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Keywords: Europe; hepatitis B infection; hepatitis C infection; migrants; refugees EN Europe hepatitis B infection hepatitis C infection migrants refugees 634 637 4 07/25/23 20230801 NES 230801 Abbreviations EEA European Economic Area EU European Union HBV hepatitis B virus HCV hepatitis C virus Migrants from some areas of the world bear a high burden of hepatitis C virus (HCV) chronic infection and may represent a major proportion of chronic HCV carriers in countries where the background infection rate is otherwise low. The rate of HBV infection among migrants to European Union (EU) countries born in highly endemic regions was reported as 6%, compared to 1% in the general population.[4] Regarding HCV infection, migrants account for a large proportion of HCV cases in the EU/EEA (on average 14% of cases and >50% of cases in some countries).[4] Data from 50 studies reporting on 38,635 migrants from all world regions show an overall seroprevalence of HCV of 1.9% (95% CI: 1.4-2.7, I I i SP 2 sp 96.1). Estimating the scale of chronic hepatitis C virus infection in the EU/EEA: a focus on migrants from anti-HCV endemic countries. In this country, migrants account for 35% of HCV infections, despite representing only 22% of the population.[1] Passos-Castilho and colleagues aimed to investigate sub-groups of migrants, defined as persons born outside of Canada with permission to live permanently in Canada, who displayed the highest HCV infection rates and changes over time. [Extracted from the article]

Summary: Through record linkage, we describe the causes of death among persons with diagnosis of hepatitis C virus (HCV) in England. Persons ≥1 year with anti‐HCV/HCV‐PCR tests reported to PHE sentinel surveillance during 2002‐2016 were linked to death registrations from the Office for National Statistics during 2008‐2016. We found that 8.6% of the 204 265 with evidence of HCV during the study period died. Among them, external causes (accidental poisoning from drugs) and liver disease (end‐stage liver disease, liver cancer, hepatitis, alcohol‐ and non–alcohol‐related) were the leading underlying causes of death (18% and 34.5%, respectively); the latter increased to 49.2% if reported anywhere on the death certificate. Median age of death was lower in persons with evidence of HCV than the general population (53 years vs 81 years). A higher proportion of persons with HCV died of external causes, liver disease and HIV compared to the general population (P < 0.001). Potential impact of new HCV treatments was observed as a relative reduction in liver‐related deaths in 2016 compared with 2015. Recording of HCV as a contributory cause of death was 28.4% for all underlying causes, but 58.8% among the subgroup who died of liver disease. Data linkage between laboratory diagnosis and deaths data is an important tool for monitoring all‐cause mortality among those with HCV and quantifying under‐reporting of HCV in death registrations. Changes in mortality trends (causes and prematurity) in people with HCV can help evaluate the impact in the UK of HCV treatment scale‐up and other interventions to achieve HCV elimination. [ABSTRACT FROM AUTHOR]

Limited data are available on direct-acting antivirals for treating hepatitis C virus ( HCV) infection in patients with severe renal impairment. The aim of this study was to evaluate the effectiveness and safety of ombitasvir/paritaprevir/ritonavir ( OBV/ PTV/r) ± dasabuvir ( DSV) ± ribavirin ( RBV) in patients with stage 4 or 5 chronic kidney disease ( CKD) and HCV genotype 1 or 4 infection in real clinical practice, and to investigate pharmacological interactions. This retrospective study included patients treated with OBV/ PTV/r+ DSV± RBV or OBV/ PTV/r+ RBV with CKD stage 4 ( eGFR: 15-29 mL/min/1.73m2) or 5 ( eGFR<15 mL/min/1.73m2 or requiring dialysis) and HCV infection by genotypes 1 and 4 between April 2015 and October 2015 in nine Spanish centres. Sustained virological response at 12 weeks ( SVR12) was assessed, and clinical and laboratory data, fibrosis stage, adverse events and pharmacological interactions were reported. Forty-six patients were included: 10 (21.7%) had CKD stage 4 and 36 (78.2%) CKD stage 5. Seventeen (36.9%) had cirrhosis. SVR12 rate in the intention-to-treat population was 95.7%. Twenty-one (45.6%) received RBV, which was discontinued in two (9.5%) patients. Anaemia (haemoglobin <10 g/dl) occurred in 12 patients (57.1%) with RBV vs 10 (40.0%) without RBV ( P=.246). Renal function remained stable during antiviral therapy. Nine patients (19.5%) experienced serious adverse events unrelated to antiviral therapy. Concomitant medication was discontinued or modified in 41.3% of patients. In conclusion, the effectiveness of OBV/ PTV/r± DSV± RBV in patients with CKD 4-5 was similar to that observed in those with normal renal function and was not associated with severe adverse events. [ABSTRACT FROM AUTHOR]

One challenge to HCV elimination through therapeutic intervention is reinfection. The aim of this analysis was to calculate the incidence of HCV reinfection among both HIV-positive and HIV-negative individuals treated for recent HCV infection (estimated infection duration <18 months). Individuals with recent HCV infection who achieved an end-of-treatment response in four open-label studies between 2004 and 2015 in Australia and New Zealand were assessed for HCV reinfection, confirmed by sequencing of the Core-E2 and/or NS5B regions. Reinfection incidence was calculated using person-time of observation. Exact Poisson regression analysis was used to assess factors associated with HCV reinfection. The cohort at risk for reinfection ( n=120; 83% male; median age 36 years) was composed of HIV-positive men-who-have-sex-with-men (53%) and people who inject drugs (current 49%, ever 69%). Total follow-up time at risk was 135 person-years (median 1.08 years, range 0.17, 2.53). Ten cases of HCV reinfection were identified, for an incidence of 7.4 per 100 py (95% CI 4.0, 13.8). Reinfection incidence was significantly higher among participants who reported injection drug use at end of or post-treatment, irrespective of HIV status (15.5 per 100 py, 95% CI 7.8, 31.1). In adjusted analysis, factors associated with reinfection were older age ( aIRR 5.3, 95% CI 1.15, 51.5, P=.042) and injection drug use at end of or post-treatment ( aIRR 7.9, 95% CI 1.6, 77.2, P=.008). High reinfection incidence following treatment for recent HCV infection in individuals with ongoing risk behaviour emphasizes the need for post-treatment surveillance, harm reduction strategies and education in at-risk populations. [ABSTRACT FROM AUTHOR]

Hepatitis C infection (HCV) and menopause are associated with insulin resistance (IR), and IR accelerates HCV-induced liver disease. The relationship between menopause and IR has not been studied in this population. This study aimed to assess the impact of menopause on IR and metabolic syndrome in HCV. One hundred and three (69 men, 16 premenopausal, 18 postmenopausal women) noncirrhotic, nondiabetic HCV-infected adults underwent IR measurement via steady-state plasma glucose during a 240-min insulin suppression test. Metabolic syndrome was defined by at least three of five standard laboratory/clinical criteria. The patient characteristics were as follows: mean age 48 years, waist circumference 94.4 ± 12.4 cm and 37.9% Caucasian. SSPG was higher in postmenopausal than premenopausal women or men (mean difference 18, 95% CI −41 to 76 and 35, 95% CI −3 to 72 mg/dL; respectively). After adjusting for waist circumference, female gender, nonwhite race and triglycerides were positively associated and high-density lipoprotein negatively associated with steady-state plasma glucose. Compared to men, both pre- (Coef 48, 95% CI 12-84) and postmenopausal women (Coef 49, 95% CI 17-82) had higher steady-state plasma glucose. Compared to premenopausal women, men (OR 2.0, 95% CI 0.38-10.2) and postmenopausal women (OR 2.9, 95% CI 0.46-18.8) had higher odds of metabolic syndrome, but this was statistically nonsignificant. Both liver inflammation (OR 7.9) and nonwhite race (OR 6.9) were associated with metabolic syndrome. We conclude that women are at inc-reased risk for IR in HCV. There may also be an increased risk of metabolic syndrome postmenopause. Along with lifestyle modification and weight loss, women with metabolic abnormalities represent an especially at-risk group warranting HCV treatment to prevent adverse metabolic outcomes. [ABSTRACT FROM AUTHOR]

. Neuropsychological assessment has three main applications in clinical hepatology: (i) to detect, grade and monitor liver failure-related cognitive alterations in end-stage liver disease (hepatic encephalopathy), (ii) to substantiate complaints of attention or concentration difficulties in patients with non-cirrhotic chronic hepatitis C viral infection, and (iii) to screen patients who are being considered for liver transplantation for early signs of dementia. However, there is limited agreement on how cognitive assessment should be conducted in these patients, and how results should be interpreted and used to implement clinical decisions. In this review, we summarize the available literature on neuropsychological dysfunction in patients with cirrhosis and with chronic hepatitis C viral infection and provide some guidance on how to utilize neuropsychological assessment in practice. [ABSTRACT FROM AUTHOR]

Knowing the likely distribution of intervals from hepatitis C infection to first RNA-negativity is important in deciding about therapeutic intervention. Prospectively collected sera and data from the Transfusion-transmitted Viruses Study (1974–1980) provide specific dates of infection and pattern of alanine aminotransferase (ALT) elevations. We examined frequency, timing and correlates of spontaneous resolution for 94 acutely infected transfusion recipients followed for a median of 9.5 months. Later, follow-up sera (>10 years) were available for 27 of the 94 cases from a Veterans Administration (VA) Study (1989–1990). Twenty-five (27%) of the 94 cases were classified as probably resolved during the episode itself. First RNA negativity occurred at 6–50 weeks (median, 19.5 weeks) after infection, and 5–43 weeks (median, 11 weeks) after ALT elevation. Thirteen of the 25 cases remained RNA-negative subsequently; 12 others had 1–6 RNA-positive sera intercalated between first and last RNA-negative results. RNA negativity, therefore, began variably and was interrupted in 12 cases of 25 (48%) by transient RNA-positive sera. Five of these 25 patients who were RNA-negative in the last study specimen had late, Veterans Administration Study follow-up; none showed viraemia. Of the remaining 69 transfusion transmitted virus study recipients, whose last serum was RNA-positive, two cleared viraemia after the last study serum but before late follow-up. Eleven (16%) had 23 intercalated RNA-negative sera before last positivity. RNA status, therefore, needs monitoring for many months before judging the spontaneous outcome as transient negativity may occur. Resolution was significantly more common in women and symptomatic cases; it was not associated with viral load in the infectious donation, HCV genotype, or the recipient’s age. [ABSTRACT FROM AUTHOR]

The on-treatment impact of interferon-based therapies on quality of life (QOL), work productivity, and medical resource utilization has not been systematically studied. We evaluated the effects of treatment with peginterferon alpha (pegIFN α) 2a monotherapy and the combination of interferon alpha (IFN α) 2b plus ribavirin (RBV) on health-related QOL, work productivity and resource utilization. A total of 412 patients with hepatitis C infection were randomized to open-label treatment with either pegIFN α 2a ( n = 206) or IFN α 2b/RBV ( n = 206). PegIFN α 2a was administered subcutaneously at a dose of 180 μg once weekly for 48 weeks; and IFN α 2b/RBV at doses of 3 MU thrice weekly subcutaneously and 1000–1200 mg/day orally. Outcome measures included the SF-36 Health Survey Questionnaire and additional generic and specific scales. During treatment, for all SF-36 summary and Hepatitis Quality of Life Questionnaire (HQLQ)-specific scales, the pegIFN α 2a group experienced less impairment than did the IFN α 2b/RBV patients. The between-treatment differences were significant for many of the scores particularly in the first 24 weeks of treatment. Across all measures of work functioning and productivity at each visit, patients randomized to pegIFN α 2a treatment showed less impairment relative to the group treated with IFN α 2b/RBV. Hence treatment with pegIFN α 2a relative to IFN α 2b/RBV minimizes the adverse impact of therapy on health-related QOL. Patients randomized to pegIFN α 2a had improved work productivity, less activity impairment, decreased need for prescription drugs to treat adverse effects, and better adherence to therapy. [ABSTRACT FROM AUTHOR]