Wendy Spearman | University of Cape Town (original) (raw)
Papers by Wendy Spearman
Journal of viral hepatitis, May 26, 2024
PubMed, Aug 8, 2018
Hepatitis B (HBV) remains a global health problem despite the availability of effective vaccines ... more Hepatitis B (HBV) remains a global health problem despite the availability of effective vaccines since 1982 and effective antiviral therapy. The global burden of disease is substantial, with HBV resulting in 887 220 deaths in 2015: acute hepatitis (87 076), cirrhosis (462 690) and hepatocellular carcinoma (337 454). The World Health Organization has a vision to eliminate viral hepatitis as a public health threat by 2030. Although HBV and its associated complications of cirrhosis, liver failure and hepatocellular carcinoma are entirely vaccine preventable, there is no cure for chronic hepatitis B as yet. HBV elimination strategies will need to focus on effective and implementable preventive and therapeutic strategies such as upscaling HBV birth-dose vaccination, full HBV vaccine coverage, vaccination of high-risk groups, prevention of mother-to-child transmission, and identification of HBV-infected individuals and linkage to care with sustainable access to antiviral therapy.
The Lancet Global Health, Jul 1, 2023
South African Medical Journal, Oct 6, 2014
The Journal of Allergy and Clinical Immunology: In Practice, Dec 1, 2021
Hepatology
Background & Aims: Fatty liver disease is a major public health threat due to its very high preva... more Background & Aims: Fatty liver disease is a major public health threat due to its very high prevalence and related morbidity and mortality. Focused and dedicated interventions are urgently needed to target disease prevention, treatment, and care. Approach & Results: We developed an aligned, prioritized action agenda for the global fatty liver disease community of practice. Following a Delphi methodology over two rounds a large panel (R1 n = 344, R2 n = 288) reviewed the action priorities, via Qualtrics XM, indicating agreement using a four-point Likert-scale and providing written feedback. Priorities were revised between rounds and in R2 panelists also ranked the priorities within six domains: epidemiology, treatment and care, models of care, education and awareness, patient and community perspectives, and leadership and public health policy. The consensus fatty liver disease action agenda encompasses 29 priorities. In R2 the mean percentage of ‘agree’ responses was 82.4%, with all ...
Hepatology
The principal limitations of the terms NAFLD and NASH are the reliance on exclusionary confounder... more The principal limitations of the terms NAFLD and NASH are the reliance on exclusionary confounder terms and the use of potentially stigmatising language. This study set out to determine if content experts and patient advocates were in favor of a change in nomenclature and/or definition. A modified Delphi process was led by three large pan-national liver associations. The consensus was defined a priori as a supermajority (67%) vote. An independent committee of experts external to the nomenclature process made the final recommendation on the acronym and its diagnostic criteria. A total of 236 panelists from 56 countries participated in 4 online surveys and 2 hybrid meetings. Response rates across the 4 survey rounds were 87%, 83%, 83%, and 78%, respectively. Seventy-four percent of respondents felt that the current nomenclature was sufficiently flawed to consider a name change. The terms “nonalcoholic” and “fatty” were felt to be stigmatising by 61% and 66% of respondents, respectivel...
Journal of Hepatology, 2022
About a third of countries (n = 32/102) scored zero on the preparedness index. No country had a n... more About a third of countries (n = 32/102) scored zero on the preparedness index. No country had a national or sub-national strategy for NAFLD. NAFLD was rarely mentioned in the strategies of related conditions such as diabetes. Only 32 countries had national NAFLD clinical guidelines. A comprehensive NAFLD public health response is lacking in all 102 countries.
The lancet. Gastroenterology & hepatology, 2020
background: Many NSTEACS patients are medically managed without coronary revascularization. The r... more background: Many NSTEACS patients are medically managed without coronary revascularization. The reasons vary and may impact prognosis. methods: EPICOR Asia (NCT01361386) is a prospective study of hospital survivors post ACS enrolled in 219 hospitals from 8 countries/ regions in Asia (06/2011-05/2012). All medically managed NSTEACS patients in EPICOR Asia were classified into 3 groups: 1) no coronary angiography (CAG-); 2) non-significant coronary artery disease (CAD) on angiogram (CAG+ CAD-); and 3) significant CAD (CAG+ CAD+). We compared baseline differences between groups, and report 1-y mortality rates. Results: Of 6,164 NSTEACS patients, 2,272 (37%) were medically managed only, with 1,339 (59%), 254 (11%) and 679 (30%) patients in the CAG-, CAG+ CAD-, and CAG+ CAD+ groups, respectively. There were marked differences in number of NSTEACS patients medically managed among the 8 countries/regions (13-81%). Between-group differences were seen in baseline characteristics (Table). CAG+ CADpatients were younger with fewer CV risk factors than CAG+ CAD+. CAG-patients were older, more likely with known CV disease, more frequently admitted to hospitals with no cath lab, and had the highest 1-y mortality (6.9% versus 3.3% for EPICOR Asia overall). conclusion: NSTEACS patients who are medically managed are a heterogeneous group with different clinical features and outcomes e.g. mortality risk. The factors underlying different management strategies, and to improve prognosis, need to be identified.
Journal of Hepatology, 2021
Oxidative Medicine and Cellular Longevity, 2017
Approximately 20% of human cancers is attributable to DNA oncogenic viruses such as human papillo... more Approximately 20% of human cancers is attributable to DNA oncogenic viruses such as human papillomavirus (HPV), hepatitis B virus (HBV), and Epstein-Barr virus (EBV). Unrepaired DNA damage is the most common and overlapping feature of these DNA oncogenic viruses and a source of genomic instability and tumour development. Sustained DNA damage results from unceasing production of reactive oxygen species and activation of inflammasome cascades that trigger genomic changes and increased propensity of epigenetic alterations. Accumulation of epigenetic alterations may interfere with genome-wide cellular signalling machineries and promote malignant transformation leading to cancer development. Untangling and understanding the underlying mechanisms that promote these detrimental effects remain the major objectives for ongoing research and hope for effective virus-induced cancer therapy. Here, we review current literature with an emphasis on how DNA damage influences HPV, HVB, and EBV replic...
Journal of Clinical Gastroenterology, 2012
The Lancet. Gastroenterology & hepatology, Apr 1, 2024
Journal of Clinical Gastroenterology, Oct 1, 2016
Review Team: Jordan Feld, MD (Chair, Canada), Harry L.A. Janssen, MD (Chair, Canada/The Netherlan... more Review Team: Jordan Feld, MD (Chair, Canada), Harry L.A. Janssen, MD (Chair, Canada/The Netherlands), Zaigham Abbas, MD (Pakistan), Andre Elewaut, MD (Belgium), Peter Ferenci, MD (Austria), Vasily Isakov, MD (Russia), Aamir G. Khan, MD (Pakistan), Seng Gee Lim, MD (Singapore), Stephen A. Locarnini, MD (Australia), Suzane K. Ono, MD (Brazil), Jose Sollano, MD (Philippines), Catherine W. Spearman, MD (South Africa), Chau-Ting Yeh, MD (Taiwan), Man Fung Yuen, MD (Hong Kong), and Anton LeMair, MD (The Netherlands)
Nature Reviews Endocrinology, Feb 17, 2023
Hyperferritinaemia is a common laboratory finding that is often associated with metabolic dysfunc... more Hyperferritinaemia is a common laboratory finding that is often associated with metabolic dysfunction and fatty liver. Metabolic hyperferritinaemia reflects alterations in iron metabolism that facilitate iron accumulation in the body and is associated with an increased risk of cardiometabolic and liver diseases. Genetic variants that modulate iron homeostasis and tissue levels of iron are the main determinants of serum levels of ferritin in individuals with metabolic dysfunction, raising the hypothesis that iron accumulation might be implicated in the pathogenesis of insulin resistance and the related organ damage. However, validated criteria for the non-invasive diagnosis of metabolic hyperferritinaemia and the staging of iron overload are still lacking, and there is no clear evidence of a benefit for iron depletion therapy. Here, we provide an overview of the literature on the relationship between hyperferritinaemia and iron accumulation in individuals with metabolic dysfunction, and on the associated clinical outcomes. We propose an updated definition and a provisional staging system for metabolic hyperferritinaemia, which has been agreed on by a multidisciplinary global panel of expert researchers. The goal is to foster studies into the epidemiology, genetics, pathophysiology, clinical relevance and treatment of metabolic hyperferritinaemia, for which we provide suggestions on the main unmet needs, optimal design and clinically relevant outcomes.
BMC Medicine
Background Elimination of mother-to-child transmission of hepatitis B virus (HBV) requires infant... more Background Elimination of mother-to-child transmission of hepatitis B virus (HBV) requires infant immunoprophylaxis and antiviral prophylaxis for pregnant women with high viral loads. Since real-time polymerase chain reaction (RT-PCR), a gold standard for assessing antiviral eligibility, is neither accessible nor affordable for women living in low-income and middle-income countries (LMICs), rapid diagnostic tests (RDTs) detecting alternative HBV markers may be needed. To inform future development of the target product profile (TPP) for RDTs to identify highly viremic women, we used a discrete choice experiment (DCE) and elicited preference and trade-off of healthcare workers (HCW) in Africa between the following four attributes of fictional RDTs: price, time-to-result, diagnostic sensitivity, and specificity. Methods Through an online questionnaire survey, we asked participants to indicate their preferred test from a set of two RDTs in seven choice tasks with varying levels of the f...
Journal of viral hepatitis, May 26, 2024
PubMed, Aug 8, 2018
Hepatitis B (HBV) remains a global health problem despite the availability of effective vaccines ... more Hepatitis B (HBV) remains a global health problem despite the availability of effective vaccines since 1982 and effective antiviral therapy. The global burden of disease is substantial, with HBV resulting in 887 220 deaths in 2015: acute hepatitis (87 076), cirrhosis (462 690) and hepatocellular carcinoma (337 454). The World Health Organization has a vision to eliminate viral hepatitis as a public health threat by 2030. Although HBV and its associated complications of cirrhosis, liver failure and hepatocellular carcinoma are entirely vaccine preventable, there is no cure for chronic hepatitis B as yet. HBV elimination strategies will need to focus on effective and implementable preventive and therapeutic strategies such as upscaling HBV birth-dose vaccination, full HBV vaccine coverage, vaccination of high-risk groups, prevention of mother-to-child transmission, and identification of HBV-infected individuals and linkage to care with sustainable access to antiviral therapy.
The Lancet Global Health, Jul 1, 2023
South African Medical Journal, Oct 6, 2014
The Journal of Allergy and Clinical Immunology: In Practice, Dec 1, 2021
Hepatology
Background & Aims: Fatty liver disease is a major public health threat due to its very high preva... more Background & Aims: Fatty liver disease is a major public health threat due to its very high prevalence and related morbidity and mortality. Focused and dedicated interventions are urgently needed to target disease prevention, treatment, and care. Approach & Results: We developed an aligned, prioritized action agenda for the global fatty liver disease community of practice. Following a Delphi methodology over two rounds a large panel (R1 n = 344, R2 n = 288) reviewed the action priorities, via Qualtrics XM, indicating agreement using a four-point Likert-scale and providing written feedback. Priorities were revised between rounds and in R2 panelists also ranked the priorities within six domains: epidemiology, treatment and care, models of care, education and awareness, patient and community perspectives, and leadership and public health policy. The consensus fatty liver disease action agenda encompasses 29 priorities. In R2 the mean percentage of ‘agree’ responses was 82.4%, with all ...
Hepatology
The principal limitations of the terms NAFLD and NASH are the reliance on exclusionary confounder... more The principal limitations of the terms NAFLD and NASH are the reliance on exclusionary confounder terms and the use of potentially stigmatising language. This study set out to determine if content experts and patient advocates were in favor of a change in nomenclature and/or definition. A modified Delphi process was led by three large pan-national liver associations. The consensus was defined a priori as a supermajority (67%) vote. An independent committee of experts external to the nomenclature process made the final recommendation on the acronym and its diagnostic criteria. A total of 236 panelists from 56 countries participated in 4 online surveys and 2 hybrid meetings. Response rates across the 4 survey rounds were 87%, 83%, 83%, and 78%, respectively. Seventy-four percent of respondents felt that the current nomenclature was sufficiently flawed to consider a name change. The terms “nonalcoholic” and “fatty” were felt to be stigmatising by 61% and 66% of respondents, respectivel...
Journal of Hepatology, 2022
About a third of countries (n = 32/102) scored zero on the preparedness index. No country had a n... more About a third of countries (n = 32/102) scored zero on the preparedness index. No country had a national or sub-national strategy for NAFLD. NAFLD was rarely mentioned in the strategies of related conditions such as diabetes. Only 32 countries had national NAFLD clinical guidelines. A comprehensive NAFLD public health response is lacking in all 102 countries.
The lancet. Gastroenterology & hepatology, 2020
background: Many NSTEACS patients are medically managed without coronary revascularization. The r... more background: Many NSTEACS patients are medically managed without coronary revascularization. The reasons vary and may impact prognosis. methods: EPICOR Asia (NCT01361386) is a prospective study of hospital survivors post ACS enrolled in 219 hospitals from 8 countries/ regions in Asia (06/2011-05/2012). All medically managed NSTEACS patients in EPICOR Asia were classified into 3 groups: 1) no coronary angiography (CAG-); 2) non-significant coronary artery disease (CAD) on angiogram (CAG+ CAD-); and 3) significant CAD (CAG+ CAD+). We compared baseline differences between groups, and report 1-y mortality rates. Results: Of 6,164 NSTEACS patients, 2,272 (37%) were medically managed only, with 1,339 (59%), 254 (11%) and 679 (30%) patients in the CAG-, CAG+ CAD-, and CAG+ CAD+ groups, respectively. There were marked differences in number of NSTEACS patients medically managed among the 8 countries/regions (13-81%). Between-group differences were seen in baseline characteristics (Table). CAG+ CADpatients were younger with fewer CV risk factors than CAG+ CAD+. CAG-patients were older, more likely with known CV disease, more frequently admitted to hospitals with no cath lab, and had the highest 1-y mortality (6.9% versus 3.3% for EPICOR Asia overall). conclusion: NSTEACS patients who are medically managed are a heterogeneous group with different clinical features and outcomes e.g. mortality risk. The factors underlying different management strategies, and to improve prognosis, need to be identified.
Journal of Hepatology, 2021
Oxidative Medicine and Cellular Longevity, 2017
Approximately 20% of human cancers is attributable to DNA oncogenic viruses such as human papillo... more Approximately 20% of human cancers is attributable to DNA oncogenic viruses such as human papillomavirus (HPV), hepatitis B virus (HBV), and Epstein-Barr virus (EBV). Unrepaired DNA damage is the most common and overlapping feature of these DNA oncogenic viruses and a source of genomic instability and tumour development. Sustained DNA damage results from unceasing production of reactive oxygen species and activation of inflammasome cascades that trigger genomic changes and increased propensity of epigenetic alterations. Accumulation of epigenetic alterations may interfere with genome-wide cellular signalling machineries and promote malignant transformation leading to cancer development. Untangling and understanding the underlying mechanisms that promote these detrimental effects remain the major objectives for ongoing research and hope for effective virus-induced cancer therapy. Here, we review current literature with an emphasis on how DNA damage influences HPV, HVB, and EBV replic...
Journal of Clinical Gastroenterology, 2012
The Lancet. Gastroenterology & hepatology, Apr 1, 2024
Journal of Clinical Gastroenterology, Oct 1, 2016
Review Team: Jordan Feld, MD (Chair, Canada), Harry L.A. Janssen, MD (Chair, Canada/The Netherlan... more Review Team: Jordan Feld, MD (Chair, Canada), Harry L.A. Janssen, MD (Chair, Canada/The Netherlands), Zaigham Abbas, MD (Pakistan), Andre Elewaut, MD (Belgium), Peter Ferenci, MD (Austria), Vasily Isakov, MD (Russia), Aamir G. Khan, MD (Pakistan), Seng Gee Lim, MD (Singapore), Stephen A. Locarnini, MD (Australia), Suzane K. Ono, MD (Brazil), Jose Sollano, MD (Philippines), Catherine W. Spearman, MD (South Africa), Chau-Ting Yeh, MD (Taiwan), Man Fung Yuen, MD (Hong Kong), and Anton LeMair, MD (The Netherlands)
Nature Reviews Endocrinology, Feb 17, 2023
Hyperferritinaemia is a common laboratory finding that is often associated with metabolic dysfunc... more Hyperferritinaemia is a common laboratory finding that is often associated with metabolic dysfunction and fatty liver. Metabolic hyperferritinaemia reflects alterations in iron metabolism that facilitate iron accumulation in the body and is associated with an increased risk of cardiometabolic and liver diseases. Genetic variants that modulate iron homeostasis and tissue levels of iron are the main determinants of serum levels of ferritin in individuals with metabolic dysfunction, raising the hypothesis that iron accumulation might be implicated in the pathogenesis of insulin resistance and the related organ damage. However, validated criteria for the non-invasive diagnosis of metabolic hyperferritinaemia and the staging of iron overload are still lacking, and there is no clear evidence of a benefit for iron depletion therapy. Here, we provide an overview of the literature on the relationship between hyperferritinaemia and iron accumulation in individuals with metabolic dysfunction, and on the associated clinical outcomes. We propose an updated definition and a provisional staging system for metabolic hyperferritinaemia, which has been agreed on by a multidisciplinary global panel of expert researchers. The goal is to foster studies into the epidemiology, genetics, pathophysiology, clinical relevance and treatment of metabolic hyperferritinaemia, for which we provide suggestions on the main unmet needs, optimal design and clinically relevant outcomes.
BMC Medicine
Background Elimination of mother-to-child transmission of hepatitis B virus (HBV) requires infant... more Background Elimination of mother-to-child transmission of hepatitis B virus (HBV) requires infant immunoprophylaxis and antiviral prophylaxis for pregnant women with high viral loads. Since real-time polymerase chain reaction (RT-PCR), a gold standard for assessing antiviral eligibility, is neither accessible nor affordable for women living in low-income and middle-income countries (LMICs), rapid diagnostic tests (RDTs) detecting alternative HBV markers may be needed. To inform future development of the target product profile (TPP) for RDTs to identify highly viremic women, we used a discrete choice experiment (DCE) and elicited preference and trade-off of healthcare workers (HCW) in Africa between the following four attributes of fictional RDTs: price, time-to-result, diagnostic sensitivity, and specificity. Methods Through an online questionnaire survey, we asked participants to indicate their preferred test from a set of two RDTs in seven choice tasks with varying levels of the f...