The burden and recent epidemiological changes of the main chronic liver diseases in a Greek referral tertiary centre

Giannousis, Ioannis; Papatheodoridis, George V.; Deutsch, Melanie; Manolakopoulos, Spilios; Manesis, Emanuel K.; Koskinas, John; Archimandritis, Athanasios

doi:10.1097/meg.0b013e328331115b

Cited by 23 publications

(20 citation statements)

References 19 publications

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“…Greece has expressed its willingness to contribute to the WHO strategy for HCV elimination, by scaling-up treatment for HCV infection in both the general population and the vulnerable population of PWID. The prevalence of HCV infection in Greece is estimated to be between 0.83% and 1.79% [22], while 20-40% of persons with chronic hepatitis C have a history of illicit drug injections [23][24][25]. In the present study, our primary objective was to evaluate the clinical outcome of HCV treatment with DAAs in a Greek cohort of PWID, as assessed by SVR12, and secondarily to define factors that may influence this outcome.…”

Section: Introductionmentioning

confidence: 99%

Direct-acting antiviral treatment for chronic hepatitis C in people who use drugs in a real-world setting

Koustenis

Anagnostou

Kranidioti

et al. 2020

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Background Direct-acting antivirals (DAAs) offer high cure rates in people who inject drugs (PWID) with hepatitis C virus (HCV) infection. There are concerns regarding lower response rates among PWID in real life. We evaluated the outcome of DAA therapy in PWID in a real-world setting and the factors that affect it. Methods We performed a retrospective analysis of 174 PWID with chronic hepatitis C who started DAAs in a Greek liver clinic in collaboration with an addiction program. Patients who did not return for reassessment were considered as lost to follow up (LTFU). A logistic regression model was used to assess factors associated with a sustained virological response 12 weeks after treatment completion (SVR12) and LTFU. Results Patients' mean age was 48±9.2 years and 91/174 (52.3%) were attending opioid substitution treatment programs. Overall, 144/174 (82.8%) patients completed therapy and presented for SVR12 testing, 8/174 (4.6%) did not complete treatment and 22/174 (12.6%) were LTFU. Overall SVR12 was 79.9% (139/174). For those with an available SVR12 test the response rate reached 96.5% (139/144). Regression analysis did not indicate any significant association between patient characteristics and SVR12. Age <45 years and genotype 3 were independent predictors of LTFU. Parallel use was found to have a trend towards LTFU. Conclusions HCV treatment by hepatologists and addiction specialists is feasible, effective and safe in a real-world setting. However, as 12% of patients appear to be LTFU, more emphasis should be placed on interventions guaranteeing follow up for SVR testing and general care. Keywords Direct-acting antivirals, hepatitis C virus infection, people who inject drugs, sustained virological response, lost to follow up

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Section: Introductionmentioning

confidence: 99%

Direct-acting antiviral treatment for chronic hepatitis C in people who use drugs in a real-world setting

Koustenis

Anagnostou

Kranidioti

et al. 2020

aog

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“…Viral hepatitis was most prevalent in many studies. [11][12][13][14][15][16][17] The data from a multicenter nationwide survey of 2557 CLD patients in Italy, has shown a steady decline of Hepatitis B, decreased impact of HCV and alcohol. [13] In the present study, there were 3 cases of Hepatitis B and one case of Hepatitis E.…”

Section: Discussionmentioning

confidence: 99%

Study of Liver Biopsy in Chronic Liver Diseases

Kulkarni

2018

APALM

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Background: Chronic liver disease (CLD)represents liver disorders of varying causes and severity in which hepatic inflammation and necrosis continue for at least 6 months.The treatment of cause leads to regression of fibrosis and parenchymal recovery. Liver biopsy is often used to establish the diagnosis, assess the severity of disease in CLD and its role is evolving with advances in medical technology. The objective was to study the histopathological pattern of injury in patients with CLD and thereby establish a possible etiologic diagnosis in correlation with clinical, biochemical and serologic findings. Methods: Thirty five cases of CLD with histopathological features of necroinflammation/fibrosis were studied for a period of five years. Along with demographics and laboratory parameters, sections were studied for the pattern and degree of injury.Grading and staging were done using standard systems. Results: Nonalcoholic fatty liver disease (31.42%) and alcoholic liver disease (25.71%) were the most common causes followed by viral hepatitis (11.42%) and drug induced liver injury (8.58%). One case each of autoimmune hepatitis and primary biliary cirrhosis were seen. A definitive diagnosis was not possible in six patients, and only a probable etiology was considered. Conclusion: The natural history of CLD is changing and is important to establish an etiological diagnosis. Despite the advances in diagnostic techniques, liver biopsy remains a valuable tool to establish the etiology and traditional descriptive reports still hold importance for the treatment and prognosis.However, it remains challenging and should be interpreted in the setting of clinical, biochemical, serological and radiological findings.

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“…However, the mean rate of no treatment in HCV RNA‐positive PDU was significantly higher than that in unselected patient populations and PDU represented the group with the higher rates of non‐compliance to follow‐up at any stage of management . Given that PDU represent a significant and increasing proportion of chronic HCV patients in all European countries , their management is becoming extremely relevant not only for decreasing the future burden of disease but also for limiting the continuing spread of HCV infection . The treatment rates in PDU are expected to improve in the forthcoming interferon‐free era with the availability of oral DAAs that will be much better tolerated, without major adverse events, much easier to apply and will require less strict patient's follow‐up .…”

Section: Discussionmentioning

confidence: 99%

Barriers to care and treatment for patients with chronic viral hepatitis in Europe: a systematic review

Papatheodoridis

Tsochatzis

Hardtke

et al. 2014

Liver International

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Background & Aims: Despite the availability of effective therapies for hepatitis B (HBV) and C virus (HCV), only a minority of these patients receive treatment. We systematically reviewed published data on barriers to management for chronic HBV/HCV patients in Europe. Methods: Literature search to identify studies including adult patients with chronic HBV/HCV infection from European countries and data on barriers to treatment. Results: Twenty-five studies including 6253 chronic HBV and 19 014 HCV patients were identified, of which only two were from Eastern Europe. The mean rate of no treatment in HBV patients was 42% being higher in North-Western European countries than Italy (56% vs. 39%, P < 0.001). Immigrants represented the most common barrier to HBV treatment. The mean rate of no treatment in HCV RNA-positive patients was 57%, being highest in Romania (89%), intermediate in France (79%) and lower though still high in other European countries (52%, P < 0.001). The predominant barriers to HCV treatment were lack of financial resources in Romania and direct/indirect limitations of interferon-alfa and/or parenteral drug and alcohol abuse in other countries. The mean rate of no treatment was highest in HCV RNA-positive parenteral drug users (72%) and intermediate in those with HCV-HIV co-infection (64%). Conclusions: A substantial proportion of diagnosed chronic HBV and the majority of diagnosed HCV patients remain untreated. The rates and most importantly the reasons of barriers to treatment in chronic HBV/HCV patients vary widely among European countries supporting the need for country-specific national strategies, resource allocation and implementation of global management policies.Hepatitis B (HBV) and C viruses (HCV) are leading causes of chronic liver disease worldwide and responsible for 1.2-1.5 million deaths annually (1, 2). In particular in Europe, according to the estimations of the European Region of the World Health Organization, there are approximately 14 and 9 million people chronically infected with HBV and HCV and around 36 000 and 86 000 related deaths each year, respectively, with the number of deaths reported to be increasing (3).Over the last 15 years, the efficacy of the therapeutic options for chronic HBV and HCV infections has dramatically improved. Practically all chronic HBV infection can now achieve at least on-therapy virological remission which is associated with improved liver histology and often even reversion of pre-existing histological cirrhosis, reduction in need for liver transplantation and eventually improved survival (4, 5). In patients with chronic HCV infection, sustained virological response, which is equivalent to viral eradication and has been shown to improve survival (6, 7), can be currently achieved in the majority of cases without contraindication for interferon-alfa-based therapies (8, 9), while emerging and future treatment options are expected to further improve the sustained virological response rates to over 90-95% extending the treatment indications ...

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The burden and recent epidemiological changes of the main chronic liver diseases in a Greek referral tertiary centre

Abstract: At Greek tertiary centres, chronic viral hepatitis remains responsible for most chronic liver disease cases, but its epidemiology is changing owing to immigrants and intravenous drug users.

Cited by 23 publications

References 19 publications

Direct-acting antiviral treatment for chronic hepatitis C in people who use drugs in a real-world setting

Direct-acting antiviral treatment for chronic hepatitis C in people who use drugs in a real-world setting

Study of Liver Biopsy in Chronic Liver Diseases

Barriers to care and treatment for patients with chronic viral hepatitis in Europe: a systematic review

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