.ConclusionThis study found excellent performance of the Xpert® HCV VL Fingerstick assay for HCV RNA detection and quantification in an African-field setting. Its clinical utility represents an important watershed in overcoming existing challenges to HCV diagnosis, which should play a crucial role in HCV elimination in Africa.
Rapoud D, Quillet C, Khue PM, et al., 2020, Towards HCV elimination among people who inject drugs in Hai Phong, Vietnam: study protocol for an effectiveness-implementation trial evaluating an integrated model of HCV care (DRIVE-C: DRug use & Infections in ViEtnam-hepatitis C), BMJ OPEN, Vol: 10, ISSN: 2044-6055
Mohamed Z, Al-Kurdi D, nelson M, et al., 2019, Time matters: Point of care screening and streamlined linkage to care dramatically improves hepatitis C treatment uptake in prisoners in England, International Journal of Drug Policy, ISSN: 0955-3959
Shimakawa Y, Boucheron P, Liem BLN, et al., 2019, Performance of two simplified HBV treatment criteria (TREAT-B score and WHO guidelines) in Burkina Faso, West Africa, JOURNAL OF HEPATOLOGY, Vol: 71, Pages: 842-844, ISSN: 0168-8278
Yoshida K, Post G, Shimakawa Y, et al., 2019, Clinical utility of TREAT-B score in African and non-African HBV-infected patients living in Europe, JOURNAL OF HEPATOLOGY, Vol: 70, Pages: 1295-1297, ISSN: 0168-8278
Mohamed Z, Kim JU, Magesa A, et al., 2019, High prevalence and poor linkage to care of transfusion transmitted infections among blood donors in Dar-es-Salaam, Tanzania, Journal of Viral Hepatitis, Vol: 26, Pages: 750-756, ISSN: 1352-0504
Blood transfusion is one of the most commonly relied upon therapies in sub‐Saharan Africa. Existing safeguards recommended include systematic screening for transfusion‐transmitted infections and restricted voluntary nonremunerated blood donor selection. We report the transfusion‐transmitted infection screening and notification practice at a large urban blood transfusion centre in Dar‐es‐Salaam, Tanzania. Between October 2016 and March 2017 anonymized records of all donors registered at the blood transfusion unit were accessed to retrospectively note demographic information, donor status, first‐time status, transfusion‐transmitted infection result and notification. 6402 consecutive donors were screened for transfusion‐transmitted infections; the majority were family/replacement blood donors (88.0%) and male (83.8%). Overall transfusion‐transmitted infections prevalence was 8.4% (95% CI 7.8‐9.1), with hepatitis B being the most prevalent infection (4.1% (95% CI 3.6‐4.6)). Transfusion‐transmitted infections were more common in family/replacement blood donors (9.0% (95% CI 8.3‐9.8)) as compared to voluntary nonremunerated blood donor (4.1% (95% CI 2.8‐5.7)). A minority of infected‐donors were notified of a positive result (8.5% (95% CI 6.3‐11.2)). Although transfusion‐transmitted infections are more prevalent among family/replacement blood donors, overall risk of transfusion‐transmitted infections across all groups is considerable. In addition, existing efforts to notify donors of a positive transfusion‐transmitted infection are poor. Future policies must focus on improving linkage to care for newly diagnosed patients with transfusion‐transmitted infections.
Post G, Shalev N, Baumgarten A, et al., 2019, Indication for treatment and severity of disease in treatment-naive patients with chronic hepatitis B virus infection, EUROPEAN JOURNAL OF GASTROENTEROLOGY & HEPATOLOGY, Vol: 31, Pages: 723-728, ISSN: 0954-691X
Background and aims The prevalence of chronic hepatitis B virus (HBV) infection in Europe is poorly defined. Data on theproportion of patients eligible for therapy are lacking but are crucial to meet WHO elimination goals. The aims of our study were toprovide an estimate of the need for antiviral treatment and to assess the prevalence of advanced liver disease in treatment-naive,chronic HBV-infected patients.Patients and methods We performed a retrospective, cross-sectional analysis of all treatment-naive HBV-infected patients.Baseline clinical assessments included sociodemographic data, hepatitis B-specific analyses, and liver stiffnessmeasurement (LSM).Results Between 2010 and 2017, 465 patients with chronic HBV infection were referred, with 301 (64.7%) being eligible for ouranalysis. Overall, 40% were female, and the mean age was 39.3 ± 13.1 years. Moreover, 61% of patients were born outsideEurope, predominantly in the Asia-Pacific region. The median HBV viral load was 1630 IU/ml (interquartile range: 240–35 000 IU/ml), 145 (48.2%) patients had an HBV viral load above 2000 IU/ml, and 14.3% were HBeAg positive. Median LSM was 5.2 kPa(interquartile range: 4.2–6.6 kPa). LSM indicating clinically significant fibrosis (≥F2) was found in 96/271 (35.0%) patients,including 20/271 (7.4%) patients with suspected advanced fibrosis/cirrhosis. Overall, 26% of patients met EASL 2017 treatmentcriteria.Conclusion In HBV-infected patients referred to one of the largest ID clinics in Berlin, only 26% met EASL treatment criteria and7% had suspected cirrhosis at presentation. Only in 4% of all patients, a treatment indication could not be determined by anoninvasive approach.
Dusheiko G, Lemoine M, 2019, An appraisal of the WHO hepatitis B treatment guidelines applicability to Africans., Journal of Hepatology, Vol: 70, Pages: 1046-1048, ISSN: 0168-8278
Cohen D, Shimakawa Y, Ndow G, et al., 2019, Prevention of liver fibrosis and liver cancer linked to hepatitis B virus in Africa: the Prolifica study, médecine/sciences, Vol: 35, Pages: 431-439, ISSN: 0767-0974
Despite the existence of an effective vaccine, HBV infects 257 million people worldwide and is the cause of the majority of HCC. With an annual mortality rate of 887 000 patients in 2015, this cancer is the second deadliest. Low-income countries such as ones in sub-Saharan Africa are the most at risk due to the limited access to healthcare. To overcome this and born from an international research collaboration within an EU project, the Prolifica study aimed at evaluating a screen-and-treat program to prevent HBV complications, and more particularly HCC. Based on communities, facilities and hospitals HBsAg+ detection, the study lasted from 2011 to 2016. From the “cost effectiveness” feasibility of such a program to the development of simple scores for antiviral treatment, Prolifica uncovered data of crucial importance in a region with low HBV infection awareness, transmissions modes and prevention means which could have impacts on public health policies.
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