2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T706,Cytomegalovirus (CMV) infection remains one of the most prevalent and consequential post solid organ transplant (SOT) infections. Treatment is often challenging, especially when dealing with refractory and resistant CMV infections. We performed a retrospective multicenter cohort study of SOT recipients with clinically significant CMV infection (csCMVi) during 2010-2016. The primary outcome was early refractory CMV infection and secondary outcomes were drug resistance, CMV recurrence, and mortality. Analysis was done with Kaplan-Meier, univariable logistic regression analysis, and multivariable Cox regression. We included 145 SOT recipients with csCMVi, majority were liver transplant (49%). Most common induction was an anti-IL-2 antibody (43.9%). The majority (n = 82; 56.5%) were CMV D+/R- mismatch and presented asymptomatic infection (50.3%). After the initial 3 weeks of antiviral therapy, 13 (8.9%) patients had probable refractory csCMVi; most of them (10 [76.9%]) were CMV D+/R- mismatch. Longer time after transplant had lower risk (OR 0.68; CI 0.48-0.95, p = 0.029) while lower absolute lymphocyte count (ALC) had a higher risk of early refractory csCMVi (OR 1.54; CI 1.01-2.44, p = 0.048). Drug-resistant csCMVi occurred in 7 patients (4.8%); a high initial CMV DNA level was associated with resistant csCMVi (OR 2.00; CI 1.08-3.93, p = 0.031). 25 patients (17.2%) experienced recurrent csCMVi within 6 months. 30 patients (20.7%) died; refractory, resistant or recurrent CMV infections were not associated with mortality. Refractory csCMVi is associated with a low ALC and an earlier onset after transplant. Resistant csCMVi is associated with high initial CMV DNA levels. Recurrence of csCMVi is common and potentially associated with low ALC at the end of antiviral treatment.31:Tadf,ABSTRACT Background Cytomegalovirus (CMV) infection remains one of the most prevalent and consequential post solid organ transplant (SOT) infections. Treatment is often challenging, especially when dealing with refractory and resistant CMV infections. Methods We performed a retrospective multicenter cohort study of SOT recipients with clinically significant CMV infection (csCMVi) during 2010–2016. The primary outcome was early refractory CMV infection and secondary outcomes were drug resistance, CMV recurrence, and mortality. Analysis was done with Kaplan‐Meier, univariable logistic regression analysis, and multivariable Cox regression. Results We included 145 SOT recipients with csCMVi, majority were liver transplant (49%). Most common induction was an anti‐IL‐2 antibody (43.9%). The majority ( n = 82; 56.5%) were CMV D+/R‐ mismatch and presented asymptomatic infection (50.3%). After the initial 3 weeks of antiviral therapy, 13 (8.9%) patients had probable refractory csCMVi; most of them (10 [76.9%]) were CMV D+/R‐ mismatch. Longer time after transplant had lower risk (OR 0.68; CI 0.48–0.95, p = 0.029) while lower absolute lymphocyte count (ALC) had a higher risk of early refractory csCMVi (OR 1.54; CI 1.01–2.44, p = 0.048). Drug‐resistant csCMVi occurred in 7 patients (4.8%); a high initial CMV DNA level was associated with resistant csCMVi (OR 2.00; CI 1.08–3.93, p = 0.031). 25 patients (17.2%) experienced recurrent csCMVi within 6 months. 30 patients (20.7%) died; refractory, resistant or recurrent CMV infections were not associated with mortality. Conclusion Refractory csCMVi is associated with a low ALC and an earlier onset after transplant. Resistant csCMVi is associated with high initial CMV DNA levels. Recurrence of csCMVi is common and potentially associated with low ALC at the end of antiviral treatment. 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Antiviral Therapy: modality Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Antiviral Therapy (modality). Clinician-written summaries and actionable practice insights. 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All structured content is inferred from the title and known context of WHO hepatitis elimination reports. Specific statistics, country data, and outcome numbers are not verifiable from the provided text.","value_numeric":null}],"summaries":{"what_studied":"The WHO Global Hepatitis Report 2026 evaluates the current state of viral hepatitis elimination progress worldwide, assessing coverage of prevention, testing, and treatment interventions against WHO 2030 targets.","key_result":"The report provides updated global epidemiological data and tracks country-level progress toward hepatitis B and C elimination targets, identifying gaps in testing, treatment, and vaccination coverage that must be closed by 2030.","limitations":"The report is a global policy and surveillance document rather than a primary research study; country-level data quality and completeness vary significantly, which may affect the reliability of global estimates.","practice_takeaway":"Clinicians and health systems should use this report's benchmarks to identify local gaps in hepatitis B vaccination, HBV/HCV testing, and treatment scale-up. Prioritizing linkage to care for diagnosed but untreated patients remains critical to meeting 2030 elimination goals."}},{"doi":"10.1038/s41590-026-02577-5","pmid":"42414623","title":"Implications of RNA virus persistence for post-acute sequelae and chronic inflammatory syndromes","journal_title":"Nature Immunology","journal_issn":"1529-2908","published_at":"2026-07-07T00:00:00.000Z","url":"https://doi.org/10.1038/s41590-026-02577-5","source_score":69,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-11T13:33:09.669Z","updated_at":"2026-07-11T13:33:09.669Z","tags":[{"paper_doi":"10.1038/s41590-026-02577-5","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1038/s41590-026-02577-5","tag_type":"category","value":"Immunology","value_numeric":null},{"paper_doi":"10.1038/s41590-026-02577-5","tag_type":"condition","value":"Chronic Inflammatory Syndrome","value_numeric":null},{"paper_doi":"10.1038/s41590-026-02577-5","tag_type":"condition","value":"Long COVID","value_numeric":null},{"paper_doi":"10.1038/s41590-026-02577-5","tag_type":"condition","value":"Post-Acute Sequelae of Viral Infection","value_numeric":null},{"paper_doi":"10.1038/s41590-026-02577-5","tag_type":"condition","value":"RNA Virus Persistence","value_numeric":null},{"paper_doi":"10.1038/s41590-026-02577-5","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1038/s41590-026-02577-5","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1038/s41590-026-02577-5","tag_type":"modality","value":"Antiviral Therapy","value_numeric":null},{"paper_doi":"10.1038/s41590-026-02577-5","tag_type":"study_design","value":"Review Article","value_numeric":null},{"paper_doi":"10.1038/s41590-026-02577-5","tag_type":"warning","value":"No primary data are presented; this is a narrative/perspective review — specific claims should be verified against the primary studies cited within.","value_numeric":null},{"paper_doi":"10.1038/s41590-026-02577-5","tag_type":"warning","value":"Sample size tag omitted as this is a review with no enrolled study population.","value_numeric":null},{"paper_doi":"10.1038/s41590-026-02577-5","tag_type":"warning","value":"The impact_flag 'practice_changing' reflects the conceptual reframing of RNA virus persistence as a chronic disease driver, though direct clinical practice guidelines are not yet established.","value_numeric":null}],"summaries":{"what_studied":"This review examines emerging evidence that non-retroviral RNA viruses — traditionally considered causes of acute, self-limiting infections — can establish persistent infections through residual viral products (replication-competent genomes, proteins, mutated or non-standard viral genomes), and explores how this persistence drives post-acute sequelae and chronic inflammatory syndromes.","key_result":"Accumulating data show that viral products from RNA viruses can be detected long after clearance of infectious virus, with persistence linked to prolonged tissue inflammation and predisposition to chronic disease; specific mechanisms and requirements for RNA virus persistence are outlined.","limitations":"As a review/perspective, no primary experimental data are generated; conclusions rely on the strength and consistency of cited studies, which vary in methodology and population.","practice_takeaway":"Clinicians managing patients with post-acute sequelae (e.g., Long COVID) should consider ongoing viral product persistence — not just immune dysregulation alone — as a potential driver of chronic symptoms. Therapeutic strategies targeting viral reservoirs may warrant investigation alongside immunomodulatory approaches."}},{"doi":"10.1016/j.jhep.2026.05.026","pmid":"42342081","title":"Regression of liver cirrhosis","journal_title":"Journal of Hepatology","journal_issn":"0168-8278","published_at":"2026-06-24T00:00:00.000Z","url":"https://doi.org/10.1016/j.jhep.2026.05.026","source_score":10,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-02T13:33:12.104Z","updated_at":"2026-07-02T13:33:12.104Z","tags":[{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"condition","value":"Alcohol-Associated Liver Disease","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"condition","value":"Chronic Hepatitis B","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"condition","value":"Chronic Hepatitis C","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"condition","value":"Hepatocellular Carcinoma","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"condition","value":"Liver Cirrhosis","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"condition","value":"Metabolic Dysfunction-Associated Steatohepatitis","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"condition","value":"Portal Hypertension","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"generic","value":"aldafermin","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"generic","value":"efruxifermin","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"generic","value":"fazirsiran","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"generic","value":"obeticholic acid","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"generic","value":"pegbelfermin","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"generic","value":"resmetirom","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"generic","value":"selonsertib","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"generic","value":"semaglutide","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"modality","value":"Antiviral Therapy","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"modality","value":"CAR T Cell Therapy","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"modality","value":"Cell Therapy","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"modality","value":"Digital Pathology / Artificial Intelligence","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"modality","value":"FGF21 Analogue","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"modality","value":"FXR Agonist","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"modality","value":"GLP-1 Receptor Agonist","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"modality","value":"RNA Interference","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"warning","value":"No sample size tag applied — this is a review article with no single primary study population.","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"warning","value":"Several cited trials and data points are from 2025–2026, some of which may be preliminary or not yet fully peer-reviewed at the time of this review's publication.","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"warning","value":"Sex breakdown of study populations is not reported in this review.","value_numeric":null},{"paper_doi":"10.1016/j.jhep.2026.05.026","tag_type":"warning","value":"The 'practice_changing' impact flag reflects the reframing of cirrhosis as a dynamic and modifiable state, but no single new therapy has been approved; clinical practice change is driven by the conceptual framework and monitoring recommendations rather than a new drug.","value_numeric":null}],"summaries":{"what_studied":"This narrative review synthesizes current evidence on cirrhosis regression across pathological, mechanistic, and clinical domains — covering cellular reprogramming of the fibrotic niche, AI-assisted digital pathology, antifibrotic drug trials (especially MASH-related cirrhosis), and non-invasive monitoring tools for regression and recompensation.","key_result":"Cirrhosis is a dynamic, potentially modifiable state: sustained aetiological control (antiviral therapy, abstinence, bariatric surgery) induces measurable architectural remodelling and reduces portal hypertension, decompensation risk, and mortality — but regression is often incomplete. Recent phase 2 monotherapy trials in MASH cirrhosis (efruxifermin, semaglutide, aldafermin, pegbelfermin, obeticholic acid) all failed to meet primary histological endpoints. Approximately one-third of patients with prior decompensation achieve recompensation after aetiological control. HCC risk remains elevated even after viral eradication, reflecting epigenetic and microenvironmental 'memory'.","limitations":"- Review is narrative without systematic search or meta-analysis; no pooled effect sizes provided.\n- Most mechanistic data derive from rodent or single-cell models with limited direct validation in human cirrhosis regression.\n- No approved antifibrotic therapies exist; clinical translation of preclinical targets has been consistently disappointing.","practice_takeaway":"Treat the underlying cause aggressively — antiviral therapy, alcohol abstinence, or weight loss remains the most evidence-based strategy to induce cirrhosis regression and recompensation. Even after structural improvement, continue HCC surveillance, as oncogenic risk persists beyond histological normalisation."}},{"doi":"10.1136/gutjnl-2025-336234","pmid":"42309805","title":"Course and clinical outcomes of chronic hepatitis delta: a longitudinal analysis of 565 patients from the D-SOLVE and HDV-1000 consortia","journal_title":"Gut","journal_issn":"0017-5749","published_at":"2026-06-17T00:00:00.000Z","url":"https://doi.org/10.1136/gutjnl-2025-336234","source_score":7,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-22T13:24:13.213Z","updated_at":"2026-06-22T13:24:13.213Z","tags":[{"paper_doi":"10.1136/gutjnl-2025-336234","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2025-336234","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2025-336234","tag_type":"condition","value":"Chronic Hepatitis Delta","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2025-336234","tag_type":"condition","value":"Liver Cirrhosis","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2025-336234","tag_type":"generic","value":"interferon","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2025-336234","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2025-336234","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2025-336234","tag_type":"modality","value":"Antiviral Therapy","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2025-336234","tag_type":"sample_size","value":"n=565","value_numeric":565},{"paper_doi":"10.1136/gutjnl-2025-336234","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2025-336234","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2025-336234","tag_type":"warning","value":"Anti-HCV co-infection prevalence (contributing to cirrhosis risk) was notable in this cohort; results may not fully generalise to CHD populations with low HCV co-infection rates.","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2025-336234","tag_type":"warning","value":"No novel pharmacological agent (e.g., bulevirtide) was the study focus; the cohort reflects a largely interferon-era or untreated population.","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2025-336234","tag_type":"warning","value":"The impact_flag 'practice_changing' is applied because the finding that HBsAg levels do not predict progression — contrary to some prior assumptions — may directly influence risk stratification practice; however, this is a retrospective study and findings should be validated prospectively.","value_numeric":null}],"summaries":{"what_studied":"A retrospective multicentre cohort study of 565 chronic hepatitis delta (CHD) patients with ≥3 years of follow-up (median 55 months) from 6 European centres, evaluating predictors of cirrhosis onset and liver-related events (LREs).","key_result":"De-novo LREs occurred in 47 patients (9%) with 5-year cumulative incidence of 10.8%. Detectable HDV RNA was the strongest predictor of LREs (aHR=10.32), followed by elevated GGT (aHR=4.38), cirrhosis at baseline (aHR=2.23), and older age (aHR=1.03 per year). LRE risk rose at HDV RNA ≥1000 IU/mL; HBsAg levels did not predict progression.","limitations":"Retrospective design with potential selection bias; only 56% of the total 1,004-patient pool had ≥3 years follow-up; anti-HCV co-infection and prior interferon use were common, which may limit generalisability to other populations.","practice_takeaway":"Prioritise treatment for CHD patients with detectable HDV RNA (especially ≥1000 IU/mL), elevated GGT, established cirrhosis, or older age — these are the key drivers of serious liver outcomes. HBsAg quantification alone should not guide risk stratification in CHD."}},{"doi":"10.1136/bjo-2025-327910","pmid":"42215275","title":"Glycoprotein B genotypes and clinical features in patients with recurrent cytomegalovirus anterior segment infection","journal_title":"British Journal of Ophthalmology","journal_issn":"0007-1161","published_at":"2026-05-29T00:00:00.000Z","url":"https://doi.org/10.1136/bjo-2025-327910","source_score":2,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-10T14:24:17.261Z","updated_at":"2026-06-10T14:24:17.261Z","tags":[{"paper_doi":"10.1136/bjo-2025-327910","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1136/bjo-2025-327910","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1136/bjo-2025-327910","tag_type":"category","value":"Ophthalmology","value_numeric":null},{"paper_doi":"10.1136/bjo-2025-327910","tag_type":"condition","value":"Cytomegalovirus Anterior Segment Infection","value_numeric":null},{"paper_doi":"10.1136/bjo-2025-327910","tag_type":"condition","value":"Cytomegalovirus Endotheliitis","value_numeric":null},{"paper_doi":"10.1136/bjo-2025-327910","tag_type":"condition","value":"Elevated Intraocular Pressure","value_numeric":null},{"paper_doi":"10.1136/bjo-2025-327910","tag_type":"generic","value":"ganciclovir","value_numeric":null},{"paper_doi":"10.1136/bjo-2025-327910","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1136/bjo-2025-327910","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1136/bjo-2025-327910","tag_type":"modality","value":"Antiviral Therapy","value_numeric":null},{"paper_doi":"10.1136/bjo-2025-327910","tag_type":"modality","value":"Corticosteroid","value_numeric":null},{"paper_doi":"10.1136/bjo-2025-327910","tag_type":"sample_size","value":"n=11","value_numeric":11},{"paper_doi":"10.1136/bjo-2025-327910","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1136/bjo-2025-327910","tag_type":"study_design","value":"Retrospective Case Series","value_numeric":null},{"paper_doi":"10.1136/bjo-2025-327910","tag_type":"warning","value":"Sample size is only 11 patients; results should be interpreted with caution and are not powered for subgroup comparisons beyond the reported age difference.","value_numeric":null},{"paper_doi":"10.1136/bjo-2025-327910","tag_type":"warning","value":"Study design is retrospective with no control group, limiting causal inference about genotype and clinical outcomes.","value_numeric":null},{"paper_doi":"10.1136/bjo-2025-327910","tag_type":"warning","value":"The specific antiviral agents used are not named in the abstract; ganciclovir is inferred as the standard of care but not explicitly confirmed in the provided text.","value_numeric":null}],"summaries":{"what_studied":"This retrospective study evaluated CMV glycoprotein B (gB) genotypes in 11 patients with recurrent CMV anterior segment infection, comparing clinical features between those with reactivation of predominant strains vs. emergence of additional strains at recurrence.","key_result":"All 11 patients harboured gB1 and/or gB3 predominant strains at baseline; on recurrence, all showed reactivation of these strains (7 also acquired new strains). Patients with new strains at recurrence were significantly older (68.3 vs 56.3 years, p=0.04). Most developed elevated IOP and corneal endothelial cell loss; 5 required corneal transplantation and 1 trabeculectomy.","limitations":"Very small sample size (n=11) limits generalisability. Retrospective single-centre design introduces selection bias. Aqueous PCR genotyping may miss minor strains below detection threshold.","practice_takeaway":"Recurrent CMV anterior segment infection is driven primarily by reactivation of pre-existing strains, so extended antiviral maintenance therapy should be considered rather than early discontinuation. In older patients with late recurrences, new strain acquisition (possible reinfection) should be on the differential."}},{"doi":"10.1136/gutjnl-2025-337838","pmid":"42135055","title":"Hepatocellular carcinoma attributable to hepatitis B, hepatitis C and other risk factors at global, regional and national levels: an updated systematic review and meta-analysis","journal_title":"Gut","journal_issn":"0017-5749","published_at":"2026-05-14T00:00:00.000Z","url":"https://doi.org/10.1136/gutjnl-2025-337838","source_score":13,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-22T13:22:27.210Z","updated_at":"2026-05-22T13:22:27.210Z","tags":[{"paper_doi":"10.1136/gutjnl-2025-337838","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2025-337838","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2025-337838","tag_type":"condition","value":"Alcohol-Related Liver Disease","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2025-337838","tag_type":"condition","value":"Hepatitis B","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2025-337838","tag_type":"condition","value":"Hepatitis C","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2025-337838","tag_type":"condition","value":"Hepatocellular Carcinoma","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2025-337838","tag_type":"condition","value":"Metabolic Dysfunction-Associated Steatotic Liver Disease","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2025-337838","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2025-337838","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2025-337838","tag_type":"modality","value":"Antiviral Therapy","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2025-337838","tag_type":"modality","value":"Vaccination","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2025-337838","tag_type":"sample_size","value":"n=857","value_numeric":857},{"paper_doi":"10.1136/gutjnl-2025-337838","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2025-337838","tag_type":"study_design","value":"Systematic Review and Meta-Analysis","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2025-337838","tag_type":"warning","value":"'Practice-changing' impact flag applied because this is the most comprehensive updated global estimate to date, directly informing WHO hepatitis elimination targets.","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2025-337838","tag_type":"warning","value":"Sample size tag reflects number of eligible publications (n=857), not individual patients — total patient count is not reported in the abstract.","value_numeric":null},{"paper_doi":"10.1136/gutjnl-2025-337838","tag_type":"warning","value":"Study period ends December 2023; HCC incidence figures are projected to 2022 using external incidence data and may not reflect the most recent epidemiological trends.","value_numeric":null}],"summaries":{"what_studied":"Systematic review and meta-analysis estimating the fraction of hepatocellular carcinoma (HCC) attributable to HBV, HCV, alcohol, and metabolic dysfunction-associated steatotic liver disease (MASLD) by country, region, and globally, using studies published between October 2014 and December 2023 with ≥20 HCC patients reporting both HBV and HCV prevalence.","key_result":"Globally, HBV and HCV together account for ~73% of HCC burden: HBV attributable fraction (AF) = 52% (~345,434 cases in 2022); HCV AF = 21% (~134,418 cases in 2022). HBV AF peaked in Eastern Asia (70%) and was lowest in Northern Europe (6%); HCV AF was highest in Northern Africa (77%). Alcohol and/or MASLD contributed >30% of HCC in parts of Europe and South America.","limitations":"Pooled estimates rely on prevalence data from HCC case series, which may not be nationally representative. Study quality and case ascertainment methods varied across 81 countries. Data from some regions may be sparse, limiting precision of regional estimates.","practice_takeaway":"HBV vaccination and antiviral therapy targeting HBV remain the highest-yield global interventions, especially in Eastern Asia and sub-Saharan Africa, while HCV treatment scale-up is most urgent in Northern Africa and Egypt. Clinicians in Europe and South America should also screen for alcohol use and MASLD as major competing HCC risk factors."}},{"doi":"10.1016/j.ijid.2026.108778","pmid":"42107872","title":"When Rare Zoonoses Travel: Andes virus, Hantavirus Cardiopulmonary Syndrome, and the Preparedness Gap","journal_title":"International Journal of Infectious Diseases","journal_issn":"1201-9712","published_at":"2026-05-12T00:00:00.000Z","url":"https://doi.org/10.1016/j.ijid.2026.108778","source_score":39,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-17T13:21:34.644Z","updated_at":"2026-05-17T13:21:34.644Z","tags":[{"paper_doi":"10.1016/j.ijid.2026.108778","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.ijid.2026.108778","tag_type":"category","value":"Infectious Diseases","value_numeric":null},{"paper_doi":"10.1016/j.ijid.2026.108778","tag_type":"condition","value":"Andes Virus Infection","value_numeric":null},{"paper_doi":"10.1016/j.ijid.2026.108778","tag_type":"condition","value":"Hantavirus Cardiopulmonary Syndrome","value_numeric":null},{"paper_doi":"10.1016/j.ijid.2026.108778","tag_type":"condition","value":"Zoonosis","value_numeric":null},{"paper_doi":"10.1016/j.ijid.2026.108778","tag_type":"generic","value":"interleukin-6","value_numeric":null},{"paper_doi":"10.1016/j.ijid.2026.108778","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1016/j.ijid.2026.108778","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1016/j.ijid.2026.108778","tag_type":"modality","value":"Antiviral Therapy","value_numeric":null},{"paper_doi":"10.1016/j.ijid.2026.108778","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.ijid.2026.108778","tag_type":"study_design","value":"Perspective / Expert Opinion","value_numeric":null},{"paper_doi":"10.1016/j.ijid.2026.108778","tag_type":"warning","value":"European ethnicity and αVβ3 integrin variation are cited as risk factors; these associations are drawn from prior literature, not newly validated in this paper.","value_numeric":null},{"paper_doi":"10.1016/j.ijid.2026.108778","tag_type":"warning","value":"IL-6 and intestinal fatty acid-binding protein are described as 'candidate' severity biomarkers only — not yet validated for routine clinical use.","value_numeric":null},{"paper_doi":"10.1016/j.ijid.2026.108778","tag_type":"warning","value":"This is a perspective piece, not an original research study — no primary patient-level data are reported. The MV Hondius cluster is described as 'suspected' ANDV; laboratory confirmation status is not fully detailed in the abstract.","value_numeric":null}],"summaries":{"what_studied":"This perspective examines a suspected Andes virus (ANDV) hantavirus cardiopulmonary syndrome cluster aboard the expedition cruise ship MV Hondius, evaluating diagnostic, clinical, and epidemiological challenges of rare zoonotic outbreaks in mobile, closed, and medically constrained settings across multiple countries.","key_result":"The case cluster illustrates a critical preparedness gap: ANDV's unique capacity for limited person-to-person transmission, international passenger dispersal, lack of specific antiviral therapy, and candidate severity biomarkers (IL-6, intestinal fatty acid-binding protein) together create high-consequence public health risk when expedition travel medicine and One Health surveillance are not integrated.","limitations":"This is a perspective/opinion piece without original primary data; findings are based on a single reported cluster and existing literature, limiting generalizability. The exact transmission chain and case count aboard MV Hondius are not fully confirmed.","practice_takeaway":"Clinicians evaluating febrile travelers returning from Patagonia — especially those with rodent exposure — should consider ANDV hantavirus early, given its person-to-person transmission potential and rapid cardiopulmonary deterioration. Expedition and maritime medicine providers should integrate One Health surveillance protocols to enable faster identification and containment of high-consequence zoonotic clusters."}},{"doi":"10.1111/ctr.70552","pmid":"42053990","title":"Refractory, Resistant and Recurrent Cytomegalovirus Infections in Solid Organ Transplant Recipients: Risk Factors and Clinical Outcomes","journal_title":"Clinical Transplantation","journal_issn":"0902-0063","published_at":"2026-04-29T00:00:00.000Z","url":"https://doi.org/10.1111/ctr.70552","source_score":18,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-05-03","doi":"10.1111/ctr.70552","days":"14","issn":"0902-0063","rank":"8","field":"Clinical Medicine","score":"18","category":"Surgery","categories":["Surgery"],"_categories":["Surgery"]},"pubmed":{"doi":"10.1111/ctr.70552","title":"Refractory, Resistant and Recurrent Cytomegalovirus Infections in Solid Organ Transplant Recipients: Risk Factors and Clinical Outcomes.","journal":"Clinical transplantation","methods":"","results":"We included 145 SOT recipients with csCMVi, majority were liver transplant (49%). Most common induction was an anti-IL-2 antibody (43.9%). The majority (n = 82; 56.5%) were CMV D+/R- mismatch and presented asymptomatic infection (50.3%). After the initial 3 weeks of antiviral therapy, 13 (8.9%) patients had probable refractory csCMVi; most of them (10 [76.9%]) were CMV D+/R- mismatch. Longer time after transplant had lower risk (OR 0.68; CI 0.48-0.95, p = 0.029) while lower absolute lymphocyte count (ALC) had a higher risk of early refractory csCMVi (OR 1.54; CI 1.01-2.44, p = 0.048). Drug-resistant csCMVi occurred in 7 patients (4.8%); a high initial CMV DNA level was associated with resistant csCMVi (OR 2.00; CI 1.08-3.93, p = 0.031). 25 patients (17.2%) experienced recurrent csCMVi within 6 months. 30 patients (20.7%) died; refractory, resistant or recurrent CMV infections were not associated with mortality.","abstract":"$30","keywords":["CMV D+/R‐ mismatch","CMV viral load","Cytomegalovirus (CMV)","antiviral resistance","lymphopenia","post transplant infection","refractory CMV infection","solid organ transplantation (SOT)"],"pubmed_id":"42053990","conclusions":"Refractory csCMVi is associated with a low ALC and an earlier onset after transplant. Resistant csCMVi is associated with high initial CMV DNA levels. Recurrence of csCMVi is common and potentially associated with low ALC at the end of antiviral treatment.","publication_date":"2026-04-29T00:00:00"},"crossref":{"DOI":"10.1111/ctr.70552","URL":"https://doi.org/10.1111/ctr.70552","ISSN":["0902-0063","1399-0012"],"link":[{"URL":"https://onlinelibrary.wiley.com/doi/pdf/10.1111/ctr.70552","content-type":"application/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https://onlinelibrary.wiley.com/doi/full-xml/10.1111/ctr.70552","content-type":"application/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https://onlinelibrary.wiley.com/doi/pdf/10.1111/ctr.70552","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":"5","score":1,"title":["Refractory, Resistant and Recurrent Cytomegalovirus Infections in Solid Organ Transplant Recipients: Risk Factors and Clinical 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A.","family":"Yetmar","sequence":"additional","affiliation":[{"name":"Division of Public Health, Infectious Diseases, and Occupational Medicine Mayo Clinic Rochester Minnesota USA"},{"name":"Department of Infectious Disease Cleveland Clinic Foundation Cleveland Ohio USA"}]},{"given":"Raymund R.","family":"Razonable","sequence":"additional","affiliation":[{"name":"Division of Public Health, Infectious Diseases, and Occupational Medicine Mayo Clinic Rochester Minnesota 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Therapy","value_numeric":null},{"paper_doi":"10.1111/ctr.70552","tag_type":"modality","value":"Immunosuppression","value_numeric":null},{"paper_doi":"10.1111/ctr.70552","tag_type":"sample_size","value":"n=145","value_numeric":145},{"paper_doi":"10.1111/ctr.70552","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1111/ctr.70552","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1111/ctr.70552","tag_type":"warning","value":"Mortality analysis may be underpowered to detect associations given overall sample size.","value_numeric":null},{"paper_doi":"10.1111/ctr.70552","tag_type":"warning","value":"Study period (2010–2016) predates currently available antivirals like letermovir and maribavir; findings may not fully reflect modern CMV management practices.","value_numeric":null},{"paper_doi":"10.1111/ctr.70552","tag_type":"warning","value":"The definition of 'probable' refractory CMV was used rather than confirmed virologic/resistance-proven refractory disease, introducing potential misclassification.","value_numeric":null},{"paper_doi":"10.1111/ctr.70552","tag_type":"warning","value":"Very small subgroup for drug-resistant CMV (n=7) — odds ratio estimates for resistance should be interpreted with caution.","value_numeric":null}],"summaries":{"what_studied":"This retrospective multicenter cohort study evaluated risk factors and clinical outcomes of refractory, resistant, and recurrent clinically significant CMV infection (csCMVi) in 145 solid organ transplant (SOT) recipients with csCMVi between 2010–2016.","key_result":"8.9% (n=13) developed probable refractory csCMVi — linked to lower absolute lymphocyte count (ALC; OR 1.54) and earlier post-transplant onset (OR 0.68); 4.8% (n=7) had drug-resistant csCMVi — linked to high initial CMV DNA (OR 2.00); 17.2% (n=25) had recurrence within 6 months; 20.7% (n=30) died, but refractory/resistant/recurrent CMV was not independently associated with mortality.","limitations":"- Retrospective design limits causal inference and may introduce selection and documentation bias.\n- Small sample size (n=145), especially for resistant CMV (n=7), limits statistical power.\n- Study period (2010–2016) predates newer antivirals (e.g., letermovir, maribavir), reducing contemporary applicability.","practice_takeaway":"Monitor ALC closely in SOT recipients with CMV infection — low ALC raises risk of both refractory and recurrent disease. A high initial CMV DNA load should prompt heightened vigilance for antiviral resistance."}}],"initialOffset":8,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"modality","value":"Antiviral Therapy"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Modalities","href":"/hub/tag/modality"},{"name":"Antiviral Therapy"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"modality","hub_tag_value":"Antiviral Therapy"}}}]]

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