Hepatitis C (HCV) therapy for HCV mono-infected and HIV-HCV co-infected individuals living in Nepal.
Background Despite direct-acting antivirals (DAA), aims to "eradicate" viral hepatitis by 2030 remain unlikely. In Nepal, an expert consortium was established to treat HCV through Nepal earthquakes aftermath offering a model for HCV treatment expansion in a resource-poor setting. Methodolo...
Published in: | PLOS Neglected Tropical Diseases |
---|---|
Main Authors: | , , , , , , , , , , , , , , , , , , |
Format: | Article in Journal/Newspaper |
Language: | English |
Published: |
Public Library of Science (PLoS)
2020
|
Subjects: | |
Online Access: | https://doi.org/10.1371/journal.pntd.0008931 https://doaj.org/article/0d1665782d4e48be9e2382f6088deac7 |
id |
ftdoajarticles:oai:doaj.org/article:0d1665782d4e48be9e2382f6088deac7 |
---|---|
record_format |
openpolar |
spelling |
ftdoajarticles:oai:doaj.org/article:0d1665782d4e48be9e2382f6088deac7 2023-05-15T15:13:31+02:00 Hepatitis C (HCV) therapy for HCV mono-infected and HIV-HCV co-infected individuals living in Nepal. Sudhamshu Kc Holly Murphy Sameer Dixit Apurva Rai Bickram Pradhan Marie Lagrange-Xelot Niyanta Karki Amélie Dureault Ujjwal Karmacharya Santosh Panthi Nabin Tulachan Prawchan Kc Anjay Kc Rajesh Rajbhandari Andrew B Trotter Jörg Gölz Pierre Pradat Christian Trépo Philippe Creac'H 2020-12-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0008931 https://doaj.org/article/0d1665782d4e48be9e2382f6088deac7 EN eng Public Library of Science (PLoS) https://doi.org/10.1371/journal.pntd.0008931 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0008931 https://doaj.org/article/0d1665782d4e48be9e2382f6088deac7 PLoS Neglected Tropical Diseases, Vol 14, Iss 12, p e0008931 (2020) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2020 ftdoajarticles https://doi.org/10.1371/journal.pntd.0008931 2022-12-31T11:50:59Z Background Despite direct-acting antivirals (DAA), aims to "eradicate" viral hepatitis by 2030 remain unlikely. In Nepal, an expert consortium was established to treat HCV through Nepal earthquakes aftermath offering a model for HCV treatment expansion in a resource-poor setting. Methodology/principal findings In 2015, we established a network of hepatologists, laboratory experts, and community-based leaders at 6 Opioid Substitution Treatment (OST) sites from 4 cities in Nepal screening 838 patients for a treatment cohort of 600 individuals with HCV infection and past or current drug use. During phase 1, patients were treated with interferon-based regimens (n = 46). During phase 2, 135 patients with optimal predictors (HIV controlled, without cirrhosis, low baseline HCV viral load) were treated with DAA-based regimens. During phase 3, IFN-free DAA treatment was expanded, regardless of HCV disease severity, HIV viremia or drug use. Sustained virologic response (SVR) was assessed at 12 weeks. Median age was 37 years and 95.5% were males. HCV genotype was 3 (53.2%) or 1a (40.7%) and 32% had cirrhosis; 42.5% were HIV-HCV coinfected. The intention-to-treat (ITT) SVR rates in phase 2 and 3 were 97% and 81%, respectively. The overall per-protocol and ITT SVR rates were 97% and 85%, respectively. By multivariable analysis, treatment at the Kathmandu site was protective and substance use, treatment during phase 3 were associated with failure to achieve SVR. Conclusions/significance Very high SVR rates may be achieved in a difficult-to-treat, low-income population whatever the patient's profile and disease severity. The excellent treatment outcomes observed in this real-life community study should prompt further HCV treatment initiatives in Nepal. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLOS Neglected Tropical Diseases 14 12 e0008931 |
institution |
Open Polar |
collection |
Directory of Open Access Journals: DOAJ Articles |
op_collection_id |
ftdoajarticles |
language |
English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
spellingShingle |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Sudhamshu Kc Holly Murphy Sameer Dixit Apurva Rai Bickram Pradhan Marie Lagrange-Xelot Niyanta Karki Amélie Dureault Ujjwal Karmacharya Santosh Panthi Nabin Tulachan Prawchan Kc Anjay Kc Rajesh Rajbhandari Andrew B Trotter Jörg Gölz Pierre Pradat Christian Trépo Philippe Creac'H Hepatitis C (HCV) therapy for HCV mono-infected and HIV-HCV co-infected individuals living in Nepal. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
Background Despite direct-acting antivirals (DAA), aims to "eradicate" viral hepatitis by 2030 remain unlikely. In Nepal, an expert consortium was established to treat HCV through Nepal earthquakes aftermath offering a model for HCV treatment expansion in a resource-poor setting. Methodology/principal findings In 2015, we established a network of hepatologists, laboratory experts, and community-based leaders at 6 Opioid Substitution Treatment (OST) sites from 4 cities in Nepal screening 838 patients for a treatment cohort of 600 individuals with HCV infection and past or current drug use. During phase 1, patients were treated with interferon-based regimens (n = 46). During phase 2, 135 patients with optimal predictors (HIV controlled, without cirrhosis, low baseline HCV viral load) were treated with DAA-based regimens. During phase 3, IFN-free DAA treatment was expanded, regardless of HCV disease severity, HIV viremia or drug use. Sustained virologic response (SVR) was assessed at 12 weeks. Median age was 37 years and 95.5% were males. HCV genotype was 3 (53.2%) or 1a (40.7%) and 32% had cirrhosis; 42.5% were HIV-HCV coinfected. The intention-to-treat (ITT) SVR rates in phase 2 and 3 were 97% and 81%, respectively. The overall per-protocol and ITT SVR rates were 97% and 85%, respectively. By multivariable analysis, treatment at the Kathmandu site was protective and substance use, treatment during phase 3 were associated with failure to achieve SVR. Conclusions/significance Very high SVR rates may be achieved in a difficult-to-treat, low-income population whatever the patient's profile and disease severity. The excellent treatment outcomes observed in this real-life community study should prompt further HCV treatment initiatives in Nepal. |
format |
Article in Journal/Newspaper |
author |
Sudhamshu Kc Holly Murphy Sameer Dixit Apurva Rai Bickram Pradhan Marie Lagrange-Xelot Niyanta Karki Amélie Dureault Ujjwal Karmacharya Santosh Panthi Nabin Tulachan Prawchan Kc Anjay Kc Rajesh Rajbhandari Andrew B Trotter Jörg Gölz Pierre Pradat Christian Trépo Philippe Creac'H |
author_facet |
Sudhamshu Kc Holly Murphy Sameer Dixit Apurva Rai Bickram Pradhan Marie Lagrange-Xelot Niyanta Karki Amélie Dureault Ujjwal Karmacharya Santosh Panthi Nabin Tulachan Prawchan Kc Anjay Kc Rajesh Rajbhandari Andrew B Trotter Jörg Gölz Pierre Pradat Christian Trépo Philippe Creac'H |
author_sort |
Sudhamshu Kc |
title |
Hepatitis C (HCV) therapy for HCV mono-infected and HIV-HCV co-infected individuals living in Nepal. |
title_short |
Hepatitis C (HCV) therapy for HCV mono-infected and HIV-HCV co-infected individuals living in Nepal. |
title_full |
Hepatitis C (HCV) therapy for HCV mono-infected and HIV-HCV co-infected individuals living in Nepal. |
title_fullStr |
Hepatitis C (HCV) therapy for HCV mono-infected and HIV-HCV co-infected individuals living in Nepal. |
title_full_unstemmed |
Hepatitis C (HCV) therapy for HCV mono-infected and HIV-HCV co-infected individuals living in Nepal. |
title_sort |
hepatitis c (hcv) therapy for hcv mono-infected and hiv-hcv co-infected individuals living in nepal. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2020 |
url |
https://doi.org/10.1371/journal.pntd.0008931 https://doaj.org/article/0d1665782d4e48be9e2382f6088deac7 |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 14, Iss 12, p e0008931 (2020) |
op_relation |
https://doi.org/10.1371/journal.pntd.0008931 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0008931 https://doaj.org/article/0d1665782d4e48be9e2382f6088deac7 |
op_doi |
https://doi.org/10.1371/journal.pntd.0008931 |
container_title |
PLOS Neglected Tropical Diseases |
container_volume |
14 |
container_issue |
12 |
container_start_page |
e0008931 |
_version_ |
1766344061362372608 |