Lakiotaki D, Papatheodoridi M, Sevastianos V
… +36 more, Zachou K, Christodoulou D, Koskinas J, Deutsch M, Alexopoulou A, Elefsiniotis I, Triantos C, Gigi E, Androutsakos T, Karagiannakis DS, Mani I, Dimitroulopoulos D, Mela M, Sinakos E, Michopoulos S, Mimidis K, Papadopoulos N, Kontos A, Veretanos C, Lymperopoulos D, Giannoulis G, Papadimitropoulos V, Avramopoulou E, Papatheodoridi A, Pantzios S, Vasilieva L, Kranidioti H, Koullias E, Soukovelos A, Fytili P, Vlachogiannakos J, Cholongitas E, Manolakopoulos S, Goulis I, Dalekos G, Papatheodoridis G
J Viral Hepat
· 2026 Jul · PMID 42322023
·
Full text
Daily subcutaneous bulevirtide (BLV) 2 mg has been approved as first-line treatment for chronic hepatitis D (CHD), but long-term real-world adherence data are limited. We assessed adherence rates during BLV therapy and t...Daily subcutaneous bulevirtide (BLV) 2 mg has been approved as first-line treatment for chronic hepatitis D (CHD), but long-term real-world adherence data are limited. We assessed adherence rates during BLV therapy and their impact on treatment response. HERACLIS_BLV_D study (NCT05928000) included adult CHD patients initiating BLV 2 mg/day and followed in routine clinical practice. Virological response (VR) was defined as HDV RNA < 57.5 IU/mL or decline > 2 log and biochemical response (BR) as normal ALT (≤ 40 IU/L). Adherence was evaluated through the national prescription system based on executed monthly BLV prescriptions. Treatment discontinuation was defined as no executed BLV prescription for > 3 months at the end of follow-up. Seventy-six patients were included. VR/BR rates were 73%/71% at 12 and 93%/74% at 24 months. Thirteen (17%) patients discontinued BLV (none due to adverse events); 6%-7% per year. Mean adherence among treated patients was 98% ± 6% in 1st year declining to 93% ± 13% in 2nd and 91% ± 17% in 3rd year (p ≤ 0.010). No baseline characteristic was associated with poor (< 90%) or good (≥ 90%) adherence to BLV therapy. Patients with poor vs. good adherence had lower VR rates (1st year: 33% vs. 77%, p = 0.038; 2nd year: 60% vs. 97%, p = 0.030). In conclusion, in clinical practice, < 10% of CHD patients discontinue BLV therapy annually. Adherence is excellent in the first year and remains > 90% until the third year although gradually declines. Poor (< 90%) adherence cannot be predicted but adversely affects the VR rates emphasizing the need for strategies to support long-term treatment retention.
Draper BL, Naing MMS, Htay H
… +4 more, Flynn M, Stoove M, Hellard M, Pedrana A
J Viral Hepat
· 2026 Jul · PMID 42304557
·
Full text
The current two-step model for HCV diagnosis risks losing people from care; a one-step diagnostic approach could improve retention. We investigated whether shortening the read time of an HCV antibody test from 20-min to...The current two-step model for HCV diagnosis risks losing people from care; a one-step diagnostic approach could improve retention. We investigated whether shortening the read time of an HCV antibody test from 20-min to 1 or 5-min could accurately predict HCV RNA viremia in-lieu of a standard RNA test. 1110 people in Yangon had a HCV Ab using Bioline HCV RDT. Results were recorded at 1-min intervals until 20-min, with HCV RNA testing of reactive results at 20-min. 884 participants returned both antibody and RNA results; 838 were Ab reactive at 1-min, 875 were reactive at 5-min and 728 were RNA positive. Sensitivity was 98.6% and 100% for 1 and 5-min read-times, and specificity was 23.1% and 5.8% for 1 and 5-min respectively. Our results suggest that reading the Bioline at 5 min has potential to identify patients with HCV infection ahead of reflexive RNA testing. Trial Registration: ClinicalTrials.gov:NCT03939013.
We evaluated cardiac extracellular volume (ECV) fraction, a sign of inflammation and fibrosis, in 10 individuals with chronic Hepatitis C virus (HCV) infection prior to treatment using cardiac magnetic resonance (CMR) at...We evaluated cardiac extracellular volume (ECV) fraction, a sign of inflammation and fibrosis, in 10 individuals with chronic Hepatitis C virus (HCV) infection prior to treatment using cardiac magnetic resonance (CMR) at 3 T. Compared to age-matched, healthy volunteers, HCV-infected individuals had significantly increased ECV fraction (0.30 ± 0.03 vs. 0.26 ± 0.03, p = 0.0036) regardless of myocardial damage markers, hypertension as a comorbidity, smoking pack-years or fibrosis stage. Our results show that untreated hepatitis C is associated with the development of extrahepatic manifestations even before the onset of liver fibrosis, highlighting that early HCV treatment is prudent to reduce all-cause morbidity.
Rains A, Almirol E, Nicholson W
… +4 more, Fletcher S, Jenkins WD, Schneider JA, Pho MT
J Viral Hepat
· 2026 Jul · PMID 42274013
·
Full text
People who use drugs (PWUD) have a disproportionately elevated risk of hepatitis C virus (HCV). Appropriate screening and treatment may be limited, especially in rural environments experiencing healthcare shortages. In o...People who use drugs (PWUD) have a disproportionately elevated risk of hepatitis C virus (HCV). Appropriate screening and treatment may be limited, especially in rural environments experiencing healthcare shortages. In order to develop targeted intervention strategies for rural PWUD, we investigated individual and network-level correlates of HCV positivity. Survey data were collected from PWUD from the Illinois region of the Federal Delta Regional Authority (DRA). The primary outcome of interest was HCV positivity by self-report. We explored associations between HCV positivity and individual demographic, drug use, and service utilisation characteristics as well as degree of connectedness within social networks. Three hundred and two participants were included in analyses. At the individual level, HCV positivity was associated with injection drug use, overdose history, and prior receipt of substance use treatment. Two hundred and one participants had at least one connection to a peer via referral chains, most of which contained a mix of HCV-negative and positive individuals. Of note, isolated individuals had comparable rates of HCV positivity compared to their socially connected peers. Degree of connectedness was not associated with HCV positivity. This study highlights the heterogeneity, both with respect to HCV positivity and other characteristics, among networks of rural PWUD. Given that most participants were connected to others, HCV interventions led by peer champions may facilitate improved access to critical services for risk mitigation.
Lopez A, Gopalakrishna H, Chang S
… +15 more, Manhas S, Peinovich N, Richards C, Chee G, Martin R, Mateo R, Mironova M, Swanson BE, Meyer WA, Marlowe EM, Li C, Mo H, Heller T, Maiorova E, Koh C
The epidemiological landscape of paired hepatitis B virus (HBV)/hepatitis delta virus (HDV) genotype (GT) among patients with HDV in the US remains unknown. HBV/HDV genotypes were assessed in two independent US cohorts:...The epidemiological landscape of paired hepatitis B virus (HBV)/hepatitis delta virus (HDV) genotype (GT) among patients with HDV in the US remains unknown. HBV/HDV genotypes were assessed in two independent US cohorts: Cohort 1 included 5222 HBV-positive patients from Quest Diagnostics, including 114 anti-HDV+ patients; Cohort 2 included 178 anti-HDV+ samples from highly phenotyped patients managed at the National Institutes of Health (NIH). HBV/HDV sequencing and genotyping were analysed using phylogenetic analyses. In the overall cohort, HBV and HDV genotypes were determined for 197 (67%) and 139 (48%) patients, respectively, with HDV GT1 and GT5 and paired HBV/HDV genotypes D/1 and A/1 being the most prevalent. The most frequent HBV genotypes were GTD (40%) and GTA (35%), and the most frequent HDV genotypes were GT1 (84%) and GT5 (13%). Among 111 paired HBV/HDV genotypes, D/1 (50%) and A/1 (26%) were most common. In Cohort 2, 77 (79%) patients with HDV GT1 were foreign-born, most commonly Mongolian-born (47/77, 61%), while 21% (20/77) were US-born. Among patients with HDV GT5, GT6, or GT7, 93% (14/15) were of African origin. Overall, these findings provide the first comprehensive US analysis of HBV/HDV paired genotypes among patients with HDV and indicate that HBV genotype distributions differ between HBV/HDV coinfection and HBV monoinfection.
People who have been detained have a higher prevalence of hepatitis B virus (HBV) than the general population, yet testing uptake remains limited. Improving testing uptake in high-risk settings is essential to the World...People who have been detained have a higher prevalence of hepatitis B virus (HBV) than the general population, yet testing uptake remains limited. Improving testing uptake in high-risk settings is essential to the World Health Organization 2030 elimination target. This systematic review examines interventions aimed at increasing hepatitis B testing uptake in prison. MEDLINE, EMBASE, CENTRAL and CINAHL were searched from January 2000 to April 2025. Quantitative interventional studies were included. Quality appraisal was conducted using the JBI critical appraisal tool. A random effects meta-analysis with Freeman-Tukey transformation estimated testing uptake. Subgroup analysis explored heterogeneity by sex, geographical region and the screening approach. Sixteen papers (15 studies) were included. Eleven were post-interventional quasi-experimental studies. Nine were conducted in Europe. The pooled testing uptake was 64% (95% CI 46%-80%; I = 98%). Opt-in interventions were associated with a higher testing uptake (77%, 95% CI 59%-91%), in comparison to opt-out testing uptake (33%, 95% CI 17%-52%; p < 0.001), although opt-in screening had enhanced characteristics such as counselling, peer education and culturally tailored approaches. HBV prevalence amongst institutions ranged between 0% and 11.4%. Only one study reports costs. Opt-in programmes were associated with a higher testing uptake in comparison to opt-out programmes, which may reflect the underlying programme characteristics rather than the screening approach alone. Evidence on cost-effectiveness is limited. Most studies were heterogeneous and conducted in high-income countries. Further robust studies are needed to evaluate enhanced screening approaches to determine the most effective and scalable screening programme.
Yilmaz Y, Yu ML, Alswat K
… +26 more, El-Kassas M, Ferret MB, Papatheodoridis G, Fernandez M, Eguchi Y, Duseja A, Keklikkiran Ç, Hamid S, Chan WK, Gordon SC, Esmat G, Isakov V, Roberts S, Méndez-Sánchez N, Fan JG, Gomez MR, George J, Singal AK, Ahmed A, Lam B, Nader F, Henry L, Stepanova M, AlQahtani S, Younossi ZM, Global Liver Council
Fatigue in chronic viral hepatitis may be associated with decreased health-related quality of life and other patient-reported outcomes (PROs). We evaluated the relationship between fatigue and PROs in patients with chron...Fatigue in chronic viral hepatitis may be associated with decreased health-related quality of life and other patient-reported outcomes (PROs). We evaluated the relationship between fatigue and PROs in patients with chronic hepatitis B (CHB) and chronic hepatitis C (CHC). Patients with CHB and CHC enrolled in the Global Liver Registry completed PRO instruments: FACIT-F, CLDQ (for CHB), CLDQ-HCV (for CHC), and WPAI:SHP. Fatigue was defined as FACIT-F Fatigue Scale (FS) score < 30 (scale range: 0-52). Among 2888 patients from 14 countries, 1561 had CHB (mean age 47 ± 13 years; 60% male; 13% advanced fibrosis; 13% depression; 17% fatigue) and 1327 had CHC (50 ± 13 years; 47% male; 21% advanced fibrosis; 18% depression; 28% fatigue). CHB-fatigue was associated with younger age, female, obesity, anxiety, depression (all p < 0.01) and worse PRO scores: CLDQ (scale 1-7): 4.1 ± 0.9 vs. 5.8 ± 0.9; FACIT score (range 0-108): 67.6 ± 14.5 vs. 87.7 ± 13.7; work productivity impairment (range 0-1): 0.33 ± 0.29 vs. 0.11 ± 0.22 (all p < 0.0001). Multivariable analysis confirmed the association of fatigue with lower PRO scores, impairment up to -23% (p < 0.01). CHC-fatigue was associated with female sex, obesity, type 2 diabetes, anxiety, depression (all p < 0.05) and worse PRO scores: CLDQ-HCV: 3.8 ± 1.0 vs. 5.5 ± 1.0; FACIT: 61.8 ± 14.1 vs. 85.6 ± 14.5; work productivity impairment: 0.49 ± 0.32 vs. 0.17 ± 0.25 (all p < 0.0001). In multivariable models, fatigue remained associated with reduced PRO scores, impairment up to -33% (p < 0.01). Almost one in five patients with chronic viral hepatitis report significant fatigue, which is associated with substantial PRO and work productivity impairment. Routine assessment for and management of fatigue in CHC or CHB care is essential.
Drysdale M, Chang R, Wang S
… +7 more, Coutinho A, Gielen V, Man T, Song R, Duh MS, Khalili M, Theodore D
J Viral Hepat
· 2026 Jun · PMID 42141794
·
Full text
Hepatitis B surface antigen (HBsAg) loss is associated with improved clinical outcomes in patients with chronic hepatitis B virus (HBV) infection based on studies predominantly in Asian populations. We assessed real-worl...Hepatitis B surface antigen (HBsAg) loss is associated with improved clinical outcomes in patients with chronic hepatitis B virus (HBV) infection based on studies predominantly in Asian populations. We assessed real-world associations between HBsAg loss and long-term clinical outcomes in a diverse US population with chronic HBV infection. This retrospective cohort study (January 2012-December 2019) used Optum electronic health records data from patients with chronic HBV infection, identified via diagnosis codes or laboratory assessments. Patients with advanced liver disease and hepatitis C, hepatitis D or HIV co-infection at baseline were excluded. Associations between HBsAg loss, as a proxy of functional cure, and clinical outcomes were assessed using doubly robust inverse probability of treatment-weighted Cox proportional hazards models. In total, 15,760 patients with chronic HBV infection were included; 5.6% were receiving stable antiviral treatment. Overall, 4.2% (n = 667) experienced HBsAg loss across the study period. HBsAg loss was associated with an 89% and 62% reduced risk of hepatocellular carcinoma (HCC; adjusted hazard ratio [aHR]: 0.11, 95% CI: 0.01-0.76) and all-cause mortality (ACM; aHR: 0.38, 95% CI: 0.20-0.74), respectively. Risks of compensated cirrhosis (aHR: 0.84, 95% CI: 0.52-1.35) and decompensated liver disease (aHR: 0.74, 95% CI: 0.37-1.48) were lower after HBsAg loss, but did not reach significance. In this large, diverse population of patients with chronic HBV infection without advanced liver disease, HBsAg loss was associated with reduced risks of HCC and ACM compared with those without HBsAg loss.
Kleiner BB, Meconnen M, Azar M
… +7 more, Minoyan N, Zang G, Artenie A, Martel-Laferrière V, Jutras-Aswad D, Bruneau J, Larney S
J Viral Hepat
· 2026 Jun · PMID 42141790
·
Full text
Ongoing monitoring of hepatitis C virus (HCV) and HIV incidence among people who inject drugs (PWID) is important for epidemic control and assessing progress towards disease elimination. We estimated trends in HIV and HC...Ongoing monitoring of hepatitis C virus (HCV) and HIV incidence among people who inject drugs (PWID) is important for epidemic control and assessing progress towards disease elimination. We estimated trends in HIV and HCV infection incidence in a community-based cohort of PWID in Montreal, Canada. Data from March 2011 to March 2025 were drawn from the HEPCO study of PWID aged ≥ 18 years and living in Montreal. Participants with at least two visits were included in analyses. We used a random point approach to estimate the date of each infection event, imputing each date 1000 times, and Rubin's rules to pool incidence rates and 95% CIs across imputations. A total of 743 participants contributed to HCV analyses, with 152 infection events and incidence of 6.47 per 100 person-years (p-y) (95% CI 6.46-6.49). Incidence peaked in 2013 and declined to 2019 before increasing again post-pandemic. There were 61 primary HCV infection events (incidence: 6.15 per 100 p-y; 95% CI 4.79-7.90) and 91 reinfection events (incidence: 6.71 per 100 p-y; 95% CI 6.69-6.73). A total of 836 participants contributed to HIV analysis, with only eight infections over 3089.89 p-y (incidence: 0.26 per 100 p-y; 95% CI 0.13-0.52). Declining HCV incidence among PWID in Montreal may have reversed, but limited data collection during the years 2020-2021 complicates interpretation. HIV incidence was persistently low. HCV incidence remains above World Health Organization elimination targets, highlighting the need for sustained investment in prevention and linkage to care for PWID.
Noviello C, Aricò M, Scazzi FL
… +9 more, Riformato G, Florio O, Furio A, Larocca AMV, Palmieri C, Manzi S, Cantalice MA, Tafuri S, Stefanizzi P
J Viral Hepat
· 2026 Jun · PMID 42124375
·
Full text
Hepatitis A virus (HAV) remains globally endemic, particularly in populations with limited sanitation and poses risks to travellers and healthcare personnel. Although vaccination provides long-term protection, data on th...Hepatitis A virus (HAV) remains globally endemic, particularly in populations with limited sanitation and poses risks to travellers and healthcare personnel. Although vaccination provides long-term protection, data on the duration of immunity in occupationally exposed groups are limited. We conducted a prospective cohort study among healthcare personnel and medical students vaccinated with either a monovalent HAV vaccine (Havrix, Avaxim) or a combined HAV/HBV vaccine (Twinrix) between 1996 and 2003 at Bari University Hospital, Italy. Vaccination records were verified, and serum anti-HAV IgG concentrations were quantified using CMIA (ARCHITECT HAVAb-IgG). Statistical analyses included Student's t-test, χ test and logistic regression (STATA MP 11). A total of 334 participants were included (167 per group; mean age 31 vs. 36 years). After a median of 23 years since vaccination, seroprotection rates were 94.6% for the monovalent and 97.0% for the bivalent vaccine groups (p = 0.28). Mean anti-HAV IgG concentrations were significantly higher in the bivalent vaccine group (10.9 ± 4.6 IU/mL) than in the monovalent group (8.3 ± 4.6 IU/mL; p < 0.001). No associations were observed with sex or behavioural factors, and younger age was the only independent predictor of higher antibody levels (β = 0.32; 95% CI, 0.10-0.43; p < 0.001). These findings demonstrate that protective HAV antibody levels persist for more than two decades after vaccination. Both monovalent and bivalent vaccines confer durable immunity, supporting the continued inclusion of HAV vaccination in national immunisation programs and occupational health strategies.
Chronic hepatitis B virus (HBV) infection in children remains a dynamic condition with an incompletely defined natural history. We conducted a multicenter, retrospective cohort study across six Italian paediatric centers...Chronic hepatitis B virus (HBV) infection in children remains a dynamic condition with an incompletely defined natural history. We conducted a multicenter, retrospective cohort study across six Italian paediatric centers to characterize disease progression, evaluate the applicability of adult-derived classification systems, and identify predictors of HBeAg seroconversion. Children aged 0-18 years with chronic HBV diagnosed between January 2006 and August 2024 were included. The primary outcome was spontaneous HBeAg seroconversion, while secondary outcomes included the applicability of the 2017 EASL phase classification and the characterization of children requiring antiviral therapy. Of 248 children included, 45% were unclassifiable by 2017 EASL criteria at baseline. HBeAg seroconversion occurred in 129 children (52%): 34 (26%) were HBeAg-negative at baseline and 95 (74%) seroconverted during follow-up. Higher baseline ALT levels were significantly associated with seroconversion (p < 0.001), whereas HBV DNA levels were not. Seroconversion was less frequent among children of Asian origin (p < 0.001). Fourteen children (6%) received antiviral therapy with 50% achieving seroconversion; all treatments were well tolerated. Applying 2024 WHO guidelines retrospectively, 81 children (33%) would have met treatment criteria. Despite this, most children were not treated, reflecting a cautious clinical approach that may be justified by the high rates of spontaneous viral control. These findings underscore the limitations of adult-derived classification systems in paediatric populations and highlight the need for paediatric-specific management frameworks and prospective studies to optimize treatment strategies.
Chronic hepatitis delta (CHD) is the most severe form of viral hepatitis and is associated with accelerated progression to cirrhosis and liver failure. Bulevirtide has shown promising results in trials, but real-world da...Chronic hepatitis delta (CHD) is the most severe form of viral hepatitis and is associated with accelerated progression to cirrhosis and liver failure. Bulevirtide has shown promising results in trials, but real-world data on its effectiveness, safety and impact on patient-reported outcomes (PROs) remain limited. To evaluate the effectiveness, safety, and PROs (quality-of life-QoL; adherence) of bulevirtide therapy in CHD patients undergoing a dedicated pharmacist-led patient-education program (PEP). A prospective observational study enrolled 31 consecutive CHD patients receiving bulevirtide 2 mg daily at a tertiary referral centre. Virological, biochemical and combined responses were assessed at weeks 24, 48 and 60. QoL (through EQ-5D-5L questionnaire), adherence (proportion of days covered), and adverse events were monitored during follow-up. Bulevirtide significantly reduced HDV-RNA by week 24 (p < 0.01), with further reductions at week 48 (p = 0.05) and 60 (p < 0.01). Liver tests improved significantly from baseline to week 24 (p < 0.01) and remained stable. Combined response was achieved in 43.7% of patients by week 60. QoL improved significantly (p = 0.03), and adherence was excellent (≥ 90%). Adverse events were mostly mild and transient. In real-world clinical practice, bulevirtide achieved sustained virological and biochemical improvements with favourable safety and quality-of-life outcomes, confirming its effectiveness in routine management of CHD. While the 60-week data (n = 16) are exploratory due to the sample size, these findings confirm its effectiveness and safety in routine management of CHD.
Covalently closed circular DNA (cccDNA), a stable episomal form of the hepatitis B virus (HBV) genome, functions as the transcriptional template for viral replication and persistence, posing a major barrier to HBV cure....Covalently closed circular DNA (cccDNA), a stable episomal form of the hepatitis B virus (HBV) genome, functions as the transcriptional template for viral replication and persistence, posing a major barrier to HBV cure. While host DNA repair factors such as DDB2 and DNA polymerase delta (Pol δ) have been involved in cccDNA regulation in vitro, clinical validation remains limited. This study investigated the role of DDB2 and Pol δ in cccDNA maintenance using HBV-infected cell models and liver tissues from patients with HBV-related and occult HBV infection (OBI)-associated hepatocellular carcinoma (HCC). HepG2-NTCP cells infected with HBV were transfected with siRNAs targeting DDB2 or Pol δ, followed by quantification of intracellular cccDNA using droplet digital PCR (ddPCR). In liver tissues from HBV-HCC and OBI-HCC patients, the expression of DDB2 and Pol δ was assessed, while intrahepatic HBV DNA and cccDNA were measured by qPCR and ddPCR. Serum HBcrAg levels were evaluated using the iTACT-HBcrAg assay. Knockdown of DDB2 and Pol δ significantly reduced intracellular cccDNA levels (p = 0.010 and p = 0.006, respectively). In patient tissues, intrahepatic HBV DNA and cccDNA were markedly lower in OBI-HCC compared to HBV-HCC, despite comparable DDB2 and Pol δ expression. HBcrAg was detectable in 91.3% of HBV-HCC versus only 23.8% of OBI-HCC cases (p < 0.001). DDB2 expression correlated with intrahepatic viral markers in both groups and with HBcrAg only in HBV-HCC. These findings suggest that DDB2 is involved in cccDNA persistence and represents potential therapeutic targets for both overt and occult HBV-related HCC.
Spencer H, Brumbach B, Geduldig A
… +2 more, Nelson L, Seaman A
J Viral Hepat
· 2026 Jun · PMID 42051020
·
Full text
Achieving hepatitis C virus (HCV) elimination requires innovative paradigms that overcome barriers to treatment, such as requiring pre-treatment elastography or phlebotomy-based fibrosis assessment. To identify patients...Achieving hepatitis C virus (HCV) elimination requires innovative paradigms that overcome barriers to treatment, such as requiring pre-treatment elastography or phlebotomy-based fibrosis assessment. To identify patients at low risk of advanced fibrosis or decompensated cirrhosis within our HCV treatment programme, we developed and retrospectively assessed a clinical decision tool, the Decompensated Cirrhosis in Hepatitis C Evaluation Questionnaire (DCHEQ). Here we describe the development of DCHEQ and its test characteristics. We conducted a retrospective, nested, case-control study within a cohort of 1743 patients with HCV enrolled in an urban HCV elimination programme. The primary analysis defined cases of decompensated cirrhosis by chart review. A secondary analysis defined cases of advanced fibrosis as those with aspartate aminotransferase (AST)-platelet ratio index (APRI) > 1.5. The primary outcome was the area under the receiver operator curve (AUC) of the total DCHEQ to predict decompensated cirrhosis. We also compared the AUC of the total DCHEQ to the AUC of components of the DHEQ. For detecting cases of decompensated cirrhosis, the total of all DCHEQ items resulted in a mean AUC = 0.991 (95% CI = 0.963-1.000), which was significantly better than the discrimination of any alternative combination of DCHEQ items (p < 0.00001). For detecting cases of advanced fibrosis, the total DCHEQ score resulted in a mean AUC = 0.921 (95% CI = 0.871-0.966), which was superior to all other DCHEQ item combinations (p < 0.02). DCHEQ exhibited exquisite discrimination between cases of both decompensated cirrhosis and advanced fibrosis versus controls. After prospective validation, DCHEQ could be included in test-and-treat HCV treatment paradigms.
J Viral Hepat
· 2026 Jun · PMID 42050986
·
Full text
Despite the availability of curative, direct-acting antiviral therapy, hepatitis C virus elimination remains incomplete. Losses across the care cascade continue to limit impact, from initial diagnosis to sustained virolo...Despite the availability of curative, direct-acting antiviral therapy, hepatitis C virus elimination remains incomplete. Losses across the care cascade continue to limit impact, from initial diagnosis to sustained virologic response. Fewer than 1/3 of individuals ultimately achieve cure. These gaps reflect a delivery system that does not align with the population most affected, many of whom have inconsistent engagement with outpatient care. The emergency department is critical, but underused point of contact, where the burden of undiagnosed and untreated infection is high. This manuscript presents a practical framework for integrating HCV testing and treatment into emergency care within a new United States. It focuses on five domains. Point of care RNA testing allows confirmation of infection during the encounter, reducing delays that contribute to loss to follow up. Treatment initiation is simplified through standardised eligibility criteria and use of pan genomic regimens supported by electronic decision support. A focused safety screen addresses key exclusions, including hepatitis B coinfection, advanced liver disease, renal impairment, and relevant drug interactions. Policy and financial barriers are examined, including prior authorisation requirements, variation of Medicaid coverage, and access to discount pricing programmes. Post treatment follow up is restructured through decentralised approaches such as dried blood spot testing, telemedicine, and linkage to harm reduction services. Implementation will vary across institutions and regions. Regulatory requirements, payer policies, and staffing models remain important constraints. These challenges identify areas for targeted policy reform and prospective study. The emergency department is not traditionally designed for chronic disease management. However, for a curable infection concentrated among patients who rely on episodic care, it may represent the most effective point of intervention.
Starinieri I, Chitnis A, Wong RJ
… +5 more, Yette E, Pham H, Tang AS, So S, Toy M
J Viral Hepat
· 2026 May · PMID 41968568
·
Full text
Monitoring and retention in care remain suboptimal for patients diagnosed with chronic hepatitis B (CHB) infection with only a minority receiving consistent follow-up. This study evaluates the cost-effectiveness of inter...Monitoring and retention in care remain suboptimal for patients diagnosed with chronic hepatitis B (CHB) infection with only a minority receiving consistent follow-up. This study evaluates the cost-effectiveness of interventions aimed at improving long-term monitoring and retention in care among diagnosed CHB. A Markov model simulated outcomes for a cohort of 100,000 adults, comparing current practice to three interventions: EHR-based provider reminders, patient navigators and a combined strategy. Costs and quality-adjusted life years (QALYs) were evaluated from a healthcare perspective. All interventions were cost-effective, with weighted incremental cost-effectiveness ratios (US$/QALY) of US$8069 (EHR reminders), US$8416 (Patient Navigators) and US$8608 (Combined). Compared with current practice, a combined strategy would avert 1670 cases of compensated cirrhosis, 738 cases of decompensated cirrhosis, 1011 cases of hepatocellular carcinoma, 188 liver transplants, and 2058 CHB-related deaths in a cohort of 100,000. Structured interventions to improve CHB monitoring can deliver substantial health gains at modest costs. These findings can support policy initiatives to improve CHB care retention and highlight the importance of tailoring interventions to local healthcare capacity and population needs.
Chronic hepatitis B (CHB) refers to a global infectious disease caused by the hepatitis B virus. The treatment of CHB causes a heavy economic burden to society. To ensure the rational allocation of medical resources in t...Chronic hepatitis B (CHB) refers to a global infectious disease caused by the hepatitis B virus. The treatment of CHB causes a heavy economic burden to society. To ensure the rational allocation of medical resources in the whole society and achieve the goal of patients' satisfaction and economy, this study aimed to evaluate the economics of de novo combination of tenofovir alafenamide fumarate (TAF) as the first-line nucleos(t)ide analogues (NAs) and peginterferon alfa-2b (PEG-IFNα-2b) versus PEG-IFNα-2b monotherapy of HBeAg-positive CHB in China. The Markov model was used to simulate the transition of HBeAg-positive CHB patients aged 30 in China under various health states using TreeAge Pro 2011 software. The cycle length was 1 year, and the cycle period of the model was 50 years. The model parameters included clinical efficacy, cost, transition probability and discount rate. Cost-effectiveness analysis was conducted through simulation of the total cost and quality adjusted life years (QALYs) of various treatment options through models. Simultaneously, one-way sensitivity analysis, probabilistic sensitivity analysis and scenario analysis were performed. De novo combination of TAF and PEG-IFNα-2b and PEG-IFNα-2b monotherapy resulted in 11.16 and 10.81 QALYs, with total costs of $55559.72 and $57670.23, respectively. De novo combination strategy for HBeAg-positive CHB patients can save costs and obtain more health outcomes. Sensitivity analyses showed the reliability of the results. From the perspective of the whole society, the de novo combination strategy of TAF and PEG-IFNα-2b for patients with HBeAg-positive CHB may be more cost-effective than PEG-IFNα-2b monotherapy.
J Viral Hepat
· 2026 May · PMID 41937404
·
Full text
Hepatitis B virus (HBV) and hepatocellular carcinoma (HCC) are serious medical problems worldwide. Today, many researchers believe that genetic variations play a major role in how easily someone gets infected and how the...Hepatitis B virus (HBV) and hepatocellular carcinoma (HCC) are serious medical problems worldwide. Today, many researchers believe that genetic variations play a major role in how easily someone gets infected and how the disease progresses over time. Although many genetic association studies have suggested various susceptibility loci, lack of consistent results across studies has limited clinical utility. We performed a comprehensive meta-analysis primarily involving East Asian cohorts. We analysed eight SNPs related to HBV infection and 11 SNPs related to HCC across multiple etiologic subgroups. We found that CD40 rs1883832 and C2 rs9267665 exhibited the strongest associations with susceptibility to HBV infection, with no heterogeneity. We found that HLA-DPA1 rs3077 and HLA-DQB1 rs2856718 were significantly associated with HBV infection susceptibility, though with considerable heterogeneity. In our HCC analyses, we found that certain risk variants are linked to specific causes. These include HBV, HCV, alcohol-related disease, and non-alcoholic fatty liver disease (NAFLD). Each cause seems to have its own genetic factors. Based on these results, our meta-analysis brings together many studies to give a clearer picture of the genetic factors that influence HBV infection and HCC in different etiologic pathways. We found that immune-related genes and HLA class II variants seem to have roles in HBV persistence, while metabolic gene variants are major contributors to HCC risk.
Despite overall decline in hepatitis C virus (HCV) incidence in the United States, incidence in rural areas has continued to increase, primarily driven by injection drug use. Models of HCV care serving people in rural ar...Despite overall decline in hepatitis C virus (HCV) incidence in the United States, incidence in rural areas has continued to increase, primarily driven by injection drug use. Models of HCV care serving people in rural areas are needed. The TRAnsporting Hep C Viral ELimination Services via Telemedicine (TRAVEL) Program was implemented to increase access to HCV care in rural Maryland through an integrated model of local nurse case management support and facilitated telemedicine embedded within a local health department. Between January 2018 and March 2024, 502 anti-HCV+ patients were referred to the program. Of those referred, 384 [76%] were linked to care, with the majority having a substance use disorder (SUD) diagnosis [236 (61%)]. Laboratory draws and challenges with subsequent phone contact were barriers to initial linkage of referred individuals. Among the 282 patients who completed baseline labs and had HCV viremia, 272 [96%] attended a provider visit, 262 [93%] initiated DAA therapy, 254 [90%] completed treatment, 188 [67%] completed HCV cure labs and 186 [66%] had confirmed HCV cure. There was no significant difference in treatment initiation and completion between patients with and without SUDs, but patients with SUD were significantly less likely to complete HCV cure labs [aOR 0.43 (0.21, 0.82)]. The TRAVEL Program achieved high retention in care and HCV cure rates; however, a quarter of referred patients were not linked to care, and laboratory draws were a barrier along the care continuum. Strategies to optimize linkage and laboratory evaluation are needed.