Journal Of Viral Hepatitis[JOURNAL]
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200 papers
Demographic and Clinical Characteristics of Patients With Hepatitis C and Hepatitis B Co-Infection, Georgia, 2017-2023.
Handanagic S, Shadaker S, BaliashvilI D … +4 more , Schumacher IT, Armstrong PA, Tohme RA, Butsashvili M
J Viral Hepat · 2025 Oct · PMID 40905619 · Full text
Persons co-infected with hepatitis C virus and hepatitis B virus (HCV-HBV) are at increased risk of developing liver disease compared with mono-infected individuals. In Georgia, all patients undergoing hepatitis C treatm...
Persons co-infected with hepatitis C virus and hepatitis B virus (HCV-HBV) are at increased risk of developing liver disease compared with mono-infected individuals. In Georgia, all patients undergoing hepatitis C treatment are eligible for free testing for hepatitis B surface antigen (HBsAg). However, further hepatitis B evaluations and treatment are not free. We explored demographic and clinical characteristics associated with HCV-HBV co-infection among persons treated for HCV infection. Persons aged ≥ 18 years with HCV infection who initiated HCV treatment during 2017-2023 were included. Patients were grouped as HCV mono-infected, HCV-HBV co-infected (HBsAg positive), and HBV exposed (total HBV core antibody positive, HBsAg negative). We present descriptive analysis and adjusted prevalence ratios (aPR) with 95% confidence intervals (95% CI). Of 54,994 adults treated for hepatitis C, 68.1% had HCV mono-infection, 29.3% were previously exposed to HBV, and 2.6% had HCV-HBV co-infection. Persons who were aged 18-45 years (aPR: 1.75, 95% CI: 1.48-2.08), male (aPR: 1.38, 95% CI: 1.11-1.71), reported ever injecting drugs (aPR: 1.40, 95% CI: 1.19-1.66), had end-of-HCV treatment, alanine transaminase (ALT) levels > 80 IU/L (aPR: 2.14, 95% CI: 1.40-3.29) and did not achieve hepatitis C cure after treatment (aPR: 1.83, 95% CI: 1.13-2.95) were more likely to have HCV-HBV co-infection vs. HCV mono-infection. Patients who did not achieve cure and had persistently higher ALT levels after hepatitis C treatment were more likely to have HCV-HBV co-infection. Expanded access to hepatitis B care and treatment, and co-management of HBV infection along with HCV treatment in co-infected persons are needed to improve clinical outcomes.
Global Trends and Health Inequalities in Acute Hepatitis E Burden: A Joinpoint Regression and Cross-Country Inequality Analysis, 1990-2021.
Huang D, Zhu Z, Peng J … +8 more , Zhang S, Chen Y, Jiang J, Lai H, Yu H, Zhao Q, Chen Y, Chen J
J Viral Hepat · 2025 Oct · PMID 40905616 · Publisher ↗
Acute hepatitis E (AHE) disproportionately affects regions with diverse socioeconomic conditions. This study aims to assess the trends in AHE burden and health inequalities from 1990 to 2021. Utilising data from the Glob...
Acute hepatitis E (AHE) disproportionately affects regions with diverse socioeconomic conditions. This study aims to assess the trends in AHE burden and health inequalities from 1990 to 2021. Utilising data from the Global Burden of Disease 2021, joinpoint regression was employed to identify significant trends. Cross-country inequality analysis was conducted to quantify the distributive inequalities in the burden of AHE. The trends of AHE incidence, prevalence, deaths and disability-adjusted life years (DALYs) rate have experienced a marked decrease from 1990 to 2021, reaching the lowest recorded in 2021. However, the numbers of those continued to increase. An inverse relationship was found between AHE disease rate and sociodemographic index (SDI) levels. The joinpoint regression analysis confirmed a downward trend of AHE globally and in the five SDI levels. Notably, incidence and prevalence rates in high-middle SDI increased from 2015, while those in high SDI slowed down from 2001. Mortality and DALYs rates showed a deceleration in high-middle SDI and a rebound in high SDI from 2009 to 2021. Cross-country inequality analysis disclosed that lower SDI countries disproportionately bear a higher AHE burden, with the magnitude of these inequalities decreasing over time. The study uncovered an inverse correlation between the AHE disease rate and SDI level. Despite a consistent decline in hepatitis E virus disease rate across the five SDI levels, the disparity in burden persists, with developing regions retaining a relatively elevated load. Meanwhile, developed regions exhibit a resurgence, characterised by an upward trend. This dynamic epidemiological shift underscores the ongoing need for vigilant monitoring and adaptable approaches in the management of the disease.
Early Read-Time Performance of the OraQuick HCV Rapid Antibody Assay for the Exclusion of HCV Viremia.
Torgersen J, Smookler D, Russell R … +7 more , Gasior J, Carbonari DM, Aitcheson N, Capraru C, Hansen B, Feld JJ, Re VL
J Viral Hepat · 2025 Oct · PMID 40905608 · Full text
Rapid point-of-care tests for hepatitis C virus (HCV) provide results in 20 min and allow linkage to care, particularly for difficult-to-reach populations. Prior work suggested an early reading time of the OraQuick (OQ)...
Rapid point-of-care tests for hepatitis C virus (HCV) provide results in 20 min and allow linkage to care, particularly for difficult-to-reach populations. Prior work suggested an early reading time of the OraQuick (OQ) rapid HCV antibody lateral flow immunoassay identified people with HCV viremia; however, these observations were not externally validated. We conducted a prospective cohort study at Penn Presbyterian Medical Center from June 2021 to August 2023 to evaluate the performance of OQ early reading times for HCV viremia among participants with reactive HCV antibody. Following test device insertion for whole blood substrate, the OQ assay was evaluated every minute from 5 to 10 min, then at 20 and 40 min. Early read time performance was evaluated against the standard of care HCV RNA. 175 participants (120 [68.6%] with detectable HCV viremia) completed the OQ assay. Among HCV viremic participants, 119 had a positive whole blood OQ by 7 min (sensitivity: 99.2% [95% confidence interval, CI: 95.4-100]; positive predictive value: 82.1% [95% CI: 74.8-87.9]); 1 viremic participant with severe immunosuppression was not identified at this early reading time. No time interval accurately identified only those with HCV viremia, yet a negative OQ test at 7 min excluded HCV viremia (negative predictive value: 96.3% [95% CI: 81.0-99.9]). A 7-min reading time for a whole blood OQ assay may reduce the need for HCV RNA testing and improve screening efficiency by identifying people without HCV viremia. Early read time results cannot be used to exclusively identify HCV viremia and should be used with caution in those with severe immunosuppression or if acute HCV infection is suspected.
Risk Factors for Hepatitis C Virus Among the General Population in Sub-Saharan Africa-An Analysis of Systematic Review Data.
Kassa GM, Lim AG, Tamiru MT … +12 more , Alamneh TS, Vickerman P, Dagne E, Mulu A, Baissa O, Paltiel O, Dillon JF, Yesuf EA, Hickman M, Walker JG, French CE, DESTINE NIHR Global Health Research Group
J Viral Hepat · 2025 Oct · PMID 40888503 · Full text
Understanding risk factors for hepatitis C virus (HCV) is critical for targeting screening and prevention. We systematically reviewed risk factors associated with HCV seroprevalence among the general population in sub-Sa...
Understanding risk factors for hepatitis C virus (HCV) is critical for targeting screening and prevention. We systematically reviewed risk factors associated with HCV seroprevalence among the general population in sub-Saharan Africa (SSA). Comprehensive systematic review of HCV seroprevalence of community-based observational studies reporting HCV risk factors in SSA. Study quality was assessed using Joanna Briggs Institute tool. Random effect meta-analyses were used to estimate odds ratios (OR) with 95% confidence intervals (CI). We identified 92 studies. Higher odds of HCV seroprevalence were observed among age 21-64 (OR = 1.77, 95% CI 1.17-2.68) and 65+ groups (OR = 11.75, 95% CI 5.51-25.05) compared to those aged ≤ 20 years; not being formally educated (OR = 1.78, 95% CI 1.35-2.35) compared to secondary/above and being married (OR = 1.91, 95% CI 1.45-2.51) or divorced (OR = 3.20, 95% CI 1.91-5.36) compared to never married. Family history of HCV (OR = 1.52, 95% CI 1.17-1.96), being a person living with HIV (OR = 2.64, 95% CI 1.61-4.33) or being HBsAg positive (OR = 1.66, 95% CI 1.10-2.50) were all positively associated with increased HCV seroprevalence, as was having a history of blood transfusion (OR = 1.81, 95% CI 1.33-2.45), hospitalisation (OR = 1.55, 95% CI 1.22-1.96), medical operation (OR = 1.28, 95% CI 1.01-1.62), scarification (OR = 1.29, 95% CI 1.01-1.64) and injection drug use (OR = 7.04, 95% CI 1.16-42.68). Pilot HCV screening programmes targeting older adults and people exposed to healthcare-associated factors could potentially lead to the efficient detection of HCV cases and reduce future HCV exposures among the general population in SSA countries.
Global Systematic Review of the Measurement of Stigma Associated With People Living With Hepatitis B or Hepatitis C Viruses.
Green F, Simmons R, Leeman D … +2 more , Desai M, Hibbert M
J Viral Hepat · 2025 Sep · PMID 40856266 · Full text
Chronic hepatitis B and C affect over 300 million people globally. Despite treatment advances, stigma towards people living with hepatitis B/C (PLWHB/C) remains a barrier to care and impacts health outcomes. Addressing t...
Chronic hepatitis B and C affect over 300 million people globally. Despite treatment advances, stigma towards people living with hepatitis B/C (PLWHB/C) remains a barrier to care and impacts health outcomes. Addressing this stigma is key to achieving hepatitis elimination goals. This systematic review aims to synthesise existing approaches to measuring stigma experienced by PLWHB/C and examine factors associated with stigma in different social contexts. Databases searched included PubMed, PsycInfo and Web of Science, as well as grey literature (01/01/2008-30/06/2023). Studies were included if stigma experienced by or directed towards PLWHB/C was measured quantitatively. Data from included studies were synthesised using a narrative approach. Among 3053 studies, 81 were included. Various tools were used to measure internalised (e.g., self-blame, shame), enacted (e.g., experiences of discrimination) and anticipated stigma (e.g., expectations of discrimination) related to PLWHB/C; most commonly the Toronto Chinese Hepatitis B Stigma Scale and Brener and Von Hippel's tool. Stigma was highly prevalent, impacting psychosocial wellbeing, treatment-seeking behaviours and quality of life. Lower knowledge and conservative beliefs were linked to higher public stigma. Educational interventions and stigma-reducing media showed some benefit in mitigating stigmatising attitudes. The review highlights stigma's pervasive nature and detrimental psychosocial impacts for PLWHB/C globally. While diverse measurement tools were used, standardising culturally validated instruments aligned with conceptual frameworks could improve research. Tailored educational initiatives could help reduce stigmatising attitudes. Crucially, stigma hindered timely diagnosis and treatment access, emphasising the need for multi-level interventions addressing stigma to achieve elimination goals.
HCV Screening Before Endoscopy in Hepatogastroenterology Outpatient Clinic: The Depist C Endo Study.
Remy AJ, Bellon S, Smadhi R … +6 more , Bottlaender J, Rosa I, Vidon M, Ehrhard F, Conroy G, Garioud A
J Viral Hepat · 2025 Sep · PMID 40827910 · Publisher ↗
Systematic screening for hepatitis C virus (HCV) by serology once in a lifetime is recommended by the French Association for the Study of the Liver, but not by the French National Authority for Health. Screening focused...
Systematic screening for hepatitis C virus (HCV) by serology once in a lifetime is recommended by the French Association for the Study of the Liver, but not by the French National Authority for Health. Screening focused on subjects aged over 40 years would seem more appropriate, as the prevalence of hepatitis C increases with age. The aim of this study was to assess the feasibility (number of serologies proposed) and acceptability (number of serologies performed) of HCV screening prior to endoscopy in people aged 40 years and over seen in gastroenterology consultations in non-university hospitals; and to determine whether the prevalence after age 40 is higher than in the general population (0.86%). As of 1 June 2023, 490 patients were included in eight different hospitals in six regions of metropolitan France; 97.4% of patients accepted the prescription of HCV serology and 97.6% of prescribed serologies were performed; 55.5% were men and 44.4% women with a mean age of 58 years (range, 40-90). The HCV serology positivity rate was 6% (29 patients). No previous HCV serology was known. Risk exposures associated with positive HCV serology were drug use in 19 patients, a history of transfusion in six patients and origin from an endemic country in five patients; 90% of positive serologies concerned men and the mean age was 65 years (range, 49-85). Mean hepatic elastometry was 8.7 kPa; 11 out of 28 patients tested had a positive HCV viral load and were treated. Systematic screening for hepatitis C after the age of 40 years and before digestive endoscopy is feasible, well accepted and enables a high number of patients to be managed.
Treatment Discontinuation and Adherence in Patients With Chronic Hepatitis B Infection Newly Initiating Nucleos(t)ide Analogues in Japan: A Retrospective Cohort Study.
Kawamatsu S, Rai KK, Gielen V … +11 more , Patel A, Massey O, Anderson SW, Handa Y, Lee EY, Payne P, Jimenez I, Begaj K, Salehi S, Inoue J, Ismaila AS
J Viral Hepat · 2025 Sep · PMID 40810215 · Full text
Nucleos(t)ide analogue (NA) therapy is the current standard of care for chronic hepatitis B (CHB) virus infection but rarely achieves functional cure, necessitating long-term therapy, which often leads to nonadherence an...
Nucleos(t)ide analogue (NA) therapy is the current standard of care for chronic hepatitis B (CHB) virus infection but rarely achieves functional cure, necessitating long-term therapy, which often leads to nonadherence and increased treatment burden. This retrospective cohort study was designed to describe treatment discontinuation and adherence to second-generation NAs among patients with CHB in Japan. We used the Japanese Medical Data Center Claims Database (JMDC Inc.) to identify adults with CHB who were newly initiated on a single-agent, second-generation NA between January 2007 and August 2023. Outcomes included treatment discontinuation and adherence, treatment restart after discontinuation, NA switching and factors associated with treatment discontinuation/adherence. Of the 2473 patients included in this study (mean age 49.9 years), 65.6% were male. The most common index NAs were entecavir (55.5%) and tenofovir alafenamide fumarate (TAF, 36.2%). Treatment discontinuation was observed in 20.3% of patients; mean time to discontinuation was 20.4 months. Of the patients who discontinued, 50.7% restarted NAs. Mean adherence (proportion of days covered [PDC]) was 0.87, and 81.2% of participants had PDC ≥ 80%. Age group 35-64 years, index treatment TAF and baseline hepatocellular carcinoma diagnosis were significantly associated with a decreased probability of treatment discontinuation and nonadherence. Although a high proportion of patients were persistent and adherent to NA treatment, there is a subgroup of patients whose needs are not met while receiving NA treatment, particularly in younger age groups. The results emphasise the need for alternative therapies with shorter, finite treatment durations to improve patient persistence, adherence and outcomes.
Clinical Observational Study on HBV Reactivation After Direct-Acting Antiviral Therapy in HCV/HBV Coinfected Patients in Guizhou, China.
Wang M, Wang Y, Yang Z … +3 more , Yang C, Wang J, Xiong H
J Viral Hepat · 2025 Sep · PMID 40767547 · Publisher ↗
The objective of this study is to analyse the prevalence and clinical characteristics of HCV/HBV coinfection in Guizhou, and evaluate the rate of HBV reactivation during and after anti-HCV treatment in a real-world study...
The objective of this study is to analyse the prevalence and clinical characteristics of HCV/HBV coinfection in Guizhou, and evaluate the rate of HBV reactivation during and after anti-HCV treatment in a real-world study. This retrospective study included 1652 patients with hepatitis C virus (HCV) infection who received direct-acting antiviral (DAA) therapy at the Guiyang Public Health Clinical Center between January 2018 and December 2022 Baseline, on-treatment and posttreatment data were collected, including HCV RNA, HCV genotypes, liver function, hepatitis B virus (HBV) markers (HBsAg, HBcAb) and HBV DNA levels. The HCV/HBV coinfection rate was analysed, and the risk of HBV reactivation and disease progression following DAA therapy was assessed. Among the 1652 HCV-infected patients, the HCV/HBV coinfection rate was 49.88% (824/1652). Of these, 5.08% (84/1652) were HBsAg-positive, while 44.79% (740/1652) were HBsAg-negative/HBcAb-positive with HBV DNA < 20 IU/mL. Compared to patients with HCV monoinfection, HBsAg-positive patients had a higher proportion of males, compensated and decompensated cirrhosis, hepatocellular carcinoma (HCC) and lower platelet (PLT) counts (χ = 15.482, 46.101; F = 7.292; all p < 0.05). Differences in HCV genotype distribution were observed among various HBV immune status groups (χ = 32.529, p < 0.05). The cumulative incidence of HBV reactivation in HCV/HBV coinfected patients treated with DAAs was 1.2% (10/824). Among these, the reactivation rate was 16.67% (9/54) in HBsAg-positive patients without prophylactic anti-HBV therapy and 0.1% (1/740) in HBsAg-negative/HBcAb-positive patients. Baseline HBsAg levels were significantly higher in patients with HBV reactivation than in those without reactivation (Z = -4.291, p < 0.05). No significant changes were observed in liver function or PLT levels after HBV reactivation compared to baseline (p > 0.05), and no cases of liver failure were reported. In Guizhou, a relatively high prevalence of HBsAg-positivity and a large proportion of past HBV exposure (HBsAg-negative/HBcAb-positive, HBV DNA < 20 IU/mL) were observed among HCV-infected patients. While HBV reactivation can occur in HCV/HBV coinfected patients undergoing DAA therapy, the overall risk is low. A baseline HBsAg level > 185 IU/mL is a significant risk factor for HBV reactivation.
The Effect of HCV on Methadone Dose During Pregnancy.
Boudova S, Iyer NS, Tholey DM … +2 more , Fenkel JM, Boelig RC
J Viral Hepat · 2025 Sep · PMID 40757762 · Full text
Pregnancy is a time of high patient motivation to initiate treatment for opioid use disorder (OUD). Hepatic drug metabolism can be altered by pregnancy and hepatitis C virus (HCV) infection. We aimed to examine the impac...
Pregnancy is a time of high patient motivation to initiate treatment for opioid use disorder (OUD). Hepatic drug metabolism can be altered by pregnancy and hepatitis C virus (HCV) infection. We aimed to examine the impact of HCV during pregnancy on methadone dosing. Retrospective chart review of all pregnant patients with OUD admitted for initiation of methadone from 1/2020-6/2022. Associations were examined using Student's T-tests, chi-squared tests, Fisher's exact tests and univariate and multivariate linear regression. We identified 191 pregnancies initiated on methadone, of which 188 were screened for HCV. 111 (59.0%) were HCV Antibody (Ab)+, of whom 108 were tested for HCV RNA and 66 (61.1%) were HCV RNA+. The median viral load was 498,500 IU/mL (range 19-46,000,000 IU/mL). Fibrosis-4 (Fib4) score, an estimate of liver fibrosis, was available for 97 pregnancies. The average Fib4 score was 0.36 (SD 0.69), and only five individuals had Fib4 scores > 1.45. White race (p < 0.001) and injection drug use (p < 0.001) were associated with being HCV RNA+. HCV RNA+ individuals had higher Fib4 scores (p = 0.022). We found no association between being HCV RNA+ and stable methadone dose achieved during hospitalisation (p = 0.105) in univariate analysis or a multivariate linear regression model (p = 0.567). There was no correlation between viral load or Fib4 score and stable methadone dose. No patient had a Fib4 score > 3.25. Our data suggest that HCV-specific alterations are unnecessary for methadone dosing in pregnancy and that fibrotic liver damage is rare in this population. However, further research is warranted for the subset of pregnant patients with advanced fibrosis.
Assessment of Hemophagocytic Lympho-Histiocytosis (HLH) in the Setting of Adult Acute Liver Failure.
Anouti A, Dahshi H, Rule J … +3 more , Wysocki C, Lee WM, Tujios SR
J Viral Hepat · 2025 Sep · PMID 40751479 · Full text
Hemophagocytic lympho-histiocytosis (HLH) is a life-threatening disease, only occasionally presenting as acute liver failure (ALF) in adults. HLH is challenging to diagnose. We reviewed the ALF Study Group (ALFSG) regist...
Hemophagocytic lympho-histiocytosis (HLH) is a life-threatening disease, only occasionally presenting as acute liver failure (ALF) in adults. HLH is challenging to diagnose. We reviewed the ALF Study Group (ALFSG) registry for suspected HLH subjects, as well as 184 with other ALF etiologies for cases that might have been missed, assessing standard laboratory tests, as well as interleukin-18 (IL-18) and soluble interleukin-2 receptor (sIL-2r), to determine the diagnostic utility of these biomarkers. We also calculated standard diagnostic algorithms (H score, HLH-2004 diagnostic criteria) to assess their value. Within 3364 ALF subjects, only 14 were initially cited as HLH. Upon thorough review by an adjudication committee, 5/14 (35.7%) were considered definite, five probable, two possible, and two unlikely. Definite HLH patients had significantly higher ferritin (p = 0.047), IL-18 (p = 0.003) and s-IL2r (p = 0.005) levels, H scores (p < 0.001) and HLH scores (p < 0.001). Other etiologies (APAP, DILI and viral) showed lower IL-18 and sIL2r levels and scores, but overlapping ferritins. Several probable/possible HLH cases lacked complete data for scoring. No additional (missed) HLH cases were identified. HLH remains a rare cause of ALF. Biomarkers, particularly IL-18 and sIL-2r, appear of value. HLH and H scores were also helpful but limited when data was missing.
CHIME: Sofosbuvir/Velpatasvir (S/V) for the Treatment of HCV Infection Among Vulnerable Inner-City Residents.
Conway B, Yi S, Truong D
J Viral Hepat · 2025 Aug · PMID 40682422 · Publisher ↗
The combination of Sofosbuvir/Velpatasvir(S/V) is approved for the treatment of chronic HCV infection. In registrational trials, cure rates of 95% or more were achieved when administered as one pill per day for a period...
The combination of Sofosbuvir/Velpatasvir(S/V) is approved for the treatment of chronic HCV infection. In registrational trials, cure rates of 95% or more were achieved when administered as one pill per day for a period of 12 weeks, regardless of genotype or disease stage. There is a need to develop and evaluate systems of care in populations excluded from clinical trials. We aim to evaluate the safety and efficacy of S/V in a prospective study of HCV-infected inner-city residents enriched for risk behaviours for non-adherence to therapy, including problematic drug use and unstable housing. Through dedicated outreach events, we identified HCV-infected patients who were not currently engaged in health care and who were eligible to receive government-funded antiviral treatment for HCV infection. We offered them the opportunity to enrol in a multidisciplinary programme of care to address medical, psychological, social, and addiction-related needs, and provide S/V therapy in this context, with enhanced supervision of adherence. We identified 222 eligible subjects, 31.5% female, median age of 47 (24-81) years. The most common genotype was 1, followed by 3 (48.2%, 38.7%) and 21.2% scored F3-F4 FibroScan scores. 55.9% have unstable housing, and 98.6% are active drug users, with the majority utilising fentanyl, followed by amphetamines (82.9%, 64.9%). HCV treatment has been started in all 222 persons within a median of 6 weeks of engagement in care. 218 persons completed treatment, one individual withdrew from the treatment, and 3 overdose deaths were documented. HCV cure was documented in 211/218 (96.8%). Virologic relapse was documented in the other 7 cases. The intent-to-treat SVR rate of HCV treatment with S/V was 211/222 (95.0%). Taken together, our data validate the development of multidisciplinary programmes such as ours to address HCV infection, yielding high rates of engagement and retention in care, promoting initiation of treatment (usually within 6 weeks) and > 97% rate of cure.
Hepatitis E Virus Infection in Hyperbilirubinemia Patients Progressed to Liver Failure in 2003-2021, China.
He Q, Dong J, Huang L … +11 more , Gao Y, Tang H, Wu Y, Ding M, Liang Z, Liu T, Yang X, Yuan D, Li Y, Wang L, Chen Y
J Viral Hepat · 2025 Aug · PMID 40679153 · Publisher ↗
Hepatitis E virus (HEV)-related liver failure is increasingly reported. Patients with hyperbilirubinemia usually indicate liver damage and may develop liver failure, but HEV infection in them is less studied. This study...
Hepatitis E virus (HEV)-related liver failure is increasingly reported. Patients with hyperbilirubinemia usually indicate liver damage and may develop liver failure, but HEV infection in them is less studied. This study aimed to investigate HEV infection in hyperbilirubinemia patients. A total of 949 patients with total bilirubin (Tbil) > 171 μmol/L during 2003-2021 in Beijing Youan hospital were tested for HEV. We found that 10.43% (99/949) patients were positive for anti-HEV IgM, or/and HEV pathogen markers. After ruling out 10 patients with incomplete data, 64.0% (57/89) progressed to liver failure. Patients with greater end-stage liver disease model scores tended to develop liver failure and have a poorer prognosis after HEV insult, evidenced by lower recovery/improvement rates. Liver cirrhosis patients with poorer Child-Turcotte-Pugh grades also tended to develop liver failure after HEV insult. In liver failure patients, those with HEV infection showed higher proportions of fatty liver and recent gastrointestinal haemorrhage than those without HEV infection. In conclusion, HEV infection is not uncommon in patients with Tbil > 171 μmol/L, and hyperbilirubinemia patients with more severe liver diseases are at more risk for liver failure after HEV infection.
Trends and Socio-Demographic Patterns of Hepatitis B Virus Hospitalisations in Poland: A 12-Year Nationwide Analysis.
Genowska A, Dobrowolska K, Zarębska-Michaluk D … +7 more , Tyszko P, Kanecki K, Lewtak K, Goryński P, Jaroszewicz J, Rzymski P, Flisiak R
J Viral Hepat · 2025 Aug · PMID 40679063 · Publisher ↗
Although acute hepatitis B virus (HBV) infections in Europe have declined, thousands of chronic cases are still identified annually, placing a strain on healthcare systems. This study aimed to retrospectively analyse the...
Although acute hepatitis B virus (HBV) infections in Europe have declined, thousands of chronic cases are still identified annually, placing a strain on healthcare systems. This study aimed to retrospectively analyse the patient profile, hospitalisation course, and admission causes for HBV infection in Poland in 2012-2023. The first-time HBV hospital admissions in Poland (ICD-10 codes B16; B18.0-B18.1) between 2012 and 2023 (n = 29,435) were analysed, examining trends by gender, age, residence and admission mode. The HBV first-time hospitalisation rate fell over tenfold, from 17.59 per 100,000 population in 2012 to 1.67 in 2021, rising to 3.45 in 2023. During 2020-2022, the share of hospitalisations with acute HBV increased (9.3% vs. 3.8% pre-pandemic; p < 0.05), but their rate was twofold lower (0.18 vs. 0.32 per 100,000 population). The mean patient age rose from 40.9 in 2012 to 51.5 years in 2023 (p < 0.05). Men from urban areas accounted for most hospitalisations, were older than rural patients, and had the highest emergency admission rates. Women from rural areas had the lowest hospitalisation share, were younger, and had over three times fewer emergency admissions. From 2012 to 2023, Poland experienced a major decline, then a resurgence, in HBV hospitalisations, with a higher share of acute cases during the COVID-19 pandemic. Hospitalised patients aged significantly, with urban men most affected. These patterns underscore the need for targeted HBV prevention and management strategies for aging urban populations.
Duration of Nucleos(t)ide Analogue Treatments in Patients With Chronic Hepatitis B Virus Infection in the United States.
Anderson S, Gielen V, Coutinho AD … +7 more , Clark L, Bell C, Salehi S, Gennarelli R, Farrelly E, Stafkey D, Gish R
J Viral Hepat · 2025 Aug · PMID 40667578 · Full text
Viral hepatitis caused by hepatitis B virus accounts for a significant disease burden. Nucleos(t)ide analogues (NAs) are the standard of care for chronic hepatitis B (CHB) infection; however, treatment is long-term, and...
Viral hepatitis caused by hepatitis B virus accounts for a significant disease burden. Nucleos(t)ide analogues (NAs) are the standard of care for chronic hepatitis B (CHB) infection; however, treatment is long-term, and viral eradication resulting in cure is rare. Adherence to NAs is vital for disease control. Here, we describe real-world treatment patterns among adult patients with CHB infection initiating second-generation NAs in the United States. This retrospective cohort study used United States administrative claims data. From the January 1, 2006 to July 31, 2023 period, we identified patients aged ≥ 18 years diagnosed with CHB infection who initiated second-generation NAs. Patient characteristics and real-world NA utilisation measures were reported, including time to discontinuation, resumption of NA treatment, adherence and predictors of adherence. In total, 6696 patients met the study eligibility criteria. Mean age was 47.2 (standard deviation: 11.5) years, and 41.6% of patients were female. The most common index NA treatments were tenofovir alafenamide (48.5%) and entecavir (41.7%). Median follow-up duration was 24.4 months. Overall, 40.6% of patients discontinued treatment; discontinuation probability was 29.4% at 12 months and 55.6% at 5 years. Of those who discontinued, 45.7% restarted during the study period. Mean adherence (proportion of days covered [PDC]) was 0.91, and 86.5% of participants had a PDC ≥ 80%. This study highlights the challenge of long-term persistence with NA treatment. An unmet need in CHB infection management is novel treatments with finite durations that offer an opportunity to achieve cure and mitigate disease progression.
M1-Like Macrophage May Contribute to the Inflammation and Fibrosis Process of Chronic Hepatitis B.
Gao Y, Yang P, Guan Y … +3 more , Liu P, Chen D, Ning Q
J Viral Hepat · 2025 Aug · PMID 40637354 · Publisher ↗
Chronic hepatitis B (CHB), driven by persistent hepatitis B virus (HBV) infection, is characterised by unresolved liver inflammation and fibrosis. Despite its clinical burden, the immune mechanisms underpinning CHB progr...
Chronic hepatitis B (CHB), driven by persistent hepatitis B virus (HBV) infection, is characterised by unresolved liver inflammation and fibrosis. Despite its clinical burden, the immune mechanisms underpinning CHB progression, particularly the role of macrophage polarisation, remain incompletely defined. We integrated multi-modal approaches to dissect the CHB immune microenvironment: immunohistochemistry (HBsAg/HBcAg quantification), imaging mass cytometry (spatial immune mapping), microfluidic high-throughput qPCR (gene profiling) and MILLIPLEX assays (cytokine quantification). In vitro, HBV-producing HepG2.2.15 cells were cocultured with polarised THP-1 macrophages (M1/M2) and LX-2 hepatic stellate cells (HSCs) to model macrophage-HSCs crosstalk. CHB severity correlated with elevated virologic markers (HBsAg, HBeAg, HBV DNA) and liver injury indices (ALT/AST). The hepatic immune landscape was dominated by M1-like macrophages, which colocalised with activated HSCs and collagenⅠ+ fibrotic niches. Intrahepatic M1 markers (CD86, TNFα, CXCL9 and CXCR3) were upregulated, while the M2 marker IL-10 was suppressed. Serum HBeAg levels positively correlated with intrahepatic CD86 and CXCL9, implicating HBeAg as a key driver of M1 polarisation. Compartment-specific cytokine profiling revealed elevated liver-to-plasma ratios of TGF-α, IFN-γ and IP-10 in advanced CHB, contrasting with reduced IL-10. In vitro, HBV skewed THP-1 macrophages towards an M1 phenotype and HBV-primed M1 macrophages potently activated LX-2 cells. Persistent HBV infection fuels CHB progression by fostering a pro-inflammatory M1 macrophage-dominated microenvironment, which synergises with HSCs activation and fibrogenesis. Our findings nominate M1 polarisation as therapeutic targets to disrupt inflammation-fibrosis crosstalk in CHB.
Occult Hepatitis C Virus Infection: A Narrative Review.
Songtanin B, Flores J, Barba R … +2 more , Saba J, Nugent K
J Viral Hepat · 2025 Aug · PMID 40616275 · Publisher ↗
Hepatitis C virus (HCV) infections occur worldwide. Approximately 75% of these acute infections lead to chronic hepatitis C with few symptoms, at least during the initial phase of infection. Occult hepatitis C develops i...
Hepatitis C virus (HCV) infections occur worldwide. Approximately 75% of these acute infections lead to chronic hepatitis C with few symptoms, at least during the initial phase of infection. Occult hepatitis C develops in some infected patients. These infections are defined by the presence of HCV RNA in hepatocytes and peripheral blood mononuclear cells (PBMCs) but not in the serum. Some of these patients have negative tests for anti-HCV antibodies, which make them very difficult to detect. These patients have been identified throughout the world. Occult infections have been found more frequently in patients with hepatitis B infection, HIV infection, cryptogenic liver disease/cirrhosis, renal failure on haemodialysis and lymphoproliferative disorders. These infections have also been identified in blood donors who have negative HCV antibodies. Low-level viral replication in the liver likely contributes to ongoing liver damage and the release of infectious virions that potentially infect adjacent hepatocytes and extrahepatic sites, such as PBMCs. Studies indicate that occult HCV infection may contribute to the pathogenesis of cryptogenic liver disease, steatotic liver disease, cirrhosis and hepatocellular carcinoma and could cause relapses following either a spontaneous clearance of the virus or treatment-induced clearance of the virus. These infections present diagnostic difficulties. This virus is present in the liver; however, that would require a liver biopsy to demonstrate this. It is also present in PBMCs, but these cells are not usually used during routine patient evaluation. The development of quasispecies, which can be identified in PBMCs by specialised labs, helps explain ineffective host defence responses and antiviral drug treatment in some patients. There is no specific therapy for the treatment of this sub-group of HCV-infected patients, and treatment should start with direct-acting antiviral drugs with careful follow-up and serial testing for viral clearance. In summary, patients with occult HCV need more study to determine the role of these infections in the progression of liver disease, to improve diagnostic algorithms and to determine treatment protocols that can eliminate these low-level infections.
Global, Regional and National Burden of Chronic Hepatitis C, 1990-2021: A Systematic Analysis for the GBD Study 2021.
Li Y, Li Z, Chen R … +12 more , Jia C, Liu H, Tang M, Zhou S, Fu D, Tang X, Chen L, Pan D, Wang L, Wen F, Luo T, He L
J Viral Hepat · 2025 Aug · PMID 40613625 · Publisher ↗
Chronic hepatitis C (CHC) remains a major global health burden, disproportionately affecting low-resource regions. Despite direct-acting antiviral (DAA) advancements, persistent liver complications and socioeconomic disp...
Chronic hepatitis C (CHC) remains a major global health burden, disproportionately affecting low-resource regions. Despite direct-acting antiviral (DAA) advancements, persistent liver complications and socioeconomic disparities hinder progress. This study aims to analyse CHC burden trends (1990-2021) across sociodemographic index (SDI), age, gender and geography using Global Burden of Disease (GBD) 2021 data. Data on incidence, death, prevalence and disability-adjusted life years (DALYs) were extracted from the Global Health Data Exchange (GHDx) platform, and countries were stratified by SDI. To analyse the trend in the disease burden of CHC, we utilised R software to compute the estimated annual percentage change (EAPC). Based on our investigation, we discovered that global incident cases rose 20.4% (3.7-4.5 M), yet age-standardised incidence rate (ASIR) declined annually by 0.55%. Globally, there has been a decreasing trend in the age-standardised mortality rate, prevalence and DALYs associated with CHC. Furthermore, women have shown a more significant decrease in incidence and mortality compared to men. New cases in those over 70 increased significantly, driven by population growth, particularly in low-SDI countries. These findings indicate that CHC burden remains concentrated in low-SDI regions and ageing populations. Persistent gender and socioeconomic inequities demand equitable DAA access, ageing-focused care and gender-sensitive interventions to achieve elimination targets.
Recognisable Alcohol Use Significantly Increases the Risk of Adverse Outcomes in Patients With Hepatitis B Virus-Related Cirrhosis.
Hui VW, Yang Z, Yip TC … +5 more , Cheung R, Lai JC, Wong VW, Wong GL, Wong RJ
J Viral Hepat · 2025 Aug · PMID 40607690 · Publisher ↗
Chronic hepatitis B virus (HBV) infection is a major contributor to cirrhosis, hepatic events and mortality, even when antiviral treatments are used. However, alcohol consumption may compromise these benefits. This study...
Chronic hepatitis B virus (HBV) infection is a major contributor to cirrhosis, hepatic events and mortality, even when antiviral treatments are used. However, alcohol consumption may compromise these benefits. This study evaluated the impact of alcohol use on outcomes in patients with HBV-related cirrhosis. Patients initiating first-line antiviral therapy between 2017 and 2023 were classified as alcohol users (including social drinkers, ex-drinkers or those with alcohol use disorders) or non-drinkers, with further differentiation between heavy and mild drinkers. A Fine-Grey model was used to adjust for the competing risks of non-liver-related death and liver transplantation, and propensity score matching and weighting balanced baseline characteristics. Among 12,317 patients (mean age 65 years, 77% male), 31% were alcohol users, of whom 32% were heavy drinkers. In propensity score-matched analyses, non-drinkers exhibited better transplant-free survival and lower liver-related mortality than drinkers. Overall, alcohol use was associated with a 20%-30% increased risk of all-cause mortality or liver transplantation, as well as liver-related death, with heavy alcohol consumption conferring even greater risk. These findings underscore the need for systematic screening for alcohol consumption and the implementation of interventions aimed at reducing alcohol use in patients with HBV-related cirrhosis.
Balancing Efficiency and Accuracy in Hepatitis C Rapid Antibody Testing: Insights From a Cluster Randomised Crossover Trial.
Heath K, Guzman R, Elsum I … +20 more , Wade AJ, Allardice K, Kasza J, Bryant M, Thompson AJ, Stoové M, Snelling T, Scott N, Spelman T, Anderson DA, Richmond J, Howell J, Andric N, Dietze P, Higgs P, Sacks-Davis R, Forbes A, Hellard ME, Pedrana AE, Doyle JS
J Viral Hepat · 2025 Aug · PMID 40607684 · Full text
Hepatitis C remains a significant global health problem, particularly among people who inject drugs. To achieve Australia's 2030 elimination targets, efficient testing strategies are needed. The OraQuick rapid antibody t...
Hepatitis C remains a significant global health problem, particularly among people who inject drugs. To achieve Australia's 2030 elimination targets, efficient testing strategies are needed. The OraQuick rapid antibody test provides results in 20 min, but many non-viraemic individuals with resolved infections test positive, potentially leading to unnecessary confirmatory RNA testing. Reducing the read time to five minutes has been proposed to reduce false positives and improve efficiency, but its impact on viremia detection is unclear. This study utilised data from the QuickStart study, a randomised controlled trial investigating different rapid testing pathways and a same-day test-and-treat model. Participants underwent OraQuick rapid antibody testing with results read at both five and 20 min, followed by confirmatory RNA testing. Among 298 participants with OraQuick and RNA test results, the 20-min OraQuick test was positive for all 79 viraemic individuals and 156 non-viraemic individuals. At five minutes, positive results decreased to 77 (97.5%) of viraemic and 135 (87%) non-viraemic individuals with positive 20-min results. Using a five-minute result to trigger RNA testing would have reduced unnecessary RNA testing by 13% in our cohort at the cost of missing 2.5% of viraemic individuals. A five-minute read time could improve efficiency by reducing unnecessary RNA testing, but confirmatory RNA testing remains essential to distinguish active from resolved infections. The balance between efficiency and accuracy may vary contextually, reflecting differing rates of resolved infections. This approach may be beneficial in resource-limited settings, but the potential for missed viremia must be considered. Trial Registration: ClinicalTrials.gov number; NCT05016609.
Hepatitis C Patients Over the Age of 75 Should Be Treated With Direct-Acting Antivirals, as Their Prognosis With Treatment Is Similar to That of Uninfected Healthy Individuals of the Same Age.
Takaki S, Ohya K, Mori N … +2 more , Ochi H, Tsuji K
J Viral Hepat · 2025 Jul · PMID 40548620 · Publisher ↗
Recently, the incidence of hepatitis C virus (HCV) in older individuals has increased. Although direct-acting antivirals (DAAs) are widely used to treat HCV without side effects in older patients, their indications are u...
Recently, the incidence of hepatitis C virus (HCV) in older individuals has increased. Although direct-acting antivirals (DAAs) are widely used to treat HCV without side effects in older patients, their indications are uncertain. This study compared the survival outcomes of older patients with HCV who received DAAs and age-matched peers without HCV infection. We enrolled 218 patients with HCV aged over 75 years treated with DAA (DAA group) and 519 HCV antibody-negative individuals (control group) who underwent physical examination and follow-up at our institute between January 2015 and December 2023. The cumulative survival rate after initial examination, cause of death, and hepatocellular carcinoma (HCC) occurrence were compared between DAA-treated patients with or without a prior HCC history and the control group. All patients treated with DAAs achieved a sustained virologic response. The prognosis of the overall DAA cohort was worse compared to the control group (p < 0.001); no significant difference emerged upon limiting the comparison to the subgroup without a prior HCC history (p = 0.280), while the prognosis was significantly worse in the DAA subgroup with a prior HCC history. Propensity-score matched analysis revealed similar results (p = 0.191). The causes of death did not differ between the DAA subgroup without prior HCC and the control group. DAA eliminates HCV in patients aged over 75 years, and offers a prognosis equivalent to that of HCV-negative healthy individuals of the same age, especially in patients without a prior HCC history.
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