The highly conserved human leukocyte antigen-A2(HLA-A2)-restricted epitope NS3-1073 represents a promising candidate for a therapeutic vaccine against hepatitis C virus(HCV).In this study,we engineered a set of fusion...The highly conserved human leukocyte antigen-A2(HLA-A2)-restricted epitope NS3-1073 represents a promising candidate for a therapeutic vaccine against hepatitis C virus(HCV).In this study,we engineered a set of fusion proteins based on the artificial self-assembling peptide(SAP),which were expressed in Escherichia coli and spontaneously self-assembled into nanosized particles displaying HCV epitopes,including NS3-1073.To enhance immunogenicity,we incorporated the T helper epitope PADRE into the construct.Alpha-helical linkers were introduced between SAP and the epitopes to facilitate proper protein folding.Notably,a helical linker with a high supercoiling propensity enabled soluble expression of the fusion protein containing both the NS3-1073 and PADRE epitopes,allowing purification of the in vivo-formed nanoparticles by metal affinity chromatography.Human dendritic cells derived from peripheral blood monocytes showed robust activation in response to the fusion proteins and preferentially stimulated T lymphocytes toward a Th1-biased immune response.In mice,immunization with nanoparticles carrying NS3-1073 induced splenocyte proliferation in response to in vitro stimulation with a mixture of NS3 peptides.These results demonstrate that recombinant nanoparticle-based carriers presenting the NS3-1073 epitope can be produced in bacterial systems and hold strong potential as a foundation for a therapeutic HCV vaccine.展开更多
Objective:To evaluate the effectiveness of direct-acting antivirals(DAAs)in patients with chronic hepatitis C,assess changes in liver function and hepatic fibrosis following treatment,and identify independent predicto...Objective:To evaluate the effectiveness of direct-acting antivirals(DAAs)in patients with chronic hepatitis C,assess changes in liver function and hepatic fibrosis following treatment,and identify independent predictors of treatment failure.Methods:This retrospective cohort study included patients who received DAA therapy at Hospital Kuala Lumpur between January 2020 and December 2023.Sustained virologic response(SVR)was assessed at least 12 weeks post-treatment by reverse transcription-polymerase chain reaction for hepatitis C virus(HCV)RNA.Demographic,clinical,and laboratory data were collected and analyzed.Multiple logistic regression analysis was performed to identify independent predictors of treatment failure.Results:A total of 335 patients in the study.The overall SVR rate was 89%.After achieving SVR,significant improvements were observed in liver enzyme levels and non-invasive liver fibrosis scores,whereas the overall Model for End-Stage Liver Disease(MELD)scores remained unchanged.Significant independent predictors of treatment failure included non-compliance with DAA therapy[adjusted odds ratio(aOR)68.3;95%confidence interval(95%CI)16.3-285.0;P<0.001],treatment with sofosbuvir/velpatasvir(aOR 6.1;95%CI 1.4-26.5;P=0.015),MELD score of 10-15(aOR 4.6;95%CI 1.1-18.2;P=0.031),HCV genotype 3 infection(aOR 4.5;95%CI 1.1-17.6;P=0.031),and elevated serum total bilirubin level(aOR 1.1;95%CI 1.0-1.1;P=0.003).Conclusions:DAA therapy yielded a high SVR rate,and treatment failure was strongly associated with non-adherence to therapy and advanced liver disease.These findings underscore the necessity of adherence support,early diagnosis,and individualized clinical management to optimize treatment outcomes in patients with chronic hepatitis C.展开更多
This study evaluated the accuracy,completeness,and comprehensibility of responses from mainstream large language models(LLMs)to hepatitis C virus(HCV)-related questions,aiming to assess their performance in addressing...This study evaluated the accuracy,completeness,and comprehensibility of responses from mainstream large language models(LLMs)to hepatitis C virus(HCV)-related questions,aiming to assess their performance in addressing patient queries about disease and lifestyle behaviors.The models selected were ChatGPT-4o,Gemini 2.0 Pro,Claude 3.5 Sonnet,and DeepSeek V3,with 12 questions chosen by two HCV experts from the domains of prevention,diagnosis,and treatment.展开更多
The clinical course of infections with the hepatitis B virus (HBV) substantially varies between individuals, as a consequence of a complex interplay between viral, host, environmental and other factors. Due to the hig...The clinical course of infections with the hepatitis B virus (HBV) substantially varies between individuals, as a consequence of a complex interplay between viral, host, environmental and other factors. Due to the high genetic variability of HBV, the virus can be categorized into different HBV genotypes and subgenotypes, which considerably differ with respect to geographical distribution, transmission routes, disease progression, responses to antiviral therapy or vaccination, and clinical outcome measures such as cirrhosis or hepatocellular carcinoma. However, HBV (sub)genotyping has caused some controversies in the past due to misclassifications and incorrect interpretations of different genotyping methods. Thus, an accurate, holistic and dynamic classification system is essential. In this review article, we aimed at highlighting potential pitfalls in genetic and phylogenetic analyses of HBV and suggest novel terms for HBV classification. Analyzing full-length genome sequences when classifying genotypes and subgenotypes is the foremost prerequisite of this classification system. Careful attention must be paid to all aspects of phylogenetic analysis, such as bootstrapping values and meeting the necessary thresholds for (sub)genotyping. Quasi-subgenotype refers to subgenotypes that were incorrectly suggested to be novel. As many of these strains were misclassified due to genetic differences resulting from recombination, we propose the term “recombino-subgenotype”. Moreover, immigration is an important confounding facet of global HBV distribution and substantially changes the geographic pattern of HBV (sub)genotypes. We therefore suggest the term “immigro-subgenotype” to distinguish exotic (sub)genotypes from native ones. We are strongly convinced that applying these two proposed terms in HBV classification will help harmonize this rapidly progressing field and allow for improved prophylaxis, diagnosis and treatment.展开更多
AIM To develop metabonomic models(MMs), using 1 H nuclear magnetic resonance(NMR) spectra of serum, to predict significant liver fibrosis(SF: Metavir ≥ F2), advanced liver fibrosis(AF: METAVIR ≥ F3) and cirrhosis(C:...AIM To develop metabonomic models(MMs), using 1 H nuclear magnetic resonance(NMR) spectra of serum, to predict significant liver fibrosis(SF: Metavir ≥ F2), advanced liver fibrosis(AF: METAVIR ≥ F3) and cirrhosis(C: METAVIR = F4 or clinical cirrhosis) in chronic hepatitis C(CHC) patients. Additionally, to compare the accuracy of the MMs with the aspartate aminotransferase to platelet ratio index(APRI) and fibrosis index based on four factors(FIB-4). METHODS Sixty-nine patients who had undergone biopsy in the previous 12 mo or had clinical cirrhosis were included. The presence of any other liver disease was a criterion for exclusion. The MMs, constructed using partial least squares discriminant analysis and linear discriminant analysis formalisms, were tested by cross-validation, considering SF, AF and C. RESULTS Results showed that forty-two patients(61%) presented SF, 28(40%) AF and 18(26%) C. The MMs showed sensitivity and specificity of 97.6% and 92.6% to predict SF; 96.4% and 95.1% to predict AF; and 100% and 98.0% to predict C. Besides that, the MMs correctly classified all 27(39.7%) and 25(38.8%) patients with intermediate values of APRI and FIB-4, respectively. CONCLUSION The metabonomic strategy performed excellently in predicting significant and advanced liver fibrosis in CHC patients, including those in the gray zone of APRI and FIB-4, which may contribute to reducing the need for these patients to undergo liver biopsy.展开更多
BACKGROUND Hepatitis B virus(HBV)infection is a major factor responsible for HBV+hepatocellular carcinoma(HCC).AIM An immunological classification of HBV+HCC may provide both biological insights and clinical implicati...BACKGROUND Hepatitis B virus(HBV)infection is a major factor responsible for HBV+hepatocellular carcinoma(HCC).AIM An immunological classification of HBV+HCC may provide both biological insights and clinical implications for this disease.METHODS Based on the enrichment of 23 immune signatures,we identified two immunespecific subtypes(Imm-H and Imm-L)of HBV+HCC by unsupervised clustering.We showed that this subtyping method was reproducible and predictable by analyzing three different datasets.RESULTS Compared to Imm-L,Imm-H displayed stronger immunity,more stromal components,lower tumor purity,lower stemness and intratumor heterogeneity,lower-level copy number alterations,higher global methylation level,and better overall and disease-free survival prognosis.Besides immune-related pathways,stromal pathways(ECM receptor interaction,focal adhesion,and regulation of actin cytoskeleton)and neuro-related pathways(neuroactive ligand-receptor interaction,and prion diseases)were more highly enriched in Imm-H than in Imm-L.We identified nine proteins differentially expressed between Imm-H and Imm-L,of which MYH11,PDCD4,Dvl3,and Syk were upregulated in Imm-H,while PCNA,Acetyl-a-Tubulin-Lys40,ER-α_pS118,Cyclin E2,andβ-Catenin were upregulated in Imm-L.CONCLUSION Our data suggest that“hot”tumors have a better prognosis than“cold”tumors in HBV+HCC and that“hot”tumors respond better to immunotherapy.展开更多
BACKGROUND Sex is one of the known factors influencing the risk of hepatitis C virus(HCV)infection and the natural course of the disease.AIM To evaluate sex-related differences in the characteristics and outcomes of d...BACKGROUND Sex is one of the known factors influencing the risk of hepatitis C virus(HCV)infection and the natural course of the disease.AIM To evaluate sex-related differences in the characteristics and outcomes of direct-acting antiviral(DAA)treatment in HCV-infected patients.METHODS The study included consecutive 9457 women and 9529 men,treated with DAA for chronic HCV infection from July 2015 to the end of 2023 whose data were collected in the nationwide multicenter retrospective Epiter-2 project.Women were divided into pre-menopausal(15-44 years),menopausal(45-55 years)and post-menopausal(>55 years)and compared with age-matched men.RESULTS Regardless of age,women had a significantly lower body mass index,prevalence of genotype 3 infection and proportion of cirrhosis compared to men.Psychiatric disorders(except depression),hepatitis B virus and human immunodeficiency virus co-infections,as well as alcohol and drug addiction,were significantly less common in women than in men in all age groups.The sustained virologic response was significantly higher in women compared to men in each age group and amounted to 98.4%and 96.6%,respectively(P<0.001).Independent predictors of treatment failure in women were genotype 3 infection,cirrhosis and postmenopausal age.Mild adverse events were reported significantly more often by women,regardless of age with the highest percentage in the postmenopausal group.CONCLUSION DAA treatment is more effective in women than in men,regardless of age,but in postmenopausal women,the effectiveness is relatively the lowest.展开更多
The aim of this study was to assess the seroprevalence of viral hepatitis B and C and co-infection with HIV among volunteer blood donors at the blood sampling and distribution depot (BSDD) in Ouahigouya. Patients and ...The aim of this study was to assess the seroprevalence of viral hepatitis B and C and co-infection with HIV among volunteer blood donors at the blood sampling and distribution depot (BSDD) in Ouahigouya. Patients and methods: Our study population consisted of all volunteer blood donors who had donated during a 2-year period from 1 January 2019 to 31 December 2020. Samples were taken from patients with no contraindications and serological tests were performed using ELISA tests. HBsAg, HCV-Ac and HIV serology were tested. All samples reactive for HIV, HBV and HCV were retested for confirmation using a second enzyme-linked immunosorbent assay. A result was considered positive if both the first and second tests were positive. Results: In two years, the Ouahigouya BSDD recorded 9726 donations, including 7983 new donors and 1743 former donors. The average age of donors was 25.59 years, with a sex ratio of 3.4. The seroprevalence of HBV, HCV and HIV was 7.31%, 3.10% and 2.12% respectively. HBV-HCV co-infection was found in 0.32% of cases, HIV-HBV, HIV-HCV, and HIV-HBV-HCV co-infection were found in 0.25%, 0.09% and 0.04% respectively. Conclusion: The seroprevalence of viral hepatitis B and C remains high among volunteer blood donors in Ouahigouya, although a decline in seroprevalence appears to be on the horizon.展开更多
To the Editor:Hepatitis caused by the hepatitis C virus(HCV)infection has a long course,insidious onset,and slow progression.Patients with hepatitis C are often in the late stages by the time of diagnoses.The long-ter...To the Editor:Hepatitis caused by the hepatitis C virus(HCV)infection has a long course,insidious onset,and slow progression.Patients with hepatitis C are often in the late stages by the time of diagnoses.The long-term chronic damage caused by HCV leads to impaired liver function,portal hypertension,liver fibrosis,cirrhosis and even hepatocellular carcinoma(HCC)[1,2].Therefore,it is imperative to improve the diagnosis and treatment of hepatitis C.In 2016,World Health Organization(WHO)set the goal of“eliminating viral hep-atitis as a public health hazard by 2030”.Some associations intro-duced guidelines for hepatitis C screening and treatment.After a period of effort,in 2020,the number of people receiving treatment for chronic HCV infection had significantly increased compared to the number in 2015,and the HCV-related mortality rate had de-creased.Nevertheless,nearly 80%of infected individuals have not been timely diagnosed and treated[3,4].Like many other coun-tries,China still faces a significant gap in achieving the goal of hep-atitis C elimination,and some literature indicated limited public awareness and high medication costs might slow the progress of policy implementation[5-7].How to effectively improve the diag-nosis and treatment of hepatitis C has garnered widespread global attention.展开更多
According to the World Health Organization,an estimated 58 million people worldwide are chronically infected with hepatitis C virus(HCV),yet only about 20%have been formally diagnosed.Traditional laboratory–based ant...According to the World Health Organization,an estimated 58 million people worldwide are chronically infected with hepatitis C virus(HCV),yet only about 20%have been formally diagnosed.Traditional laboratory–based antibody and RNA assays require infrastructure and trained personnel,limiting their uptake in resource-limited and hard-to-reach settings.The OraQuick HCV self-test(HCVST)is the first World Health Organization-prequalified HCVST,which delivers results in 20-40 min via an easy-to-use gum-swab format.Field evaluations report a sensitivity of about 97%–98%and a specificity of about 99%–100%that are comparable with those of blood-based lateral-flow assays(e.g.,Alere Truline,SD Bioline).Usability studies demonstrated an acceptability rate of over 90%and a correct self-test completion rate of over 85%in key populations.HCVST with the Ora-Quick HCVST kit provides a practical,evidence-based approach to closing diagnostic gaps,particularly among underserved or stigmatized populations.To maximize the public health impact,programs should integrate self-testing into national screening algorithms,ensure linkage to RNA confirmation and treatment,and consider economic and operational contexts.展开更多
This editorial provides commentary on the study by Dobrowolska et al,highlighting the influence of biological sex on hepatitis C virus(HCV)infection risk and disease progression.HCV infection is more common in men;how...This editorial provides commentary on the study by Dobrowolska et al,highlighting the influence of biological sex on hepatitis C virus(HCV)infection risk and disease progression.HCV infection is more common in men;however,women,regardless of age,show a lower prevalence of genotype 3 infection,diabetes mellitus,and coinfections with hepatitis B virus and human immunodeficiency virus.Women also experience slower liver fibrosis progression.Despite this,mild adverse events,autoimmune diseases,and depression occur more frequently in women.Sustained virologic response at 12 weeks post-treatment was significantly higher in women(98.4%)than in men(96.6%).In women,postmenopausal status,genotype 3 infection,and cirrhosis were independently associated with treatment failure.Early diagnosis and timely antiviral therapy in women are critical to preventing vertical transmission and mitigating disease advancement.展开更多
Hepatitis C virus(HCV)infection has been increasingly associated with cardio-vascular complications,particularly atherosclerosis and cardiomyopathy,in addition to its primary hepatic effects.Studies indicate a higher ...Hepatitis C virus(HCV)infection has been increasingly associated with cardio-vascular complications,particularly atherosclerosis and cardiomyopathy,in addition to its primary hepatic effects.Studies indicate a higher prevalence of carotid atherosclerosis in patients with chronic hepatitis C infection,with viral load and steatosis emerging as independent risk factors.HCV-related athero-sclerosis appears to develop through complex processes involving endothelial dysfunction,inflammation,oxidative stress,and immune dysregulation.Key cytokines,including tumor necrosis factor-alpha and interleukin-6,increase inflammatory responses,while oxidative stress markers,such as malondial-dehyde,are associated with an increased risk of atherogenesis.In addition,HCV infection has been linked to cardiomyopathy.Direct viral effects,including HCV replication within cardiomyocytes and cytotoxicity induced by viral proteins,lead to myocardial injury and functional decline.Indirectly,HCV triggers immune-mediated damage,with heightened pro-inflammatory cytokines exacerbating cardiomyocyte apoptosis and fibrosis.Furthermore,HCV infection promotes a procoagulant imbalance,as evidenced by elevated factor VIII levels and thrombin potential,contributing to the increased cardiovascular risk.While substantial evidence indicates a relationship between HCV and cardiovascular disease,further research is needed to establish causality and guide therapeutic interventions.展开更多
Objective To investigate chronic hepatitis C virus(HCV)infection's effect on gestational liver function,pregnancy and delivery complications,and neonatal development.Methods A total of 157 HCV antibody-positive(an...Objective To investigate chronic hepatitis C virus(HCV)infection's effect on gestational liver function,pregnancy and delivery complications,and neonatal development.Methods A total of 157 HCV antibody-positive(anti-HCV[+])and HCV RNA(+)patients(Group C)and121 anti-HCV(+)and HCV RNA(-)patients(Group B)were included as study participants,while 142 antiHCV(-)and HCV RNA(-)patients(Group A)were the control group.Data on biochemical indices during pregnancy,pregnancy complications,delivery-related information,and neonatal complications were also collected.Results Elevated alanine aminotransferase(ALT)rates in Group C during early,middle,and late pregnancy were 59.87%,43.95%,and 42.04%,respectively—significantly higher than Groups B(26.45%,15.70%,10.74%)and A(23.94%,19.01%,6.34%)(P<0.05).Median ALT levels in Group C were significantly higher than in Groups A and B at all pregnancy stages(P<0.05).No significant differences were found in neonatal malformation rates across groups(P>0.05).However,neonatal jaundice incidence was significantly greater in Group C(75.16%)compared to Groups A(42.25%)and B(57.02%)(χ^(2)=33.552,P<0.001).HCV RNA positivity during pregnancy was an independent risk factor for neonatal jaundice(OR=2.111,95%CI 1.242–3.588,P=0.006).Conclusions Chronic HCV infection can affect the liver function of pregnant women,but does not increase the pregnancy or delivery complication risks.HCV RNA(+)is an independent risk factor for neonatal jaundice.展开更多
BACKGROUND Steatotic liver disease(SLD)including metabolic dysfunction-associated SLD is the most prevalent chronic liver disease worldwide and is strongly associated with metabolic dysfunction as well as chronic hepa...BACKGROUND Steatotic liver disease(SLD)including metabolic dysfunction-associated SLD is the most prevalent chronic liver disease worldwide and is strongly associated with metabolic dysfunction as well as chronic hepatitis C(CHC).AIM To compare the characteristics of patients with CHC virus infection and the treatment with direct-acting antivirals(DAAs),considering the presence of SLD comorbidity.METHODS The study included all consecutive hepatitis C virus-infected patients treated with pangenotypic DAA regimens at a single tertiary hepatology center in 2018-2024.SLD was diagnosed via abdominal ultrasound.RESULTS Among 688 patients included in the study,290(42.2%)had comorbid SLD.The highest prevalence(62.3%)was observed in patients infected with genotype 3.The SLD group was predominantly male(62.8%),in contrast to the non-SLD group,where women predominated.Patients with SLD were significantly older(P=0.0007),had a higher body mass index(P<0.0001),and more frequently pre-sented with diabetes(P=0.01),obesity(P<0.0001),hyperlipidemia(P=0.004),and a history of alcohol abuse(P<0.0001).They also had more advanced liver disease as indicated by a higher rate of cirrhosis(35.5%vs 12%in the non-SLD group,P<0.0001),elevated aminotransferase activity(P<0.0001),bilirubin concentration(P<0.0001),and international normalized ratio values(P=0.0001),and lower albumin concentration(P=0.0028).While most patients in both groups completed treatment as planned,adverse events,including severe events and deaths,were more frequent in the SLD group.A sustained virologic response was achieved in 97.6%of the overall population but was significantly lower among patients with SLD compared to the non-SLD group(95.6%vs 99.0%,P=0.0081).However,logistic regression analysis did not identify SLD as an independent predictor of treatment failure.CONCLUSION Comorbid SLD was common among CHC patients treated with DAAs and was associated with adverse baseline characteristics,including older age,higher body mass index,greater comorbidity burden,and more advanced liver disease.Although SLD patients achieved slightly lower rates of sustained virologic response,SLD itself was not an independent predictor of treatment failure.These findings suggest that poorer treatment outcomes in this subgroup are largely attributable to coexisting risk factors rather than SLD per se,highlighting the need for comprehensive management of metabolic and liver-related comorbidities to optimize antiviral therapy outcomes.展开更多
BACKGROUND Liver imaging and transient elastography(TE)are both tools used to assess liver fibrosis and steatosis among people with hepatitis C virus(HCV)infection.However,the diagnostic accuracy of conventional imagi...BACKGROUND Liver imaging and transient elastography(TE)are both tools used to assess liver fibrosis and steatosis among people with hepatitis C virus(HCV)infection.However,the diagnostic accuracy of conventional imaging in detecting fibrosis and steatosis in this patient population remains unclear.AIM To investigate the correlation between steatosis and fibrosis and abnormal findings on liver imaging in patients with HCV.METHODS We conducted a retrospective cross-sectional analysis of patients with HCV at Grady Liver Clinic who had TE exams between 2018-2019.We analyzed the correlation of controlled attenuation parameter and liver stiffness measurement on TE and abnormal findings on liver imaging.Liver imaging findings(hepatic steatosis,increased echogenicity,cirrhosis,and chronic liver disease)were further evaluated for their diagnostic performance in detecting fibrosis(≥F2,≥F3,≥F4)and steatosis(≥S1,≥S2,≥S3).RESULTS Of 959 HCV patients who underwent TE,651 had liver imaging.Higher controlled attenuation parameter scores were observed in patients with abnormal liver findings(P=0.0050),hepatic steatosis(P<0.0001),and increased echogenicity(P<0.0001).Higher liver stiffness measurement values were also noted in those with abnormal liver(P<0.0001)and increased echogenicity(P=0.0026).Steatosis severity correlated with hepatic steatosis(r=0.195,P<0.001)and increased echogenicity(r=0.209,P<0.001).For fibrosis detection,abnormal liver imaging had moderate sensitivity(81.7%)and specificity(70.4%)for cirrhosis(≥F4),while cirrhosis on imaging had high specificity(99.2%)but low sensitivity(18.3%).Increased echogenicity showed high specificity(92.8%)but low sensitivity(20.9%)for steatosis detection.CONCLUSION Liver imaging detects advanced fibrosis and steatosis but lacks early-stage sensitivity.Integrating TE with imaging may improve evaluation in patients with HCV.展开更多
BACKGROUND Hepatitis C virus(HCV)affects millions of individuals globally and is linked to dilated cardiomyopathy and hypertrophic cardiomyopathy via complex direct viral,immune,and metabolic mechanisms,often exacerba...BACKGROUND Hepatitis C virus(HCV)affects millions of individuals globally and is linked to dilated cardiomyopathy and hypertrophic cardiomyopathy via complex direct viral,immune,and metabolic mechanisms,often exacerbated by cirrhosis,increasing cardiovascular morbidity.AIM To review the pathogenesis of cardiomyopathy in patients infected with HCV and investigate its clinical implications.METHODS A narrative literature review(PubMed,Scopus,Google Scholar;1990–2024)focused on English-language studies examining the HCV–cardiomyopathy link,pathophysiology,and treatment.The findings were qualitatively synthesized.RESULTS HCV drives cardiomyopathy through direct viral toxicity,immune damage,genetic factors,and apoptosis.The associated cirrhosis contributes via cirrhotic cardiomyopathy mechanisms.Clinically,HCV increases cardiovascular events.Direct-acting antivirals(DAAs)generally improve cardiovascular outcomes by reducing adverse events and enhancing cardiac function.CONCLUSION HCV is a significant cardiomyopathy risk factor involving diverse pathways,including cirrhosis.DAA therapy offers cardiovascular benefits.Further research on the underlying mechanisms,biomarkers(e.g.,M2BPGi,Ang-2),and global DAA access is warranted.展开更多
AIM: To establish a computed tomography (CT)-morphological classification for hepatic alveolar echinococcosis was the aim of the study.METHODS: The CT morphology of hepatic lesions in 228 patients with confirmed alveo...AIM: To establish a computed tomography (CT)-morphological classification for hepatic alveolar echinococcosis was the aim of the study.METHODS: The CT morphology of hepatic lesions in 228 patients with confirmed alveolar echinococcosis (AE) drawn from the Echinococcus Databank of the University Hospital of Ulm was reviewed retrospectively. For this reason, CT datasets of combined positron emission tomography (PET)-CT examinations were evaluated. The diagnosis of AE was made in patients with unequivocal seropositivity; positive histological findings following diagnostic puncture or partial resection of the liver; and/or findings typical for AE at either ultrasonography, CT, magnetic resonance imaging or PET-CT. The CT-morphological findings were grouped into the new classification scheme.RESULTS: Within the classification a lesion was dedicated to one out of five “primary morphologies” as well as to one out of six “patterns of calcification”. “primary morphology” and “pattern of calcification” are primarily focussed on separately from each other and combined, whereas the “primary morphology” V is not further characterized by a “pattern of calcification”. Based on the five primary morphologies, further descriptive sub-criteria were appended to types I-III. An analysis of the calcification pattern in relation to the primary morphology revealed the exclusive association of the central calcification with type IV primary morphology. Similarly, certain calcification patterns exhibited a clear predominance for other primary morphologies, which underscores the delimitation of the individual primary morphological types from each other. These relationships in terms of calcification patterns extend into the primary morphological sub-criteria, demonstrating the clear subordination of those criteria.CONCLUSION: The proposed CT-morphological classification (EMUC-CT) is intended to facilitate the recognition and interpretation of lesions in hepatic alveolar echinococcosis. This could help to interpret different clinical courses better and shall assist in the context of scientific studies to improve the comparability of CT findings.展开更多
BACKGROUND Direct acting antivirals have revolutionized hepatitis C virus(HCV)treatment.However,the high price of the brand forms is a barrier for their use in resource limited countries as Egypt.AIM To assess the saf...BACKGROUND Direct acting antivirals have revolutionized hepatitis C virus(HCV)treatment.However,the high price of the brand forms is a barrier for their use in resource limited countries as Egypt.AIM To assess the safety and efficacy of the generic sofosbuvir(SOF)/ledipasvir(LED)in Egyptian HCV-infected children and to compare the results with the brand form.METHODS This analytical retrospective study included HCV infected children and adolescents aged 12-18 years or weighing>35 kg.Collected data included:Age,sex,risk factors of HCV acquisition,comorbidities,liver functions,HCV viral load,degree of hepatic fibrosis,sustained virologic response(SVR)and frequency of treatment adverse effects.Patients who received the generic form of SOF/LED(Ledisbuvir)were compared to patients who received the brand form(Harvoni®)regarding SVR and frequency of adverse events.RESULTS The study included 43 patients who received Ledisbuvir and 73 who received Harvoni®.All patients achieved SVR.Treatment side effects were mild,transient and comparable in both groups.CONCLUSION The use of generic SOF/LED in HCV infected children is safe and effective.It is comparable to the brand form at a reduced price and represents an affordable and effective alternative.展开更多
Considering the recent study by Dobrowolska et al,which investigated sex-related differences in treatment outcomes for chronic hepatitis C infection,this letter endorses the findings that highlight significant dispari...Considering the recent study by Dobrowolska et al,which investigated sex-related differences in treatment outcomes for chronic hepatitis C infection,this letter endorses the findings that highlight significant disparities between male and female patients.The study revealed that women,particularly those in the premen-opausal and menopausal stages,exhibited higher sustained virologic response rates than men.However,postmenopausal women encounter unique challenges that merit attention.This letter emphasizes the necessity for healthcare providers to implement sex-sensitive approaches in the management of hepatitis C,acknow-ledging the impact of biological,hormonal,and psychosocial factors on treatment efficacy.By advocating tailored treatment strategies that address these disparities,we can improve patient outcomes and ensure equitable healthcare for all indi-viduals affected by hepatitis C.Furthermore,this letter calls for additional rese-arch to explore the underlying mechanisms driving these differences,ultimately contributing to more effective and personalized care of patients across diverse demographics.展开更多
BACKGROUND Hepatitis C virus(HCV)infection process of progression encompasses multiple stages,commencing with inflammation and culminating in hepatocellular cancer.Numerous invasive and non-invasive procedures exist f...BACKGROUND Hepatitis C virus(HCV)infection process of progression encompasses multiple stages,commencing with inflammation and culminating in hepatocellular cancer.Numerous invasive and non-invasive procedures exist for diagnosing chronic HCV infection.Though beneficial,invasive procedures can cause morbidity and inadequate representation of the overall degree of fibrosis.Due to these reasons,non-invasive liver fibrosis biomarkers are becoming more prevalent to diagnose and track liver fibrosis without a liver biopsy.These biomarkers can detect liver fibrosis early,improving treatment and preventing cirrhosis and liver failure.Micro ribonucleic acid(MiRNA)dysregulation causes and worsens several diseases including liver disease.MiRNAs can facilitate the diagnosis of liver fibrosis and serve as a predictive tool to enhance patient care by minimizing invasive procedures and enabling more efficient and prompt therapy.AIM To investigate the diagnostic effectiveness of several miRNAs(miRNA-122,miRNA-21,miRNA-199a,miRNA-155)in assessing the liver fibrosis severity in untreated HCV patients from the Indian Punjab population.We seek to identify the intricate diagnostic relationship of miRNAs with the extent of fibrosis among individuals with HCV.METHODS We considered 100 persons determined as HCV infected by a quantitative Real-Time Polymerase Chain Reaction examination.We employed statistical as well as probabilistic tools to ascertain the diagnostic validity of miRNAs for determining the liver fibrosis stages.We employed Bayesian Networks,to introduce a unique diagnostic paradigm for miRNAs that can be adopted as benchmark to evaluate the liver fibrosis severity in HCV cases.RESULTS We found that miRNAs(miR-122,miR-155 and miR-21)showed significant upregulation when compared with control and according to severity of fibrosis(P≤0.05).The area under the curve for miR-122,miR-155,miR-21 and miR-199a in HCV group in relation to Liver Stiffness Measurement was calculated as 0.889,0.933,0.912 and 0.035 respectively.MiR-199a was downregulated according to degree of fibrosis.CONCLUSION Depending on the diagnostic accuracy,we have concluded that miR-122,miR-155 and miR-21 are reliable markers to detect fibrosis in Hepatitis C patients.展开更多
基金supported by the Russian Science Foundation(Grant No.24-25-20087 to V.K.)。
文摘The highly conserved human leukocyte antigen-A2(HLA-A2)-restricted epitope NS3-1073 represents a promising candidate for a therapeutic vaccine against hepatitis C virus(HCV).In this study,we engineered a set of fusion proteins based on the artificial self-assembling peptide(SAP),which were expressed in Escherichia coli and spontaneously self-assembled into nanosized particles displaying HCV epitopes,including NS3-1073.To enhance immunogenicity,we incorporated the T helper epitope PADRE into the construct.Alpha-helical linkers were introduced between SAP and the epitopes to facilitate proper protein folding.Notably,a helical linker with a high supercoiling propensity enabled soluble expression of the fusion protein containing both the NS3-1073 and PADRE epitopes,allowing purification of the in vivo-formed nanoparticles by metal affinity chromatography.Human dendritic cells derived from peripheral blood monocytes showed robust activation in response to the fusion proteins and preferentially stimulated T lymphocytes toward a Th1-biased immune response.In mice,immunization with nanoparticles carrying NS3-1073 induced splenocyte proliferation in response to in vitro stimulation with a mixture of NS3 peptides.These results demonstrate that recombinant nanoparticle-based carriers presenting the NS3-1073 epitope can be produced in bacterial systems and hold strong potential as a foundation for a therapeutic HCV vaccine.
文摘Objective:To evaluate the effectiveness of direct-acting antivirals(DAAs)in patients with chronic hepatitis C,assess changes in liver function and hepatic fibrosis following treatment,and identify independent predictors of treatment failure.Methods:This retrospective cohort study included patients who received DAA therapy at Hospital Kuala Lumpur between January 2020 and December 2023.Sustained virologic response(SVR)was assessed at least 12 weeks post-treatment by reverse transcription-polymerase chain reaction for hepatitis C virus(HCV)RNA.Demographic,clinical,and laboratory data were collected and analyzed.Multiple logistic regression analysis was performed to identify independent predictors of treatment failure.Results:A total of 335 patients in the study.The overall SVR rate was 89%.After achieving SVR,significant improvements were observed in liver enzyme levels and non-invasive liver fibrosis scores,whereas the overall Model for End-Stage Liver Disease(MELD)scores remained unchanged.Significant independent predictors of treatment failure included non-compliance with DAA therapy[adjusted odds ratio(aOR)68.3;95%confidence interval(95%CI)16.3-285.0;P<0.001],treatment with sofosbuvir/velpatasvir(aOR 6.1;95%CI 1.4-26.5;P=0.015),MELD score of 10-15(aOR 4.6;95%CI 1.1-18.2;P=0.031),HCV genotype 3 infection(aOR 4.5;95%CI 1.1-17.6;P=0.031),and elevated serum total bilirubin level(aOR 1.1;95%CI 1.0-1.1;P=0.003).Conclusions:DAA therapy yielded a high SVR rate,and treatment failure was strongly associated with non-adherence to therapy and advanced liver disease.These findings underscore the necessity of adherence support,early diagnosis,and individualized clinical management to optimize treatment outcomes in patients with chronic hepatitis C.
基金funded by the National Key Research and Development Program of China(No.2021YFA1100500)the National Natural Science Foundation of China(No.82370662)the Key Research&Development Plan of Zhejiang Province(No.2024C03051).
文摘This study evaluated the accuracy,completeness,and comprehensibility of responses from mainstream large language models(LLMs)to hepatitis C virus(HCV)-related questions,aiming to assess their performance in addressing patient queries about disease and lifestyle behaviors.The models selected were ChatGPT-4o,Gemini 2.0 Pro,Claude 3.5 Sonnet,and DeepSeek V3,with 12 questions chosen by two HCV experts from the domains of prevention,diagnosis,and treatment.
基金Supported by Mahmoud Reza Pourkarim is supported by a postdoctoral grant from the''Fonds voor Wetenschappelijk Onderzoek Vlaanderen''
文摘The clinical course of infections with the hepatitis B virus (HBV) substantially varies between individuals, as a consequence of a complex interplay between viral, host, environmental and other factors. Due to the high genetic variability of HBV, the virus can be categorized into different HBV genotypes and subgenotypes, which considerably differ with respect to geographical distribution, transmission routes, disease progression, responses to antiviral therapy or vaccination, and clinical outcome measures such as cirrhosis or hepatocellular carcinoma. However, HBV (sub)genotyping has caused some controversies in the past due to misclassifications and incorrect interpretations of different genotyping methods. Thus, an accurate, holistic and dynamic classification system is essential. In this review article, we aimed at highlighting potential pitfalls in genetic and phylogenetic analyses of HBV and suggest novel terms for HBV classification. Analyzing full-length genome sequences when classifying genotypes and subgenotypes is the foremost prerequisite of this classification system. Careful attention must be paid to all aspects of phylogenetic analysis, such as bootstrapping values and meeting the necessary thresholds for (sub)genotyping. Quasi-subgenotype refers to subgenotypes that were incorrectly suggested to be novel. As many of these strains were misclassified due to genetic differences resulting from recombination, we propose the term “recombino-subgenotype”. Moreover, immigration is an important confounding facet of global HBV distribution and substantially changes the geographic pattern of HBV (sub)genotypes. We therefore suggest the term “immigro-subgenotype” to distinguish exotic (sub)genotypes from native ones. We are strongly convinced that applying these two proposed terms in HBV classification will help harmonize this rapidly progressing field and allow for improved prophylaxis, diagnosis and treatment.
文摘AIM To develop metabonomic models(MMs), using 1 H nuclear magnetic resonance(NMR) spectra of serum, to predict significant liver fibrosis(SF: Metavir ≥ F2), advanced liver fibrosis(AF: METAVIR ≥ F3) and cirrhosis(C: METAVIR = F4 or clinical cirrhosis) in chronic hepatitis C(CHC) patients. Additionally, to compare the accuracy of the MMs with the aspartate aminotransferase to platelet ratio index(APRI) and fibrosis index based on four factors(FIB-4). METHODS Sixty-nine patients who had undergone biopsy in the previous 12 mo or had clinical cirrhosis were included. The presence of any other liver disease was a criterion for exclusion. The MMs, constructed using partial least squares discriminant analysis and linear discriminant analysis formalisms, were tested by cross-validation, considering SF, AF and C. RESULTS Results showed that forty-two patients(61%) presented SF, 28(40%) AF and 18(26%) C. The MMs showed sensitivity and specificity of 97.6% and 92.6% to predict SF; 96.4% and 95.1% to predict AF; and 100% and 98.0% to predict C. Besides that, the MMs correctly classified all 27(39.7%) and 25(38.8%) patients with intermediate values of APRI and FIB-4, respectively. CONCLUSION The metabonomic strategy performed excellently in predicting significant and advanced liver fibrosis in CHC patients, including those in the gray zone of APRI and FIB-4, which may contribute to reducing the need for these patients to undergo liver biopsy.
文摘BACKGROUND Hepatitis B virus(HBV)infection is a major factor responsible for HBV+hepatocellular carcinoma(HCC).AIM An immunological classification of HBV+HCC may provide both biological insights and clinical implications for this disease.METHODS Based on the enrichment of 23 immune signatures,we identified two immunespecific subtypes(Imm-H and Imm-L)of HBV+HCC by unsupervised clustering.We showed that this subtyping method was reproducible and predictable by analyzing three different datasets.RESULTS Compared to Imm-L,Imm-H displayed stronger immunity,more stromal components,lower tumor purity,lower stemness and intratumor heterogeneity,lower-level copy number alterations,higher global methylation level,and better overall and disease-free survival prognosis.Besides immune-related pathways,stromal pathways(ECM receptor interaction,focal adhesion,and regulation of actin cytoskeleton)and neuro-related pathways(neuroactive ligand-receptor interaction,and prion diseases)were more highly enriched in Imm-H than in Imm-L.We identified nine proteins differentially expressed between Imm-H and Imm-L,of which MYH11,PDCD4,Dvl3,and Syk were upregulated in Imm-H,while PCNA,Acetyl-a-Tubulin-Lys40,ER-α_pS118,Cyclin E2,andβ-Catenin were upregulated in Imm-L.CONCLUSION Our data suggest that“hot”tumors have a better prognosis than“cold”tumors in HBV+HCC and that“hot”tumors respond better to immunotherapy.
文摘BACKGROUND Sex is one of the known factors influencing the risk of hepatitis C virus(HCV)infection and the natural course of the disease.AIM To evaluate sex-related differences in the characteristics and outcomes of direct-acting antiviral(DAA)treatment in HCV-infected patients.METHODS The study included consecutive 9457 women and 9529 men,treated with DAA for chronic HCV infection from July 2015 to the end of 2023 whose data were collected in the nationwide multicenter retrospective Epiter-2 project.Women were divided into pre-menopausal(15-44 years),menopausal(45-55 years)and post-menopausal(>55 years)and compared with age-matched men.RESULTS Regardless of age,women had a significantly lower body mass index,prevalence of genotype 3 infection and proportion of cirrhosis compared to men.Psychiatric disorders(except depression),hepatitis B virus and human immunodeficiency virus co-infections,as well as alcohol and drug addiction,were significantly less common in women than in men in all age groups.The sustained virologic response was significantly higher in women compared to men in each age group and amounted to 98.4%and 96.6%,respectively(P<0.001).Independent predictors of treatment failure in women were genotype 3 infection,cirrhosis and postmenopausal age.Mild adverse events were reported significantly more often by women,regardless of age with the highest percentage in the postmenopausal group.CONCLUSION DAA treatment is more effective in women than in men,regardless of age,but in postmenopausal women,the effectiveness is relatively the lowest.
文摘The aim of this study was to assess the seroprevalence of viral hepatitis B and C and co-infection with HIV among volunteer blood donors at the blood sampling and distribution depot (BSDD) in Ouahigouya. Patients and methods: Our study population consisted of all volunteer blood donors who had donated during a 2-year period from 1 January 2019 to 31 December 2020. Samples were taken from patients with no contraindications and serological tests were performed using ELISA tests. HBsAg, HCV-Ac and HIV serology were tested. All samples reactive for HIV, HBV and HCV were retested for confirmation using a second enzyme-linked immunosorbent assay. A result was considered positive if both the first and second tests were positive. Results: In two years, the Ouahigouya BSDD recorded 9726 donations, including 7983 new donors and 1743 former donors. The average age of donors was 25.59 years, with a sex ratio of 3.4. The seroprevalence of HBV, HCV and HIV was 7.31%, 3.10% and 2.12% respectively. HBV-HCV co-infection was found in 0.32% of cases, HIV-HBV, HIV-HCV, and HIV-HBV-HCV co-infection were found in 0.25%, 0.09% and 0.04% respectively. Conclusion: The seroprevalence of viral hepatitis B and C remains high among volunteer blood donors in Ouahigouya, although a decline in seroprevalence appears to be on the horizon.
基金supported by a grant from the R&D Program of China(2022YFC2304500).
文摘To the Editor:Hepatitis caused by the hepatitis C virus(HCV)infection has a long course,insidious onset,and slow progression.Patients with hepatitis C are often in the late stages by the time of diagnoses.The long-term chronic damage caused by HCV leads to impaired liver function,portal hypertension,liver fibrosis,cirrhosis and even hepatocellular carcinoma(HCC)[1,2].Therefore,it is imperative to improve the diagnosis and treatment of hepatitis C.In 2016,World Health Organization(WHO)set the goal of“eliminating viral hep-atitis as a public health hazard by 2030”.Some associations intro-duced guidelines for hepatitis C screening and treatment.After a period of effort,in 2020,the number of people receiving treatment for chronic HCV infection had significantly increased compared to the number in 2015,and the HCV-related mortality rate had de-creased.Nevertheless,nearly 80%of infected individuals have not been timely diagnosed and treated[3,4].Like many other coun-tries,China still faces a significant gap in achieving the goal of hep-atitis C elimination,and some literature indicated limited public awareness and high medication costs might slow the progress of policy implementation[5-7].How to effectively improve the diag-nosis and treatment of hepatitis C has garnered widespread global attention.
文摘According to the World Health Organization,an estimated 58 million people worldwide are chronically infected with hepatitis C virus(HCV),yet only about 20%have been formally diagnosed.Traditional laboratory–based antibody and RNA assays require infrastructure and trained personnel,limiting their uptake in resource-limited and hard-to-reach settings.The OraQuick HCV self-test(HCVST)is the first World Health Organization-prequalified HCVST,which delivers results in 20-40 min via an easy-to-use gum-swab format.Field evaluations report a sensitivity of about 97%–98%and a specificity of about 99%–100%that are comparable with those of blood-based lateral-flow assays(e.g.,Alere Truline,SD Bioline).Usability studies demonstrated an acceptability rate of over 90%and a correct self-test completion rate of over 85%in key populations.HCVST with the Ora-Quick HCVST kit provides a practical,evidence-based approach to closing diagnostic gaps,particularly among underserved or stigmatized populations.To maximize the public health impact,programs should integrate self-testing into national screening algorithms,ensure linkage to RNA confirmation and treatment,and consider economic and operational contexts.
文摘This editorial provides commentary on the study by Dobrowolska et al,highlighting the influence of biological sex on hepatitis C virus(HCV)infection risk and disease progression.HCV infection is more common in men;however,women,regardless of age,show a lower prevalence of genotype 3 infection,diabetes mellitus,and coinfections with hepatitis B virus and human immunodeficiency virus.Women also experience slower liver fibrosis progression.Despite this,mild adverse events,autoimmune diseases,and depression occur more frequently in women.Sustained virologic response at 12 weeks post-treatment was significantly higher in women(98.4%)than in men(96.6%).In women,postmenopausal status,genotype 3 infection,and cirrhosis were independently associated with treatment failure.Early diagnosis and timely antiviral therapy in women are critical to preventing vertical transmission and mitigating disease advancement.
文摘Hepatitis C virus(HCV)infection has been increasingly associated with cardio-vascular complications,particularly atherosclerosis and cardiomyopathy,in addition to its primary hepatic effects.Studies indicate a higher prevalence of carotid atherosclerosis in patients with chronic hepatitis C infection,with viral load and steatosis emerging as independent risk factors.HCV-related athero-sclerosis appears to develop through complex processes involving endothelial dysfunction,inflammation,oxidative stress,and immune dysregulation.Key cytokines,including tumor necrosis factor-alpha and interleukin-6,increase inflammatory responses,while oxidative stress markers,such as malondial-dehyde,are associated with an increased risk of atherogenesis.In addition,HCV infection has been linked to cardiomyopathy.Direct viral effects,including HCV replication within cardiomyocytes and cytotoxicity induced by viral proteins,lead to myocardial injury and functional decline.Indirectly,HCV triggers immune-mediated damage,with heightened pro-inflammatory cytokines exacerbating cardiomyocyte apoptosis and fibrosis.Furthermore,HCV infection promotes a procoagulant imbalance,as evidenced by elevated factor VIII levels and thrombin potential,contributing to the increased cardiovascular risk.While substantial evidence indicates a relationship between HCV and cardiovascular disease,further research is needed to establish causality and guide therapeutic interventions.
基金The National Key Research and Development Program(2022YFC2603500,2022YFC2603505,2023YFC2306901,2023YFC2308105)The capital health research and development of special public health project(2022-1-2172)+3 种基金Beijing Municipal Health Commission high-level public health technical personnel construction project,discipline leader-03-26Beijing Hospitals Authority“peak”talent training program(DFL20241803)Beijing Hospitals Authority Clinical medicine Development of special funding support(ZLRK202301)Beijing Research Ward Excellence Program(BRWEP2024W102170101)。
文摘Objective To investigate chronic hepatitis C virus(HCV)infection's effect on gestational liver function,pregnancy and delivery complications,and neonatal development.Methods A total of 157 HCV antibody-positive(anti-HCV[+])and HCV RNA(+)patients(Group C)and121 anti-HCV(+)and HCV RNA(-)patients(Group B)were included as study participants,while 142 antiHCV(-)and HCV RNA(-)patients(Group A)were the control group.Data on biochemical indices during pregnancy,pregnancy complications,delivery-related information,and neonatal complications were also collected.Results Elevated alanine aminotransferase(ALT)rates in Group C during early,middle,and late pregnancy were 59.87%,43.95%,and 42.04%,respectively—significantly higher than Groups B(26.45%,15.70%,10.74%)and A(23.94%,19.01%,6.34%)(P<0.05).Median ALT levels in Group C were significantly higher than in Groups A and B at all pregnancy stages(P<0.05).No significant differences were found in neonatal malformation rates across groups(P>0.05).However,neonatal jaundice incidence was significantly greater in Group C(75.16%)compared to Groups A(42.25%)and B(57.02%)(χ^(2)=33.552,P<0.001).HCV RNA positivity during pregnancy was an independent risk factor for neonatal jaundice(OR=2.111,95%CI 1.242–3.588,P=0.006).Conclusions Chronic HCV infection can affect the liver function of pregnant women,but does not increase the pregnancy or delivery complication risks.HCV RNA(+)is an independent risk factor for neonatal jaundice.
文摘BACKGROUND Steatotic liver disease(SLD)including metabolic dysfunction-associated SLD is the most prevalent chronic liver disease worldwide and is strongly associated with metabolic dysfunction as well as chronic hepatitis C(CHC).AIM To compare the characteristics of patients with CHC virus infection and the treatment with direct-acting antivirals(DAAs),considering the presence of SLD comorbidity.METHODS The study included all consecutive hepatitis C virus-infected patients treated with pangenotypic DAA regimens at a single tertiary hepatology center in 2018-2024.SLD was diagnosed via abdominal ultrasound.RESULTS Among 688 patients included in the study,290(42.2%)had comorbid SLD.The highest prevalence(62.3%)was observed in patients infected with genotype 3.The SLD group was predominantly male(62.8%),in contrast to the non-SLD group,where women predominated.Patients with SLD were significantly older(P=0.0007),had a higher body mass index(P<0.0001),and more frequently pre-sented with diabetes(P=0.01),obesity(P<0.0001),hyperlipidemia(P=0.004),and a history of alcohol abuse(P<0.0001).They also had more advanced liver disease as indicated by a higher rate of cirrhosis(35.5%vs 12%in the non-SLD group,P<0.0001),elevated aminotransferase activity(P<0.0001),bilirubin concentration(P<0.0001),and international normalized ratio values(P=0.0001),and lower albumin concentration(P=0.0028).While most patients in both groups completed treatment as planned,adverse events,including severe events and deaths,were more frequent in the SLD group.A sustained virologic response was achieved in 97.6%of the overall population but was significantly lower among patients with SLD compared to the non-SLD group(95.6%vs 99.0%,P=0.0081).However,logistic regression analysis did not identify SLD as an independent predictor of treatment failure.CONCLUSION Comorbid SLD was common among CHC patients treated with DAAs and was associated with adverse baseline characteristics,including older age,higher body mass index,greater comorbidity burden,and more advanced liver disease.Although SLD patients achieved slightly lower rates of sustained virologic response,SLD itself was not an independent predictor of treatment failure.These findings suggest that poorer treatment outcomes in this subgroup are largely attributable to coexisting risk factors rather than SLD per se,highlighting the need for comprehensive management of metabolic and liver-related comorbidities to optimize antiviral therapy outcomes.
文摘BACKGROUND Liver imaging and transient elastography(TE)are both tools used to assess liver fibrosis and steatosis among people with hepatitis C virus(HCV)infection.However,the diagnostic accuracy of conventional imaging in detecting fibrosis and steatosis in this patient population remains unclear.AIM To investigate the correlation between steatosis and fibrosis and abnormal findings on liver imaging in patients with HCV.METHODS We conducted a retrospective cross-sectional analysis of patients with HCV at Grady Liver Clinic who had TE exams between 2018-2019.We analyzed the correlation of controlled attenuation parameter and liver stiffness measurement on TE and abnormal findings on liver imaging.Liver imaging findings(hepatic steatosis,increased echogenicity,cirrhosis,and chronic liver disease)were further evaluated for their diagnostic performance in detecting fibrosis(≥F2,≥F3,≥F4)and steatosis(≥S1,≥S2,≥S3).RESULTS Of 959 HCV patients who underwent TE,651 had liver imaging.Higher controlled attenuation parameter scores were observed in patients with abnormal liver findings(P=0.0050),hepatic steatosis(P<0.0001),and increased echogenicity(P<0.0001).Higher liver stiffness measurement values were also noted in those with abnormal liver(P<0.0001)and increased echogenicity(P=0.0026).Steatosis severity correlated with hepatic steatosis(r=0.195,P<0.001)and increased echogenicity(r=0.209,P<0.001).For fibrosis detection,abnormal liver imaging had moderate sensitivity(81.7%)and specificity(70.4%)for cirrhosis(≥F4),while cirrhosis on imaging had high specificity(99.2%)but low sensitivity(18.3%).Increased echogenicity showed high specificity(92.8%)but low sensitivity(20.9%)for steatosis detection.CONCLUSION Liver imaging detects advanced fibrosis and steatosis but lacks early-stage sensitivity.Integrating TE with imaging may improve evaluation in patients with HCV.
文摘BACKGROUND Hepatitis C virus(HCV)affects millions of individuals globally and is linked to dilated cardiomyopathy and hypertrophic cardiomyopathy via complex direct viral,immune,and metabolic mechanisms,often exacerbated by cirrhosis,increasing cardiovascular morbidity.AIM To review the pathogenesis of cardiomyopathy in patients infected with HCV and investigate its clinical implications.METHODS A narrative literature review(PubMed,Scopus,Google Scholar;1990–2024)focused on English-language studies examining the HCV–cardiomyopathy link,pathophysiology,and treatment.The findings were qualitatively synthesized.RESULTS HCV drives cardiomyopathy through direct viral toxicity,immune damage,genetic factors,and apoptosis.The associated cirrhosis contributes via cirrhotic cardiomyopathy mechanisms.Clinically,HCV increases cardiovascular events.Direct-acting antivirals(DAAs)generally improve cardiovascular outcomes by reducing adverse events and enhancing cardiac function.CONCLUSION HCV is a significant cardiomyopathy risk factor involving diverse pathways,including cirrhosis.DAA therapy offers cardiovascular benefits.Further research on the underlying mechanisms,biomarkers(e.g.,M2BPGi,Ang-2),and global DAA access is warranted.
文摘AIM: To establish a computed tomography (CT)-morphological classification for hepatic alveolar echinococcosis was the aim of the study.METHODS: The CT morphology of hepatic lesions in 228 patients with confirmed alveolar echinococcosis (AE) drawn from the Echinococcus Databank of the University Hospital of Ulm was reviewed retrospectively. For this reason, CT datasets of combined positron emission tomography (PET)-CT examinations were evaluated. The diagnosis of AE was made in patients with unequivocal seropositivity; positive histological findings following diagnostic puncture or partial resection of the liver; and/or findings typical for AE at either ultrasonography, CT, magnetic resonance imaging or PET-CT. The CT-morphological findings were grouped into the new classification scheme.RESULTS: Within the classification a lesion was dedicated to one out of five “primary morphologies” as well as to one out of six “patterns of calcification”. “primary morphology” and “pattern of calcification” are primarily focussed on separately from each other and combined, whereas the “primary morphology” V is not further characterized by a “pattern of calcification”. Based on the five primary morphologies, further descriptive sub-criteria were appended to types I-III. An analysis of the calcification pattern in relation to the primary morphology revealed the exclusive association of the central calcification with type IV primary morphology. Similarly, certain calcification patterns exhibited a clear predominance for other primary morphologies, which underscores the delimitation of the individual primary morphological types from each other. These relationships in terms of calcification patterns extend into the primary morphological sub-criteria, demonstrating the clear subordination of those criteria.CONCLUSION: The proposed CT-morphological classification (EMUC-CT) is intended to facilitate the recognition and interpretation of lesions in hepatic alveolar echinococcosis. This could help to interpret different clinical courses better and shall assist in the context of scientific studies to improve the comparability of CT findings.
文摘BACKGROUND Direct acting antivirals have revolutionized hepatitis C virus(HCV)treatment.However,the high price of the brand forms is a barrier for their use in resource limited countries as Egypt.AIM To assess the safety and efficacy of the generic sofosbuvir(SOF)/ledipasvir(LED)in Egyptian HCV-infected children and to compare the results with the brand form.METHODS This analytical retrospective study included HCV infected children and adolescents aged 12-18 years or weighing>35 kg.Collected data included:Age,sex,risk factors of HCV acquisition,comorbidities,liver functions,HCV viral load,degree of hepatic fibrosis,sustained virologic response(SVR)and frequency of treatment adverse effects.Patients who received the generic form of SOF/LED(Ledisbuvir)were compared to patients who received the brand form(Harvoni®)regarding SVR and frequency of adverse events.RESULTS The study included 43 patients who received Ledisbuvir and 73 who received Harvoni®.All patients achieved SVR.Treatment side effects were mild,transient and comparable in both groups.CONCLUSION The use of generic SOF/LED in HCV infected children is safe and effective.It is comparable to the brand form at a reduced price and represents an affordable and effective alternative.
文摘Considering the recent study by Dobrowolska et al,which investigated sex-related differences in treatment outcomes for chronic hepatitis C infection,this letter endorses the findings that highlight significant disparities between male and female patients.The study revealed that women,particularly those in the premen-opausal and menopausal stages,exhibited higher sustained virologic response rates than men.However,postmenopausal women encounter unique challenges that merit attention.This letter emphasizes the necessity for healthcare providers to implement sex-sensitive approaches in the management of hepatitis C,acknow-ledging the impact of biological,hormonal,and psychosocial factors on treatment efficacy.By advocating tailored treatment strategies that address these disparities,we can improve patient outcomes and ensure equitable healthcare for all indi-viduals affected by hepatitis C.Furthermore,this letter calls for additional rese-arch to explore the underlying mechanisms driving these differences,ultimately contributing to more effective and personalized care of patients across diverse demographics.
文摘BACKGROUND Hepatitis C virus(HCV)infection process of progression encompasses multiple stages,commencing with inflammation and culminating in hepatocellular cancer.Numerous invasive and non-invasive procedures exist for diagnosing chronic HCV infection.Though beneficial,invasive procedures can cause morbidity and inadequate representation of the overall degree of fibrosis.Due to these reasons,non-invasive liver fibrosis biomarkers are becoming more prevalent to diagnose and track liver fibrosis without a liver biopsy.These biomarkers can detect liver fibrosis early,improving treatment and preventing cirrhosis and liver failure.Micro ribonucleic acid(MiRNA)dysregulation causes and worsens several diseases including liver disease.MiRNAs can facilitate the diagnosis of liver fibrosis and serve as a predictive tool to enhance patient care by minimizing invasive procedures and enabling more efficient and prompt therapy.AIM To investigate the diagnostic effectiveness of several miRNAs(miRNA-122,miRNA-21,miRNA-199a,miRNA-155)in assessing the liver fibrosis severity in untreated HCV patients from the Indian Punjab population.We seek to identify the intricate diagnostic relationship of miRNAs with the extent of fibrosis among individuals with HCV.METHODS We considered 100 persons determined as HCV infected by a quantitative Real-Time Polymerase Chain Reaction examination.We employed statistical as well as probabilistic tools to ascertain the diagnostic validity of miRNAs for determining the liver fibrosis stages.We employed Bayesian Networks,to introduce a unique diagnostic paradigm for miRNAs that can be adopted as benchmark to evaluate the liver fibrosis severity in HCV cases.RESULTS We found that miRNAs(miR-122,miR-155 and miR-21)showed significant upregulation when compared with control and according to severity of fibrosis(P≤0.05).The area under the curve for miR-122,miR-155,miR-21 and miR-199a in HCV group in relation to Liver Stiffness Measurement was calculated as 0.889,0.933,0.912 and 0.035 respectively.MiR-199a was downregulated according to degree of fibrosis.CONCLUSION Depending on the diagnostic accuracy,we have concluded that miR-122,miR-155 and miR-21 are reliable markers to detect fibrosis in Hepatitis C patients.
