Publications by authors named "Rafael Esteban"

Aim: To assess the feasibility and acceptability of massive hepatitis C virus (HCV) testing in point of care on the street using quick tests, determine the characteristics of the population included, and the prevalence of HCV infection in this population.

Methods: Cross-sectional community-based study including adult men who have sex with men (MSM) who attended the three most important LGTB+ events in Sitges (Catalonia, Spain) in 2022. Points of care were set up on tents on the street and attendees were offered voluntary anti-HCV antibody self-testing.

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Acute hepatitis E virus (HEV) infection is typically self-limiting and has a favourable prognosis. However, certain populations such as patients with pre-existing chronic liver disease may experience severe manifestations, including progression to acute-on-chronic liver failure (ACLF). Among viral hepatitis types, hepatitis A, E, and B are major causes of ACLF.

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Background: The WHO has set a goal to decrease viral hepatitis-related fatalities by 65% by 2030.

Aims: To locate and retrieve to care all individuals diagnosed with hepatitis B, D or C, and investigate why they were not linked to appropriate medical management.

Methods: We conducted a retrospective-prospective search for patients with hepatitis B, D or C virus (HBV, HDV and HCV) infection in the central laboratory database of the Barcelona northern health area (catchment population, 450,000).

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Article Synopsis
  • The introduction of sofosbuvir/velpatasvir (SOF/VEL-Epclusa®) marked a significant advancement in hepatitis C virus (HCV) treatment, demonstrating high cure rates in patients and aiding in HCV elimination efforts in Spain.
  • A Markov model simulation analyzed the clinical and economic impact of SOF/VEL on 30,488 chronic HCV patients over five years, showing it had a much better sustained viral response rate of 98.9% compared to 61.0% with prior therapies.
  • The results indicated that SOF/VEL significantly reduced liver complications and related healthcare costs, leading to savings of 197 million euros and lowering rates of severe outcomes like decompens
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Background: Undiagnosed cases of hepatitis C virus (HCV) infection result in significant morbidity and mortality, further transmission, and increased public health costs. Testing in emergency departments (EDs) is an opportunity to expand HCV screening. The goal of this project was to increase the proportion of eligible patients screened for HCV in urban areas.

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Background & Aims: Hepatitis B infection is the most frequent cause of chronic hepatitis and liver cancer worldwide. Active searching for individuals with chronic hepatitis B has been proposed as a strategy to achieve the elimination of this virus. The primary aim of this study was to link to specialists HBsAg-positive individuals detected in a laboratory database and to characterize individuals who were not linked to care.

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  • Many individuals with Hepatitis C virus (HCV) and Hepatitis B virus (HBV) infections are unaware of their conditions, especially vulnerable populations who struggle with access to healthcare; emergency departments often serve as their only healthcare point of contact.
  • A study conducted in emergency departments tested over 17,500 adults for HBsAg and HCV antibodies, discovering a higher prevalence than in the general population, with a significant percentage of positive cases previously unaware of their infections and successfully linking many to care.
  • The screening program demonstrated cost-effectiveness, notably in individuals aged 40-70 with HCV, suggesting that emergency department screenings could improve health outcomes and provide a cost-efficient intervention for viral hepatitis.
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Chronic hepatitis D (CHD) is a severe form of viral hepatitis that leads to liver cirrhosis and hepatocellular carcinoma. CHD is underdiagnosed, and this study aimed to assess the impact of hepatitis D reflex testing in HBsAg-positive individuals in Spain over the next 8 years. Two scenarios were compared: the current situation (7.

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Background & Aims: HBsAg proteins are useful to identify HBV inactive carriers (ICs), but data on chronic hepatitis D (CHD) are scarce. This study aimed to describe HBsAg composition in CHD, its changes during the evolution, and the potential association with clinical outcomes. In addition, we assess the composition of HBsAg across different HBV genotypes and validate previous results on HBsAg proteins in an independent HBV cohort.

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Background: Chronic hepatitis E virus (HEV) in persons with immune impairment has a progressive course leading to a rapid progression to liver cirrhosis. However, prospective data on chronic HEV is scarce. The aim of this study was to determine the prevalence and risk factors for chronic HEV infection in subjects with immune dysfunction and elevated liver enzymes.

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  • An estimated 290 million people worldwide have hepatitis B virus (HBV), with a prevalence of 0.4% in Spain, and many affected individuals are not receiving necessary care, which the project aims to address.
  • The study will retrospectively and prospectively evaluate HBsAg-positive patients in a large hospital setting, aiming to re-engage around 4,000 individuals who have not been linked to specialist care over the project duration.
  • A dedicated website and mobile app will be developed to provide information and enhance communication between patients and healthcare providers, and the project has received ethical approval for its implementation.
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Article Synopsis
  • - The study evaluated the effectiveness of Sofosbuvir (SOF)-based treatments for chronic hepatitis C in Spain from 2015-2019, showing improved patient outcomes compared to older therapies like peginterferon and ribavirin.
  • - SOF-based regimens yielded a sustained virological response (SVR) of 93-98% and significantly reduced complications such as decompensated cirrhosis (by 89%) and liver-related mortality (by 82%), while also providing substantial cost savings.
  • - Overall, the findings support SOF-based treatments as a cost-effective solution that enhances health outcomes for HCV patients in Spain, aligning with global health objectives set by the WHO.
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Background And Aims: Hepatitis B virus (HBV) biomarkers have been used for a better categorization of patients, even though the lack of simple algorithms and the impact of genotypes limit their application. Our aim was to assess the usefulness of noninvasive markers for the identification of HBV inactive carriers (ICs) in a single-point evaluation and to design a predictive model for their identification.

Methods: This retrospective-prospective study included 343 consecutive HBeAg-negative individuals.

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  • Tolvaptan (TV) is the first drug approved for treating autosomal dominant polycystic kidney disease (ADPKD), and its real-world effectiveness during the first year had not been previously documented.* -
  • In a study of 220 rapidly progressing patients, 163 (78.2%) completed one year of TV treatment, with the main reasons for stopping being side effects like aquaretic effects (11%), eGFR decline (5%), and liver toxicity (2.3%).* -
  • While TV caused a significant drop in estimated glomerular filtration rate (eGFR) in the first month, this decline was less severe compared to the two years before treatment, and TV was
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  • In 2016, a group called HepBCPPA created a plan called the HCV Elimination Manifesto to try to get rid of Hepatitis C in Europe by 2030.
  • Even though some countries have made progress, many are still not on track, especially after COVID-19 slowed down diagnoses and treatments.
  • To reach the goal, it's really important for government leaders to work together and support new actions, which was the purpose of the EU Policy Summit in March 2021.
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Background & Aims: Although EASL guidelines recommend anti-HDV testing in all HBsAg-positive individuals, HDV infection remains an underdiagnosed condition. We describe the impact of an HDV screening program by reflex anti-HDV testing in all HBsAg-positive samples and compare the results before and after its implementation.

Methods: In total, 2,236 HBsAg-positive determinations were included from January 2018 to December 2021.

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The measurement and interpretation of HBV DNA and RNA levels in HBV infected patients treated with antiviral therapy supports the objective of HBV disease management. Here, we quantified circulating HBV RNA through a standardized and sensitive assay in follow-up samples from both naive and treated patients as a marker of infection evolution. HBV DNA (HBV DNA for use in Cobas 6800/8800 Automated Roche Molecular Systems), RNA (Roche HBV RNA Investigational Assay for use in the Cobas 6800/8800; Roche), HBeAg and HBsAg (Elycsys HBsAg chemiluminescence immunoassay by Cobas 8000; Roche), and core-related antigen (Lumipulse G chemiluminescence assay; Fujirebio) levels were measured in cohorts of untreated or nucleos(t)ide treated, HBV-infected subjects in an outpatient hospital setting.

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Background: Different forms of pregenomic and other hepatitis B virus (HBV) RNA have been detected in patients' sera. These circulating HBV-RNAs may be useful for monitoring covalently closed circular DNA activity, and predicting hepatitis B e-antigen seroconversion or viral rebound after nucleos(t)ide analog cessation. Data on serum HBV-RNA quasispecies, however, is scarce.

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  • The study investigates kidney transplantation outcomes specifically for cases involving controlled circulatory death (cDCD) donors and highly expanded criteria donors (ECD) and recipients, using a cohort of 1161 KT
  • ECD-KT was identified to have the lowest graft survival rates, influenced by factors including donor characteristics, cold ischemia time, and recipient health history, validated in a European cohort
  • While kidney transplantation (KT) typically offers better outcomes than remaining on the waitlist, high mortality risks were associated with the worst risk-prediction scenarios, highlighting the need for careful evaluation when using expanded donor criteria.
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Nucleoside analogues are the drugs most commonly used in the treatment of chronic hepatitis B. They act by inhibiting viral replication and have minimal impact on HBsAg loss. Nucleoside analogues are indicated in patients with chronic hepatitis, cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and in those with extrahepatic manifestations.

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Background: There is an increased risk of atherosclerosis in patients with chronic hepatitis C or human immunodeficiency virus, but there is scarce data on hepatitis B virus infection. The hypothesis of this study is that hepatitis B virus infection increases the risk of carotid plaques and subclinical atherosclerosis in naïve hepatitis B e antigen (HBeAg) negative subjects.

Aim: To assess the rate of carotid plaques and subclinical atherosclerosis in naïve HBeAg negative subjects in comparison with a cohort of healthy controls.

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Background: Hepatitis C virus (HCV) management is a challenge in patients with substance use disorder (SUD). This study aimed to describe an HCV screening and linkage to care program in SUD patients, and analyze the characteristics of this population in relation to HCV infection, particularly the impact of psychiatric comorbidities (dual diagnosis).

Methods: This study was a prospective clinical cohort study using a collaborative, multidisciplinary model to offer HCV care (screening, diagnosis, and therapy) to individuals with SUD attending a dedicated hospital clinic.

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  • The study examines fluctuations in HDV-RNA levels in patients with chronic hepatitis delta (CHD) to understand how it relates to other hepatitis B markers.
  • Approximately 25% of the patients experienced a significant decrease in HDV-RNA over an average follow-up period of 5.6 years, with 20% achieving undetectable levels.
  • The research suggests that declines in HDV-RNA are linked to improvements in liver enzyme levels, hinting at potential new treatment strategies for CHD.
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