S1008 Viral Load Predicts Outcome of Hepatitis C Patients After Liver Transplantation
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Hepatitis C
Viral Hepatitis
Objective To assess the occurrence of viral load greater than 50 copies/ml in patients on highly active antiretroviral therapy (HAART) having achieved less than 50 copies/ml and the chance of whether a viral load greater than 50 copies/ml would lead to a sustained and increasing viral load. Design A cohort of 553 patients on HAART with viral loads of less than 50 copies/ml were followed. Results Over a median of 56 weeks 35% of patients experienced a transient increase and 8% virological failure (two consecutive viral loads of > 400 copies/ml). Transient increases and virological failure were more common in those with greater drug experience, and those with initial raised viral load values of more than 400 copies/ml were more likely to have a sustained increase and become virological failures. Conclusion Transient increases in viral load are common, mainly in the 50–400 copies/ml range, and the majority of subsequent viral load estimations show a return to less than 50 copies/ml. A single raised viral load should lead to adherence support and intensified monitoring. Subsequent treatment decisions can then be based on evidence of true virological rebound and failure.
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After scale-up of antiretroviral therapy (ART), routine annual viral load monitoring has been adopted by most countries, but reduced frequency of viral load monitoring may offer cost savings in resource-limited settings. We investigated if viral load monitoring frequency could be reduced while maintaining detection of treatment failure.
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Objective: To address the question of whether individuals with chronic HIV-1 infection have a stable viral load set-point and to assess the influence of host and viral factors on the evolution of viral load in a subset of stable asymptomatic patients with a baseline viral load below 5000 copies/ml and CD4+ T-cell count above 500 × 106/l. Methods: Medical visits were performed at least every 6 months including routine blood analysis, viral load and CD4+ T-cell count. HIV-1 RNA was measured in frozen (−70°C) plasma samples using PCR. Patients were classified into three groups according to baseline viral load: group A, < 200 copies/ml (undetectable); group B, 201–2000 copies/ml; group C, 2001–5000 copies/ml. A survival analysis and a Cox regression model were performed to assess the influence of viral and host factors in the increase of baseline viral load. The endpoint was the time to increase viral load to a stable level > 0.5 log10 copies/ml above baseline viral load in groups B and C and to a stable detectable viral load (> 200 copies/ml) in group A. Results: A cohort of 114 patients with viral load below 5000 copies/ml was followed for a median of 12 months (6–42 months). Overall, 22 (19%) out of 114 patients had an increase > 0.5 log10 copies/ml of baseline viral load. Baseline viral load increased in two (5%) out of 37 patients in group A, four (12%) out of 33 patients in group B, and 16 (36%) out of 44 patients in group C (survival analysis, P < 0.002). Patients of group C had a eightfold higher risk of increasing baseline viral load than patients in the other two groups pooled together (hazards ratio, 8.28; 95% confidence interval, 1.78–38; P = 0.006). Patients with an increase of viral load to the virological endpoint had a threefold higher risk of decreasing baseline CD4+ T-cell counts > 100 × 106/l than patients with stable viral load (hazards ratio, 2.78; 95% confidence interval, 1.12–14; P = 0.03). Conclusions: In our cohort of chronically HIV-1-infected asymptomatic patients with a baseline viral load < 5000 copies/ml and CD4+ cell count > 500 × 106/l, a true viral load set-point did not seem to exist. Patients with baseline viral load of 2000–5000 copies/ml had an eightfold higher risk of increasing the level of viral load than patients with a baseline viral load below 2000 copies/ml.
Viral Shedding
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The Quasi-purchase system of research outcome is a research funds' system based upon research outcome. The thesis analyses the characteristics of research outcomes' honour under the quasi-purchase system of research outcome. It researches the evaluation of the follow-up impact of the honoured outcome. And make a greater impact on the honoured outcome for incentives and penalties for false results of the proposal.
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HIV plasma viral load is an established marker of disease progression and of response to antiretroviral therapy, but currently there is no commercial assay validated for the quantification of viral load in HIV-2-infected individuals. We sought to make the first clinical evaluation of Cavidi ExaVir Load (version 3) in HIV-2-infected patients. Samples were collected from a total of 102 individuals living in Cape Verde, and the HIV-2 viral load was quantified by both ExaVir Load and a reference in-house real-time quantitative PCR (qPCR) used in Portugal in 91 samples. The associations between viral load and clinical prognostic variables (CD4+ T cell counts and antiretroviral therapy status) were similar for measurements obtained using ExaVir Load and qPCR. There was no difference between the two methods in the capacity to discriminate between nonquantifiable and quantifiable HIV-2 in the plasma. In samples with an HIV-2 viral load quantifiable by both methods (n = 27), the measurements were highly correlated (Pearson r = 0.908), but the ExaVir Load values were systematically higher relative to those determined by qPCR (median difference, 0.942 log10 copies/ml). A regression model was derived that enables the conversion of ExaVir Load results to those that would have been obtained by the reference qPCR. In conclusion, ExaVir Load version 3 is a reliable commercial assay to measure viral load in HIV-2-infected patients and therefore a valuable alternative to the in-house assays in current use.
Antiretroviral treatment
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Although viral load of hepatitis C virus (HCV) is a predictor of response to interferon therapy, little is known about its fluctuations. We assessed its fluctuations and their correlation with serum alanine aminotransferase (ALT) levels. Viral load was prospectively measured bimonthly for 22 months in 109 patients. In 40 patients, viral load changed more than five fold. Changes were transient and always returned to the baseline levels. ALT levels changed more than three fold in 30 patients. Changes of viral load accompanied simultaneous changes of ALT levels in only 7 of 40 patients with changes of viral load. Mean viral load in 22 months was significantly correlated with mean ALT levels inversely (r = 0.278, P = 0.0036). Mean viral load was significantly higher in 27 patients with persistently normal ALT levels (452.0 +/- 342.5pg/ml) than in 30 patients with changes of ALT levels (202.4 +/- 215.0pg/ml) (P = 0.0016) and than in 52 patients without changes of ALT levels (301.1 +/- 295.4pg/ml) (P = 0.0458). Inverse correlation of viral load with ALT levels suggests that viral load is in suppression by inflammatory activity. However, changes of ALT levels infrequently accompanied simultaneous changes of viral load and vice versa, as often seen in chronic hepatitis B virus infection.
Viral Hepatitis
Alanine aminotransferase
BDNA test
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Abstract Introduction HIV viral load testing in resource-limited settings is often centralized, limiting access. Near point-of-care (POC) viral load testing was introduced in Myanmar in 2017. We assessed its uptake and utilization. Methods Routine program data from three HIV clinics of Medical Action Myanmar were used. Annual viral load uptake was cross-sectionally analysed in people living with HIV (PLHIV) on antiretroviral therapy (ART) initiated between July 2009-June 2019. Attrition at two years was assessed between PLHIV with different access to viral load testing with Kaplan-Meier analysis. For those eligible for a first viral load when near POC viral load became available, a viral load cascade was constructed. We used logistic regression to explore predictors of confirmed virological failure after a first high viral load. Results Among 5271 PLHIV who started ART between July 2009-December 2019, annual viral load uptake increased significantly after near POC was introduced. Attrition in the first two years after ART initiation was not different among those eligible for a first viral load before viral load was available, after centralized laboratory-based viral load, and after near POC viral load introduction. After introduction of near POC viral load, 92% (2945/3205) of eligible PLHIV received a first viral load, a median of 2.8 years (IQR: 1.4-4.4) after initiation. The delay was 3.7 years (IQR: 2.8-5.1) and 0.9 years (IQR: 0.6-1.4) in those becoming eligible before and after near POC viral load was available, respectively. Among those with a first viral load, 95% (2796/2945) were ≤1000 copies/ml. Eighty-four % (125/149) of those with a viral load >1000 copies/ml received enhanced adherence counselling and a follow up viral load, a median of 119 days (IQR: 95-167) after the first viral load. Virological failure was confirmed in 67% (84/125), and 82% (69/84) of them were switched to second-line ART. Nine-three % (64/69) among those switched were alive on ART at end of follow-up. Having a first viral load of ≥5000 copies/ml was associated with confirmed virological failure. Conclusion Near POC viral load testing enabled rapid scale-up of viral load testing in Myanmar. PLHIV with a high viral load were adequately managed.
Attrition
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Aim: Our main objective in this study was to rigorously measure global interest and awareness of viral hepatitis through a systematic evaluation of data collected from Google Trends.
Material and Methods: We compiled and categorized the Search Volume Index (SVI), a quantitative measure covering the global regional distribution associated with the search terms "Hepatitis A", "Hepatitis B", "Hepatitis C", "Hepatitis D" and "Hepatitis E" over a period of approximately ten years from 2013 to 2022.
Results: According to our analysis, there has been a noticeable increase in interest in Hepatitis A and B, while interest in Hepatitis C has declined after peaking in 2015. Meanwhile, interest in Hepatitis D and E continued to show a very low profile. Our rigorous research found that Guatemala recorded the highest rate of interest for Hepatitis A, Ghana for Hepatitis B, Pakistan for Hepatitis C, Kyrgyzstan for Hepatitis D and Namibia for Hepatitis E. Conclusions: This study highlights the potential for using tools such as Google Trends in organizing public health monitoring and awareness campaigns.
Viral Hepatitis
Hepatitis C
Hepatitis B
Hepatitis E
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To examine the relation between symptoms, initial viral load, and viral load set point in primary HIV infection (PHI).Prospective cohort of patients with preseroconversion or recent seroconversion HIV infection (typically <60 days) in San Francisco.Subjects were questioned about 21 potential PHI symptoms at enrollment and were subsequently followed with viral load measures.The analysis included 57 subjects with preseroconversion HIV infection and 120 with recent seroconversion. In univariate analysis, most symptoms and the total number of symptoms were each associated with a significantly higher initial viral load. In stepwise multiple linear regression, however, only the number of symptoms was independently associated with a higher initial viral load, with an increase in the initial viral load of 0.08 log10 per additional symptom (P < 0.001). In univariate analysis, more PHI symptoms were associated with a higher viral load set point, but in a multivariable mixed-effects model, this association was accounted for by the initial viral load, which was strongly correlated with viral load set point (R = 0.44, P < 0.001).A high initial viral load was associated with more symptoms during PHI. The strong correlation between initial HIV-1 RNA viral load levels and viral load set point suggests that early interactions between the HIV-1 virus and a new host, even before fully developed adaptive immune responses, are important in establishing viral load set point.
Seroconversion
Set point
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1030 www.thelancet.com Vol 388 September 10, 2016 A recurring question about viral hepatitis is why it receives so little funding and attention from global health policy makers and donors. For example, the Sustainable Development Goals have a goal to “end the epidemics of” HIV, tuberculosis, and malaria by 2030 while only “combating” hepatitis, despite the fact that hepatitis accounts for more deaths than each of those infections individually. One reason for this is the diffi culty in accurately quantifying and explaining the morbidity and mortality related to viral hepatitis. This diffi culty stems from the fact that hepatitis deaths are caused by fi ve distinct viruses (hepatitis A–E) with diff erent routes of transmission, that death occurs decades after infection, and that when people die with hepatitis-related liver cancer and cirrhosis, these deaths are not always linked to the underlying infection. In The Lancet, Jeff rey Stanaway and colleagues have made a major advance in addressing these challenges. Using the Global Burden of Disease (GBD) Study approach, which estimates the causes of mortality and morbidity and their relative importance, they have assessed the burden of disease caused by viral hepatitis from 1990 to 2013 at the country, regional, and global levels. The main conclusion from their analysis is that viral hepatitis accounted for 1·45 million deaths (95% uncertainty interval [UI] 1·38–1·54) in 2013, a 63% (95% UI 52–75) increase compared with the 0·89 million deaths (0·86–0·94) in 1990. Morbidity also increased in terms of years lived with disability (from 0·65 million [0·45–0·89] to 0·87 million [0·61–1·18]) and disability-adjusted life-years (DALYs; from 31·7 million [30·2–33·3] to 42·5 million [39·9–45·6]). The biggest increase was noted for hepatitis C infection, for which the rate of DALYs increased by 43%. Most The global burden of viral hepatitis: better estimates to guide hepatitis elimination eff orts balloon assisted maturation is not done in these centres. However, the low patency rate does raise the question of whether the benefi t of BPB would still be evident at higher patency rates. The study results seem to suggest that sympathetic blockade with BPB is of sustained benefi t in patients undergoing radiocephalic fi stula formation, and both surgeons and anaesthetists should consider its use in this group of patients.
Viral Hepatitis
Hepatitis C
Global Health
Hepatitis B
Hepatitis E
Liver disease
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