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1.
Zoonoses ; 2(19), 2022.
Article in English | CAB Abstracts | ID: covidwho-2025752

ABSTRACT

Since the International Health Regulations National Focal Point for the United Kingdom alerted the WHO of ten cases of acute severe hepatitis of unknown etiology in children on April 5, 2022, relevant cases have been reported worldwide. These patients had acute hepatitis (negative for hepatitis viruses A-E) and elevated aminotransferase (AST) or alanine aminase (ALT) exceeding 500 U/L. Furthermore, severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) and/or adenovirus type F41 have been detected in some cases. This unknown hepatitis has been hypothesized to be induced by a viral reservoir of novel coronavirus superantigen, which repeatedly stimulates the intestines and leads to a multisystem inflammatory syndrome in children (MIS-C), which causes immune abnormalities in the presence of human adenovirus. Although this hypothesis has not been confirmed by any in vivo experimental or clinical studies, it may provide ideas for possible intervention strategies.

2.
Frontiers in Immunology ; 13, 2022.
Article in English | Web of Science | ID: covidwho-2022724

ABSTRACT

Immune system is a versatile and dynamic body organ which offers survival and endurance of human beings in their hostile living environment. However, similar to other cells, immune cells are hijacked by senescence. The ageing immune cells lose their beneficial functions but continue to produce inflammatory mediators which draw other immune and non-immune cells to the senescence loop. Immunosenescence has been shown to be associated with different pathological conditions and diseases, among which atherosclerosis has recently come to light. There are common drivers of both immunosenescence and atherosclerosis;e.g. inflammation, reactive oxygen species (ROS), chronic viral infections, genomic damage, oxidized-LDL, hypertension, cigarette smoke, hyperglycaemia, and mitochondrial failure. Chronic viral infections induce inflammaging, sustained cytokine signaling, ROS generation and DNA damage which are associated with atherogenesis. Accumulating evidence shows that several DNA and RNA viruses are stimulators of immunosenescence and atherosclerosis in an interrelated network. DNA viruses such as CMV, EBV and HBV upregulate p16, p21 and p53 senescence-associated molecules;induce inflammaging, metabolic reprogramming of infected cells, replicative senescence and telomere shortening. RNA viruses such as HCV and HIV induce ROS generation, DNA damage, induction of senescence-associated secretory phenotype (SASP), metabolic reprogramming of infected cells, G1 cell cycle arrest, telomere shortening, as well as epigenetic modifications of DNA and histones. The newly emerged SARS-CoV-2 virus is also a potent inducer of cytokine storm and SASP. The spike protein of SARS-CoV-2 promotes senescence phenotype in endothelial cells by augmenting p16, p21, senescence-associated beta-galactosidase (SA-beta-Gal) and adhesion molecules expression. The impact of SARS-CoV-2 mega-inflammation on atherogenesis, however, remains to be investigated. In this review we focus on the common processes in immunosenescence and atherogenesis caused by chronic viral infections and discuss the current knowledge on this topic.

3.
Journal of Viral Hepatitis ; : 1, 2022.
Article in English | Academic Search Complete | ID: covidwho-2019528

ABSTRACT

The COVID‐19 pandemic necessitates healthcare restrictions that also affected ongoing hepatitis C virus (HCV) elimination efforts. We assessed the value of a physician‐operated HCV hotline on treatment and cure rates throughout the pandemic. All HCV patients undergoing HCV therapy at the Vienna General Hospital from 2019 to 2021 were included. An HCV hotline was established in 2019 and provided services including phone calls, text messages and voicemails. Patients were stratified by date of HCV therapy: 2019 (pre‐COVID) vs. 2020/2021 (during‐COVID) and use of the HCV hotline: users vs. non‐users. Overall, 220 patients were included (pre‐COVID: n = 91 vs. during‐COVID: n = 129). The prevalence of intravenous drug use (60.5%) and alcohol abuse (24.8%) was high during COVID. During COVID, the number of DAA treatment starts declined by 24.2% (n = 69) in 2020 and by 34.1% (n = 60) in 2021 vs. pre‐COVID (n = 91, 100%). Significantly more patients used the HCV hotline during‐COVID (95.3%) vs. pre‐COVID (65.9%;p < .001). Sustained virologic response (SVR) was 84.6% pre‐COVID and 86.0% during‐COVID. HCV hotline users achieved higher SVR rates during‐COVID (88.2% vs. 33.3%, p = .004), but also pre‐COVID (96.7% vs. 61.3%, p < .001) compared with non‐users. Considering only patients with completed DAA treatments, SVR rates remained similarly high during‐COVID (96.9%) versus pre‐COVID (98.1%). HCV treatment initiations decreased during‐COVID but importantly, nearly all DAA‐treated HCV patients used the HCV hotline during the COVID pandemic. Overall, the SVR rate remained at 88.2% during COVID and was particularly high in HCV phone users—most likely due to facilitation of adherence. [ FROM AUTHOR] Copyright of Journal of Viral Hepatitis is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

4.
Journal of the Formosan Medical Association ; 121(9):1617-1621, 2022.
Article in English | Scopus | ID: covidwho-2015654
5.
Annals of the Rheumatic Diseases ; 81:1688, 2022.
Article in English | EMBASE | ID: covidwho-2009058

ABSTRACT

Background: According to the recent medical literature, COVID-19 disease can lead to a constellation of clinical syndromes lasting well beyond the frst 30 days of infection. The most common post COVID sequalae includes pulmonary, nervous system and neurocognitive, mental, metabolic, cardiovascular, gastrointestinal and several other clinical manifestations. Regarding joint involvement and particularly reactive arthritis (ReA), literature data is limited and describes case reports or series of cases of patients diagnosed with this condition following COVID-19 disease. Objectives: To describe the pattern and the management of post-COVID reactive arthritis. Methods: We have conducted a descriptive study of consecutive adult patients who presented to rheumatology outpatient clinic for joint or peri-articular pain/swelling/stiffness and received a diagnosis of post-COVID 19 reactive arthritis, by excluding other types of rheumatological conditions. The assessed clinical variables were: visual analogue scale (VAS) pain, swollen joint count (SJC), tender joint count (TJC), duration of morning stiffness, presence of enthesitis/tendinitis and axial involvement. Biochemistry and serology was performed: rheumatoid factor, ACPA, ANA, HLA B27, antiChlamydia Trachomatis, Ureaplasma Urealyticum and Mycoplasma Hominis Ab, anti HBs and HBc Ab, and anti HCV. COVID-19 disease prior to diagnosis of ReA was confrmed by PCR test. Results: In the study were included 16 patients with confrmed post COVID-19 ReA. The mean age of the study group was 43.5±10.8 (range 21-60), the female: male ratio was 4:1 and the duration of joint symptoms was 10.4±11.8 (range 1-42) weeks. The severity of COVID-19 disease was mild in 68.7% cases, moderate in 18.7% and severe in only 6.2% of the cases. The duration between COVID-19 diagnosis and ReA varied between cases, with a mean value of 4.3±4.2 (range 1-12) weeks. In 43.7% of the cases patients had peripheral joint involvement (synovitis), in 37.5%-periarticular involvement (enthesitis), 6.25%-isolate axial involvement (sacroiliac joints), 6.25% enthesitis and axial involvement (cervical spine) and 6.25% synovitis and enthesitis. In patients with peripheral joint pattern, the distribution of pain was symmetric (71.4%). The pattern of synovitis was determined by a TJC of 6.25±5.2 (range 1-16) joints and SJC 1.6±2.4 (range 0-7) joints. Both TJC and SJC correlated positively with the duration of morning stiffness (r=0.9 and r=0.6), but did not correlate with the VAS pain scale. In most of the cases synovitis affected the hand (wrist, MCP and PIP) 62.5% and the knee, feet and ankles-50%. Two patients presented with monoarthritis, 1 with oligoarthritis and 5 with polyarthritis, in the majority of cases, involvement being symmetric (75%). Periarticular pattern was determined by enthesi-tis, affecting the elbow and shoulder (50%), costo-sternal enthesitis (25%) and trochanteritis (25%). From the entire study group, 31.2% had elevated serum infammatory markers (ESR and/or CRP). Patients responded well to NSAIDs alone in 68.7% cases, local (intra-articular or peri-articular infltrations) or and systemic corticoids (5 mg Prednisolone equivalent) were administered in 5.3% and 12.5% cases respectively, in 12.5% cases (two patients) Methotrexate was administered. Conclusion: Reactive arthritis represents a post COVID-19 sequelae. The time of onset of ReA varied between 1 and 12 weeks after COVID-19 diagnosis. The clinical pattern of the disease was expressed by joint or periarticular involvement, mainly affecting the hand, feet and knee symmetrically. Cases of axial manifestations were less common. Most of the patients responded well to NSAIDs, only in a few particular cases, low doses of corticoids and/or Methotrexate were recommended.

6.
Indian Journal of Critical Care Medicine ; 26:S13, 2022.
Article in English | EMBASE | ID: covidwho-2006326

ABSTRACT

Aim and Background: We present a rare case of autoimmune haemolytic anemia (AIHA) in a 65-year-old patient 1-month post- COVID-19 vaccination. AIHA is a clinical condition characterized by autoantibody-mediated RBC destruction. Materials and methods: Our patient had cold agglutinin disease, where antibody-mediated RBC lysis was demonstrated predominantly at 4-degree centigrade. Although AIHA is rare in this age group, after excluding all secondary causes of AIHA like Epstein bar virus (EBV), hepatitis C virus, cryoglobulinemia, lymphomas we came to a conclusion that AIHA in this patient was triggered post-vaccination. We treated AIHA with steroids and rituximab. Conclusion: Though vaccination is safe patients present with mild-to-moderate symptoms post-vaccination like fevers, limb pain, allergies hair loss, which are transient. Some patients may develop haemolysis secondary to autoantibody production post-vaccination owing to molecular mimicry. Hence, clinicians treating should have a high suspicion for it.

7.
Canadian Liver Journal ; 2022.
Article in English | Web of Science | ID: covidwho-2005842

ABSTRACT

BACKGROUND: Infection with chronic hepatitis C virus is a global public health concern. A recent study concluded that Canada is on track to achieve hepatitis C elimination goals set by the World Health Organization if treatment levels are maintained. However, recently a falling temporal trend in treatments in Canada was observed, with most provinces seeing a decrease before the global coronavirus pandemic. This study assesses the timing of elimination of hepatitis C in the 10 provinces of Canada. METHODS: Previously published disease and economic burden model of hepatitis C infection was populated with the latest epidemiological and cost data for each Canadian province. Five scenarios were modelled: maintaining the status quo, decreasing diagnosis and treatment levels by 10% annually, decreasing diagnosis and treatment levels by 20% annually, increasing them by 10% annually, and assuming a scenario with no post-coronavirus pandemic recovery in treatment levels. Year of achieving hepatitis C elimination, necessary annual treatments for elimination, and associated disease and economic burden were determined for each province. RESULTS: If status quo is maintained, Manitoba, Ontario, and Quebec are off track to achieve hepatitis C elimination by 2030 and would require 540, 7,700, and 2,800 annual treatments, respectively, to get on track. Timely elimination would save 170 lives and CAD$122.6 million in direct medical costs in these three provinces. CONCLUSIONS: Three of Canada's provinces-two of them most populous in the country-are off track to achieve the hepatitis C elimination goal. Building frameworks and innovative approaches to prevention, testing, and treatment will be necessary to achieve this goal.

8.
Gut ; 71:A82-A83, 2022.
Article in English | EMBASE | ID: covidwho-2005361

ABSTRACT

Introduction Delivery of the World Health Organisation elimination agenda for Hepatitis C Virus (HCV) requires active case finding, to engage hard to reach risk groups. Surrey is a relatively affluent part of the country, but contains pockets of significant unmet need, which are a barrier to the HCV care cascade. In 2020 the Surrey HCV Operational Delivery Network (ODN) piloted 'pop up clinics' for housed homeless populations during the COVID 19 pandemic. Based on this experience the ODN lead successfully bid for NHS England funding for a Mobile Outreach Van (MOV). Methods Detailed mapping of the ODN was undertaken jointly with the Hepatitis C Trust to identify potential locations to screen e.g., Opiate Substation Therapy dispensing pharmacies, and areas with high numbers of homeless people. MOV procurement and governance obtained in accordance with Trust policy. Individuals complete a brief liver health questionnaire including Blood Bourne Virus (BBV) risk factors. HCV screening is undertaken using Oraquick point of care testing. Those screening HCV Antibody positive (Ab +ve) receive a Clinical Nurse Specialist (CNS) assessment for therapy including a BBV screen HCV PCR and Fibro Scan. Hepatitis C Trust peer support is available to all individuals. Other significant findings prompt onward referral e.g., cirrhosis surveillance. Results First six months of operation the team have undertaken 50 testing days in 16 venues. 761 individuals have accepted HCV Ab screening. 40 (5.2%) tested HCV Ab +ve. 10 individuals confirmed viraemic and eligible for treatment. Another 7 individuals were re-engaged to undertake end of treatment or Sustained Virologic Response 12/48 PCR. In addition, 1 HCV Ab +ve (PCR negative), patient was diagnosed with Human Immunodeficiency Virus and referred to the local sexual health team. 16 individuals identified with advanced fibrosis or cirrhosis were referred to hospital for Hepatocellular Carcinoma surveillance. Patients engaged through the MOV service have received their treatment in the community via this service delivered by a CNS. Conclusions Nurse led MOV screen test treat model has proven to be safe and effective in engaging difficult to reach populations. Hepatitis C Trust peers accessibility help to address the anxiety/stigma surrounding HCV. MOV wider benefits include engagement with drug and alcohol services, and harm reduction. The next phase of implementation, the team plan to deliver needle exchange and naloxone in a partnership agreement with Surrey County Council.

9.
Gut ; 71:A80-A81, 2022.
Article in English | EMBASE | ID: covidwho-2005360

ABSTRACT

Introduction As part of the national Hepatitis C (HCV) elimination strategy, NHS England aims to eliminate HCV by 2025. As part of this programme, identifying undiagnosed cases through HCV testing is critical. Unfortunately, the global COVID 19 pandemic led to a reduction in HCV testing in England, potentially slowing progress towards elimination. To mitigate the impact of this, innovative ways of increasing HCV testing are required. Individuals detained in police custody have higher rates of injecting drug use than the general population and may therefore be at risk of HCV transmission. Police custody suites may therefore provide an opportunity to offer HCV testing to 'at risk' individuals. In collaboration with local police custody healthcare staff, we developed a pilot of HCV testing for individuals in police custody. Here we describe the outcomes of this pilot Methods Since 01/07/2021, all individuals presenting to Northumbria police custody suites who were reviewed by a healthcare professional were offered Dried Blood Spot test (DBS) for HCV Antibody/RNA, HIV and HBsAg. Individuals were excluded if they were <16 years of age or alleged perpetrators of sexual violence. The Newcastle HCV team were responsible for informing people of their results and establishing those with a positive HCV result on a treatment pathway. Results Of the 3116 people in police custody identified as eligible to be offered BBV testing (See figure 1), 193 accepted (6%). A total of 19 were HCV Ab positive (10% of total individuals tested) and of these 12 were HCV RNA detected (63.0% of HCV Ab positive and 6% of total individuals tested). No cases of HIV or hepatitis B were identified. 137 (71.0%) individuals were negative for all BBV's. Unfortunately, 37 (19%) samples could not be processed by the lab due to insufficient samples (19.0%). This was identified as a training issue and addressed by senior custody suite staff. of the 12 cases of active HCV identified, 5 have commenced HCV antiviral treatment, 6 are awaiting treatment and 1 person is awaiting retesting as the result was 'weak positive'. of the 7 individuals who were HCV Antibody positive but RNA negative, 3 had self-cleared, 3 were known to have received antiviral treatment and achieved a sustained virological response and 1 patient was currently on treatment. Conclusions The pilot demonstrated that HCV screening can successfully be implemented into the police custody suites, leading to a diagnosis of active HCV in 6%. Wider implementation of this strategy could help progress towards HCV elimination.

10.
Gut ; 71:A74-A75, 2022.
Article in English | EMBASE | ID: covidwho-2005357

ABSTRACT

Introduction Home self-testing has been validated for HIV with evidence for increased uptake, comparable linkage to care and an absence of harm in those at risk. However, there are limited data on this strategy for people at risk of HCV infection (WHO 2021). Surrey HCV ODN Drug and Alcohol services (iAccess & Inclusion) provide a range of interventions including structured treatment for people with a history of alcohol or substance misuse. During COVID most clinics moved to telephone consultations, reducing BBV screening opportunities. This project targeted service users with > 12 months follow up for reengagement with HCV testing through supported home self-testing for HCV with rapid linkage to care through the ODN. Methods Interrogation of the EPR at the DTS (iAccess and Inclusion) identified a target population of older clients (>45years) who had not previously engaged with the offer of HCV testing. Exclusion criteria: previous positive HCVAb result, prior HCV treatment, negative DBS test within 6 months. Initial telephone contact from the hepatology CNS, Hep C Trust peer or Drug service recovery worker to was used to explain the project in detail and gain consent for participation. Participants received a postal testing pack including bespoke patient information leaflet and Oraquick® point of care test. The team used a dedicated phone number to discuss results and deliver support. Positive HCV Ab tests triggered an urgent assessment by the hepatology CNS supported by Hep C Trust peers. Results Preliminary results are available for the first six months (completion planned May 2022). Across the network 210 people agreed to participate and received home HCV self-test kits. 92 reported test results (44% of postal tests dispatched). Six HCVAb+ 80 HCVAb-, six test failures. 6.5% of completed tests detected HCV Ab. Of the six HCVAb+ identified to date five have attended for confirmatory PCR in the ODN. Two of five were PCR negative (spontaneous clearance), two PCR positive patients have commenced treatment and one awaits additional diagnostics. The strength of the ODN linkage to care processes is reflected in the client pathway, including two patients who were subsequently incarcerated and followed up by the ODN prison in reach team. Conclusions Postal testing for HCV using a rapid point of care test is feasible and provides an opportunity to engage at risk individuals for HCV testing. Once engaged linkage to care was effective utilizing the ODN network. This approach has also provided a useful avenue for HCV diagnosis and the care cascade during the pandemic when many clinic assessments have been managed remotely.

11.
Gut ; 71:A73, 2022.
Article in English | EMBASE | ID: covidwho-2005356

ABSTRACT

Introduction NICE guidelines (2017) recommend offering 6 monthly surveillance with USS for all cirrhotic patients with exception for patients identified for end of life care. But surveillance intervals are often missed where care is delivered through Consultant-led clinics. Having introduced a nurse-led stable cirrhosis clinic in 2016, we assessed whether the recommended interval was being achieved, and what impact the 'aMAP' score stratifying annual HCC risk as low(<0.2%), medium( 1%) and high(4%) might have on service utilisation. Methods A retrospective review of all patients attending our nurse-led stable cirrhosis clinic. Review included demographic data, aetiology of liver disease, calculation of Child and aMAP (age, gender, albumin-bilirubin) scores using parameters from initial clinic visits. We assessed adherence to the twice yearly US scan since our adaptation of NICE guidelines in 2018. Results Between 2016-2018, 117(49 female) cirrhotic patients were enrolled in the clinic. Majority of the patients had ALD (55) and NASH(24). Other aetiologies included HCV, HFE and PBC. All patients had Child A disease except 7 with Child B (B7:3;B8:4). 13/117 patients were excluded from the surveillance program mainly because other co-morbidities and age. of the remaining 104 enrolled in surveillance, 90(87%) patients had their USS at 6 months interval, 2(2%) missed only one scan (not requested by clinician), 7(7%) failed to attend their appointments, 5(4%) either declined surveillance or were lost to follow up. aMAP score identified 70/104 (67%) high risk, 29 (28%) medium risk and only 5(5%) low risk for HCC. HCC was diagnosed in 4/104 patients after 3 years follow up (2 medium risk;2 high risk).Death was reported in 10/104 patients (1 HCC;4 liver failure;3 other cancers;1 post-operative complications following orthopaedic surgery;1 2ry to sepsis). Despite interruptions caused by COVID-19 pandemic, no HCC was diagnosed in 1st US scan after restarting the services. Conclusions HCC surveillance organised through a dedicated nurse-led stable cirrhosis clinic can achieve excellent adherence to planned USS intervals. Only a small number were identified as low risk within our cohort using the aMAP score offering limited opportunity to reduce the volume of USS for this indication in Derby.

12.
Journal of the American College of Cardiology ; 79(15):S257-S259, 2022.
Article in English | EMBASE | ID: covidwho-2004168

ABSTRACT

Clinical Information Patient Initials or Identifier Number: Mr. AL Relevant Clinical History and Physical Exam: 59-year-old gentleman. CAD risk factors: Hypertension, Diabetes Mellitus, Dyslipidaemia, Positive family history of CAD. Admitted with Acute Anterior MI & got Tenecteplase. Relevant Test Results Prior to Catheterization: Troponin-I: >50000 ng/L, ECG: ST Elevation in V1-V6, Echo: Anterior wall is hypokinetic with Mild LV systolic dysfunction (EF- 45%). Hb-14.2 gm/dl, Creatinine: 1.12 mg/dl, Na- 135, K- 4.0, Cl- 100 m mol/L, Plasma BNP: 235 pg/ml, COVID-19 RT-PCR- Negative, S. Bilirubin- 0.3 mg/dl, ALT- 45 IU/L, AST- 107 IU/L, Anti-HCV- Negative, Anti-HIV- Negative, HbsAg- Negative, Relevant Catheterization Findings: LMCA: Normal. LAD: Got 90-99% narrowing in its proximal segment followed by 90-99% diffuse disease. DG1 is small and diseased. DG2 has got sub-total occlusion at its origin. LCX: Good size artery with mild ostial narrowing & 50% narrowing in its mid segment. Principal OM has got 50% narrowing in its ostium. RCA: Dominant artery has got 60% narrowing in its proximal segment. PDA is a good size artery & got mild irregular narrowing in its proximal segment. Recommendation: PCI to LAD [Formula presented] [Formula presented] [Formula presented] Interventional Management Procedural Step: LCA was engaged with guiding catheter EBU -3.5 (6F). Sion Blue wire crossed the lesion of LAD, another wire crossed the lesion of Diagonal branch and pre-dilatation was done with 2.0 x 15 mm balloon at 08-10 ATM. Proximal lesion was stented with a 2.75 mm x 18 mm stent (Xience Alpine) at 12-14 ATM. After withdrawing the wire following angiogram showed proximal LAD was well dilated but mid LAD having a long dissection which interrupted the distal flow. So, decided to put stent in mid LAD. Again, repeated ballooning was done in mid LAD to prepare the lesion and a 2.25 mm x 28 mm stent (Xience Xpedition) was taken for mid LAD but stent didn't cross the mid LAD lesion. During stent withdrawal, it was struck in the previous Proximal stent and proximal calcified segment. When trying to pull it back, the delivery system shaft was tear off. Tried to get the shaft by coronary snare but failed to get it back. Finally, he was recommended to retrieve the torn delivery system & stent surgically. [Formula presented] [Formula presented] [Formula presented] Conclusions: • Stent with torn delivery system entrapment might not be rare. • In this situation, emergency decision to tackle the situation and Bail out decision to send the patient for surgical retrieval of the delivery system & stent saved the life of the patient. Take Home Message: • No case is simple in intervention. • Preparedness to tackle any untoward consequence is the key to success and save lives.

13.
Journal of Hepatology ; 77:S596, 2022.
Article in English | EMBASE | ID: covidwho-1996645

ABSTRACT

Background and aims: As a result of disengagement in addiction care during the COVID-19 pandemic, there has been a record increase in mortality associated with opioid overdoses (primarily fentanyl), particularly in North America. In the USA there were over 100, 000 overdose deaths in 2021, while over 2000 were recorded in the province of British Columbia. As we attempt to develop novel ways to increase HCV treatment following ≥30% declines during the pandemic, we evaluated publicly available adverse events (AEs) reports for opioids and DAAs to assess whether safety concerns from potential drug interactions arewarranted, particularly amongst those using fentanyl. Method: Data were downloaded from the US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) Public Dashboard. AEswith the DAAs glecaprevir/pibrentasvir (G/P), sofosbuvir/ velpatasvir (SOF/VEL), ledipasvir/sofosbuvir (LDV/SOF), sofosbuvir/ velpatasvir/voxilaprevir (SOF/VEL/VOX), andelbasvir/grazoprevir (EBR/ GZR) listed as the suspect product were analyzed with an initial received date from July 28, 2017-December 31, 2021, as were opioidassociated AEs for all 2017–2021. Subsequently, AEs were counted based on listed concomitant use of opioids (fentanyl, oxycodone, hydrocodone), or overdose outcomes irrespective of concomitant opioid use. Data are descriptivewithout any statistical analyses. Results: In the reporting period, 40 total AEs were recorded with concomitant DAA and fentanyl use, 14 resulting in death (G/p = 3, SOF/VEL = 11;Table 1);626 total AEs were recorded with concomitant DAA and oxycodone or hydrocodone use, 28 resulting in death. Separately, overdose events were reported 196 times, 32 resulting in death. The number of overdoses declined each year from 2018 (N = 56) to 2021 (N = 29). Fentanyl AEs showed no trend year to year. Table 1: FAERs AEs and deaths with opioids and with concomitant HCV DAAs. (Table Presented) *N represents the sum of fentanyl, oxycodone, and hydrocodone overdose AEs and deaths, whereas n’s for DAA overdose AEs and deaths are irrespective of concomitant opioids. Conclusion: With the limitations of FAERS data (under or duplicate reporting, inability to establish causation or incidence), these data showthat among ~58, 000 fentanyl, ~189, 000 oxycodone, and ~100, 000 hydrocodone AEs reported to FAERS since 2017, a small proportion (0.19%) have been reported in association with concomitant DAA therapy, with no association between recorded events and a specific DAA regimen. This should reassure HCV treaters on a lack of safety signal for concomitant opioid and DAA use.

14.
Journal of Hepatology ; 77:S554, 2022.
Article in English | EMBASE | ID: covidwho-1996644

ABSTRACT

Background and aims: National Health Service England (NHSE) plans to eliminate Hepatitis C (HCV) in England by 2025, five years earlier than World Health Organisation goals. With a reported HCV prevalence of ∼6% in male prisons, and ∼12% in female prisons, secure environments are an essential component of this elimination plan. In 2020, NHSE defined HCV micro-elimination as ³95% of prison residents tested within the previous 12 months, ³90% of RNA positive patients treated or initiated on treatment and presence of a robust system to review ongoing testing and treatment performance to ensure these targets are maintained. Method: To support NHSE in their HCV Elimination Program, a partnership between Gilead Sciences, Practice Plus Group (PPG) and the Hepatitis C Trust (HCT)was formed in 2019. PPG is the provider of healthcare to 47 English prisons with approximately 30, 000 residents. PPG Regional BBV Lead Nurses, and Gilead Medical Scientists worked with prison and HCV stakeholders to optimise test and treat pathways for new prison admissions. Whole prison HCV Intensive Test and Treat events (HITTs) were also run in targeted prisons to ensure testing of residents who were incarcerated before these optimisations were implemented. Results: Following pathway optimisation across the PPG network of 47 prisons, the HCV screening within 7 days of prison entry increased from 41% in May 2019 to 84% in October 2021. This increase was achieved despite there being significant restrictions to reduce the transmission of COVID-19 being in place across all English prisons. HITTs have been performed in 15 PPG prisons to-date. 1, 909 new RNA+ diagnoses were made during this time with 1, 848 patients started on direct-acting antiviral treatments. By November 2021, 16 out of the 47 prisons have been given micro-elimination status by NHSE with 4 more having submitted data demonstrating achievement of this target and awaiting decision. A further 4 more prisons are on track to achieve micro-elimination by April 2022. Conclusion: This partnership has demonstrated that, even during a global pandemic, it is possible to achieve the micro-elimination of HCV in a defined setting. Maintenance of micro-elimination status is essential if we are to achieve the WHO HCV targets, requiring robust pathways that are regularly adapted to the changing environment, and systems for tracking performance, both of which have been put in place by this partnership.

15.
Journal of Hepatology ; 77:S553, 2022.
Article in English | EMBASE | ID: covidwho-1996643

ABSTRACT

Background and aims: Hepatitis C virus (HCV) is a major public health burden in Canada, with prevalence in Indigenous (First Nation, Metis and Inuit) communities 4–6 times higher than non-Indigenous population. Conventional care models have created barriers to curative DAA therapy in remote Indigenous communities. Innovative approaches are required to improve access to HCV services.Method: The ECHO+ telehealth program in Alberta aims to increase access to HCV treatment through a hub-and-spoke model led by a hepatologist (hub) working with Indigenous communities (spokes) designing a model of care tailored to local needs. We incorporated Indigenous ways of knowingl (see figure), including building a predominantly Indigenous team, and embedding the 5 R’s of Indigenous Research Methodology (Respect, Relationship, Relevance, Reciprocity, and Responsibility). ECHO+ builds relationships with Indigenous community healthcare teams while using a novel co-design approach to remove barriers while increasing awareness, screening for HCV, and providing telehealth access to specialist care. Results: Collaborative methods included developing information resources translated into local languages;building infrastructure and supporting community-directed implementation to include other health topics. Due to the COVID-19 pandemic, virtual awareness presentations (HCV awareness topics, community interaction and knowledge sharing, opportunity to follow up with mailed resources packages, and sharing lived experience stories from Indigenous youth and Elders) have been shared with every Indigenous community in Alberta. Practitioners were interviewed to identify barriers to care. Biweekly Zoom meetings with community healthcare teams have expanded during the pandemic to include pandemic topics, and other liver diseases. Collaboration between ECHO+ and Indigenous community leadership and healthcare teams has improved HCV screening, de-stigmatization, increased treatment access, and supported local community healthcare providers to effectively access DAA therapy. Thus, currently 92% of the 53 Indigenous communities in Alberta have engaged with ECHO+, compared to 23% before this approach. This reflects success of the 5R method.(Figure Presented) Conclusion: A culturally-sensitive framework combines Indigenous with western approaches to improve access to HCV awareness and care in remote Indigenous communities. This approach has increased community communication and involvement, facilitated engagement with every Indigenous community, and provided practical support throughout the pandemic.

16.
Journal of Hepatology ; 77:S551, 2022.
Article in English | EMBASE | ID: covidwho-1996642

ABSTRACT

Background and aims: Hepatitis C virus (HCV) infection is a major global health problem in adults & children. The recent efficacy of Direct Acting Anti-viral therapy (DAA) has cure rates of 99% in adults and adolescents. These drugs were licensed for children 3–12 yrs during the recent coronavirus pandemic. To ensure equitable access, safe & convenient supply during lockdown, we established a virtual national treatment pathway for children with HCV in England & evaluated its feasibility, efficacy & treatment outcomes. Method: A paediatric Multidisciplinary Team Operational Delivery Network (pMDT ODN), supported by NHS England (NHSE), was established with relevant paediatric specialists to provide a single point of contact for referrals & information. Referral & treatment protocolswere agreed for HCV therapy approved byMHRA& EMA. On referral the pMDT ODN agreed the most appropriate DAA therapy based on clinical presentation & patient preferences, including ability to swallow tablets. Treatment was prescribed in association with the local paediatrician & pharmacist, without the need for children & families to travel to national centres. All children were eligible for NHS funded therapy;referral centres were approved by the pMDT ODN to dispense medication;funding was reimbursed via a national NHSE agreement. Demographic & clinical data, treatment outcomes & SVR 12 were collected. Feedback on feasibility & satisfaction on the pathway was sought from referrers. Results: In the first 6 months, 34 childrenwere referred;30- England;4-Wales;median (range) age 10 (3.9–14.5) yrs;15M;19F: Most were genotype type 1 (17) & 3 (12);2 (1);4 (4). Co-morbidities included: obesity (2);cardiac anomaly (1);Cystic Fibrosis (1);Juvenile Arthritis (1). No child had cirrhosis. DAA therapy prescribed: Harvoni (21);Epclusa (11);Maviret (2). 27/34 could swallow tablets;3/7 received training to swallowtablets;4/7 are awaiting release of granules.11/27 have completed treatment and cleared virus;of these 7/11 to date achieved SVR 12. 30 children requiring DAA granule formulation are awaiting referral and treatment. Referrers found the virtual process easy to access, valuing opportunity to discuss their patient’s therapy with the MDT & many found it educational. There were difficulties in providing the medication through the local pharmacy. However there are manufacturing delays in providing granule formulations because suppliers focused on treatments for COVID, leading to delays in referring and treating children unable to swallow tablets. Conclusion: The National HCV pMDT ODN delivers high quality treatment & equity of access for children & young people, 3–18 yrs with HCV in England, ensuring they receive care close to home with 100% cure rates.

17.
Journal of Hepatology ; 77:S547-S548, 2022.
Article in English | EMBASE | ID: covidwho-1996640

ABSTRACT

Background and aims: Universal screening appears to be the most cost-effective strategy to reach the HCV elimination planned byWHO for 2030. All HCV patients have currently access to treatment. In France HCV screening is based on identification of Risk Factor. The aim of the present studywas to test universal screening strategy in all hospitalized patients. Method: From November 2019 to November 2021, we conduct a prospective, longitudinal monocentric study screening all consent patients for HCV regardless identification of Risk Factor. All HCV Ab positive was followed by HCV RNA screening. All replicating patients were proposed to be treated according to the other pathologies for which the patients were hospitalized. The study was authorized by CPP Toulouse. Because of occurrence COVID 19 pandemics, conducting this studywe identify several limitations leading to the prolongation of inclusion time and to develop adaptive measures such as oral consent. Results: As of September 30, 2021 results are shown in this figure: (Figure Presented) HCV Ab + patients seemed older;however this difference is not statistically different. Large part of patients (2/3) were unware of the HCV status. 49 (39.5%) patients come from surgical departments, 38 (30.5%) from the medical department and 37 (30%) are followed in gastroenterology office. All HCV RNA+ patients have been evaluated for treatment. 8 are eradicated, 2 DAA therapy are still on going,1patient refuse treatment (89 years old), 5 patients suffer from HCC and treatmentwas delayed, 2 patients died during palliative management Conclusion: HCVAb prevalence recorded is significantly higher than that observed in the general population in France. However only 15.8% of hospitalized patients have been included. Motivation of all health care workers is essential. Final results of the study will be present at the meeting

18.
Journal of General Internal Medicine ; 37:S568-S569, 2022.
Article in English | EMBASE | ID: covidwho-1995629

ABSTRACT

STATEMENT OF PROBLEM/QUESTION: HIV and HCV infections remain a significant cause of morbidity and mortality, yet despite recommendations from numerous agencies (including the CDC and USPTF) screening rates for both HIV and HCV as well as linkage to care remain suboptimal. DESCRIPTION OF PROGRAM/INTERVENTION: The Allegheny Health Network is a ten-hospital health care system located in Western PA in and around Pittsburgh/Allegheny county. The Center for Inclusion Health's, a division within AHN, received funding from Gilead Sciences to implement the Frontlines of Communities in the United States (FOCUS) program to expand HIV and HCV screening in an "opt out" model and provide linkage to care fo patients who test positive. As of June 2021, FOCUS project was integrated into 5 EDs and one outpatient IM clinic. The EDs range from 2 inner city, 2 urban and 1 rural hospital. All patients entering the participating ED's are screened for eligibility automatically utilizing an EMR BPA. If the patient is eligible, the BPA will alert the nursing staff of the need for testing. It utilizes an “opt-out script” to offer the testing, consistent with CDC/WHO guidelines and with Act 148 (the PA law that covers permission for HIV consent). Patients who test positive are then linked to care through a Linkage Coordinator who provides notification of results, disease education, appointment scheduling and support to FOCUS screened patients. MEASURES OF SUCCESS: Measures of success are: Number of patients screened for HIV and HCV infection, Number of patients who screen positive for HIV or HCV infection, Number of patients who screen positive for HIV or HCV infection who are linked to care. FINDINGS TO DATE: The volume for both HIV and HCV testing rose progressively in all years after conception of the project, until 2020. A similar pattern occurred for HCV testing. We then assessed the percent of those eligible for HIV and HCV screening who underwent testing. In the year prior to implementation, only 1.3% of those eligible for HIV screening had testing completed. This increased steadily to 16% of those eligible completing testing in 2019. HCV testing had a similar trend going from 1.5% in 2016 to 13.3% in 2019. In 2016, 0.8% of those screened for HIV were positive. This number stayed between 0.1-0.5%. For HCV, the positivity rate was 1.7% in 2016 and ranged from 2.4% to 4.0% afterwards. Linkage to care was variable during the study period, with 46% to 85.7% for HIV positive patients linked and 33% to 73% for HCV positive patients. KEY LESSONS FOR DISSEMINATION: Our program showed that HIV and HCV screening can be successfully integrated into a variety of settings. Education to staff and additions to the EMR are needed. However, barriers do exist including competing clinical demands and reliance on providers adopting it into usual care. Also, the stress to the medical system from the Coronavirus pandemic led to a decrease in screening for HIV and HCV seen in 2020. Implementing HIV and HCV screening into unusal settings takes buy-in, effort, and champions to help the program be successful.

19.
Reviews in Medical Virology ; 32(2), 2022.
Article in English | EMBASE | ID: covidwho-1995555

ABSTRACT

Viral disease outbreaks have been always a threat to global public health making affordable, rapid and accurate diagnostics highly important tools to slow down the spread of viruses and decrease the mortality rate. Point-of-care (POC) diagnostics have emerged as a strong tool for the diagnosis of viral infections, especially in countries where health-care systems are inadequate to provide proper services to all citizens. According to the World Health Organization, an ideal POC diagnostic must be Affordable, Sensitive, Specific, User-friendly, Rapid/Robust, Equipment-free and Deliverable (ASSURED). This review surveys carefully each ASSURED criterion and identifies where existing viral POC diagnostics fail to meet these criteria. Given the widespread concern with plastic pollution, we also propose the addition of 'disposability' to the existing ASSURED criteria and consider the letter “D” as the representative of both Deliverable and Disposable. Next, the POC tests used for the diagnosis of several common human viral infections which met all the ASSURED criteria (ASSURED-compliant) are described in detail. Finally, the future of ASSURED-compliant POC diagnostics, capable of generating comparable results to the viral diagnostic gold standards, is discussed.

20.
Hepatology International ; 16:S122, 2022.
Article in English | EMBASE | ID: covidwho-1995898

ABSTRACT

Objectives: In the recent 2 years,a novel Covid-19 virus played a crucial role in development of severe respiratory and multiple organ failure, including liver.The aim of the study is determine liver injury in patients with underlying liver diseases and evaluate the effect of treatment. Materials and Methods: 137 patients (51% males, 49% females, mean age 34 years ± 6.5 with known liver diseases were admitted to our department for post-COVID control (median time post-infection 34 days ± 1.4). Previously, HBV was diagnoses in 18 (13.5%),mean ALT 31 (52.4-12.6),mean AST 24.8 (52.4-12.6), HCV in 43 (32% mean ALT 57 (195.1-16.9)mean AST 31.3 (61.9-17)), NAFLD/ NASH in 74 ( (54.5%)mean ALT 152.4 (1186 -19.7)mean AST 57.9 (70-19.4)). 22 (32.8%) have received antibiotic prophylaxis only, 25 (37% antiviral treatment (40% favipiravir,60% remdesivir)),9 (13.4%) had both antibiotics and antiviral treatment). Results: Median Elevation of ALT/AST was mostly observed in NASH/NAFLD group with pre-COVID high liver enzymes (median ALT value 42 IU/ml vs 98 IU/ml p<0.005;AST 26 IU/ml vs 84 p<0.005).Mixed treatment with both antibiotics (azithromycin) and Favipirovir was associated with higher elevation of liver enzyme in all groups. NASH/NAFLD patients had the highest elevation of liver enzymes following COVID among chronic liver disease groups. Conclusion: All Post-Covid patients, especially those with NASH/ NAFLD, regardless of the presence or absence of concurrent chronic liver disease, regardless of receiving antibiotics, require monitoring of liver function tests from the beginning of the disease.

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