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  • 1.
    Aleman, Soo
    et al.
    Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Söderholm, Jonas
    AbbVie AB, Stockholm, Sweden; Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden.
    Büsch, Katharina
    AbbVie AB, Stockholm, Sweden; Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden.
    Kövamees, Jan
    AbbVie AB, Stockholm, Sweden.
    Duberg, Ann-Sofi
    Örebro University, School of Health Sciences. partment of Infectious Diseases.
    Frequent loss to follow-up after diagnosis of hepatitis C virus infection: A barrier towards the elimination of hepatitis C virus2020In: Liver international (Print), ISSN 1478-3223, E-ISSN 1478-3231, Vol. 40, no 8, p. 1832-1840Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Previous studies on hepatitis C cascade of care have been mainly focused on diagnosis and treatment rate, while less attention has been given to patients lost to follow-up (LTFU) after diagnosis. Analyses of this latter issue on population level are missing.

    AIMS: In this nationwide study of people with HCV, we aimed to estimate the proportion LTFU after HCV diagnosis, characterize them, and analyze their other healthcare contacts.

    METHODS: Patients diagnosed with chronic HCV in the Swedish National Patient register during 2001-2011 and still alive December 31, 2013, were included. The number of cured patients without need of follow-up was estimated. Visits to HCV specialist care during 2012-2013 were analysed. For those LTFU, other specialist care contacts were studied.

    RESULTS: In total 29,217 patients were included, with 24,733 with need of HCV care. 61% (n=15,007) of them were LTFU from HCV care in 2012-2013 and 58% did not attend HCV care during the second year after HCV diagnosis. The departments of surgery/orthopedic or psychiatry/dependency were the most common other non-primary healthcare contacts. Predictors for LTFU were young age, male sex, low education, presence of psychiatric/dependency diagnosis, unmarried, and longer duration since diagnosis of HCV.

    CONCLUSIONS: This study showed that almost two-thirds of patients were LTFU after HCV diagnosis, with frequent occurrence early after diagnosis. Efforts to link patients back to HCV care, in combination with early and easy access to HCV treatment and harm reduction, are necessary to reach the HCV elimination goal.

  • 2.
    Batyrbekova, Nurgul
    et al.
    Department of Biostatistics, Scandinavian Development Services AB.
    Aleman, Soo
    Karolinska Institute, Stockholm, Sweden.
    Lybeck, Charlotte
    Örebro University, School of Medical Sciences. Infectious Diseases.
    Montgomery, Scott
    Örebro University, School of Medical Sciences.
    Duberg, Ann-Sofi
    Örebro University, School of Medical Sciences.
    Hepatitis C virus infection and the temporal trends in the risk of liver cancer: a national register-based cohort study in Sweden2020In: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 29, no 1, p. 63-70Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In many countries, including Sweden, the birth cohorts with the highest prevalence of hepatitis C virus (HCV) infection have now reached the ages with high risk of primary liver cancer (PLC). The aims were to investigate the temporal trends in PLC incidence and the relative risks of PLC among people diagnosed with HCV-infection between 1990 and 2015.

    METHODS: The HCV-cohort (n: 52,853) was compared with a matched non-HCV comparison-cohort (n: 523,649). Both the Cancer (CR) and Death registers (DR) were used for follow-up. The crude and age-standardised PLC incidence rates were calculated. The relative risk was estimated as standardized incidence ratios (SIR) and as hazard ratios (HR) using stratified Cox hazards regression.

    RESULTS: There were 1,609 with PLC-diagnosis in the HCV-cohort, the annual number increased continuously with the crude incidence rate reaching 4.56 per 1,000 person-years in 2013, while remaining low and stable in the comparison-cohort. In the HCV-cohort, the age-standardised PLC incidence rates per 1,000 person-years remained relatively constant at 2.64 (95% CI: 1.54, 3.75) in 2000 and 3.31 (2.51, 4.12) in 2014. The highest SIR was 73 (65.9, 79.5) among those infected for 35-40 years; and the highest HR was 65.9 (55.9, 77.6) for men and 62.2 (31.9, 121.1) for women.

    CONCLUSIONS: There was a considerable increase in PLC-incidence over time and an extremely high relative risk in the population with HCV-infection for more than 35 years.

    IMPACT: The national HCV-associated PLC-incidence should be monitored in future studies to evaluate the effect of DAA-treatment.

  • 3.
    Blach, S.
    et al.
    Center for Disease Analysis Foundation, Lafayette, CO, USA.
    Blomé, M.
    Faculty of Medicine, Department of Translational Medicine, Clinical Infection Medicine, Lund University, Malmö, Sweden.
    Duberg, Ann-Sofi
    Örebro University, School of Medical Sciences. Department of Infectious Diseases.
    Jerkeman, A.
    Faculty of Medicine, Department of Translational Medicine, Clinical Infection Medicine, Lund University, Malmö, Sweden.
    Kåberg, M.
    Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden; Department of Medicine Huddinge, Division of Infection and Dermatology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
    Klasa, P-E.
    Addiction Medicine, PRIMA Maria OST Clinic, Stockholm, Sweden.
    Lagging, M.
    Department of Infectious Diseases / Virology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Clinical Microbiology, Gothenburg, Sweden.
    Razavi-Shearer, D.
    Center for Disease Analysis Foundation, Lafayette, CO, USA.
    Razavi, H.
    Center for Disease Analysis Foundation, Lafayette, CO, USA.
    Aleman, S.
    Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Sweden.
    Hepatitis C Elimination in Sweden: Progress, Challenges and Opportunities for Growth in the time of COVID-192021In: Liver international, ISSN 1478-3223, E-ISSN 1478-3231, Vol. 41, no 9, p. 2024-2031Article in journal (Refereed)
    Abstract [en]

    BACKGROUND & AIMS: In 2014, the burden of hepatitis C virus (HCV) in Sweden was evaluated, to establish a baseline and inform public health interventions. Considering the changing landscape of HCV treatment, prevention, and care, and in light of the COVID-19 pandemic, this analysis seeks to evaluate Sweden's progress toward the WHO elimination targets and identify remaining barriers.

    METHODS: The data used for modeling HCV transmission and disease burden in Sweden were obtained through literature review, unpublished sources, and expert input. A dynamic Markov model was employed to forecast population sizes and incidence of HCV through 2030. Two scenarios ("2019 Base" and "WHO Targets") were developed to evaluate Sweden's progress toward HCV elimination.

    RESULTS: At the beginning of 2019, there were 29,700 (95% UI: 19,300 - 33,700) viremic infections in Sweden. Under the base scenario, Sweden would achieve and exceed the WHO targets for diagnosis, treatment, and liver-related death. However, new infections would decrease by less than 10%, relative to 2015. Achieving all WHO targets by 2030 would require 1) expanding harm reduction programs to reach more than 90% of PWID and 2) treating 90% of HCV+ PWID engaged in harm reduction programs and ≥7% of PWID not involved in harm reduction programs, annually by 2025.

    CONCLUSIONS: It is of utmost importance that Sweden, and all countries, find sustainability in HCV programs by broadening the setting and base of providers to provide stability and continuity of care during turbulent times.

  • 4.
    Blach, Sarah
    et al.
    Ctr Dis Anal Fdn, Lafayette CO, USA.
    Duberg, Ann-Sofi
    Örebro University, School of Medical Sciences.
    Razavi, Homie A.
    Ctr Dis Anal Fdn, Lafayette CO, USA.
    Global change in hepatitis C virus prevalence and cascade of care between 2015 and 2020: a modelling study2022In: The Lancet Gastroenterology & Hepatology, ISSN 2468-1253, Vol. 7, no 5, p. 396-415Article in journal (Refereed)
    Abstract [en]

    Background: Since the release of the first global hepatitis elimination targets in 2016, and until the COVID-19 pandemic started in early 2020, many countries and territories were making progress toward hepatitis C virus (HCV) elimination. This study aims to evaluate HCV burden in 2020, and forecast HCV burden by 2030 given current trends.

    Methods: This analysis includes a literature review, Delphi process, and mathematical modelling to estimate HCV prevalence (viraemic infection, defined as HCV RNA-positive cases) and the cascade of care among people of all ages (age =0 years from birth) for the period between Jan 1, 2015, and Dec 31, 2030. Epidemiological data were collected from published sources and grey literature (including government reports and personal communications) and were validated among country and territory experts. A Markov model was used to forecast disease burden and cascade of care from 1950 to 2050 for countries and territories with data. Model outcomes were extracted from 2015 to 2030 to calculate population-weighted regional averages, which were used for countries or territories without data. Regional and global estimates of HCV prevalence, cascade of care, and disease burden were calculated based on 235 countries and territories.

    Findings: Models were built for 110 countries or territories: 83 were approved by local experts and 27 were based on published data alone. Using data from these models, plus population-weighted regional averages for countries and territories without models (n=125), we estimated a global prevalence of viraemic HCV infection of 0.7% (95% UI 0.7-0.9), corresponding to 56.8 million (95% UI 55.2-67.8) infections, on Jan 1, 2020. This number represents a decrease of 6.8 million viraemic infections from a 2015 (beginning of year) prevalence estimate of 63.6 million (61.8-75.8) infections (0.9% [0.8-1.0] prevalence). By the end of 2020, an estimated 12.9 million (12.5-15.4) people were living with a diagnosed viraemic infection. In 2020, an estimated 641 000 (623 000-765 000) patients initiated treatment.

    Interpretation: At the beginning of 2020, there were an estimated 56.8 million viraemic HCV infections globally. Although this number represents a decrease from 2015, our forecasts suggest we are not currently on track to achieve global elimination targets by 2030. As countries recover from COVID-19, these findings can help refocus efforts aimed at HCV elimination.

  • 5.
    Bruggmann, P.
    et al.
    Arud Ctr Addict Med, Zurich, Switzerland.
    Berg, T.
    Univ Leipzig, Leipzig, Germany.
    Ovrehus, A. L. H.
    Dept Infect Dis, Odense Univ Hosp, Odense, Denmark.
    Moreno, C.
    Erasme Univ Hosp, Univ Libre Brussels, Brussels, Belgium.
    Brandao Mello, C. E.
    Dept Gastroenterol, Univ Fed Rio de Janeiro, Rio De Janeiro, Brazil.
    Roudot-Thoraval, F.
    Dept Sante Publ, Hop Henri Mondor, Creteil, France.
    Marinho, R. T.
    Ctr Hosp Lisboa Norte, Dept Gastroenterol, Hosp Santa Maria,Lisbon, Portugal.
    Sherman, M.
    Toronto Gen Hosp, Univ Hlth Network, Univ Toronto, Toronto, Canada.
    Ryder, S. D.
    Nottingham Univ Hosp NHS Trust, Nottingham, England; Biomed Res Unit, Nottingham, England.
    Sperl, J.
    Dept Hepatogastroenterol, Inst Clin & Expt Med, Prague, Czech Republic.
    Akarca, U.
    Ege Univ, Izmir, Turkey.
    Balik, I.
    Ankara Univ, Ankara, Turkey.
    Bihl, F.
    Dept Gastroenterol, Osped Cantonale, Bellinzona, Switzerland.
    Bilodeau, M.
    Dept Med, Liver Unit, Univ Montreal, Montreal, Canada.
    Blasco, A. J.
    Adv Tech Hlth Serv Res TAISS, Madrid, Spain.
    Buti, M.
    Biomedical Research Networking Center in Hepatic and Digestive Diseases (CIBEREHD), Hosp Valle De Hebron, Barcelona, Spain.
    Calinas, F.
    Dept Gastroenterol, Ctr Hosp Lisboa Cent, Hosp Santo Antonio Capuchos, Lisbon, Portugal.
    Calleja, J. L.
    Hosp Puerta Hierro, Madrid, Spain.
    Cheinquer, H.
    Hosp Clin, Univ Fed Rio Grande do Sul, Porto Alegre RS, Brazil.
    Christensen, P. B.
    Dept Infect Dis, Odense Univ Hosp, Odense, Denmark.
    Clausen, M.
    Region Hosp Hovedstaden, Region Hovedstaden, Hillerød, Denmark.
    Coelho, H. S. M.
    Dept Clin Med, Univ Fed Rio de Janeiro, Rio De Janeiro, Brazil.
    Cornberg, M.
    Dept Gastroenterol Hepatol & Endocrinol,Hannover Med Sch, Hannover, Germany; German Liver Fdn, Hannover, Germany.
    Cramp, M. E.
    Peninsula Schools Med & Dent, Univ Plymouth, Plymouth, England.
    Dore, G. J.
    Kirby Inst, Univ New S Wales, Sydney NSW, Australia.
    Doss, W.
    Cairo Univ, Cairo, Egypt.
    Duberg, Ann-Sofi
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital. Dept Infect Dis, Örebro University Hospital, Örebro, Sweden.
    El-Sayed, M. H.
    Ain Shams Univ, Cairo, Egypt.
    Ergor, G.
    Dokuz Eylul Univ, Izmir, Turkey.
    Esmat, G.
    Cairo Univ, Cairo, Egypt.
    Estes, C.
    Ctr Dis Anal CDA, Louisville CO, USA.
    Falconer, K.
    Infect Dis Unit, Dept Med Huddinge, Karolinska Inst, Stockholm, Sweden.
    Felix, J.
    Exigo Consultores, Alhos Vedros, Portugal.
    Ferraz, M. L. G.
    Div Gastroenterol, Univ Fed Sao Paulo, Sao Paulo, Brazil.
    Ferreira, P. R.
    Div Infect Dis, Univ Fed Sao Paulo, Sao Paulo, Brazil.
    Frankova, S.
    Dept Hepatogastroenterol, Inst Clin & Expt Med, Prague, Czech Republic.
    Garcia-Samaniego, J.
    Biomedical Research Networking Center in Hepatic and Digestive Diseases (CIBEREHD), Hosp Carlos III, Madrid, Spain.
    Gerstoft, J.
    Univ Copenhagen, Copenhagen, Denmark.
    Giria, J. A.
    Direccao Geral Saude, Lisbon, Portugal.
    Goncales, F. L., Jr.
    Fac Ciencias Med, UNICAMP,Dept Clin Med, Grp Estudo Hepatites,Disciplina Doencas Infeccios, Univ Estadual Campinas, Sao Paulo, Brazil.
    Gower, E.
    Ctr Dis Anal CDA, Louisville CO, USA.
    Gschwantler, M.
    Dept Internal Med 4, Wilhelminenspital Stadt Wien, Vienna, Austria.
    Guimaraes Pessoa, M.
    Sch Med, Div Gastroenterol & Hepatol, Univ Sao Paulo, Sao Paulo, Brazil.
    Hezode, C.
    Serv Hepatogastroenterol, Hop Henri Mondor, Creteil, France.
    Hofer, H.
    Dept Internal Med 3, Div Gastroenterol & Hepatol, Med Univ Vienna, Vienna, Austria.
    Husa, P.
    Clin Infect Dis, Univ Hosp Brno, Masaryk Univ, Brno, Czech Republic.
    Idilman, R.
    Dept Gastroenterol, Sch Med, Ankara Univ, Ankara, Turkey.
    Kåberg, M.
    Infect Dis Unit, Dept Med Huddinge, Karolinska Inst, Stockholm, Sweden.
    Kaita, K. D. E.
    Dept Internal Med, Sect Hepatol, Univ Manitoba, Winnipeg MB, Canada; Viral Hepatitis Invest Unit, Hlth Sci Ctr, Winnipeg MB, Canada.
    Kautz, A.
    European Liver Patients Assoc, St Truiden, Belgium.
    Kaymakoglu, S.
    Istanbul Univ, Istanbul, Turkey.
    Krajden, M.
    British Columbia Ctr Dis Control, Univ British Columbia, Vancouver, Canada.
    Krarup, H.
    Dept Med Gastroenterol, Aalborg Univ Hosp, Aalborg, Denmark; Sect Mol Diagnost, Aalborg Univ Hosp, Aalborg, Denmark.
    Laleman, W.
    Univ Hosp Leuven, Katholieke Univ Leuven, Louvain, Belgium.
    Lavanchy, D.
    Lazaro, P.
    Adv Tech Hlth Serv Res TAISS, Madrid, Spain.
    Marotta, P.
    Div Gastroenterol, Univ Western Ontario, London ON, Canada.
    Mauss, S.
    Univ Dusseldorf, Dusseldorf, Germany.
    Mendes Correa, M. C.
    Sch Med, Univ Sao Paulo, Sao Paulo, Brazil.
    Muellhaupt, B.
    Swiss HPB Hepatopancreatobiliary Ctr, Univ Zurich Hosp, Zurich, Switzerland; Dept Gastroenterol & Hepatol, Univ Zurich Hosp, Zurich, Switzerland.
    Myers, R. P.
    Liver Unit, Div Gastroenterol & Hepatol, Univ Calgary, Calgary AB, Canada.
    Negro, F.
    Div Gastroenterol & Hepatol, Univ Hosp, Geneva, Switzerland; Div Clin Pathol,Univ Hosp, Geneva, Switzerland.
    Nemecek, V.
    Natl Reference Lab Hepatitis, Natl Inst Publ Hlth, Prague, Czech Republic.
    Ormeci, N.
    Ankara Univ, Ankara, Turkey.
    Parkes, J.
    Univ Southhampton, Southampton, England.
    Peltekian, K. M.
    Dept Med, Halifax, NS, Canada; Dept Surg, Dalhousie Univ, Halifax, Canada; Serv Hepatol, Queen Elizabeth II Hlth Sci Ctr, Capital Dist Hlth Author, Halifax NS, Canada.
    Ramji, A.
    Dept Gastroenterol, Univ British Columbia, Vancouver, Canada.
    Razavi, H.
    Ctr Dis Anal CDA, Louisville CO, USA.
    Reis, N.
    Assembleia Republ, Lisbon, Portugal.
    Roberts, S. K.
    Alfred Hosp, Melbourne Vic, Australia; Monash Univ, Melbourne, Australia.
    Rosenberg, W. M.
    Inst Liver & Digest Hlth, Div Med, University College London (UCL), London, England.
    Sarmento-Castro, R.
    Dept Infect Dis, Ctr Hosp Porto, Oporto, Portugal.
    Sarrazin, C.
    JW Goethe Univ Hosp, Frankfurt, Germany.
    Semela, D.
    Div Gastroenterol & Hepatol, Cantonal Hosp St Gallen, St Gallen, Switzerland.
    Shiha, G. E.
    Egyptian Liver Res Inst & Hosp ELRIAH, Dakahliah, Egypt.
    Sievert, W.
    Monash Univ, Melbourne, Australia; Monash Hlth, Melbourne Vic, Australia.
    Starkel, P.
    Clin Univ St Luc, Catholic Univ Louvain, Brussels, Belgium.
    Stauber, R. E.
    Dept Internal Med, Div Gastroenterol & Hepatol, Med Univ Graz, Graz, Austria.
    Thompson, A. J.
    Dept Gastroenterol, St Vincents Hosp, Melbourne Vic, Australia; Univ Melbourne, Melbourne Vic, Australia.
    Urbanek, P.
    Dept Internal Med, Fac Med 1, Charles Univ Prague, Prague, Czech Republic; Cent Mil Hosp, Prague, Czech Republic.
    van Thiel, I.
    St Truiden, Belgium; Deutsch Leberhilfe eV, European Liver Patients Assoc, Cologne, Germany.
    Van Vlierberghe, H.
    Ghent Univ Hosp, Ghent, Belgium.
    Vandijck, D.
    Ghent Univ Hosp, Ghent, Belgium; Univ Ghent, Ghent, Belgium; Dept Hlth Econ & Patient Safety, Hasselt Univ, Diepenbeek, Belgium.
    Vogel, W.
    Med Univ Innsbruck, Innsbruck, Austria.
    Waked, I.
    Natl Liver Inst, Menoufia, Egypt.
    Wedemeyer, H.
    Dept Gastroenterol Hepatol & Endocrinol, Hannover Med Sch, Hannover, Germany; German Liver Fdn, Hannover, Germany.
    Weis, N.
    Copenhagen Univ Hosp, Hvidovre, Denmark.
    Wiegand, J.
    Univ Leipzig, Leipzig, Germany.
    Yosry, A.
    Cairo Univ, Cairo, Egypt.
    Zekry, A.
    St George Hosp Clin Sch Med, Univ New S Wales, Sydney NSW, Australia; Sch Med Sci, Univ New S Wales, Sydney NSW, Australia.
    Van Damme, P.
    Univ Antwerp, Antwerp, Belgium.
    Aleman, S.
    Dept Med Huddinge, Karolinska Inst, Stockholm, Sweden; Dept Gastroenterol & Hepatol Infect Dis, Karolinska Univ Hosp, Stockholm, Sweden.
    Hindman, S. J.
    Ctr Dis Anal CDA, Louisville CO, USA.
    Historical epidemiology of hepatitis C virus (HCV) in selected countries2014In: Journal of Viral Hepatitis, ISSN 1352-0504, E-ISSN 1365-2893, Vol. 21, p. 5-33Article in journal (Refereed)
    Abstract [en]

    Chronic infection with hepatitis C virus (HCV) is a leading indicator for liver disease. New treatment options are becoming available, and there is a need to characterize the epidemiology and disease burden of HCV. Data for prevalence, viremia, genotype, diagnosis and treatment were obtained through literature searches and expert consensus for 16 countries. For some countries, data from centralized registries were used to estimate diagnosis and treatment rates. Data for the number of liver transplants and the proportion attributable to HCV were obtained from centralized databases. Viremic prevalence estimates varied widely between countries, ranging from 0.3% in Austria, England and Germany to 8.5% in Egypt. The largest viremic populations were in Egypt, with 6358000 cases in 2008 and Brazil with 2106000 cases in 2007. The age distribution of cases differed between countries. In most countries, prevalence rates were higher among males, reflecting higher rates of injection drug use. Diagnosis, treatment and transplant levels also differed considerably between countries. Reliable estimates characterizing HCV-infected populations are critical for addressing HCV-related morbidity and mortality. There is a need to quantify the burden of chronic HCV infection at the national level.

  • 6.
    Büsch, Katharina
    et al.
    AbbVie AB, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Waldenström, Jesper
    Department of Infectious Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Lagging, Martin
    Department of Infectious Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Aleman, Soo
    Department of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Gastroenterology and Hepatology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Weiland, Ola
    Department of Medicine Huddinge, Division of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Kövamees, Jan
    AbbVie AB, Stockholm, Sweden.
    Duberg, Ann-Sofi
    Örebro University, School of Health Sciences. Department of Infectious Diseases, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Söderholm, Jonas
    AbbVie AB, Stockholm, Sweden; Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Prevalence and comorbidities of chronic hepatitis C: a nationwide population-based register study in Sweden2017In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 52, no 1, p. 61-68Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of this study was to estimate the prevalence of physician-diagnosed and registered chronic hepatitis C (CHC), and to estimate the reported frequencies of Charlson comorbidities compared with matched comparators from the general population.

    Materials and methods: Patients were identified according to ICD codes for CHC in the Swedish National Patient Register (1997-2013). Prevalence was estimated according to different patient identification algorithms and for different subgroups. Charlson comorbidities were ascertained from the same register and compared with age/sex/county of residence matched general population comparators.

    Results: A total of 34,633 individuals with physician-diagnosed CHC were alive in Sweden in 2013 (mean age, 49 years; 64% men), corresponding to a physician-diagnosed prevalence of 0.36%. The prevalence varied by case definition (0.22%-0.36%). The estimate dropped to 0.14% for monitored CHC disease (defined as ≥1 CHC-related visit in 2013). Overall, 41.3% of the CHC patients had ≥1 physician-registered Charlson comorbidity; the most common was liver diseases (22.1%). Compared with matched comparators from the general population (n = 171,338), patients with CHC had more physician-diagnosed and registered diseases such as chronic pulmonary disease (10.2% vs. 4.0%), diabetes (10.6% vs. 5.5%) and liver-related cancer (1.3% vs. 0.2%; all p < .01). No information on behavioural factors, such as smoking, alcohol consumption or on-going illicit drug use, was available.

    Conclusion: The physician-diagnosed prevalence of CHC was slightly lower than previously reported estimates, and varied by case definition. The additional comorbidities observed in the CHC group should be taken into consideration, as these comorbidities add to the disease burden.

  • 7.
    Christensen, P. B.
    et al.
    Department of Infectious Diseases Q, Odense University Hospital, Denmark; Clinical Institute, University of Southern Denmark, Odense, Denmark .
    Debrabant, B.
    Department of Mathematics and Computer Science, University of Southern Denmark, Odense, Denmark; Department of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark .
    Cowan, S.
    Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark.
    Debrabant, K.
    Department of Mathematics and Computer Science, University of Southern Denmark, Odense, Denmark.
    Ovrehus, A.
    Department of Infectious Diseases Q, Odense University Hospital, Denmark; Clinical Institute, University of Southern Denmark, Odense, Denmark .
    Duberg, Ann-Sofi
    Örebro University, School of Medical Sciences. Department of Infectious Diseases, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Sweden .
    Hepatitis C time trends in reported cases and estimates of the hidden population born before 1965, Denmark and Sweden, 1990 to 20202022In: Eurosurveillance, ISSN 1025-496X, E-ISSN 1560-7917, Vol. 27, no 50, p. 30-38Article in journal (Refereed)
    Abstract [en]

    Background: According to the World Health Organization, hepatitis C virus (HCV) infection should be under control by 2030.

    Aim: Our aim was to describe the size and temporal changes in reported cases of chronic HCV infection in Denmark and Sweden and to estimate the size of the hidden (undiagnosed) population born before 1965.

    Methods: We extracted all HCV infections reported to national surveillance systems in Denmark and Sweden from 1990 to 2020. Prediction of the size of the hidden HCV-infected population was restricted to the cohort born before 1965 and cases reported up to 2017. We applied a model based on removal sampling from binomial distributions, estimated the yearly probability of diagnosis, and deducted the original HCV-infected population size.

    Results: Denmark (clinician-based) reported 10 times fewer hepatitis C cases annually than Sweden (laboratory and clinician-based), peaking in 2007 (n = 425) and 1992 (n = 4,537), respectively. In Denmark, the birth year distribution was monophasic with little change over time. In recent years, Sweden has had a bimodal birth year distribution, suggesting ongoing infection in the young population. In 2017, the total HCV infected population born before 1965 was estimated at 10,737 living persons (95% confidence interval (CI): 9,744-11,806), including 5,054 undiagnosed, in Denmark and 16,124 (95% CI: 13,639-18,978), including 10,580 undiagnosed, in Sweden.

    Conclusions: The reporting of HCV cases in Denmark and Sweden was different. For Denmark, the estimated hidden population was larger than the current national estimate, whereas in Sweden the estimate was in line with the latest published numbers.

  • 8.
    Colombe, Soledad
    et al.
    Public Health Agency of Sweden, Solna, Sweden; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden; Outbreak Research Team, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
    Axelsson, Maria
    Public Health Agency of Sweden, Solna, Sweden.
    Aleman, Soo
    Department of Infectious Diseases, Karolinska University Hospital/Karolinska Institutet, Stockholm, Sweden.
    Duberg, Ann-Sofi
    Örebro University, School of Medical Sciences. Department of Infectious Diseases, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Lundberg Ederth, Josefine
    Public Health Agency of Sweden, Solna, Sweden.
    Dahl, Viktor
    Public Health Agency of Sweden, Solna, Sweden.
    Monitoring the progress towards the elimination of hepatitis B and C in Sweden: estimation of core indicators for 2015 and 20182022In: BMC Infectious Diseases, E-ISSN 1471-2334, Vol. 22, no 1, article id 885Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: To monitor Sweden's progress towards the WHO goal of eliminating viral hepatitis, we estimated the prevalence, notification rate, and liver-related morbidity and mortality for diagnosed hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in 2015 and 2018.

    METHODS: We identified cases of hepatitis B and C within the National System for Notifiable Diseases and obtained data on treatment and whether the case was deceased or not. We calculated prevalence, notification rates per 100,000, and proportion of newly diagnosed cases of hepatitis with liver disease at the time of diagnosis, and proportion of all deceased cases who died from liver disease. We calculated Poisson 95% confidence intervals (CIs) around the notification rates and Wilson 95% CIs around prevalence and mortality estimates.

    RESULTS: In 2015 and 2018, the prevalence of diagnosed HBV infections was 0.20% [95% CI: 0.19-0.20] and 0.21% [0.20-0.21]. Notification rates per 100,000 for HBV infections were 13.02 [12.32-13.76] and 7.71 [7.18-8.27]. HBV liver-related morbidity was 2.65% [1.90-3.68] and 2.16% [1.35-3.43]. HBV liver-related mortality was 20.00% [14.81-26.44] and 17.95% [13.20-23.94]. In 2015 and 2018, the prevalence of diagnosed HCV-infections was 0.24% [0.24-0.25] and 0.18% [0.18-0.19]. Notification rates per 100,000 for HCV infections were 15.92 [15.14-16.73] and 13.05 [12.36-13.77]. HCV liver-related morbidity was 8.14% [6.89-9.60] and 3.90% [2.99-5.08]. HCV liver-related mortality was 27.08% [24.54-29.77] and 26.90% [24.12-29.88].

    CONCLUSIONS: All indicators decreased or remained stable between 2015 and 2018, indicating progress in the elimination of viral hepatitis, especially for HCV infection.

  • 9.
    Davídsdóttir, Lóa
    et al.
    Department of Gastroenterology and Hepatology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden .
    Duberg, Ann-Sofi
    Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden .
    Törner, Anna
    Department of Epidemiology, Swedish Institute for Infectious Disease Control, Solna, Sweden .
    Aleman, Soo
    Department of Gastroenterology and Hepatology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden .
    Bäck, Erik
    Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden .
    Ekdahl, Karl
    European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
    Blaxhult, Anders
    Department of Epidemiology, Swedish Institute for Infectious Disease Control, Solna, Sweden .
    Ekbom, Anders
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Solna, Sweden .
    Hultcrantz, Rolf
    Department of Gastroenterology and Hepatology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden .
    Hepatocellular carcinoma in individuals with HBV infection or HBV-HCV co-infection in a low endemic country2010In: Scandinavian journal of gastroenterology, ISSN 1502-7708, Vol. 45, no 7-8, p. 944-952Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this nationwide cohort study was to assess the risk for hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus (HBV) infection or HBV and hepatitis C virus (HCV) co-infection in Sweden, a low endemic country.

    MATERIAL AND METHODS: A total of 12,080 patients with HBV and 3238 patients with HBV-HCV co-infection were notified to the Swedish institute for Infectious Disease Control between 1990 and 2004. After excluding 1850 patients with acute HBV and 584 patients infected in adult life, we analyzed the cohort of 9646 subjects with chronic HBV infection. In the co-infection cohort, 1697 patients were analyzed after excluding 1541 cases with acute HBV. The Swedish national cancer registry was used for follow-up. The HCC incidence rate in the cohorts was compared with the HCC incidence rate in the general population and the standardized incidence ratio (SIR) was calculated for different strata according to estimated infection period.

    RESULTS: HCC was found in 45 patients in the HBV cohort. In the stratum of 40-49 years of infection we found a SIR of 47 and in stratum 50-59 years the SIR was 54. In the co-infected cohort 10 HCCs were found. The SIR in the stratum 20-29 years of infection was 34 and the SIR in the stratum 30 years and over was 91.

    CONCLUSIONS: This national cohort study of HBV infected and HBV-HCV co-infected subjects in a low endemic country confirms a highly increased risk of liver cancer compared to the general population.

  • 10.
    Duberg, Ann-Sofi
    Örebro University, School of Medical Sciences. Universitetssjukhuset i Örebro, Örebro, Sweden.
    Bakterie- och parasitorsakade leversjukdomar2016In: Gastroenterologi och Hepatologi / [ed] Greger Lindberg, Henry Nyhlin, Lund: Studentlitteratur AB, 2016, 1, p. 253-256Chapter in book (Other academic)
  • 11.
    Duberg, Ann-Sofi
    Örebro University, School of Health and Medical Sciences.
    Hepatitis C virus infection: a nationwide study of associated morbidity and mortality2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The hepatitis C virus (HCV) was characterised in 1989. HCV was transmitted through transfusion of blood/blood products, but injection drug use is now the most common route of transmission. The infection is usually asymptomatic but becomes chronic in about 75%, and in 20 years 15-25% develops liver cirrhosis, with a risk for liver failure and liver cancer. HCV has also been associated with lymphoproliferative disorders. The aim of this thesis was to study morbidity and mortality in a national, population-based cohort of HCV-infected individuals. The study population consisted of all persons with a diagnosed HCV-infection recorded in the national surveillance database. This file was linked to other national registers to obtain information of emigration, deaths, cancers, and inpatient care. All personal identifiers were removed before analysis.

    In Paper I the standardized incidence ratios (SIR) for Hodgkin’s and non-Hodgkin’s lymphoma (NHL), multiple myeloma, acute and chronic lymphatic leukaemia, and thyroid cancer were studied. In the HCV-cohort (n: 27,150) there was a doubled risk for NHL and multiple myeloma in patients infected for more than 15 years, compared with the general population (age-, sex- and calendar-year specific incidence rates). The results strengthened these earlier controversial associations.

    The SIR and also the absolute risk for primary liver cancer were estimated in Paper II. In the HCV-cohort (n: 36,126) the individuals infected for more than 25 years had a more than 40 times increased risk for liver cancer compared with the general population. The absolute risk of primary liver cancer was 7% within 40 years of HCV-infection.

    Mortality and cause of death were studied in Paper III. The standardized mortality ratio (SMR) demonstrated a 5.8 times excess mortality in the HCV-cohort (n: 34,235) compared with the general population, and a 35.5 times excess mortality from liver disease. Deaths from illicit drugs and external reasons were common in young adults.

    Paper IV presents a study of inpatient care. The HCV-cohort (n: 43,000) was compared with a matched reference population (n: 215,000). Cox regression was used to estimate the likelihood, a hazard ratio, for admission to hospital, and frequencies and rates to estimate the total burden. In the HCV-cohort inpatient care was high and about 50% was psychiatric, often drug-related care. The likelihood for liver-related admissions was very high, and serious liver complications increased in the 2000s, indicating that HCV-associated liver disease will increase the next decade. In the 2000s, about 1000 individuals per year were treated with HCV-combination therapy.

    To conclude, the risk for NHL and multiple myeloma was doubled, and liver- and drug-related morbidity and mortality was very high in the HCV-cohort. Serious liver complications increased in the 2000s and will probably increase the coming decade.

    List of papers
    1. Non-Hodgkin's lymphoma and other nonhepatic malignancies in Swedish patients with hepatitis C virus infection
    Open this publication in new window or tab >>Non-Hodgkin's lymphoma and other nonhepatic malignancies in Swedish patients with hepatitis C virus infection
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    2005 (English)In: Hepatology, ISSN 0270-9139, E-ISSN 1527-3350, Vol. 41, no 3, p. 652-659Article in journal (Refereed) Published
    Abstract [en]

    The aim of this study was to evaluate the association between hepatitis C virus (HCV) infection and non-Hodgkin's lymphoma (NHL), multiple myeloma (MM), thyroid cancer (TC), chronic lymphatic leukemia (CLL), acute lymphatic leukemia (ALL), and Hodgkin's lymphoma (HL). A Swedish cohort of 27,150 HCV-infected persons notified during 1990-2000 was included in the study. The database was linked to other national registers to calculate the observation time, expressed as person-years, and to identify all incident malignancies in the cohort. The patients were stratified according to assumed time of previous HCV infection. The relative risk of malignancy was expressed as a standardized incidence ratio (SIR)-the observed number compared to the expected number. During 1990-2000 there were 50 NHL, 15 MM, 14 ALL, 8 TC, 6 CLL, and 4 HL diagnoses in the cohort. Altogether, 20 NHL, 7 MM, 5 TC, 4 CLL, 1 ALL, and 1 HL patient fulfilled the criteria to be included in the statistical analysis. The observation time was 122,272 person-years. The risk of NHL and MM was significantly increased in the stratum with more than 15 years of infection (SIR 1.89 [95% CI, 1.10-3.03] and 2.54 [95% CI, 1.11-5.69], respectively). The association was not significant in TC or CLL. In conclusion, we report the incidence of several malignancies in a nationwide cohort of HCV-infected persons. Although the delayed diagnosis of HCV probably has resulted in an underestimation of the risk, this study showed a significantly increased risk of NHL and MM.

    Keywords
    Hepatitis C/*complications, Humans, Leukemia; Lymphocytic; Chronic; B-Cell/etiology, Lymphoma; Non-Hodgkin/*etiology, Male, Middle Aged, Multiple Myeloma/etiology, Neoplasms, Precursor Cell Lymphoblastic Leukemia-Lymphoma/etiology, RNA; Viral/analysis, Risk Factors, Thyroid Neoplasms/etiology
    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-4743 (URN)10.1002/hep.20608 (DOI)000227298200030 ()15723449 (PubMedID)2-s2.0-14244260267 (Scopus ID)
    Available from: 2008-11-24 Created: 2008-11-24 Last updated: 2023-12-08Bibliographically approved
    2. Hepatocellular carcinoma and other primary liver cancers in hepatitis C patients in Sweden: a low endemic country
    Open this publication in new window or tab >>Hepatocellular carcinoma and other primary liver cancers in hepatitis C patients in Sweden: a low endemic country
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    2008 (English)In: Journal of Viral Hepatitis, ISSN 1352-0504, E-ISSN 1365-2893, Vol. 15, no 7, p. 531-537Article in journal (Refereed) Published
    Abstract [en]

    The aim of this study was to assess the risk of hepatocellular carcinoma (HCC) and other primary liver cancers (PLC) in the nationwide cohort of hepatitis C virus (HCV) infected patients in Sweden. The basis was the total HCV-cohort notified in 1990-2004, after excluding 3238 people also reported with hepatitis B, the study cohort consisted of 36 126 people contributing an observation time of 246 105 person-years. The most common route of transmission was intravenous drug use (57%). The national Cancer Registry was used for follow-up, and 354 developed PLC (mainly HCC), of whom 234 were eligible for statistical analysis. The PLC incidence in the HCV cohort was compared with the incidence in the general population, and a standardized incidence ratio (SIR) was calculated for six different strata according to estimated duration of infection. The highest relative risk, SIR: 46 (95% CI: 36-56) was found in the stratum 25-30 years with HCV infection and SIR: 40 (95% CI: 31-51) in the stratum 30-35 years with infection. In the entire community-based HCV cohort in Sweden we found a highly increased risk of liver cancer compared to the general population. The highest relative risk was among people who had been infected for more than 25 years.

    PMID: 18397224 [PubMed - indexed for MEDLINE]

    Keywords
    Carcinoma; Hepatocellular/*epidemiology/etiology/virology, Cohort Studies, Female, Hepatitis C/*complications, Humans, Liver Neoplasms/epidemiology/*etiology/virology, Male, Substance Abuse; Intravenous, Sweden/epidemiology
    National Category
    Medical and Health Sciences Infectious Medicine Microbiology in the medical area
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-4745 (URN)10.1111/j.1365-2893.2008.00979.x (DOI)000256494900008 ()18397224 (PubMedID)2-s2.0-44849128679 (Scopus ID)
    Note

    Delat 1:e författarskap Strauss, Törner, Duberg. Part of thesis: http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-7835

    Available from: 2008-11-24 Created: 2008-11-24 Last updated: 2023-12-08Bibliographically approved
    3. Cause of death in individuals with chronic HBV and/or HCV infection, a nationwide community-based register study
    Open this publication in new window or tab >>Cause of death in individuals with chronic HBV and/or HCV infection, a nationwide community-based register study
    Show others...
    2008 (English)In: Journal of Viral Hepatitis, ISSN 1352-0504, E-ISSN 1365-2893, Vol. 15, no 7, p. 538-550Article in journal (Refereed) Published
    Abstract [en]

    Studies on chronic viral hepatitis and mortality have often been made on selected populations or in high-endemic countries. The aim of this study was to investigate the causes of death and the mortality rates in the nationwide cohorts of people chronically infected with hepatitis B virus (HBV) and/or hepatitis C virus (HCV) in Sweden, a low-endemic country. All notifications on chronic HBV infection and HCV infection 1990-2003 were linked to the Cause of Death Register. A total of 9517 people with chronic HBV infection, 34 235 people with HCV infection and 1601 with chronic HBV-HCV co-infection were included, and the mean observation times were 6.4, 6.3 and 7.9 years, respectively. The mortality in the cohorts was compared with age- and gender-specific mortality in the general population and standardized mortality ratios (SMR) were calculated. All-cause mortality was significantly increased, SMR 2.3 (HBV), 5.8 (HCV) and 8.5 (HBV-HCV), with a great excess liver-related mortality in all cohorts, SMR 21.7, 35.5 and 46.2, respectively. In HCV and HBV-HCV infected there was an increased mortality due to drug-related psychiatric diagnoses (SMR: 20.7 and 27.6) and external causes (SMR: 12.4 and 11.4), predominantly at younger age. To conclude, this study demonstrated an increased all-cause mortality, with a great excess mortality from liver disease, in all cohorts. In people with HCV infection the highest excess mortality in younger ages was from drug-related and external reasons.

    PMID: 18397223 [PubMed - indexed for MEDLINE]

    Keywords
    Carcinoma; Hepatocellular/*mortality, Cohort Studies, Female, Hepatitis B; Chronic/epidemiology/*mortality, Hepatitis C; Chronic/epidemiology/*mortality, Humans, Liver Neoplasms/etiology/*mortality, Male, Medical Record Linkage, Population Surveillance/methods, Registries
    National Category
    Medical and Health Sciences Infectious Medicine
    Research subject
    Infectious Diseases
    Identifiers
    urn:nbn:se:oru:diva-4744 (URN)10.1111/j.1365-2893.2008.00982.x (DOI)000256494900009 ()18397223 (PubMedID)2-s2.0-44849093942 (Scopus ID)
    Note

    Part of thesis: http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-7835

    Available from: 2008-11-24 Created: 2008-11-24 Last updated: 2023-12-08Bibliographically approved
    4. The burden of hepatitis C in Sweden: a national study of inpatient care
    Open this publication in new window or tab >>The burden of hepatitis C in Sweden: a national study of inpatient care
    Show others...
    (English)Manuscript (preprint) (Other academic)
    Keywords
    Hepatitis C, hepatocellular carcinoma, psychiatric disease, epidemiology, hospitalization
    National Category
    Medical and Health Sciences Microbiology in the medical area Infectious Medicine
    Research subject
    Infectious Diseases; Medicine
    Identifiers
    urn:nbn:se:oru:diva-7869 (URN)
    Available from: 2009-09-09 Created: 2009-09-09 Last updated: 2018-01-13Bibliographically approved
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  • 12.
    Duberg, Ann-Sofi
    Örebro University, School of Medical Sciences. Universitetssjukhuset i Örebro, Örebro, Sweden.
    Virushepatiter2016In: Gastroenterologi och Hepatologi / [ed] Greger Lindberg, Henry Nyhlin, Lund: Studentlitteratur AB, 2016, 1, p. 247-252Chapter in book (Other academic)
  • 13.
    Duberg, Ann-Sofi
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Infectious Diseases, , Örebro University Hospital, Örebro, Sweden.
    Blach, Sarah
    Center for Disease Analysis (CDA), Louisville CO, USA.
    Falconer, Karolin
    Department of Medicine Huddinge, Division of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Kåberg, Martin
    Department of Medicine Huddinge, Division of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, , Stockholm, Sweden.
    Razavi, Homie
    Center for Disease Analysis (CDA), Louisville CO, USA.
    Aleman, Soo
    Department of Medicine Huddinge, Division of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Medicine Huddinge, Division of Gastroenterology and Hepatology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    The future disease burden of hepatitis C virus infection in Sweden and the impact of different treatment strategies2015In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 50, no 2, p. 233-244Article in journal (Refereed)
    Abstract [en]

    Objective: Recently, new highly effective direct-acting antivirals (DAAs) against hepatitis C virus (HCV) were introduced. Whether these will alleviate the anticipated increase of liver disease burden in Sweden is unknown, partly because high costs may restrict the use. The objectives were to model the HCV epidemic in Sweden, the burden of disease, and the potential impact of different treatment strategies.

    Material and methods: HCV disease progression was modeled to 2030. Scenarios were simulated using new DAAs with sustained annual treatment rate (n = 1130), reduced treatment rate (n = 380) to maintain budget, and increased treatment rates (n = 1430 or 2260) to reduce HCV infections.

    Results: With today's triple therapies, the estimated number of serious liver complications and death are expected to peak in 2021. Using new DAAs among F0-F4 patients, an unchanged annual treatment rate can reduce the number of HCV infections by 10% by 2030; however, hepatocellular carcinoma (HCC) and mortality will remain unchanged. By reducing to 380 treatments annually and focusing on patients with advanced fibrosis (F3-F4), serious complications will remain constant but the total number of HCV infections will increase. By doubling the number of DAA treatments, HCC-incidence and liver-related deaths would decrease by 65-70% by 2030.

    Conclusion: Mortality and HCC can be reduced with new DAAs and sustained treatment uptake when restricted to F2-F4 patients, or with increased uptake in F0-F4 patients. Treatment restrictions to limit cost may reduce the positive effects and increase the burden of HCV infection. These results may be important for the future strategies of HCV management.

  • 14.
    Duberg, Ann-Sofi
    et al.
    Örebro University Hospital.
    Hansdotter, F.
    How, A. -L
    Holmström, A.
    Lesko, B.
    Angeläget med generösare provtagning för hepatit C efter blodtransfusion Socialstyrelsens nya rekommendation för riskgrupper2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 34-35, p. 1477-Article in journal (Refereed)
  • 15.
    Duberg, Ann-Sofi
    et al.
    Örebro University, School of Health and Medical Sciences.
    Hultcrantz, Rolf
    Misleading figures on trends in mortality from hepatocellular carcinoma in Europe2009In: Hepatology, ISSN 0270-9139, E-ISSN 1527-3350, Vol. 49, no 1, p. 336-336Article in journal (Refereed)
  • 16.
    Duberg, Ann-Sofi
    et al.
    Örebro University, School of Health and Medical Sciences.
    Janzon, R.
    Bäck, Erik
    Örebro University, School of Health and Medical Sciences.
    Ekdahl, Karl
    Blaxhult, A.
    The epidemiology of hepatitis C virus infection in Sweden2008In: Eurosurveillance, ISSN 1025-496X, E-ISSN 1560-7917, Vol. 13, no 21Article in journal (Refereed)
    Abstract [en]

    In Sweden, infection with hepatitis C virus (HCV) has been a notifiable disease since 1990, when diagnostic methods became available. Blood donor screening indicated that about 0.5% of the Swedish population (9 millions) had been HCV infected. Here we present the Swedish hepatitis C epidemic based on data from all the HCV notifications 1990-2006. During this time about 42,000 individuals (70% men) were diagnosed and reported as HCV infected. The majority (80%) were born in 1950 or later, with a high percentage (60%) born in the 1950s and 1960s. Younger people, 15-24 years old at notification, were reported on the same level each year. The main reported routes of HCV transmission were intravenous drug use in 65%, blood transfusions/products in 6%, and sexual in 2%, though unknown or not stated in 26%. Approximately 6,000 of all notified individuals have died during the study period. To conclude, the Swedish HCV epidemic is highly related to the increase of intravenous drug use in the late 1960s and 1970s, with a high proportion of people now chronically infected for more than 25 years, resulting in an increase of severe liver complications in form of cirrhosis and hepatocellular carcinoma. Furthermore the unchanged number of notifications of newly infected younger people indicates an ongoing HCV epidemic.

    PMID: 18761966 [PubMed - indexed for MEDLINE]

  • 17.
    Duberg, Ann-Sofi
    et al.
    Örebro University, School of Medical Sciences.
    Lybeck, Charlotte
    Örebro University, School of Medical Sciences.
    Fält, A.
    Department of Clinical Epidemiology and Biostatistics, Örebro University, Örebro, Sweden.
    Wedemeyer, H.
    Department of Gastroenterology and Hepatology, Hannover Medical School, Hannover, Germany.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Aleman, S.
    Department of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden.
    The incidence of hepatocellular carcinoma in hepatitis B virus infected persons of different origins, living in Sweden2018In: Journal of Hepatology, ISSN 0168-8278, E-ISSN 1600-0641, Vol. 68, no Suppl. 1, p. S488-S488Article in journal (Other academic)
    Abstract [en]

    Background and Aims: Chronic hepatitis B (CHB) is associated with an increased risk of hepatocellular carcinoma (HCC) in both cirrhotic and non-cirrhotic persons. CHB patients with high risk for HCC are therefore recommended to undergo surveillance for HCC, with an estimated cut-off for surveillance in non-cirrhotic patients at incidence rate (IR) of 0.2% per year. People originating from Asia and men from Africa are estimated to have particularly high risks, but the IR for HCC when living in the Western world has not been fully estimated. Therefore, our aim was to study the incidence of HCC by age and origin in persons with CHB who are living in Sweden.

    Method: In this national population-based study all persons diagnosed with CHB in Sweden during 1990–2015, their country of birth, co-infections, antiviral therapy, liver cancer or death/emigration were identified retrospectively, using the national HBV-surveil-lance register and other national registers. Those co-infected with hepatitis C were excluded. Observation time started at date of reported CHB diagnosis. The IR was calculated for different age groups and by region of birth.

    Results: In total 16,410 persons (47% women) with CHB were studied. The number of persons and observation time (person-years) by origin were: Western Europe 2,316 (25,415); Eastern Europe 2,349 (26,237); Middle East/North Africa 4,402 (47,320); Sub-Saharan Africa 3,677 (30,565), Asia 3,537 (35,358) and other 129 (1,277). Those from Sub-Saharan Africa were youngest and had the shortest mean time in Sweden, 11.6 years. There were in total 232 diagnosed HCCs (82% in men); 23, 54 and 58 in people from Sub-Saharan Africa ,Asia and Middle East/North Africa, respectively. The corresponding mean ages at HCC diagnoses were 45, 51 and 59 years, respectively. The IRexceeded 0.2% for men from Asia from age-group≥40–49 years (IR 0.63, 95%CI 0.39–1.00), and for men of all other origins from age-group≥50–59 years. Among African men aged <40 yearstherewere 7 HCC, with incidence rate 0.05 and 0.11 in age groups 20–29 and 30–39 years, respectively. In women, HCC was rare but exceeded 0.2% among those aged≥60 years with origins from East Europe, Asia and Middle East/North Africa.

    Conclusion: In this study only men of Asian origin exceeded the cut-off for HCC surveillance by ages 40–49 years. African men had a few HCCs at youngerages, but did not exceed the cut-off before age 50–59 years. This study confirms the high risk for HCC in especially Asian men living in the Western world, but questions the benefit of surveillance at younger ages for men with African origin who live in a Northern European country

  • 18.
    Duberg, Ann-Sofi
    et al.
    Örebro University, School of Medical Sciences. Department of Infectious Diseases.
    Lybeck, Charlotte
    Örebro University, School of Medical Sciences. Department of Infectious Diseases.
    Fält, Anna
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Aleman, Soo
    Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
    Chronic hepatitis B virus infection and the risk of hepatocellular carcinoma by age and country of origin in people living in Sweden: A national register study2022In: Hepatology communications, E-ISSN 2471-254X, Vol. 6, no 9, p. 2418-2430Article in journal (Refereed)
    Abstract [en]

    Chronic hepatitis B virus (HBV) infection is a major risk factor for hepatocellular carcinoma (HCC), and surveillance is recommended for patients without cirrhosis when risk exceeds an incidence rate (IR) of 0.2%. Populations in Asia and sub-Saharan Africa have been associated with HCC at younger ages, but the risk after immigration to Western countries should be investigated. The aim of this study was to study HCC by age and country of origin in people with chronic HBV infection in Sweden. Through national registers, residents with chronic HBV diagnosis (1990-2015) were identified with information on country of origin, immigration/emigration, death, coinfections, antiviral therapy, and HCC. Observation time started at HBV diagnosis, and IR and hazard ratios for HCC were calculated by sex, age, and region of origin. Among 16,410 individuals (47% women), the origin and observation time (person years) were as follows: Western Europe, 2316 (25,415); Eastern Europe, 2349 (26,237); Middle East/North Africa, 4402 (47,320); sub-Saharan Africa, 3677 (30,565); Asia, 3537 (35,358); and other, 129 (1277). There were 232 individuals with HCC (82% in men). The IR increased with age and exceeded 0.2% for Asian men from age group 40-49 years (IR, 0.63; 95% confidence interval, 0.39-1.00), for men of other origins from age group 50-59 years, and for women aged ≥60 years originating from Eastern Europe, Asia, and Middle East/North Africa. After exclusion of patients with cirrhosis or HBV treatment, the IR still exceeded 0.2% in Asian men aged 40-49 years. This study demonstrates that HBV-infected men of Asian origin should be recommended HCC surveillance at younger ages, but there is a need for further studies of HCC incidence in African-born men without cirrhosis living in the Western world.

  • 19.
    Duberg, Ann-Sofi
    et al.
    Örebro University, School of Medical Sciences.
    Lybeck, Charlotte
    Örebro University, School of Medical Sciences.
    Fält, Anna
    Karolinska Institutet, Stockholm, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Aleman, Soo
    Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
    Reply Comment on risk of HCC with chronic hepatitis B infection in Sweden2022In: Hepatology communications, E-ISSN 2471-254X, Vol. 6, no 12, p. 3593-3594Article in journal (Other academic)
  • 20.
    Duberg, Ann-Sofi
    et al.
    Örebro University, Department of Clinical Medicine.
    Nordström, Marie
    Törner, Anna
    Reichard, Olle
    Strauss, Reinhild
    Janzon, Ragnhild
    Bäck, Erik
    Örebro University, Department of Clinical Medicine.
    Ekdahl, Karl
    Non-Hodgkin's lymphoma and other nonhepatic malignancies in Swedish patients with hepatitis C virus infection2005In: Hepatology, ISSN 0270-9139, E-ISSN 1527-3350, Vol. 41, no 3, p. 652-659Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate the association between hepatitis C virus (HCV) infection and non-Hodgkin's lymphoma (NHL), multiple myeloma (MM), thyroid cancer (TC), chronic lymphatic leukemia (CLL), acute lymphatic leukemia (ALL), and Hodgkin's lymphoma (HL). A Swedish cohort of 27,150 HCV-infected persons notified during 1990-2000 was included in the study. The database was linked to other national registers to calculate the observation time, expressed as person-years, and to identify all incident malignancies in the cohort. The patients were stratified according to assumed time of previous HCV infection. The relative risk of malignancy was expressed as a standardized incidence ratio (SIR)-the observed number compared to the expected number. During 1990-2000 there were 50 NHL, 15 MM, 14 ALL, 8 TC, 6 CLL, and 4 HL diagnoses in the cohort. Altogether, 20 NHL, 7 MM, 5 TC, 4 CLL, 1 ALL, and 1 HL patient fulfilled the criteria to be included in the statistical analysis. The observation time was 122,272 person-years. The risk of NHL and MM was significantly increased in the stratum with more than 15 years of infection (SIR 1.89 [95% CI, 1.10-3.03] and 2.54 [95% CI, 1.11-5.69], respectively). The association was not significant in TC or CLL. In conclusion, we report the incidence of several malignancies in a nationwide cohort of HCV-infected persons. Although the delayed diagnosis of HCV probably has resulted in an underestimation of the risk, this study showed a significantly increased risk of NHL and MM.

  • 21.
    Duberg, Ann-Sofi
    et al.
    Örebro University, School of Health and Medical Sciences.
    Pettersson, Helena
    Smittskyddsinstitutet.
    Aleman, Soo
    Karolinska Sjukhuset.
    Blaxhult, Anders
    Smittskyddsinstitutet.
    Davidsdottir, Loa
    Karolinska sjukhuset.
    Hultcrantz, Rolf
    Karolinska Institutet.
    Bäck, Erik
    Örebro University, School of Health and Medical Sciences.
    Ekdahl, Karl
    Karolinska Institutet.
    Montgomery, Scott M.
    Örebro University, School of Health and Medical Sciences.
    The burden of hepatitis C in Sweden: a national study of inpatient careManuscript (preprint) (Other academic)
  • 22.
    Duberg, Ann-Sofi
    et al.
    Örebro University, School of Health and Medical Sciences. Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden.
    Pettersson, Helena
    Department of Epidemiology, Swedish Institute for Infectious Disease Control Solna, Stockholm, Sweden.
    Aleman, Soo
    Department of Gastroenterology and Hepatology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
    Blaxhult, Anders
    Department of Epidemiology, Swedish Institute for Infectious Disease Control Solna, Stockholm, Sweden.
    Davidsdottir, Loa
    Department of Gastroenterology and Hepatology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
    Hultcrantz, Rolf
    Department of Gastroenterology and Hepatology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
    Bäck, Erik
    Örebro University, School of Health and Medical Sciences. Department of Clinical Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Ekdahl, Karl
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
    Montgomery, Scott M.
    Örebro University, School of Health and Medical Sciences. Department of Clinical Medicine, Örebro University, Örebro, Sweden; Department of Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
    The burden of hepatitis C in Sweden: a national study of inpatient care2011In: Journal of Viral Hepatitis, ISSN 1352-0504, E-ISSN 1365-2893, Vol. 18, no 2, p. 106-118Article in journal (Refereed)
    Abstract [en]

    The spread of hepatitis C virus (HCV) in Sweden in the 1970s indicated that serious liver complications (SLC) would increase in the 2000s. The aim of this study was to analyse the burden of HCV-associated inpatient care in Sweden, to demonstrate the changes over time and to compare the findings with a noninfected population. The HCV-cohort (n: 43 000) was identified from the national surveillance database 1990-2006, and then linked to national registers to produce an age-, sex-, and region-matched noninfected comparison population (n: 215 000) and to obtain information on demographics, cancers, inpatient care and prescriptions. Cox regression was used to estimate the likelihood (hazard ratios) for admission to hospital in the HCV compared with the noninfected cohort. The hazard ratios were 4.03 (95% CI: 3.98-4.08) for all care, 77.52 (71.02-84.60) for liver-related care and 40.74 (30.58-54.27) for liver cancer care. The admission rate in the HCV-cohort compared with the noninfected cohort, the rate ratio (age- and sex-adjusted) for all inpatient care was 5.91 (95% CI: 5.87-5.94), and the rate ratio for liver-related care was 70.05 (66.06-74.28). In the HCV-cohort, 45% of all episodes were for psychiatric, mostly drug-related, care. Inpatient care for SLC increased in the 2000s. To conclude, drug-related care was common in the HCV-infected cohort, the demand for liver-related care was very high, and SLC increased notably in the 2000s, indicating that the burden of inpatient care from serious liver disease in HCV-infected individuals in Sweden is an increasing problem.

  • 23.
    Duberg, Ann-Sofi
    et al.
    Örebro University, School of Health and Medical Sciences.
    Törner, Anna
    Davidsdóttir, Lóa
    Aleman, Soo
    Blaxhult, Anders
    Svensson, Åke
    Hultcrantz, Rolf
    Bäck, Erik
    Örebro University, School of Health and Medical Sciences.
    Ekdahl, Karl
    Cause of death in individuals with chronic HBV and/or HCV infection, a nationwide community-based register study2008In: Journal of Viral Hepatitis, ISSN 1352-0504, E-ISSN 1365-2893, Vol. 15, no 7, p. 538-550Article in journal (Refereed)
    Abstract [en]

    Studies on chronic viral hepatitis and mortality have often been made on selected populations or in high-endemic countries. The aim of this study was to investigate the causes of death and the mortality rates in the nationwide cohorts of people chronically infected with hepatitis B virus (HBV) and/or hepatitis C virus (HCV) in Sweden, a low-endemic country. All notifications on chronic HBV infection and HCV infection 1990-2003 were linked to the Cause of Death Register. A total of 9517 people with chronic HBV infection, 34 235 people with HCV infection and 1601 with chronic HBV-HCV co-infection were included, and the mean observation times were 6.4, 6.3 and 7.9 years, respectively. The mortality in the cohorts was compared with age- and gender-specific mortality in the general population and standardized mortality ratios (SMR) were calculated. All-cause mortality was significantly increased, SMR 2.3 (HBV), 5.8 (HCV) and 8.5 (HBV-HCV), with a great excess liver-related mortality in all cohorts, SMR 21.7, 35.5 and 46.2, respectively. In HCV and HBV-HCV infected there was an increased mortality due to drug-related psychiatric diagnoses (SMR: 20.7 and 27.6) and external causes (SMR: 12.4 and 11.4), predominantly at younger age. To conclude, this study demonstrated an increased all-cause mortality, with a great excess mortality from liver disease, in all cohorts. In people with HCV infection the highest excess mortality in younger ages was from drug-related and external reasons.

    PMID: 18397223 [PubMed - indexed for MEDLINE]

  • 24.
    Einberg, Afrodite Psaros
    et al.
    Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Karolinska University Hospital, Stockholm, Sweden.
    Duberg, Ann-Sofi
    Örebro University, School of Medical Sciences. Department of Infectious Diseases, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Filipovich, Olga
    North-Western State Medical University of I.I.Mechnikov, Saint Petersburg, Russia.
    Nyström, Jessica
    Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, Stockholm, Sweden.
    Zhirkov, Anton
    Science Research Institute of Children's Infections, Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia.
    Brenndörfer, Erwin Daniel
    Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, Stockholm, Sweden.
    Frelin, Lars
    Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, Stockholm, Sweden.
    Rukoiatkina, Elena
    Maternity Hospital No. 16, Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia; Department of Pediatrics, Gynecology and Female Reproductology, Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia.
    Lobzin, Yuriy
    Science Research Institute of Children's Infections, Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia.
    Sällberg, Matti
    Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, Stockholm, Sweden.
    Fischler, Björn
    Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Karolinska University Hospital, Stockholm, Sweden.
    Lutckii, Anton
    Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, Stockholm, Sweden; Science Research Institute of Children's Infections.
    Lack of association between interleukin 28B polymorphism and vertical transmission of hepatitis C2017In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 65, no 6, p. 608-612Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Single genetic nucleotide polymorphism (rs12979860) near the gene for Interleukin 28B (IL28B), is known to be of importance for frequency of spontaneous clearance and treatment outcome in interferon based therapies in patients with hepatitis C virus (HCV) infection. The aim of this study was to investigate if IL28B polymorphism in children and/or their mothers plays a role in vertical transmission of HCV (HCV-VT).

    METHODS: Plasma samples from 59 infected women, 76 uninfected children born to infected mothers, and 47 children with known vertically transmitted HCV infection, were analysed for IL28B polymorphism and classified by the IL28B genotype (C/C, C/T and T/T) as well as by viral genotype.

    RESULTS: The proportion of children with genotype C/C was the same in the vertically infected (36%, 17/47) and the exposed uninfected children (38%, 29/76). No difference was seen when stratifying for viral genotype. There was no association between mothers' IL28B genotype and the risk of vertical transmission.

    CONCLUSION: Regardless of viral genotype we found no association between IL28B genotype and the risk of HCV-VT. The IL28B genotype CC, which has been shown to be favourable in other settings, was not protective of HCV-VT. Thus, other factors possibly associated with the risk of HCV-VT need to be explored.

  • 25.
    Gahrton, Caroline
    et al.
    Division of Infection and Dermatology, Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Håkansson, Anders
    Faculty of Medicine, Department of Clinical Sciences Lund, Lund University, Psychiatry, Lund, Sweden; Region Skåne, Malmö Addiction Center, Clinical Research Unit, Malmö, Sweden.
    Kåberg, Martin
    Division of Infection and Dermatology, Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden.
    Jerkeman, Anna
    Faculty of Medicine, Department of Translational Medicine, Clinical Infection Medicine, Lund University, Malmö, Sweden.
    Häbel, Henrike
    Division of Biostatistics, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Dalgard, Olav
    Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
    Duberg, Ann-Sofi
    Örebro University, School of Medical Sciences. Department of Infectious Diseases.
    Aleman, Soo
    Division of Infection and Dermatology, Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Mortality among amphetamine users with hepatitis C virus infection: A nationwide study2021In: PLOS ONE, E-ISSN 1932-6203, Vol. 16, no 6, article id e0253710Article in journal (Refereed)
    Abstract [en]

    AIMS: To investigate liver-related and all-cause mortality among amphetamine users with hepatitis C virus (HCV) infection and compare this with opioid users with HCV infection and the uninfected general population.

    METHODS: In this national register study of mortality in persons notified with HCV infection 1990-2015 and a substance-related diagnosis in Sweden, amphetamine users (n = 6,509) were compared with opioid users (n = 5,739) and a matched comparison group without HCV infection/substance use (n = 152,086).

    RESULTS: Amphetamine users were observed for 91,000 years and 30.1% deceased. Crude liver-related mortality was 1.8 times higher in amphetamine users than opioid users (crude mortality rate ratio 1.78, 95% CI 1.45-2.19), but there was no significant difference when adjusting for age and other defined risk factors. An alcohol-related diagnosis was associated with liver-related death and was more common among amphetamine users. Crude and adjusted liver-related mortality was 39.4 and 5.8 times higher, respectively, compared with the uninfected group. All-cause mortality was lower than in opioid users (adjusted mortality rate ratio 0.78, 95% CI 0.73-0.84), but high compared with the uninfected group. External causes of death dominated in younger ages whereas liver-related death was more common among older individuals.

    CONCLUSIONS: This national register study presents a higher crude risk of liver-related death among HCV-infected amphetamine users compared with opioid users or the uninfected general population. The higher risk of liver-related death compared with opioid users may be explained by lower competing death risk and higher alcohol consumption. Treatment of HCV infection and alcohol use disorders are needed to reduce the high liver-related mortality.

  • 26.
    Gahrton, Caroline
    et al.
    Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
    Lindahl, K.
    Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
    Westman, G.
    Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden.
    Öhrn, F.
    Center for Innovation, Karolinska University Hospital, Stockholm, Sweden.
    Dalgard, O.
    Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Division of Medicine and Laboratory Sciences, University of Oslo, Oslo, Norway.
    Duberg, Ann-Sofi
    Örebro University, School of Medical Sciences. Department of Infectious Diseases.
    Lidman, C.
    Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
    Said, K.
    Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden; Department of Upper Gastrointestinal Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Aleman, S.
    Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
    Prevalence of viremic hepatitis C virus, hepatitis B virus, or HIV infection and vaccination status among Swedish prisoners2018Conference paper (Other academic)
  • 27.
    Gahrton, Caroline
    et al.
    Department of Infectious Diseases, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
    Westman, Gabriel
    Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden.
    Lindahl, Karin
    Department of Infectious Diseases, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
    Öhrn, Fredrik
    Center for Innovation, Karolinska University Hospital, Stockholm, Sweden.
    Dalgard, Olav
    Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
    Lidman, Christer
    Department of Infectious Diseases, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
    Nilsson, Lars-Håkan
    The Swedish Prison and Probation Service, Norrköping, Sweden.
    Said, Karouk
    Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden; Department of Upper Gastrointestinal Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Duberg, Ann-Sofi
    Örebro University, School of Medical Sciences. Department of Infectious Diseases.
    Aleman, Soo
    Prevalence of Viremic hepatitis C, hepatitis B, and HIV infection, and vaccination status among prisoners in Stockholm County2019In: BMC Infectious Diseases, E-ISSN 1471-2334, Vol. 19, no 1, article id 955Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Identification and knowledge of settings with high prevalence of hepatitis C virus (HCV) infection is important when aiming for elimination of HCV. The primary aim of this study was to estimate the prevalence of viremic HCV infection among Swedish prisoners. Secondary aims were to estimate the prevalence of hepatitis B surface antigen (HBsAg), human immunodeficiency virus (HIV), and the proportion who have received hepatitis B virus (HBV) vaccination.

    METHODS: A cross-sectional study of all incarcerated persons (n = 667) at all prisons (n = 9) in Stockholm County was conducted. All prisoners are routinely offered opt-in screening for HCV antibodies (anti-HCV), HCV RNA, HBsAg, anti-HBs, anti-HBc and HIV Ag/Ab at prison in Sweden. Data on the results of these tests and the number of received HBV vaccine doses were collected from the prison medical records. The parameters of HCV RNA, anti-HCV, and occurrence of testing for HCV were analysed in multiple logistic regression models in relation to age, sex and prison security class.

    RESULTS: The median age was 35 (IQR 26-44) years, and 93.4% were men. Seventy-one percent (n = 471) had been tested for anti-HCV, 70% (n = 465) for HBsAg and 71% (n = 471) for HIV. The prevalence of anti-HCV, HCV RNA, HBsAg and HIV Ag/Ab was 17.0, 11.5, 1.9, and 0.2%, respectively among tested persons. The proportion of prisoners who had received full HBV vaccination was 40.6% (n = 271) among all study subjects.

    CONCLUSIONS: The prevalence of viremic HCV infection among Swedish prisoners in Stockholm County was 11.5%, which is high in comparison to the general population. Therefore, when aiming for the WHO goal of HCV elimination, prisons could suit as a platform for identification and treatment of HCV infection. There is a need to increase testing for blood-borne viruses and to improve vaccination coverage against HBV in Swedish prisons.

  • 28.
    Hofmann, Jonathan N.
    et al.
    Div Canc Epidemiol & Genet, National Cancer Institute, Bethesda MD, USA.
    Törner, Anna
    Dept Epidemiol, Swedish Inst Infect Dis Control, Solna, Sweden.
    Chow, Wong-Ho
    Div Canc Epidemiol & Genet, National Cancer Institute, Bethesda MD, USA.
    Ye, Weimin
    Dept Med Epidemiol & Biostat, Karolinska Institute, Stockholm, Sweden.
    Purdue, Mark P
    Div Canc Epidemiol & Genet, National Cancer Institute, Bethesda MD, USA.
    Duberg, Ann-Sofi
    Dept Infect Dis, Örebro University Hosp, Örebro, Sweden.
    Risk of kidney cancer and chronic kidney disease in relation to hepatitis C virus infection: a nationwide register-based cohort study in Sweden2011In: European Journal of Cancer Prevention, ISSN 0959-8278, E-ISSN 1473-5709, Vol. 20, no 4, p. 326-30Article in journal (Refereed)
    Abstract [en]

    Chronic hepatitis C virus (HCV) infection is an established cause of liver cancer, and recent studies have suggested a link with kidney cancer. The aim of this study was to evaluate risk of kidney cancer in relation to HCV infection in a nationwide registry-based study of Swedish residents diagnosed with HCV between 1990 and 2006. A total of 43 000 individuals with chronic HCV infection were included, and the mean follow-up time was 9.3 years. Observed kidney cancer incidence and mortality in the cohort were compared with expected values based on the age-adjusted and sex-adjusted rates in the general population. Risk of hospitalization for other chronic kidney disease was also evaluated using Cox proportional hazards regression. No association between HCV infection and risk of kidney cancer was observed [standardized incidence ratio with 1-year lag=1.2; 95% confidence interval (CI): 0.8-1.7]. Risk of hospitalization for noncancer kidney disease was significantly elevated in the HCV cohort, with significantly stronger associations observed among women than among men [hazard ratio=5.8 (95% CI: 4.2-7.9) and 3.9 (95% CI: 3.2-4.8) for women and men, respectively]. Results of this study do not support the hypothesis that chronic HCV infection confers an increased risk of kidney cancer. However, we did find an association between HCV infection and chronic kidney disease, particularly among women. Given inconsistent findings in the literature, it is premature to consider HCV infection to be a risk factor for kidney cancer.

  • 29.
    Holmström, M.
    et al.
    Coagulation Unit, Department of Medicine Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Nangarhari, A.
    Department of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Öhman, J.
    Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Duberg, Ann-Sofi
    Örebro University, School of Medical Sciences. Department of Infectious Diseases, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Majeed, A.
    Coagulation Unit, Department of Medicine Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Aleman, S.
    Department of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Long-term liver-related morbidity and mortality related to chronic hepatitis C virus infection in Swedish patients with inherited bleeding disorders2016In: Haemophilia, ISSN 1351-8216, E-ISSN 1365-2516, Vol. 22, no 6, p. e494-e501Article in journal (Refereed)
    Abstract [en]

    Introduction: Hepatitis C virus (HCV) infection is common in patients with inherited bleeding disorders treated with clotting factor concentrates prior to the introduction of viral inactivation of these products. The long-term consequences of hepatitis C infection in Swedish patients are not fully understood.

    Aim: To examine the impact of HCV infection on liver-related morbidity and mortality in Swedish patients with inherited bleeding disorders.

    Methods: We retrospectively collected data on 183 patients with inherited bleeding disorders infected with HCV who attended the Coagulation Unit at Karolinska University Hospital, Sweden. Data regarding end-stage liver disease (ESLD), defined as presence of ascites, encephalopathy, variceal bleeding, hepatocellular carcinoma or liver-related death, were collected from the patient records and the national registers.

    Results: The median follow-up time was 35.9 years (IQR 29.0-41.2). A total of 41% had achieved sustained virological response (SVR) after treatment. In total, 14.2% developed ESLD at the median age of 52.6 years (IQR 46.5-64.7). Nineteen (35.8%) of all deaths were due to liver-related causes. Co-infection with human immunodeficiency virus (HIV), older age at time of infection and severe form of bleeding disorder was associated with higher risk of developing ESLD, while SVR was a strong protective factor.

    Conclusions: This study demonstrated that liver-related morbidity and mortality was significant in patients with bleeding disorders and HCV infection in Sweden. Patients with HCV-infection should be candidates for treatment with the new highly effective antiviral drugs, since SVR proved to be a strong protective factor.

  • 30.
    Huang, Jiaqi
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden .
    Magnusson, Måns
    Department of Analysis and Prevention, Swedish Institute for Communicable Disease Control, Solna, Sweden .
    Törner, Anna
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden .
    Ye, Weimin
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden .
    Duberg, Ann-Sofi
    Örebro University Hospital. Department of Infectious Diseases.
    Risk of pancreatic cancer among individuals with hepatitis C or hepatitis B virus infection: a nationwide study in Sweden2013In: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 109, no 11, p. 2917-2923Article in journal (Refereed)
    Abstract [en]

    Background: A few studies indicated that hepatitis C and hepatitis B virus (HCV/HBV) might be associated with pancreatic cancer risk. The aim of this nationwide cohort study was to examine this possible association.

    Methods: Hepatitis C virus- and hepatitis B virus-infected individuals were identified from the national surveillance database from 1990 to 2006, and followed to the end of 2008. The pancreatic cancer risk in the study population was compared with the general population by calculation of Standardized Incidence Ratios (SIRs), and with a matched reference population using a Cox proportional hazards regression model to calculate hazard ratios (HRs).

    Results: In total 340 819 person-years in the HCV cohort and 102 295 in the HBV cohort were accumulated, with 34 and 5 pancreatic cancers identified, respectively. The SIRHCV was 2.1 (95% confidence interval, CI: 1.4, 2.9) and the SIRHBV was 1.4 (0.5, 3.3). In the Cox model analysis, the HR for HCV infection was 1.9 (95% CI: 1.3, 2.7), diminishing to 1.6 (1.04, 2.4) after adjustment for potential confounders.

    Conclusion: Our results indicated that HCV infection might be associated with an increased risk of pancreatic cancer but further studies are needed to verify such association. The results in the HBV cohort indicated an excess risk, however, without statistical significance due to lack of power.

  • 31.
    Kamal, Habiba
    et al.
    Department of Infectious Diseases, Karolinska University Hospital, Solna, Sweden; Department of Medicine, Karolinska Institutet, Solna, Sweden.
    Falconer, Karolin
    Department of Infectious Diseases, Karolinska University Hospital, Solna, Sweden; Department of Medicine, Karolinska Institutet, Solna, Sweden.
    Westman, Gabriel
    Medical Sciences, Uppsala University, Uppsala, Sweden.
    Duberg, Ann-Sofi
    Örebro University, School of Medical Sciences. Department of Infectious Diseases.
    Weiland, Ola R. H. J.
    Department of Infectious Diseases, Karolinska University Hospital, Solna, Sweden; Department of Medicine, Karolinska Institutet, Solna, Sweden.
    Wejstal, Rune
    Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Carlssson, Tony
    Department of Infectious Diseases, Danderyd University Hospital, Danderyd, Sweden.
    Kampmann, Christian
    Department of Infectious Diseases, Skåne University Hospital, Lund, Sweden.
    Björkman, Per
    Department of Infectious Diseases, Lund University, Lund, Sweden.
    Nystedt, Anders
    Department of Infectious Diseases, Sunderby Hospital, Södra Sunderbyn, Sweden.
    Cardell, Kristina
    Department of Infectious Diseases and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Svensson, Stefan
    Department of Infectious Diseases and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Stenmark, Stephan
    Department of Infectious Diseases, University Hospital of Umeå, Umeå, Sweden; Department of Translational Medicine, Lund University, Lund, Sweden.
    Wedemeyer, Heiner
    Klinik für Gastroenterologie und Hepatologie, University Hospital, Essen, Germany.
    Aleman, Soo
    Department of Infectious Diseases, Karolinska University Hospital, Solna, Sweden; Department of Medicine, Karolinska Institutet, Solna, Sweden.
    Long-Term Liver-Related Outcomes in Hepatitis B and D Co-Infected Patients in Sweden2018In: Hepatology, ISSN 0270-9139, E-ISSN 1527-3350, Vol. 68, no Suppl.1, p. 1190A-1191AArticle in journal (Refereed)
  • 32.
    Kamal, Habiba
    et al.
    Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
    Fornes, Romina
    Centre for Translational Microbiome Research (CTMR), Department of Microbiology, Tumor and Cell biology (MTC), Karolinska Institutet, Stockholm, Sweden.
    Simin, Johanna
    Centre for Translational Microbiome Research (CTMR), Department of Microbiology, Tumor and Cell biology (MTC), Karolinska Institutet, Stockholm, Sweden.
    Stål, Per
    Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden; Department of Upper GI, Karolinska University Hospital, Stockholm, Sweden.
    Duberg, Ann-Sofi
    Örebro University, School of Medical Sciences. Department of Infectious Diseases.
    Brusselaers, Nele
    Centre for Translational Microbiome Research (CTMR), Department of Microbiology, Tumor and Cell biology (MTC), Karolinska Institutet, Stockholm, Sweden.
    Aleman, Soo
    Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
    Risk of hepatocellular carcinoma in hepatitis B and D virus co-infected patients: A systematic review and meta-analysis of longitudinal studies2021In: Journal of Viral Hepatitis, ISSN 1352-0504, E-ISSN 1365-2893, Vol. 28, no 10, p. 1431-1442Article, review/survey (Refereed)
    Abstract [en]

    Hepatitis D virus (HDV) infection causes a severe chronic viral hepatitis with accelerated development of liver cirrhosis and decompensation, but whether it further increases the risk of hepatocellular carcinoma (HCC) is unclear. We performed a comprehensive systematic review of the published literature and meta-analysis to assess the risk of HCC in HDV and hepatitis B virus (HBV) co-infected, compared to HBV mono-infected patients. The study was conducted per a priori defined protocol, including only longitudinal studies, thus excluding cross-sectional studies. Random-effects models were used to determine aggregate effect sizes (ES) with 95% confidence intervals (CI). Meta-regression was used to examine the associations among study level characteristics. Twelve cohort studies comprising a total of 6099 HBV/HDV co-infected and 57,620 chronic HBV mono-infected patients were analysed. The overall pooled ES showed that HBV/HDV co-infected patients were at 2-fold increased risk of HCC compared to HBV mono-infected patients (ES = 2.12, 95% CI 1.14-3.95, I2  = 72%, N = 12). A six-fold significant increased risk of HCC was noted among HIV/HBV/HDV triple-infected, compared to HIV/HBV co-infected patients. The magnitude of ES did not differ significantly after adjustment for study design and quality, publication year and follow-up duration in univariable meta-regression analysis. This systematic review and meta-analysis shows that infection with HDV is associated with a 2-fold higher risk of HCC development compared to HBV mono-infection. HCC surveillance strategies taking this increased risk into account, and new treatment options against HDV, are warranted.

  • 33.
    Kamal, Habiba
    et al.
    Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden; Centre for Bioinformatics and Biostatistics, Karolinska Institute, Stockholm, Sweden.
    Ingre, Michael
    Centre for Bioinformatics and Biostatistics, Karolinska Institute, Stockholm, Sweden; Department of Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Stål, Per
    Centre for Bioinformatics and Biostatistics, Karolinska Institute, Stockholm, Sweden; Department of Medical Sciences, Section of Infectious diseases, Uppsala University, Uppsala Sweden.
    Westman, Gabriel
    SDS Life Science, Stockholm, Sweden.
    Bruce, Daniel
    Department of Gastroenterology and Hepatology, University of Hannover, Germany.
    Wedemeyer, Heiner
    Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden.
    Duberg, Ann-Sofi
    Örebro University, School of Medical Sciences. Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden.
    Aleman, Soo
    Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden; Centre for Bioinformatics and Biostatistics, Karolinska Institute, Stockholm, Sweden.
    Age-specific and sex-specific risks for HCC in African-born persons with chronic hepatitis B without cirrhosis2023In: Hepatology communications, E-ISSN 2471-254X, Vol. 7, no 12, article id e0334Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The international recommendations of HCC surveillance for African-born persons with chronic hepatitis B (CHB) without cirrhosis are divergent, probably due to scarce data on incidence rate (IR) for HCC.

    METHODS: We assembled a cohort with prospectively collected data of Swedish residents of African origin with diagnosed CHB without cirrhosis at baseline from 1990 to 2015. Data from nationwide registers were used to calculate the sex-specific IR and IR ratio (incidence rate ratios) in relation to age, comorbidities, and birth region, using a generalized linear model with a log-link function and Poisson distribution.

    RESULTS: Among 3865 African-born persons with CHB without cirrhosis at baseline, 31 (0.8%; 77.4% men) developed HCC during a median of 11.1 years of follow-up, with poor survival after HCC diagnosis. The mean age at HCC diagnosis was 46.8 (SD±14.7; range 23-79) in men. HCC IR exceeded the recommended surveillance threshold of 0.2%/year at ages 54 and 59 years in men and women, respectively, and at ages 20-40 years if HCV or HDV co-infection was present. African-born men with CHB had an incidence rate ratios of 10.6 (95% CI 4.4-31.5) for HCC compared to matched African-born peers without CHB, and an incidence rate ratios of 35.3 (95% CI 16.0-88.7) compared to a matched general population.

    CONCLUSIONS: African-born men with CHB without cirrhosis reached an IR of 0.2%/year between 50 and 60 years, and at younger ages if HCV or HDV co-infection was present. Our findings need further confirmation, and new cost-effectiveness analyses specific for young populations are needed, to provide personalized and cost-effective HCC surveillance.

  • 34.
    Kamal, Habiba
    et al.
    Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden.
    Lindahl, Karin
    Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden.
    Ingre, Michael
    Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden; Centre for Bioinformatics and Biostatistics, Karolinska Institute, Stockholm, Sweden.
    Gahrton, Caroline
    Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden.
    Karkkonen, Kerstin
    Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden.
    Nowak, Piotr
    Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden.
    Vesterbacka, Jan
    Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden.
    Stål, Per
    Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden; Department of Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Wedemeyer, Heiner
    Department of Gastroenterology and Hepatology, University of Hannover, Hannover, Germany.
    Duberg, Ann-Sofi
    Örebro University, School of Medical Sciences. Department of Infectious Diseases, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Aleman, Soo
    Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden.
    The cascade of care for patients with chronic hepatitis delta in Southern Stockholm, Sweden for the past 30 years2024In: Liver international, ISSN 1478-3223, E-ISSN 1478-3231, Vol. 44, no 1, p. 228-240Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: Previous studies have shown suboptimal screening for hepatitis D virus (HDV) among patients with chronic hepatitis B (CHB). This study presents the cascade of care for HDV infection in a major secondary referral centre in Southern Stockholm, Sweden.

    METHODS: HBsAg+ve patients attending Karolinska University Hospital (KUH) from 1992 to 2022 were identified. The prevalence of anti-HDV and/or HDV RNA positivity, interferon (IFN) therapy and maintained virological responses (MVR) after HDV treatment were assessed. Also, time to anti-HDV testing was analysed in relation to liver-related outcomes with logistic regression.

    RESULTS: Among 4095 HBsAg+ve persons, 3703 (90.4%) underwent an anti-HDV screening; within a median of 1.8 months (range 0.0-57.1) after CHB diagnosis. This screening rate increased over time, to 97.9% in the last decade. Overall, 310 (8.4%) were anti-HDV+ve, of which 202 (65.2%) were HDV RNA+ve. Eighty-five (42%) received IFN, and 9 (10.6%) achieved MVR at the last follow-up. The predictive factors for anti-HDV screening were Asian origin, diagnosis after the year 2012, HIV co-infection (negative factor) and HBV DNA level < 2000 IU/mL in univariable analysis, while HIV co-infection was the only remaining factor in multivariable analysis. Delayed anti-HDV test >5 years was independently associated with worsened liver-related outcomes (adjusted odds ratio = 7.6, 95% CI 1.8-31.6).

    CONCLUSION: Higher frequency of HDV screening than previously published data could be seen among CHB patients at KUH in a low-endemic setting. Receiving a delayed screening test seems to be associated with worse outcomes, stressing the need of a strategy for timely HDV diagnosis.

  • 35.
    Kamal, Habiba
    et al.
    Department of Infectious Diseases, Karolinska University Hospital, Sweden; Department of Medicine Huddinge, Karolinska Institutet, Sweden.
    Westman, Gabriel
    Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden.
    Falconer, Karolin
    Department of Infectious Diseases, Karolinska University Hospital, Sweden; Department of Medicine Huddinge, Karolinska Institutet, Sweden.
    Duberg, Ann-Sofi
    Department of Infectious Diseases, Örebro University Hospital, Sweden.
    Weiland, Ola
    Department of Infectious Diseases, Karolinska University Hospital, Sweden; Department of Medicine Huddinge, Karolinska Institutet, Sweden.
    Haverinen, Susanna
    Department of Infectious Diseases, Karolinska University Hospital, Sweden.
    Wejstål, Rune
    Department of Infectious Diseases, Sahlgrenska University Hospital, Sweden.
    Carlsson, Tony
    Department of Infectious Diseases, Danderyd University Hospital, Sweden.
    Kampmann, Christian
    Department of Infectious Diseases, Skåne University Hospital Lund, Sweden.
    Larsson, Simon
    Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Björkman, Per
    Department of Infectious Diseases, Skåne University Hospital Malmö, Sweden.
    Nystedt, Anders
    Department of Infectious Diseases, Sunderby Hospital, Sweden.
    Cardell, Kristina
    Department of Infectious Diseases, Sunderby Hospital, Sweden.
    Svensson, Stefan
    Department of Infectious Diseases and Department of Clinical and Experimental Medicine, Linköping University, Sweden.
    Stenmark, Stephan
    Department of Infectious Diseases, University Hospital of Umeå, Sweden.
    Wedemeyer, Heiner
    Department of Gastroenterology and Hepatology, University of Essen.
    Aleman, Soo
    Department of Infectious Diseases, Karolinska University Hospital, Sweden; Department of Medicine Huddinge, Karolinska Institutet, Sweden.
    Long-Term Study of Hepatitis Delta Virus Infection at Secondary Care Centers: The Impact of Viremia on Liver-Related Outcomes2020In: Hepatology, ISSN 0270-9139, E-ISSN 1527-3350, Vol. 72, no 4, p. 1177-1190Article in journal (Refereed)
    Abstract [en]

    BACKGROUND & AIMS: Hepatitis delta virus (HDV) infection is associated with fast progression to liver cirrhosis and liver complications. Previous studies have though been mainly from tertiary care centers, with risk for referral bias towards patients with worse outcomes. Furthermore, the impact of HDV viremia per se on liver-related outcomes is not really known outside HIV co-infection setting. We have therefore evaluated the long-term impact of HDV viremia on liver-related outcomes in a nationwide cohort of hepatitis B and D co-infected patients, cared for at secondary care centers in Sweden.

    APPROACH & RESULTS: In total 337 anti-HDV positive patients including 233 patients with HDV RNA viremia and 91 without HDV viremia at baseline were retrospectively studied, with a mean follow-up of 6.5 years (range 0.5-33.1). The long-term risks for liver-related events (i.e. hepatocellular carcinoma [HCC], hepatic decompensation, or liver-related death/transplantation) were assessed, using Cox regression analysis. The risk for liver-related events and HCC was 3.8 and 2.6 fold higher, respectively, in patients with HDV viremia compared to those without viremia, although the latter was not statistically significant. Among HDV viremic patients with no baseline cirrhosis, the cumulative risk of being free of liver cirrhosis or liver-related events was 81.9% and 64.0%, after 5 and 10 years of follow-up, respectively. This corresponds to an incidence rate of 0.04 per person-year.

    CONCLUSION: HDV RNA viremia is associated with a 3.8 fold higher risk for liver-related outcomes. The prognosis was rather poor for non-cirrhotic patients with HDV viremia at baseline, but it was nevertheless more benign than previous estimates from tertiary centers. Our findings can be of importance when treatment decision making, and evaluating outcomes of upcoming new antivirals against HDV.

  • 36.
    Kileng, Hege
    et al.
    Department of Clinical Medicine, Gastroenterology and Nutrition Research Group, UiT The Arctic University of Norway, Tromsø, Norway; Department of Medicine, University Hospital of North Norway, Tromsø, Norway.
    Kjellin, Midori
    Department of Medical Sciences, Section of Clinical Microbiology, Uppsala University, Uppsala, Sweden.
    Akaberi, Dario
    Department of Medical Sciences, Section of Clinical Microbiology, Uppsala University, Uppsala, Sweden.
    Bergfors, Assar
    Department of Medical Sciences, Section of Clinical Microbiology, Uppsala University, Uppsala, Sweden.
    Duberg, Ann-Sofi
    Örebro University, School of Medical Sciences. Department of Infectious Diseases.
    Wesslén, Lars
    Gävle Hospital, Gävle, Sweden.
    Danielsson, Astrid
    Falun Hospital, Falun, Sweden.
    Gangsøy Kristiansen, Magnhild
    Nordlandssykehuset Bodø, Department of Clinical Medicine (IKM), UiT The Artic University of Tromsø, Bodø, Norway.
    Gutteberg, Tore
    Department of Medical Biology, Research Group for Host-Microbe Interactions, UiT The Arctic University of Norway, Tromsø, Norway; Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway.
    Goll, Rasmus
    Department of Clinical Medicine, Gastroenterology and Nutrition Research Group, UiT The Arctic University of Norway, Tromsø, Norway; Department of Medicine, University Hospital of North Norway, Tromsø, Norway.
    Lannergård, Anders
    Department of Medical Sciences, Section of Infectious Diseases, Uppsala University Hospital, Uppsala, Sweden.
    Lennerstrand, Johan
    Department of Medical Sciences, Section of Clinical Microbiology, Uppsala University, Uppsala, Sweden.
    Personalized treatment of hepatitis C genotype 1a in Norway and Sweden 2014-2016: a study of treatment outcome in patients with or without resistance-based DAA-therapy2018In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 53, no 10-11, p. 1347-1353Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Resistance-associated substitutions (RASs) may impair treatment response to direct-acting antivirals (DAA) in hepatitis C virus (HCV) treatment. We investigated the effects of baseline NS3-RASs (Q80K and R155K) and clinically relevant NS5A-RASs in patients with HCV genotype (GT) 1a infection on treatment outcome, with or without resistance-based DAA-treatment. This multi-center study was carried out between 2014 and 2016.

    PATIENTS/METHODS: Treatment in the intervention group (n = 92) was tailored to baseline resistance. Detection of NS3-RAS led to an NS5A-inhibitor-based regimen and detection of NS5A-RAS to a protease-inhibitor regimen. Patients without baseline RAS in the intervention group and all patients in the control group (n = 101) received recommended standard DAA-treatment.

    RESULTS: The sustained virologic response rates (SVR) in the intervention and control groups were 97.8% (90/92) and 93.1% (94/101), respectively (p = .174). A trend toward higher SVR-rate in cirrhotic patients (p = .058) was noticed in the intervention group compared to the control group with SVR-rates 97.5% (39/40) and 83.3% (35/42), respectively. All patients with baseline NS3 (Q80K/R155K) or NS5A-RASs in the intervention group achieved SVR with personalized resistance-based treatment. In the control group, five patients with Q80K or R155K at baseline were treated with simeprevir + sofosbuvir and treatment failed in two of them. Furthermore, one of three patients who failed ledipasvir + sofosbuvir treatment had NS5A-RASs at baseline.

    CONCLUSIONS: In line with the findings of the OPTIMIST-2 trial for Q80K and the EASL-guidelines 2016 for NS5A-RASs, baseline RASs appeared to have an impact on treatment outcome albeit a statistical significance was not observed in this low-prevalence population.

  • 37.
    Kileng, Hege
    et al.
    Tromsø University Hospital, Tromsø, Norway.
    Kjellin, Midori
    Medical Science, Uppsala University, Uppsala, Sweden.
    Bergfors, Assar
    Medical Science, Uppsala University, Uppsala, Sweden.
    Duberg, Ann-Sofi
    Örebro University, School of Medical Sciences. Öebro University Hospital, Örebro, Sweden.
    Wesslen, Lars
    Gävle Hospital, Gävle, Sweden.
    Danielsson, Astrid
    Falun Hospital, Falun, Sweden.
    Kristiansen, Magnhild G.
    Bodø Hospital, Bodø, Norway.
    Gutteberg, Tore
    Tromsø University Hospital, Tromsø, Norway.
    Lannergard, Anders
    Medical Science, Uppsala University, Uppsala, Sweden.
    Lennerstrand, Johan
    Medical Science, Uppsala University, Uppsala, Sweden.
    Effect of pre-existing Hepatitis C NS3 Q80K variant in Genotype la and NS5A Y93H variant in Genotype 3 for interferon-free treatment combinations with direct antiviral agents (DAAs): Real-life experience from a multicenter study in Sweden and Norway2016In: Hepatology, ISSN 0270-9139, E-ISSN 1527-3350, Vol. 64, no Suppl. S1, p. 1001A-1001A, article id 2014Article in journal (Other academic)
  • 38.
    Kjellin, Midori
    et al.
    Department of Medical Sciences, Section of Clinical Microbiology, Uppsala University, Uppsala, Sweden.
    Kileng, Hege
    Gastroenterology and Nutrition Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway; Department of Medicine, University Hospital of North Norway, Tromsø, Norway.
    Akaberi, Dario
    Department of Medical Sciences, Section of Clinical Microbiology, Uppsala University, Uppsala, Sweden.
    Palanisamy, Navaneethan
    Institute of Biology II, University of Freiburg, Freiburg, Germany; Institute of Biology II, University of Freiburg, Freiburg, Germany.
    Duberg, Ann-Sofi
    Örebro University, School of Medical Sciences. Department of Infectious Diseases.
    Danielsson, Astrid
    Department of Infectious Diseases, Falun Hospital, Falun, Sweden.
    Kristiansen, Magnhild Gangsøy
    Nordlandssykehuset Bodø, Department of Clinical Medicine (IKM), UiT the Artic University of Tromsø, Tromsø, Norway.
    Nöjd, Johan
    Nordlandssykehuset Bodø, Department of Clinical Medicine (IKM), UiT the Artic University of Tromsø, Tromsø, Norway.
    Aleman, Soo
    Department of Infectious Diseases, Karolinska University Hospital/Karolinska Institutet, Stockholm, Sweden.
    Gutteberg, Tore
    Research Group for Host-Microbe Interactions, Department of Medical Biology, UiT the Arctic University of Norway, Tromsø, Norway; Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway.
    Goll, Rasmus
    Gastroenterology and Nutrition Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway; Department of Medicine, University Hospital of North Norway, Tromsø, Norway.
    Lannergård, Anders
    Department of Medical Sciences, Section of Infectious Diseases, Uppsala University Hospital, Uppsala, Sweden.
    Lennerstrand, Johan
    Department of Medical Sciences, Section of Clinical Microbiology, Uppsala University, Uppsala, Sweden.
    Effect of the baseline Y93H resistance-associated substitution in HCV genotype 3 for direct-acting antiviral treatment: real-life experience from a multicenter study in Sweden and Norway2019In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 54, no 8, p. 1042-1050Article in journal (Refereed)
    Abstract [en]

    Background: The NS5A resistance-associated substitution (RAS) Y93H is found quite frequently (5-10%) at baseline in direct-acting antiviral agents (DAA) treatment-naive genotype (GT) 3a patients when studied by the population-sequencing method (cut-off 20%). This RAS may impair HCV DAA treatment response, since it possesses a high fold in vitro resistance to daclatasvir (DCV) and velpatasvir (VEL) in GT 3. We investigated the effect of baseline Y93H in patients with GT 3a infection on treatment outcome, with or without resistance-based DAA-treatment during 2014-2017.

    Patients/Methods: Treatment in the intervention group (n = 130) was tailored to baseline resistance-findings by population-sequencing method. Detection of baseline Y93H above 20% prompted a prolonged treatment duration of NS5A-inhibitor and sofosbuvir (SOF) and/or addition of ribavirin (RBV). Patients without baseline Y93H in the intervention group and all patients in the control group (n = 78) received recommended standard DAA-treatment.

    Results: A higher sustained virologic response rate (SVR) in the intervention group was shown compared to the control group at 95.4% (124/130) and 88.5% (69/78), respectively (p = .06). All five patients with baseline Y93H in the intervention group achieved SVR with personalised treatment based on results from resistance testing; either with the addition of RBV or prolonged treatment duration (24w). In the control group, 2/4 patients with Y93H at baseline treated with ledipasvir/SOF/RBV or DCV/SOF without RBV, failed treatment.

    Conclusion: The results from this real-life study are in accordance with the findings of the randomised controlled trials in 2015 and the EASL-guidelines of 2016, thus, baseline Y93H impacts on DCV and VEL treatment outcome.

  • 39.
    Kåberg, Martin
    et al.
    Department of Medicine Huddinge, Division of Infectious Diseases, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden.
    Larsson, Simon B.
    Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Addiction, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Jerkeman, Anna
    Department of Translational Medicine, Section of Infectious Disease, Malmö, Lund University, Malmö, Sweden.
    Nystedt, Anders
    Department of Translational Medicine, Section of Infectious Disease, Malmö, Lund University, Malmö, Sweden.
    Duberg, Ann-Sofi
    Örebro University, School of Medical Sciences. Department of Infectious Diseases.
    Kövamees, Jan
    AbbVie AB, Stockholm, Sweden.
    Ydreborg, Magdalena
    Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Aleman, Soo
    Department of Medicine Huddinge, Division of Infectious Diseases, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
    Büsch, Katharina
    AbbVie AB, Stockholm, Sweden; Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet at Karolinska University Hospital, Huddinge, Stockholm, Sweden.
    Alanko Blomé, Marianne
    Department of Translational Medicine, Section of Infectious Disease, Malmö, Lund University, Malmö, Sweden; Center for Communicable Disease Control, Region Skåne, Sweden.
    Weiland, Ola
    Department of Medicine Huddinge, Division of Infectious Diseases, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
    Söderholm, Jonas
    AbbVie AB, Stockholm, Sweden; Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet at Karolinska University Hospital, Huddinge, Stockholm, Sweden.
    High risk of non-alcoholic liver disease mortality in patients with chronic hepatitis C with illicit substance use disorder2020In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 55, no 5, p. 574-580Article in journal (Refereed)
    Abstract [en]

    Aims: Hepatitis C virus (HCV) is a slowly progressive disease, often transmitted among people who inject drugs (PWID). Mortality in PWID is high, with an overrepresentation of drug-related causes. This study investigated the risk of death in patients with chronic hepatitis C virus (HCV) infection with or without illicit substance use disorder (ISUD).

    Methods: Patients with HCV were identified using the Swedish National Patient Registry according to the International Classification of Diseases-10 (ICD-10) code B18.2, with ≤5 matched comparators from the general population. Patients with ≥2 physician visits with ICD-10 codes F11, F12, F14, F15, F16, or F19 were considered to have ISUD. The underlying cause of death was analyzed for alcoholic liver disease, non-alcoholic liver disease, liver cancer, drug-related and external causes, non-liver cancers, or other causes. Mortality risks were assessed using the standardized mortality ratio (SMR) with 95% CIs and Cox regression analyses for cause-specific hazard ratios.

    Results: In total, 38,186 patients with HCV were included, with 31% meeting the ISUD definition. Non-alcoholic liver disease SMRs in patients with and without ISUD were 123.2 (95% CI, 103.7-145.2) and 69.4 (95% CI, 63.8-75.3), respectively. The significant independent factors associated with non-alcoholic liver disease mortality were older age, being unmarried, male sex, and having ISUD.

    Conclusions: The relative risks for non-alcoholic liver disease mortality were elevated for patients with ISUD. Having ISUD was a significant independent factor for non-alcoholic liver disease. Thus, patients with HCV with ISUD should be given HCV treatment to reduce the risk for liver disease.

  • 40.
    Lagging, Martin
    et al.
    Dept Infect Dis, Inst Biomed, Univ Gothenburg, Gothenburg, Sweden.
    Duberg, Ann-Sofi
    Dept Infect Dis, Örebro Univ Hosp, Örebro, Sweden.
    Wejstål, Rune
    Dept Infect Dis, Inst Biomed, Univ Gothenburg, Gothenburg, Sweden; Swedish Reference Grp Antiviral Therapy RAV, Karolinska Univ Hosp, Stockholm, Sweden.
    Weiland, Ola
    Dept Infect Dis, Karolinska Univ Hosp, Stockholm, Sweden.
    Lindh, Magnus
    Dept Infect Dis, Inst Biomed, Univ Gothenburg, Gothenburg, Sweden.
    Aleman, Soo
    Dept Infect Dis, Karolinska Univ Hosp, Stockholm, Sweden.
    Josephson, Filip
    Medical Products Agency (Läkemedelsverket), Uppsala, Sweden.
    Treatment of hepatitis C virus infection in adults and children: updated Swedish consensus recommendations2012In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 44, no 7, p. 502-521Article in journal (Refereed)
    Abstract [en]

    Swedish recommendations for the treatment of hepatitis C virus (HCV) infection were updated at a recent expert meeting. Therapy for acute HCV infection should be initiated if spontaneous resolution does not occur within 12 weeks. The recommended standard-of-care therapy for chronic HCV genotype 1 infection is an HCV protease inhibitor in combination with peginterferon (peg-IFN) and ribavirin. Treatment is strongly recommended in patients with bridging fibrosis and cirrhosis, whereas in patients with less advanced fibrosis, deferring therapy may be preferential in light of likely therapeutic improvements in the near future. Patients with chronic genotype 2/3 infection should generally be treated with peg-IFN and ribavirin for 24 weeks. In patients with a very rapid viral response (i.e. HCV RNA below 1000 IU/ml on day 7), or favourable baseline characteristics and undetectable HCV RNA week 4, treatment can be shortened to 12-16 weeks, provided that no dose reductions are needed.

  • 41.
    Lagging, Martin
    et al.
    Department of Infectious Diseases, Institute of Biomedicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Wejstål, Rune
    Department of Infectious Diseases, Institute of Biomedicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Duberg, Ann-Sofi
    Örebro University, School of Medical Sciences. Department of Infectious Diseases.
    Aleman, Soo
    Department of Medicine, Division of Infectious Diseases, Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden.
    Weiland, Ola
    Department of Medicine, Division of Infectious Diseases, Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden.
    Westin, Johan
    Department of Infectious Diseases, Institute of Biomedicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Swedish Reference Group for Antiviral Therapy (RAV), Stockholm, Sweden.
    Treatment of hepatitis C virus infection for adults and children: updated Swedish consensus guidelines 20172018In: Infectious Diseases, ISSN 2374-4235, E-ISSN 2374-4243, Vol. 50, no 8, p. 569-583Article, review/survey (Refereed)
    Abstract [en]

    Aim: Following the approval of two new therapeutic combinations within the European Union in 2017, the former Swedish recommendations for the treatment of hepatitis C virus (HCV) infection from 2016 were deemed in need of updating.

    Materials and methods: An expert meeting to this end was held in Stockholm, Sweden in October 2017.

    Results and conclusions: An interferon-free combination of direct-acting antiviral agents is now recommended for all patients with chronic HCV infection, regardless of liver fibrosis stage, in order to limit morbidity and spread of the disease. An extended discussion of treatment for people who inject drugs in order to diminish transmission is included.

  • 42.
    Leblebicioglu, Hakan
    et al.
    Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University, Medical School, Samsun, Turkey.
    Arends, Joop E.
    Internal Medicine and Infectious Diseases, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands.
    Ozaras, Resat
    Department of Infectious Diseases and Clinical Microbiology, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey.
    Corti, Giampaolo
    Infectious Disease Unit, University of Florence School of Medicine, Florence, Italy.
    Santos, Lurdes
    Infectious Diseases Service C Hospitalar São João, Faculty of Medicine, Alameda Professor Hernani Monteiro, Porto, Portugal.
    Boesecke, Christoph
    Department of Medicine I, Bonn University, Bonn, Germany.
    Ustianowski, Andrew
    Infectious Diseases & Tropical Medicine and Research Lead, North Western Infectious Diseases Unit, Pennine Acute Hospitals NHS Trust, North Manchester General Hospital, Manchester, UK.
    Duberg, Ann-Sofi
    Örebro University, School of Medical Sciences. Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden.
    Ruta, Simona
    Stefan S. Nicolau Institute of Virology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
    Salkic, Nermin N.
    Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.
    Husa, Petr
    Infectious Diseases, Masaryk University, Brno, Czech Republic; Infectious Diseases, University Hospital Brno, Brno, Czech Republic.
    Lazarevic, Ivana
    Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
    Pineda, Juan A.
    Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, Spain.
    Pshenichnaya, Natalia Yurievna
    Rostov State Medical University, Rostov-on-Don, Russia.
    Tsertswadze, Tengiz
    Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia.
    Matičič, Mojca
    Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre, Ljubljana, Slovenia.
    Puca, Edmond
    Department of Infection Diseases, University Hospital Center, Tirane, Albania.
    Abuova, Gulzhan
    Infectious Diseases Department, South - Kazakhstan State Pharmaceutical Academy, Shymkent, Kazakhstan.
    Gervain, Judit
    Division Hepato-Pancreatology, 1st Department of Gastroenterology and Molecular Diagnostic Laboratory, "Szent György" Teaching Hospital Székesfehérvár, Székesfehérvár, HungaryDivision Hepato-Pancreatology, 1st Department of Gastroenterology and Molecular Diagnostic Laboratory, "Szent György" Teaching Hospital Székesfehérvár, Székesfehérvár, Hungary.
    Bayramli, Ramin
    Department of Microbiology and Immunology, Azerbaijan Medical University, Educational Therapeutic Hospital, Baku, Azerbaijan.
    Ahmeti, Salih
    Infectious Disease Clinic, University Clinical Centre of Kosova, Faculty of Medicine, Prishtina University, Pristina, Kosovo.
    Koulentaki, Mairi
    Department of Gastroenterology, University Hospital of Heraklion, Heraklion, Crete, Greece.
    Kilani, Badreddine
    Service des Maladies Infectieuses, Faculté de Médecine de Tunis, Université Tunis EL Manar, Hôpital la Rabta, Tunis, Tunisia.
    Vince, Adriana
    University Hospital of Infectious Diseases, Zagreb School of Medicine, Zagreb, Croatia.
    Negro, Francesco
    Divisions of Gastroenterology and Hepatology of Clinical Pathology, University Hospital of Geneva, Geneva, Switzerland.
    Sunbul, Mustafa
    Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University, Medical School, Samsun, Turkey.
    Salmon, Dominique
    Infectious Diseases, Hôpitaux Universitaires Paris Centre, Université Paris Descartes, Paris, France.
    Availability of hepatitis C diagnostics and therapeutics in European and Eurasia countries2018In: Antiviral Research, ISSN 0166-3542, E-ISSN 1872-9096, Vol. 150, p. 9-14Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Treatment with direct acting antiviral agents (DAAs) has provided sustained virological response rates in >95% of patients with chronic hepatitis C virus (HCV) infection. However treatment is costly and market access, reimbursement and governmental restrictions differ among countries. We aimed to analyze these differences among European and Eurasian countries.

    METHODS: A survey including 20-item questionnaire was sent to experts in viral hepatitis. Countries were evaluated according to their income categories by the World Bank stratification.

    RESULTS: Experts from 26 countries responded to the survey. As of May 2016, HCV prevalence was reported as low (≤1%) in Croatia, Czech Republic, Denmark, France, Germany, Hungary, the Netherlands, Portugal, Slovenia, Spain, Sweden, UK; intermediate (1-4%) in Azerbaijan, Bosnia and Herzegovina, Italy, Kosovo, Greece, Kazakhstan, Romania, Russia, Serbia and high in Georgia (6.7%). All countries had national guidelines except Albania, Kosovo, Serbia, Tunisia, and UK. Transient elastography was available in all countries, but reimbursed in 61%. HCV-RNA was reimbursed in 81%. PegIFN/RBV was reimbursed in 54% of the countries. No DAAs were available in four countries: Kazakhstan, Kosovo, Serbia, and Tunisia. In others, at least one DAA combination with either PegIFN/RBV or another DAA was available. In Germany and the Netherlands all DAAs were reimbursed without restrictions: Sofosbuvir and sofosbuvir/ledipasvir were free of charge in Georgia.

    CONCLUSION: Prevalence of HCV is relatively higher in lower-middle and upper-middle income countries. DAAs are not available or reimbursed in many Eurasia and European countries. Effective screening and access to care are essential for reducing liver-related morbidity and mortality.

  • 43. Lindh, Magnus
    et al.
    Uhnoo, Ingrid
    Bläckberg, Joans
    Duberg, Ann-Sofi
    Örebro University, School of Health and Medical Sciences.
    Friman, Stybjörn
    Fischler, Björn
    Karlström, Olof
    Norkrans, Gunnar
    Reichard, Olle
    Sangfeldt, Per
    Söderström, Ann
    Sönnerborg, Anders
    Weiland, Ola
    Wejstål, Rune
    Wiström, Johan
    Treatment of chronic hepatitis B infection: an update of Swedish recommendations2008In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 40, no 6-7, p. 436-450Article, review/survey (Refereed)
    Abstract [en]

    The main goal for treatment of chronic hepatitis B is to prevent complications such as liver cirrhosis or hepatocellular carcinoma. Knowledge from population studies of the long-term risk of chronic HBV infection, as well as the recent introduction of pegylated interferon and additional nucleoside analogues has changed the therapeutic situation. Recently, a Swedish expert panel convened to update the national recommendations for treatment. The panel recommends treatment for patients with active HBV infection causing protracted liver inflammation or significant liver fibrosis, verified by liver histology. In general, pegylated interferon alpha-2a is recommended as first-line treatment, in particular for HBeAg-positive patients with HBV genotypes A or B. Among nucleoside analogues, entecavir is the first choice and adefovir or tenofovir can be used as alternatives. Lamivudine monotherapy is not recommended due to the high risk of resistance development. Combinations of nucleoside analogues such as tenofovir and lamivudine or emtricitabine are alternatives for patients with non-response or infection with resistant variants, or as first choice for patients with advanced liver disease. Nucleoside analogue treatment should be monitored to detect primary non-response and virological breakthrough. Special recommendations are given for HBV/HIV coinfected patients, immunosuppressed patients, children, and for treatment before and after liver transplantation. The present guideline is translated from Swedish, where it is published on the MPA and RAV websites (www.mpa.se and www.rav.nu.se) including 7 separate papers based on thorough literature search. The complete reference list can be received from the Medical Products Agency upon request.

  • 44.
    Lybeck, Charlotte
    et al.
    Örebro University, School of Medical Sciences. Department of Infectious Diseases.
    Brenndörfer, Erwin D.
    Department of Laboratory Medicine, Division of Clinical Microbiology.
    Sällberg, Matti
    Department of Laboratory Medicine, Division of Clinical Microbiology.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Unit; Department of Epidemiology and Public Health, University College London, London, UK.
    Aleman, Soo
    Department of Gastroenterology and Hepatology; Department of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden.
    Duberg, Ann-Sofi
    Örebro University, School of Health Sciences. Department of Infectious Diseases, Faculty of Medicine and Health.
    Long-term follow-up after cure from chronic hepatitis C virus infection shows occult hepatitis and a risk of hepatocellular carcinoma in noncirrhotic patients2019In: European Journal of Gastroenterology and Hepathology, ISSN 0954-691X, E-ISSN 1473-5687, Vol. 31, no 4, p. 506-513Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Curing hepatitis C virus (HCV) infection primarily aims to prevent severe liver complications. Our objectives were to investigate the long-term presence and impact of occult HCV infection (OCI) and to study the outcomes in terms of liver disease after virological cure.

    PATIENTS AND METHODS: A total of 97 patients with achieved sustained virological response (SVR) during 1990-2005 were followed either by a clinical follow-up (FU) visit with blood sampling and liver elastography (n=54) or through national registries for outcomes (n=43). To diagnose OCI among patients with SVR, a highly sensitive method was used to detect HCV-RNA traces in whole blood. The FU duration was a median of 10.5 years, with samples up to 21.5 years after the end of treatment (EOT).

    RESULTS: The majority of patients [52 (96%)] were HCV-RNA negative at FU, and regression of fibrosis was statistically significant. OCI was found in two (4%) of them at 8 and 9 years after EOT. These patients had F1 and F2 fibrosis before treatment and F2 at FU, but no other abnormal findings. Three previously noncirrhotic men were diagnosed with hepatocellular carcinoma 8-11 years after EOT.

    CONCLUSION: Occult infection could be detected many years after the achievement of SVR but was not associated with the serious liver disease. The majority had persistent viral eradication and regression of fibrosis after SVR. However, an increased risk of hepatocellular carcinoma may persist in the long term after SVR even in noncirrhotic patients. Further studies with FU after direct-acting antiviral therapy and on the long-term impact after cure are needed.

  • 45.
    Lybeck, Charlotte
    et al.
    Örebro University, School of Medical Sciences. Department of Infectous diseases.
    Bruce, D.
    Department of Statistics, Scandinavian Development Services, Danderyd, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences.
    Aleman, S.
    Department of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden.
    Duberg, Ann-Sofi
    Örebro University, School of Medical Sciences. Department of Infectous diseases.
    A national study of risk for non-liver cancer in people with hepatitis C treated with direct acting antivirals or an interferon-based regimen2018In: Journal of Hepatology, ISSN 0168-8278, E-ISSN 1600-0641, Vol. 68, no Suppl. 1, p. S263-S264Article in journal (Other academic)
    Abstract [en]

    Background and Aims: Direct acting antivirals (DAA) against hepatitis C virus (HCV) have been shown to have an immune modulatory effect, with a possibly decreased tumour specific CD8 T cell response. Reports indicative of a high risk for hepatocellular carcinoma or advanced tumours early after DAA treatment, have raised concerns about whether the risk for non-liver cancer could be increased. Therefore, our aim was to study the early incidence of non-liver cancer after initiation of DAA or interferon (IFN-based) therapy in a national HCV cohort.

    Method: All diagnosed HCV-infected persons in Sweden, their antiviral treatments, non-liver cancer or death/emigration were identified retrospectively, using the national HCV-surveillance register and other national registers. Cox regression was used to compare persons treated with DAAs (n = 1,920), IFN-based therapy(n = 2,586) or no HCV therapy (n = 13,872) between 2009 and 2015. Persons with a previous cancer diagnosis (5.7%) were studied separately. Age was used as the time-scale, and the analyses were stratified by sex and adjusted for the Charlson comorbidity index.

    Results: In total 492 non-liver cancers were diagnosed, with 222 among persons with no previous cancer and 270 new cancer diagnoses among those with previous cancer. Among persons with no previous cancer, 21, 24 and 177 developed non-liver cancer following DAA, IFN-based and no treatment, respectively. The corresponding numbers for those with previous cancer were 25, 20 and 225, respectively. The hazard ratios (and 95% confidence intervals) for non-liver cancer in the no previous cancer group are 1.35 (0.66–2.76; p = 0.41) for men and 1.75 (0.59–5.18; p = 0.31) for women with DAA treatment, compared with IFN treatment. For those with previous cancer, the corresponding hazard ratios are 1.03 (0.41–2.57; p = 0.95) for men and 0.86 (0.35–2.13; p = 0.75) for women with DAA treatment.

    Conclusion: This study did not demonstrate any significantly increased risk for non-liver cancer early after DAA therapy initiation. The hazard ratio was slightly increased among those with outprevious cancer, but the cancers were few and the results were not statistically significant. Further studies with higher numbers of DAA treated patients and longer follow-up are needed to fully explore thisissue.

  • 46.
    Lybeck, Charlotte
    et al.
    Örebro University, School of Medical Sciences. Department of Infectious Diseases.
    Bruce, Daniel
    Scandinavian Development Services, Stockholm, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Aleman, Soo
    Department of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden; Department of Gastroenterology and Hepatology, Karolinska Institutet, Stockholm, Sweden.
    Duberg, Ann-Sofi
    Örebro University, School of Medical Sciences.
    Risk of extrahepatic cancer in a nationwide cohort of hepatitis C virus infected persons treated with direct-acting antivirals2021In: GastroHep, E-ISSN 1478-1239, Vol. 3, no 3, p. 185-195Article in journal (Refereed)
    Abstract [en]

    Background and aims: Direct-acting antivirals (DAAs) against HCV have an immune modulatory effect, this could possibly lead to a decreased tumour control. We, therefore, aimed to assess the risk of extrahepatic cancer (EHC) during and the first years after DAA treatment.

    Methods and Results: This is a nationwide cohort study with prospectively collected data for 19 685 persons with HCV, 4013 DAA treated, 3071 interferon (IFN) treated and 12 601 untreated, from 2008 to 2016. Follow-up time was maximum 3 years. The risk for EHC was compared between the groups using Cox regression analyses, with adjustment for age and Charlson Comorbidity Index (CCI). The HCV-infected groups were also compared with matched cohorts without HCV from the general population. In total 341 EHCs were identified, 84, 43 and 214 EHC in the DAA, IFN and untreated group respectively. The EHC risk in DAA treated compared with IFN treated was doubled, but when adjusted for age and CCI the HR was 1.07 (95% CI 0.74-1.56). Compared with the general population, the HR of EHC for the DAA group was 1.45 (CI 1.13-1.86), with the difference remaining statistically significant after adjusting for CCI.

    Conclusion: We found no increased risk for EHC associated with DAA therapy after adjustment for age and CCI. An increased risk of EHC in DAA treated compared with the general population was though seen, and attention should be paid to this association in the ageing population with a history of HCV infection.

  • 47.
    Lybeck, Charlotte
    et al.
    Örebro University, School of Medical Sciences. Department of Infectious Diseases.
    Bruce, Daniel
    Scandinavian Development Services, SDS lifescience, Stockholm, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden; Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK .
    Aleman, Soo
    Department of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden; Department of Gastroenterology and Hepatology, Karolinska Institutet, Stockholm, Sweden.
    Duberg, Ann-Sofi
    Örebro University, School of Medical Sciences. Department of Infectious Diseases.
    Risk of hepatocellular carcinoma after DAA treatment and association with pretreatment liver stiffness in a national hepatitis C cohortManuscript (preprint) (Other academic)
  • 48.
    Lybeck, Charlotte
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Infectious Diseases.
    Bruce, Daniel
    Cytel Inc, Stockholm, Sweden.
    Szulkin, Robert
    Cytel Inc, Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden; Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Aleman, Soo
    Department of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden; Department of Gastroenterology and Hepatology, Karolinska Institutet, Stockholm, Sweden.
    Duberg, Ann-Sofi
    Örebro University, School of Medical Sciences. Department of Infectious Diseases, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Long-term risk of HCC in a DAA-treated national hepatitis C cohort, and a proposed risk score2024In: Infectious Diseases, ISSN 2374-4235, E-ISSN 2374-4243Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The risk of hepatocellular carcinoma (HCC) remains elevated in cirrhotic hepatitis C patients with sustained virological response (SVR) after DAA treatment. We assessed long-term HCC risk stratified by pretreatment liver stiffness measurement (LSM) and developed a risk score algorithm.

    METHODS: This register-based nationwide cohort study of 7,227 DAA-treated patients with SVR evaluated annual HCC incidence rates (IRs) and cumulative incidences stratified by pretreatment LSM. The association between LSM and HCC risk was analyzed using multivariate Cox regression. A risk score algorithm was developed and internally validated in 2,664 individuals with LSM >9.5 kPa, assigning each patient a score based on risk factors, proportionally weighted by the association with HCC risk.

    RESULTS: During a median follow-up of 1.8 years (3.2 years for LSM ≥12.5 kPa), 92 patients (1.3%) developed HCC. The IRs for LSM 9.5-12.4, 12.5-19.9 and ≥20 kPa were 0.21, 0.99 and 2.20 HCC/100 PY, respectively, with no significant risk reduction during follow-up. The HRs (and 95% CI) for LSM 9.5-12.5, 12.5-19.9 and ≥20 kPa are 1.19 (0.43-3.28), 4.66 (2.17-10.01) and 10.53 (5.26-21.08), respectively. Risk score models including FIB-4, alcohol, diabetes, age and LSM effectively stratified patients with LSM >9.5 kPa into low-, intermediate- and high-risk groups, with a Harrell's C of 0.799. Notably, 48% with LSM ≥9.5 kPa and 27% ≥12.5 kPa were classified as low-risk.

    CONCLUSION: Pretreatment LSM is associated with HCC risk, which remains stable during the initial five years post-SVR. The HCC risk score algorithm effectively identifies low-risk patients, who may not require HCC surveillance.

  • 49.
    Malm, Kerstin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Duberg, Ann-Sofi
    Örebro University, School of Medicine, Örebro University, Sweden.
    Sundqvist, Martin
    Fredlund, Hans
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Andersson, Sören
    Evaluation of a hepatitis C virus core antigen assay to monitor viral load in patients on antiviral therapy and in untreated patientsManuscript (preprint) (Other academic)
  • 50.
    Millbourn, C.
    et al.
    Department of Medicine Huddinge, Unit of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden; Dept of Infectious Diseases, I73, Karolinska University Hospital, Stockholm, Sweden.
    Lybeck, Charlotte
    Örebro University, School of Medical Sciences. Dept of Infectious Diseases, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Fadl, Helena
    Örebro University, School of Medical Sciences. Örebro University Hospital. Dept of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Fredlund, Hans
    Dept Clin Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Lindahl, K.
    Department of Medicine Huddinge, Unit of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden; Dept of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Duberg, Ann-Sofi
    Örebro University, School of Medical Sciences. Dept of Infectious Diseases, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Screening for HCV in pregnant women and their partners2017In: Journal of Hepatology, ISSN 0168-8278, E-ISSN 1600-0641, Vol. 66, no 1, p. S404-S405Article in journal (Refereed)
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