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Fulltext Social determinants of Hepatitis C virus infection among people who inject drug in Negeri Sembilan

Azline Abdilah,, Sri Ganesh Muthiah, Hayati Kadir Shahar

Malaysian Journal of Medicine and Health Sciences, 2019;15(104):62-62.
MyJurnal

Introduction: Hepatitis C virus (HCV) infection is a major leading cause of morbidity and mortality worldwide. Per-sistent HCV infection is associated with major liver complications such as liver failure, liver cancer and fatality. It is estimated that 5.6 million people who inject drugs (PWID) were chronically infected with HCV globally, meanwhile, 59% of those diagnosed as HCV in Malaysia were PWID. The objective of this study was to determine the social determinants of HCV infection among PWID in Negeri Sembilan, Malaysia. Methods: A cross-sectional study was conducted based on stratified proportionate to size sampling among registered Methadone Maintenance Therapy (MMT) clients with PWID attending health clinics in Negeri Sembilan from February 2018 to July 2018. All eligi-ble respondents were randomly selected. Data were collected using an interviewer-guided questionnaire and was analysed using Statistical Package of IBM SPSS version 23. Independent T test and Chi-square test (χ2) were used to determine the associations between the variables. Results: Majority of the respondents in this study were between 20 and 63 years of age, Malay (90.1%) and infected with HCV (89%). There was a significant association between the respondent’s age (p

Matched MeSH terms: Hepatitis C
Clinical experience in using CD20 monoclonal antibody in treating severe systemic lupus erythematosus

Mohd Shahrir MS, Abdul Halim AG, Soehardy Z, Kong NCT

APLAR Journal of Rheumatology, 2007;10(2):112-116.
DOI: 10.1111/j.1479-8077.2007.00270.x

Background and method: This clinical experience involved the treatment of resistant systemic lupus erythematosus (SLE) patients with CD20 monoclonal antibody. Five patients failed conventional therapy, two developed complications and one needed rituximab as an emergency measure. Four patients had lupus nephritis, three had autoimmune hemolytic anemia, two had immune thrombocytopenia and one had lupoid hepatitis. The patients were aged 14-49 years, (mean 28.63). Three were Malays, two Chinese, two Indian and one Turkish; six were females. Mean disease duration was 63.25 months and mean total rituximab dose received was 2812.50 mL. Results: Hemoglobin levels improved from 9.3 ± 5.7 to 13.1 ± 8.6 g/dL for two SLE patients with autoimmune hemolytic anemia after 34 weeks (P = 0.180). Platelet counts improved from 25 ± 17 to 198 ± 97 × 10 9/high powered field from 0 to 10 weeks for three SLE patients with immune thrombocytopenia (P = 0.109). In the lupus nephritis patients on rituximab, serum albumin improved from 24.5 ± 23.2 to 37.5 ± 31.8 mmol/L (n = 3) from week 0 to week 17 (P = 0.100). Urine protein creatinine ratio improved from 0.55 ± 0.23 to 0.08 ± 0.03 g/mmol creatinine (P = 0.068) from week 0 to week 13. C3 and C4 improved from 90.8 ± 36.5 to 120.7 ± 37.9 (P = 0.07) and 21.6 ± 10.1-27.3 ± 16.2 mg/dL (P = 0.27), respectively, and Systemic Lupus Erythematosus Activity Disease Index was reduced from 17.9 ± 11.2 to 6.3 ± 6.8 (P = 0.375) after 8 weeks. Two patients developed drug reactions to rituximab. Conclusion: All of the patients responded to rituximab on top of their conventional therapy. © 2007 Asia Pacific League of Associations for Rheumatology and Blackwell Publishing Asia Pty Ltd.

Matched MeSH terms: Hepatitis C
Fulltext Non-tuberculous mycobacterial ocular infection masquerading as choroidal tumour - a diagnostic conundrum

Yeap KC, Sivagurunathan PD, Raman P, Khalid KHM

GMS Ophthalmol Cases, 2019;9:Doc25.
PMID: 31355123 DOI: 10.3205/oc000114

Purpose: To report a rare case of non-tuberculous mycobacterial (NTM) choroiditis masquerading as choroidal tumour, where the initial diagnosis was masked by keratitis. Casedescription: A 57-year-old heroin chaser with a pre-existing left eye blindness due to past blunt trauma presented with diffuse bacterial keratitis on the same side. Systemic examination revealed multiple non-tender cervical lymphadenopathies. B-scan ultrasonography showed a hyperechoic choroidal mass with surrounding exudative retinal detachment, resembling a choroidal tumour. However, computed tomography (CT) and magnetic resonance imaging (MRI) scan findings were suggestive of inflammatory choroidal changes. Inflammatory markers were significantly raised and infective screening was positive for HIV and Hepatitis C. Tuberculosis workup was normal. In view of intractable pain, evisceration was done and his vitreous humour was sent for polymerase chain reaction (PCR). It was reported to be positive for Mycobacterium Fortuitum. Conclusion: NTM ocular infections are rare, challenging to diagnose, and potentially sight threatening. Early recognition and prompt treatment is life and vision saving.

Matched MeSH terms: Hepatitis C
Fulltext Increasing the percentage of appropriate tests conducted in the serology laboratory, Hospital Sultanah Nur Zahirah

Azlina Yahya, Osama Abdul Nasir

Q Bulletin, 2019;1(28):36-44.
MyJurnal

Wastage due to unnecessary laboratory test requests is a major problem in government hospitals because they have cost implications. Although screening of infectious marker tests such as Human Immunodeficiency Virus (HIV), Hepatitis B surface Antigen (HBsAg), Hepatitis B antibody (AHBS) and Hepatitis C Virus (HCV)) before testing have been put in place, inappropriate tests were still being carried out in the Serology laboratory, which resulted in wasted human resources and reagents, increased workload and increased maintenance costs. Based on the verification studies using the Laboratory Information System (LIS), we observed only 70% of the tests followed the ordering guidelines or test specifications. Thus, we aim to increase the standard to more than 95% of the infectious marker test requests which were appropriate according to a few guidelines.
A cross-sectional study was conducted for all infectious marker tests received at Serology Laboratory from January 2015 to June 2016 to verify the problem. A workplace audit and questionnaire survey on the staff were carried out to gain more information. Low level of knowledge, unavailability of standardised guidelines for quick and easy reference, lack of staff and inefficient work processes were among the main contributing factors. Empowering new staff to screen specimens, developing simple and informative screening guidelines, providing adequate trays and refrigerators for screening purposes and strengthening and developing a more effective process of care were the strategies taken during this study.
The appropriate tests carried out from July to September 2015, October to December 2015, January to March 2016 and April to June 2016 were 99%, 98.80%, 99.50%, 98.90% respectively. During the same period, 711, 411, 710 and 768 tests were rejected. We monitored the performance and managed to achieve 100% appropriate testing for the period of July 2016 to June 2018 and an estimation of MYR 73,437.50 cost saving was achieve

Matched MeSH terms: Hepatitis C
Fulltext Diabetes-associated autoantibodies among young diabetes mellitus patients in Malaysia

Hasni Mahayidin, Siti Zulaikha Zakariah, Noor Ashidah Ishah, Xu Ann Wee, Masita Arip, Nurhanani Mohamed Nor

Malaysian Journal of Medicine and Health Sciences, 2020;16(2):118-125.
MyJurnal

Introduction: Diabetes-associated autoantibodies (DAA) is the hallmark of T1DM and LADA which are frequently tested in young diabetes patients. It was noted that up to 10-15% of patients with initial diagnosis of T2DM also exhibit DAA. Regardless of the classification, the presence of DAA suggests an underlying islet autoimmunity which lead to progressive pancreatic β-cell failure. There is limited data reported on DAA in young diabetes patients in Malaysia. This study aims to determine the frequency of DAA positivity and its association with demographic and clinical characteristics among this cohort. Methods: A retrospective study using secondary data obtained from Al- lergy and Immunology Research Centre, Institute for Medical Research, Malaysia. This study included 194 diabetes patients who were diagnosed before the age of 40 years old and tested for GADA, ICA, IA2A and IAA. Results: From 194 patients, 91 (46.9%) were positive for least one of the following DAA: ICA (79, 40.7%), GADA (61, 31.4%), IA2A (37, 19.1%) and IAA (9, 4.6%). Multiple positivity was higher (73.6%) compared to single positivity. Highest com- bination of double positivity was ICA+GADA (54, 59.3%) and triple positivity was ICA+GADA+IA2A (25, 27.5%). Simultaneous positivity of four autoantibodies was seen in only one (1.1%) patient. ICA, GADA and IA2A were asso- ciated with age group and ethnicity (all p < 0.001). Only IA2A was associated with gender (p = 0.012). Conclusions: GADA, ICA ad IA2A are more significant in young Malaysian diabetes patients. IAA has a very low frequency in this studied population.

Matched MeSH terms: Hepatitis C, Chronic
Fulltext Factors associated with occupational exposure to blood and body fluids among healthcare worker in a government hospital in Sabah

Che Wan Ilmiyah Ahmad, Raja Muhammad Raja Omar, Khamisah Awang Lukman

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):32-32.
MyJurnal

Introduction: Healthcare workers (HCWs) are exposed to occupational blood and body fluid exposure (OBBE) that potentially cause blood-borne infection such as HIV, Hepatitis B and Hepatitis C, with risk of transmission 0.3%, 6 to 30% and 0-10% respectively. They are exposed to these infections through percutaneous injury, splash exposure of blood and body fluids to mucous membrane and non-intact skin. Aim of this study was to determine prevalence and risk factors associated with occupational exposure of blood and body fluid in a tertiary government hospital in Sabah. Methods: A cross sectional study was conducted involving 10 places, was chosen by stratified random sampling and involved various job categories (specialist, medical officer, house officer, nurse, hospital assistant and Sedafiat worker). Self-administered questionnaire used as study tool. The data was analysed by using SPSS version 22.0. Association of risk factors and OBBE incidence were determined by Chi-square test and simple logistic regression. Results: A total of 334 respondents involved in this study. Prevalence of OBBE was 25.2% with 95% CI of 20.6% to 30.2% and highest (41.3%) among HCWs working in medical ward. Nurses were less likely to have occupational exposure to blood and body fluids (Crude OR=0.33, 95% CI: 0.20, 0.57). Needle recapping (Crude OR=3.77, 95% CI: 1.99, 7.10) and never attend training in infection prevention (Crude OR=3.19, 95% CI: 1.69, 6.05) were associ-ated with higher odds of OBBE. There was 76.3% of respondents adhere to universal precaution. HCWs who did not work in shift (Crude OR=3.04, 95% CI: 1.49, 6.21) and non-nurses (Crude OR=2.04, 95% CI: 1.06, 3.92) profession had better adherence to universal precaution. Conclusion: Prevalence of OBBE was 25.2%. Modifiable risk factors for OBBE were identified including needle recapping and training on infection prevention. Shift work is associated with adherence to universal precaution. Adequate training, increasing knowledge and awareness may help to reduce OBBE burden.

Matched MeSH terms: Hepatitis C
Fulltext Sharps injury in Hospital Universiti Kebangsaan Malaysia (HUKM): experiences of health care workers and students

Santhna LP, Samsiah M, Raja Lexshimi RG, Roshdinom R, Ho SE, Hamidah H

Medicine & Health, 2007;2(1):86-92.
MyJurnal

Sharps injury among health care workers in HUKM has received serious attention lately due to the possible transmission of diseases like HIV, Hepatits B and Hepatitis C, which can cause serious consequences for the victim. The aim of the study was to gain a deeper understanding of the emotional problems experienced by health care workers who had incurred a sharps injury and the coping strategies adopted by them to overcome the problem. A 28 item semi-structured questionnaire was designed by the supervisors and the researcher as there was no existing questionnaire to be adopted, as no research had been carried out in this area prior to this. The target group consisted of 64 health care workers of different categories working in HUKM. Data was collected over a period of five months from November 2000 to March 2001. The results of the study revealed that the most frequently injured were the staff nurses, nearly 90% of whom were emotionally upset and were worried that they might contract a disease. There was no significant difference in the emotional stress experienced by the different categories of the health care workers, all were equally upset about the injury but each category of staff adopted different methods to overcome the tragedy. Open comments and opinions about prevention and the management of the sharps injury in HUKM as given by the respondents here are taken into account. Several views given by the participants were explored and discussed. Finally, several implications for nursing and recommendations have been presented.
Study site: Wards and the general operating theatres in Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia

Matched MeSH terms: Hepatitis C
Fulltext Needle stick injuries among health care workers in Negeri Sembilan

Mohd Faid AR, Zainudin MA, Yusmah M, Norizah M, Rosnah I

Malaysian Journal of Public Health Medicine, 2005;5(2):10-14.
MyJurnal

Prevention of needle stick injuries (NSI) remained a challenge to the health care workers throughout the world. In Malaysia, efforts to prevent NSI among health care workers has been one ofthe emphases as these injuries may cause serious and potential fatal infections such as Hepatitis B, Hepatitis C and HIV. This retrospective cohort study was done to determine factors related to prevalence of NSI among health care workers in government health facilities in Negeri Sembilan that were reported from 2001 until 2003. There were 101 cases of NSI reported affecting various categories of health staff and also paramedical trainees and medical students. The NSI occurs mostly in females (72.35%), age 30 years or less (73.2%), and trainees of medical or paramedical courses (45.4%). Other characteristics found are as follows: cases had attended SP courses (60.4%) , had less than 5 years in service (78.1%) and mostly never had NSI before (93.1%), However 84.2% of N SI among the respondents that have good and very good knowledge levels on NSI prevention. It is recommended that follow-up or audit on the practice of the Standard Precautions (SP) should be implemented following the training of staff. It is also important that medical trainees or paramedical students be adequately trained on SP before entering the clinical environment.

Matched MeSH terms: Hepatitis C
Seroprevalence of selected transfusion transmissible infections among blood donors in Region 3, Philippines: A 5-year retrospective study

Rivera NS, Tiongco REG, Salita CL, Kawano RL

Trop Biomed, 2019 Dec 01;36(4):993-1002.
PMID: 33597469

Transfusion of blood is a life-saving intervention that saves many lives. Unsafe practices in blood donation and pre-transfusion testing place people's lives at risk of transfusion transmissible infections (TTIs). The study aims to determine the overall seroprevalence of the selected TTIs for the past 5 years (2013-2017) among blood donors from a hospital in Region 3, Philippines. The trend and distribution of the TTIs according to age group, sex, donor category, and number of donations were also determined. Data extracted include the age, sex, donor category, number of donations, and screening results of all donors from January 2013 to December 2017. The overall seroprevalence of the selected TTIs from over the 5-year period is 4.17%. The seroprevalence rates of hepatitis B, hepatitis C, HIV and syphilis from 2013 to 2017 are 2.87%, 0.48%, 0.10%, and 0.62%, respectively. The age group of 25 to 44 years old showed the highest rate of reactive donors. Also, higher rates of reactive donors are seen among male donors, replacement donors, and first-time donors. The overall seroprevalence of TTIs in the study locale is low and it shows a decreasing trend from 2013 to 2017. Donors who are 25 to 44 years old, males, replacement, and first-time donors showed highest seroprevalence rates of TTIs.

Matched MeSH terms: Hepatitis C
Fulltext Biodynamics of hepatitis C virus in haemodialysis patients in Pahang

Mohammed Saad, A.M., Mohammed Imad, A.M., Aini, H.H., Seman, M.R.

International Medical Journal Malaysia, 2012;11(1):23-30.
MyJurnal

Introduction: HCV infection is frequent in patients undergoing maintenance haemodialysis, with prevalence between 8 and 10%. Hepatitis C has an adverse effect on both patient and graft survival in those who get renal transplants. There are relatively scarce reports on the natural fluctuation in viral load level in patients on chronic haemodialysis. Materials and Methods: This is a longitudinal short-term three months study, where 27 chronic haemodialysis patients infected with known HCV genotypes were recruited from seven haemodialysis centres in Pahang. Serum samples were collected monthly, both pre- and post-haemodialysis sessions, over a period of three months. Viral RNA was extracted from serum using QIAamp Viral RNA Extraction kit (Qiagen). The HCV viral load was measured using one-step reverse transcriptase qPCR (Applied Biosystems) targeting the 5`HCV non-coding region (5’UTR). The serum α-IFN level was measured using commercial ELISA kit (Amersham, UK). Six biochemical liver function tests (AST, ALP, TP, albumin, ALT and TB) were also done for all pre-haemodialysis samples. Results: All patients showed persistent low level viral load that varied significantly over the study period (p = 0.001). HCV genotype 1 viral load was significantly higher than that of genotype 3. Conclusion: No apparent correlation could be recognized between the viral loads and the corresponding interferon-alpha levels which were detectable in only a few patients during the period of study.

Matched MeSH terms: Hepatitis C
Current issues in the management of thalassaemia

Rahman Jamal

Malaysian Journal of Child Health, 1998;10(1):1-8.
MyJurnal

The thalassaemias are the commonest single gene disorders amongst the inherited diseases. In Malaysia, there are an estimated 2200 transfusion dependent thalassaemia patients. With a carrier rate of 3-5%, 120-340 new cases of thalassaemia are expected to be born each year. The reference treatments for these patients are regular blood transfusions and iron chelation therapy. With optimal management, these patients are able to survive into the third or fourth decade of life and most importantly avoid the complications related to transfusions and iron overload. The use of desferal locally is still limited to only those who can afford i.e. about 30% of the cases. Treatment for some of the complications such as hepatitis C, diabetes mellitus, growth impairment and pubertal delay, are now available. Curative treatment approaches like bone marrow transplantation have now become standard treatment for eligible cases whilst cord blood transplantation may yet offer hope for those who are without compatible sibling donors. Research on globin gene therapy looks very promising but will probably take some time to deliver. Hb F switching is a very novel idea but so far the results are mainly anecdotal. Finally, the strive for optimal management of thalassaemia must come hand in hand with a prevention programme to achieve a reduction of new cases.

Matched MeSH terms: Hepatitis C
Fulltext Hepatocellular Carcinoma in Malaysia and Its Changing Trend

Raihan R, Azzeri A, H Shabaruddin F, Mohamed R

Euroasian J Hepatogastroenterol, 2018 05 01;8(1):54-56.
PMID: 29963463 DOI: 10.5005/jp-journals-10018-1259

Hepatocellular carcinoma (HCC) is one of the leading causes of death globally. In Malaysia liver cancer is the eighth most common cause of cancer for both gender and fifth most common cause of cancer for males. Liver cancer is a cause of premature death in Malaysia: The trend from 1990 to 2010 was observed upward. Since 1990, the annual years of life lost (YLLs) from liver cancer have increased by 31.5%. Older persons are at higher risk and there is male predominance observed. Curative surgical resection, liver transplantation, and supportive symptomatic care, including percutaneous ethanol injection and radiofrequency ablation (RFA), and noncurative transarterial chemoembolization (TACE) are among available treatment facilities. Yet the survival rate is very poor as majority of patients present at very advanced stage. Hepatitis B virus (HBV) remained the leading cause of HCC in Malaysia. Several studies showed cryptogenic causes, which are mainly nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) among the predominant causes of HCC in Malaysia than hepatitis C virus (HCV), alcohol, or any other reason. This mainly correlates with the increasing incidence of diabetes and obesity in Malaysia. How to cite this article: Raihan R, Azzeri A, Shabaruddin FH, Mohamed R. Hepatocellular Carcinoma in Malaysia and Its Changing Trend. Euroasian J Hepato-Gastroenterol 2018;8(1):54-56.

Matched MeSH terms: Hepatitis C
A Case Study on Chronic Hepatitis-C Viral infection Associated with Hepatocellular Carcinoma in a Tertiary Hospital of Bangladesh

Islam MJ, Saha SK, Das AK, Jahan MS, Pervin S, Karim CF, et al.

Mymensingh Med J, 2019 Oct;28(4):935-939.
PMID: 31599264

Hepatocellular carcinoma (HCC) is an important reason of liver-related death globally. HCC is the fifth most common cancer, the third most common cause for cancer related death in the world and responsible for approximately one million deaths each year. The incidence of HCC is expected to increase in the next two decades, largely due to hepatitis C infection and secondary cirrhosis. We have reported a case of hepatocellular carcinoma in a 56-year-old man with peritoneal metastasis. Diagnostic imaging (Ultra sonogram & CT-Scan) shown: a large hypo density, irregular outline lesion noted in right lower liver, post contrast image shown patchy enhancement of the lesion. His serum Alpha-Feto Protein (AFP) level was very high with elevated serum alanine amino transaminase (ALT) enzyme and prothrombin time. Histopathological (microscopic) features are compatible with Hepatocellular carcinoma. His Hepatitis C viral DNA load e.g., core protein variants and genotype 1, have been reported. The patient was treated by surgical resection followed by conservative treatment includes sorafenib & interferon alpha. This case report aims to outlines the epidemiology of HCC in chronic HCV, risk factors and pathophysiology that contribute to this disease process, related pathophysiology of patient's clinical features, screening recommendations, and the available statistics on the impact of new direct-acting antiviral treatment on the development on HCC.

Matched MeSH terms: Hepatitis C
Immigrant Health Study. 3. Foreign workers' study microbiological investlgations. [Abstract]

Lam SK, Ng KP, Ngeow YF, Puthucheary SD

JUMMEC, 1998;3:61-62.

During the study period, a total of 241 foreign workers were examined. The countries represented were Indonesia (103), Bangladesh (133), Myanmar (I), Pakistan (3) and others (1). The specimens collected were blood (238) and stool samples (173). The tests conducted on blood samples were for syphilis by RPR and TPHA, HIV, Hepatitis B, and from stool samples, enteric pathogens such as Salirzoirella spp, Shigelln spp. and Vibrio clrolerne. Table I shows the type of tests performed on the various nationalities and Table 2 the results of testing. Of the 230 blood samples tested by RPWPHA, five were positive, one from Indonesia (1.09%) and four from Bangladesh (3.79%). There was only one sample of blood out of 238 tested which was HIV positive (0.42%) and this was in an Indonesian. Twenty three workers were found to be Hepatitis B antigen positive (9.66%), 10 out of 102 (9.80%) from Indonesia and 13 out of 131 from Bangladesh (9.92%). As for the entric bacterial pathogens, only six out of 173 stool samples tested were positive, five for Saliizoilella Spp. and one for Slligdla sp. Of the five positives for Salmonella, one was from Indonesia and four from Bangladesh. The single isolate of Shigella was from Pakistan. From this pretiniinary study, it is obvious that hepatitis B is the most important problem among the workers from Indonesia and Bangladesh. The second of importance is venereal disease and enteric bacteria among Bangladesh workers. The other three national groups are too small to be analyzed. It is interesting to note that although these workers are supposed to have been screened for venereal diseases, a number of them were still found to be positive. However, we are not certain that these might not have been acquired locally. There was only one case of HIV detected but if the foreign workers continue with their pronliscuous lifestyle they are likely to pick up other sexually transmitted diseases including HIV and chlamydia1 infections. For those who were found to be stool positive for enteric pathogens, it is important to determine whether they are food-handlers as they will prove a significant risk for the spread of infections. Originally, it was intended to test blood samples for hepatitis C and E markers since the incidence in foreign countries from which the workers come are higher. However, due to the shortage of the samples, this had to be deferred. In the light that hepatitis carriage rate is the highest for the microbes tested, it is important to include these two markers in future studies.

Matched MeSH terms: Hepatitis C
Fulltext Efficacy and safety of ravidasvir plus sofosbuvir in patients with chronic hepatitis C infection without cirrhosis or with compensated cirrhosis (STORM-C-1): interim analysis of a two-stage, open-label, multicentre, single arm, phase 2/3 trial

Andrieux-Meyer I, Tan SS, Thanprasertsuk S, Salvadori N, Menétrey C, Simon F, et al.

Lancet Gastroenterol Hepatol, 2021 Jun;6(6):448-458.
PMID: 33865507 DOI: 10.1016/S2468-1253(21)00031-5

BACKGROUND: In low-income and middle-income countries, affordable direct-acting antivirals are urgently needed to treat hepatitis C virus (HCV) infection. The combination of ravidasvir, a pangenotypic non-structural protein 5A (NS5A) inhibitor, and sofosbuvir has shown efficacy and safety in patients with chronic HCV genotype 4 infection. STORM-C-1 trial aimed to assess the efficacy and safety of ravidasvir plus sofosbuvir in a diverse population of adults chronically infected with HCV.
METHODS: STORM-C-1 is a two-stage, open-label, phase 2/3 single-arm clinical trial in six public academic and non-academic centres in Malaysia and four public academic and non-academic centres in Thailand. Patients with HCV with compensated cirrhosis (Metavir F4 and Child-Turcotte-Pugh class A) or without cirrhosis (Metavir F0-3) aged 18-69 years were eligible to participate, regardless of HCV genotype, HIV infection status, previous interferon-based HCV treatment, or source of HCV infection. Once daily ravidasvir (200 mg) and sofosbuvir (400 mg) were prescribed for 12 weeks for patients without cirrhosis and for 24 weeks for those with cirrhosis. The primary endpoint was sustained virological response at 12 weeks after treatment (SVR12; defined as HCV RNA <12 IU/mL in Thailand and HCV RNA <15 IU/mL in Malaysia at 12 weeks after the end of treatment). This trial is registered with ClinicalTrials.gov, number NCT02961426, and the National Medical Research Register of Malaysia, NMRR-16-747-29183.
FINDINGS: Between Sept 14, 2016, and June 5, 2017, 301 patients were enrolled in stage one of STORM-C-1. 98 (33%) patients had genotype 1a infection, 27 (9%) had genotype 1b infection, two (1%) had genotype 2 infection, 158 (52%) had genotype 3 infection, and 16 (5%) had genotype 6 infection. 81 (27%) patients had compensated cirrhosis, 90 (30%) had HIV co-infection, and 99 (33%) had received previous interferon-based treatment. The most common treatment-emergent adverse events were pyrexia (35 [12%]), cough (26 [9%]), upper respiratory tract infection (23 [8%]), and headache (20 [7%]). There were no deaths or treatment discontinuations due to serious adverse events related to study drugs. Of the 300 patients included in the full analysis set, 291 (97%; 95% CI 94-99) had SVR12. Of note, SVR12 was reported in 78 (96%) of 81 patients with cirrhosis and 153 (97%) of 158 patients with genotype 3 infection, including 51 (96%) of 53 patients with cirrhosis. There was no difference in SVR12 rates by HIV co-infection or previous interferon treatment.
INTERPRETATION: In this first stage, ravidasvir plus sofosbuvir was effective and well tolerated in this diverse adult population of patients with chronic HCV infection. Ravidasvir plus sofosbuvir has the potential to provide an additional affordable, simple, and efficacious public health tool for large-scale implementation to eliminate HCV as a cause of morbidity and mortality.
FUNDING: National Science and Technology Development Agency, Thailand; Department of Disease Control, Ministry of Public Health, Thailand; Ministry of Health, Malaysia; UK Aid; Médecins Sans Frontières (MSF); MSF Transformational Investment Capacity; FIND; Pharmaniaga; Starr International Foundation; Foundation for Art, Research, Partnership and Education; and the Swiss Agency for Development and Cooperation.

Matched MeSH terms: Hepatitis C, Chronic/complications; Hepatitis C, Chronic/drug therapy*; Hepatitis C, Chronic/virology
Burden and nutritional deficiencies in opiate addiction- systematic review article

Nabipour S, Ayu Said M, Hussain Habil M

Iran J Public Health, 2014 Aug;43(8):1022-32.
PMID: 25927032

Addiction to the illicit and prescribed use of opiate is an alarming public health issue. Studies on addictive disorders have demonstrated severe nutritional deficiencies in opiate abusers with behavioral, physiological and cognitive symptoms. Opiate addiction is also link with a significant number of diseases including Human Immunodeficiency Virus (HIV), Hepatitis C Virus (HCV) and other blood borne diseases generally stem from the use of needles to inject heroin. The use of medication assisted treatment for opioid addicts in combination with behavioural therapies has been considered as a highly effective treatment. Methadone is a long-lasting μ-opioid agonist and a pharmacological tool which attenuates withdrawal symptoms effectively replacement therapies. This review article aims to explain opiate addiction mechanisms, epidemiology and disease burden with emphasis on dietary and nutritional status of opiate dependent patients in methadone maintenance therapy.

Matched MeSH terms: Hepatitis C
The 2017 M Balasegaram Memorial Lecture: The Changing Landscape of Liver Diseases in Malaysia-60 Years On!

Goh KL

Malays J Med Sci, 2019 Mar;26(2):18-29.
PMID: 31447605 DOI: 10.21315/mjms2019.26.2.3

The landscape of liver diseases in Malaysia has changed dramatically since the time of Professor Balasegaram Manickavasagar-an eminent surgeon in the 1960s. The most significant discoveries in hepatology have been that of hepatitis B virus in 1963 and hepatitis C virus in 1989, which have both been shown to be predominantly blood borne diseases. Hepatitis B and C infections result in long term carrier state and a high propensity to develop liver cirrhosis and cancer. Hepatitis B is the most common cause of liver cirrhosis and cancer in Malaysia. Blood bank screening and public health preventive measures have reduced the disease burden significantly and an effective vaccination for hepatitis B is now incorporated in our National Immunisation Programme. Although no vaccine is available for hepatitis C, highly effective eradication therapies were introduced in 2011. These agents will significantly change the disease scenario across the world. A "new" disease was described in 1980, by Ludwig et al.-non-alcoholic fatty liver (NAFLD) disease. With the global epidemic of obesity and diabetes mellitus, NAFLD is set to increase exponentially across the world including in Malaysia. It will be the most important liver disease in the future, replacing hepatitis B and C infections.

Matched MeSH terms: Hepatitis C
Liver cirrhosis in Malaysia: peculiar epidemiology in a multiracial Asian country

Qua CS, Goh KL

J Gastroenterol Hepatol, 2011 Aug;26(8):1333-7.
PMID: 21443669 DOI: 10.1111/j.1440-1746.2011.06732.x

To determine the etiology of liver cirrhosis and risk factors for hepatocellular carcinoma (HCC) in a multiracial Asian population.

Matched MeSH terms: Hepatitis C, Chronic/ethnology
CD8+ T cells of chronic HCV-infected patients express multiple negative immune checkpoints following stimulation with HCV peptides

Barathan M, Mohamed R, Vadivelu J, Chang LY, Vignesh R, Krishnan J, et al.

Cell Immunol, 2017 03;313:1-9.
PMID: 28104239 DOI: 10.1016/j.cellimm.2016.12.002

Hepatitis C virus (HCV)-specific CD4+ and CD8+ T cells are key to successful viral clearance in HCV disease. Accumulation of exhausted HCV-specific T cells during chronic infection results in considerable loss of protective functional immune responses. The role of T-cell exhaustion in chronic HCV disease remains poorly understood. Here, we studied the frequency of HCV peptide-stimulated T cells expressing negative immune checkpoints (PD-1, CTLA-4, TRAIL, TIM-3 and BTLA) by flow cytometry, and measured the levels of Th1/Th2/Th17 cytokines secreted by T cells by a commercial Multi-Analyte ELISArray™ following in vitro stimulation of T cells using HCV peptides and phytohemagglutinin (PHA). HCV peptide-stimulated CD4+ and CD8+ T cells of chronic HCV (CHC) patients showed significant increase of CTLA-4. Furthermore, HCV peptide-stimulated CD4+ T cells of CHC patients also displayed relatively higher levels of PD-1 and TRAIL, whereas TIM-3 was up-regulated on HCV peptide-stimulated CD8+ T cells. Whereas the levels of IL-10 and TGF-β1 were significantly increased, the levels of pro-inflammatory cytokines IL-2, TNF-α, IL-17A and IL-6 were markedly decreased in the T cell cultures of CHC patients. Chronic HCV infection results in functional exhaustion of CD4+ and CD8+ T cells likely contributing to viral persistence.

Matched MeSH terms: Hepatitis C, Chronic/immunology*
Increased frequency of late-senescent T cells lacking CD127 in chronic hepatitis C disease

Barathan M, Mohamed R, Saeidi A, Vadivelu J, Chang LY, Gopal K, et al.

Eur J Clin Invest, 2015 May;45(5):466-74.
PMID: 25721991 DOI: 10.1111/eci.12429

Hepatitis C virus (HCV) causes persistent disease in ~85% of infected individuals, where the viral replication appears to be tightly controlled by HCV-specific CD8+ T cells. Accumulation of senescent T cells during infection results in considerable loss of functional HCV-specific immune responses.

Matched MeSH terms: Hepatitis C, Chronic/immunology*

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