MARIO GUIMARAES PESSOA
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Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
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- Prevention, Diagnosis, Evaluation, and Treatment of Hepatitis C in Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2022 Clinical Practice Guideline(2023) AWAN, Ahmed Arslan Yousuf; BERENGUER, Marina C.; BRUCHFELD, Annette; FABRIZI, Fabrizio; GOLDBERG, David S.; JIA, Jidong; KAMAR, Nassim; MOHAMED, Rosmawati; PESSOA, Mario Guimaraes; POL, Stanislas; SISE, Meghan E.; BALK, Ethan M.; GORDON, Craig E.; ADAM, Gaelen; CHEUNG, Michael; EARLEY, Amy; MARTIN, Paul; JADOUL, MichelDescription: The Kidney Disease: Improving Global Outcomes (KDIGO) 2022 clinical practice guideline on prevention, diagnosis, evaluation, and treatment of hepatitis C in chronic kidney disease (CKD) is an update of the 2018 guideline from KDIGO.Methods: The KDIGO Work Group (WG) updated the guideline, which included reviewing and grading new evidence that was identified and summarized. As in the previous guideline, the WG used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to appraise evidence and rate the strength of recommendations and used expert judgment to develop recommendations. New evidence led to updating of recommendations in the chapters on treatment of hepatitis C virus (HCV) infection in patients with CKD (Chapter 2), management of HCV infection before and after kidney transplant (Chapter 4), and diagnosis and management of kidney disease associated with HCV infection (Chapter 5). Recommendations in chapters on detection and evaluation of hepatitis C in CKD (Chapter 1) and prevention of HCV transmission in hemodialysis units (Chapter 3) were not updated because of an absence of significant new evidence.Recommendations: The 2022 updated guideline includes 43 graded recommendations and 20 ungraded recommendations, 7 of which are new or modified on the basis of the most recent evidence and consensus among the WG members. The updated guidelines recommend expanding treatment of hepatitis C with sofosbuvir-based regimens to patients with CKD glomerular filtration rate categories G4 and G5, including those receiving dialysis; expanding the donor pool for kidney transplant recipients by accepting HCV-positive kidneys regardless of the recipient's HCV status; and initiating direct-acting antiviral treatment of HCV-infected patients with clinical evidence of glomerulonephritis without requiring kidney biopsy. The update also addresses the use of immunosuppressive regimens in such patients.
- Global prevalence, cascade of care, and prophylaxis coverage of hepatitis B in 2022: a modelling study(2023) RAZAVI-SHEARER, Devin M.; GAMKRELIDZE, Ivane; PAN, Calvin Q.; JIA, Jidong; BERG, Thomas; GRAY, Richard T.; LIM, Young-Suk; CHEN, Chien-Jen; OCAMA, Ponsiano; DESALEGN, Hailemichael; ABBAS, Zaigham; ABDALLAH, Ayat R.; AGHEMO, Alessio; AHMADBEKOVA, Sabohat; AHN, Sang Hoon; AHO, Inka; AKARCA, Ulus S.; MASRI, Nasser M. Al; ALALWAN, Abduljaleel M.; ALAVIAN, Seyed M.; AL-BUSAFI, Said A.; ALEMAN, Soo; ALFALEH, Faleh Z.; ALGHAMDI, Abdullah S.; AL-HAMOUDI, Waleed K.; ALJUMAH, Abdulrahman A.; AL-NAAMANI, Khalid; AL-RIFAI, Ahmad; ALSERKAL, Yousif M.; ALTRAIF, Ibrahim H.; AMARSANAA, Jazag; ANDERSON, Motswedi; I, Monique Andersson; ARMSTRONG, Paige; ASSELAH, Tarik; ATHANASAKIS, Kostas; BAATARKHUU, Oidov; BEN-ARI, Ziv; BENSALEM, Aicha; BESSONE, Fernando; BIONDI, Mia J.; BIZRI, Abdul Rahman N.; BLACH, Sarah; BRAGA, Wornei S. M.; BRANDAO-MELLO, Carlos E.; BROSGART, Carol L.; BROWN, Kimberly A.; JR, Robert S. Brown; BRUGGMANN, Philip; BRUNETTO, Maurizia R.; BUTI, Maria; CABEZAS, Joaquin; CASANOVAS, Teresa; CHAE, Chungman; CHAN, Henry Lik Yuen; CHEINQUER, Hugo; CHEN, Pei-Jer; CHENG, Kent Jason G.; CHEON, Myeong-Eun; CHIEN, Cheng-Hung; CHOUDHURI, Gourdas; CHRISTENSEN, Peer Brehm; CHUANG, Wan-Long; CHULANOV, Vladimir; GARZA, Laura E. Cisneros; COFFIN, Carla S.; CONTRERAS, Fernando A.; COPPOLA, Nicola; CORNBERG, Markus; COWIE, Benjamin; CRAMP, Matthew E.; CRAXI, Antonio; CRESPO, Javier; CUI, Fuqiang; CUNNINGHAM, Chris W.; DALGARD, Olav; KNEGT, Robert J. De; LEDINGHEN, Victor De; DORE, Gregory J.; DRAZILOVA, Sylvia; DUBERG, Ann-Sofi; EGEONU, Steve; ELBADRI, Mohammed; EL-KASSAS, Mohamed; EL-SAYED, Manal H.; ESTES, Chris; ETZION, Ohad; FARAG, Elmobashar; FERRADINI, Laurent; FERREIRA, Paulo R. A.; FLISIAK, Robert; FORNS, Xavier; FRANKOVA, Sona; FUNG, James; GANE, Edward J.; GARCIA, Virginia; GARCIA-SAMANIEGO, Javier; GEMILYAN, Manik; GENOV, Jordan; GHEORGHE, Liliana S.; GHOLAM, Pierre M.; GISH, Robert G.; GOLEIJ, Pouya; GOTTFREDSSON, Magnus; GREBELY, Jason; GSCHWANTLER, Michael; GUINGANE, Nanelin Alice; HAJARIZADEH, Behzad; HAMID, Saeed S.; HAMOUDI, Waseem; HARRIS, Aaron M.; HASAN, Irsan; HATZAKIS, Angelos; HELLARD, Margaret E.; HERCUN, Julian; HERNANDEZ, Javier; HOCKICKOVA, Ivana; HSU, Yao-Chun; HU, Ching-Chih; HUSA, Petr; JANICKO, Martin; JANJUA, Naveed; JARCUSKA, Peter; JAROSZEWICZ, Jerzy; JELEV, Deian; JERUMA, Agita; JOHANNESSEN, Asgeir; KABERG, Martin; KAITA, Kelly D. E.; KALIASKAROVA, Kulpash S.; KAO, Jia-Horng; KELLY-HANKU, Angela; KHAMIS, Faryal; KHAN, Aamir G.; KHEIR, Omer O.; KHOUDRI, Ibtissam; KONDILI, Loreta A.; KONYSBEKOVA, Aliya; KRISTIAN, Pavol; KWON, Jisoo A.; LAGGING, Martin; LALEMAN, Wim; LAMPERTICO, Pietro; LAVANCHY, Daniel; LAZARO, Pablo; V, Jeffrey Lazarus; LEE, Alice U.; LEE, Mei-Hsuan; LIAKINA, Valentina; LUKSIC, Boris; MALEKZADEH, Reza; MALU, Abraham O.; MARINHO, Rui T.; MENDES-CORREA, Maria Cassia; MERAT, Shahin; MESHESHA, Berhane Redae; MIDGARD, Havard; MOHAMED, Rosmawati; MOKHBAT, Jacques E.; MOONEYHAN, Ellen; MORENO, Christophe; MORTGAT, Laure; MULLHAUPT, Beat; MUSABAEV, Erkin; MUYLDERMANS, Gaetan; NAVEIRA, Marcelo C. M.; NEGRO, Francesco; V, Alexander Nersesov; Van Thi Thuy Nguyen; NING, Qing; NJOUOM, Richard; NTAGIRABIRI, Renovat; NURMATOV, Zuridin S.; OGUCHE, Stephen; OMUEMU, Casimir E.; ONG, Janus P.; OPARE-SEM, Ohene K.; ORMECI, Necati; ORREGO, Mauricio; OSIOWY, Carla; V, George Papatheodoridis; PECK-RADOSAVLJEVIC, Markus; PESSOA, Mario G.; PHAM, Trang N. D.; PHILLIPS, Richard O.; PIMENOV, Nikolay; PINCAY-RODRIGUEZ, Loreley D. R.; PLASESKA-KARANFILSKA, Dijana; POP, Cora; POUSTCHI, Hossein; PRABDIAL-SING, Nishi N.; QURESHI, Huma; RAMJI, Alnoor; RAUTIAINEN, Henna; RAZAVI-SHEARER, Kathryn; REMAK, William M.; RIBEIRO, Sofia; RIDRUEJO, Ezequiel; RIOS-HINCAPIE, Cielo Y.; ROBALINO, Marcia C.; ROBERTS, Lewis R.; ROBERTS, Stuart K.; RODRIGUEZ, Manuel; ROULOT, Dominique; RWEGASHA, John; RYDER, Stephen D.; SADIROVA, Shakhlo; SAEED, Umar; SAFADI, Rifaat; SAGALOVA, Olga; SAID, Sanaa S.; SALUPERE, Riina; SANAI, Faisal M.; SANCHEZ-AVILA, Juan F.; SARASWAT, Vivek A.; SARGSYANTS, Narina; SARRAZIN, Christoph; SARYBAYEVA, Gulya; SCHRETER, Ivan; SEGUIN-DEVAUX, Carole; SETO, Wai-Kay; SHAH, Samir R.; I, Ala Sharara; SHEIKH, Mahdi; SHOUVAL, Daniel; SIEVERT, William; SIMOJOKI, Kaarlo; SIMONOVA, Marieta Y.; SINN, Dong Hyun; SONDERUP, Mark W.; SONNEVELD, Milan J.; SPEARMAN, C. Wendy; SPERL, Jan; STAUBER, Rudolf E.; STEDMAN, Catherine A. M.; SYPSA, Vana; TACKE, Frank; TAN, Soek-Siam; TANAKA, Junko; TERGAST, Tammo L.; TERRAULT, Norah A.; THOMPSON, Alexander J.; THOMPSON, Peyton J.; TOLMANE, Ieva; TOMASIEWICZ, Krzysztof; TSANG, Tak-Yin; UZOCHUKWU, Benjamin S. C.; WELZEN, Berend Van; VANWOLLEGHEM, Thomas; VINCE, Adriana; VOELLER, Alexis S.; WAHEED, Yasir; WAKED, Imam; WALLACE, Jack; WANG, Cong; WEIS, Nina; WONG, Grace L-H; WONG, Vincent W-S; WU, Jaw-Ching; YAGHI, Cesar G.; YESMEMBETOV, Kakharman; YIP, Terry C-F; YOSRY, Ayman; YU, Ming-Lung; YUEN, Man-Fung; YURDAYDIN, Cihan; ZEUZEM, Stefan; ZUCKERMAN, Eli; RAZAVI, Homie A.Background The 2016 World Health Assembly endorsed the elimination of hepatitis B virus (HBV) infection as a public health threat by 2030; existing therapies and prophylaxis measures make such elimination feasible, even in the absence of a virological cure. We aimed to estimate the national, regional, and global prevalence of HBV in the general population and among children aged 5 years and younger, as well as the rates of diagnosis, treatment, prophylaxis, and the future burden globally. Methods In this modelling study, we used a Delphi process with data from literature reviews and interviews with country experts to quantify the prevalence, diagnosis, treatment, and prevention measures for HBV infection. The PRoGReSs Model, a dyn amic Markov model, was used to estimate the country, regional, and global prevalence of HBV infection in 2022, and the effects of treatment and prevention on disease burden. The future incidence of morbidity and mortality in the absence of additional interventions was also estimated at the global level. Findings We developed models for 170 countries which resulted in an estimated global prevalence of HBV infection in 2022 of 3.2% (95% uncertainty interval 2.7-4.0), corresponding to 257.5 million (216.6-316.4) individuals positive for HBsAg. Of these individuals, 36.0 million were diagnosed, and only 6.8 million of the estimated 83.3 million eligible for treatment were on treatment. The prevalence among children aged 5 years or younger was estimated to be 0.7% (0.6-1.0), corresponding to 5.6 million (4.5-7.8) children with HBV infection. Based on the most recent data, 85% of infants received three-dose HBV vaccination before 1 year of age, 46% had received a timely birth dose of vaccine, and 14% received hepatitis B immunoglobulin along with the full vaccination regimen. 3% of mothers with a high HBV viral load received antiviral treatment to reduce mother-to-child transmission. Interpretation As 2030 approaches, the elimination targets remain out of reach for many countries under the current frameworks. Although prevention measures have had the most success, there is a need to increase these efforts and to increase diagnosis and treatment to work towards the elimination goals.
- Adjusted estimate of the prevalence of hepatitis delta virus in 25 countries and territories(2024) RAZAVI-SHEARER, Devin M.; BUTI, Maria; TACKE, Frank; TERRAULT, Norah A.; ZEUZEM, Stefan; ABBAS, Zaigham; AGHEMO, Alessio; AKARCA, Ulus S.; MASRI, Nasser M. Al; ALALWAN, Abduljaleel M.; BLOME, Marianne Alanko; ALEMAN, Soo; ALGHAMDI, Abdullah S.; ALGHAMDI, Mohammed; ALGHAMDI, Saad; AL-HAMOUDI, Waleed K.; ALI, Ela; ALJUMAH, Abdulrahman A.; ALTRAIF, Ibrahim H.; AMARSANAA, Jazag; ASSELAH, Tarik; BAATARKHUU, Oidov; BABAMETO, Adriana; BEN-ARI, Ziv; BERG, Thomas; BIONDI, Mia J.; BRAGA, Wornei S. M.; BRANDAO-MELLO, Carlos E.; BROWN JR., Robert S.; BRUNETTO, Maurizia R.; CABEZAS, Joaquin; CARDOSO, Mariana; CHAN, Henry Lik Yuen; CHEINQUER, Hugo; CHEN, Chien-Jen; CHEN, Pei-Jer; CHIEN, Cheng-Hung; CHILD, Hailey; CHUANG, Wan-Long; GARZA, Laura E. Cisneros; COCO, Barbara; COFFIN, Carla S.; COPPOLA, Nicola; CORNBERG, Markus; CRAXI, Antonio; CRESPO, Javier; CUKO, Liri; LEDINGHEN, Victor De; DUBERG, Ann-Sofi; ETZION, Ohad; FERRAZ, Maria Lucia G.; FERREIRA, Paulo R. A.; FORNS, Xavier; FOSTER, Graham R.; FUNG, James; GAETA, Giovanni B.; GARCIA-SAMANIEGO, Javier; GENOV, Jordan; GHEORGHE, Liliana S.; GHOLAM, Pierre M.; GISH, Robert G.; GLENN, Jeffrey; GOLDIS, Adrian; HAMID, Saeed S.; HERCUN, Julian; HSU, Yao-Chun; HU, Ching-Chih; HUANG, Jee-Fu; IDILMAN, Ramazan; JAFRI, Wasim S. M.; JANJUA, Naveed; JELEV, Deian; JERKEMAN, Anna; JIA, Jidong; KABERG, Martin; KAITA, Kelly D. E.; KAO, Jia-Horng; KHAN, Aamir G.; KIM, Do Young; KONDILI, Loreta A.; LAGGING, Martin; LAMPERTICO, Pietro; LAZARO, Pablo; V, Jeffrey Lazarus; LEE, Mei-Hsuan; LIM, Young-Suk; LOBATO, Cirley M. O.; MACEDO, Guilherme; MARINHO, Rui T.; MAROTTA, Paul J.; MARTINS, Alexanda; MENDES-CORREA, Maria Cassia; MENDEZ-SANCHEZ, Nahum; NAVAS, Maria-Cristina; NING, Qing; ORMECI, Necati; ORREGO, Mauricio; OSIOWY, Carla; PAN, Calvin Q.; PESSOA, Mario G.; PIRACHA, Zahra Z.; POP, Cora; RAMOS, Jose A. Presa; QURESHI, Huma; RAIMONDO, Giovanni; RAMJI, Alnoor; RAZAVI-SHEARER, Kathryn; RIBEIRO, Sofia; RIOS-HINCAPIE, Cielo Y.; RODRIGUEZ, Manuel; ROSENBERG, William M. C.; ROULOT, Dominique; RYDER, Stephen D.; SAEED, Umar; SAFADI, Rifaat; SANAI, Faisal M.; SANCHEZ-AVILA, Juan F.; SANTANTONIO, Teresa A.; SARRAZIN, Christoph; SETO, Wai-Kay; SHOUVAL, Daniel; SIMONOVA, Marieta Y.; TANAKA, Junko; TERGAST, Tammo L.; TSENDSUREN, Oyunsuren; VALENTE, Cristina; VILLALOBOS-SALCEDO, Juan Miguel; VOELLER, Alexis S.; WAHEED, Yasir; WONG, Grace L-H; WONG, Vincent W-S; WU, Jaw-Ching; I, Hwai- Yang; YIP, Terry C-F; YU, Ming-Lung; YUEN, Man-Fung; YURDAYDIN, Cihan; ZUCKERMAN, Eli; RAZAVI, Homie A.Background & Aims: Hepatitis delta virus (HDV) is a satellite RNA virus that requires the hepatitis B virus (HBV) for assembly and propagation. Individuals infected with HDV progress to advanced liver disease faster than HBV-monoinfected individuals. Recent studies have estimated the global prevalence of anti-HDV antibodies among the HBV-infected population to be 5-15%. This study aimed to better understand HDV prevalence at the population level in 25 countries/territories. Methods: We conducted a literature review to determine the prevalence of anti-HDV and HDV RNA in hepatitis B surface antigen (HBsAg)-positive individuals in 25 countries/territories. Virtual meetings were held with experts from each setting to discuss the findings and collect unpublished data. Data were weighted for patient segments and regional heterogeneity to estimate the prevalence in the HBV-infected population. The findings were then combined with The Polaris Observatory HBV data to estimate the anti-HDV and HDV RNA prevalence in each country/territory at the population level. Results: After adjusting for geographical distribution, disease stage and special populations, the anti-HDV prevalence among the HBsAg+ population changed from the literature estimate in 19 countries. The highest anti-HDV prevalence was 60.1% in Mongolia. Once adjusted for the size of the HBsAg+ population and HDV RNA positivity rate, China had the highest absolute number of HDV RNA+ cases. Conclusions: We found substantially lower HDV prevalence than previously reported, as prior meta-analyses primarily focused on studies conducted in groups/regions that have a higher probability of HBV infection: tertiary care centers, specific risk groups or geographical regions. There is large uncertainty in HDV prevalence estimates. The implementation of reflex testing would improve estimates, while also allowing earlier linkage to care for HDV RNA+ individuals. The logistical and economic burden of reflex testing on the health system would be limited, as only HBsAg+ cases would be screened.