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Liver Int ; 42(5): 1012-1016, 2022 05.
Article in English | MEDLINE | ID: covidwho-1741473

ABSTRACT

BACKGROUND AND AIM: The World Health Organization (WHO) goal of hepatitis C virus (HCV) elimination by 2030 relies on the scaling-up of both identification and linkage to care of the infected population, worldwide. In Italy, the estimated burden of HCV carriers who are unaware of their infection amounts to 200 000 persons, a projection that reinforces the need for broadening population access to effective screening programmes. METHODS: A pivotal screening programme targeting subjects born between 1969 and 1989 has been conducted in Lombardy, Northern Italy, where point-of-care (POC) testing was offered for free concomitantly to COVID-19 vaccination. RESULTS: Amongst 7219 subjects born between 1969 and 1989 who underwent HCV screening through POC, 7 (0.10%) subjects tested anti-HCV positive: 5 (0.07%) had confirmed anti-HCV positivity (Table 1) and 4 of them (0.05%) were HCV-RNA positive by standard confirmation tests. CONCLUSIONS: This pivotal study demonstrated the feasibility of a POC-based anti-HCV screening programme in young adults undergoing COVID-19 vaccination. The prevalence of HCV infection in subjects born in the 1969-1989 cohort in Italy seems to be lower than previously estimated. Whether the extension of this programme to subjects born before 1969 could lead to improved screening effectiveness should be a matter of debate.


Subject(s)
COVID-19 , Hepatitis C , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines , Hepacivirus/genetics , Hepatitis C/diagnosis , Hepatitis C/epidemiology , Hepatitis C/prevention & control , Hepatitis C Antibodies , Humans , Mass Screening , Vaccination
4.
Viruses ; 14(3)2022 02 28.
Article in English | MEDLINE | ID: covidwho-1715780

ABSTRACT

Following the availability of highly effective direct-acting antivirals (DAAs) to treat hepatitis C infection, the uptake of treatment by people living with hepatitis C rose dramatically in high- and middle-income countries but has since declined. To achieve the World Health Organization's (WHO) 2030 target to eliminate hepatitis C as a public health threat among people who inject drugs, an increase in testing and treatment is required, together with improved coverage of harm reduction interventions. The population that remains to be treated in high- and middle-income countries with high hepatitis C prevalence are among the most socially disadvantaged, including people who inject drugs and are involved in the criminal justice system, a group with disproportionate hepatitis C prevalence, compared with people in the wider community. Imprisonment provides an unrivalled opportunity for screening and treating large numbers of people for hepatitis C, who may not access mainstream health services in the community. Despite some implementation challenges, evidence of the efficacy, acceptability, and cost-effectiveness of in-prison hepatitis treatment programs is increasing worldwide, and evaluations of these programs have demonstrated the capacity for treating people in high numbers. In this Perspective we argue that the scale-up of hepatitis C prevention, testing, and treatment programs in prisons, along with the investigation of new and adapted approaches, is critical to achieving WHO elimination goals in many regions; the Australian experience is highlighted as a case example. We conclude by discussing opportunities to improve access to prevention, testing, and treatment for people in prison and other justice-involved populations, including harnessing the changed practices brought about by the COVID-19 pandemic.


Subject(s)
COVID-19 , Hepatitis C, Chronic , Hepatitis C , Antiviral Agents/therapeutic use , Australia/epidemiology , Hepatitis C/drug therapy , Hepatitis C/epidemiology , Hepatitis C/prevention & control , Humans , Pandemics , Prisons
5.
Viruses ; 14(3)2022 02 26.
Article in English | MEDLINE | ID: covidwho-1715776

ABSTRACT

In 2016, the WHO announced a plan to eliminate viral hepatitis as a public health threat by 2030. In this narrative review, experts from Bulgaria, Croatia, the Czech Republic, Hungary, Latvia, Lithuania, Poland and Slovakia assessed the feasibility of achieving the WHO 2030 target for HCV infections in Central Europe. They focused mainly on HCV micro-elimination in prisons, where the highest incidence of HCV infections is usually observed, and the impact of the COVID-19 pandemic on the detection and treatment of HCV infections. According to the presented estimates, almost 400,000 people remain infected with HCV in the analyzed countries. Interferon-free therapies are available ad libitum, but the number of patients treated annually in the last two years has halved compared to 2017-2019, mainly due to the COVID-19 pandemic. None of the countries analyzed had implemented a national HCV screening program or a prison screening program. The main reason is a lack of will at governmental and prison levels. None of the countries analyzed see any chance of meeting the WHO targets for removing viral hepatitis from the public threat list by 2030, unless barriers such as a lack of political will and a lack of screening programs are removed quickly.


Subject(s)
COVID-19 , Hepatitis C , COVID-19/epidemiology , COVID-19/prevention & control , Europe/epidemiology , Hepatitis C/diagnosis , Hepatitis C/epidemiology , Hepatitis C/prevention & control , Humans , Pandemics/prevention & control , Prisons
6.
Ann Ist Super Sanita ; 57(3): 201-204, 2021.
Article in English | MEDLINE | ID: covidwho-1468620

ABSTRACT

Italy has been one of the countries with the greatest burden of HCV in Western Europe and with the highest number of HCV liver-related deaths. In order to achieve HCV elimination by 2030 Italy, like many other countries, will need to succeed in tackling the undiagnosed individuals with active HCV infection. To this aim beginning in 2021, a nationwide action has been implemented, consisting of the performance of screening tests among key populations and birth cohorts (1969-1989), estimated to have a high prevalence of undiagnosed individuals. The realization of the proactive screening during the first two years will define the tracks for the whole optimized screening strategy, including also the screening of 1948-1968 birth cohorts, reported to be the best cost-effective strategy in achieving the HCV elimination targets by 2030 in Italy. Each Italian region needs to define the present and future steps to reach HCV elimination goal by 2030 guaranteeing the equity of care.


Subject(s)
Goals , Hepatitis C , Antiviral Agents/therapeutic use , Hepacivirus , Hepatitis C/diagnosis , Hepatitis C/epidemiology , Hepatitis C/prevention & control , Humans , Mass Screening , World Health Organization
8.
Viruses ; 13(7)2021 07 19.
Article in English | MEDLINE | ID: covidwho-1344395

ABSTRACT

OBJECTIVES: HCV shows complex interactions with lipid metabolism. Our aim was to examine total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) changes in HIV/HCV coinfected patients, after achieving sustained virological response (SVR), according to different HCV genotypes and specific antiretroviral use. METHODS: HIV/HCV coinfected patients, enrolled in the ICONA and HepaICONA cohorts, who achieved DAA-driven SVR were included. Paired t-tests were used to examine whether the pre- and post-SVR laboratory value variations were significantly different from zero. ANCOVA regression models were employed to estimate the causal effect of SVR and of PI/r use on lipid changes. The interaction between the effect of eradication and HCV genotype was formally tested. RESULTS: six hundred and ninety-nine HIV/HCV coinfected patients were enrolled. After HCV eradication, a significant improvement in liver function occurred, with a significant decrease in AST, ALT, GGT, and total plasmatic bilirubin. TC and LDL-C significantly increased by 21.4 mg/dL and 22.4 mg/dL, respectively (p < 0.001), after SVR, whereas there was no evidence for a change in HDL-C (p = 0.45) and triglycerides (p = 0.49). Notably, the TC and LDL-C increase was higher for participants who were receiving darunavir/ritonavir, and the TC showed a more pronounced increase among HCV genotype 3 patients (interaction-p value = 0.002). CONCLUSIONS: complex and rapid changes in TC and LDL-C levels, modulated by HCV genotype and PI/r-based ART combinations, occurred in HIV/HCV coinfected patients after SVR. Further studies are needed to evaluate the clinical impact of these changes on the long-term risk of cardiovascular disease.


Subject(s)
Disease Eradication/statistics & numerical data , HIV Infections/virology , Hepacivirus/genetics , Hepatitis C/prevention & control , Lipid Metabolism , Antiviral Agents/therapeutic use , Cholesterol/blood , Cholesterol, LDL/blood , Cohort Studies , Female , Genotype , Hepacivirus/classification , Hepacivirus/drug effects , Hepatitis C/drug therapy , Humans , Italy , Male , Middle Aged , Sustained Virologic Response
10.
Viruses ; 13(6)2021 05 29.
Article in English | MEDLINE | ID: covidwho-1282636

ABSTRACT

An effective vaccine for the hepatitis C virus (HCV) is a major unmet medical and public health need, and it requires an antigen that elicits immune responses to multiple key conserved epitopes. Decades of research have generated a number of vaccine candidates; based on these data and research through clinical development, a vaccine antigen based on the E1E2 glycoprotein complex appears to be the best choice. One bottleneck in the development of an E1E2-based vaccine is that the antigen is challenging to produce in large quantities and at high levels of purity and antigenic/functional integrity. This review describes the production and characterization of E1E2-based vaccine antigens, both membrane-associated and a novel secreted form of E1E2, with a particular emphasis on the major challenges facing the field and how those challenges can be addressed.


Subject(s)
Hepacivirus/chemistry , Hepatitis C/prevention & control , Viral Envelope Proteins/chemistry , Viral Hepatitis Vaccines/chemistry , Animals , Epitopes/immunology , HEK293 Cells , Hepacivirus/genetics , Hepacivirus/immunology , Hepatitis C/virology , Humans , Mice , Models, Molecular , Protein Conformation , Protein Multimerization , Viral Envelope Proteins/immunology , Viral Envelope Proteins/metabolism
11.
Liver Int ; 41(9): 2024-2031, 2021 09.
Article in English | MEDLINE | ID: covidwho-1247255

ABSTRACT

BACKGROUND & AIMS: In 2014, the burden of hepatitis C virus (HCV) in Sweden was evaluated, to establish a baseline and inform public health interventions. Considering the changing landscape of HCV treatment, prevention, and care, and in light of the COVID-19 pandemic, this analysis seeks to evaluate Sweden's progress towards the World Health Organization (WHO) elimination targets and identify remaining barriers. METHODS: The data used for modelling HCV transmission and disease burden in Sweden were obtained through literature review, unpublished sources and expert input. A dynamic Markov model was employed to forecast population sizes and incidence of HCV through 2030. Two scenarios ('2019 Base' and 'WHO Targets') were developed to evaluate Sweden's progress towards HCV elimination. RESULTS: At the beginning of 2019, there were 29 700 (95% uncertainty interval: 19 300-33 700) viremic infections in Sweden. Under the base scenario, Sweden would achieve and exceed the WHO targets for diagnosis, treatment and liver-related death. However, new infections would decrease by less than 10%, relative to 2015. Achieving all WHO targets by 2030 would require (i) expanding harm reduction programmes to reach more than 90% of people who inject drugs (PWID) and (ii) treating 90% of HCV + PWID engaged in harm reduction programmes and ≥7% of PWID not involved in harm reduction programmes, annually by 2025. CONCLUSIONS: It is of utmost importance that Sweden, and all countries, find sustainability in HCV programmes by broadening the setting and base of providers to provide stability and continuity of care during turbulent times.


Subject(s)
COVID-19 , Hepatitis C , Substance Abuse, Intravenous , Antiviral Agents/therapeutic use , Hepacivirus , Hepatitis C/drug therapy , Hepatitis C/epidemiology , Hepatitis C/prevention & control , Humans , Pandemics , SARS-CoV-2 , Substance Abuse, Intravenous/epidemiology , Sweden/epidemiology
13.
Liver Int ; 41(4): 649-655, 2021 04.
Article in English | MEDLINE | ID: covidwho-1042740

ABSTRACT

The World Health Organization (WHO) targets for eliminating HCV by 2030 may be overambitious for many high-income countries. Recent analyses (ie, data from 2017 to 2019) show that only 11 countries are on track for meeting WHO's elimination targets. For a country to be truly on track, it is important that the majority of infected individuals be identified and treated. There is still a need for country and population-specific evaluations within the different HCV screening and treatment strategies available, in order to assess their cost-effectiveness and sustainability and support an evidence-based policy for HCV elimination. Any health policy model is affected by the diversity and quality of the available data and by gaps in data. Given the differences among countries, comparing progress based on fixed global targets will not necessarily be suitable in the same measure for each country. In a recent document, the European Collaborators of Polaris Observatory provide insight into the limitations of the current WHO targets. The absolute targets identified by each country in accordance with the measures set by WHO would be essential in reaching the HCV elimination. All analytic models to assess the progress towards HCV elimination are based on projections to 2030 not including the impact of the COVID-19 pandemic on hepatitis-related services. With specific regard to the achievement of WHO hepatitis elimination goals, all measures that will be put in place during and after COVID-19 pandemic could be transferred in increasing diagnosis and linkage to care of people with hepatitis.


Subject(s)
Disease Eradication , Hepatitis C/prevention & control , COVID-19 , Health Policy , Humans , World Health Organization
16.
J Stud Alcohol Drugs ; 81(5): 556-560, 2020 09.
Article in English | MEDLINE | ID: covidwho-841750

ABSTRACT

People who use drugs (PWUD) face concurrent public health emergencies from overdoses, HIV, hepatitis C, and COVID-19, leading to an unprecedented syndemic. Responses to PWUD that go beyond treatment--such as decriminalization and providing a safe supply of pharmaceutical-grade drugs--could reduce impacts of this syndemic. Solutions already implemented for COVID-19, such as emergency safe-supply prescribing and providing housing to people experiencing homelessness, must be sustained once COVID-19 is contained. This pandemic is not only a public health crisis but also a chance to develop and maintain equitable and sustainable solutions to the harms associated with the criminalization of drug use.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , HIV Infections/epidemiology , Hepatitis C/epidemiology , Pneumonia, Viral/epidemiology , Substance-Related Disorders/epidemiology , Syndemic , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/prevention & control , Criminals , Drug Overdose/complications , Drug Overdose/epidemiology , Drug Overdose/prevention & control , Emergency Medical Services , HIV Infections/complications , HIV Infections/prevention & control , Hepatitis C/complications , Hepatitis C/prevention & control , Housing , Humans , Pandemics/prevention & control , Pneumonia, Viral/complications , Pneumonia, Viral/prevention & control , Prescriptions , SARS-CoV-2 , Substance-Related Disorders/prevention & control , United States/epidemiology , United States Public Health Service
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