213 research outputs found
Peroxisome Proliferator-Activated Receptors in HCV-Related Infection
The topic of peroxisome proliferator-activated receptors has been developed in the field of hepatology allowing envisaging therapeutic strategies for the most frequent chronic liver diseases such as chronic infection with hepatitis C virus (HCV). PPARs contribute to wide physiological processes within the liver such as lipid/glucid metabolisms, inflammatory response, cell differentiation, and cell cycle. In vitro experiments and animal studies showed that PPARα discloses anti-inflammatory property, and PPARγ discloses anti-inflammatory, antifibrogenic, and antiproliferative properties in the liver. Experimental and human studies showed impaired PPARs expression and function during HCV infection. The available nonhepatotoxic agonists of PPARs may constitute a progress in the therapeutic management of patients chronically infected with HCV
PPAR and Liver Injury in HIV-Infected Patients
Due to the introduction of active HIV antiretroviral treatment, AIDS-related morbidity and mortality have markedly decreased and liver diseases are now a major cause of morbidity and mortality in HIV-infected patients. Chronic liver injury encompasses a wide spectrum of diseases due to HCV and HBV coinfection, drug-related toxicity, and NASH. HIV-infected patients who are receiving treatment present with a high prevalence of metabolic complications and lipodystrophy. Those patients are at high risk of nonalcoholic fatty liver disease, the liver feature of the metabolic syndrome. This review will focus on (1) the liver injuries in HIV-infected patients; (2) both the current experimental and human data regarding PPAR and liver diseases; (3) the interactions between HIV and PPAR; (4) the potential use of PPAR agonists for the management of HIV-related liver diseases
Economic evaluations of HBV testing and treatment strategies and applicability to low and middle-income countries
BACKGROUND: Many people living with chronic HBV infection remain
undiagnosed until later stages of disease. Increasing testing
and treatment rates form part of the strategy to respond to the
WHO goal of eliminating viral hepatitis as a public health
threat by 2030. However, achieving these ambitious targets is
dependent on finding effective and cost-effective methods of
scale up strategies. The aim of this study was to undertake a
narrative review of the literature on economic evaluations of
testing and treatment for HBV infection, to help inform the
development of the 2017 WHO Hepatitis Testing Guidelines.
METHODS: We undertook a focussed literature review for economic
evaluations on testing for HBV accompanied by antiviral
treatment. The search was carried out in Pubmed and included
only articles published after 2000 and written in English. We
narratively synthesise the results and discuss the key drivers
of cost-effectiveness and their applicability to low and
middle-income countries (LMICs). RESULTS: Nine published studies
were included in this review, only one of which was performed in
a low or middle-income setting in West Africa. Eight studies
were performed in high-income settings, seven among high risk
groups and one among the general population. The studies were
heterogeneous in many respects including the population and
testing strategy under consideration, model structure and
baselines parameters, willingness to pay thresholds and outcome
measures used. However, most studies found HBV testing and
treatment to be cost-effective, even at low HBsAg prevalence
levels. CONCLUSIONS: Currently economic evaluations of HBV
testing and treatment strategies in LMICs is lacking, therefore
limiting the ability to provide formal recommendations on the
basis of cost-effectiveness alone. Further implementation
research is needed in order to help guide national policy
planning
Population-based interventions to reduce the public health burden related with hepatitis B virus infection in the gambia, west Africa.
In The Gambia, West Africa, the prevalence of chronic hepatitis B virus (HBV) infection in adults exceeds eight percent and hepatocellular carcinoma (HCC) has been the most frequent type of malignancy. Two population-based intervention studies to control HBV infection, namely, GHIS (Gambia Hepatitis Intervention Study) and PROLIFICA (Prevention of Liver Fibrosis and Cancer in Africa), are discussed. The GHIS started in 1986 as a nation-wide trial of the HBV vaccine to evaluate the effectiveness of infant HBV vaccination in preventing HCC in adulthood. The vaccine was progressively introduced into the Expanded Program of Immunization (EPI) of The Gambia over four years in a phased manner, called the "stepped-wedge" design. This was because instantaneous universal vaccination in the country was impossible for logistic and financial reasons. However, this design also allowed the study to have an unvaccinated control group which consisted of the newborns of the areas where HBV vaccine has not yet been incorporated in the EPI. To assess the outcome, a national cancer registry was founded and all HCC patients in this birth cohort are linked with the vaccine trial database. The study is still ongoing to answer whether the HBV vaccine in infancy prevent HCC in adulthood in The Gambia. Although the universal HBV vaccination since 1990 has been successful in reducing the prevalence of chronic HBV infection in young Gambians, the number of HCC cases may not decline over the next decades as people infected prior to the immunization program are likely to continue to develop the diseases. To reduce the HCC incidence through community-based screening of HBV infection and provision of antiviral therapy, the PROLIFICA project started in 2011. Study hypothesis and design of these two studies, GHIS and PROLIFICA, are further discussed
Hepatitis B Virus: Infection, liver disease, carcinogen or syndemic threat? Remodelling the clinical and public health response
Hepatitis B: The view from West Africa
The Prevention of Liver Fibrosis and Cancer in Africa (PROLIFICA) study began in 2011 in The Gambia, Sénégal and Nigeria. The study aims to reduce the risk of hepatocellular carcinoma (HCC) in West Africa through the suppression of the Hepatitis B virus (HBV). The biological samples collected allow for the detection of novel liver cancer biomarkers in the hope of improving the diagnostic ability of early disease states. The PROLIFICA platform hopes to improve cancer diagnostics whilst simultaneously providing the training, skills and infrastructure necessary to develop the quality of liver cancer care in West Africa
Acceptability and feasibility of a screen-and-treat programme for hepatitis B virus infection in The Gambia: the Prevention of Liver Fibrosis and Cancer in Africa (PROLIFICA) study
Background Despite the introduction of immunisation for hepatitis B virus (HBV) in the 1990s, HBV-related morbidity
and mortality remain high in sub-Saharan Africa. Identifi cation and treatment of asymptomatic people with chronic
HBV infection should reduce the disease burden. We therefore assessed the feasibility of a screen-and-treat
programme for HBV infection in The Gambia, west Africa, and estimated the proportion of HBV-infected people who
had signifi cant liver disease in need of treatment.
Methods Between Dec 7, 2011, and Jan 24, 2014, individuals living in randomly selected communities in western
Gambia were off ered hepatitis B surface antigen (HBsAg) screening via a point-of-care test. The test was also off ered
to potential blood donors attending the central hospital in the capital, Banjul. HBsAg-positive individuals were invited
for a comprehensive liver assessment and were off ered treatment according to international guidelines. We defi ned
linkage to care as visiting the liver clinic at least once. Eligibility for treatment was judged in accordance with the 2012
European Association for the Study of the Liver guidelines.
Findings HBsAg screening was accepted by 5980 (weighted estimate 68·9%, 95% CI 65·0–72·4) of 8170 adults from
27 rural and 27 urban communities and 5559 (81·4%, 80·4–82·3) of 6832 blood donors. HBsAg was detected in 495 (8·8%,
7·9–9·7) individuals in communities and 721 (13·0%, 12·1–13·9) blood donors. Prevalence was higher in men
(239 [10·5%, 8·9–12·1] of 2328 men vs 256 [7·6%, 6·5–8·7] of 3652 women; p=0·004) and middle-aged participants.
Linkage to care was high in the communities, with 402 (81·3%) of 495 HBsAg-positive individuals attending the clinic.
However, only 300 (41·6%) of 721 HBsAg-positive people screened at the blood bank linked into care. Of those who
attended the clinic, 18 (4·4%, 2·5–7·7) patients from the communities and 29 (9·7%, 6·8–13·6) from the blood bank were
eligible for treatment. Male sex was strongly associated with treatment eligibility (odds ratio 4·35, 1·50–12·58; p=0·007).
Interpretation HBV infection remains highly prevalent in The Gambia. The high coverage of community-based
screening, good linkage into care, and the small proportion of HBsAg carriers who need treatment suggest that largescale
screening and treatment programmes are feasible in sub-Saharan Africa
Cost-eff ectiveness of community-based screening and treatment for chronic hepatitis B in The Gambia: an economic modelling analysis
Background Despite the high burden of hepatitis B virus (HBV) infection in sub-Saharan Africa, absence of widespread
screening and poor access to treatment leads to most people remaining undiagnosed until later stages of disease
when prognosis is poor and treatment options are limited. We examined the cost-eff ectiveness of community-based
screening and early treatment with antiviral therapy for HBV in The Gambia.
Methods In this economic evaluation, we combined a decision tree with a Markov state transition model to compare
a screen and treat intervention consisting of adult community-based screening using a hepatitis B surface antigen
(HBsAg) rapid test and subsequent HBV antiviral therapy versus current practice, in which there is an absence of
publicly provided screening or treatment for HBV. We used data from the PROLIFICA study to parameterise
epidemiological, primary screening, and cost information, and other model parameter inputs were obtained from a
literature search. Outcome measures were cost per disability-adjusted life-year (DALY) averted; cost per life-year
saved; and cost per quality-adjusted life-year (QALY) gained. We calculated the incremental cost-eff ectiveness ratios
(ICERs) between current practice and the screen and treat intervention. Costs were assessed from a health provider
perspective. Costs (expressed in 2013 US540 per DALY averted, 511 per QALY gained, compared with current practice. These ICERs are in line with willingness-to-pay
levels of one times the country’s gross domestic product per capita ($487) per DALY averted, and remain robust over
a wide range of epidemiological and cost parameter inputs.
Interpretation Adult community-based screening and treatment for HBV in The Gambia is likely to be a cost-eff ective
intervention. Higher cost-eff ectiveness might be achievable with targeted facility-based screening, price reductions of
drugs and diagnostics, and integration of HBV screening with other public health interventions
Letter: liver disease and COVID-19 - not the perfect storm
This article is linked to Garrido et al papers. To view these articles, visit https://doi.org/10.1111/apt.15813 and https://doi.org/10.1111/apt.15886
Endoscopic capacity in West Africa
Background: Levels of endoscopic demand and capacity in West Africa are unclear.Objectives: This paper aims to: 1. describe the current labor and endoscopic capacity, 2. quantify the impact of a mixed-methods endoscopy course on healthcare professionals in West Africa, and 3. quantify the types of diagnoses encountered.Methods: In a three-day course, healthcare professionals were surveyed on endoscopic resources and capacity and were taught through active observation of live cases, case discussion, simulator experience and didactics. Before and after didactics, multiplechoice exams as well as questionnaires were administered to assess for course efficacy. Also, a case series of 23 patients needing upper GI endoscopy was done.Results: In surveying physicians, less than half had resources to perform an EGD and none could perform an ERCP, while waiting time for emergency endoscopy in urban populations was at least one day. In assessing improvement in medical knowledge among participants after didactics, objective data paired with subjective responses was more useful than either alone. Of 23 patients who received endoscopy, 7 required endoscopic intervention with 6 having gastric or esophageal varices. Currently the endoscopic capacity in West Africa is not sufficient. A formal GI course with simulation and didactics improves gastrointestinal knowledge amongst participants.Keywords: Endoscopic capacity, endoscopic demand, West Africa, training cours
- …