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Hepatology ; 76(Supplement 1):S386-S388, 2022.
Article in English | EMBASE | ID: covidwho-2157790


Background: In France, prescribing authorization for hepatitis C virus (HCV) treatment has been expanded to all physicians including non-specialists working in addiction and psychiatric centers and in jails. Patient management includes a Test and Treat approach (TnT) to expedite treatment initiation and a pathway for severe patients followed-up by specialists. This is a descriptive, interim analysis of an ongoing study to assess the efficacy and safety of Sofosbuvir/Velpatasvir (SOF/VEL) for 12 weeks after prescription expansion in patients treated by specialists and non-specialists. Method(s): Included patients are HCV-infected adults following SOF/VEL-based regimens prescribed by primary care physicians and specialists. Data collected from available information in medical records include patient characteristics, number of days between positive PCR/fibrosis assessment and start of therapy, and proportion of patients with sustained virologic response (SVR) 12 weeks after treatment end. Qualitative variables are described as number and percentage (%);quantitative measures as mean (standard deviation;SD) or median (range) as indicated. Result(s): Table) As of January 2022, 286 patients had received at least one dose of SOF/VEL treatment;217 were managed by specialists and 69 by non-specialists. Median patient age was 53.14 years (19.8-88.7), 80 (28%) were F3/F4 and 185 (64.7%) were male. Occasional and excessive consumption of alcohol was reported in 43 (62.3%) and 87 (40.8 %) patients managed by specialists and non-specialists respectively. Current recreational drug use was reported more frequently in 37 patients (53.6%) managed by non-specialists and 40 patients (18.6%) managed by specialists. Mean number of days between SOF/VEL initiation and fibroscan and Fib 4 were 62.16 +/- 306.39 and 40.35 +/- 60.24, respectively. Median number of days between positive PCR and start of therapy was 89.19 +/- 311.17 and 60.65 +/- 80.71 for patients managed by specialists and non-specialists respectively, and only 2 were lost to follow-up. Among 167 eligible patients who achieved an SVR12, 124 (97.6%) [93.28;99.19] were managed by specialists and 40 (100.0%) [91.24;100.00] by non-specialists;according to fibrosis stage, 107 F0-F2 patients (100.0%) and 39 F3-F4 (92.9%) achieved SVR12. Overall, at least one adverse event was observed in 34 patients (11.9%), of which only 2 (0.7%) lead to drug withdrawal. Conclusion(s): This interim analysis describes a French study population benefiting from SOF/VEL in real world use after treatment prescription expansion. SVR12 rates were high, regardless of the type of patient management and stage of fibrosis suggesting that HCV patients could be treated by SOF/VEL for 12 weeks by non-specialists. Despite the COVID 19 situation this study suggested that HCV patient pathway could be more optimized regarding fibrosis assessment or genotype determination.

Transplantation ; 106(8):44, 2022.
Article in English | EMBASE | ID: covidwho-2040915


Background: Liver transplant recipients have a poorer vaccine response than the general population. Real-life data on SARS-CoV-2 vaccination in liver transplant recipients are limited. The objective of this study was to evaluate the efficacy and safety of the vaccine and identify factors associated with vaccine response. Methods: This was a retrospective observational study of consecutive liver transplant recipients attending CHU De Montpellier. Data on the transplantation indication, immunosuppression, vaccine type, and serology 28 days after the last vaccine dose were collected. Serology below 30 BAU/ml (WHO units) defined non-responders, 30-260 BAU/ml low responders, and >260 BAU/ml responders. Results: 494 patients were included between 1 January and 15 March 2021. 366 (74%) patients were vaccinated: 280 with 3 doses, 63 with 2 doses, and 23 with 1 dose. Complete data were available for 234 patients. 164 (70.1%) patients were male, with a mean age of 59±12 years with a mean time to transplantation of 4.9±5.9 years. No serious adverse events were reported. Of 201 (85.9%) patients with complete vaccination and post-vaccination serology, 104 (51.7%) were responders, 45 (22.4%) poor responders, and 52 (25.9%) nonresponders. In multivariate analysis, factors associated with no or low response were vaccination with Vaxzevria alone (HR 6.8 [1.46- 31.67], p=0.046), mycophenolate mofetil (MMF) therapy (HR 2.1 [1.1-3.9], p=0.025), no previous SARS-CoV-2 infection prior to vaccination (HR 3.6 [1.025-12.89], p=0.046), and female gender (HR 2.4 [1.15-4.99], p=0.02). Conclusions: Only half of our patients were vaccine responders after three injections. MMF, female gender, and Vaxzevria vaccination were associated with a poorer response, while previous SARS-CoV-2 exposure was associated with a better response.

Public Finance Quarterly ; 67(2):217-234, 2022.
Article in Hungarian | Scopus | ID: covidwho-1989031
Journal of Hepatology ; 77:S771-S771, 2022.
Article in English | Web of Science | ID: covidwho-1980863
Article in English | Web of Science | ID: covidwho-1939733


The Covid-19 crisis and its economic consequences for emerging countries have highlighted the role of robust, inclusive, and equitable elements of multiple contingency lines to keep these economies away from falling into a devastating cycle of rising sovereign spread. This study first summarizes the crisis-fighting performance of the IMF and eight major RFAs since the outbreak of Covid-19. Then our theoretical model focuses on the deterioration of market expectations (namely about future global economic growth, funding conditions in key currencies and public default) influence on the sovereign spread, by employing a structural panel Vector Autoregression. The results showed that sovereign spread depended not only on the global and local growth or the external funding environment but on the market sentiment as well. Also, the results pointed out the importance of financial supports by international actors like the IMF and partially the RFAs in managing the sovereign spread.