Microenvironment Eradication of Hepatitis C: A Novel Treatment Paradigm

Fecha de publicación: 01/11/2018 Fecha Ahead of Print: 27/06/2018

Autores de IDIVAL

Autores ajenos al IDIVAL

Cobo C
Pallás JR
Mateo M
Alvarez S
Setién E
Chueca N
Garcia F
Calleja JL

Unidades

Abstract

OBJECTIVES: Prisons are major reservoirs of hepatitis C virus (HCV) in which a therapeutic approach has been particularly difficult so far. Our aim was to create a permanent program of HCV elimination in a prison based on a "test and treat" strategy. METHODS: This open-label clinical trial was conducted in the Spanish prison "El Dueso" between May 2016 and July 2017. Viremic patients were treated with a ledipasvir-sofosbuvir regimen (8-12 weeks) according to the 2015 Spanish Guidelines. A teleconsultation program was established to follow-up patients from the hospital. Non-responders were submitted for a phylogenetic analysis and offered retreatment. An evaluation of new cases of HCV infection was performed every 6 months and upon release in all inmates. RESULTS: 847 (99.5%) inmates accepted to participate. HCV antibodies were present in 110 (13.0%) and 86 (10.2%) had detectable viremia. Most of them were genotype 1 or 3 (82.6%) and had <F2 fibrosis (52.2%). Treatment was started in the 69 inmates whose stay in prison was longer than 30 days. Sustained virological response was achieved in 64 out of 66 patients (96.9%), three of whom were successfully rescued with a salvage regimen after treatment failure. Two patients were lost to follow-up and three are currently on treatment without viremia. As a result, by July 2017 none of the 409 imprisoned was viremic, and neither reinfections nor de novo infections were detected. CONCLUSIONS: A sustained "test-and-treat" strategy against HCV in prisons is feasible and beneficial. Spreading this strategy should entail a public health impact.

Datos de la publicación

ISSN/ISSNe:: 0002-9270, 1572-0241
Tipo:: Article
Páginas:: 1639-1648
DOI:: 10.1038/s41395-018-0157-x
PubMed:: 29946175

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Cuadrado A:: Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain

Instituto de Investigación. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain
Llerena S:: Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain

Instituto de Investigación. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain
Cobo C:: Medical Service. El Dueso Penitentiary Centre, Santoña, Spain
Pallás JR:: Medical Service. El Dueso Penitentiary Centre, Santoña, Spain
Mateo M:: Medical Service. El Dueso Penitentiary Centre, Santoña, Spain
Cabezas J:: Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain

Instituto de Investigación. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain
Fortea JI:: Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain

Instituto de Investigación. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain
Alvarez S:: Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain

Instituto de Investigación. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain
Pellón R:: Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain
J. Crespo del Pozo:: Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain
Echevarría S:: Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain

Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain
Ayesa R:: Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain

Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain
Setién E:: Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain

Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain
Lopez-Hoyos M:: Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain
Crespo-Facorro B:: Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain

Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain
Agüero J:: Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain
Chueca N:: Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain
Garcia F:: Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain
Calleja JL:: Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain
Javier Crespo:: Instituto de Investigación. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain.

Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain.

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Microenvironment Eradication of Hepatitis C: A Novel Treatment Paradigm

Autores de IDIVAL

Antonio Cuadrado Lavín

Susana Llerena Santiago

Joaquín Cabezas González

José Ignacio Fortea Ormaechea

Raúl Pellón Daben

Juan Crespo Del Pozo

María Aranzazu Mouriz Moleón

María Rosa Ayesa Arriola

Marcos López Hoyos

Benedicto Crespo Facorro

Jesús Agüero Balbín

Javier Crespo García

Autores ajenos al IDIVAL

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DIAGNÓSTICO Y TRATAMIENTO POR IMAGEN

ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLÍNICA

INMUNOPATOLOGÍA

INVESTIGACIÓN CLÍNICA Y TRASLACIONAL EN ENFERMEDADES DIGESTIVAS

INVESTIGACIÓN EN ENFERMEDADES MENTALES

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Microenvironment Eradication of Hepatitis C: A Novel Treatment Paradigm

Autores de IDIVAL

Benedicto Crespo Facorro

Jesús Agüero Balbín

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