BACKGROUND: There are limited data on end-stage liver disease (ESLD) and mortality in people with HIV (PWH) coinfected with both hepatitis B virus (HBV) and hepatitis C virus (HCV). METHODS: All PWH aged greater than 18 under follow-up in EuroSIDA positive for HBsAg (HBV), and/or HCVRNA+, were followed from baseline (latest of 1 January 2001, EuroSIDA recruitment, known HBV/HCV status) to ESLD, death, last visit, or 31 December 2020. Follow-up while HCVRNA- was excluded. In two separate models, Poisson regression compared three groups updated over time; HIV/HBV, HIV/HCV, and HIV/HBV/HCV. RESULTS: Among 5733 included individuals, 4476 (78.1%) had HIV/HCV, 953 (16.6%) had HIV/HBV and 304 (5.3%) had HIV/HBV/HCV. In total, 289 (5%) developed ESLD during 34 178 person-years of follow-up (PYFU), incidence 8.5/1000 PYFU [95% confidence interval (CI) 7.5-9.4] and 707 deaths occurred during 34671 PYFU (incidence 20.4/1000 PYFU; 95% CI 18.9-21.9). After adjustment, compared with those with HIV/HCV, persons with HIV/HBV had significantly lower rates of ESLD [adjusted incidence rate ratio (aIRR) 0.53; 95% CI 0.34-0.81]. Those with HIV/HBV/HCV had marginally significantly higher rates of ESLD (aIRR 1.49; 95% CI 0.98-2.26). Those under follow-up in 2014 or later had significantly lower rates of ESLD compared with 2007-2013 (aIRR 0.65; 95% CI 0.47-0.89). Differences in ESLD between the three groups were most pronounced in those aged at least 40. After adjustment, there were no significant differences in all-cause mortality across the three groups. CONCLUSION: HIV/HBV-coinfected individuals had lower rates of ESLD and HIV/HBV/HCV had higher rates of ESLD compared with those with HIV/HCV, especially in those aged more than 40. ESLD decreased over time across all groups. CLINICALTRIALSGOV IDENTIFIER: NCT02699736.
- MeSH
- Hepacivirus MeSH
- HIV infekce * komplikace MeSH
- konečné stadium selhání jater * MeSH
- lidé MeSH
- RNA MeSH
- virus hepatitidy B MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
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.
- MeSH
- Hepacivirus fyziologie genetika patogenita MeSH
- herpesvirus B fyziologie genetika patogenita MeSH
- infekce viry z rodu Deltaretrovirus genetika MeSH
- lidské papilomaviry fyziologie genetika patogenita MeSH
- nádorové buněčné linie klasifikace virologie MeSH
- onkogenní viry * růst a vývoj MeSH
- transformace genetická MeSH
- virová transformace buněk MeSH
- virus hepatitidy B fyziologie genetika patogenita MeSH
The hepatitis C virus (HCV)-related bovine hepacivirus (BovHepV) can cause acute as well as persistent infections in cattle. The true clinical relevance of the virus is not yet known. As reliable antibody detection methods are lacking and prevalence studies have only been conducted in cattle and few countries to date, the true distribution, genetic diversity, and host range is probably greatly underestimated. In this study, we applied several RT-PCR methods and a nano-luciferase-based immunoprecipitation system (LIPS) assay to analyze bovine serum samples from Bulgaria as well as wild ruminant sera from Germany and the Czech Republic. Using these methods, BovHepV infections were confirmed in Bulgarian cattle, with viral genomes detected in 6.9% and serological reactions against the BovHepV NS3 helicase domain in 10% of bovine serum samples. Genetic analysis demonstrated co-circulation of highly diverse BovHepV strains in Bulgarian cattle, and three novel BovHepV subtypes within the genotype 1 could be defined. Furthermore, application of a nested RT-PCR led to the first description of a BovHepV variant (genotype 2) in a wild ruminant species. The results of this study significantly enhance our knowledge of BovHepV distribution, genetic diversity, and host range.
- MeSH
- genomika MeSH
- Hepacivirus * genetika MeSH
- hepatitida C * MeSH
- hostitelská specificita MeSH
- přežvýkavci MeSH
- skot MeSH
- zvířata MeSH
- Check Tag
- skot MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
The aim of this paper is to introduce the digitalization process and its effects on better reach of the target population. Progress in the digitalization and e-health tools worldwide enables new opportunities in prevention, diagnostics and treatment for people living with HIV (PLHIV) and people in the risk of HIV infection, hepatitis C (HCV) and other sexually transmitted infections (STIs), especially in the context of the COVID-19 pandemic. The system already used for voluntary counselling and testing (VCT) at the CheckPoint Centre Zagreb run by the non-governmental organization (NGO) Croatian Association for HIV and Viral Hepatitis (CAHIV) was upgraded and adapted (due to the COVID-19 prevention epidemiological measures) and developed for implementation of the pilot project of feasibility and acceptability of home HIV self-testing (HIVST) among men who have sex with men (MSM) in Zagreb. A special feature of the HIVST mobile application enables an innovative approach in collecting clients' test result feedback. This paper presents the method of use digitalization of the VCT and HIVST activities to support and increase availability of screening testing. Described procedures of new technologies application in VCT services and preliminary results of the HIVST pilot project indicate that technology-delivered interventions can contribute and improve access and utilisation of HIV/STI prevention and care services.
- MeSH
- COVID-19 * MeSH
- digitální technologie MeSH
- Hepacivirus MeSH
- hepatitida C * diagnóza epidemiologie prevence a kontrola MeSH
- HIV infekce * diagnóza epidemiologie prevence a kontrola MeSH
- homosexualita mužská MeSH
- lidé MeSH
- pandemie MeSH
- pilotní projekty MeSH
- poradenství MeSH
- sexuálně přenosné nemoci * diagnóza epidemiologie prevence a kontrola MeSH
- sexuální a genderové menšiny * MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Chorvatsko MeSH
OBJECTIVES: The aim of the study is to analyse drug-related infectious diseases (DRID) rates for people who inject drugs (PWID) in the Pilsen Region in order to identify the main determiners of infection risk and also to provide a foundation for comparison between this region and the others in the Czech Republic. METHODS: In a descriptive cross-sectional study, we analysed the Pilsen Region's data on PWID. The data was transcribed from the 2003 to 2018 internal database of the Ulice Outreach Programme. In addition to the data regarding the testing of DRID, we analysed commercial sex work (CSW) and the PWID's duration of drug use, age and current address. The statistical analysis was performed using SPSS, primarily employing logistic regression (i.e., backward elimination method) to explore predictors of seropositivity. Moreover, we calculated its prevalence from an epidemiological perspective. RESULTS: In total, 384 PWID were tested, from which 54.7% were males, and 84.1% were from Pilsen. The average age for initiation of using drug was 19.37 years. The most used drug was methamphetamine (64.8%), 77 women (20.1%) were reported to be CSW. The prevalence of DRID was as follows: hepatitis C virus (HCV) 37.24%, syphilis 1.82%, hepatitis B virus (HBV) 0.78%, and HIV infection 0.26%. The analysis showed that men had a lower risk of syphilis than women. Individuals who started their drug use via injection had a 1.365-times higher risk of DRID in comparison to those who initiated intravenous drug use later in their drug-using lives. We identified a significant association between the drug type and the risk of HCV infection: the main predictor of seropositivity was the use of fentanyl, which posed a 1.930-times higher risk than in the case of methamphetamine. CONCLUSIONS: This study is the first descriptive cross-sectional study implemented in the Pilsen Region in the Czech Republic with a focus on the subpopulation of PWID with individual data. A high prevalence of HCV infection still persists but the prevalence of HBV and HIV infections in this study (and generally in the Czech Republic) is relatively low compared to foreign studies. Syphilis is not closely associated with injecting-drug use, but rather with the sexual behaviour of the people who use drugs intravenously. The most important predictor of seropositivity for syphilis was CSW. We also found the duration of being a CSW to be significant influence. The women who had been CSWs for less than 5 years had a significantly lower risk of syphilis than those who had prostituted for more than 5 years.
- MeSH
- dospělí MeSH
- Hepacivirus MeSH
- hepatitida C * epidemiologie MeSH
- HIV infekce * epidemiologie MeSH
- intravenózní abúzus drog * epidemiologie MeSH
- lidé MeSH
- methamfetamin * MeSH
- mladý dospělý MeSH
- prevalence MeSH
- prostituce MeSH
- průřezové studie MeSH
- riskování MeSH
- syfilis * epidemiologie MeSH
- uživatelé drog * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
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.
- MeSH
- antivirové látky terapeutické užití MeSH
- Hepacivirus MeSH
- hepatitida C * diagnóza epidemiologie prevence a kontrola MeSH
- intravenózní abúzus drog * komplikace farmakoterapie epidemiologie MeSH
- lidé MeSH
- Světová zdravotnická organizace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Following the introduction of direct-acting antiviral therapy in 2013, WHO launched the first Global Health Sector Strategy on Viral Hepatitis. We describe a hepatitis C virus (HCV) cascade of care in people with HIV (PWH) across Europe in terms of reaching the WHO elimination targets of diagnosing 90% and treating 80% of HCV-infected individuals. METHODS: HIV/HCV-coinfected participants in the EuroSIDA cohort under prospective follow-up at October 1, 2019, were described using a nine-stage cascade of care. Care cascades were constructed across Europe, on a regional (n = 5) and country (n = 21) level. RESULTS: Of 4773 anti-HCV positive PWH, 4446 [93.1%, 95% confidence interval (CI) 92.4-93.9)] were ever tested for HCV RNA, and 19.0% (95% CI 16.4-21.6) were currently HCV RNA positive, with the highest prevalence in Eastern and Central-Eastern Europe (33.7 and 29.6%, respectively). In Eastern Europe, 78.1% of the estimated number of chronic infections have been diagnosed, whereas this proportion was above 95% in the other four regions. Overall, 3116 persons have ever started treatment (72.5% of the ever chronically infected, 95% CI 70.9-74.0) and 2404 individuals (55.9% of the ever chronically infected, 95% CI 53.9-57.9) were cured. Cure proportion ranged from 11.2% in Belarus to 87.2% in Austria. CONCLUSION: In all regions except Eastern Europe, more than 90% of the study participants have been tested for HCV-RNA. In Southern and Central-Western regions, more than 80% ever chronically HCV-infected PWH received treatment. The proportion with cured HCV infection did not exceed 80% in any region, with significant heterogeneity between countries. SUMMARY: In a pan-European cohort of PWH, all regions except Eastern Europe achieved the WHO target of diagnosing 90% of chronic HCV infections, while the target of treating 80% of eligible persons was achieved in none of the five regions.
- MeSH
- antivirové látky terapeutické užití MeSH
- chronická hepatitida C * komplikace farmakoterapie epidemiologie MeSH
- Hepacivirus genetika MeSH
- hepatitida C * komplikace farmakoterapie epidemiologie MeSH
- HIV infekce * komplikace farmakoterapie epidemiologie MeSH
- koinfekce * farmakoterapie MeSH
- lidé MeSH
- prospektivní studie MeSH
- RNA terapeutické užití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Evropa MeSH
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.
