Glecaprevir–pibrentasvir for chronic hepatitis C: Comparing treatment effect in patients with and without end-stage renal disease in a real-world setting

et al. 2021

BMC Gastroenterol

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Background Hepatitis C virus (HCV) is one of the major causes of chronic liver disease, cirrhosis, and liver cancer. Most of the infected people have no clinical symptoms. The current strategy for HCV elimination includes test and treatment. In this study, we aimed to evaluate the campaign for retrieving patients who were lost to follow-up, for subsequent re-evaluation. Methods From January 2020 to October 2020, patients who had prior tests for positive anti-HCV antibody in 2010–2018 in our hospital were enrolled for our patient callback campaign. Patients who had unknown HCV RNA status or no documented successful antiviral therapy history were selected for anti-HCV therapy re-evaluation. To facilitate patient referral in the hospital, we developed an electronic reminding system and called the candidate patients via telephone during the study period. Results Through the hospital electronic system, 3783 patients with positive anti-HCV antibody documentation were identified. Among them, 1446 (38.22%) had tested negative for HCV RNA or had anti-HCV therapy, thereby excluded. Of the 2337 eligible patients, 1472 (62.99%) were successfully contacted and called back during the study period for subsequent HCV RNA testing and therapy. We found that 42.19% of the patients had positive HCV RNA and 88% received subsequent anti-HCV therapy. Conclusions A significant number of patients with positive HCV serology were lost for HCV confirmatory test or therapy in the hospital. Therefore, this targeted HCV callback approach in the hospital is feasible and effective in achieving microelimination.

Section: Introductionmentioning

confidence: 99%

Retrieval of lost patients in the system for hepatitis C microelimination: a single-center retrospective study

Yen

et al. 2021

BMC Gastroenterol

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“…Although HCV treatment may reduce not only liver disease progression but also the risk for cardiovascular disease and delay renal dysfunction ( Lee et al, 2019 ; Polo & Laufer, 2017 ; Soriano et al, 2016 ; Wu et al, 2018b ), IFN-based therapy has not been routinely recommended for the geriatric population ( Cainelli, 2008 ) considering their low response and high withdraw rates ( Hu et al, 2013 ; Roeder et al, 2014 ). With the introduction of IFN-free therapy for HCV, populations previous considered difficult to treat, such as those with renal dysfunction ( Chen et al, 2019 ; Yen et al, 2020 ), HIV co-infections ( Liu et al, 2020b ), or older age ( Villani et al, 2019 ), are currently no longer considered as such.…”

Section: Discussionmentioning

confidence: 99%

“…SVR was defined as an HCV RNA level below the LLOQ 3 months after the last dose. Data were collected as our previously described work ( Liu et al, 2020a ; Liu et al, 2020b ; Yen et al, 2020 ). Specifically The treatment period ranged from 8 to 24 weeks according to the medication package insert considering cirrhosis status and HCV genotype.…”

Section: Methodsmentioning

confidence: 99%

“…Moreover, recent studies have demonstrated that HCV infection was associated with extrahepatic complications, such as increased rate of lymphoproliferative disorder, rheumatic disorders, and extrahepatic malignancy ( Huang et al, 2020b ; Lee et al, 2019 ; Polo & Laufer, 2017 ; Soriano et al, 2016 ). Persistent systemic inflammation can also promote increased risk for renal, neurologic, and cardiovascular disease progression ( Huang et al, 2020a ; Wu et al, 2018b ; Yen et al, 2012 ; Yen et al, 2020 ). Thus, control of HCV infection may help prevent extrahepatic complications despite mild liver involvement.…”

Section: Introductionmentioning

confidence: 99%

“…Interferon-based (IFN) therapy has been the gold standard treatment for HCV infection since the early 21st century. Although 60%–80% of patients receiving IFN-based therapy are ultimately cured of HCV infection, significant side effects from such a therapy have limited its widespread use among vulnerable populations, such as those with HIV infection, renal insufficiency, and older age ( Ansaldi et al, 2014 ; Liu et al, 2013 ; Liu et al, 2020b ; Yen et al, 2020 ). Increased rates of HCV infection and HCV-related liver fibrosis have been reported in the geriatric population ( Huang & Yu, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

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Direct-acting antiviral treatment for Hepatitis C Virus in geriatric patients: a real-world retrospective comparison between early and late elderly patients

Yen

et al. 2021

PeerJ

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Introduction Chronic hepatitis C virus (HCV) infection rates are high in the geriatric population considering that interferon-based therapy is usually intolerable. With the introduction of oral antiviral therapy for HCV, increased treatment tolerability and good treatment responses have been observed. However, treatment data regarding the geriatric population have been limited. Therefore, this retrospective study aimed to evaluate the efficacy and safety of direct-acting antiviral therapy for HCV in the geriatric population. Materials and Methods The primary end point was sustained virologic response (SVR) 12 weeks after treatment completion, whereas the secondary end points were treatment-related side effects and short-term survival rate following treatment. Results In total, 492 patients (median age, 73 years; 43.9% males), including 278 early elderly patients, were enrolled. Among the included patients, 45% had cirrhosis. HCV genotypes 1 (72.4%) and 2 (25.4%) were the most common. The overall SVR rate was 96.7%, with no difference in SVR rates observed between early and late elderly groups (96.8% vs. 96.7%; p = 0.983). Both groups showed similar side effects, including dizziness (11.4%), and fatigue (8.7%), with three patients discontinuing therapy owing to side effects. Both groups had a similar 3-year survival rate. Significant factors associated with post-treatment survival included cirrhosis, albumin, and creatinine level. Conclusions Our real-world data showed that both early and late elderly patients could undergo direct-acting antiviral treatment for HCV with excellent treatment outcomes.

Pan-genotypic direct-acting antivirals for patients with hepatitis C virus infection and chronic kidney disease stage 4 or 5

Kao

2022

Hepatol Int

Hepatitis C virus (HCV) infection is a major health problem with significant clinical and economic burdens in patients with chronic kidney disease (CKD) stage 4 or 5. Current guidelines recommend pan-genotypic direct-acting antivirals (DAAs) to be the first-line treatment of choice for HCV. This review summarizes the updated knowledge regarding the epidemiology, natural history, public health perspectives of HCV in patients with CKD stage 4 or 5, including those on maintenance dialysis, and the performance of pan-genotypic DAAs in these patients. The prevalence and incidence of HCV are much higher in patients with CKD stage 4 or 5 than in the general population. The prognosis is compromised if HCV patients are left untreated regardless of kidney transplantation (KT). Following treatment-induced HCV eradication, patient can improve the health-related outcomes by maintaining a long-term aviremic state. The sustained virologic response (SVR 12 ) rates and safety profiles of pan-genotypic DAAs against HCV are excellent irrespective of KT. No dose adjustment of pan-genotypic DAAs is required across CKD stages. Assessing drug–drug interactions (DDIs) before HCV treatment is vital to secure on-treatment safety. The use of prophylactic or preemptive pan-genotypic DAAs in HCV-negative recipients who receive HCV-positive kidneys has shown promise in shortening KT waiting time, achieving excellent on-treatment efficacy and safety, and maintaining post-KT patient and graft survival. HCV elimination is highly feasible through multifaceted interventions, including mass screening, treatment scale-up, universal precautions, and post-SVR 12 reinfection surveillance.