Hepatitis D is common among immigrants in Canada, who account for approximately 23% of the population and tend to originate from high-endemic countries. Mortality rates are notably high among those with chronic infections, and immigrants are less likely to engage in screening and treatment services. This paper aims to assess the cost-utility of screening and treating Hepatitis D Virus (HDV)-positive immigrants in Canada compared with a scenario in which no screening is conducted. This analysis takes a public-payer perspective, uses a lifetime time horizon with a 1.5% annual discount rate, and expresses costs in 2023 Canadian dollars. A state-transition model representing the natural progression of chronic hepatitis B and hepatitis D was developed in TreeAge Pro and mapped onto three interventions: screening and treatment with bulevirtide; screening and treatment with pegylated interferon alfa-2a; and screening and treatment with both bulevirtide and pegylated interferon alfa-2a. The analysis was conducted in accordance with the guidelines of Canada's Drug Agency. The incremental cost-effectiveness ratio (ICER) was estimated for each intervention. Model sensitivity was performed using both univariate and probabilistic sensitivity analyses. All screening and treatment strategies resulted in a reduction in cases of decompensated cirrhosis, hepatocellular carcinoma and liver death, with combination therapy demonstrating the most favourable outcomes. Nevertheless, HDV screening and treatment with pegylated interferon alfa-2a monotherapy was the only cost-effective strategy (ICER: $23,177/QALY). While monotherapy with pegylated interferon alfa-2a proved cost-effective, combination therapy with bulevirtide is likely more clinically effective and may be cost-effective if treatment costs decrease significantly.

Therapeutic phlebotomy maintains hematocrit (Hct) <45% in patients with polycythemia vera (PV) and reduces thrombotic risks. However, frequent phlebotomy can induce iron deficiency. Ropeginterferon alfa-2b (ropeg) is a new-generation interferon therapy that induces durable complete hematologic and molecular responses through reduction of the Janus kinase 2 (JAK2)-mutated clone. Two dosing regimens have been investigated: the FDA-approved slow-titration regimen and a higher initial dose and accelerated titration (HIDAT) regimen. A cross-analysis of three prospective trials showed that ropeg achieved sustained Hct control and reduction of phlebotomy dependence in PV patients, including high-risk and hydroxyurea-resistant/intolerant patients. In exploratory cross-study comparisons, the HIDAT regimen was associated with more rapid phlebotomy-free Hct response rates, lower mean annualized phlebotomy frequency, higher overall hematologic response rates and deeper JAK2V617F allele burden reduction than slow titration. Both regimens were safe and well tolerated. Ropeg treatment provides durable Hct control and phlebotomy-independence in a broad PV population, including high-risk patients.

Chronic hepatitis delta is the most aggressive form of chronic viral hepatitis. Although pegylated interferon alfa (PegIFNα) has been the reference treatment for decades, the recent introduction of bulevirtide raises questions about its current role. To evaluate our real-world experience with PegIFNα, we conducted an observational, retrospective, single-centre study including patients with chronic hepatitis delta virus infection followed between 2014 and 2026. Fifteen patients were included, of whom 8 received PegIFNα. Toxicity was common, mainly due to haematological adverse effects, although flu-like symptoms and one serious neuropsychiatric event were also recorded. Of seven patients who completed treatment, two achieved a sustained virological response. Both patients also achieved HBV functional cure, being the only patients in the cohort to reach this endpoint. Our results confirm the considerable toxicity and limited efficacy of PegIFNα, but also its capacity to induce a sustained virological response and HBV functional cure in a subgroup of patients. In the bulevirtide era, PegIFNα remains a valid treatment option in selected patients given its curative potential.

HIV cure remains one of the major unsolved global health challenges. The persistence of the HIV reservoir is the key barrier to achieving viral eradication. The acute HIV infection (AHI) is crucial for reservoir establishment, making early intervention essential for long-term viral remission. Pegylated interferon-α (Peg-IFN-α) exhibits potent antiviral and immunomodulatory properties that may enhance reservoir clearance when combined with antiretroviral therapy (ART). This study aims to evaluate the efficacy and safety of Peg-IFN-α combined with ART in promoting reservoir reduction and immune reconstitution in individuals with AHI.

Chronic hepatitis B virus (HBV) infection remains a major global health concern due to the limited availability of curative treatment options. In this study, we investigate both analytically and numerically a spatiotemporal mathematical model of HBV infection incorporating pharmacological effects. The model consists of a system of three partial differential equations describing the dynamics and interactions between healthy hepatocytes (S), infected cells (I) and free viral particles (V). The model also considers spatial diffusion and dual-drug treatment of lamivudine and pegylated interferon alfa-2b (PEG-IFN alfa-2b). A general analytical expression is derived to determine the minimal drug dose required to effectively suppress viral replication and eliminate the infection. The basic reproduction number ([Formula: see text]) is calculated as a function of drug effectiveness and model parameters. To illustrate the relevance of the model, we apply it to clinical data from two HBV infected patients undergoing different therapeutic regimens. The first patient received 200 mg daily of lamivudine, while the second was treated with 200 mg of lamivudine daily and 0.2 mg weekly of PEG-IFN alfa-2b. Using nonlinear least squares, we fit the model to clinical data and estimate relevant parameters. In the absence of treatment, we find [Formula: see text]. Pharmacodynamic results show that after 4 weeks, the first patient experienced a [Formula: see text] copies/ml viral decline (64% effectiveness), while the second exhibited a [Formula: see text] copies/ml decline (69% and 64% effectiveness for PEG-IFN alfa-2b and lamivudine, respectively), corresponding to basic reproduction numbers of 185 and 58, respectively. To achieve sustained viral suppression ([Formula: see text]), we optimize the therapies. Lamivudine alone requires 99% effectiveness, which corresponds to a minimum dose of 565.92 mg daily over 350 days. For combination therapy, a PEG-IFN alfa-2b efficacy of 69% and lamivudine efficacy of 94.36% are sufficient to reach [Formula: see text] after 315 days. A Turing instability analysis reveals the emergence of diffusion-driven instabilities and allows the identification of a critical Turing wave number [Formula: see text]. Numerical simulations confirm the analytical predictions and show the formation of circular patterns. These patterns have been identified as having promising diagnostic and therapeutic value. Under treatment, the model predicts a progressive disappearance of infected patterns and a return toward spatial homogeneity. These findings highlight the crucial role of mathematical modeling in refining HBV treatment protocols and provide valuable insights for optimizing antiviral strategies.

Immunocompromised patients are exposed to a variety of viral and bacterial infections. Orf disease is a viral infection of the Parapoxvirus family cause mild symptoms in healthy people. In patients with immunodeficiency-induced giant atypical lesions, the management of giant and multiple lesions of the hand in an immunocompromised host is problematic. In this report, we present the extensive involvement of the hand and lower limb in a patient with immunodeficiency. Contamination of surgical instruments had caused the disease to spread rapidly to other areas during primary lesion excision.

Myeloproliferative neoplasms (MPNs) are commonly linked to driver mutations in the JAK2, MPL, and CALR genes. In contrast, SH2B3 (LNK) mutations are uncommon and remain an under-characterized contributor to dysregulated JAK-STAT signaling. The clinical features and treatment responsiveness of SH2B3-mutated MPNs are not well defined, and data on outcomes with ropeginterferon alfa-2b in this molecular subgroup are limited. We report a 75-year-old man who presented for evaluation of headache, generalized bone pain, and night sweats and was found to have abnormal blood counts including persistent leukocytosis, erythrocytosis, and thrombocytosis. Prior molecular testing was negative for JAK2, MPL, and CALR mutations. Bone marrow examination showed hypercellularity with panmyelosis, mild megakaryocytic atypia, and WHO grade 1 reticulin fibrosis. Hematologic next-generation sequencing identified a pathogenic SH2B3 c.1481C>G (p.Ser494*) nonsense mutation, predicted to result in a loss of SH2B3's C-terminal regulatory domain. Given the tri-lineage cytoses and marrow findings, a diagnosis of SH2B3-mutated MPN was established. He was started on ropeginterferon alfa-2b, resulting in resolution of his symptoms and complete hematologic response (WBC ≤ 10 × 10[3]/μL, Hct ≤ 45%, and PLT ≤ 400 × 10[3]/μL) within 12 weeks, without the need for phlebotomy or treatment-limiting adverse effects. This case underscores the clinical significance of SH2B3 mutations as a driver of triple-negative MPNs and supports their inclusion in molecular evaluation when classical mutations are absent. The favorable clinical and hematologic response to ropeginterferon alfa-2b suggests that interferon-based therapy may be effective in SH2B3-mutated MPNs.

Ropeginterferon alfa-2b-njft (ropeg), a mono-PEGylated interferon-α, showed efficacy and safety in patients with hydroxyurea-intolerant/resistant essential thrombocythemia (ET) in the phase 3 SURPASS-ET largely conducted in Asia. Here we report the results from the EXCEED-ET study, which evaluated ropeg in both treatment-naïve and hydroxyurea pre-treated ET in North America.

To provide a usage reference for clinicians with the increasing use of pegylated interferon alpha (PEG-IFN-ɑ) in treating chronic hepatitis B (CHB), the expert panel retrospectively summarized previous clinical experience and formulated expert recommendations based on the latest research findings and evidence-based medical data of this field, focusing on pre-treatment assessment to better assist clinicians in managing adverse reactions, help patients complete treatment courses, and maximize patient benefits.