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Ghose R, Cowden F, Veluchamy A, Smith BH, Colvin LA. Characteristics of non-fatal overdoses and associated risk factors in patients attending a specialist community-based substance misuse service. Br J Pain 2022; 16:458-466. [PMID: 36032347 PMCID: PMC9411761 DOI: 10.1177/20494637221095447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction There are concerns about rising drug-related deaths and the potential contribution of prescription analgesics. There is limited understanding regarding the role of prescription analgesics in non-fatal overdoses (NFODs), nor is there a good understanding of what factors are associated with more severe overdose. Objectives To explore risk factors and characteristics of NFODs among people attending a specialist community-based substance misuse service. Methods After Caldicott approval, data on NFODs, in people attending the Tayside Substance Misuse Service (TSMS), were extracted from the Scottish Ambulance Service database, along with opioid replacement therapy (ORT) prescribing data. Statistical analysis was performed using R studio and Microsoft Excel. Results 557 people (78% [434/556] male, mean age ± standard deviation 38.4 ± 7.95) had an NFOD. Repeat NFODs were more likely in males compared to females ( p < .0065). Males were more likely to be administered naloxone (OR = 1.94, 95% CI = 1.10–3.40, p < .02). NFODs at home were more likely to be moderate to severe (categorized by Glasgow Comma Scale [ p < .02, OR = 4.95, 95% CI = 1.24–24.38]). Methadone (321/557, 57.63%), benzodiazepines (281/557, 50.45%) and heroin (244/557, 43.81%) were the commonest substances: prescribed methadone overdose was more likely than buprenorphine ( p < .00001). Opioids and benzodiazepines were often taken together (275/557, 49.40%), with almost all gabapentinoid NFODs also involving opioids (60/61, 98.40%). Conclusions Polysubstance use with opioids prescribed for ORT, such as methadone, is highly likely to be implicated in NFOD, with males being at the highest risk of severe and repeat NFOD. Future work should focus on strategies to further reduce NFODs.
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Affiliation(s)
- Riya Ghose
- Department of Medicine, School of Medicine, University of Dundee, Dundee, UK
| | | | - Abirami Veluchamy
- Department of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Blair H Smith
- Department of Population Health Sciences, Medical Research Institute, Dundee, UK
| | - Lesley A Colvin
- Department of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
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2
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Busschots D, Ho E, Blach S, Nevens F, Razavi H, Van Damme B, Vanwolleghem T, Robaeys G. Ten years countdown to hepatitis C elimination in Belgium: a mathematical modeling approach. BMC Infect Dis 2022; 22:397. [PMID: 35459120 PMCID: PMC9026052 DOI: 10.1186/s12879-022-07378-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic infection with the hepatitis C virus (HCV) remains a worldwide health problem. As a result, the World Health Organization (WHO) has set elimination targets by 2030. This study aims to examine the position of Belgium in meeting the WHO's targets by 2030. METHODS A Markov disease progression model, constructed in Microsoft Excel, was utilized to quantify the size of the HCV-infected population, by the liver disease stages, from 2015 to 2030. Two scenarios were developed to (1) forecast the disease burden in Belgium under the 2019 Base and (2) see what is needed to achieve the WHO targets. RESULTS It was estimated that the number of HCV RNA-positive individuals in Belgium in 2015 was 18,800. To achieve the WHO goals, Belgium needs to treat at least 1200 patients per year. This will only be feasible if the number of screening tests increases. CONCLUSIONS Belgium is on target to reach the WHO targets by 2030 but will have to make sustained efforts. However, eradicating HCV requires policy changes to significantly increase prevention, screening, and treatment, alongside public health promotion, to raise awareness among high-risk populations and health care providers.
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Affiliation(s)
- Dana Busschots
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Martelarenlaan 42, 3500, Hasselt, Belgium. .,Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium.
| | - Erwin Ho
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium
| | - Sarah Blach
- Center for Disease Analysis, Lafayette, CO, USA
| | - Frederik Nevens
- Department of Gastroenterology and Hepatology, University Hospitals KU Leuven, Leuven, Belgium
| | | | - Brieuc Van Damme
- National Institute for Health and Disability Insurance (NIHDI), Brussels, Belgium.,Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Thomas Vanwolleghem
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium.,Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
| | - Geert Robaeys
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Martelarenlaan 42, 3500, Hasselt, Belgium.,Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals KU Leuven, Leuven, Belgium
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3
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George BE, Barth SH, Kuiper LB, Holleran KM, Lacy RT, Raab-Graham KF, Jones SR. Enhanced heroin self-administration and distinct dopamine adaptations in female rats. Neuropsychopharmacology 2021; 46:1724-1733. [PMID: 34040157 PMCID: PMC8358024 DOI: 10.1038/s41386-021-01035-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/03/2021] [Accepted: 05/07/2021] [Indexed: 02/04/2023]
Abstract
Increasing evidence suggests that females are more vulnerable to the harmful effects of drugs of abuse, including opioids. Additionally, rates of heroin-related deaths substantially increased in females from 1999 to 2017 [1], underscoring the need to evaluate sex differences in heroin vulnerability. Moreover, the neurobiological substrates underlying sexually dimorphic responding to heroin are not fully defined. Thus, we evaluated male and female Long Evans rats on acquisition, dose-responsiveness, and seeking for heroin self-administration (SA) as well as using a long access model to assess escalation of intake at low and high doses of heroin, 0.025 and 0.1 mg/kg/inf, respectively. We paired this with ex vivo fast-scan cyclic voltammetry (FSCV) in the medial nucleus accumbens (NAc) shell and quantification of mu-opioid receptor (MOR) protein in the ventral tegmental area (VTA) and NAc. While males and females had similar heroin SA acquisition rates, females displayed increased responding and intake across doses, seeking for heroin, and escalation on long access. However, we found that males and females had similar expression levels of MORs in the VTA and NAc, regardless of heroin exposure. FSCV results revealed that heroin exposure did not change single-pulse elicited dopamine release, but caused an increase in dopamine transporter activity in both males and females compared to their naïve counterparts. Phasic-like stimulations elicited robust increases in dopamine release in heroin-exposed females compared to heroin-naïve females, with no differences seen in males. Together, our results suggest that differential adaptations of dopamine terminals may underlie the increased heroin SA behaviors seen in females.
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Affiliation(s)
- Brianna E. George
- grid.241167.70000 0001 2185 3318Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Samuel H. Barth
- grid.241167.70000 0001 2185 3318Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Lindsey B. Kuiper
- grid.241167.70000 0001 2185 3318Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Katherine M. Holleran
- grid.241167.70000 0001 2185 3318Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Ryan T. Lacy
- grid.256069.eDepartment of Psychology, Franklin and Marshall College, Lancaster, PA USA
| | - Kimberly F. Raab-Graham
- grid.241167.70000 0001 2185 3318Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Sara R. Jones
- grid.241167.70000 0001 2185 3318Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC USA
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4
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Tatara E, Schneider J, Quasebarth M, Collier N, Pollack H, Boodram B, Friedman S, Salisbury-Afshar E, Mackesy-Amiti ME, Ozik J. Application of Distributed Agent-based Modeling to Investigate Opioid Use Outcomes in Justice Involved Populations. IEEE INTERNATIONAL SYMPOSIUM ON PARALLEL & DISTRIBUTED PROCESSING, WORKSHOPS AND PHD FORUM : [PROCEEDINGS]. IEEE INTERNATIONAL SYMPOSIUM ON PARALLEL & DISTRIBUTED PROCESSING, WORKSHOPS AND PHD FORUM 2021; 2021:989-997. [PMID: 35865008 PMCID: PMC9297575 DOI: 10.1109/ipdpsw52791.2021.00157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Criminal justice involved (CJI) individuals with a history of opioid use disorder (OUD) are at high risk of overdose and death in the weeks following release from jail. We developed the Justice-Community Circulation Model (JCCM) to investigate OUD/CJI dynamics post-release and the effects of interventions on overdose deaths. The JCCM uses a synthetic agent-based model population of approximately 150,000 unique individuals that is generated using demographic information collected from multiple Chicago-area studies and data sets. We use a high-performance computing (HPC) workflow to implement a sequential approximate Bayesian computation algorithm for calibrating the JCCM. The calibration results in the simulated joint posterior distribution of the JCCM input parameters. The calibrated model is used to investigate the effects of a naloxone intervention for a mass jail release. The simulation results show the degree to which a targeted intervention focusing on recently released jail inmates can help reduce the risk of death from opioid overdose.
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Affiliation(s)
- Eric Tatara
- Decision and Infrastructure Sciences Division, Argonne National Laboratory, Lemont, IL, USA
- Consortium for Advanced Science and Engineering, University of Chicago, Chicago, IL, USA
| | - John Schneider
- Departments of Medicine and Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Madeline Quasebarth
- Departments of Medicine and Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Nicholson Collier
- Decision and Infrastructure Sciences Division, Argonne National Laboratory, Lemont, IL, USA
- Consortium for Advanced Science and Engineering, University of Chicago, Chicago, IL, USA
| | - Harold Pollack
- Crown School of Social Work Policy and Practice, University of Chicago, Chicago, IL, USA
| | - Basmattee Boodram
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Sam Friedman
- Department of Population Health, New York University Langone Medical School, New York, NY, USA
| | - Elizabeth Salisbury-Afshar
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Mary Ellen Mackesy-Amiti
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Jonathan Ozik
- Decision and Infrastructure Sciences Division, Argonne National Laboratory, Lemont, IL, USA
- Consortium for Advanced Science and Engineering, University of Chicago, Chicago, IL, USA
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5
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Binka M, Janjua NZ, Grebely J, Estes C, Schanzer D, Kwon JA, Shoukry NH, Kwong JC, Razavi H, Feld JJ, Krajden M. Assessment of Treatment Strategies to Achieve Hepatitis C Elimination in Canada Using a Validated Model. JAMA Netw Open 2020; 3:e204192. [PMID: 32374397 PMCID: PMC7203608 DOI: 10.1001/jamanetworkopen.2020.4192] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/04/2020] [Indexed: 12/19/2022] Open
Abstract
Importance Achievement of the World Health Organization (WHO) target of eliminating hepatitis C virus (HCV) by 2030 will require an increase in key services, including harm reduction, HCV screening, and HCV treatment initiatives in member countries. These data are not available for Canada but are important for informing a national HCV elimination strategy. Objective To use a decision analytical model to explore the association of different treatment strategies with HCV epidemiology and HCV-associated mortality in Canada and to assess the levels of service increase needed to meet the WHO elimination targets by 2030. Design, Setting, and Participants Study participants in this decision analytical model included individuals with hepatitis C virus infection in Canada. Five HCV treatment scenarios (optimistic, very aggressive, aggressive, gradual decrease, and rapid decrease) were applied using a previously validated Markov-type mathematical model. The optimistic and very aggressive treatment scenarios modeled a sustained annual treatment of 10 200 persons and 14 000 persons, respectively, from 2018 to 2030. The aggressive, gradual decrease, and rapid decrease scenarios assessed decreases in treatment uptake from 14 000 persons to 10 000 persons per year, 12 000 persons to 8500 persons per year, and 12 000 persons to 4500 persons per year, respectively, between 2018 and 2030. Main Outcomes and Measures Hepatitis C virus prevalence and HCV-associated health outcomes were assessed for each of the 5 treatment scenarios with the goal of identifying strategies to achieve HCV elimination by 2030. Results An estimated mean 180 142 persons (95% CI, 122 786-196 862 persons) in Canada had chronic HCV infection at the end of 2017. The optimistic and gradual decrease scenarios estimated a decrease in HCV prevalence from 180 142 persons to 37 246 persons and 37 721 persons, respectively, by 2030. Relative to 2015, this decrease in HCV prevalence was associated with 74%, 69%, and 69% reductions in the prevalence of decompensated cirrhosis, hepatocellular carcinoma, and liver-associated mortality, respectively, leading to HCV elimination by 2030. More aggressive treatment uptake (very aggressive scenario) could result in goal achievement up to 3 years earlier than 2030, although a rapid decrease in the initiation of treatment (rapid decrease scenario) would preclude Canada from reaching the HCV elimination goal by 2030. Conclusions and Relevance The study findings suggest that Canada could meet the WHO goals for HCV elimination by 2030 by sustaining the current national HCV treatment rate during the next decade. This target will not be achieved if treatment uptake is allowed to decrease rapidly.
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Affiliation(s)
- Mawuena Binka
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Naveed Z. Janjua
- British Columbia Centre for Disease Control, Vancouver, Canada
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
- University of British Columbia, Vancouver, Canada
| | - Jason Grebely
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | - Chris Estes
- Center for Disease Analysis, Lafayette, Colorado
| | - Dena Schanzer
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
| | - Jisoo A. Kwon
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | - Naglaa H. Shoukry
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
- Centre de Recherche du Centre Hospitalier de l’Universite de Montreal, Montreal, Quebec, Canada
| | - Jeffrey C. Kwong
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
- ICES, Toronto, Ontario, Canada
| | - Homie Razavi
- Center for Disease Analysis, Lafayette, Colorado
| | - Jordan J. Feld
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, Canada
- Canadian Network on Hepatitis C, Montreal, Quebec, Canada
- University of British Columbia, Vancouver, Canada
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6
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Mortality Among People With Opioid Use Disorder: A Systematic Review and Meta-analysis. J Addict Med 2020; 14:e118-e132. [DOI: 10.1097/adm.0000000000000606] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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7
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Papp J, Vallabhaneni M, Morales A, Schrock JW. Take -home naloxone rescue kits following heroin overdose in the emergency department to prevent opioid overdose related repeat emergency department visits, hospitalization and death- a pilot study. BMC Health Serv Res 2019; 19:957. [PMID: 31829228 PMCID: PMC6907348 DOI: 10.1186/s12913-019-4734-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/11/2019] [Indexed: 11/12/2022] Open
Abstract
Background Opioid overdoses are at an epidemic in the United States causing the deaths of thousands each year. Project DAWN (Deaths Avoided with Naloxone) is an opioid overdose education and naloxone distribution program in Ohio that distributes naloxone rescue kits at clinics and in the emergency departments of a single hospital system. Methods We performed a retrospective analytic cohort study comparing heroin overdose survivors who presented to the emergency department and were subsequently discharged. We compared those who received a naloxone rescue kit at discharge with those who did not. Our composite outcome was repeat opioid overdose related emergency department visit(s), hospitalization and death at 0–3 months and at 3–6 months following emergency department overdose. Heroin overdose encounters were identified by ICD- 9 or 10 codes and data was abstracted from the electronic medical record for emergency department patients who presented for heroin overdose and were discharged over a 31- month period between 2013 and 2016. Patients were excluded for previous naloxone access, incarceration, suicidal ideation, admission to the hospital or death from acute overdose on initial emergency department presentation. Data was analyzed with the Chi- square statistical test. Results We identified 291emergency department heroin overdose encounters by ICD-9 or 10 codes and were analyzed. A total of 71% of heroin overdose survivors received a naloxone rescue kit at emergency department discharge. Between the patients who did not receive a naloxone rescue kit at discharge, no overdose deaths occurred and 10.8% reached the composite outcome. Of the patients who received a naloxone rescue kit, 14.4% reached the composite endpoint and 7 opioid overdose deaths occurred in this cohort. No difference in mortality at 3 or 6 months was detected, p = 0.15 and 0.36 respectively. No difference in the composite outcome was detected at 3 or 6 months either, p = 0.9 and 0.99 respectively. Conclusions Of our emergency department patients receiving a naloxone rescue kit we did not find a benefit in the reduction of repeat emergency department visits hospitalizations, or deaths following a non-fatal heroin overdose.
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8
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The prevalence of non-fatal overdose among people who inject drugs: A multi-stage systematic review and meta-analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 73:172-184. [DOI: 10.1016/j.drugpo.2019.07.030] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/15/2019] [Accepted: 07/15/2019] [Indexed: 12/13/2022]
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9
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Fraňková S, Urbánek P, Husa P, Němeček V, Razavi H, Razavi-Shearer D, Chlíbek R, Šperl J. Chronic hepatitis C in the Czech Republic: Forecasting the disease burden. Cent Eur J Public Health 2019; 27:93-98. [PMID: 31241282 DOI: 10.21101/cejph.a5350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 04/25/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Chronic HCV infection is associated with cirrhosis of the liver, hepatocellular carcinoma (HCC), and liver transplantation. HCV disease burden and the impact of new potent direct acting antivirals (DAAs) in the Czech Republic are unknown. METHODS Using a modelling framework, HCV disease progression in the Czech Republic was predicted to 2030 under the current standard of care treatment structure. In addition, two strategies to reduce the future burden of HCV infection were modelled: an incremental increase in treatment annually and WHO targets. RESULTS The number of viremic infected individuals in the Czech Republic is estimated to peak in 2026 (n = 55,130) and to decline by 0.5% by 2030 (n = 54,840). The number of individuals with compensated cirrhosis (n = 1,400), decompensated cirrhosis (n = 80), HCC (n = 70), and liver-related deaths (n = 60) is estimated to more than double by 2030. Through aggressive increases in diagnosis and treatment, HCV related mortality may decrease by 70% by 2030. CONCLUSIONS Disease burden associated with chronic HCV infection is projected to peak in the Czech Republic in 30-40 years. Assuming that the current portion of DAAs used remains constant, a significant reduction in HCV disease burden is possible through increased diagnosis and treatment through 2030. This analysis provides evidence in order to facilitate the development of national strategies for HCV care and management in the Czech Republic.
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Affiliation(s)
- Soňa Fraňková
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petr Urbánek
- Department of Internal Medicine, First Faculty of Medicine, Charles University and Central Military Hospital, Prague, Czech Republic
| | - Petr Husa
- Clinic of Infectious Diseases, University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Vratislav Němeček
- National Reference Laboratory for Hepatitis, National Institute of Public Health, Prague, Czech Republic
| | - Homie Razavi
- Center for Disease Analysis, Lafayette, Colorado, USA
| | | | - Roman Chlíbek
- Department of Epidemiology, Vaccination Centre, Faculty of Military Health Sciences, University of Defence, Hradec Kralove, Czech Republic
| | - Jan Šperl
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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10
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Gladman J. Pins and needles in the groin: an incidental finding of retained needle fragments in an intravenous drug user. BMJ Case Rep 2019; 12:12/2/bcr-2018-226220. [PMID: 30733247 DOI: 10.1136/bcr-2018-226220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A female intravenous drug user was reviewed in A&E following a deliberate overdose. After claiming to have swallowed a razor blade, an abdominal radiograph was performed; this showed a linear metallic density projected over the right side of the pelvis, eventually identified as a needle fragment. Subsequent CT imaging revealed three additional needles situated within the groin. Duplex assessment also identified bilateral arteriovenous fistulae. The patient remained asymptomatic and was managed conservatively. She could recall several occasions when a needle had broken while injecting. This scenario was more likely if the needle had been used many times previously, causing it to become blunt and bent. There are cases reported of adverse patient outcomes secondary to broken needle fragments but awareness among medical professionals remains poor.
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Affiliation(s)
- Joshua Gladman
- Central and North West London NHS Foundation Trust, London, UK
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11
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Popova S, Rehm J, Patra J. Illegal Drug-Attributable Mortality and Potential Years of Life Lost in Canada 2002: Implications for Prevention and Policy. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/009145090603300302] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The article estimates the deaths and years of life lost due to use of illegal drugs in Canada in the year 2002. In 2002, for Canada, 1,695 deaths were attributable to illegal drug use, 0.8% of all deaths: 1,183 of men (1.0%) and 512 in women (0.5%). Main causes of illegal drug use-attributable death were drug overdose, suicide, and hepatitis C. In 2002 in total, 62,110 years of life were lost prematurely, 42,306 years among men and 19,805 years among women. Illegal drug use constitutes a major contributor to the burden of mortality in Canada. A mixture of prevention and harm reduction measures is proposed to reduce the burden of mortality associated with drug use.
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12
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Mumtaz GR, Awad SF, Feizzadeh A, Weiss HA, Abu‐Raddad LJ. HIV incidence among people who inject drugs in the Middle East and North Africa: mathematical modelling analysis. J Int AIDS Soc 2018; 21:e25102. [PMID: 29577623 PMCID: PMC5867334 DOI: 10.1002/jia2.25102] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 03/08/2018] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Emerging HIV epidemics have been documented among people who inject drugs (PWID) in the Middle East and North Africa (MENA). This study estimates the HIV incidence among PWID due to sharing needles/syringes in MENA. It also delineates injecting drug use role as a driver of the epidemic in the population, and estimates impact of interventions. METHODS A mathematical model of HIV transmission among PWID was applied in seven MENA countries with sufficient and recent epidemiological data and HIV prevalence ≥1% among PWID. Estimations of incident and/or prevalent infections among PWID, ex-PWID and sexual partners of infected current and ex-PWID were conducted. RESULTS The estimated HIV incidence rate for 2017 among PWID ranged between 0.7% per person-year (ppy) in Tunisia and 7.8% ppy in Pakistan, with Libya being an outlier (24.8% ppy). The estimated number of annual new infections was lowest in Tunisia (n = 79) and Morocco (n = 99), and highest in Iran and Pakistan (approximately n = 6700 each). In addition, 20 to 2208 and 5 to 837 new annual infections were estimated across the different countries among sexual partners of PWID and ex-PWID respectively. Since epidemic emergence, the number of total ever acquired incident infections across countries was 706 to 90,015 among PWID, 99 to 18,244 among sexual partners of PWID, and 16 to 4360 among sexual partners of ex-PWID. The estimated number of prevalent infections across countries was 341 to 23,279 among PWID, 119 to 16,540 among ex-PWID, 67 to 10,752 among sexual partners of PWID, and 12 to 2863 among sexual partners of ex-PWID. Increasing antiretroviral therapy (ART) coverage to the global target of 81% - factoring in ART adherence and current coverage - would avert about half of new infections among PWID and their sexual partners. Combining ART with harm reduction could avert over 90% and 70% of new infections among PWID and their sexual partners respectively. CONCLUSIONS There is considerable HIV incidence among PWID in MENA. Of all new infections ultimately due to injecting drug use, about 75% are among PWID and the rest among sexual partners. Of all prevalent infections ultimately attributed to injecting drug use as epidemic driver, about half are among PWID, 30% among ex-PWID and 20% among sexual partners of PWID and ex-PWID. These findings call for scale-up of services for PWID, including harm reduction as well as testing and treatment services.
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Affiliation(s)
- Ghina R Mumtaz
- Infectious Disease Epidemiology GroupWeill Cornell Medicine ‐ QatarCornell UniversityDohaQatar
- Department of Infectious Disease EpidemiologyFaculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Susanne F Awad
- Infectious Disease Epidemiology GroupWeill Cornell Medicine ‐ QatarCornell UniversityDohaQatar
| | - Ali Feizzadeh
- Regional Support Team for the Middle East and North AfricaJoint United Nations Programme on HIV/AIDSCairoEgypt
| | - Helen A Weiss
- MRC Tropical Epidemiology GroupDepartment of Infectious Disease EpidemiologyFaculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Laith J Abu‐Raddad
- Infectious Disease Epidemiology GroupWeill Cornell Medicine ‐ QatarCornell UniversityDohaQatar
- Department of Healthcare Policy and ResearchWeill Cornell MedicineCornell UniversityNYUSA
- College of Public HealthHamad bin Khalifa UniversityDohaQatar
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13
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Epidemiological Study of Mortality Rate from Alcohol and Illicit Drug Abuse in Iran. J Res Health Sci 2017. [PMCID: PMC7189946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: The estimate of mortality associated with illicit opiate use provides useful information
to those directing and monitoring local, national and international policies and programs. This study
investigated the epidemiology of mortality due to the illegal consumption of narcotics and psychotropic
substances in the Iran to provide evidence-based public health data for useful programs and actions
aimed at preventing drug-related mortality.
Study Design: A cross-sectional study.
Methods: The information regarding all cases of psychotropic positive was collected from Legal
Medicine Organization, occurred on Mar 2015 to Feb 2016. Demographic and epidemiological data
were extracted from recorded documents. Data were then analyzed in Stata software.
Results: Overall, 2306 died cases from opioid or psychotropic abuse were evaluated. The mean age
of the subjects was 36.07±12.61 yr, they were mostly single male, and 88.64% of them had Iranian
nationality. The mortality rate from opiate and psychotropic abuse in the whole country was 38.22 per
1,000,000 population. The most common location of death was at home or in another private
residence. History of overdose, suicide, hospitalization in psychiatric hospital, staying in prison and
substance abuse in the family observed in some people who died from drug abuse.
Conclusions: Mortality rate from substance abuse is more among unmarried young men aged 30-39
yr with low education level also in self-employed. We suggest policies to prevent this person accessing
and using drug.
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14
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Chan HLY, Chen CJ, Omede O, Al Qamish J, Al Naamani K, Bane A, Tan SS, Simonova M, Cardenas I, Derbala M, Akin O, Phillips RO, Abdelmageed MK, Abdulla M, Adda D, Al Baqali A, Al Dweik N, Al Ejji K, Al Ghazzawi I, Al Kaabi S, Al Sadadi M, Al Salman J, AlBadri M, Al-Busafi SA, Al-Romaihi HE, Ampofo W, Antonov K, Anyaike C, Arome F, Blach S, Borodo MM, Brandon SM, Bright B, Butt MT, Chen DS, Chen PJ, Chien RN, Chuang WL, Cuellar D, Elbardiny AA, Estes C, Farag E, Fung J, Gamkrelidze I, Garcia V, Genov J, Ghandour Z, Ghuloom M, Gomez B, Gunter J, Habeeb J, Hajelssedig O, Hamoudi W, Himatt SM, Hrstic I, Hu CC, Huang CF, Hui YT, Jahis R, Jelev D, John AK, Kaliaskarova KS, Kamel Y, Kao JH, Khamis J, Khattabi H, Khoudri I, Konysbekova A, Kotzev I, Lai MS, Lao WC, Layden J, Lee MH, Lesi O, Li M, Lo A, Loo CK, Lukšić B, Maaroufi A, Malu AO, Mateva L, Mitova R, Mohamed R, Morović M, Murphy K, Mustapha B, Nersesov A, Ngige E, Njouom R, Njoya O, Nonković D, Obekpa S, Oguche S, Okolo EE, Omuemu C, Ondoa P, Opare-Sem O, Owusu-Ofori S, Prokopenko YN, Razavi H, Razavi-Shearer D, Razavi-Shearer K, Redae B, Reic T, Rinke de Wit T, Rios C, Robbins S, Roberts LR, Sanad SJ, Schmelzer JD, Sharma M, Su TH, Sultan K, Tchernev K, Tsang OTY, Tsang S, Tzeuton C, Ugoeze S, Uzochukwu B, Vi R, Vince A, Wani HU, Wong VWS, Workneh A, Yacoub R, Yesmembetov KI, Youbi M, Yuen MF, Nde H. The present and future disease burden of hepatitis C virus infections with today's treatment paradigm: Volume 4. J Viral Hepat 2017; 24 Suppl 2:25-43. [PMID: 29105283 DOI: 10.1111/jvh.12760] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/03/2017] [Indexed: 12/13/2022]
Abstract
Factors influencing the morbidity and mortality associated with viremic hepatitis C virus (HCV) infection change over time and place, making it difficult to compare reported estimates. Models were developed for 17 countries (Bahrain, Bulgaria, Cameroon, Colombia, Croatia, Dominican Republic, Ethiopia, Ghana, Hong Kong, Jordan, Kazakhstan, Malaysia, Morocco, Nigeria, Qatar and Taiwan) to quantify and characterize the viremic population as well as forecast the changes in the infected population and the corresponding disease burden from 2015 to 2030. Model inputs were agreed upon through expert consensus, and a standardized methodology was followed to allow for comparison across countries. The viremic prevalence is expected to remain constant or decline in all but four countries (Ethiopia, Ghana, Jordan and Oman); however, HCV-related morbidity and mortality will increase in all countries except Qatar and Taiwan. In Qatar, the high-treatment rate will contribute to a reduction in total cases and HCV-related morbidity by 2030. In the remaining countries, however, the current treatment paradigm will be insufficient to achieve large reductions in HCV-related morbidity and mortality.
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Affiliation(s)
- H L Y Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China.,Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | | | - O Omede
- Federal Ministry of Health, Abuja, Nigeria
| | - J Al Qamish
- Gastroenterolgy Clinic, IBN Al-Nafees Hospital, Manama, Bahsrain
| | - K Al Naamani
- Division of Gastroenterology and Hepatology, Department of Medicine, Armed Forces Hospital, Muscat, Oman
| | - A Bane
- Gastroenterology and Hepatology, Addis Ababa University Medical School, Addis Ababa, Ethiopia.,Ethiopian Gastroenterological Association, Addis Ababa, Ethiopia
| | - S S Tan
- Department of Hepatology, Selayang Hospital, Selangor, Malaysia
| | - M Simonova
- Clinic of Gastroenterology, Military Medical Academy, Sofia, Bulgaria
| | - I Cardenas
- Communicable Diseases Division, Ministry of Health and Social Protection, Bogota, Colombia
| | - M Derbala
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - O Akin
- Federal Ministry of Health, Abuja, Nigeria
| | - R O Phillips
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - M Abdulla
- Salmaniya Medical Complex, Manama, Bahrain
| | - D Adda
- Civil Society Network on Hepatitis, Abuja, Nigeria.,Chagro-Care Trust (CCT), Jalingo, Nigeria
| | - A Al Baqali
- Al Kindi Specialised Hospital, Manama, Bahrain
| | - N Al Dweik
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - K Al Ejji
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - I Al Ghazzawi
- GI and Hepatology Department, Jordan Royal Medical Services, Amman, Jordan
| | - S Al Kaabi
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | | | - M AlBadri
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - S A Al-Busafi
- Division of Gastroenterology, Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - W Ampofo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - K Antonov
- University Hospital "St. Ivan Rilski", Sofia, Bulgaria
| | - C Anyaike
- Federal Ministry of Health, Abuja, Nigeria
| | - F Arome
- Advocacy for the Prevention of Hepatitis in Nigeria, Jos, Nigeria
| | - S Blach
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - M M Borodo
- Aminu Kano Teaching Hospital, Kano, Nigeria.,Bayero University, Kano, Nigeria
| | - S M Brandon
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - B Bright
- LiveWell Initiative (LWI), Lagos, Nigeria
| | - M T Butt
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - D S Chen
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - P J Chen
- National Taiwan University, Taipei, Taiwan
| | - R N Chien
- Liver Research Unit, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - W L Chuang
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - D Cuellar
- Department of Epidemiology and Demography, Ministry of Health and Social Protection, Bogota, Colombia
| | | | - C Estes
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - E Farag
- Ministry of Public Health Qatar, Doha, Qatar
| | - J Fung
- Department of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - I Gamkrelidze
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - V Garcia
- Ministry of Public Health, Santo Domingo, Dominican Republic
| | - J Genov
- University Hospital "Queen Joanna", Sofia, Bulgaria
| | - Z Ghandour
- BDF Hospital, Royal Medical Services, Riffa, Bahrain
| | - M Ghuloom
- Salmaniya Medical Complex, Manama, Bahrain
| | - B Gomez
- Pan American Health Organization, Washington, DC, USA
| | - J Gunter
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - J Habeeb
- Salmaniya Medical Complex, Manama, Bahrain
| | - O Hajelssedig
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - W Hamoudi
- Department of Gastroenterology & Hepatology, Al Bashir Hospital, Amman, Jordan.,Jordan Ministry of Health, Amman, Jordan
| | - S M Himatt
- Ministry of Public Health Qatar, Doha, Qatar
| | - I Hrstic
- General Hospital Pula, Pula, Croatia
| | - C C Hu
- Liver Research Unit, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - C F Huang
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - Y T Hui
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, SAR, China
| | - R Jahis
- Disease Control Division, Ministry of Health, Putrajaya, Malaysia
| | - D Jelev
- University Hospital "St. Ivan Rilski", Sofia, Bulgaria
| | - A K John
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - K S Kaliaskarova
- Ministry of Healthcare and Social Development of the Republic of Kazakhstan, Astana, Kazakhstan.,Republican Coordination Center for Hepatology and Gastroenterology, Astana, Kazakhstan
| | - Y Kamel
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,Department of Medicine, Miniya University, Minya, Egypt
| | - J H Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - J Khamis
- Salmaniya Medical Complex, Manama, Bahrain
| | - H Khattabi
- Eastern Mediterranean Regional Office, World Health Organization, Cairo, Egypt
| | - I Khoudri
- Department of Epidemiology and Disease Control, Ministry of Health, Rabat, Morocco
| | - A Konysbekova
- Republican Diagnostic Center, Astana, Kazakhstan.,University Medical Center, Astana, Kazakhstan
| | - I Kotzev
- University Hospital "St. Marina", Varna, Bulgaria
| | - M S Lai
- Department of Medicine, North District Hospital, Hong Kong, SAR, China
| | - W C Lao
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, SAR, China
| | - J Layden
- Department of Public Health Sciences, Loyola University Chicago, Chicago, IL, USA
| | - M H Lee
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - O Lesi
- University of Lagos, Lagos, Nigeria.,Lagos University Teaching Hospital, Lagos, Nigeria
| | - M Li
- Division of Gastroenterology and Hepatology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, SAR, China
| | - A Lo
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - C K Loo
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong, SAR, China
| | - B Lukšić
- Clinical Department of Infectious Diseases, Split University Hospital and Split University Medical School, Split, Croatia
| | - A Maaroufi
- Department of Epidemiology and Disease Control, Ministry of Health, Rabat, Morocco
| | - A O Malu
- Benue State University Teaching Hospital, Makurdi, Nigeria
| | - L Mateva
- University Hospital "St. Ivan Rilski", Sofia, Bulgaria
| | - R Mitova
- University Hospital "Queen Joanna", Sofia, Bulgaria
| | - R Mohamed
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - M Morović
- Department of Infectious Diseases, Zadar General Hospital, Zadar, Croatia
| | - K Murphy
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | | | - A Nersesov
- National Research Institute of Cardiology and Internal Diseases, Almaty, Kazakhstan
| | - E Ngige
- Federal Ministry of Health, Abuja, Nigeria
| | - R Njouom
- Virology Department, Centre Pasteur of Cameroon, Yaounde, Cameroon
| | - O Njoya
- Research Laboratory on Viral Hepatitis & Health Communication, Faculty of Medicine, University of Yaoundé, Yaoundé, Cameroon
| | - D Nonković
- Department of Epidemiology, Institute of Public Health, County of Dalmatia, Split, Croatia
| | - S Obekpa
- Advocacy for the Prevention of Hepatitis in Nigeria, Jos, Nigeria.,Benue State University Teaching Hospital, Makurdi, Nigeria
| | - S Oguche
- Department of Pediatrics, University of Jos, Jos, Nigeria.,Department of Medicine, University of Jos, Jos, Nigeria.,Jos University Teaching Hospital, Jos, Nigeria
| | - E E Okolo
- Beacon Youth Initiative, Lafia, Nigeria
| | - C Omuemu
- University of Benin, Benin City, Nigeria
| | - P Ondoa
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.,African Society of Laboratory Medicine, Addis Ababa, Ethiopia
| | - O Opare-Sem
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Y N Prokopenko
- Republican Coordination Center for Hepatology and Gastroenterology, Astana, Kazakhstan
| | - H Razavi
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | | | | | - B Redae
- Ethiopian Gastroenterological Association, Addis Ababa, Ethiopia.,St. Paul's Hospital Millennium College, Addis Ababa, Ethiopia
| | - T Reic
- European Liver Patients Association, Sint-Truiden, Belgium
| | - T Rinke de Wit
- PharmAccess Foundation, Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - C Rios
- Department of Health Promotion and Disease Prevention, Ministry of Health and Social Protection, Bogota, Colombia
| | - S Robbins
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - L R Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - S J Sanad
- BDF Hospital, Royal Medical Services, Riffa, Bahrain
| | - J D Schmelzer
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - M Sharma
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - T H Su
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - K Sultan
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - O T Y Tsang
- Department of Medicine and Geriatrics, Princess Margaret Hospital Authority, Hong Kong, SAR, China
| | - S Tsang
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong, SAR, China
| | - C Tzeuton
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - S Ugoeze
- Federal Medical Centre, Jalingo, Nigeria
| | - B Uzochukwu
- Institute of Public Health, University of Nigeria, Nsukka, Nigeria
| | - R Vi
- Republican Coordination Center for Hepatology and Gastroenterology, Astana, Kazakhstan.,International HepatoTransplant Group, Astana, Kazakhstan
| | - A Vince
- Medical School University of Zagreb, University Hospital of Infectious Diseases Zagreb, Zagreb, Croatia
| | - H U Wani
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - V W S Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China.,State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - A Workneh
- Non-Communicable Diseases Programme, World Health Organization, Addis Ababa, Ethiopia.,Federal Ministry of Health, Addis Ababa, Ethiopia
| | - R Yacoub
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - K I Yesmembetov
- National Scientific Center of Oncology and Transplantology, Astana, Kazakhstan
| | - M Youbi
- Department of Epidemiology and Disease Control, Ministry of Health, Rabat, Morocco
| | - M F Yuen
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, SAR, China
| | - H Nde
- Center for Disease Analysis (CDA), Lafayette, CO, USA
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15
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Gountas I, Sypsa V, Papatheodoridis G, Souliotis G, Razavi H, Hatzakis A. Is elimination of HCV possible in a country with low diagnostic rate and moderate HCV prevalence?: The case of Greece. J Gastroenterol Hepatol 2017; 32:466-472. [PMID: 27403912 DOI: 10.1111/jgh.13485] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM The treatment of hepatitis C (HCV) with interferon (IFN)-free direct-acting antivirals (DAAs) is anticipated to change the future burden of disease. The aim of this study is to quantify the impact of IFN-free DAAs on HCV-related morbidity and mortality in Greece under different scenarios concerning treatment coverage and primary prevention, including the proposed by World Health Organization Global Hepatitis Strategy. METHODS A previously described model was used to project the future disease burden up to 2030 under scenarios, which includes treatment based on the combination of pegylated-IFN with ribavirin (base case) and scenarios using DAAs therapies. RESULTS Under the base case scenario, an increase in HCV-related morbidity and mortality is predicted in Greece (mortality in 2030: +23.6% compared with 2015). If DAAs are used with the same treatment coverage, the number of hepatocellular carcinoma cases and of liver related deaths are predicted to be lower by 4-7% compared with 2015. Under increased treatment coverage (from 2000 treated/year to approximately 5000/year in 2015-2020 and 2500/year subsequently), morbidity and mortality will decrease by 43-53% in 2030 compared with 2015. To achieve the WHO Global Hepatitis Strategy goals, a total number of 86 500 chronic hepatitis C patients will have to be treated during 2015-2030. CONCLUSIONS Elimination of HCV in Greece by 2030 necessitates great improvements in primary prevention, implementation of large screening programs and high treatment coverage.
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Affiliation(s)
- Ilias Gountas
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Papatheodoridis
- Department of Gastroenterology, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - George Souliotis
- Faculty of Social and Political Sciences, University of Peloponnese, Korinthos, Greece
| | - Homie Razavi
- Center for Disease Analysis, Lafayette, Colorado, USA
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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16
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Hajarizadeh B, Grebely J, McManus H, Estes C, Razavi H, Gray RT, Alavi M, Amin J, McGregor S, Sievert W, Thompson A, Dore GJ. Chronic hepatitis C burden and care cascade in Australia in the era of interferon-based treatment. J Gastroenterol Hepatol 2017; 32:229-236. [PMID: 27197716 DOI: 10.1111/jgh.13453] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIM Interferon-free direct-acting antiviral regimens for hepatitis C virus (HCV) infection have been recently available in Australia, beginning a new era in clinical and public health management of HCV infection. This study provided updated estimates of the HCV infection care cascade and burden in Australia as a reliable platform for assessing the future impact of interferon-free therapies. METHODS A modeling approach was applied to estimate the number of individuals living with chronic HCV infection and with various liver disease stages. Data from national registries of HCV notification and liver transplantation, literature review, and expert consensus informed the model parameters. HCV notification and Pharmaceutical Benefits Scheme data were used to estimate the number of HCV diagnosed individuals and treatment uptake. RESULTS In 2014, an estimated 230 470 individuals (range: 180 490-243 990) were living with HCV, among whom 75% were diagnosed (n = 172 720; range: 156 720-188 770), 20% had ever received treatment (n = 45 000; range: 39 280-50 720), and 11% had been cured (n = 24 750; range: 21 520-27 990). Among individuals with HCV infection, the proportion with hepatic fibrosis stage ≥F3 doubled during the last decade, increasing from 9% (n = 18 580) in 2004 to 19% (n = 44,730) in 2014. Individuals initiating HCV treatment increased from 1100 in 1997 to 3840 in 2007, plateaued until 2010 and decreased to 2790 in 2014. CONCLUSIONS The burden of HCV-related liver disease has increased markedly. Although the proportion diagnosed was high, treatment uptake remained low, with no increase over the last 7 years. Reducing the HCV burden in Australia requires scale-up of interferon-free HCV therapies.
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Affiliation(s)
| | - Jason Grebely
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - Hamish McManus
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - Chris Estes
- Center for Disease Analysis, Louisville, Colorado, USA
| | - Homie Razavi
- Center for Disease Analysis, Louisville, Colorado, USA
| | - Richard T Gray
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - Maryam Alavi
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - Janaki Amin
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - Skye McGregor
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - William Sievert
- Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Alexander Thompson
- St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
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17
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Walley AY, Cheng DM, Quinn EK, Blokhina E, Gnatienko N, Chaisson CE, Krupitsky E, Coffin PO, Samet JH. Fatal and non-fatal overdose after narcology hospital discharge among Russians living with HIV/AIDS who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 39:114-120. [PMID: 27907848 DOI: 10.1016/j.drugpo.2016.10.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/16/2016] [Accepted: 10/29/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Among Russians living with HIV/AIDS who inject drugs, we examined the incidence of fatal and non-fatal overdoses following discharge from a narcology hospital and the associations with more advanced HIV infection. DESIGN Prospective cohort study of data collected at baseline, 3 and 6 months from HIV-infected patients with a history of injection drug use who were not treated with anti-retroviral therapy. Participants were recruited between 2012-2014 from a narcology (addiction) hospital in St. Petersburg, Russia. METHODS Fatal overdose was determined based on contact reports to study staff in the year after discharge. Non-fatal overdose was self-reported at the 3- and 6-month assessments. The main independent variable for HIV severity was CD4 cell count at the baseline interview (<200cells/mm3≥200cells/mm3). Secondary analyses assessed time since HIV diagnosis and treated with anti-retroviral treatment (ART) prior to enrolment as independent variables. We fit Cox proportional hazards models to assess whether HIV severity is associated with either fatal or non-fatal overdose. RESULTS Among 349 narcology patients, 18 participants died from overdose within one year after discharge (8.7%, 95% CI 3.4-14.2 by Kaplan-Meier); an estimated 51% [95% CI 34-68%] reported at least one non-fatal overdose within 6 months of discharge. HIV severity, time since HIV diagnosis and ever ART were not significantly associated with either fatal or non-fatal overdose events. CONCLUSION Fatal and non-fatal overdose are common among Russians living with HIV/AIDS who inject drugs after narcology hospital discharge. Overdose prevention interventions are urgently warranted among Russian narcology patients with HIV infection.
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Affiliation(s)
- Alexander Y Walley
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit, Boston University School of Medicine & Boston Medical Center, 801 Massachusetts Avenue, Boston, USA.
| | - Debbie M Cheng
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, USA
| | - Emily K Quinn
- Data Coordinating Center, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, USA
| | - Elena Blokhina
- First Pavlov State Medical University, St. Petersburg, Russian Federation
| | - Natalia Gnatienko
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit, Boston University School of Medicine & Boston Medical Center, 801 Massachusetts Avenue, Boston, USA
| | - Christine E Chaisson
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, USA; Data Coordinating Center, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, USA
| | - Evgeny Krupitsky
- First Pavlov State Medical University, St. Petersburg, Russian Federation; Bekhterev Research Psychoneurological Institute, St.Petersburg, Russian Federation
| | - Philip O Coffin
- San Francisco Department of Public Health, San Francisco, CA 94102, USA; Division of HIV/AIDS, University of California San Francisco, San Francisco CA 94103, USA
| | - Jeffrey H Samet
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit, Boston University School of Medicine & Boston Medical Center, 801 Massachusetts Avenue, Boston, USA; Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, USA
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18
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Abstract
Drug users are generally thought to experience higher mortality rates than those found among the general population. This study analyzes mortality rates among different subgroups of drug users in the Czech Republic. For this project, a retrospective cohort mortality study was conducted. A cohort of 12,207 persons aged 15 to 49 who had been hospitalized for drug related behavioral disorders was followed from 1997 to 2002. The study findings indicate that direct standardized mortality for the cohort of drug users was 16.78 per 1000 person-years (PY); 22.38 for men and 11.18 per 1000 PY for women. After reaching a peak in 1998, mortality rates began to decrease and stabilized around 14 per 1,000 PY from 2000 to 2002. When compared to the rates found in the general population, drug user mortality is eight times higher than nonuser rates (SMR = 8.15; 8.13 for men and 8.22 for women). These mortality rates are highest among polyvalent drug and opiate users and lowest among stimulant users. The authors conclude that the overall mortality of opiate users in the Czech Republic is relatively low when compared with those reported in similar European and non-European studies. There were few overdoses found in the cohort, and in sharp contrast to other available studies, no AIDS related cases were observed.
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19
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Ridruejo E, Bessone F, Daruich JR, Estes C, Gadano AC, Razavi H, Villamil FG, Silva MO. Hepatitis C virus infection in Argentina: Burden of chronic disease. World J Hepatol 2016; 8:649-658. [PMID: 27239258 PMCID: PMC4876291 DOI: 10.4254/wjh.v8.i15.649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/13/2016] [Accepted: 05/11/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To estimate the progression of the hepatitis C virus (HCV) epidemic and measure the burden of HCV-related morbidity and mortality.
METHODS: Age- and gender-defined cohorts were used to follow the viremic population in Argentina and estimate HCV incidence, prevalence, hepatic complications, and mortality. The relative impact of two scenarios on HCV-related outcomes was assessed: (1) increased sustained virologic response (SVR); and (2) increased SVR and treatment.
RESULTS: Under scenario 1, SVR raised to 85%-95% in 2016. Compared to the base case scenario, there was a 0.3% reduction in prevalent cases and liver-related deaths by 2030. Given low treatment rates, cases of hepatocellular carcinoma and decompensated cirrhosis decreased < 1%, in contrast to the base case in 2030. Under scenario 2, the same increases in SVR were modeled, with gradual increases in the annual diagnosed and treated populations. This scenario decreased prevalent infections 45%, liver-related deaths 55%, liver cancer cases 60%, and decompensated cirrhosis 55%, as compared to the base case by 2030.
CONCLUSION: In Argentina, cases of end stage liver disease and liver-related deaths due to HCV are still growing, while its prevalence is decreasing. Increasing in SVR rates is not enough, and increasing in the number of patients diagnosed and candidates for treatment is needed to reduce the HCV disease burden. Based on this scenario, strategies to increase diagnosis and treatment uptake must be developed to reduce HCV burden in Argentina.
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20
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Lee D, Delcher C, Maldonado-Molina MM, Thogmartin JR, Goldberger BA. Manners of Death in Drug-Related Fatalities in Florida. J Forensic Sci 2016; 61:735-42. [DOI: 10.1111/1556-4029.12999] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 03/09/2015] [Accepted: 05/12/2015] [Indexed: 01/18/2023]
Affiliation(s)
- Dayong Lee
- UF Health Pathology Laboratories; Department of Pathology, Immunology and Laboratory Medicine; University of Florida College of Medicine; Gainesville FL
| | - Chris Delcher
- Department of Health Outcomes and Policy; Institute for Child Health Policy; University of Florida College of Medicine; Gainesville FL
| | - Mildred M. Maldonado-Molina
- Department of Health Outcomes and Policy; Institute for Child Health Policy; University of Florida College of Medicine; Gainesville FL
| | | | - Bruce A. Goldberger
- UF Health Pathology Laboratories; Department of Pathology, Immunology and Laboratory Medicine; University of Florida College of Medicine; Gainesville FL
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21
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Cousins G, Boland F, Courtney B, Barry J, Lyons S, Fahey T. Risk of mortality on and off methadone substitution treatment in primary care: a national cohort study. Addiction 2016; 111:73-82. [PMID: 26234389 DOI: 10.1111/add.13087] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 05/05/2015] [Accepted: 07/30/2015] [Indexed: 11/28/2022]
Abstract
AIM To assess whether risk of death increases during periods of treatment transition, and investigate the impact of supervised methadone consumption on drug-related and all-cause mortality. DESIGN National Irish cohort study. SETTING Primary care. PARTICIPANTS A total of 6983 patients on a national methadone treatment register aged 16-65 years between 2004 and 2010. MEASUREMENT Drug-related (primary outcome) and all-cause (secondary outcome) mortality rates and rate ratios for periods on and off treatment; and the impact of regular supervised methadone consumption. RESULTS Crude drug-related mortality rates were 0.24 per 100 person-years on treatment and 0.39 off treatment, adjusted mortality rate ratio 1.63 [95% confidence interval (CI) = 0.66-4.00]. Crude all-cause mortality rate per 100 person-years was 0.51 on treatment versus 1.57 off treatment, adjusted mortality rate ratio 3.64 (95% CI = 2.11-6.30). All-cause mortality off treatment was 6.36 (95% CI = 2.84-14.22) times higher in the first 2 weeks, 9.12 (95% CI = 3.17-26.28) times higher in weeks 3-4, compared with being 5 weeks or more in treatment. All-cause mortality was lower in those with regular supervision (crude mortality rate 0.60 versus 0.81 per 100 person-years) although, after adjustment, insufficient evidence exists to suggest that regular supervision is protective (mortality rate ratio = 1.23, 95% CI = 0.67-2.27). CONCLUSIONS Among primary care patients undergoing methadone treatment, continuing in methadone treatment is associated with a reduced risk of death. Patients' risk of all-cause mortality increases following treatment cessation, and is highest in the initial 4-week period.
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Affiliation(s)
- Gráinne Cousins
- School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fiona Boland
- Health Research Board Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Brenda Courtney
- Health Research Board Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Joseph Barry
- Trinity College Centre for Health Sciences, Tallaght Hospital, Dublin, Ireland
| | | | - Tom Fahey
- Health Research Board Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
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22
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Sibley A, Han KH, Abourached A, Lesmana LA, Makara M, Jafri W, Salupere R, Assiri AM, Goldis A, Abaalkhail F, Abbas Z, Abdou A, Al Braiki F, Al Hosani F, Al Jaberi K, Al Khatry M, Al Mulla MA, Al Quraishi H, Al Rifai A, Al Serkal Y, Alam A, Alavian SM, Alashgar HI, Alawadhi S, Al-Dabal L, Aldins P, Alfaleh FZ, Alghamdi AS, Al-Hakeem R, Aljumah AA, Almessabi A, Alqutub AN, Alswat KA, Altraif I, Alzaabi M, Andrea N, Babatin MA, Baqir A, Barakat MT, Bergmann OM, Bizri AR, Blach S, Chaudhry A, Choi MS, Diab T, Djauzi S, El Hassan ES, El Khoury S, Estes C, Fakhry S, Farooqi JI, Fridjonsdottir H, Gani RA, Ghafoor Khan A, Gheorghe L, Gottfredsson M, Gregorcic S, Gunter J, Hajarizadeh B, Hamid S, Hasan I, Hashim A, Horvath G, Hunyady B, Husni R, Jeruma A, Jonasson JG, Karlsdottir B, Kim DY, Kim YS, Koutoubi Z, Liakina V, Lim YS, Löve A, Maimets M, Malekzadeh R, Matičič M, Memon MS, Merat S, Mokhbat JE, Mourad FH, Muljono DH, Nawaz A, Nugrahini N, Olafsson S, Priohutomo S, Qureshi H, Rassam P, Razavi H, Razavi-Shearer D, Razavi-Shearer K, Rozentale B, Sadik M, Saeed K, Salamat A, Sanai FM, Sanityoso Sulaiman A, Sayegh RA, Sharara AI, Siddiq M, Siddiqui AM, Sigmundsdottir G, Sigurdardottir B, Speiciene D, Sulaiman A, Sultan MA, Taha M, Tanaka J, Tarifi H, Tayyab G, Tolmane I, Ud Din M, Umar M, Valantinas J, Videčnik-Zorman J, Yaghi C, Yunihastuti E, Yusuf MA, Zuberi BF, Schmelzer JD. The present and future disease burden of hepatitis C virus infections with today's treatment paradigm - volume 3. J Viral Hepat 2015; 22 Suppl 4:21-41. [PMID: 26513446 DOI: 10.1111/jvh.12476] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 09/06/2015] [Indexed: 02/05/2023]
Abstract
The total number, morbidity and mortality attributed to viraemic hepatitis C virus (HCV) infections change over time making it difficult to compare reported estimates from different years. Models were developed for 15 countries to quantify and characterize the viraemic population and forecast the changes in the infected population and the corresponding disease burden from 2014 to 2030. With the exception of Iceland, Iran, Latvia and Pakistan, the total number of viraemic HCV infections is expected to decline from 2014 to 2030, but the associated morbidity and mortality are expected to increase in all countries except for Japan and South Korea. In the latter two countries, mortality due to an ageing population will drive down prevalence, morbidity and mortality. On the other hand, both countries have already experienced a rapid increase in HCV-related mortality and morbidity. HCV-related morbidity and mortality are projected to increase between 2014 and 2030 in all other countries as result of an ageing HCV-infected population. Thus, although the total number of HCV countries is expected to decline in most countries studied, the associated disease burden is expected to increase. The current treatment paradigm is inadequate if large reductions in HCV-related morbidity and mortality are to be achieved.
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Affiliation(s)
- A Sibley
- Center for Disease Analysis (CDA), Louisville, CO, USA
| | - K H Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - A Abourached
- National Hepatitis Program, Ministry of Public Health, Beirut, Lebanon
| | - L A Lesmana
- Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine, Dr. Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia.,Digestive Disease and GI Oncology Center, Medistra Hospital, Jakarta, Indonesia
| | - M Makara
- Central Outpatient Clinic, Saint Laszlo Hospital, Budapest, Hungary
| | - W Jafri
- Aga Khan University, Karachi, Pakistan
| | - R Salupere
- Tartu University Hospital, University of Tartu, Tartu, Estonia
| | - A M Assiri
- Department of Preventive Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - A Goldis
- Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania
| | - F Abaalkhail
- Department of Liver and Small Bowel Transplantation, King Faisal Specialist Hospital and Research Centre, Alfaisal University, Riyadh, Saudi Arabia
| | - Z Abbas
- Ziauddin University, Karachi, Pakistan
| | - A Abdou
- Rashid Hospital, Dubai Health Authority, Dubai, UAE
| | - F Al Braiki
- Abu Dhabi Health Services Company, Abu Dhabi, UAE
| | - F Al Hosani
- Communicable Diseases Department, Health Authority Abu Dhabi, Abu Dhabi, UAE
| | - K Al Jaberi
- Health Regulation Division, Health Authority Abu Dhabi, Abu Dhabi, UAE
| | - M Al Khatry
- Ras Al Khaimah Hospital, Ras Al Khaimah, UAE
| | - M A Al Mulla
- Communicable Diseases Department, Health Authority Abu Dhabi, Abu Dhabi, UAE
| | | | | | - Y Al Serkal
- Hospitals Sector, Ministry of Health, Abu Dhabi, UAE
| | - A Alam
- Shaikh Zayed Hospital, Lahore, Pakistan
| | - S M Alavian
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, Tehran, Iran.,Middle East Liver Diseases Centre, Tehran, Tehran, Iran
| | - H I Alashgar
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - S Alawadhi
- Rashid Hospital, Dubai Health Authority, Dubai, UAE
| | - L Al-Dabal
- Department of Pulmonary Medicine, Rashid Hospital, Dubai Health Authority, Dubai, UAE
| | - P Aldins
- Infection Control Department, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - F Z Alfaleh
- Liver Disease Research Center, King Saud University, Riyadh, Saudi Arabia
| | - A S Alghamdi
- Gastroenterology and Hepatology Unit, Medical Specialties Department, King Fahad Hospital, Riyadh, Saudi Arabia
| | - R Al-Hakeem
- Department of Preventive Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - A A Aljumah
- King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - A Almessabi
- Abu Dhabi Health Services Company, Abu Dhabi, UAE
| | - A N Alqutub
- Gastroenterology and Hepatology Unit, Medical Specialties Department, King Fahad Hospital, Riyadh, Saudi Arabia
| | - K A Alswat
- Department of Medicine, King Saud University Liver Disease Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - I Altraif
- King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - M Alzaabi
- Zayed Military Hospital, Abu Dhabi, UAE
| | - N Andrea
- Daman National Health Insurance Company, Abu Dhabi, UAE
| | - M A Babatin
- Gastroenterology and Hepatology Unit, Medical Specialties Department, King Fahad Hospital, Riyadh, Saudi Arabia
| | - A Baqir
- Seyal Medical Centre, Multan, Pakistan
| | | | - O M Bergmann
- Division of Gastroenterology and Hepatology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - A R Bizri
- Division of Infectious Diseases, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - S Blach
- Center for Disease Analysis (CDA), Louisville, CO, USA
| | - A Chaudhry
- Gujranwala Liver Foundation, Siddiq Sadiq Hospital, Gujranwala, Pakistan
| | - M S Choi
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - T Diab
- Al Ain Hospital, Al Ain, UAE
| | - S Djauzi
- Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine, Dr. Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia
| | | | - S El Khoury
- Gastroenterology Department, Saint George Hospital, University of Balamand, Beirut, Lebanon
| | - C Estes
- Center for Disease Analysis (CDA), Louisville, CO, USA
| | - S Fakhry
- Abu Dhabi Police, Abu Dhabi, UAE
| | - J I Farooqi
- Postgraduate Medical Institute, Khyber Medical University, Peshawar, Pakistan.,Government Lady Reading Hospital, Peshawar, Pakistan
| | - H Fridjonsdottir
- Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - R A Gani
- Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine, Dr. Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia
| | - A Ghafoor Khan
- Department of Gastroenterology & Hepatology, Lady Reading Hospital, Peshawar, Pakistan
| | - L Gheorghe
- Center of Gastroenterology & Hepatology, Fundeni Clinical Institute, Bucharest, Romania
| | - M Gottfredsson
- Faculty of Medicine, School of Health Sciences, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - S Gregorcic
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre, Ljubljana, Slovenia
| | - J Gunter
- Center for Disease Analysis (CDA), Louisville, CO, USA
| | - B Hajarizadeh
- The Kirby Institute, University of New South Wales Australia, Sydney, NSW, Australia.,The Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic., Australia
| | - S Hamid
- The Aga Khan University, Karachi, Pakistan
| | - I Hasan
- Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine, Dr. Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia
| | - A Hashim
- Liver Transplantation, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - G Horvath
- Hepatology Center of Buda, Budapest, Hungary
| | - B Hunyady
- Department of Gastroenterology, Somogy County Kaposi Mor Teaching Hospital, Kaposvar, Hungary.,First Department of Medicine, University of Pecs, Pecs, Hungary
| | - R Husni
- Lebanese American University Medical Center, Rizk Hospital, Beirut, Lebanon
| | - A Jeruma
- Department of Hepatology, Infectology Center of Latvia, Riga, Latvia.,Department of Infectology and Dermatology, Riga Stradins University, Riga, Latvia
| | - J G Jonasson
- Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.,Icelandic Cancer Registry, Reykjavik, Iceland.,The Faculty of Medicine, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - B Karlsdottir
- Division of Infectious Disease, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - D Y Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Y S Kim
- Department of Internal Medicine, Soon Chun Hyang University Bucheon Hospital, Bucheon, Korea
| | - Z Koutoubi
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - V Liakina
- Centre of Hepatology, Gastroenterology, and Dietetics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Department of Biomechanics, Vilnius Gediminas Technical University, Vilnius, Lithuania
| | - Y S Lim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - A Löve
- Faculty of Medicine, School of Health Sciences, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.,Department of Virology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - M Maimets
- Tartu University Hospital, University of Tartu, Tartu, Estonia
| | - R Malekzadeh
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - M Matičič
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre, Ljubljana, Slovenia
| | - M S Memon
- Asian Institute of Medical Science (AIMS), Hyderabad, Sindh, Pakistan
| | - S Merat
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - J E Mokhbat
- Divisions of Infectious Diseases and Clinical Microbiology, Lebanese American University Medical Center Rizk Hospital, Beirut, Lebanon
| | - F H Mourad
- Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon
| | - D H Muljono
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia.,Department of Hepatitis & Emerging Infectious Diseases, University of Sydney, Sydney, NSW, Australia
| | - A Nawaz
- Department of Gastroenterology, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, Pakistan
| | - N Nugrahini
- Sub-Directorate for Gastrointestinal Infection, Diarrheal Diseases, and Hepatitis, Directorate of Direct Transmitted Disease Control, Disease Control & Environmental Health, Ministry of Health, Jakarta, Indonesia
| | - S Olafsson
- Division of Gastroenterology and Hepatology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - S Priohutomo
- Directorate of Direct Transmitted Disease Control, Disease Control & Environmental Health, Ministry of Health, Jakarta, Indonesia
| | - H Qureshi
- Pakistan Medical Research Council, Islamabad, Pakistan
| | - P Rassam
- Gastroenterology Department, Saint George Hospital, University of Balamand, Beirut, Lebanon
| | - H Razavi
- Center for Disease Analysis (CDA), Louisville, CO, USA
| | | | | | - B Rozentale
- Department of Hepatology, Infectology Center of Latvia, Riga, Latvia.,Department of Infectology and Dermatology, Riga Stradins University, Riga, Latvia
| | - M Sadik
- Asian Institute of Medical Science (AIMS), Hyderabad, Sindh, Pakistan
| | - K Saeed
- Khawar Clinic, Sahiwal, Pakistan
| | - A Salamat
- Department of Gastroenterology, Military Hospital, Rawalpindi, Pakistan
| | - F M Sanai
- Liver Disease Research Center, King Saud University, Riyadh, Saudi Arabia
| | - A Sanityoso Sulaiman
- Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine, Dr. Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia
| | - R A Sayegh
- Department of Hepatology and Gastroenterology, School of Medical Science, Saint Joseph University, Beirut, Lebanon
| | - A I Sharara
- Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon
| | - M Siddiq
- Jinnah Memorial Hospital, Rawalpindi, Pakistan.,Yusra Medical College, Rawalpindi, Pakistan
| | | | - G Sigmundsdottir
- Centre for Health Security and Communicable Disease Control, Directorate of Health in Iceland, Reykjavik, Iceland
| | - B Sigurdardottir
- Division of Infectious Disease, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - D Speiciene
- Centre of Hepatology, Gastroenterology, and Dietetics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - A Sulaiman
- Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine, Dr. Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia.,Klinik Hati Prof. Ali Sulaiman, Jakarta, Indonesia
| | - M A Sultan
- Health Funding Department, Enaya Insurance Company, Abu Dhabi, UAE
| | - M Taha
- Department of Medicine, Tawam Hospital, Al Ain, UAE
| | - J Tanaka
- Department of Epidemiology, Infectious Disease Control and Prevention, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - H Tarifi
- Pharmacy Department, Tawam Hospital, Al Ain, UAE
| | - G Tayyab
- Postgraduate Medical Institute, Lahore General Hospital, Lahore, Pakistan.,Doctors Hospital and Medical Center, Lahore, Pakistan
| | - I Tolmane
- Department of Hepatology, Infectology Center of Latvia, Riga, Latvia.,Department of Infectology and Dermatology, Riga Stradins University, Riga, Latvia
| | - M Ud Din
- Pakistan Society of Gastroenterology, Karachi, Pakistan
| | - M Umar
- Department of Medicine, Rawalpindi Medical College, Rawalpindi, Pakistan.,Department of Medicine, Holy Family Hospital, Rawalpindi, Pakistan
| | - J Valantinas
- Centre of Hepatology, Gastroenterology, and Dietetics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - J Videčnik-Zorman
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre, Ljubljana, Slovenia
| | - C Yaghi
- Department of Hepatology and Gastroenterology, School of Medical Science, Saint Joseph University, Beirut, Lebanon
| | - E Yunihastuti
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - M A Yusuf
- Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | | | - J D Schmelzer
- Center for Disease Analysis (CDA), Louisville, CO, USA
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23
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Okolie C, Evans BA, John A, Moore C, Russell D, Snooks H. Community-based interventions to prevent fatal overdose from illegal drugs: a systematic review protocol. BMJ Open 2015; 5:e008981. [PMID: 26534734 PMCID: PMC4636603 DOI: 10.1136/bmjopen-2015-008981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Drug overdose is the most frequent cause of death among people who misuse illegal drugs. People who inject these drugs are 14-17 times more likely to die than their non-drug using peers. Various strategies to reduce drug-related deaths have failed to meet target reductions. Research into community-based interventions for preventing drug overdose deaths is promising. This review seeks to identify published studies describing community-based interventions and to evaluate their effectiveness at reducing drug overdose deaths. METHODS AND ANALYSIS We will systematically search key electronic databases using a search strategy which groups terms into four facets: (1) Overdose event, (2) Drug classification, (3) Intervention and (4) Setting. Searches will be limited where possible to international literature published in English between 1998 and 2014. Data will be extracted by two independent reviewers using a predefined table adapted from the Cochrane Collaboration handbook. The quality of included studies will be evaluated using the Cochrane Collaboration's tool for assessing risk of bias. We will conduct a meta-analysis for variables which can be compared across studies, using statistical methods to control for heterogeneity where appropriate. Where clinical or statistical heterogeneity prevents a valid numerical synthesis, we will employ a narrative synthesis to describe community-based interventions, their delivery and use and how effectively they prevent fatal overdoses. ETHICS AND DISSEMINATION We will publish findings from this systematic review in a peer-reviewed scientific journal and present results at national and international conferences. It will be disseminated electronically and in print. TRIAL REGISTRATION NUMBER PROSPERO CRD42015017833.
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Affiliation(s)
| | | | - Ann John
- College of Medicine, Swansea University, Swansea, UK
| | - Chris Moore
- Welsh Ambulance Services NHS Trust, Blackweir Ambulance Station, Cardiff, UK
| | | | - Helen Snooks
- College of Medicine, Swansea University, Swansea, UK
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24
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Gutfraind A, Boodram B, Prachand N, Hailegiorgis A, Dahari H, Major ME. Agent-Based Model Forecasts Aging of the Population of People Who Inject Drugs in Metropolitan Chicago and Changing Prevalence of Hepatitis C Infections. PLoS One 2015; 10:e0137993. [PMID: 26421722 PMCID: PMC4589282 DOI: 10.1371/journal.pone.0137993] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 08/16/2015] [Indexed: 01/05/2023] Open
Abstract
People who inject drugs (PWID) are at high risk for blood-borne pathogens transmitted during the sharing of contaminated injection equipment, particularly hepatitis C virus (HCV). HCV prevalence is influenced by a complex interplay of drug-use behaviors, social networks, and geography, as well as the availability of interventions, such as needle exchange programs. To adequately address this complexity in HCV epidemic forecasting, we have developed a computational model, the Agent-based Pathogen Kinetics model (APK). APK simulates the PWID population in metropolitan Chicago, including the social interactions that result in HCV infection. We used multiple empirical data sources on Chicago PWID to build a spatial distribution of an in silico PWID population and modeled networks among the PWID by considering the geography of the city and its suburbs. APK was validated against 2012 empirical data (the latest available) and shown to agree with network and epidemiological surveys to within 1%. For the period 2010–2020, APK forecasts a decline in HCV prevalence of 0.8% per year from 44(±2)% to 36(±5)%, although some sub-populations would continue to have relatively high prevalence, including Non-Hispanic Blacks, 48(±5)%. The rate of decline will be lowest in Non-Hispanic Whites and we find, in a reversal of historical trends, that incidence among non-Hispanic Whites would exceed incidence among Non-Hispanic Blacks (0.66 per 100 per years vs 0.17 per 100 person years). APK also forecasts an increase in PWID mean age from 35(±1) to 40(±2) with a corresponding increase from 59(±2)% to 80(±6)% in the proportion of the population >30 years old. Our studies highlight the importance of analyzing subpopulations in disease predictions, the utility of computer simulation for analyzing demographic and health trends among PWID and serve as a tool for guiding intervention and prevention strategies in Chicago, and other major cities.
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Affiliation(s)
- Alexander Gutfraind
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, United States of America
- The Program for Experimental & Theoretical Modeling, Department of Medicine, Loyola University Medical Center, Maywood, Illinois, United States of America
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, United States of America
- * E-mail: (MM); (AG)
| | - Basmattee Boodram
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Nikhil Prachand
- STI/HIV Surveillance, Chicago Department of Public Health, Chicago, Illinois, United States of America
| | - Atesmachew Hailegiorgis
- Department of Computational Social Science, George Mason University, Fairfax, Virginia, United States of America
| | - Harel Dahari
- The Program for Experimental & Theoretical Modeling, Department of Medicine, Loyola University Medical Center, Maywood, Illinois, United States of America
- Theoretical Division, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
| | - Marian E. Major
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, United States of America
- * E-mail: (MM); (AG)
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25
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Ferreira PRA, Brandão-Mello CE, Estes C, Gonçales Júnior FL, Coelho HSM, Razavi H, Cheinquer H, Wolff FH, Ferraz MLG, Pessoa MG, Mendes-Correa MC. Disease burden of chronic hepatitis C in Brazil. Braz J Infect Dis 2015; 19:363-8. [PMID: 26051505 PMCID: PMC9427494 DOI: 10.1016/j.bjid.2015.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 03/22/2015] [Accepted: 04/05/2015] [Indexed: 12/12/2022] Open
Abstract
Background Hepatitis C virus infection is a major cause of cirrhosis; hepatocellular carcinoma; and liver transplantation. The aim of this study was to estimate hepatitis C virus disease progression and the burden of disease from a nationwide perspective. Methods Using a model developed to forecast hepatitis C virus disease progression and the number of cases at each stage of liver disease; hepatitis C virus-infected population and associated disease progression in Brazil were quantified. The impact of two different strategies was compared: higher sustained virological response and treatment eligibility rates (1) or higher diagnosis and treatment rates associated with increased sustained virological response rates (2). Results The number of infected individuals is estimated to decline by 35% by 2030 (1,255,000 individuals); while the number of cases of compensated (n = 325,900) and decompensated (n = 45,000) cirrhosis; hepatocellular carcinoma (n = 19,100); and liver-related deaths (n = 16,700) is supposed to peak between 2028 and 2032. In strategy 2; treated cases increased over tenfold in 2020 (118,800 treated) as compared to 2013 (11,740 treated); with sustained virological response increased to 90% and treatment eligibility to 95%. Under this strategy; the number of infected individuals decreased by 90% between 2013 and 2030. Compared to the base case; liver-related deaths decreased by 70% by 2030; while hepatitis C virus-related liver cancer and decompensated cirrhosis decreased by 75 and 80%; respectively. Conclusions While the incidence and prevalence of hepatitis C virus in Brazil are decreasing; cases of advanced liver disease continue to rise. Besides higher sustained virological response rates; new strategies focused on increasing the proportion of diagnosed patients and eligibility to treatment should be adopted in order to reduce the burden of hepatitis C virus infection in Brazil.
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Affiliation(s)
| | - Carlos Eduardo Brandão-Mello
- Department of Gastroenterology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil
| | - Chris Estes
- Center for Disease Analysis (CDA), Louisville, CO, USA
| | - Fernando Lopes Gonçales Júnior
- Grupo de Estudo das Hepatites, Disciplina de Doenças Infecciosas, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), São Paulo, SP, Brazil
| | | | - Homie Razavi
- Center for Disease Analysis (CDA), Louisville, CO, USA
| | - Hugo Cheinquer
- Hospital das Clínicas da Universidade Federal do Rio Grande do Sul (UFRS), Porto Alegre, RS, Brazil
| | - Fernando Herz Wolff
- Hospital das Clínicas da Universidade Federal do Rio Grande do Sul (UFRS), Porto Alegre, RS, Brazil
| | - Maria Lúcia Gomes Ferraz
- Division of Gastroenterology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Mário Guimarães Pessoa
- Division of Gastroenterology and Hepatology, Escola de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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Lappalainen L, Hayashi K, Dong H, Milloy MJ, Kerr T, Wood E. Ongoing impact of HIV infection on mortality among people who inject drugs despite free antiretroviral therapy. Addiction 2015; 110:111-9. [PMID: 25203392 PMCID: PMC4270909 DOI: 10.1111/add.12736] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 08/01/2014] [Accepted: 08/27/2014] [Indexed: 11/27/2022]
Abstract
AIMS To determine the impact of HIV infection on mortality over time among people who inject drugs (PWID) in settings with free HIV/AIDS care. DESIGN AND SETTING Prospective cohort study of PWID in Vancouver, Canada, recruited between May 1996 and December 2011. We ascertained morality rates and causes of death through a confidential linkage with the provincial vital statistics registry. PARTICIPANTS A total of 2283 individuals were followed for a median of 60.9 months (interquartile range: 34.4-113.1), among whom 622 (27.2%) individuals were HIV-positive at baseline, and 179 (7.8%) seroconverted during follow-up. MEASUREMENTS The primary and secondary outcomes of interests were all-cause mortality and cause of death, respectively. The main independent variable of interest was HIV serostatus (positive versus negative). We used Cox proportional hazards regression to determine factors associated with mortality, including socio-demographic variables, drug use behaviors and other risk behaviors. FINDINGS During the study period, 491 (21.5%) individuals died. In multivariate analyses, HIV infection remained associated independently with all-cause mortality (adjusted hazard ratio = 3.15; 95% CI: 2.59-3.82). While all-cause mortality rates declined markedly during the study period (P < 0.001), the independent effect of HIV infection on mortality remained unchanged over time (P = 0.640). Among HIV-positive individuals, significant changes in causes of death from infectious and AIDS-related causes to non-AIDS-related etiologies were observed. CONCLUSIONS HIV infection continues to have a persistent impact on mortality rates among people who inject drugs in settings with free HIV/AIDS care, although causes of death have shifted markedly from infectious and AIDS-related causes to non-AIDS-related etiologies.
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Affiliation(s)
- Leslie Lappalainen
- Department of Family Medicine, University of British Columbia, Vancouver, Canada
| | - Kanna Hayashi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Huiru Dong
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - M-J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada,Department of Medicine, University of British Columbia, Vancouver, Canada
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Hatzakis A, Chulanov V, Gadano AC, Bergin C, Ben-Ari Z, Mossong J, Schréter I, Baatarkhuu O, Acharya S, Aho I, Anand AC, Andersson MI, Arendt V, Arkkila P, Barclay K, Bessone F, Blach S, Blokhina N, Brunton CR, Choudhuri G, Cisneros L, Croes EA, Dahgwahdorj YA, Dalgard O, Daruich JR, Dashdorj NR, Davaadorj D, de Knegt RJ, de Vree M, Estes C, Flisiak R, Gane E, Gower E, Halota W, Henderson C, Hoffmann P, Hornell J, Houlihan D, Hrusovsky S, Jarčuška P, Kershenobich D, Kostrzewska K, Kristian P, Leshno M, Lurie Y, Mahomed A, Mamonova N, Mendez-Sanchez N, Norris S, Nurmukhametova E, Nymadawa P, Oltman M, Oyunbileg J, Oyunsuren T, Papatheodoridis G, Pimenov N, Prabdial-Sing N, Prins M, Radke S, Rakhmanova A, Razavi-Shearer K, Reesink HW, Ridruejo E, Safadi R, Sagalova O, Sanchez Avila JF, Sanduijav R, Saraswat V, Seguin-Devaux C, Shah SR, Shestakova I, Shevaldin A, Shibolet O, Silva MO, Sokolov S, Sonderup M, Souliotis K, Spearman CW, Staub T, Stedman C, Strebkova EA, Struck D, Sypsa V, Tomasiewicz K, Undram L, van der Meer AJ, van Santen D, Veldhuijzen I, Villamil FG, Willemse S, Zuckerman E, Zuure FR, Puri P, Razavi H. The present and future disease burden of hepatitis C virus (HCV) infections with today's treatment paradigm - volume 2. J Viral Hepat 2015; 22 Suppl 1:26-45. [PMID: 25560840 DOI: 10.1111/jvh.12351] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Morbidity and mortality attributable to chronic hepatitis C virus (HCV) infection are increasing in many countries as the infected population ages. Models were developed for 15 countries to quantify and characterize the viremic population, as well as estimate the number of new infections and HCV related deaths from 2013 to 2030. Expert consensus was used to determine current treatment levels and outcomes in each country. In most countries, viremic prevalence has already peaked. In every country studied, prevalence begins to decline before 2030, when current treatment levels were held constant. In contrast, cases of advanced liver disease and liver related deaths will continue to increase through 2030 in most countries. The current treatment paradigm is inadequate if large reductions in HCV related morbidity and mortality are to be achieved.
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Affiliation(s)
- A Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece
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Abstract
After a 40-year hiatus there is now a revisiting of psychedelic drug therapy throughout psychiatry, with studies examining the drugs psilocybin, ketamine, ibogaine and ayahuasca in the treatment of drug dependence. Limitations to these therapies are both clinical and legal, but the possibility of improving outcomes for patients with substance dependency imposes an obligation to research this area.
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Affiliation(s)
- Ben Sessa
- Ben Sessa, MBBS, MRCPsych, AddAction, Weston-Super-Mare, Cardiff University Medical School, UK; Matthew W. Johnson, PhD, Johns Hopkins School of Medicine, Baltimore, USA
| | - Matthew W Johnson
- Ben Sessa, MBBS, MRCPsych, AddAction, Weston-Super-Mare, Cardiff University Medical School, UK; Matthew W. Johnson, PhD, Johns Hopkins School of Medicine, Baltimore, USA
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Abstract
BACKGROUND AND AIMS Chronic hepatitis C virus infection is prevalent among 200,000 individuals in Poland; however, few are aware of their condition (30,000 diagnosed) and even fewer are treated (2490 in 2014). This analysis projected future disease burden and developed two treatment scenarios to control or eliminate hepatitis C virus-related disease in Poland. METHODS Using a modeling approach, the infected population and future disease progression were quantified. Baseline variables included viremic prevalence, age and sex, diagnosis rate, treatment rate, disease progression, and sustained virologic response rates. Data were collected from the literature and through expert interviews. RESULTS The number of prevalent hepatitis C virus infections is projected to decrease (5%) by 2030. However, the numbers of individuals with compensated and decompensated cirrhosis, and hepatocellular carcinoma are estimated to increase by 40, 55, and 60%, respectively. By increasing sustained virologic response rates to 95% from 2015 onward, and the number of treated cases (from 2490 to 5000), the number of individuals with cirrhosis, decompensated cirrhosis, and hepatocellular carcinoma is projected to remain constant until 2030. A strategy to eliminate chronic hepatitis C virus infection was also considered. To reduce total infections by 90% and mortality by 80%, treatment was increased to 15,000 patients annually. This scenario required the diagnosis of 15,000 new cases (compared with 3000 today). CONCLUSION A marked reduction in hepatitis C virus-related disease burden is possible, with increased diagnosis and treatment. The results could inform the development of effective disease management in Poland.
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Hayden A, Hayashi K, Dong H, Milloy MJ, Kerr T, Montaner JSG, Wood E. The impact of drug use patterns on mortality among polysubstance users in a Canadian setting: a prospective cohort study. BMC Public Health 2014; 14:1153. [PMID: 25377274 PMCID: PMC4246520 DOI: 10.1186/1471-2458-14-1153] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 10/09/2014] [Indexed: 11/10/2022] Open
Abstract
Background Illicit drug use is a well-established risk factor for morbidity and mortality. However, few studies have examined the impact of different drug use patterns on mortality among polysubstance using populations. This study aimed to identify drug-specific patterns of mortality among a cohort of polysubstance using persons who inject drugs (PWIDs). Methods PWIDs in Vancouver, Canada were prospectively followed between May 1996 and December 2011. Participants were linked to the provincial vital statistics database to ascertain mortality rates and causes of death. We used multivariate Cox proportional hazards regression to investigate the relationships between drug use patterns (daily alcohol use, heroin injection and non-injection use, cocaine injection, amphetamine injection and non-injection use, crack smoking and speedball injecting) and time to all-cause mortality. Results 2330 individuals were followed for a median of 61 months (inter-quartile range: 33 – 112). In total, 466 (19.1%) individuals died for an incidence density of 3.1 (95% confidence interval [CI]: 2.8 – 3.4) deaths per 100 person-years. In multivariate analyses, after adjusting for HIV infection and other potential confounders, only daily cocaine injection remained independently associated with all-cause mortality (adjusted hazard ratio [AHR] = 1.36, 95% CI: 1.06 – 1.76). Conclusions Although heroin injecting is traditionally viewed as carrying the highest risk of mortality, in this setting, only daily cocaine injecting was associated with all-cause mortality. These findings highlight the urgent need to identify novel treatments and harm reduction strategies for cocaine injectors.
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Affiliation(s)
| | | | | | | | | | | | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St, Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
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Abstract
Objective: To systematically review and analyse data from cohorts of people who inject drugs (PWID) to improve existing estimates of non-AIDS mortality used to calculate mortality among PWID in the Spectrum Estimates and Projection Package. Design: Systematic review and meta-analysis. Methods: We conducted an update of an earlier systematic review of mortality among PWID, searching specifically for studies providing data on non-AIDS-related deaths. Random-effects meta-analyses were performed to derive pooled estimates of non-AIDS crude mortality rates across cohorts disaggregated by sex, HIV status and periods in and out of opioid substitution therapy (OST). Within each cohort, ratios of non-AIDS CMRs were calculated and then pooled across studies for the following paired sub-groups: HIV-negative versus HIV-positive PWID; male versus female PWID; periods in OST versus out of OST. For each analysis, pooled estimates by country income group and by geographic region were also calculated. Results: Thirty-seven eligible studies from high-income countries and five from low and middle-income countries were found. Non-AIDS mortality was significantly higher in low and middle-income countries [2.74 per 100 person-years; 95% confidence interval (CI) 1.76–3.72] than in high-income countries (1.56 per 100 person-years; 95% CI 1.38–1.74). Non-AIDS CMRs were 1.34 times greater among men than women (95% CI 1.14–1.57; N = 19 studies); 1.50 times greater among HIV-positive than HIV-negative PWID (95% CI 1.15, 1.96; N = 16 studies); and more than three times greater during periods out of OST than for periods on OST (N = 7 studies). Conclusions: A comprehensive response to injecting drug must include efforts to reduce the high levels of non-AIDS mortality among PWID. Due to limitations of currently available data, including substantial heterogeneity between studies, estimates of non-AIDS mortality specific to geographic regions, country income level, or the availability of OST should be interpreted with caution.
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Cramp ME, Rosenberg WM, Ryder SD, Blach S, Parkes J. Modelling the impact of improving screening and treatment of chronic hepatitis C virus infection on future hepatocellular carcinoma rates and liver-related mortality. BMC Gastroenterol 2014; 14:137. [PMID: 25100159 PMCID: PMC4128826 DOI: 10.1186/1471-230x-14-137] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 07/17/2014] [Indexed: 12/14/2022] Open
Abstract
Background The societal, clinical and economic burden imposed by the complications of chronic hepatitis C virus (HCV) infection - including cirrhosis and hepatocellular carcinoma (HCC) - is expected to increase over the coming decades. However, new therapies may improve sustained virological response (SVR) rates and shorten treatment duration. This study aimed to estimate the future burden of HCV-related disease in England if current management strategies remain the same and the impact of increasing diagnosis and treatment of HCV as new therapies become available. Methods A previously published model was adapted for England using published literature and government reports, and validated through an iterative process of three meetings of HCV experts. The impact of increasing diagnosis and treatment of HCV as new therapies become available was modelled and compared to the base-case scenario of continuing current management strategies. To assess the ‘best case’ clinical benefit of new therapies, the number of patients treated was increased by a total of 115% by 2018. Results In the base-case scenario, total viraemic (HCV RNA-positive) cases of HCV in England will decrease from 144,000 in 2013 to 76,300 in 2030. However, due to the slow progression of chronic HCV, the number of individuals with cirrhosis, decompensated cirrhosis and HCC will continue to increase over this period. The model suggests that the ‘best case’ substantially reduces HCV-related hepatic disease and HCV-related liver mortality by 2020 compared to the base-case scenario. The number of HCV-related HCC cases would decrease 50% by 2020 and the number progressing from infection to decompensated cirrhosis would decline by 65%. Therefore, compared to projections of current practices, increasing treatment numbers by 115% by 2018 would reduce HCV-related mortality by 50% by 2020. Conclusions This analysis suggests that with current treatment practices the number of patients developing HCV-related cirrhosis, decompensated cirrhosis and HCC will increase substantially, with HCV-related liver deaths likely to double by 2030. However, increasing diagnosis and treatment rates could optimise the reduction in the burden of disease produced by the new therapies, potentially halving HCV-related liver mortality and HCV-related HCC by 2020.
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Affiliation(s)
| | | | - Steven D Ryder
- NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases, Nottingham University Hospitals NHS Trust and The University of Nottingham, Nottingham NG7 2UH, UK.
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Sievert W, Razavi H, Estes C, Thompson AJ, Zekry A, Roberts SK, Dore GJ. Enhanced antiviral treatment efficacy and uptake in preventing the rising burden of hepatitis C-related liver disease and costs in Australia. J Gastroenterol Hepatol 2014; 29 Suppl 1:1-9. [PMID: 25055928 DOI: 10.1111/jgh.12677] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIM Chronic hepatitis C virus (HCV) infection is an important cause of advanced liver disease and liver-related deaths in Australia. Our aim was to describe the burden of HCV infection and consider treatment strategies to reduce HCV-related morbidity and mortality. METHODS Baseline model parameters were based upon literature review and expert consensus with a focus on Australian data. Three treatment scenarios based on anticipated introduction of improved direct-acting antiviral regimens were considered to reduce HCV disease burden. Scenario 1 evaluated the impact of increased treatment efficacy alone (to 80-90% by 2016). Scenario 2 evaluated increased efficacy and increased treatment uptake (2550 to 13,500 by 2018) without treatment restriction, while Scenario 3 considered the same increases with treatment limited to ≥ F3 during 2015-2017. RESULTS In 2013, there were an estimated 233,490 people with chronic HCV infection: 13,850 with cirrhosis, 590 with hepatocellular carcinoma (HCC) and 530 liver-related deaths. If the current HCV treatment setting is unchanged, threefold increases in the number of people with cirrhosis, HCC, and liver disease deaths will be seen by 2030. Scenario 1 resulted in modest impacts on disease burden (4% decrease in HCC, decompensated cirrhosis, and liver deaths) and costs. Scenario 3 had the greatest impact on disease burden (approximately 50% decrease in HCC, decompensated cirrhosis, and liver deaths) and costs, while Scenario 2 had slightly lesser impact. CONCLUSIONS Considerable increases in the burden of HCV-related advanced liver disease and its complications will be seen in Australia under current treatment levels and outcomes. Introduction of improved direct-acting antiviral regimens with enhanced efficacy at current treatment levels will lead to limited impacts on this disease burden. A combination of increased treatment efficacy and greater uptake is required to achieve major reductions in advanced liver disease and related costs.
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Affiliation(s)
- William Sievert
- Monash University and Monash Health, Melbourne, Victoria, Australia
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Myers RP, Krajden M, Bilodeau M, Kaita K, Marotta P, Peltekian K, Ramji A, Estes C, Razavi H, Sherman M. Burden of disease and cost of chronic hepatitis C infection in Canada. Can J Gastroenterol Hepatol 2014; 28:243-50. [PMID: 24839620 PMCID: PMC4049256 DOI: 10.1155/2014/317623] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 04/02/2014] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Chronic infection with hepatitis C virus (HCV) is a major cause of cirrhosis, hepatocellular carcinoma and liver transplantation. OBJECTIVE To estimate the burden of HCV-related disease and costs from a Canadian perspective. METHODS Using a system dynamic framework, the authors quantified the HCV-infected population, disease progression and costs in Canada between 1950 and 2035. Specifically, 36 hypothetical, age- and sex-defined cohorts were tracked to define HCV prevalence, complications and direct medical costs (excluding the cost of antivirals). Model assumptions and costs were extracted from the literature with an emphasis on Canadian data. No incremental increase in antiviral treatment over current levels was assumed, despite the future availability of potent antivirals. RESULTS The estimated prevalence of viremic hepatitis C cases peaked in 2003 at 260,000 individuals (uncertainty interval 192,460 to 319,880), reached 251,990 (uncertainty interval 177,890 to 314,800) by 2013 and is expected to decline to 188,190 (uncertainty interval 124,330 to 247,200) in 2035. However, the prevalence of advanced liver disease is increasing. The peak annual number of patients with compensated cirrhosis (n=36,210), decompensated cirrhosis (n=3380), hepatocellular carcinoma (n=2220) and liver-related deaths (n=1880) are expected to occur between 2031 and 2035. During this interval, an estimated 32,460 HCV-infected individuals will die of liver-related causes. Total health care costs associated with HCV (excluding treatment) are expected to increase by 60% from 2013 until the peak in 2032, with the majority attributable to cirrhosis and its complications (81% in 2032 versus 56% in 2013). The lifetime cost for an individual with HCV infection in 2013 was estimated to be $64,694. CONCLUSIONS Although the prevalence of HCV in Canada is decreasing, cases of advanced liver disease and health care costs continue to rise. These results will facilitate disease forecasting, resource planning and the development of rational management strategies for HCV in Canada.
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Affiliation(s)
- Robert P Myers
- Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta
| | - Mel Krajden
- BC Centre for Disease Control, Vancouver, British Columbia
| | | | | | | | | | - Alnoor Ramji
- University of British Columbia, Vancouver, British Columbia
| | - Chris Estes
- Center for Disease Analysis, Louisville, Colorado, USA
| | - Homie Razavi
- Center for Disease Analysis, Louisville, Colorado, USA
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Razavi H, Waked I, Sarrazin C, Myers RP, Idilman R, Calinas F, Vogel W, Mendes Correa MC, Hézode C, Lázaro P, Akarca U, Aleman S, Balık I, Berg T, Bihl F, Bilodeau M, Blasco AJ, Brandão Mello CE, Bruggmann P, Buti M, Calleja JL, Cheinquer H, Christensen PB, Clausen M, Coelho HSM, Cramp ME, Dore GJ, Doss W, Duberg AS, El-Sayed MH, Ergör G, Esmat G, Falconer K, Félix J, Ferraz MLG, Ferreira PR, Frankova S, García-Samaniego J, Gerstoft J, Giria JA, Gonçales FL, Gower E, Gschwantler M, Guimarães Pessôa M, Hindman SJ, Hofer H, Husa P, Kåberg M, Kaita KDE, Kautz A, Kaymakoglu S, Krajden M, Krarup H, Laleman W, Lavanchy D, Marinho RT, Marotta P, Mauss S, Moreno C, Murphy K, Negro F, Nemecek V, Örmeci N, Øvrehus ALH, Parkes J, Pasini K, Peltekian KM, Ramji A, Reis N, Roberts SK, Rosenberg WM, Roudot-Thoraval F, Ryder SD, Sarmento-Castro R, Semela D, Sherman M, Shiha GE, Sievert W, Sperl J, Stärkel P, Stauber RE, Thompson AJ, Urbanek P, Van Damme P, van Thiel I, Van Vlierberghe H, Vandijck D, Wedemeyer H, Weis N, Wiegand J, Yosry A, Zekry A, Cornberg M, Müllhaupt B, Estes C. The present and future disease burden of hepatitis C virus (HCV) infection with today's treatment paradigm. J Viral Hepat 2014; 21 Suppl 1:34-59. [PMID: 24713005 DOI: 10.1111/jvh.12248] [Citation(s) in RCA: 282] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The disease burden of hepatitis C virus (HCV) is expected to increase as the infected population ages. A modelling approach was used to estimate the total number of viremic infections, diagnosed, treated and new infections in 2013. In addition, the model was used to estimate the change in the total number of HCV infections, the disease progression and mortality in 2013-2030. Finally, expert panel consensus was used to capture current treatment practices in each country. Using today's treatment paradigm, the total number of HCV infections is projected to decline or remain flat in all countries studied. However, in the same time period, the number of individuals with late-stage liver disease is projected to increase. This study concluded that the current treatment rate and efficacy are not sufficient to manage the disease burden of HCV. Thus, alternative strategies are required to keep the number of HCV individuals with advanced liver disease and liver-related deaths from increasing.
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Affiliation(s)
- H Razavi
- Center for Disease Analysis, Louisville, Colorado, USA
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Abstract
Cuyahoga County, Ohio has recently seen a dramatic rise in the number of deaths associated with heroin (DAH). DAH rose from 40 in 2007 to 161 in 2012 with heroin now identified in half of all overdose deaths. One third of DAH involve heroin alone; the remainder, in combination with other drugs. Over this period, opioid pain reliever (OPR) deaths appear to have plateaued. Along with this rise have been shifts in overdose victim demographics. These data most notably include a rise in the number of women (from 15% to 24%), overdoses between the ages 19 and 29 (8% to 25%), and a generally equal number of urban and suburban fatalities. The Medical Examiner's Office conducted a retrospective analysis of 2012 fatalities to identify potential risk factors and intervention points. This review indicates that most victims (81%) were known to abuse drugs. Half were found with drug paraphernalia at the scene. Approximately 12% were using heroin with other addicts, while 60% were using drugs or succumbed to them in proximity to other non-using people. Emergency medical services were only able to administer naloxone in 22% of cases. Histories of recent abstinence (29%), incarceration (18%), and detoxification (31%) were noted and may reflect times of increased risk secondary to decreased tolerance. A prescription for legal controlled substances was noted in 64% of DAH (the most common medications being OPRs and benzodiazepines). This suggests a need to address prescribing practices. Public health interventions, implemented or planned, based on these data are discussed.
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Affiliation(s)
- Thomas Gilson
- Medical Examiner for Cuyahoga County and Executive Cuyahoga County Regional Forensic Science Laboratory
| | - Camille Herby
- Case Western Reserve University - Public Health, Cleveland, OH
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Mathers BM, Degenhardt L, Bucello C, Lemon J, Wiessing L, Hickman M. Mortality among people who inject drugs: a systematic review and meta-analysis. Bull World Health Organ 2014; 91:102-23. [PMID: 23554523 DOI: 10.2471/blt.12.108282] [Citation(s) in RCA: 320] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 11/26/2012] [Accepted: 11/28/2012] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To systematically review cohort studies of mortality among people who inject drugs, examine mortality rates and causes of death in this group, and identify participant- and study-level variables associated with a higher risk of death. METHODS Tailored search strings were used to search EMBASE, Medline and PsycINFO. The grey literature was identified through online grey literature databases. Experts were consulted to obtain additional studies and data. Random effects meta-analyses were performed to estimate pooled crude mortality rates (CMRs) and standardized mortality ratios (SMRs). FINDINGS Sixty-seven cohorts of people who inject drugs were identified, 14 of them from low- and middle-income countries. The pooled CMR was 2.35 deaths per 100 person-years (95% confidence interval, CI: 2.12-2.58). SMRs were reported for 32 cohorts; the pooled SMR was 14.68 (95% CI: 13.01-16.35). Comparison of CMRs and the calculation of CMR ratios revealed mortality to be higher in low- and middle-income country cohorts, males and people who injected drugs that were positive for human immunodeficiency virus (HIV). It was also higher during off-treatment periods. Drug overdose and acquired immunodeficiency syndrome (AIDS) were the primary causes of death across cohorts. CONCLUSION Compared with the general population, people who inject drugs have an elevated risk of death, although mortality rates vary across different settings. Any comprehensive approach to improving health outcomes in this group must include efforts to reduce HIV infection as well as other causes of death, particularly drug overdose.
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Affiliation(s)
- Bradley M Mathers
- The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia.
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Cao X, Wu Z, Li L, Pang L, Rou K, Wang C, Luo W, Yin W, Li J, McGoogan JM. Mortality among methadone maintenance clients in China: a six-year cohort study. PLoS One 2013; 8:e82476. [PMID: 24349294 PMCID: PMC3861403 DOI: 10.1371/journal.pone.0082476] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Accepted: 11/02/2013] [Indexed: 11/24/2022] Open
Abstract
Objective To assess the overall mortality of methadone maintenance treatment (MMT) clients in China and its associated factors. Methods A total of 1,511 MMT clients, all of whom enrolled in China's first eight MMT clinics between March and December 2004, were included in this cohort study and followed for approximately six years, until June 2010. Mortality and its predictors were examined using Cox proportional hazards regression models. Results A total of 154 deaths were observed within 5,391 person-years (PY) of follow-up for an all-cause mortality rate of 28.6 per 1,000 PY. The leading causes of death were drug overdose (33.8%), HIV/AIDS-unrelated disease (21.4%), and HIV/AIDS (16.9%). The all-cause mortality rate of clients engaged in MMT for one year or less was roughly three times that of clients who stayed in MMT for four years or more (14.0 vs. 4.6, p<0.0001), HIV-positive subjects was nearly four times mortality rate than that of HIV-negative individuals (28.1 vs.6.8, p<0.0001). ART-naive HIV-positive subjects had approximately two times higher mortality rate than those receiving ART (31.2 vs. 17.3, <0.0001). After adjusting for confounding variables, we found that being male (HR = 1.63, CI: 1.03–2.57, p = 0.0355) and being HIV-positive (HR = 5.16, CI: 3.70–7.10, p<0.0001) were both associated with higher risk of death whereas increased durations of methadone treatment were associated with a lower risk of death (HR = 0.26, CI: 0.18–0.38, p<0.0001 for two to three years, HR = 0.08, CI: 0.05–0.14, p<0.0001 for four or more years). Conclusion Overall mortality was high among MMT clients in China. Specific interventions aimed at decreasing mortality among MMT clients are needed. Our study supports the need for keeping client at MMT longer and for expanding ART coverage and suggests the potential benefits of integrated MMT and ART services for drug users in China.
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Affiliation(s)
- Xiaobin Cao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail:
| | - Li Li
- Semel Institute Center for Community Health, University of California Los Angeles, Los Angeles, California, United States of America
| | - Lin Pang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Keming Rou
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Changhe Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wei Luo
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wenyuan Yin
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jianhua Li
- Yunnan Institute of Drug Abuse, Kunming, Yunnan, China
| | - Jennifer M. McGoogan
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Lloyd B, Barratt MJ, Ferris J, Best D, Lubman DI. Factors influencing mortality among alcohol and drug treatment clients in Victoria, Australia: the role of demographic and substance use characteristics. Aust N Z J Psychiatry 2013; 47:859-67. [PMID: 23719182 DOI: 10.1177/0004867413491155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Clinical studies consistently identify alcohol- and drug-related treatment populations as more likely to die prematurely compared with an age-matched general population. However, demographic characteristics and primary drug of concern as predictors of mortality risk following treatment have not been adequately explored. This paper examines relationships between substance use, demographic factors and mortality among alcohol and drug treatment clients. METHOD A retrospective cohort incorporating 7 years of data was utilised to examine mortality outcomes in the 2 years following treatment among Victorian clients recorded on the Alcohol and Drug Information Service (ADIS) database by linking partial client identifiers with the National Death Index (NDI). A cohort of 18,686 clients engaged in at least one course of treatment over a 12-month period was included. Analysis was of crude and standardised mortality rates across client groups in terms of the presenting drug of concern for treatment and demographic characteristics. RESULTS A higher risk of premature death was associated with older age, being male, not being employed, living alone, medical and psychiatric comorbidity, recent injecting, and a history of intensive drug treatment access. Alcohol treatment clients had the worst prognosis. After adjustment for client characteristics, alcohol treatment clients experienced a significantly higher rate of death compared with other clients. CONCLUSIONS Findings from these previously unexplored data highlight the need to increase awareness of the range and magnitude of risks associated with harmful alcohol use, and to identify approaches to enhance treatment effectiveness to reduce negative outcomes following treatment for populations at elevated risk of harm.
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Affiliation(s)
- Belinda Lloyd
- Turning Point Alcohol & Drug Centre, Eastern Health, Melbourne, Australia.
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Vickerman P, Martin NK, Roy A, Beattie T, Jarlais DD, Strathdee S, Wiessing L, Hickman M. Is the HCV-HIV co-infection prevalence amongst injecting drug users a marker for the level of sexual and injection related HIV transmission? Drug Alcohol Depend 2013; 132:172-81. [PMID: 23453261 DOI: 10.1016/j.drugalcdep.2013.01.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 01/28/2013] [Accepted: 01/28/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Amongst injecting drug users (IDUs), HIV is transmitted sexually and parenterally, but HCV is transmitted primarily parenterally. We assess and model the antibody prevalence of HCV amongst HIV-infected IDUs (denoted as HCV-HIV co-infection prevalence) and consider whether it proxies the degree of sexual HIV transmission amongst IDUs. METHODS HIV, HCV and HCV-HIV co-infection prevalence data amongst IDU was reviewed. An HIV/HCV transmission model was adapted. Multivariate model uncertainty analyses determined whether the model's ability to replicate observed data trends required the inclusion of sexual HIV transmission. The correlation between the model's HCV-HIV co-infection prevalence and estimated proportion of HIV infections due to injecting was evaluated. RESULTS The median HCV-HIV co-infection prevalence (prevalence of HCV amongst HIV-infected IDUs) was 90% across 195 estimates from 43 countries. High HCV-HIV co-infection prevalences (>80%) occur in most (75%) settings, but can be lower in settings with low HIV prevalence (<10%) or high HIV/HCV prevalence ratios (HIV prevalence divided by HCV prevalence>0.75). The model without sexual HIV transmission reproduced some data trends but could not reproduce any epidemics with high HIV/HCV prevalence ratios (>0.85) or low HCV-HIV co-infection prevalence (<60%) when HIV prevalence>10%. The model with sexual HIV transmission reproduced data trends more closely. The proportion of HIV infections due to injecting correlated with HCV-HIV co-infection prevalence; suggesting that up to 80/60/<20% of HIV infections could be sexually transmitted in settings with HCV-HIV co-infection prevalence between 50-60/70-80/>90%. CONCLUSION Substantial sexual HIV transmission may occur in many IDU populations; HCV-HIV co-infection prevalence could signify its importance.
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Affiliation(s)
- Peter Vickerman
- Social and Mathematical Epidemiology Group London School of Hygiene and Tropical Medicine, London, UK.
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Pani PP, Trogu E, Maremmani I, Pacini M. QTc interval screening for cardiac risk in methadone treatment of opioid dependence. Cochrane Database Syst Rev 2013:CD008939. [PMID: 23787716 DOI: 10.1002/14651858.cd008939.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Methadone represents today the gold standard of efficacy for the pharmacological treatment of opioid dependence. Methadone, like many other medications, has been implicated in the prolongation of the rate-corrected QT (QTc) interval of the electrocardiogram (ECG), which is considered a marker for arrhythmias such as torsade de pointes (TdP). Indications on the association between methadone, even at therapeutic dosages, and TdP or sudden cardiac death have been reported. On these bases, consensus and recommendations involving QTc screening of patients receiving methadone treatment have been developed to identify patients with QTc above the thresholds considered at risk for cardiac arrhythmias, and they provide these individuals with alternative treatment (reduction of methadone dosage; provision of alternative opioid agonist treatment; treatment of associated risk factors). OBJECTIVES To evaluate the efficacy and acceptability of QTc screening for preventing cardiac-related morbidity and mortality in methadone-treated opioid dependents. SEARCH METHODS We searched MEDLINE, EMBASE, CINAHL (to April 2013), the Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library Cochrane Drug and Alcohol Review Group Specialised Register (Issue 3, 2013), main electronic sources of ongoing trials, specific trial databases and reference lists of all relevant papers. SELECTION CRITERIA Randomised controlled trials (RCTs), controlled clinical trials (CCTs) and non-randomised studies (cohort studies, controlled before and after studies, interrupted time series studies, case control studies) examining the efficacy of QTc screening for the prevention of methadone-related mortality and morbidity in opioid addicts. DATA COLLECTION AND ANALYSIS Two review authors independently screened and extracted data from studies. MAIN RESULTS The search strategy led to the identification of 872 records. Upon full-text assessment, no study was found to meet the quality criteria used for this review. AUTHORS' CONCLUSIONS It is not possible to draw any conclusions about the effectiveness of QTc screening strategies for preventing cardiac morbidity/mortality in methadone-treated opioid addicts. Research efforts should focus on strengthening the evidence about the effectiveness of widespread implementation of such strategies and clarifying the associated benefits and harms.
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Affiliation(s)
- Pier Paolo Pani
- Social-Health Division, Health District 8 (ASL 8) Cagliari, Cagliari, Italy.
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Tempalski B, Pouget ER, Cleland CM, Brady JE, Cooper HLF, Hall HI, Lansky A, West BS, Friedman SR. Trends in the population prevalence of people who inject drugs in US metropolitan areas 1992-2007. PLoS One 2013; 8:e64789. [PMID: 23755143 PMCID: PMC3673953 DOI: 10.1371/journal.pone.0064789] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 04/17/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND People who inject drugs (PWID) have increased risk of morbidity and mortality. We update and present estimates and trends of the prevalence of current PWID and PWID subpopulations in 96 US metropolitan statistical areas (MSAs) for 1992-2007. Current estimates of PWID and PWID subpopulations will help target services and help to understand long-term health trends among PWID populations. METHODOLOGY We calculated the number of PWID in the US annually from 1992-2007 and apportioned estimates to MSAs using multiplier methods. We used four types of data indicating drug injection to allocate national annual totals to MSAs, creating four distinct series of component estimates of PWID in each MSA and year. The four component estimates are averaged to create the best estimate of PWID for each MSA and year. We estimated PWID prevalence rates for three subpopulations defined by gender, age, and race/ethnicity. We evaluated trends using multi-level polynomial models. RESULTS PWID per 10,000 persons aged 15-64 years varied across MSAs from 31 to 345 in 1992 (median 104.4) to 34 to 324 in 2007 (median 91.5). Trend analysis indicates that this rate declined during the early period and then was relatively stable in 2002-2007. Overall prevalence rates for non-Hispanic black PWID increased in 2005 as compared to other racial/ethnic groups. Hispanic prevalence, in contrast, declined across time. Importantly, results show a worrisome trend in young PWID prevalence since HAART was initiated--the mean prevalence was 90 to 100 per 10,000 youth in 1992-1996, but increased to >120 PWID per 10,000 youth in 2006-2007. CONCLUSIONS Overall, PWID rates remained constant since 2002, but increased for two subpopulations: non-Hispanic black PWID and young PWID. Estimates of PWID are important for planning and evaluating public health programs to reduce harm among PWID and for understanding related trends in social and health outcomes.
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Affiliation(s)
- Barbara Tempalski
- Institute for AIDS Research, National Development and Research Institutes, Inc.-NDRI, New York, New York, United States of America.
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Abstract
Cohort study on 471 subjects resident in the metropolitan area of Bologna who had visited a public treatment center for problems due to the abuse of cocaine from January 1, 1988 to December 31, 2009. Two user typologies were created: cocaine users (no heroin) and heroin and cocaine users. Crude mortality rates and standardized mortality ratios were calculated. We performed a regression analysis using the Poisson method. The study results show a higher mortality risk for those injecting substances and for subjects who took both heroin and cocaine. They appear to have different characteristics from their counterparts who do not use heroin. Future studies should be oriented to this aspect.
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Affiliation(s)
- Raimondo Maria Pavarin
- Epidemiological Monitoring Center on Addiction, Mental Health and Dependences AUSL Bologna, Italy.
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Häkkinen M, Launiainen T, Vuori E, Ojanperä I. Comparison of fatal poisonings by prescription opioids. Forensic Sci Int 2012; 222:327-31. [DOI: 10.1016/j.forsciint.2012.07.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 07/11/2012] [Accepted: 07/22/2012] [Indexed: 10/28/2022]
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Vickerman P, Martin NK, Hickman M. Understanding the trends in HIV and hepatitis C prevalence amongst injecting drug users in different settings--implications for intervention impact. Drug Alcohol Depend 2012; 123:122-31. [PMID: 22138540 DOI: 10.1016/j.drugalcdep.2011.10.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 10/11/2011] [Accepted: 10/30/2011] [Indexed: 12/26/2022]
Abstract
BACKGROUND A recent systematic review observed that HIV prevalence amongst injectors is negligible (<1%) below a threshold HCV prevalence of 30%, but thereafter increases with HCV prevalence. We explore whether a model can reproduce these trends, what determines different epidemiological profiles and how this affects intervention impact. METHODS An HIV/HCV transmission model was developed. Univariate sensitivity analyses determined whether the model projected a HCV prevalence threshold below which HIV is negligible, and how different behavioural and epidemiological factors affect the threshold. Multivariate uncertainty analyses considered whether the model could reproduce the observed breadth of HIV/HCV epidemics, how specific behavioural patterns produce different epidemic profiles, and how this affects an intervention's impact (reduces injecting risk by 30%). RESULTS The model projected a HCV prevalence threshold, which varied depending on the heterogeneity in risk, mixing, and injecting duration in a setting. Multivariate uncertainty analyses showed the model could produce the same range of observed HIV/HCV epidemics. Variability in injecting transmission risk, degree of heterogeneity and injecting duration mainly determined different epidemic profiles. The intervention resulted in 50%/28% reduction in HIV incidence/prevalence and 37%/10% reduction in HCV incidence/prevalence over five years. For either infection, greater impact occurred in settings with lower prevalence of that infection and higher prevalence of the other infection. DISCUSSION There are threshold levels of HCV prevalence below which HIV risk is negligible but these thresholds are likely to vary by setting. A setting's HIV and HCV prevalence may give insights into IDU risk behaviour and intervention impact.
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A 25-year follow-up of patients admitted to methadone treatment for the first time: mortality and gender differences. Addict Behav 2011; 36:1184-90. [PMID: 21835551 DOI: 10.1016/j.addbeh.2011.07.019] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 07/06/2011] [Accepted: 07/15/2011] [Indexed: 11/22/2022]
Abstract
INTRODUCTION We conducted a follow-up study to evaluate the outcome of a heroin-dependent population 25 years after their first enrollment in methadone maintenance treatment (MMT). We assessed mortality in the sample plus actual drug use, treatment, and medical factors associated with drug dependence, focusing on possible gender differences. METHODS Prospective follow-up study of 214 heroin-dependent patients consecutively admitted for MMT between 1980 and 1984 in the Asturias Public Health Service. The standardized mortality ratio (SMR) and 95% confidence interval (CI) were calculated. An ad-hoc protocol on drug misuse and treatment, drug-related morbidity and Clinical Global Impression (CGI) scores were assessed in the survivors' sample. RESULTS Information was received on 159 subjects, 106 of whom were deceased. Men accounted for 76.2% of the study cohort. Over the 25-year follow-up period, the SMR was 22.51 (95% CI=22.37-22.64). In the survivors sample, 39.6% were still enrolled in MMT; human immunodeficiency virus (HIV) was diagnosed in 47.2% and hepatitis B/C in 81.1%; current heroin use was reported by 22.6%. There were no gender differences in mortality or HIV and hepatitis B/C status. None of the female survivors were using heroin at the 25-year follow-up compared with 31.1% of males. CONCLUSIONS This study confirms the high mortality of heroin addicts even after enrollment in MMT. Severity of the addiction in terms of mortality was similar in both genders. Women who survived the 25-year follow-up were more likely to have stopped using heroin than men.
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Domingo-Salvany A, Brugal MT, Barrio G, González-Saiz F, Bravo MJ, de la Fuente L. Gender differences in health related quality of life of young heroin users. Health Qual Life Outcomes 2010; 8:145. [PMID: 21122134 PMCID: PMC3014889 DOI: 10.1186/1477-7525-8-145] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Accepted: 12/01/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health Related Quality of Life (HRQL) of opiate users has been studied in treatment settings, where assistance for drug use was sought. In this study we ascertain factors related to HRQL of young opiate users recruited outside treatment facilities, considering both genders separately. METHODS Current opiate users (18-30 y) were recruited in outdoor settings in three Spanish cities (Barcelona, Madrid, Seville). Standardised laptop interviews included socio-demographic data, drug use patterns, health related issues, the Severity of Dependence Scale (SDS) and the Nottingham Health Profile (NHP). RESULTS A total of 991 subjects (73% males), mean age = 25.7 years were interviewed. The mean global NHP score differed by gender (women: 41.2 (sd:23.8); men:34.1(sd:23.6);p < 0.05). Multivariate analysis was implemented separately by gender, variables independently related with global NHP score, both for males and females, were heroin and cocaine SDS scores. For women, only other drug related variables (alcohol intake and length of cocaine use) were independently associated with their HRQL. HIV+ males who suffered an opiate overdose or had psychiatric care in the last 12 months perceived their health as poorer, while those who had ever been in methadone treatment in the last 12 months perceived it as better. The model with both genders showed all factors for males plus quantity of alcohol and an interaction between gender and HIV status. CONCLUSIONS Heroin users were found to be at a considerable risk of impaired HRQL, even in these young ages. A score approaching severity of dependence was the factor with the strongest relation with it.
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Affiliation(s)
- Antònia Domingo-Salvany
- Drug Abuse Epidemiology Research Group, IMIM-Hospital del Mar, Dr. Aiguader 88, Barcelona, Spain.
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Mcauley A, Forsyth AJ. The impact of drug-related death on staff who have experienced it as part of their caseload: An exploratory study. JOURNAL OF SUBSTANCE USE 2010. [DOI: 10.3109/14659891.2010.487555] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cornish R, Macleod J, Strang J, Vickerman P, Hickman M. Risk of death during and after opiate substitution treatment in primary care: prospective observational study in UK General Practice Research Database. BMJ 2010; 341:c5475. [PMID: 20978062 PMCID: PMC2965139 DOI: 10.1136/bmj.c5475] [Citation(s) in RCA: 214] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2010] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate the effect of opiate substitution treatment at the beginning and end of treatment and according to duration of treatment. DESIGN Prospective cohort study. Setting UK General Practice Research Database. PARTICIPANTS Primary care patients with a diagnosis of substance misuse prescribed methadone or buprenorphine during 1990-2005. 5577 patients with 267 003 prescriptions for opiate substitution treatment followed-up (17 732 years) until one year after the expiry of their last prescription, the date of death before this time had elapsed, or the date of transfer away from the practice. MAIN OUTCOME MEASURES Mortality rates and rate ratios comparing periods in and out of treatment adjusted for sex, age, calendar year, and comorbidity; standardised mortality ratios comparing opiate users' mortality with general population mortality rates. RESULTS Crude mortality rates were 0.7 per 100 person years on opiate substitution treatment and 1.3 per 100 person years off treatment; standardised mortality ratios were 5.3 (95% confidence interval 4.0 to 6.8) on treatment and 10.9 (9.0 to 13.1) off treatment. Men using opiates had approximately twice the risk of death of women (morality rate ratio 2.0, 1.4 to 2.9). In the first two weeks of opiate substitution treatment the crude mortality rate was 1.7 per 100 person years: 3.1 (1.5 to 6.6) times higher (after adjustment for sex, age group, calendar period, and comorbidity) than the rate during the rest of time on treatment. The crude mortality rate was 4.8 per 100 person years in weeks 1-2 after treatment stopped, 4.3 in weeks 3-4, and 0.95 during the rest of time off treatment: 9 (5.4 to 14.9), 8 (4.7 to 13.7), and 1.9 (1.3 to 2.8) times higher than the baseline risk of mortality during treatment. Opiate substitution treatment has a greater than 85% chance of reducing overall mortality among opiate users if the average duration approaches or exceeds 12 months. CONCLUSIONS Clinicians and patients should be aware of the increased mortality risk at the start of opiate substitution treatment and immediately after stopping treatment. Further research is needed to investigate the effect of average duration of opiate substitution treatment on drug related mortality.
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Affiliation(s)
- Rosie Cornish
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
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Baldacchino A, Crome IB, Zador D, McGarrol S, Taylor A, Hutchison S, Fahey T, Hickman M, Kidd B. Recording of clinical information in a Scotland-wide drug deaths study. J Psychopharmacol 2010; 24:1289-98. [PMID: 19351800 DOI: 10.1177/0269881109103797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to analyse the nature and extent of data extracted from case files of deceased individuals in contact with services 6 months prior to drug deaths in Scotland during 2003. A cross-sectional descriptive analysis of 317 case notes of 237 individuals who had drug-related deaths was undertaken, using a data linkage process. All contacts made with services in the 6 months prior to death were identified. Information on clinical and social circumstances obtained from social care, specialist drug treatment, mental health, non-statutory services, the Scottish Prison Service and Criminal Records Office was collated. More than 70% (n = 237) were seen 6 months prior to their drug death. Sociodemographic details were reported much more frequently than medical problems, for example, ethnicity (49%), living accommodation (66%), education and income (52%) and dependent children (73%). Medical and psychiatric history was recorded in only 12%, blood-borne viral status in 17% and life events in 26%. This paucity of information was a feature of treatment plans and progress recorded. The 237 drug deaths were not a population unknown to services. Highly relevant data were missing. Improved training to promote in-depth recording and effective monitoring may result in better understanding and reduction of drug deaths.
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Affiliation(s)
- A Baldacchino
- Centre for Addiction Research and Education Scotland (CARES), Division of Molecular and Translational Medicine, College of Medicine, Nursing and Dentistry, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland, UK.
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