Antiviral Therapy for Chronic HCV Infection: Virological Response and Long-Term Outcome

__Abstract__ Hepatitis C is a major global health problem which is responsible for over 350,000 deaths each year.1 In total, there are thought to be around 150 million hepatitis C virus (HCV) carriers, which comprise about 3% of the world population. The prevalence of HCV infection, however, shows a substantial geographical variation. In Europe the prevalence of HCV infection varies from 0.1 to 6.0%, with the highest occurrence in Southern and Eastern Europe.2 The Netherlands represents a country in which HCV infection is not frequently observed. A recently performed Dutch epidemiological study i

Recent advances in managing chronic HCV infection: Focus on therapy in patients with severe liver disease

Chronic hepatitis C virus (HCV) infection still represents a major public health problem, as it is thought to be responsible for more than 350,000 deaths around the globe on a yearly basis. Fortunately, successful eradication of the virus has been associated with improved clinical outcome and reduced mortality rates. In the past few years, treatment has improved considerably by the implementation of direct-acting antivirals (DAAs). From 2014 onwards, sofosbuvir, simeprevir, daclatasvir, ledipasvir, paritaprevir, ombitasvir, and dasabuvir have been approved by the US Food and Drug Administration (FDA) and European Medicines Agency (EMA). Regimens with various combinations of these new drugs, without the use of interferon (IFN), proved to be very effective and well tolerated, even among patients with advanced liver disease. Moreover, treatment duration could be shortened to 12 weeks in the majority of patients. The high costs of these DAAs, however, limit the availability of IFN-free therapy worldwide. Even in wealthy countries, it is deemed necessary to prioritize DAA treatment in order to limit the immediate impact on the health budget. As patients with advanced liver disease are in most need of HCV clearance, many countries decided to treat those patients first. In the current review, we focus on the currently available IFN-free treatment options for patients with cirrhosis. We discuss the virological efficacy as well as the clinical relevance of these regimens among this specific patient population

Evaluation of ear, nose, and throat-screening in liver transplantation candidates:A retrospective cohort study

Background:Patients with end-stage liver disease can be treated with a liver transplantation (LT). Before listing, candidates are subjected to a screening procedure according to the EASL Clinical Practice Guidelines for LT. In our hospital, this includes an ear, nose, and throat (ENT) examination, directed towards the identification of (asymptomatic) infections and head and neck malignancies.Methods:We retrospectively reviewed all ENT screening examinations in LT candidates from 2007 to 2022. The screening consisted of a visit to the ENT outpatient clinic combined with sinus radiography.Results:ENT screening was performed in 1099 patients. Sixty-one cases were identified, either diagnosed with an infection (n = 58, almost exclusively sinusitis) or a neoplasm (n = 3, of which two malignancies). With binary logistic regression, we could not identify significant risk factors for diagnosing sinusitis. 711 patients underwent LT. After LT, two patients developed a novel malignancy of the head and neck area, while 14 patients were diagnosed with sinusitis, two of the latter already showed opacification on sinus radiography during screening. Despite immunosuppressive drugs, no complicated sinusitis was observed.Conclusion:Sinusitis or a neoplasm was diagnosed in almost 6% in a large cohort of LT candidates. Although almost a third of sinusitis patients were not treated accordingly, we did not observe any complicated sinusitis after LT. A more conservative approach to sinusitis may therefore be justified in LT candidates, especially in asymptomatic cases. At our institution, we aim to refer only those patients with specific ENT complaintsimage.This study aimed to evaluate the outcome of routine ear, nose, and throat screening in a large cohort of liver transplantation candidates. Note that, 6% were diagnosed with either sinusitis or a neoplasm. We did not observe any complicated sinusitis after transplantation. A more conservative approach may therefore be justified, especially in asymptomatic cases.imag

Connecting foraging and roosting areas reveals how food stocks explain shorebird numbers

Shorebird populations, especially those feeding on shellfish, have strongly declined in recent decades and identifying the drivers of these declines is important for conservation. Changing food stocks are thought to be a key driver of these declines and may also explain why trends have not been uniform across Europe's largest estuary. We therefore investigated how winter population trends of Eurasian oystercatchers (Haematopus ostralegus) were linked to food availability in the Dutch Wadden Sea. Our analysis incorporated two spatial scales, a smaller scale focused on roost counting areas and food available to birds in these areas and a larger spatial scale of tidal basins. A novelty in our study is that we quantify the connectivity between roosting and foraging areas, identified from GPS tracking data. This allowed us to estimate food available to roosting birds and thus how food availability may explain local population trends. At the smaller spatial scale of roost counting areas, there was no clear relationship between available food and the number of roosting oystercatchers, indicating that other factors may drive population fluctuations at finer spatial scales. At the scale of tidal basins, however, there was a significant relationship between population trends and available food, especially cockle Cerastoderma edule,. Mortality and recruitment alone could not account for the large fluctuations in bird counts, suggesting that the site choice of wintering migratory oystercatchers may primarily drive these large fluctuations. Furthermore, the relationship between oystercatcher abundance and benthic food stocks, suggests winter shorebird counts could act as ecological indicators of ecosystem health, informing about the winter status of food stocks at a spatial scale of tidal basins