Hepatitis C virus elimination in Swiss opioid agonist therapy programmes - the SAMMSU cohort.

BACKGROUND Hepatitis C virus (HCV) infections in Switzerland are mainly related to intravenous drug use. Since 2017, all patients with chronic hepatitis C can be treated with direct-acting antivirals (DAAs) irrespective of fibrosis stage. In March 2019, the Federal Office of Public Health (FOPH) published guidelines for HCV management in people who use drugs. To achieve HCV elimination by 2030, 80% treatment uptake is necessary. AIM To evaluate the benefit of interferon-based and interferon-free HCV treatment in patients on opioid agonist therapy (OAT) and monitor HCV elimination, a 2-year study commissioned by the FOPH and conducted within the Swiss Association for the Medical Management in Substance Users (SAMMSU) cohort was performed. METHODS Since 2014, the SAMMSU cohort has recruited OAT patients from eight different centres throughout Switzerland. In addition to yearly follow up, cross-sectional data were collected at the time-points 1 May 2017, 1 May 2018 and 1 May 2019. HCV treatment uptake, adherence and success, as well as reinfection rates, the effect of early versus late treatment and the efficacy of the “treatment-as-prevention” approach were analysed. RESULTS Between 1 May 2017 and 1 May 2019, the number of patients enrolled into the SAMMSU cohort increased from 623 to 900: 78% were male, the median age was 45 years, 81% had ever used intravenous drugs, 13% were human immunodeficiency virus (HIV) positive and 66% were HCV antibody positive. HCV treatment up to 2012 was exclusively interferon based (maximum 21 patients/year) and since 2016 exclusively interferon free (102 patients in 2017). Treatment success increased from 57% (112/198; interferon based) to 97% (261/268; interferon free) irrespective of cirrhosis or prior non-response to interferon. Simultaneously, treatments became shorter and better tolerated in the interferon-free era, resulting in fewer preterm stops (17% vs 1%) and adherence problems (9% vs 2%). Between 2015 and 2018, the proportion of patients with no/mild fibrosis (F0/F1) at first HCV treatment increased from 0% to 61%. Earlier treatment reduced the duration of infectiousness. Between 1 May 2017 and 1 May 2019, the proportion of chronic hepatitis C patients ever treated increased from 62% (198/321) to 80% (391/490). In parallel, the HCV-RNA prevalence among HCV antibody-positive patients declined from 36% (139/385) to 19% (113/593). The reinfection rate after successful treatment was 2.7/100 person-years. The number of HCV first diagnoses per year decreased from >20 up to 2015 to <10 in 2017 and 2018. CONCLUSION With nearly 100% DAA treatment success and a low reinfection rate, treatment uptake directly translates into a reduction of HCV-RNA prevalence. Eighty percent treatment uptake is feasible in OAT patients, and adherence and treatment success are not worse than in other populations. Duration of infectiousness and thus HCV transmission can be reduced by early detection and treatment of chronic hepatitis C

Nonalcoholic fatty liver disease burden - Switzerland 2018-2030.

As a result of epidemic levels of obesity and diabetes mellitus, nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) will contribute to increases in the liver-related disease burden in Switzerland. A Markov model was built to quantify fibrosis progression among the NAFLD and NASH populations, and predict disease burden up to 2030. Long-term trending of NAFLD prevalence was based on changes in the prevalence of adult obesity. Published estimates and surveillance data were applied to build and validate the model projections. The prevalence of NAFLD increased up to 2030 in tandem with projected increases in adult obesity. By 2030, there were an estimated 2,234,000 (1,918,000–2,553,000) NAFLD cases, or 24.3% (20.9–27.8%) of the total Swiss population (all ages). Increases in NASH cases were relatively greater than NAFLD cases. Incident cases of advanced liver disease are projected to increase by approximately 40% by 2030, and incident NAFLD liver deaths to increase from 580 deaths in 2018 to 820 deaths in 2030. Continued growth in obesity, in combination with an aging population, will result in increasing number of cases of advanced liver disease and mortality related to NAFLD and NASH. Slowing the growth in obesity and metabolic syndrome, along with future potential therapies, are required to reduce liver disease burden. &nbsp

Coinvolgimento cardiovascolare nella sindrome di Erdheim-Chester: aspetti clinici e terapeutici.

Erdheim-Chester disease (ECD) is a rare form of non-Langerhans' cell histiocytosis of unknown etiology and its incidence is constantly increasing. ECD is characterized by a xantomatous or xanthogranulomatous infiltration of various tissues by foamy histiocytes surrounded by fibrosis. ECD is characterized by multi-organ involvement and is generally associated with a poor prognosis with a median survival of 32 months after diagnosis. Cardiovascular involvement concerns mainly the thoraco-abdominal aorta and pericardium. Less frequently, infiltration affects the myocardial tissue, especially the right atrium, and the valvular endocardium. Recently, the involvement of the vena cava has also been described. The diagnosis of ECD is made by the identification of foamy histiocytes CD68 positive and CD1a/S100 negative embedded in a polymorphic inflammatory tissue on biopsy. Despite the adoption of several therapeutic strategies until now prognosis has remained poor. Interferon-α can be considered the first line therapy, but its effects on central nervous system and cardiovascular localization have been shown to be often poor. In this context a combined treatment with the anti-TNFα monoclonal antibody infliximab and methotrexate seems to be effective and well tolerated.info:eu-repo/semantics/publishe

Characteristics of Foreign-Born Persons in the Swiss Hepatitis C Cohort Study: Implications for Screening Recommendations

Switzerland recommends individuals who originate from high-prevalence countries to be screened for hepatitis C virus (HCV) infection. However, not all these persons are equally at risk. We thus aimed to describe the number and characteristics of persons with HCV infection born outside of Switzerland

Ratio of proportions in the Swiss Hepatitis C Cohort Study (SCCS) respectively in cases mandatorily reported to the Federal Office of Public Health (FOPH) compared to the proportion in the general population, by country of birth/origin and age group.

<p>Ratio of proportions in the Swiss Hepatitis C Cohort Study (SCCS) respectively in cases mandatorily reported to the Federal Office of Public Health (FOPH) compared to the proportion in the general population, by country of birth/origin and age group.</p

Persons who do not inject drugs (non-PWID) versus persons who inject drugs (PWID) among foreign-born persons in the national surveillance data of the Federal Office of Public Health, by country of origin and age (please note the different y-axis scale for Italy).

<p>Persons who do not inject drugs (non-PWID) versus persons who inject drugs (PWID) among foreign-born persons in the national surveillance data of the Federal Office of Public Health, by country of origin and age (please note the different y-axis scale for Italy).</p