Hepcare Europe - bridging the gap in the treatment of hepatitis C:study protocol

BACKGROUND: Hepatitis C (HCV) infection is highly prevalent among people who inject drugs (PWID). Many PWID are unaware of their infection and few have received HCV treatment. Recent developments in treatment offer cure rates >90%. However, the potential of these treatments will only be realised if HCV identification among PWID with linkage to treatment is optimised. This paper describes the Hepcare Europe project, a collaboration between five institutions across four member states (Ireland, UK, Spain, Romania), to develop, implement and evaluate interventions to improve the identification, evaluation and treatment of HCV among PWID. METHODS: A service innovation project and a mixed-methods, pre-post intervention study, Hepcare will design and deliver interventions in Dublin, London, Seville and Bucharest to enhance PWID engagement and retention in the cascade of HCV care. RESULTS: The feasibility, acceptability, potential efficacy and cost-effectiveness of these interventions to improve care processes and outcomes among PWID will be evaluated. CONCLUSION: Hepcare has the potential to make an important impact on patient care for marginalised populations who might otherwise go undiagnosed and untreated. Lessons learned from the study can be incorporated into national and European guidelines and strategies for HCV

Servicii medicale integrate pentru pacienții coinfectați HIV/VHC din România ce provin din populațiile marginalizate – modelul Proiectului HepCare Europe implementat la Spitalul „Dr. Victor Babeș“ din București

Background. Proiectul HepCare Europe, cofinanţat de Comisia Europeană, a avut ca scop crearea şi implementarea unui model de management al VHC (screening, evaluare şi tratament) adresat pacienţilor ce provin din populaţiile vulnerabile. Ideea de bază a proiectului a fost creşterea accesului acestor pacienţi la servicii medicale integrate, prin implicarea cadrelor medicale din comunitate. Scopul acestui studiu a fost să evalueze caracteristicile socio-demografice şi clinice ale pacienţilor coinfectaţi HIV/VHC comparativ cu cei monoinfectaţi cu VHC înrolaţi în Proiectul HepCare Europe, în cadrul Spitalului Clinic de Boli Infecţioase şi Tropicale „Dr. Victor Babeş“ din Bucureşti. Metode. Studiu prospectiv efectuat la pacienţii cu anticorpi anti-VHC pozitivi (prin teste rapide orale), ce au fost evaluaţi la Spitalul „Dr. Victor Babeş“ din Bucureşti, România (SVB), în perioada aprilie 2016 – aprilie 2019. Caracteristicile socio-demografice şi clinice ale pacienţilor au fost comparate în funcţie de statusul de coinfectat HIV. Analiza statistică a datelor s-a realizat folosind programul SPSS versiunea 20.0. Rezultate. Screening-ul pentru hepatita cronică cu virus C s-a realizat la 525 de pacienţi, dintre care 230 (43,8%) au avut rezultat pozitiv. Majoritatea erau tineri, de sex masculin (85,2%) şi utilizatori de droguri injectabile (92,2%). 168 de pacienţi (73,0%) au fost evaluaţi la spital, din care 41,6% erau coinfectaţi HIV. Evaluarea gradului de fibroză hepatică s-a realizat pentru 82,1% dintre pacienţi, aproape o treime fiind identificaţi cu fibroză hepatică avansată (27,5%). ARN-VHC în plasmă a fost efectuat pentru jumătate din pacienţii luaţi în evidenţă, 80,9% din aceştia având încărcătură virală detectabilă. 24 de pacienţi au iniţiat tratamentul cu agenţi antivirali direcţi, din care 22 au obţinut răspuns viral susţinut, iar 2 au fost nonresponderi (utilizatori de droguri infectaţi cu genotip 3 ce nu au primit tratament cu regim pangenotipic). Infecţia HIV s-a asociat cu lipsa locuinţei (p < 0,0001), consumul de droguri injectabile (p = 0,001), consumul de etnobotanice în asociere cu opioidele (p < 0,0001), utilizarea de ace la comun (p < 0,0001) sau consumul de alcool (p < 0,0001). Valoarea mediană a limfocitelor CD4 la diagnostic a fost de 483/µl (IQR 290, 646), iar valoarea mediană a încărcăturii virale HIV în plasmă a fost de 2.74 log10copii/ml (IQR 1,27, 4,67). Încărcătura virală VHC în plasmă a fost semnificativ mai mare la pacienţii coinfectaţi HIV/VHC (p = 0,047). Concluzii. Coinfecţia HIV/VHC a fost frecventă la pacienţii ce provin din populaţiile vulnerabile. Infecţia HIV a fost asociată cu multipli factori de risc şi încărcătură virală VHC plasmatică mai ridicată. Barierele socio-economice şi accesul redus la tratamente pangenotipice cu agenţi antivirali direcţi (DAA) au limitat semnificativ iniţierea tratamentului la aceşti pacienţi. Acesta este primul studiu pilot din România despre managementul pacienţilor cu hepatită C care provin din populaţiile cheie

Integrating primary and secondary care to optimize hepatitis C treatment:development and evaluation of a multidisciplinary educational Masterclass series

[Background] It is increasingly being recognized that the elimination of HCV requires a multidisciplinary approach and effective cooperation between primary and secondary care.[Objectives] As part of a project (HepCare Europe) to integrate primary and secondary care for patients at risk of or infected with HCV, we developed a multidisciplinary educational Masterclass series for healthcare professionals (HCPs) working in primary care in Dublin and Bucharest. This article aims to describe and evaluate the series and examine how this model might be implemented into practice.[Methods] GPs and other HCPs working in primary care, addiction treatment services and NGOs were invited to eight 1 day symposia (HCV Masterclass series), examining the burden and management of HCV in key populations. Peer-support sessions were also conducted, to give people affected by HCV and community-based organizations working with those directly affected, an update on the latest developments in HCV treatment.[Results] One hundred percent of participants ‘strongly agreed’ or ‘agreed’ that the Masterclass helped them to appreciate the role of integrated services in ‘the management of patients with HCV’. One hundred percent of participants indicated the importance of a ‘designated nurse to liaise with hospital services’. An improvement of knowledge regarding HCV management of patients with high-risk behaviour was registered at the end of the course.[Conclusions] Integrated approaches to healthcare and improving the knowledge of HCPs and patients of the latest developments in HCV treatment are very important strategies that can enhance the HCV care pathway and treatment outcomes.This work was supported by the European Commission through its EU Third Health Programme (Grant Agreement Number 709844) and Ireland’s Health Services Executive.Peer reviewe

Cerebrospinal Fluid Viral Load Across the Spectrum of Untreated Human Immunodeficiency Virus Type 1 (HIV-1) Infection: A Cross-Sectional Multicenter Study

Background The aim of this large multicenter study was to determine variations in cerebrospinal fluid (CSF) HIV-RNA in different phases of untreated human immunodeficiency virus type 1 (HIV-1) infection and its associations with plasma HIV-RNA and other biomarkers. Methods Treatment naive adults with available CSF HIV-RNA quantification were included and divided into groups representing significant disease phases. Plasma HIV-RNA, CSF white blood cell count (WBC), neopterin, and albumin ratio were included when available. Results In total, 1018 patients were included. CSF HIV-RNA was in median (interquartile range [IQR]) 1.03 log(10) (0.37-1.86) copies/mL lower than in plasma, and correlated with plasma HIV-RNA (r = 0.44, P &lt; .01), neopterin concentration in CSF (r = 0.49, P &lt; .01) and in serum (r = 0.29, P &lt; .01), CSF WBC (r = 0.34, P &lt; .01) and albumin ratio (r = 0.25, P &lt; .01). CSF HIV-RNA paralleled plasma HIV-RNA in all groups except neuroasymptomatic patients with advanced immunodeficiency (CD4 &lt; 200) and patients with HIV-associated dementia (HAD) or opportunistic central nervous system (CNS) infections. Patients with HAD had the highest CSF HIV-RNA (in median [IQR] 4.73 (3.84-5.35) log(10) copies/mL). CSF &gt; plasma discordance was found in 126 of 972 individuals (13%) and varied between groups, from 1% in primary HIV, 11% in neuroasymptomatic groups, up to 30% of patients with HAD. Conclusions Our study confirms previous smaller observations of variations in CSF HIV-RNA in different stages of HIV disease. Overall, CSF HIV-RNA was approximately 1 log(10) copies/mL lower in CSF than in plasma, but CSF discordance was found in a substantial minority of subjects, most commonly in patients with HAD, indicating increasing CNS compartmentalization paralleling disease progression. HIV-RNA is detectable in cerebrospinal fluid (CSF) across all stages of untreated HIV and usually parallel plasma HIV-RNA at a lower level. A substantial proportion (13%) of patients have CSF&gt;plasma HIV-RNA, most commonly in patients with HIV-associated dementia

Major revision version 12.0 of the European AIDS Clinical Society guidelines 2023

Background The European AIDS Clinical Society (EACS) guidelines were revised in 2023 for the 19th time, and all aspects of HIV care were updated.Key Points of the Guidelines Update Version 12.0 of the guidelines recommend the same six first-line treatment options for antiretroviral treatment (ART)-naive adults as versions 11.0 and 11.1: tenofovir-based backbone plus an unboosted integrase inhibitor or doravirine; abacavir/lamivudine plus dolutegravir; or dual therapy with lamivudine or emtricitabine plus dolutegravir. The long-acting section has been expanded in the ART and drug-drug interaction (DDI) panels. Tables for preferred and alternative ART in children and adolescents have been updated, as has the section on prevention of vertical transmission, particularly with new guidance for breastfeeding. A new DDI table has been included for the ART and anti-infective drugs used for opportunistic infections, sexually transmitted infections, and other infectious conditions; lenacapavir has been included in all DDI tables. New sections on alcohol use and patient-reported outcome measures (PROMs) have been included in the comorbidity panel, in addition to updates on many relevant topics, such as new resource guidance for deprescribing in people with HIV. Other sections, including travel, cognitive impairment, cancer screening, sexual health, and diabetes have also been revised extensively. The algorithm for the management of acute hepatitis C virus infection has been removed, as current guidelines recommend immediate treatment of all people with recently acquired hepatitis C virus. Updates on vaccination for hepatitis B virus and recommendations for simplification to tenofovir-free two-drug regimens in people with isolated anti-hepatitis B core antibodies are provided. In the opportunistic infections and COVID-19 panel, guidance on the management of COVID-19 in people with HIV has been updated according to the most up-to-date evidence, and a new section on monkeypox has been added.Conclusions In 2023, the EACS guidelines were updated extensively and now include several new sections. The recommendations are available as a free app, in interactive web format, and as a pdf online

Integrating hepatitis C care for at-risk groups (HepLink):baseline data from a multicentre feasibility study in primary and community care

OBJECTIVES To examine HCV prevalence and management among people who inject drugs (PWID) attending primary care and community-based health services at four European sites using baseline data from a multicentre feasibility study of a complex intervention (HepLink). METHODS Primary care and community-based health services in Dublin, London, Bucharest and Seville were recruited from the professional networks of the HepLink consortium. Patients were eligible to participate if aged ≥18 years, on opioid substitution treatment or at risk of HCV (i.e. injecting drug use, homeless or incarcerated), and attended the service. Data on patient demographics and prior HCV management were collected on participants at baseline. RESULTS Twenty-nine primary care and community-based health services and 530 patients were recruited. Baseline data were collected on all participants. Participants' mean age ranged from 35 (Bucharest) to 51 years (London), with 71%-89% male. Prior lifetime HCV antibody testing ranged from 65% (Bucharest) to 95% (Dublin) and HCV antibody positivity among those who had been tested ranged from 78% (Dublin) to 95% (Bucharest). Prior lifetime HCV RNA testing among HCV antibody-positive participants ranged from 17% (Bucharest) to 84% (London). Among HCV antibody- or RNA-positive participants, prior lifetime attendance at a hepatology/infectious disease service ranged from 6% (London) to 50% (Dublin) and prior lifetime HCV treatment initiation from 3% (London) to 33% (Seville). CONCLUSIONS Baseline assessment of the HCV cascade of care among PWID attending primary care and community-based health services at four European sites identified key aspects of the care cascade at each site that need to be improved

Neutron Induced Capture and Fission Processes on

Nuclear data on Uranium isotopes are of crucial interest for new generation of nuclear reactors. Processes of interest are the nuclear reactions induced by neutrons and in this work mainly the capture and the fission process on 238U will be analyzed in a wide energy interval. For slow and resonant neutrons the many levels Breit – Wigner formalism is necessary. In the case of fast and very fast neutrons up to 200 MeV the nuclear reaction mechanism implemented in Talys will be used. The present evaluations are necessary in order to obtain the field of neutrons in the design of nuclear reactors and they are compared with experimental data from literature obtained from capture and (n,xn) processes