Key Role of Multidisciplinary Collaboration towards Global Elimination of HCV Infection.

The elimination of HCV (hepatitis C virus) infection is, according to WHO (World Health Organization), of international interest. With new diagnostic tools and treatment possibilities, one major challenge for the elimination is to involve infected patients, especially those from socially excluded subpopulations, into HCV infection-treatment programs. The key question is how to help people who inject drugs (PWID) to engage in HCV infection-treatment programs and improve communication between PWID and hepatologists or other medical professionals involved in the treatment of chronic HCV infection. Furthermore, the medical professionals have to accept the changing spectrum of patients with chronic viral hepatitis. Without close interdisciplinary cooperation, it would be extremely difficult to achieve the WHO goal of global viral hepatitis C elimination. Here, we try to encourage our colleagues as well as addictologists and social workers to play their crucial part in the viral hepatitis C eradication process. It is extremely important for the healthcare providers to be able to communicate with addicted clients, inform PWID about the latest developments in the diagnosis and HCV infection treatment, and get them motivated to engage with specialized treatment programs.

Pilot Outreach Program in Remedis-The Promising Step toward HCV Elimination among People Who Inject Drugs.

The global effort to eliminate HCV infection requires new approaches to accessing and testing the affected population in a setting with as low of a threshold as possible. The focus should be on socially marginalized people who inject drugs (PWIDs) and who are not willing or able to visit standard medical services. With this vision, we established an outreach service-a testing point in an ambulance in the park in front of the Main Railway Station of the capital city of Prague-to provide bloodborne disease testing and treatment. The service was available every week on Wednesday afternoon. Over the initial two years of our experience, 168 unique people were tested. Of them, 82 (49%) were diagnosed with chronic HCV infection and were eligible for treatment with antivirals. Of these, 24 (29%) initiated antiviral treatment over the study period, and 17 (71%) of these individuals achieved a documented sustained virological response. Offering medical services in PWIDs' neighborhoods helps overcome barriers and increase the chances that they will become patients and begin HCV treatment. The described outcomes appear promising for reaching the vision of linkage to the care of such a hard-to-reach population and can serve as a feasible model of care for further expansion.

Viral hepatitis C pandemic: Challenges and threats to its elimination.

Under the WHO plan, the global elimination of the HCV pandemic is scheduled for 2030. The burden of HCV infection in developed countries is largely borne by people who inject drugs (PWID): new infections and reinfections are related to their risky behaviour. Although safe and sensitive hepatitis C diagnostic tools and directly acting antiviral medication are widely used, major challenges to disease elimination still remain in developed countries, where the WHO plan is in progress. The challenge is in the involvement and engagement of infected PWID. There is a strong need to change our uptake and treatment strategies to address all patients from the risk groups, connect them with the healthcare system and cure them with the vision to eliminate this HCV pandemic.

Obstacles and problems in global elimination of viral hepatitis C.

The global elimination of viral hepatitis C (HCV) infection according to WHO plan 2016 is conditioned by controlling the HCV epidemic among people who inject drug (PWID). This high-risk subpopulation has no interest in prevention, diagnostic or treatment of HCV infection. The problem is not only the lack of interest in changing their behaviour pattern, but also inability of health care professionals to conduct efficient assistance to PWID. The key to any successful intervention or treatment is to master the communication with problem patients. Providing efficient care of PWID with HCV is the most important step to successful HCV elimination.

Hepatitis C virus (HCV) 5'NC sequence variants and their association with hepatitis C risk groups.

BACKGROUND: Genotype distribution of hepatitis C virus (HCV) is relatively uniform in Prague, Czech Republic. Unlike the other developed countries where HCV genotype 3 is increasingly associated with injection drug users (IDU), subtype 1b remains the most prevalent HCV subtype in Prague, regardless of risk factors. OBJECTIVE: We wished to determine if subtype 1b strains could be further differentiated by comparing the conserved 5'NC sequences of the strains infecting IDU and non-IDU populations. STUDY DESIGN: All prospectively collected serum samples that were HCV RNA positive were genotyped according to the 5'NC and NS5b regions. All 5'NC sequences were further analyzed for new mutations and these data were compared to patient epidemiologic information. RESULTS: We found eight 5'NC sequence variants among 96 specimens tested. Further analysis of subtype 1b strains showed that a variant with a nucleotide insertion at -138 positions was found only among non-IDU subjects, while the variant with T-->C substitution at -94 was found only among the IDUs. CONCLUSIONS: These observations suggest that the current HCV transmission between the IDU and non-IDU populations is uncommon, and may reflect the beginning of divergence of HCV genotypes in the IDU population in Prague.

Genotypic distribution of hepatitis B virus in the Czech Republic: a possible association with modes of transmission and clinical outcome.

OBJECTIVE: The relationship between hepatitis B virus (HBV) genotype with disease or treatment outcome is beginning to be characterized. However, the link between genotype and disease transmission route has not been closely examined. We addressed this question in high-risk populations in Prague, Czech Republic. DESIGN: Patients with HBV infection were consecutively recruited into the study at an outpatient clinic between June 2000 and March 2001. Their serum samples were analysed for HBV S gene segments by polymerase chain reaction (PCR) test. The amplified product sequences were compared to those of known HBV genotypes. Patients were evaluated for other virus co-infections, and parenteral and sexual exposure histories. RESULTS: Of 57 consecutively recruited patients with evidence of HBV infection, 45 (79%) had PCR-detectable S gene sequences. Only genotypes A (n = 33; 73%) and D (n = 12; 27%) were found. There was no difference in the development of chronic infection between the two genotypes. Of nine patients co-infected with TTV, all were infected with HBV genotype A. There was a trend towards an association between number of lifetime sex partners and genotype A but not genotype D. CONCLUSIONS: In Prague, the number of HBV genotypes appears to be limited compared to other northern European countries, suggesting that the virus has recently spread in the high-risk populations. While a large proportion of HBV infections occur in intravenous drug users, a subset of HBV genotype A may be transmitted by sexual contact. An HBV subtype may influence modes of transmission of HBV.