Emergence of resistance against direct acting antivirals in chronic HCV patients: A real-world study.

Interferon/Ribavirin therapy has been replaced by Direct Acting Antivirals (DAAs) due to emergence of Resistance Associated Variants (RAVs) and decrease Sustain Virologic Response (SVR). Current study investigated treatment response of Sofosbuvir and Ribavirin in chronic HCV patients. Total 256 HCV patients with genotype 1a, 2 and 3a received sofosbuvir/ribavirin according to international standards. HCV RNA presence in serum was used as marker for end treatment response (ETR) and sustain virologic response after 24 weeks of treatment (SVR24) in each case. Response to treatment with SOF + RBV was found statistically significant among different HCV genotypes (GT) as out of 47 HCV GT1 patients 42(89.36%) resulted into good ETR but 4(9.52%) of these relapsed and 5(10.63%) led into virologic failure. 5(100%) HCV GT2 patients resulted into SVR24 whereas, out of 204 HCV GT3 patients 194(95.69%) achieved good ETR however, 8(4.12%) of these relapsed and 10(4.90%) resulted in to virologic failure. Efficacy of therapy was found non-significant in treatment naïve and treatment experienced patients as in this study out of 145 treatment naïve patients 139(95.86%) achieved good ETR where 4(2.87%) relapsed while 6(4.13%) led into virologic break through on the other hand among 111 treatment experienced patients 102(91.89%) resulted into good ETR but 8(7.84%) relapsed whereas 9(8.10%) lead into virologic failure. Current study also propose that various liver and spleen complications/liver cirrhosis are related to response of HCV patients to SOF + RBV therapy whereas, variables like old age, gender is not compromising treatment response to DAAs therapy. Various mild side effects encountered by patients during treatment were fatigue, insomnia, headache, nausea, burning body, diarrhea, cough. Overall, this study reported 89.45% efficacy of SOF + RBV regime in chronic HCV Pakistani patients. Current study suggests hunting for possible reasons of resistance so that SOF + RBV therapy may not share the same fortune as previous therapies in near future.

Does Working in a COVID-19 Receiving Health Facility Influence Seroprevalence to SARS-CoV-2?

Objective In this study, we aimed at comparing the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in healthcare workers (HCWs) in coronavirus disease 2019 (COVID-19) receiving and non-COVID-19 receiving hospitals in Peshawar, Pakistan. Methods This cross-sectional analytical study was conducted in a COVID-19 receiving hospital (hospital 'A') and a non-COVID-19 receiving hospital (hospital 'B'). Using stratified random sampling, 1,011 HCWs (439 from hospital 'A' and 572 from hospital 'B') were recruited to participate in the study. Immunoglobulin G/immunoglobulin M (IgG/IgM) antibodies were checked using Elecsys® (Roche, Basel, Switzerland) Anti-SARS-CoV-2 immunoassay. The chi-squared test was used to compare frequencies, and the binary logistic regression model was used to predict the association between study variables' seropositivity to SARS-CoV-2. A p-value of <0.05 was considered statistically significant. Results The overall seroprevalence to SARS-CoV-2 antibodies in the two hospitals was 30.76%. It was 28.2% in hospital 'A' and 32.7% in hospital 'B' (p=0.129). The seroprevalence in HCWs having direct contact with COVID-19 patients was higher (33.1%) in non-COVID-19 receiving hospital versus 23.8% in COVID-19 receiving hospital (p=0.034). Seroprevalence was highest among administrative staff (44.0%), followed by nurses (30.8%), residents (19.8%), and consultants (17.8%) (p=0.001). As compared to consultants, the administrative and nursing staff were 3.398 and 3.116 times more likely to have positive antibodies, respectively. There were no significant differences in the seroprevalence between the respective categories of staff of the two hospitals. Conclusions The non-COVID-19 receiving hospital had a higher proportion of seropositive HCWs than the COVID-19 receiving hospital. The HCWs in the non-COVID-19 receiving hospital who had direct contact with patients had significantly higher seroprevalence. Seroprevalence was highest for administrative staff followed by nursing staff, residents, and consultants. Regardless of the COVID-19 status of the healthcare facility, all HCWs shall be trained on, and consistently follow, the proper protocols for donning and doffing of personal protective equipment (PPE).

Immunogenicity of 10 and 20 microgram hepatitis B vaccine in a two-dose schedule.

Healthy subjects (15-50 years old) were randomised to receive, intramuscularly, 10 or 20 micrograms of a yeast-derived recombinant hepatitis B vaccine (Heberbiovac HB) on a two-dose (0-1) schedule. Anti-hepatitis B surface antigen antibodies (HBsAb) were determined at 2, 3 and 6 months. Twenty micrograms immunisation yielded 96.3% seroprotection (HBsAb >10 IU/l) at t=3, which persisted to 97.2% at t=6. The 10 microgram group resulted in 87.4% seroprotection at t=3 and 81% at t=6, but reached >95% among subjects <21 years old, both at t=3 and 6. It is concluded that the vaccine used is highly immunogenic and the two-dose 20 microgram immunisation can be used in all age groups and 10 micrograms in subjects up to 20 years. These schedules can result in significantly better compliance and cost-effectiveness of the vaccination programs.