Antiviral Therapy 2015; 20:65 72 (doi: /IMP2827)
|
|
- Darren Phelps
- 6 years ago
- Views:
Transcription
1 Antiviral Therapy 2015; 20:65 72 (doi: /IMP2827) Original article Long-term survival and liver-related events after pegylated interferon/ribavirin therapy in HIV infected patients with chronic hepatitis C Pablo Labarga 1,2, José V Fernández-Montero 1, Carmen de Mendoza 3, Pablo Barreiro 1,4, Vincent Soriano 1,4 * 1 Department of Infectious Diseases, Hospital Carlos III, Madrid, Spain 2 Department of Internal Medicine, Clínica La Luz, Madrid, Spain 3 Department of Internal Medicine, Puerta de Hierro Research Institute & University Hospital, Majadahonda, Spain 4 Department of Internal Medicine, La Paz University Hospital, Madrid, Spain *Corresponding author vsoriano@dragonet.es Background: Sustained HCV clearance after hepatitis C therapy is associated with reduced liver-related complications and death. It is unknown if treatment may provide any clinical benefit in patients that fail therapy. This could be particularly relevant in HIV HCV-coinfected patients, in whom liver disease progresses more rapidly. Methods: This was a retrospective study of clinical end points in a large cohort of HIV HCV-coinfected patients with compensated liver disease followed since Patients were stratified into three groups: treated and cured, treatment failures and non-treated. Follow-up ended at the time of last visit, first liver decompensation event or death. Results: A total of 527 HIV HCV-coinfected patients were examined, of whom 339 (64.3%) had been treated with pegylated interferon/ribavirin. During a mean follow-up of 70.5 months, hepatic decompensation events or liver-related deaths occurred less frequently in cured patients (4/138; 2.9%) than in treatment failures (28/201; 13.9%) or untreated (25/188; 13.3%) patients (P<01). Interestingly, in the subset of patients with baseline advanced liver fibrosis (Metavir F3 F4), those with treatment failure experienced less hepatic decompensation events or deaths than untreated patients (19% versus 42%; P=05) and this finding was more pronounced in patients harbouring IL28B-CC alleles (15.8% versus 47.4%; P=2). Conclusions: Sustained HCV clearance following pegylated interferon/ribavirin therapy is associated with a reduced incidence of liver complications and death in HIV HCVcoinfected patients. In the subset of patients with baseline advanced liver fibrosis, treatment provides clinical benefit despite lack of sustained virological response. The transient antiviral and/or anti-inflammatory effect of interferon, more recognizable in IL28B-CC carriers, could explain this finding. Introduction Sustained HCV clearance following hepatitis C therapy with interferon-based regimens has been associated with regression of liver fibrosis, even in patients with cirrhosis [1] or HIV coinfection [2]. This histological benefit has been shown to translate into a reduced incidence of liver-related complications and mortality in both HCV-monoinfected individuals [3,4] and HIV HCV-coinfected patients [5,6]. It is unknown if antiviral treatment may provide any recognizable clinical benefit in patients that fail therapy. This could be particularly relevant in HIV HCVcoinfected patients, in whom liver disease progresses more rapidly [7,8]. New oral antivirals to treat hepatitis C have raised enormous expectations [9]. However, many of these agents are and will be given for a while as part of triple combinations along with pegylated interferon/ribavirin. Furthermore, a few are active mainly against HCV genotype 1, exhibiting null or poor activity against other HCV genotypes, particularly to HCV genotype 3. Finally, the high price of these drugs is becoming an important obstacle to their broader use. In this regard, considerations are given to prioritization of treatment with new oral antivirals only for patients with more advanced liver disease and/or those more difficult-tocure. A course of pegylated interferon/ribavirin dual 2015 International Medical Press (print) (online) 65
2 P Labarga et al. therapy is encouraged as a first option when treatment does not need to be deferred. Alternatively, this latest group might defer therapy and wait for cheaper new drugs and/or progression of liver disease fibrosis [10]. Treatment of hepatitis C in HIV-coinfected patients does not escape from this debate [11]. In this regard updated information on the long-term clinical benefit of antiviral therapy in this population is of much interest. Methods Study design Retrospective analysis of clinical end points in a large cohort of HIV HCV-coinfected patients with compensated liver disease who have attended our institution since Hepatic events were defined as follows: ascites, oesophageal variceal bleeding, spontaneous acute peritonitis, hepatic encephalopathy, hepatocellular carcinoma or liver transplantation. Patients were stratified into three groups: treated and cured, treatment failures and non-treated. Follow-up began after completion of pegylated interferon/ribavirin in treated patients and since the first elastometry examination in untreated individuals. Sustained virological response (SVR) was defined as negative serum HCV RNA 6 months after treatment discontinuation. Follow-up ended at the time of first liver decompensation event or death, or at last visit either in year 2012 (when the database was closed) or earlier if due to loss of follow-up. None of these patients had received direct-acting antivirals for HCV at the time the study was closed. Data recording Main demographics (age, gender, alcohol intake, body mass index), haematological variables (haemoglobin, leukocyte and platelet counts), biochemistry (glucose, aspartate aminotransferase [AST], alanine aminotransferase [ALT], gamma-glutamyl transpeptidase, alkaline phosphatase, total bilirubin, total cholesterol, lowdensity lipoprotein [LDL]-cholesterol, triglycerides and creatinine), HIV parameters (current and nadir CD4 + T-cell counts, plasma HIV RNA, current and prior antiretroviral drugs), hepatitis C variables (HCV genotype, HCV RNA, prior pegylated interferon/ribavirin therapy) and hepatitis B (HBV) serostatus were examined. All patients were followed regularly at around 4-month intervals. At every visit they were evaluated for clinical manifestations potentially associated with either HIV or HCV infections. Likewise, patients were interviewed for consumption of alcohol and/or other medications. Standard haematological, immunological, virological and biochemical examinations were performed at each time point. Prescription of antiretroviral therapy was made following international guidelines [12 14]. Liver fibrosis assessment Transient elastometry (FibroScan ; EchoSens, Paris, France) was performed by experienced operators using a single machine. The right lobe of the liver was explored through intercostal spaces on patients lying on their back, with the right arm at maximal abduction. At least 10 valid measurements were required before producing a result. Examinations with a success rate (ratio between number of validated and total measurements) <0.7 were excluded, as previously recommended [15]. Final liver stiffness was reported as the median value of all valid measurements, expressed as kilopascals (kpa). Values <7.5 kpa were considered as equivalent to histological Metavir stages F0 F1, values 7.5 to 9.4 kpa reflected F2, values 9.5 to 14.4 kpa were considered as F3 and values 14.5 kpa were equivalent to F4. Advanced liver fibrosis was considered for Metavir F3 or F4 estimates. Study end points The primary end point of the study was the development of a first hepatic decompensation event or liver-related death in the three groups. The association between the primary end point and other variables, including age, gender, body mass index, alcohol abuse, hepatitis B surface antigen [HBsAg], baseline liver stiffness, CD4 + T-cell counts, CD4 + T-cell nadir, plasma HIV RNA and baseline HCV RNA was examined using Cox logistic regression. Statistical analyses Continuous variables are expressed as mean and standard deviations (sd), while categorical variables are recorded as percentages and 95% CIs. The Student s t-test was used for the comparison of continuous variables whereas categorical variables were compared using the c 2 test. Univariate and multivariate analyses were performed using logistic regression. Variables with P-values <5 in the univariate analysis were included in the multivariate analysis. SPSS version 17.0 software (SPSS Inc., Chicago, IL, USA) was used for calculations. Results A total of 527 HIV HCV-coinfected patients were included in the study. Table 1 summarizes the main characteristics of the study population. The mean age was 41.4 ±5.2 years, 72% were male, 86% had prior history of injection drug use and 9.6% of alcohol abuse. Mean body mass index was 23.3 ±3.9 kg/m 2 and mean CD4 + T-cell count was 517 ±273 cells/ml. Overall 35% had advanced liver fibrosis (Metavir F3 F4 estimates) at baseline. Favourable IL28B alleles CC (rs ) were present in 44% of 406 tested individuals International Medical Press
3 Hepatitis C outcome after treatment Table 1. Main characteristics of the study population Treatment Untreated Total (n=527) SVR (n=138) failure (n=201) (n=188) P-value Mean age, years NS Male gender, n (%) 379 (72) 102 (74) 151 (75) 126 (67) NS Mean body mass index, kg/m NS Injecting drug users, n (%) 427 (86) 116 (86) 164 (85) 147 (86) NS Mean baseline CD4 + T-cell count, cells/µl a ; 07 b Mean CD4 + T-cell count nadir, cells/µl NS On antiretroviral therapy at baseline, n (%) 487 (92.4) 130 (94.2) 186 (92.5) 171 (91) NS Plasma HIV RNA<50 copies/ml at baseline, n (%) 342 (68.7) 130 (97) 132 (69.5) 113 (63.5) 3 c HCV genotypes 1 or 4, n (%) 391 (77) 68 (50.7) 179 (9) 144 (81) <01 a,c ; 08 b Mean baseline serum HCV RNA, log IU/ml NS Baseline advanced liver fibrosis (Metavir F3 F4), n (%) 183 (35) 46 (33.3) 88 (43.8) 49 (26.1) 5 a ; <01 b IL28B CC (data for only 406 patients), n (%) 186 (44.1) 65 (64.4) 43 (27.2) 67 (45.6) 04 c ; <01 a ; 01 b Positive serum HBsAg, n (%) 21 (4.8) 6 (4.7) 4 (2.4) 11 (7.6) 2 b Delta hepatitis, n (%) 7 (1.3) 1 (0.7) 0 (0) 6 (3.2) 1 b Alcohol intake >60 g/day, n (%) 45 (9.6) 5 (3.7) 17 (9.2) 23 (15.3) 01 c ; 5 a a Sustained virological response (SVR) versus treatment failure. b Treatment failure versus untreated. c SVR versus untreated. HBsAg, hepatitis B surface antigen; NS, not significant. Of 201 patients that had failed prior hepatitis C therapy, 40 (19.9%) were relapsers, 61 (30.3%) were partial responders, 71 (35.3%) were null responders and 29 (14.4%) had discontinued therapy prematurely due to serious adverse events. Clinical benefit in patients treated and cured Patients were followed for a mean of 70.5 months but this was significantly lower in untreated patients compared to the rest (65.2 versus 73.4 months; P<01), which was explained by the development of more rapid and frequent end points in the former group. The mean time to liver decompensation events or death was shorter in untreated patients compared to the rest (42.1 versus 54.5 months; P=02). Table 2 summarizes the number of deaths and hepatic decompensation events in the whole study population and in each of the three groups. Overall, patients with SVR after successful hepatitis C treatment experienced significantly less frequent episodes of hepatic decompensation and/or mortality (both all causes and liver-related deaths). Variables associated with the development of liverrelated events (decompensation events or hepatic deaths) were assessed using univariate and multivariate analysis. As shown in Table 3, the lack of achievement of SVR, the presence of advanced liver fibrosis at baseline and low CD4 + T-cell counts were the major and independent predictors of liver decompensation events or death in this cohort. During the entire follow-up, for more than 5 years in all groups, the rate of hepatic decompensation events or deaths was reduced between three- and fivefold in HIV HCV-coinfected individuals that cleared the virus with antiviral therapy, compared with the rest (Table 4). Interestingly, there was a lower rate of events in the treatment failure group compared with the untreated population. Therefore, a sub-analysis was conducted in this specific group of patients with persistent HCV viraemia. Comparison of treatment failures versus untreated patients A total of 389 coinfected patients remained positive for HCV RNA during the study period, of whom 201 (52%) had failed pegylated interferon/ribavirin therapy and 188 (48%) had not been treated. As shown in Table 1, the two groups were comparable for mean age (41 years old), male gender (72%), injection drug user (86%), use of antiretroviral therapy (92%), mean CD4 + T-cell count (480 cells/ml) and mean serum HCV RNA (5.5 log IU/ml). However, there were differences comparing treatment failures and untreated patients for the proportion of HCV genotypes 1 or 4 (90% versus 81%; P=08), baseline Metavir F3 F4 (44% versus 26%; P<01), IL28B CC alleles (27% versus 46%; P=01), positive HBsAg (2.4% versus 7.6%; P=2) and alcohol abuse (9.2% versus 15.3%; P=8). After a mean follow-up of 68 months, treatment failures versus untreated patients experienced similar rates of liver decompensation events (12% versus 13.5%; P=) and deaths (2% versus 0%; P=0.1). Interestingly, there were no significant differences in the rate of hepatic events or deaths when comparing patients with different treatment failure modalities, such as relapsers, partial responders and null responders (10%, 12.7% and 11.5%, respectively). Antiviral Therapy
4 P Labarga et al. Table 2. Clinical outcomes in the study population Treatment Untreated Total (n=527) SVR (n=138) failure (n=201) (n=188) P-value Mean follow-up, months <01 a,b Deaths (all causes), n (%) 12 (2.2) 1 (0.7) 9 (4.5) 2 (1.1) 4 c,b Liver-related deaths d, n (%) 4 (0.75) 0 4 (2) 0 NS Liver decompensation events, n (%) 53 (10) 4 (3) 24 (12) 25 (13.5) 01 a ; 03 c Deaths (all causes) or liver decompensation events, n (%) 60 (11) 5 (3) 29 (11.9) 26 (13.5) 02 a ; 01 c Liver-related deaths or hepatic decompensation events, n (%) 57 (1) 4 (3) 28 (13.9) 25 (13.3) 01 a ; 03 c Mean time to liver decompensation events or death, months a,c a Sustained virological response (SVR) versus untreated. b Treatment failure versus untreated. c SVR versus treatment failure. d The four liver-related deaths were due to hepatocellualr carcinoma (one), hepato-renal syndrome (one) and variceal bleeding (two). NS, not significant. Table 3. Predictors of liver-related deaths or hepatic decompensation events in the study population Adjusted hazard ratio 95% CI P-value Older age , Male gender 4 4, Baseline CD4 + T-cell count <200 cells/µl , Plasma HIV RNA>50 copies/ml 5 8, Baseline liver fibrosis F3 F , <01 IL28B-CC alleles , Positive serum HBsAg , SVR , Multivariate analysis by Cox regression. P-values with statistical significance are shown in bold. HBsAg, hepatitis B surface antigen; SVR, sustained virological response. Table 4. Rate of events in the study population (liver-related deaths or hepatic decompensation events/100 patient-years) SVR (n=138) Treatment failure (n=201) Untreated (n=188) P-value Deaths (all causes) a,b Liver-related deaths b Liver decompensation events c ; 03 a Deaths (all causes) or liver decompensation events c ; 01 a Liver-related deaths or decompensation events c ; 03 a a Sustained virological response (SVR) versus treatment failure. b Treatment failure versus untreated. c SVR versus untreated. Overall, in the subset of patients with baseline Metavir F3 F4, decompensation events or deaths were less frequent among treatment failures than in non-treated patients (19% versus 42%; P=05). This finding was confirmed after adjusting for other variables, including baseline haemoglobin, platelets or CD4 + T-cell counts (Table 5). The incidence of hepatic decompensation episodes or liver-related deaths in the study population is represented in Figure 1. It is noteworthy that hepatitis C treatment exposure, despite not being curative, was associated with a reduced incidence of hepatic events in the subset of patients with advanced liver fibrosis. Interestingly, the protective effect of treatment exposure on hepatic outcomes in treatment failures versus untreated individuals in the subset of patients with advanced liver fibrosis was significantly greater in those with IL28B-CC alleles (15.8% versus 47.4%; P=2) than in non-cc carriers (16.3% versus 35.7%; P=0.1; Figure 2). Discussion Clinical complications of liver disease are currently major causes of hospitalization and death in HIVinfected individuals in Western countries [16,17] where the widespread use of antiretroviral therapy has dramatically reduced the incidence of classical opportunistic conditions. Chronic hepatitis C is the most frequent cause of advanced cirrhosis in HIV-infected persons [18], International Medical Press
5 Hepatitis C outcome after treatment Table 5. Predictors of liver-related events (decompensation episodes or death) in HIV-infected patients viraemic for HCV during the study period Adjusted hazard ratio 95% CI P-value Untreated versus treatment failure 1.57, Advanced liver fibrosis (Metavir F3 F4) , 3.52 <01 HCV genotypes 1 or 4 7 6, 1.69 Baseline CD4 + T-cell count, cells/µl , 0 7 Positive serum HBsAg , 5.03 Plasma HIV RNA<50 copies/ml , 2.32 Multivariate analysis by Cox regression. HBsAg, hepatitis B surface antigen. in whom the pace of liver fibrosis, hepatic decompensation events and liver-related deaths is accelerated in comparison with HCV-monoinfected individuals [19]. Thus, the prompt availability of new potent oral regimens as hepatitis C therapy is eagerly awaited for this population [11]. In our study, SVR following pegylated interferon/ ribavirin therapy was associated on average with a fourfold reduction in hepatic complications and mortality in HIV HCV-coinfected patients followed for over 5 years. This observation confirms prior findings [5,6] highlighting that the achievement of SVR is associated with improved survival and reduced incidence of hepatic events in HIV HCV-coinfected patients. However, none of those studies showed any benefit in patients that had been treated and failed, which was one of our major findings. In the subset of patients with baseline advanced liver fibrosis (Metavir F3 F4), the clinical benefit of antiviral therapy was recognized even in patients that did not achieve SVR in comparison with untreated individuals. The longer follow-up of our cohort in comparison with that of Berenguer et al. [6] could explain it (70.5 versus 2 months, respectively). Although it might be argued that untreated patients experienced faster liver disease progression due to the presence of other comorbidities, some of which might have deferred them from HCV treatment and contribute to liver disease progression (for example, alcohol abuse, low CD4 + T-cell counts, active injection drug use, neuropsychiatric illness), we adjusted for these variables in a multivariate model. On the other hand, more patients that failed therapy had baseline advanced liver fibrosis with respect to untreated individuals, reflecting that HCV treatment was prioritized in patients with Metavir F3 F4 estimates. Despite the negative impact of advanced liver fibrosis on clinical outcomes, untreated patients decompensated or died more frequently of liver complications than patients that failed therapy. A large study conducted in HIV HCV-coinfected patients in the United States also pointed out the strong predictive value of baseline liver fibrosis staging on the subsequent rate of liver-related events and deaths but could not find any significant difference between treatment failures and untreated patients [20]. Among other differences, distinct patient demographics (80% were Black and 47% abused alcohol) and very low SVR rates with large heterogeneity among non-responders could have limited the accuracy of that study to explore the impact of non-curative hepatitis C therapy on clinical outcomes with more refinement. By contrast, one study conducted in HIV HCVcoinfected patients acknowledged that relapses after a course of pegylated interferon/ribavirin therapy provided a significant clinical benefit over 4 years in comparison with treatment failure [21]. However, this study did not include, as comparator, a group of untreated patients and therefore could not assess the contribution of antiviral treatment exposure per se. Our results suggest that benefits of interferon-based therapy may be seen in failing patients other than relapsers. Our results point out that interferon exposure might improve the natural history of HIV HCV-coinfected patients even when HCV eradication is not achieved, reducing per se the incidence of hepatic decompensation episodes and liver-related deaths. We should acknowledge several limitations of our study. Because only four hepatic events occurred in the cured group, we could not examine differences between groups in individual outcomes (for example, liver cancer). Likewise, we could not compare with enough power differences between distinct subsets of patients with prior treatment failure modalities, such as relapse, partial response and null response. In addition, the study was retrospective, and therefore unaccounted selection and survival biases could have influenced estimates of effects. Finally, the benefit of antiviral therapy despite lack of SVR was found only in the subset of patients with advanced liver fibrosis and adjustment for other variables such as Model of End-Stage Liver Disease (MELD) was not taken into account. Overall, however, the population size in our study is one of the largest and had one of the longest follow-ups examined so far in HIV HCV-coinfected patients with compensated liver disease that tested the impact of hepatitis C therapy on clinical end points. It would be of Antiviral Therapy
6 P Labarga et al. Figure 1. Incidence of hepatic decompensation events or death A P=02 SVR (n=138) Treatment failure (n=201) Untreated (n=185) B Metavir F0 F2 C Metavir F3 F4 P=4 SVR (n=92) Treatment failure (n=113) Untreated (n=137) SVR (n=46) Treatment failure (n=88) Untreated (n=48) P=02 P<01 Incidence of hepatic decompensation events or death in (A) the study population and (B&C) split out by baseline liver fibrosis staging. SVR, sustained virological response. interest to examine if the new oral direct-acting antivirals against HCV may retain a similar residual clinical benefit compared with interferon when HCV is not eliminated. In summary, the achievement of SVR following pegylated interferon/ribavirin therapy was associated with a fourfold reduction in hepatic complications and mortality in HIV HCV-coinfected patients followed for over 5 years. More interestingly, in the subset of patients with advanced liver fibrosis, the clinical benefit of treatment was recognized even in patients that did not achieve SVR in comparison with untreated individuals. This effect was mainly noticed in patients harbouring International Medical Press
7 Hepatitis C outcome after treatment Figure 2. Incidence of liver-related deaths and/or hepatic decompensation events in patients with baseline Metavir F3-F4 according to IL28B alleles IL28B non-cc IL28B CC P=0.1 P= P=0.1 P=2 P=2 SVR (n=12) Treatment failure (n=43) Untreated (n=14) SVR (n=23) Treatment failure (n=19) Untreated (n=19) P=01 SVR, sustained virological response. IL28B-CC alleles, suggesting that transient antiviral and/or anti-inflammatory effects of exogenous interferon, which are more pronounced in IL2B-CC carriers, might account for this residual benefit of interferon in the absence of SVR in this population. Acknowledgements This work was supported in part by grants from Fundación Investigación y Educación en SIDA (FIES); and European Community s Seventh Framework Programs NEAT (European AIDS Treatment Network; LSHM-CT ) and CHAIN (Collaborative HIV and Anti-HIV Drug Resistance Network; FP7/ ). Disclosure statement The authors declare no competing interests. References 1. Mallet V, Gilgenkrantz H, Serpaggi J, et al. The relationship of regression of cirrhosis to outcome in chronic hepatitis C. Ann Intern Med 2008; 149: Fernández-Montero JV, Barreiro P, Vispo E, et al. Liver fibrosis progression in HIV HCV-coinfected patients treated with distinct antiretroviral drugs and impact of pegylated interferon/ribavirin therapy. Antivir Ther 2014; 19: Veldt BJ, Heathcote EJ, Wedemeyer H, et al. Sustained virologic response and clinical outcomes in patients with chronic hepatitis C and advanced fibrosis. Ann Intern Med 2007; 147: van der Meer AJ, Veldt B, Feld J, et al. Association between sustained virological response and all-cause mortality among patients with chronic hepatitis C and advanced hepatic fibrosis. JAMA 2012; 308: Soriano V, Maida I, Núñez M, et al. Long-term follow-up of HIV-infected patients with chronic hepatitis C virus infection treated with interferon-based therapies. Antivir Ther 2004; 9: Berenguer J, Alvarez-Pellicer J, Martín P, et al. Sustained virological response to interferon plus ribavirin reduces liver-related complications and mortality in patients coinfected with HIV and hepatitis C virus. Hepatology 2009; 50: Macías J, Berenguer J, Japón MA, et al. Fast fibrosis progression between repeated liver biopsies in patients coinfected with HIV/hepatitis C virus. Hepatology 2009; 50: Konerman MA, Mehta S, Sutcliffe C, et al. Fibrosis progression in HIV/hepatitis C virus coinfected adults: prospective analysis of 435 liver biopsy pairs. Hepatology 2014; 59: Thomas DL. Cure of hepatitis C virus infection without interferon alfa: scientific basis and current clinical evidence. Top Antivir Med 2014; 21: Shiffman ML, Benhamou Y. HCV F1/2 patients: treat now or continue to wait. Liver Int 2014; 34 Suppl 1: Barreiro P, Fernández-Montero JV, de Mendoza C, Labarga P, Soriano V. Towards hepatitis C eradication from the HIV-infected population. Antiviral Res 2014; 105: Thompson MA, Aberg J, Hoy J, et al. Antiretroviral treatment of adult HIV infection: 2012 recommendations of the International Antiviral Society-USA panel. JAMA 2012; 308: Antiviral Therapy
8 P Labarga et al. 13. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. (Accessed 5 March 2014.) Available from lvguidelines/adultandadolescentgl.pdf 14. European AIDS Clinical Society (EACS). Guidelines version 7.1 (October 2013). (Accessed 5 March 2014.) Available from de Lédinghen V, Douvin C, Kettaneh A, et al. Diagnosis of hepatic fibrosis and cirrhosis by transient elastography in HIV/hepatitis C virus-coinfected patients. J Acquir Immune Defic Syndr 2006; 41: Crowell TA, Gebo K, Balagopal A, Fleishman J, Agwu A, Berry S. Impact of hepatitis coinfection on hospitalization rates and causes in a multicenter cohort of persons living with HIV. J Acquir Immune Defic Syndr 2014; 65: Linas BP, Wang B, Smurzynski M, et al. The impact of HIV/ HCV co-infection on health care utilization and disability: results of the ACTG Longitudinal Linked Randomized Trials (ALLRT) Cohort. J Viral Hepat 2011; 18: Accepted 9 July 2014; published online 8 August Castellares C, Barreiro P, Martín-Carbonero L, et al. Liver cirrhosis in HIV-infected patients: prevalence, aetiology and clinical outcome. J Viral Hepat 2008; 15: Graham CS, Baden L, Yu E, et al. Influence of HIV infection on the course of hepatitis C virus infection: a meta-analysis. Clin Infect Dis 2001; 33: Limketkai BN, Mehta S, Sutcliffe C, et al. Relationship of liver disease stage and antiviral therapy with liver-related events and death in adults coinfected with HIV/HCV. JAMA 2012; 308: Berenguer J, Alvarez-Pellicer J, Carrero A, et al. Clinical effects of viral relapse after interferon plus ribavirin in patients co-infected with HIV and hepatitis C virus. J Hepatol 2013; 58: International Medical Press
Original article Liver fibrosis progression despite HCV cure with antiviral therapy in HIV HCV-coinfected patients
Antiviral Therapy 2015; 20:329 334 (doi: 10.3851/IMP2909) Original article Liver fibrosis progression despite HCV cure with antiviral therapy in HIV HCV-coinfected patients Pablo Labarga 1,2, Jose V Fernandez-Montero
More informationOriginal article Progression to advanced liver fibrosis in HIV HCV coinfected patients and prioritization of new hepatitis C therapies
Antiviral Therapy 2014; 19:799 803 (doi: 10.3851/IMP2816) Original article Progression to advanced liver fibrosis in HIV HCV coinfected patients and prioritization of new hepatitis C therapies Pablo Labarga
More informationLiver stiffness predicts liver related events and mortality in HIV/HCV coinfected patients
Liver stiffness predicts liver related events and mortality in HIV/HCV coinfected patients José Vicente Fernández-Montero, Pablo Barreiro, Eugenia Vispo, Pablo Labarga, Francisco Blanco, Fernanda Rick,
More informationTreatment of Hepatitis C in HIV-Coinfected Patients. Vincent Soriano Department of Infectious Diseases Hospital Carlos III Madrid, Spain
Treatment of Hepatitis C in HIV-Coinfected Patients Vincent Soriano Department of Infectious Diseases Hospital Carlos III Madrid, Spain Estimated no. of persons infected with HIV and hepatitis viruses
More informationcoinfected patients predicts HBsAg clearance during long term exposure to tenofovir
Measurement of serum HBsAg in HIV/HBV coinfected patients predicts HBsAg clearance during long term exposure to tenofovir Zulema Plaza 1, Antonio Aguilera 2, Alvaro Mena 3, Luz Martín-Carbonero 1, Eugenia
More informationHepatitis Delta. Vicente Soriano Infectious Diseases Unit La Paz University Hospital & IdiPAZ Madrid, Spain
Hepatitis Delta Vicente Soriano Infectious Diseases Unit La Paz University Hospital & IdiPAZ Madrid, Spain Disclosures Member of speaker bureau and advisory board for: Roche, Boehringer, Gilead, Viiv,
More informationVicente Soriano Department of Infectious Diseases
Predictors of Response to Hepatitis C Therapy Vicente Soriano Department of Infectious Diseases Hospital Carlos III, Madrid, Spain Diagnosis Therapy IL28B alleles Non-invasive liver fibrosis methods Viral
More informationProfessor Vincent Soriano
Five Nations Conference on HIV and Hepatitis in partnership with Professor Vincent Soriano Hospital Carlos III, Madrid, Spain Professor Vincent Soriano in partnership with Hospital Carlos III, Madrid,
More informationClinical cases: HIV/HCV coinfection
Clinical cases: HIV/HCV coinfection José Vicente Fernández-Montero Hospital Carlos III, Madrid Case #1 General considerations about antiviral therapy CASE # 1 43 year-old, male patient Former IDU No prior
More informationMolecular Epidemiology of Infectious Diseases Laboratory, Instituto de Salud Carlos III, Majadahonda, Spain 3
Antiviral Therapy 2010 15:881 886 (doi: 10.3851/IMP1630) Original article Incidence of liver cirrhosis in HIV-infected patients with chronic hepatitis B or C in the era of highly active antiretroviral
More informationGlecaprevir-Pibrentasvir in HCV GT 1 or 4 & Prior DAA Treatment MAGELLAN-1 (Part 2)
Phase 3 Treatment-Experienced in HCV GT 1 or 4 & Prior DAA Treatment MAGELLAN-1 (Part 2) in HCV GT 1 or 4 & Prior DAA Treatment MAGELLAN-1 (Part 2): Study Features MAGELLAN-1 (Part 2) Trial Design: Randomized,
More informationMeet the Professor: HIV/HCV Coinfection
Meet the Professor: HIV/HCV Coinfection Vincent Lo Re, MD, MSCE Assistant Professor of Medicine and Epidemiology Division of Infectious Diseases Center for Clinical Epidemiology and Biostatistics University
More informationUpdate on HIV-HCV Epidemiology and Natural History
Update on HIV-HCV Epidemiology and Natural History Jennifer Price, MD Assistant Clinical Professor of Medicine University of California, San Francisco Learning Objectives Upon completion of this presentation,
More informationHepatitis C Update on New Treatments
Hepatitis C Update on New Treatments Kevork M. Peltekian, MD, FRCPC 44th Annual Dalhousie Spring Refresher Course - Therapeutics April 5 - April 7, 2018 Halifax Convention Centre Disclosures Conflicts
More informationIntron A Hepatitis B. Intron A (interferon alfa-2b) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.01.01 Subject: Intron A Hepatitis B Page: 1 of 7 Last Review Date: November 30, 2018 Intron A Hepatitis
More informationMonitoring Patients Who Are Starting HCV Treatment, Are On Treatment, Or Have Completed Therapy
Monitoring Patients Who Are Starting HCV Treatment, Are On Treatment, Or Have Completed Therapy WV ECHO August 10, 2017 Selection of patients for HCV treatment Despite current guidance to treat everyone,
More informationHealthy Liver Cirrhosis
Gioacchino Angarano Clinica delle Malattie Infettive Università degli Studi di Foggia Healthy Liver Cirrhosis Storia naturale dell epatite HCVcorrelata in assenza di terapia Paestum 13-15 Maggio 24 The
More informationTreatment of genotype 4 patient. with cirrhosis. Vincent LEROY Clinique Universitaire d Hépato-Gastroentérologie INSERM U823 CHU de Grenoble
Treatment of genotype 4 patient with cirrhosis Vincent LEROY Clinique Universitaire d Hépato-Gastroentérologie INSERM U823 CHU de Grenoble Clinical case 52 year-old patient Intra-venous drug user 1987-1989
More informationHCV care after cure. This program is supported by educational grants from
HCV care after cure This program is supported by educational grants from Raffaele Bruno,MD Department of Infectious Diseases, Hepatology Outpatients Unit University of Pavia Fondazione IRCCS Policlinico
More informationAbstract and Introduction. Patients and Methods. M. Hedenstierna; A. Nangarhari; A. El-Sabini; O. Weiland; S.
www.medscape.com Cirrhosis, High Age and High Body Mass Index Are Risk Factors for Persisting Advanced Fibrosis After Sustained Virological Response in Chronic Hepatitis C M. Hedenstierna; A. Nangarhari;
More informationHCV RNA profiles among chronic HIV/HCV coinfected individuals in ESPRIT; spontaneous HCV RNA clearance observed in 9 individuals
HCV RNA profiles among chronic HIV/HCV coinfected individuals in ESPRIT; spontaneous HCV RNA clearance observed in 9 individuals Daniel GRINT 1,2, Ellen TEDALDI 3, Lars PETERS 4, Amanda MOCROFT 1, Brian
More informationSuccessful hepatitis C treatment lowers risk of death for people with HIV and HCV co infection
Successful hepatitis C treatment lowers risk of death for people with HIV and HCV co infection Liz Highleyman Produced in collaboration with hivandhepatitis.com Published: 28 October 2015 Jump to Trends
More informationAntiretroviral Therapy in HIV and Hepatitis Coinfection: What Do We Need to Consider?
Antiretroviral Therapy in HIV and Hepatitis Coinfection: What Do We Need to Consider? Saturday 22nd March 2014, Mumbai, India Jürgen K. Rockstroh Department of Internal Medicine I University Hospital Bonn,
More informationThe Effect of Antiviral Therapy on Liver Fibrosis in CHC. Jidong Jia Beijing Friendship Hospital, Capital Medical University
The Effect of Antiviral Therapy on Liver Fibrosis in CHC Jidong Jia Beijing Friendship Hospital, Capital Medical University 2016-5-29 1 Disclosure Consultation for Abbvie, BMS, Gilead, MSD, Novartis and
More informationPredictors of Response to Hepatitis C Therapy in the DAA Era. Pablo Barreiro Servicio de Enfermedades Infecciosas Hospital Carlos III, Madrid
Predictors of Response to Hepatitis C Therapy in the DAA Era Pablo Barreiro Servicio de Enfermedades Infecciosas Hospital Carlos III, Madrid Why Predicting HCV Response? Select candidates for therapy Prioritizing
More informationProfessor Mark Nelson. Chelsea and Westminster Hospital, London, UK
Professor Mark Nelson Chelsea and Westminster Hospital, London, UK Treatment should be prioritized Treatment Indicated All naive and experienced pts with liver disease Prioritized Pts with fibrosis (F3)
More informationHepatitis Alert: Management of Patients With HCV Who Have Achieved SVR
Hepatitis Alert: Management of Patients With HCV Who Have Achieved SVR This program is supported by educational grants from AbbVie, Gilead Sciences, and Merck About These Slides Please feel free to use,
More informationHIV coinfection and HCC
HIV coinfection and HCC 3 rd APASL STC on HCC 21 st -23 rd Nov 2013 Cebu, Phillippines George KK Lau MBBS (HK), MRCP(UK), FHKCP, FHKAM (GI), MD(HK), FRCP (Edin, Lond) Consultant, Humanity and Health GI
More informationANTIVIRAL THERAPY FOR HCV. Alfredo Alberti
CLINICAL IMPACT OF SVR AFTER ANTIVIRAL THERAPY FOR HCV Alfredo Alberti Department of Histology,Microbiology and Medical Biotechnologies Molecular Hepatology Unit Venetian Institute of Molecular Medicine
More informationAppendix This appendix was part of the submitted manuscript and has been peer reviewed. It is posted as supplied by the authors.
Appendix This appendix was part of the submitted manuscript and has been peer reviewed. It is posted as supplied by the authors. Appendix to: Thompson AJV; Expert panel representing the Gastroenterological
More informationIL28B gene polymorphisms and viral kinetics in HIV/hepatitis C virus-coinfected patients treated with pegylated interferon and ribavirin
IL28B gene polymorphisms and viral kinetics in HIV/hepatitis C virus-coinfected patients treated with pegylated interferon and ribavirin Norma I. Rallón a, Vincent Soriano a, Susanna Naggie b, Clara Restrepo
More informationIntron A (interferon alfa-2b) with ribavirin, (Moderiba, Rebetol, Ribasphere, RibaTab, ribavirin tablets/capsules - all strengths)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.01.06 Subject: Intron A Ribavirin Page: 1 of 6 Last Review Date: March 18, 2016 Intron A Ribavirin Description
More informationHepatitis C Virus (HCV)
Clinical Practice Guidelines Hepatitis C Virus (HCV) OBJECTIVE The purpose is to guide the appropriate diagnosis and management of Hepatitis C Virus (HCV). GUIDELINE These are only guidelines, and are
More informationSupplementary Table 1. The distribution of IFNL rs and rs and Hardy-Weinberg equilibrium Genotype Observed Expected X 2 P-value* CHC
Supplementary Table 1. The distribution of IFNL rs12979860 and rs8099917 and Hardy-Weinberg equilibrium Genotype Observed Expected X 2 P-value* CHC rs12979860 (n=3129) CC 1127 1145.8 CT 1533 1495.3 TT
More informationHepatocellular Carcinoma: Can We Slow the Rising Incidence?
Hepatocellular Carcinoma: Can We Slow the Rising Incidence? K.Rajender Reddy M.D. Professor of Medicine Director of Hepatology Medical Director of Liver Transplantation University of Pennsylvania Outline
More informationHepatitis C: Management of Previous Non-responders with First Line Protease Inhibitors
Hepatitis C: Management of Previous Non-responders with First Line Protease Inhibitors Fred Poordad, MD The Texas Liver Institute Clinical Professor of Medicine University of Texas Health Science Center
More informationGlecaprevir-Pibrentasvir in Cirrhotic Genotype 1, 2, 4, 5, and 6 EXPEDITION-1
Phase 3 Treatment-Naïve and Treatment-Experienced Glecaprevir-Pibrentasvir in Cirrhotic Genotype 1, 2, 4, 5, and 6 EXPEDITION-1 EXPEDITION-1: Study Features EXPEDITION-1 Trial Design: Open-label, single-arm,
More informationDelta hepatitis: How to manage and optimize therapy? Dominique ROULOT Unité d Hépatologie, Hôpital Avicenne
Delta hepatitis: How to manage and optimize therapy? Dominique ROULOT Unité d Hépatologie, Hôpital Avicenne Delta hepatitis treatment in 2018 Currently, Peg-IFNα 180 µg/wk is the only effective treatment
More informationEPIDEMIOLOGY, CLINICAL FEATURES AND OUTCOME OF ACUTE HEPATITIS C IN HIV-POSITIVE PATIENTS: PRESENTATION OF OUR EXPERIENCE
EPIDEMIOLOGY, CLINICAL FEATURES AND OUTCOME OF ACUTE HEPATITIS C IN HIV-POSITIVE PATIENTS: PRESENTATION OF OUR EXPERIENCE E. Angeli, A. Mainini, C. Atzori, G. Gubertini and G. Rizzardini II Dept. Infectious
More informationApplied Health Economics and Health Policy
Applied Health Economics and Health Policy Cost-Effectiveness Analysis of Boceprevir for the Treatment of Chronic Hepatitis C Virus Genotype 1 Infection in Portugal Elamin H. Elbasha, Jagpreet Chhatwal,
More informationDeterminants of Response to Pegylated Interferon and Ribavirin for Acute Hepatitis C Infection in Patients with Human Immunodeficiency Virus
Determinants of Response to Pegylated Interferon and Ribavirin for Acute Hepatitis C Infection in Patients with Human Immunodeficiency Virus Leah Burke, M.D. 1, Daniel Fierer, M.D. 2, David Cassagnol,
More informationApproved regimens for cirrhotic patients
5th Workshop on HCV THERAPY ADVANCES New antivirals in clinical practice Approved regimens for cirrhotic patients Amsterdam, 4-5 december 2015 Disease burden in Spain 400000 350000 300000 F0 Peak cirrhosis
More informationShould Elderly CHC Patients (>70 years old) be Treated?
Should Elderly CHC Patients (>70 years old) be Treated? Deepak Amarapurkar Consultant Gastroenterologist & Hepatologist Bombay Hospital & Medical Research Center, Mumbai & Jagjivanram Western Railway Hospital,
More informationCIRROSI E IPERTENSIONE PORTALE NELLA DONNA
Cagliari, 16 settembre 2017 CIRROSI E IPERTENSIONE PORTALE NELLA DONNA Vincenza Calvaruso, MD, PhD Ricercatore di Gastroenterologia Gastroenterologia & Epatologia, Di.Bi.M.I.S. Università degli Studi di
More informationOriginal article Ledipasvir and sofosbuvir for HCV infection in patients coinfected with HBV
Antiviral Therapy 2016; 21:605 609 (doi: 10.3851/IMP3066) Original article Ledipasvir and sofosbuvir for HCV infection in patients coinfected with HBV Edward J Gane 1,2 *, Robert H Hyland 3, Di An 3, Evguenia
More informationExpress Scripts, Inc. monograph dated 5/25/2011; selected revision 6/1/2011
BENEFIT DESCRIPTION AND LIMITATIONS OF COVERAGE ITEM: PRODUCT LINES: COVERED UNDER: DESCRIPTION: CPT/HCPCS Code: Company Supplying: Setting: Coverage Criteria: Approval Period: Victrelis (boceprevir capsules)
More informationLa gestione corrente dell infezione cronica da HCV: la progressione verso la cirrosi. Simona Landonio I Div Mal inf H Sacco Milano
La gestione corrente dell infezione cronica da HCV: la progressione verso la cirrosi Simona Landonio I Div Mal inf H Sacco Milano HCV Natural History Viganò M et al Gastroenterology 27;133:835-842 Overall
More informationViral Hepatitis The Preventive Potential of Antiviral Therapy. Thomas Berg
Viral Hepatitis The Preventive Potential of Antiviral Therapy Thomas Berg Therapeutic and preventive strategies in patients with hepatitis virus infection Treatment of acute infection Treatment of chronic
More informationHepatology for the Nonhepatologist
Hepatology for the Nonhepatologist Kenneth E. Sherman, MD, PhD Gould Professor of Medicine Director, Division of Digestive Diseases University of Cincinnati College of Medicine Cincinnati, Ohio Learning
More informationCase 4: A 61-year-old man with HCV genotype 3 with cirrhosis. Ira M. Jacobson, M.D. Weill Cornell Medical College New York, New York USA
Case 4: A 61-year-old man with HCV genotype 3 with cirrhosis Ira M. Jacobson, M.D. Weill Cornell Medical College New York, New York USA 1 Genotype 3 case 61-year-old man with HCV genotype 3 Cirrhosis on
More informationIntron A Hepatitis C. Intron A (interferon alfa-2b) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.01.05 Subject: Intron A Hepatitis C Page: 1 of 5 Last Review Date: November 30, 2018 Intron A Hepatitis
More informationManagement of Acute HCV Infection
Management of Acute HCV Infection This section provides guidance on the diagnosis and medical management of acute HCV infection, which is defined as presenting within 6 months of the exposure. During this
More informationPEGINTRON (peginterferon alfa-2b) SECTION 1: Pegintron - Hepatitis C Monotherapy
SECTION 1: Hepatitis C Pegintron SECTION 2: Hepatitis C Pegintron & Ribavirin SECTION 3: Hepatitis C Pegintron, Ribavirin, & Sovaldi SECTION 4: Hepatitis C Pegintron, Ribavirin, & Olysio SECTION 1: Pegintron
More informationIntron A (interferon alfa-2b) with ribavirin, (Copegus, Moderiba, Rebetol, Ribapak, Ribasphere, RibaTab, ribavirin tablets/capsules - all strengths)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Intron A Ribavirin Page: 1 of 5 Last Review Date: November 30, 2018 Intron A Ribavirin Description
More informationB C Outlines. Child-Pugh scores
B C 2016-12-09 Outlines Child-Pugh scores CT MRI Fibroscan / ARFI Histologic Scoring Systems for Fibrosis Fibrosis METAVIR Ishak None 0 0 Portal fibrosis (some) 1 1 Portal fibrosis (most) 1 2 Bridging
More informationLiver Transplantation: The End of the Road in Chronic Hepatitis C Infection
University of Massachusetts Medical School escholarship@umms UMass Center for Clinical and Translational Science Research Retreat 2012 UMass Center for Clinical and Translational Science Research Retreat
More informationEvaluating HIV Patient for Liver Transplantation. Marion G. Peters, MD Professor of Medicine University of California San Francisco USA
Evaluating HIV Patient for Liver Transplantation Marion G. Peters, MD Professor of Medicine University of California San Francisco USA Slide 2 ESLD and HIV Liver disease has become a major cause of death
More informationTopic: Sovaldi, sofosbuvir Date of Origin: March 14, Committee Approval Date: August 15, 2014 Next Review Date: March 2015
Medication Policy Manual Policy No: dru332 Topic: Sovaldi, sofosbuvir Date of Origin: March 14, 2014 Committee Approval Date: August 15, 2014 Next Review Date: March 2015 Effective Date: October 1, 2014
More information5/12/2016. Learning Objectives. Management of Hepatitis C Virus Genotype 2 or 3 Infected Treatment-Naive or Experienced Patients
5/12/216 Management of Hepatitis C Virus Genotype 2 or 3 Infected Treatment-Naive or Experienced Patients Alexander Monto, MD Professor of Clinical Medicine University of California San Francisco San Francisco,
More informationDAA-based treatment in cirrhotic and post-transplanted patients. Audrey Coilly, MD Hôpital Paul Brousse, Villejuif, France
DAA-based treatment in cirrhotic and post-transplanted patients Audrey Coilly, MD Hôpital Paul Brousse, Villejuif, France Cirrhosis and transplantation 2 populations with similar issues Hepatic impairment
More informationPEARL-I. Ombitasvir + Paritaprevir + Ritonavir +/- Ribavirin in HCV GT4. Treatment Naïve and Treatment Experienced
Phase 2b Treatment Naïve and Treatment Experienced Ombitasvir + Paritaprevir + Ritonavir +/- Ribavirin in HCV GT4 PEARL-I Hézode C, et al. Lancet. 2015 March 30. [Epub ahead of print] PEARL-I: Study Design
More informationTreatment of chronic hepatitis C in HIV co-infected patients
Treatment of chronic hepatitis C in HIV co-infected patients Vicente Soriano Department of Infectious Diseases Hospital Carlos III, Madrid, Spain The most prevalent chronic viral infections in humans HBV
More informationOriginal Article. Six Month Follow-up of Liver Stiffness Measurement in Untreated Chronic Hepatitis C With or Without HIV Co-infection
Original Article Phrommee N, et al. 15 Six Month Follow-up of Liver Stiffness Measurement in Untreated Chronic Hepatitis C With or Without HIV Co-infection Phrommee N Leerapun A Pisespongsa P Chitapanarux
More informationOpen Forum Infectious Diseases MAJOR ARTICLE
Open Forum Infectious Diseases MAJOR ARTICLE Liver Fibrosis Regression Measured by Transient Elastography in Human Immunodeficiency Virus (HIV)- Hepatitis B Virus (HBV)-Coinfected Individuals on Long-
More informationWhy make this statement?
HCV Council 2014 10 clinical practice statements were evaluated by the Council A review of the available literature was conducted The level of support and level of evidence for the statements were discussed
More informationPrior Authorization Guideline
Prior Authorization Guideline Guideline Name Olysio (simeprevir) Formulary UnitedHealthcare Community & State Formulary Note Approval Date 2/19/2014 Revision Date 7/9/2014 1. Indications Drug Name: Olysio
More informationSimeprevir + PEG + RBV in Treatment-Naïve Genotype 1 QUEST-1 Trial
Phase 3 Treatment Naïve Simeprevir + in Treatment-Naïve Genotype 1 QUEST-1 Trial Jacobson IM, et al. Lancet. 2014;384:403-13. Simeprevir + PEG + Ribavirin for Treatment-Naïve HCV GT1 QUEST-1 Trial QUEST-1
More informationAASLD, Boston, USA, 10 th November 2014 [oral presentation]
Effects of Sustained Virological Response on the of liver transplant, hepatocellular carcinoma, death and re-infection: meta-analysis of 129 studies in 34,563 patients with Hepatitis C infection. Andrew
More informationSYNOPSIS Final Clinical Study Report for Study AI444031
Name of Sponsor/Company: Bristol-Myers Squibb Name of Finished Product: Name of Active Ingredient: () Individual Study Table Referring to the Dossier (For National Authority Use Only) SYNOPSIS for Study
More informationHepatitis C Virus (HCV) & Infectious Disease 101 for Hubs & Spokes April 24, :00 pm 1:00 pm
Hepatitis C Virus (HCV) & Infectious Disease 101 for Hubs & Spokes April 24, 2018 12:00 pm 1:00 pm Presenters: Thomas E. Freese, PhD, Larissa Mooney, MD, & Rachel McLean, MPH, Chief, Office of Viral Hepatitis
More informationDetection and significance of PD-1.3 SNP (rs ) and IL28B SNP (rs ) in patients with current or past hepatitis B virus (HBV) infection
Detection and significance of PD-1.3 SNP (rs11568821) and IL28B SNP (rs12979860) in patients with current or past hepatitis B virus (HBV) infection Asterios Saitis 1, Nikolaos K. Gatselis 1, Kalliopi Azariadi
More informationHepatology For The Nonhepatologist
Hepatology For The Nonhepatologist Andrew Aronsohn, MD Associate Professor of Medicine University of Chicago Chicago, Illinois Learning Objectives After attending this presentation, learners will be able
More informationNovedades en el tratamiento de la hepatitis B: noticias desde la EASL. Maria Buti Hospital Universitario Valle Hebrón Barcelona
Novedades en el tratamiento de la hepatitis B: noticias desde la EASL Maria Buti Hospital Universitario Valle Hebrón Barcelona Milestones in CHB treatment Conventional IFN 1991 Lamivudine (LAM) 1998 Adefovir
More informationGlecaprevir-Pibrentasvir in Non-Cirrhotic Genotype 2 ENDURANCE-2
Phase 3 Treatment Naïve or Experienced Glecaprevir-Pibrentasvir in Non-Cirrhotic Genotype 2 ENDURANCE-2 *ENDURANCE-2: Study Features ENDURANCE-2 Trial Design: Randomized, double-blind, placebo-controlled
More informationThe Impact of HBV Therapy on Fibrosis and Cirrhosis
The Impact of HBV Therapy on Fibrosis and Cirrhosis Jordan J. Feld, MD, MPH Associate Professor of Medicine University of Toronto Hepatologist Toronto Centre for Liver Disease Sandra Rotman Centre for
More informationEfficacy of prolonged tenofovir therapy on hepatitis delta in HIV-infected patients
Efficacy of prolonged tenofovir therapy on hepatitis delta in HIV-infected patients Vincent Soriano a,b, Eugenia Vispo a, Rocío Sierra-Enguita a, Carmen de Mendoza c, José V. Fernández-Montero a, Pablo
More informationMEDIC CENTER. Case 2
Case 2 Case history 57 year old Vietnamese man He lives in HCM city and works as a engineer The patient presented in July 2012 with fatigue Diagnosed with HCV in 2004 Negative for both HBV and HIV antibodies
More informationFollow-up of patients with SVR Lawrence Serfaty Service d Hépatologie, UMR_S 938 Hôpital Saint-Antoine Université Pierre&Marie Curie Paris, France
9th Paris Hepatitis Conference, January 11-12, 2016 Follow-up of patients with SVR Lawrence Serfaty Service d Hépatologie, UMR_S 938 Hôpital Saint-Antoine Université Pierre&Marie Curie Paris, France Disclosures
More informationHow to treat HCV in HIV coinfection
How to treat HCV in HIV coinfection Dr. med. Stefan Mauss Center for HIV and Hepatogastroenterology Duesseldorf, Germany These are real world cases from a rather wealthy social health care system off label
More informationWorldwide Causes of HCC
Approach to HCV Treatment in Patients with HCC JORGE L. HERRERA, MD, MACG UNIVERSITY OF SOUTH ALABAMA COLLEGE OF MEDICINE Worldwide Causes of HCC 60% 50% 40% 54% 30% 20% 10% 31% 15% 0% Hepatitis B Hepatitis
More informationLength of Authorization: 8-16 weeks. Requires PA: All direct-acting antivirals for treatment of Hepatitis C. Approval Criteria
Hepatitis C Direct-Acting Antivirals Goals: Approve use of cost-effective treatments supported by the evidence. Provide consistent patient evaluations across all hepatitis C treatments. Ensure appropriate
More informationPegylated Interferons and Ribavirins
Pegylated Interferons and Ribavirins Goal(s): Cover drugs only for those clients where there is evidence of effectiveness and safety Length of Authorization: 16 weeks plus 12-36 additional weeks or 12
More informationHepatitis C Eradication Reduces Liver Decompensation, HIV progression, and Death in HIV/HCV-coinfected Patients with non-advanced Liver Fibrosis
Hepatitis C Eradication Reduces Liver Decompensation, HIV progression, and Death in HIV/HCV-coinfected Patients with non-advanced Liver Fibrosis J. Berenguer 1, F. X. Zamora 2, C. Díez 1, M. Crespo 3,
More informationAntiviral Therapy 2015; 20: (doi: /IMP2805)
Antiviral Therapy 2015; 20:185 192 (doi: 10.3851/IMP2805) Original article Non-invasive fibrosis assessment predicts sustained virological response to telaprevir with pegylated interferon and ribavirin
More informationTransplantation. Professor Didier. Centre Hépatobiliaire, Hépatobiliaire, C.H.B.
Treatment Treatment of of Hepatitis Hepatitis C C in in Liver Liver Transplantation Transplantation Professor Professor Didier Didier Samuel Samuel Centre Centre Hépatobiliaire, Hépatobiliaire, Inserm
More informationBackground. ΝΑ therapy in CHBe- until HBsAg clearance. (EASL guidelines 2012)
Interferon-induced protein 10 (IP10) at discontinuation of effective entecavir (ETV) or tenofovir (TDF) therapy cannot predict subsequent relapses in non-cirrhotic HBeAgnegative chronic hepatitis B (CHBe-)
More informationHIV-HBV coinfection: Issues with treatment in 2018
HIV-HBV coinfection: Issues with treatment in 2018 Pr Karine Lacombe, INSERM UMR-S1136, IPLESP Infectious Diseases Dpt, St Antoine, AP-HP Sorbonne Université, Paris, France Global epidemiology Same routes
More informationLearning Objectives. After attending this presentation, participants will be able to:
Learning Objectives After attending this presentation, participants will be able to: Describe HCV in 2015 Describe how to diagnose advanced liver disease and cirrhosis Identify the clinical presentation
More informationCENTENE PHARMACY AND THERAPEUTICS DRUG REVIEW 3Q17 July August
BRAND NAME Technivie GENERIC NAME Ombitasvir/paritaprevir/ritonavir MANUFACTURER AbbVie, Inc. DATE OF APPROVAL February 27, 2017 PRODUCT LAUNCH DATE Already available on the market REVIEW TYPE Review type
More informationConsensus AASLD-EASL HBV Treatment Endpoint and HBV Cure Definition
Consensus AASLD-EASL HBV Treatment Endpoint and HBV Cure Definition Anna S. Lok, MD, DSc Alice Lohrman Andrews Professor in Hepatology Director of Clinical Hepatology Assistant Dean for Clinical Research
More informationTechnology appraisal guidance Published: 22 September 2010 nice.org.uk/guidance/ta200
Peginterferon alfa and ribavirin for the treatment of chronic hepatitis C Technology appraisal guidance Published: 22 September 2010 nice.org.uk/guidance/ta200 NICE 2018. All rights reserved. Subject to
More informationNational Hepatitis C Elimination Program of Georgia
European Roundtable on Hepatitis Cure & Eradication 2015 9-10 September 2015, Frankfurt, Germany National Hepatitis C Elimination Program of Georgia Tengiz Tsertsvadze MD, PhD Director General Infectious
More informationPosition Paper of the Italian Association for the Study of the Liver for the rational use of anti-hcv drugs available in Italy
Position Paper of the Italian Association for the Study of the Liver for the rational use of anti-hcv drugs available in Italy Advisory committee on new drugs for Hepatitis C : Alessio Aghemo (Coordinator)
More informationNatural History of Chronic Hepatitis B
Natural History of Chronic Hepatitis B Anna SF Lok, MD Alice Lohrman Andrews Professor in Hepatology Director of Clinical Hepatology Assistant Dean for Clinical Research University of Michigan Ann Arbor,
More informationWho to Treat? Consider biopsy Treat. > 2 ULN Treat Treat Treat Treat CIRRHOTIC PATIENTS Compensated Treat HBV DNA detectable treat
Who to Treat? Parameter AASLD US Algorithm EASL APASL HBV DNA CRITERIA HBeAg+ >, IU/mL > 2, IU/mL > 2, IU/mL >, IU/mL HBeAg- > 2, IU/mL > 2, IU/mL > 2, IU/mL > 2, IU/mL ALT CRITERIA PNALT 1-2 ULN Monitor
More informationLife After SVR for Cirrhotic HCV
Life After SVR for Cirrhotic HCV KIM NEWNHAM MN, NP CIRRHOSIS CARE CLINIC UNIVERSITY OF ALBERTA Objectives To review the benefits of HCV clearance in cirrhotic patients To review some of the emerging data
More informationSupplementary materials: Predictors of response to pegylated interferon in chronic hepatitis B: a
Supplementary materials: Predictors of response to pegylated interferon in chronic hepatitis B: a real-world hospital-based analysis Yin-Chen Wang 1, Sien-Sing Yang 2*, Chien-Wei Su 1, Yuan-Jen Wang 3,
More informationHCV TREATMENT PRE- AND POST TRANSPLANTATION
HCV TREATMENT PRE- AND POST TRANSPLANTATION Mitchell L. Shiffman, MD, FACG Medical Director Liver Institute of Virginia Bon Secours Health System Richmond and Newport News, VA, USA IVer Liver Institute
More informationPrior Authorization Guideline
Prior Authorization Guideline Guideline Name Sovaldi (sofosbuvir) Formulary UnitedHealthcare Community & State Formulary Note Approval Date 2/19/2014 Revision Date 7/8/2014 1. Indications Drug Name: Sovaldi
More information