BACKGROUND & AIMS Elimination of HCV by 2030, as defined by the World Health Organization (WHO), is attainable with the availability of highly efficacious therapies. This study reports progress made in the timing of HCV elimination in 45 high‐income countries between 2017 and 2019. METHODS Disease progression models of HCV infection for each country were updated with latest data on chronic HCV prevalence, and annual diagnosis and treatment levels, assumed to remain constant in the future. Modelled outcomes were analysed to determine the year in which each country would meet the WHO 2030 elimination targets. RESULTS Of the 45 countries studied, 11 (Australia, Canada, France, Germany, Iceland, Italy, Japan, Spain, Sweden, Switzerland, and United Kingdom) are on track to meet WHO's elimination targets by 2030; five (Austria, Malta, Netherlands, New Zealand, and South Korea) by 2040; and two (Saudi Arabia and Taiwan) by 2050. The remaining 27 countries are not expected to achieve elimination before 2050. Compared to progress in 2017, South Korea is no longer on track to eliminate HCV by 2030, three (Canada, Germany, and Sweden) are now on track, and most countries (30) saw no change. CONCLUSIONS Assuming high‐income countries will maintain current levels of diagnosis and treatment, only 24% are on track to eliminate HCV by 2030, and 60% are off track by at least 20 years. If current levels of diagnosis and treatment continue falling, achieving WHO's 2030 targets will be more challenging. With less than ten years remaining, screening and treatment expansion is crucial to meet WHO's HCV elimination targets.

A microbiologic method is necessary for the correct prescription of antibiotics in children with streptococcal sore throat.

BACKGROUND AIMS Direct-acting antiviral (DAA) therapy for HCV has high efficacy and limited toxicity. We hypothesised that the efficacy of glecaprevir-pibrentasvir for chronic HCV with a simplified treatment monitoring schedule would be non-inferior to a standard treatment monitoring schedule. METHODS In this open-label multicentre phase IIIb trial, treatment-naïve adults with chronic HCV without cirrhosis were randomly assigned (2:1) to receive glecaprevir-pibrentasvir 300 mg-120 mg daily for 8 weeks administered with a simplified or standard monitoring strategy. Clinic visits occurred at baseline and post-treatment week 12 in the simplified arm, and at baseline, week 4, week 8, and post-treatment week 12 in the standard arm. Study nurse phone contact occurred at week 4 and week 8 in both arms. Participants requiring adherence support were not eligible, including those reporting recent injecting drug use. The primary endpoint was sustained virological response at post-treatment week 12 (SVR12), with a non-inferiority margin of 6%. RESULTS Overall, 380 participants (60% male, 47% genotype 1, 32% genotype 3) with chronic HCV were randomised and treated with glecaprevirpibrentasvir in the simplified (n = 253) and standard (n = 127) arms. In the intention-to-treat population, SVR12 was 92% (95% CI 89%-95%) in the simplified and 95% (95% CI 92%-99%) in the standard arm (difference between arms -3.2%; 95% CI -8.2% to 1.8%) and did not reach non-inferiority. In the perprotocol population, SVR12 was 97% (95% CI 96%-99%) in the simplified and 98% (95% CI 96%-100%) in the standard arm. No treatment-related serious adverse events were reported. CONCLUSIONS In patients with chronic HCV infection without cirrhosis, treatment with glecaprevir-pibrentasvir was safe and effective. In comparison to standard monitoring, a simplified monitoring schedule did not achieve non-inferiority. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT03117569. LAY SUMMARY Direct-acting antiviral (DAA) therapy for hepatitis C is highly effective and well tolerated. The SMART-C randomised trial evaluated an 8-week regimen of glecaprevir-pibrentasvir for hepatitis C treatment, using a simplified monitoring schedule that included no pathology tests or clinic visits during treatment. This simplified strategy produced a high cure rate (92%), but this was not equivalent to the standard monitoring schedule cure rate (95%).

Objectives: Diagnosis and correct treatment of group A streptococcal sore throat is important particularly to prevent non-suppurative sequelae. Clinical findings continue to be used to differentiate streptococcal infection from viral sore throat. The American Academy of Pediatrics recommends that streptococcal sore throat diagnosis should always be performed by microbiological identification methods. The aim of this study is to evaluate the accuracy of clinical diagnosis in comparison with culture and rapid test.Methods: Children aged 2 to 13 years who had received a clinical diagnosis of sore throat and sought treatment at the pediatric emergency unit of São Paulo Santa Casa were evaluated and those with clinical signs or viral infection were excluded. Clinical findings were recorded and swabs were taken for group A Streptococcus cultures and a Streptococcus rapid test. Results:The culture was positive in 96 (24.4%) of the 376 children evaluated. The presence of petechiae, purulent exudate and painful tonsils were more likely to occur in children with positive streptococcus cultures, however they exhibited low diagnostic accuracy. The doctors subjective evaluation failed to identify 21% of positive cases and antibiotics were prescribed in 47% of negative cases, compared with 3 and 6%, respectively, for the rapid test.Conclusions: A microbiologic method is necessary for the correct prescription of antibiotics in children with streptococcal sore throat.

BACKGROUND & AIMS: The direct-acting antiviral combination glecaprevir/pibrentasvir has been approved by the Food and Drug Administration for 8 weeks of treatment in treatment-naïve patients with hepatitis C virus (HCV) infection without cirrhosis or with compensated cirrhosis. We performed an integrated analysis of data from trials to evaluate the overall efficacy and safety of 8 weeks of glecaprevir/pibrentasvir in treatment-naïve patients without cirrhosis or with compensated cirrhosis. METHODS: We pooled data from 8 phase 2 or phase 3 trials of treatment-naïve patients with HCV genotype 1 to 6 infections, without cirrhosis or with compensated cirrhosis, who received 8 weeks of glecaprevir/pibrentasvir. RESULTS: Of 1248 patients, 343 (27%) had cirrhosis. Most patients were white (80%) and had HCV genotype 1 infection (47%) or genotype 3 infection (22%); the median age was 54 years. Overall rates of sustained virologic response at post-treatment week 12 were 97.6% (1218 of 1248) in the intention to treat (ITT) and 99.3% (1218 of 1226) in the modified ITT populations. When we excluded patients with genotype 3 infections with compensated cirrhosis (consistent with the European label), rates of sustained virologic response at post-treatment week 12 were 97.6% in the ITT and 99.4% in the modified ITT populations. Eight virologic failures (7 in patients without cirrhosis and 1 in a patient with cirrhosis) occurred in the ITT population. Virologic failure was not associated with markers of advanced liver disease or populations of interest (current alcohol use, opioid substitution therapy, history of injection-drug use, and severe renal impairment). Treatment-emergent adverse events (AEs) occurred in 58% of patients. The most frequent AEs (>10%) were headache (12%) and fatigue (12%). Serious AEs and AEs that led to glecaprevir/pibrentasvir discontinuation were reported in 2% and less than 1% of patients, respectively.