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Occupational exposure during emergency department thoracotomy: A prospective, multi-institution study. J Trauma Acute Care Surg 2019; 85:78-84. [PMID: 29664893 DOI: 10.1097/ta.0000000000001940] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Occupational exposure is an important consideration during emergency department thoracotomy (EDT). While human immunodeficiency virus/hepatitis prevalence in trauma patients (0-16.8%) and occupational exposure rates during operative trauma procedures (1.9-18.0%) have been reported, exposure risk during EDT is unknown. We hypothesized that occupational exposure risk during EDT would be greater than other operative trauma procedures. METHODS A prospective, observational study at 16 US trauma centers was performed (2015-2016). All bedside EDT resuscitation providers were surveyed with a standardized data collection tool and risk factors analyzed with respect to the primary end point, EDT occupational exposure (percutaneous injury, mucous membrane, open wound, or eye splash). Provider and patient variables and outcomes were evaluated with single and multivariable logistic regression analyses. RESULTS One thousand three hundred sixty participants (23% attending, 59% trainee, 11% nurse, 7% other) were surveyed after 305 EDTs (gunshot wound, 68%; prehospital cardiopulmonary resuscitation, 57%; emergency department signs of life, 37%), of which 15 patients survived (13 neurologically intact) their hospitalization. Overall, 22 occupational exposures were documented, resulting in an exposure rate of 7.2% (95% confidence interval [CI], 4.7-10.5%) per EDT and 1.6% (95% CI, 1.0-2.4%) per participant. No differences in trauma center level, number of participants, or hours worked were identified. Providers with exposures were primarily trainees (68%) with percutaneous injuries (86%) during the thoracotomy (73%). Full precautions were utilized in only 46% of exposed providers, while multiple variable logistic regression determined that each personal protective equipment item utilized during EDT correlated with a 34% decreased risk of occupational exposure (odds ratio, 0.66; 95% CI, 0.48-0.91; p = 0.010). CONCLUSIONS Our results suggest that the risk of occupational exposure should not deter providers from performing EDT. Despite the small risk of viral transmission, our data revealed practices that may place health care providers at unnecessary risk of occupational exposure. Regardless of the lifesaving nature of the procedure, improved universal precaution compliance with personal protective equipment is paramount and would further minimize occupational exposure risks during EDT. LEVEL OF EVIDENCE Therapeutic/care management study, level III.
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Aguinaga A, Díaz-González J, Pérez-García A, Barrado L, Martínez-Baz I, Casado I, Juanbeltz R, Ezpeleta C, Castilla J. The prevalence of diagnosed and undiagnosed hepatitis C virus infection in Navarra, Spain, 2014-2016. Enferm Infecc Microbiol Clin 2017; 36:325-331. [PMID: 28110858 DOI: 10.1016/j.eimc.2016.12.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 11/30/2016] [Accepted: 12/04/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate the prevalence of hepatitis C virus (HCV) infection in Navarra, Spain, as well as to distinguish between diagnosed and undiagnosed infections. METHODS A study was conducted on patients scheduled for surgery unrelated to HCV infection. They were all tested for HCV antibodies, under a routine scheme, from January 2014 to September 2016. Patients with a positive result by enzyme immunoassay were confirmed using immunoblot and/or HCV-RNA. Previous laboratory results were also taken into account. The prevalence was adjusted to the sex and age structure of the Navarra population. RESULTS The study included a total of 7,378 patients with a median age 46 years, of whom 50% women. HCV antibodies were detected in 69 patients, which is a prevalence in the population of 0.83% (95% confidence interval: 0.64-1.05), and was higher in men (1.11%) than in women (0.56%; P=.0102). Among the HCV positive patients, 67 (97%) had had another previous positive result. Population prevalence of previous positive HCV was 0.80%, and was 0.03% for a new diagnosis. Of the HCV positive patients, 78% had detectable HCV-RNA. It was estimated that 0.65% of the population had had detectable HCV-RNA, and 0.51% continued to have it when recruited into the study. CONCLUSION Previous estimates of prevalence of HCV infection should be revised downwards. Only a small proportion of HCV positive patients remain undiagnosed, and only a small part have active infection.
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Affiliation(s)
- Aitziber Aguinaga
- Servicio de Microbiología Clínica, Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, España
| | - Jorge Díaz-González
- Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, España
| | - Alejandra Pérez-García
- Servicio de Microbiología Clínica, Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Pamplona, España
| | - Laura Barrado
- Hospital García Orcoyen, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Estella, Navarra, España
| | - Iván Martínez-Baz
- Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Pamplona, España
| | - Itziar Casado
- Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Pamplona, España
| | - Regina Juanbeltz
- Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Pamplona, España
| | - Carmen Ezpeleta
- Servicio de Microbiología Clínica, Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, España
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Pamplona, España.
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Taylor BS, Hanson JT, Veerapaneni P, Villarreal R, Fiebelkorn K, Turner BJ. Hospital-Based Hepatitis C Screening of Baby Boomers in a Majority Hispanic South Texas Cohort: Successes and Barriers to Implementation. Public Health Rep 2016; 131 Suppl 2:74-83. [PMID: 27168665 PMCID: PMC4853332 DOI: 10.1177/00333549161310s212] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To comply with the 2012 CDC recommendations for hepatitis C virus (HCV) screening, we implemented a new HCV screening program for patients born between 1945 and 1965 at a South Texas safety-net hospital. METHODS Patients with no HCV diagnosis or prior HCV test received an automated order for HCV antibody (anti-HCV) tests combined with reflex HCV ribonucleic acid (RNA) polymerase chain reaction. An inpatient counselor educated anti-HCV-positive patients. A bilingual patient navigator assisted newly diagnosed chronic HCV patients with linkage to primary and specialty care. We examined results for Hispanic vs. non-Hispanic patients in the first 10 months of project implementation in 2013-2014. RESULTS Of 2,327 patients screened for HCV, the 192 (8%) patients who tested anti-HCV positive were younger than those who tested negative (56 vs. 58 years, respectively, p<0.001) and more likely to be male (p<0.001). Of the 167 anti-HCV-positive patients tested for HCV RNA, 108 (65%) were HCV RNA positive (5% of cohort). Barriers to care for HCV RNA-positive patients included a lack of health insurance, current substance abuse, incarceration, and homelessness. Hispanic HCV RNA-positive patients were more likely than non-Hispanic HCV RNA-positive patients to be substance abusers or incarcerated. Of all HCV RNA-positive patients, 103 patients (95%) received counseling, 94 patients (87%) were linked to primary care, 47 patients (44%) were linked to specialty care, and eight patients (7%) started treatment. CONCLUSION The prevalence of anti-HCV-positive and chronically HCV-infected patients was higher than many Hispanic or non-Hispanic white cohorts. Most Hispanic patients newly diagnosed with chronic HCV had barriers to care for HCV infection that must be overcome if HCV screening is to reduce morbidity and mortality in this population.
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Affiliation(s)
- Barbara S. Taylor
- University of Texas Health Science Center, Center for Research to Advance Community Health, San Antonio, TX
- University of Texas Health Science Center, Department of Medicine, Division of Infectious Diseases, San Antonio, TX
| | - Joshua T. Hanson
- University of Texas Health Science Center, Center for Research to Advance Community Health, San Antonio, TX
- University of Texas Health Science Center, Department of Medicine, Division of Hospital Medicine, San Antonio, TX
| | - Poornachand Veerapaneni
- University of Texas Health Science Center, Center for Research to Advance Community Health, San Antonio, TX
| | | | - Kristin Fiebelkorn
- University of Texas Health Science Center, Department of Medicine, Division of Infectious Diseases, San Antonio, TX
- University Health System, San Antonio, TX
- University of Texas Health Science Center, Department of Pathology, San Antonio, TX
| | - Barbara J. Turner
- University of Texas Health Science Center, Center for Research to Advance Community Health, San Antonio, TX
- University of Texas Health Science Center, Department of Medicine, Division of General Internal Medicine, San Antonio, TX
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Smyth D, Webster D. Hepatitis C: pay now or pay later? Future Virol 2015. [DOI: 10.2217/fvl.15.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Hepatitis C is a leading cause of liver disease and resulting complications are predicted to increase in the coming decades. However, recent availability of interferon-free treatment has put the spotlight on this epidemic and its health and economic impacts. Yet the cost of therapy is frequently prohibitive. When available, treatment provides an opportunity to abort disease progression, thus forgoing expensive downstream healthcare expenditures. Cost savings from therapy seem both probable and measurable in select patients with advanced disease and low risk of reinfection. The economic argument for early treatment is not as clear in those with less advanced liver disease and higher risk of reinfection. The optimal alignment of the relevant clinical and epidemiologic variables has yet to be clearly defined.
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Affiliation(s)
- Dan Smyth
- Division of Infectious Diseases, Department of Medicine, Horizon Health, 135 Macbeath Avenue, Moncton, NB E1C 6Z8, Canada
- Faculty of Medicine, Dalhousie University, 6299 South St, Halifax, NS B3H 4R2, Canada
| | - Duncan Webster
- Faculty of Medicine, Dalhousie University, 6299 South St, Halifax, NS B3H 4R2, Canada
- Division of Infectious Diseases, Department of Medicine, Horizon Health, Saint John, NB E2L 4L4, Canada
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Wicker S, Rabenau H, Scheller B, Marzi I, Wutzler S. Prävalenz blutübertragbarer Virusinfektionen bei 275 Schockraumpatienten. Unfallchirurg 2015; 119:648-53. [DOI: 10.1007/s00113-015-0110-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Turner BJ, Taylor BS, Hanson J, Liang Y, Veerapaneni P, Villarreal R, Perez M, Hernandez L, Sandhu J, Fiebelkorn K. High priority for hepatitis C screening in safety net hospitals: Results from a prospective cohort of 4582 hospitalized baby boomers. Hepatology 2015; 62:1388-95. [PMID: 26250753 DOI: 10.1002/hep.28018] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 07/29/2015] [Indexed: 12/19/2022]
Abstract
UNLABELLED Low-income populations are disproportionately affected by hepatitis C virus (HCV) infection. Thus, implementing baby boomer screening (born 1945-1965) for HCV may be a high priority for safety net hospitals. We report the prevalence and predictors of HCV infection and advanced fibrosis or cirrhosis based on the Fibrosis-4 score plus imaging for a baby boomer cohort admitted to a safety net hospital over a 21-month interval with >9 months of follow-up. Anti-HCV antibody testing was performed for 4582, or 90%, of all never-screened patients, of whom 312 (6.7%) tested positive. Adjusted odds ratios of testing anti-HCV-positive were 2.66 for men versus women (P<0.001), 1.25 for uninsured versus insured (P=0.06), 0.70 for Hispanics versus non-Hispanic whites (P=0.005), and 0.93 per year of age (P<0.001). Among 287 patients tested for HCV RNA (91% of all anti-HCV-positive cases), 175 (61%) were viremic (3.8% overall prevalence in cohort), which was 5% less likely per year of age (P<0.03). Noninvasive staging of 148 (84.6%) chronic HCV patients identified advanced fibrosis or cirrhosis in 50 (33.8%), with higher adjusted odds ratios of 3.21 for Hispanics versus non-Hispanic whites/Asians (P=0.02) and 1.18 per year of age (P=0.001). Other factors associated with significantly higher adjusted odds ratios of advanced fibrosis or cirrhosis were alcohol abuse/dependence, obesity, and being uninsured. CONCLUSION In this low-income, hospitalized cohort, 4% of 4582 screened baby boomers were diagnosed with chronic HCV, nearly twice the rate in the community; one-third had noninvasive testing that indicated advanced fibrosis or cirrhosis, which was significantly more likely for Hispanics, those of older age, those with obesity, those with alcohol abuse/dependence, and those who lacked insurance.
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Affiliation(s)
- Barbara J Turner
- Department of Medicine and Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Barbara S Taylor
- Department of Medicine and Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Joshua Hanson
- Department of Medicine and Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Yuanyuan Liang
- Department of Epidemiology and Biostatistics and Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Poornachand Veerapaneni
- Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | | | - Mary Perez
- Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Ludivina Hernandez
- Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Jasdeep Sandhu
- School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Kristin Fiebelkorn
- Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, TX
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An evidence-based approach to patient selection for emergency department thoracotomy: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 2015; 79:159-73. [PMID: 26091330 DOI: 10.1097/ta.0000000000000648] [Citation(s) in RCA: 187] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Within the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework, we performed a systematic review and developed evidence-based recommendations to answer the following PICO (Population, Intervention, Comparator, Outcomes) question: should patients who present pulseless after critical injuries (with and without signs of life after penetrating thoracic, extrathoracic, or blunt injuries) undergo emergency department thoracotomy (EDT) (vs. resuscitation without EDT) to improve survival and neurologically intact survival? METHODS All patients who underwent EDT were included while those involving either prehospital resuscitative thoracotomy or operating room thoracotomy were excluded. Quantitative synthesis via meta-analysis was not possible because no comparison or control group (i.e., survival or neurologically intact survival data for similar patients who did not undergo EDT) was available for the PICO questions of interest. RESULTS The 72 included studies provided 10,238 patients who underwent EDT. Patients presenting pulseless after penetrating thoracic injury had the most favorable EDT outcomes both with (survival, 182 [21.3%] of 853; neurologically intact survival, 53 [11.7%] of 454) and without (survival, 76 [8.3%] of 920; neurologically intact survival, 25 [3.9%] of 641) signs of life. In patients presenting pulseless after penetrating extrathoracic injury, EDT outcomes were more favorable with signs of life (survival, 25 [15.6%] of 160; neurologically intact survival, 14 [16.5%] of 85) than without (survival, 4 [2.9%] of 139; neurologically intact survival, 3 [5.0%] of 60). Outcomes after EDT in pulseless blunt injury patients were limited with signs of life (survival, 21 [4.6%] of 454; neurologically intact survival, 7 [2.4%] of 298) and dismal without signs of life (survival, 7 [0.7%] of 995; neurologically intact survival, 1 [0.1%] of 825). CONCLUSION We strongly recommend that patients who present pulseless with signs of life after penetrating thoracic injury undergo EDT. We conditionally recommend EDT for patients who present pulseless and have absent signs of life after penetrating thoracic injury, present or absent signs of life after penetrating extrathoracic injury, or present signs of life after blunt injury. Lastly, we conditionally recommend against EDT for pulseless patients without signs of life after blunt injury. LEVEL OF EVIDENCE Systematic review/guideline, level III.
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Turner BJ, Taylor BS, Hanson JT, Perez ME, Hernandez L, Villarreal R, Veerapaneni P, Fiebelkorn K. Implementing hospital-based baby boomer hepatitis C virus screening and linkage to care: Strategies, results, and costs. J Hosp Med 2015; 10:510-6. [PMID: 26033458 DOI: 10.1002/jhm.2376] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 04/10/2015] [Accepted: 04/19/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND/OBJECTIVE The US Preventive Services Task Force recommends 1-time hepatitis C virus (HCV) screening of all baby boomers (born 1945-1965). However, little is known about optimal ways to implement HCV screening, counseling, and linkage to care. We developed strategies following approaches used for HIV to implement baby boomer HCV screening in a hospital setting and report results as well as costs. DESIGN/PATIENTS Prospective cohort of 6140 baby boomers admitted to a safety-net hospital in South Texas from December 1, 2012 to January 31, 2014 and followed to December 10, 2014. PROCEDURES/MEASUREMENTS The HCV screening program included clinician/staff education, electronic medical record algorithm for eligibility and order entry, opt-out consent, anti-HCV antibody test with reflex HCV RNA, personalized inpatient counseling, and outpatient case management. Outcomes were anti-HCV antibody-positive and HCV RNA-positive results. RESULTS Of 3168 eligible patients, 240 (7.6%) were anti-HCV positive, which was more likely (P < 0.05) for younger age, men, and uninsured. Of 214 (89.2%) patients tested for HCV RNA, 134 (4.2% of all screened) were positive (chronic HCV). Among patients with chronic HCV, 129 (96.3%) were counseled, 108 (80.6%) received follow-up primary care, and 52 (38.8%) received hepatology care. Five patients initiated anti-HCV therapy. Total costs for start-up and implementation for 14 months were $286,482. CONCLUSIONS This inpatient HCV screening program diagnosed chronic HCV infection in 4.2% of tested patients and linked >80% to follow-up care. Yet access to therapy is challenging for largely uninsured populations, and most programmatic costs of the program are not currently covered.
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Affiliation(s)
- Barbara J Turner
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Barbara S Taylor
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Joshua T Hanson
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Mary Elizabeth Perez
- Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Ludivina Hernandez
- Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | - Poornachand Veerapaneni
- Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Kristin Fiebelkorn
- Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Smyth DJ, Webster D, Barrett L, MacMillan M, McKnight L, Schweiger F. Transitioning to highly effective therapies for the treatment of chronic hepatitis C virus infection: a policy statement and implementation guideline. Can J Gastroenterol Hepatol 2014; 28:529-34. [PMID: 25390613 PMCID: PMC4234351 DOI: 10.1155/2014/109046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 09/08/2014] [Indexed: 01/22/2023] Open
Abstract
Chronic hepatitis C virus (HCV) infection increases all-cause mortality, rates of cirrhosis, hepatocellular carcinoma, liver transplantation and overall health care utilization. Morbidity and mortality disproportionately affect individuals born between 1945 and 1975. The recent development of well-tolerated and highly effective therapies for chronic HCV infection represents a unique opportunity to dramatically reduce rates of HCV-related complications and their costs. Critical to the introduction of such therapies will be well-designed provincial programming to ensure immediate treatment access to individuals at highest risk for complication, and well-defined strategies to address the global treatment needs of traditionally high-risk and marginalized populations. HCV practitioners in New Brunswick created a provincial strategy that stratifies treatment according to those at highest need, measures clinical impact, and creates evaluation strategies to demonstrate the significant direct and indirect cost savings anticipated with curative treatments.
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Affiliation(s)
- Daniel J Smyth
- Horizon Health Network, New Brunswick
- Dalhousie University, Halifax, Nova Scotia
| | - Duncan Webster
- Horizon Health Network, New Brunswick
- Dalhousie University, Halifax, Nova Scotia
| | - Lisa Barrett
- Capital Health, Halifax, Nova Scotia
- Dalhousie University, Halifax, Nova Scotia
| | - Mark MacMillan
- Horizon Health Network, New Brunswick
- Dalhousie University, Halifax, Nova Scotia
| | - Lisa McKnight
- Horizon Health Network, New Brunswick
- Dalhousie University, Halifax, Nova Scotia
| | - Frank Schweiger
- Horizon Health Network, New Brunswick
- Dalhousie University, Halifax, Nova Scotia
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Bräu N. Evaluation of the hepatitis C virus-infected patient: the initial encounter. Clin Infect Dis 2012; 56:853-60. [PMID: 23243172 DOI: 10.1093/cid/cis957] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Deaths from hepatitis C virus (HCV)-related disease are increasing, now exceeding those from human immunodeficiency virus. Up to 7 million Americans (2.3%) may be infected with HCV, and more than half are undiagnosed. Proposed expansion of hepatitis C screening to include all persons born between 1945 and 1965 will lead to many new diagnoses, and infectious diseases physicians have a unique opportunity to be part of managing these patients. Apart from a liver-focused history and examination, the initial evaluation includes determination of the liver function via serum tests and assessment of liver fibrosis and necroinflammation through biopsy or noninvasive means. Patients with cirrhosis require screening for esophageal varices and for liver cancer. Nonimmune patients need vaccinations against hepatitis A and B, and alcohol abstinence is critical. Initial counseling on therapy emphasizes viral cure rates of currently 70%-80% as well as expected side effects. New treatments with fewer side effects and potentially higher cure rates are currently in development.
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Affiliation(s)
- Norbert Bräu
- Division of Liver Diseases, Mount Sinai School of Medicine, New York, USA.
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