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Luo S, Zhang P, Wang Y, Huang Y, Ma X, Deng Q, Zou P, Wang C, Zhang L, Li Y, Fu Y, Li T, Li C. Adenoviruses vectored hepatitis C virus vaccine cocktails induce broadly specific immune responses against multi-genotypic HCV in mice. Biomed Pharmacother 2024; 170:115901. [PMID: 38056238 DOI: 10.1016/j.biopha.2023.115901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) vaccines are an urgent need to prevent hepatitis C and its further progression of hepatocellular carcinoma. Since the promising T cell based chimpanzee adenovirus and modified vaccinia virus Ankara vectorial HCV vaccines were failed in clinical phase II trial, the vaccine designs to improve protection efficacy in combination of cellular and humoral immunity have been hypothesized against multi-genotypic HCV. METHODS Eight HCV vaccine strains were constructed with two novel adenovirus vectors (Sad23L and Ad49L) encoding E1E2 or NS3-5B proteins of HCV genotype (Gt) 1b and 6a isolates, covering 80 % HCV strains prevalent in south China and south-east Asia. Eight HCV vaccine strains were grouped into Sad23L-based vaccine cocktail-1 and Ad49L-based vaccine cocktail-2 for vaccinating mice, respectively. RESULTS The immunogenicity of a single dose of 107-1010 PFU HCV individual vaccines was evaluated in mice, showing weak specific antibody to E1 and E2 protein but a dose-dependent T cell response to E1E2/NS3-5B peptides, which could be significantly enhanced by boosting with an alternative vector vaccine carrying homologous antigen. Prime-boost vaccinations with vaccine cocktail-1 and cocktail-2 induced significantly higher cross-reactive antibody and stronger T cell responses to HCV Gt-1b/6a. The high frequency of intrasplenic and intrahepatic NS31629-1637 CD8+ T cell responses were identified, in which the high proportion of TRM and TEM cells might play an important role against HCV infection in liver. CONCLUSIONS Prime-boost regimens with HCV vaccine cocktails elicited the broad cross-reactive antibody and robust T cell responses against multi-genotypic HCV in mice.
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Affiliation(s)
- Shengxue Luo
- Department of Transfusion Medicine, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, China; Guangzhou Blood Center, Guangzhou, China
| | - Panli Zhang
- Department of Transfusion Medicine, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, China
| | - Yilin Wang
- Department of Transfusion Medicine, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, China; Department of Pathology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, China
| | - Yunzhu Huang
- Institute of Human Virology, Zhongshan School of Medicine, and Key Laboratory of Tropical Disease Control of Ministry of Education, Sun Yat-sen University, Guangzhou 501180, China
| | - Xiaorui Ma
- Department of Transfusion Medicine, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, China
| | - Qitao Deng
- Department of Transfusion Medicine, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, China
| | - Peng Zou
- Department of Transfusion Medicine, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, China
| | - Cong Wang
- Department of Transfusion Medicine, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, China; Guangzhou Bai Rui Kang (BRK) Biological Science and Technology Limited Company, China
| | - Ling Zhang
- Department of Transfusion Medicine, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, China
| | - Yiping Li
- Institute of Human Virology, Zhongshan School of Medicine, and Key Laboratory of Tropical Disease Control of Ministry of Education, Sun Yat-sen University, Guangzhou 501180, China
| | | | - Tingting Li
- Department of Transfusion Medicine, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, China.
| | - Chengyao Li
- Department of Transfusion Medicine, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, China.
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Universal screening for hepatitis C - in for a penny, in for a pound. Eur J Clin Microbiol Infect Dis 2022; 41:341-347. [PMID: 35022892 DOI: 10.1007/s10096-021-04395-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/06/2021] [Indexed: 12/09/2022]
Abstract
Infection with hepatitis C virus (HCV) is a major public health problem. In fact, chronic HCV is a leading cause of cirrhosis, hepatocellular carcinoma, and death from liver disease in most countries. The advent of highly effective oral direct-acting antiviral therapy is the most significant advance in the treatment of HCV in decades and now allows us to cure chronic HCV. However, a large number of infected patients have not been diagnosed since hepatitis C is a largely asymptomatic disease. Thus, it is fundamental to improve the screening system in order to identify individuals who are currently infected and to treat them. Risk-based hepatitis C testing and birth cohort screening have had limited success and many patients living with the infection are not aware of their status. Universal screening for HCV is a tremendous improvement compared with the previous strategies. Indeed, global screening leads to the appropriate identification and treatment of all individuals chronically infected with HCV and prevents the progression of liver disease and the associated morbidity and mortality. In addition, universal HCV testing appears to be cost-effective. In this article, we review the current barriers to HCV eradication and the different strategies for HCV infection screening.
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Chen YC, Thio CL, Kamangar F, Cox AL, Wiberg KJ. Evolving trends in the prevalence of hepatitis C virus antibody positivity among HIV-infected men in a community-based primary care setting. J Viral Hepat 2020; 27:1202-1213. [PMID: 32579777 PMCID: PMC7544680 DOI: 10.1111/jvh.13354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 05/04/2020] [Accepted: 05/20/2020] [Indexed: 12/09/2022]
Abstract
Hepatitis C virus (HCV) infections in the United States occurred mostly among those born between 1945 and 1965. However, new infections continue to increase in recent years. To understand the changes in the prevalence and risk factors of HCV infection in different age and risk groups among men living with HIV, we performed a retrospective cross-sectional analyses of 1948 HIV-infected men at a multisite community health centre in urban/suburban and rural Maryland from 2003 through 2014. We used multivariate logistic regression to determine factors associated with HCV antibody (anti-HCV) positivity and restricted cubic spline method to model trends in anti-HCV prevalence over time. The overall anti-HCV prevalence was 24.2%. The annual prevalence declined in the full cohort, from 38% in 2003 to 24% in 2014, and among those ≥ 40 years old. However, the annual prevalence increased initially and then stabilized in the groups of men who were younger (<40 years old) or had injection-drug use and/or sex with men. Among the younger injection-drug users, the prevalence rose from 33% in 2003 to 79% in 2009 and then stabilized. The independent predictors for anti-HCV positivity differed between the men with and without injection-drug use and between those < 40 and ≥ 40 years old. Notably, a high prevalence of anti-HCV was observed among the younger, white injection-drug users residing in rural areas. Thus, the HCV epidemic continued unabated among high-risk individuals in this diverse population of HIV-infected men. The ongoing HCV transmission among young HIV-infected men poses a challenge en route to HCV eradication.
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Affiliation(s)
- Yun-Chi Chen
- Department of Biology, Morgan State University, Baltimore, MD,Corresponding author: Yun-Chi Chen, D.Phil (Oxon). Department of Biology, Morgan State University, 1700 Cold Spring Lane, Baltimore, 21251 MD, Phone: 1-443-885-1997,
| | - Chloe L Thio
- Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Farin Kamangar
- Department of Biology, Morgan State University, Baltimore, MD
| | - Andrea L Cox
- Department of Medicine, Johns Hopkins University, Baltimore, MD
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Coppock D, Chou E, Gracely E, Gross R, Heun-Lee D. Hepatitis C antibody screening and determinants of initial and duplicate screening in the baby boomer patients of six urban primary care clinics. PLoS One 2020; 15:e0235778. [PMID: 32645083 PMCID: PMC7347094 DOI: 10.1371/journal.pone.0235778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 06/22/2020] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION In 2012, the Centers for Disease Control and Prevention released updated guidelines recommending universal, one-time hepatitis C virus screening for all individuals born between 1945 and 1965. Prior to the implementation of these guidelines, testing rates were inappropriately low, but unnecessary duplicate antibody testing was also problematic. In the era of increased efforts to screen "baby boomers", the prevalence and social determinants of initial and duplicate hepatitis C testing have not been well described. METHODS A hepatitis C screening program was implemented at six urban primary care clinics affiliated with Drexel University College of Medicine. Data was collected regarding the screening patterns in these clinics. Annual screening rates for the program were assessed. Multivariate logistic regression analyses were used to examine the association of demographic variables and the outcomes of subjects having ever been tested and subjects having received duplicate testing. RESULTS Following the implementation of the program, the screening rate increased from 16% in the first year of analysis to 82% in the final year of analysis. Of the 6,717 patients screened, 1,207 had duplicate testing, of which 14% had inappropriate duplicate antibody screening. African Americans and Asian patients had a higher odds of being screened. Patients with public insurance had a higher odds of duplicate screening. CONCLUSIONS In the setting of an aggressive hepatitis C screening program, high testing rates may be attained in a target population. However, inappropriate duplicate antibody testing rates may be high, which may be a burden in resource-limited settings.
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Affiliation(s)
- Dagan Coppock
- Department of Medicine, Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - Edgar Chou
- Department of Medicine, Division of General Internal Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Edward Gracely
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Robert Gross
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Dong Heun-Lee
- Department of Medicine, Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
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Geboy AG, Nichols WL, Fernandez SJ, Desale S, Basch P, Fishbein DA. Leveraging the electronic health record to eliminate hepatitis C: Screening in a large integrated healthcare system. PLoS One 2019; 14:e0216459. [PMID: 31120906 PMCID: PMC6532960 DOI: 10.1371/journal.pone.0216459] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 04/22/2019] [Indexed: 12/26/2022] Open
Abstract
Highly efficacious and tolerable treatments that cure hepatitis C viral (HCV) infection exist today, increasing the feasibility of disease elimination. However, large healthcare systems may not be fully prepared for supporting recommended actions due to knowledge gaps, inadequate infrastructure and uninformed policy direction. Additionally, the HCV cascade of care is complex, with many embedded barriers, and a significant number of patients do not progress through the cascade and are thus not cured. The aim of this retrospective cohort study was to evaluate a large healthcare system's HCV screening rates, linkage to care efficiency, and provider testing preferences. Patients born during 1945-1965, not previously HCV positive or tested from within the Electronic Health Record (EHR), were identified given that three-quarters of HCV-infected persons in the United States are from this Birth Cohort (BC). In building this HCV testing EHR prompt, non-Birth Cohort patients were excluded as HCV-specific risk factors identifying this population were not usually captured in searchable, structured data fields. Once completed, the BC prompt was released to primary care locations. From July 2015 through December 2016, 11.5% of eligible patients (n = 9,304/80,556) were HCV antibody tested (anti-HCV), 3.8% (353/9,304) anti-HCV positive, 98.1% (n = 311/317) HCV RNA tested, 59.8% (n = 186/311) HCV RNA positive, 86.6% (161/186) referred and 76.4% (n = 123/161) seen by a specialist, and 34.1% (n = 42/123) cured of their HCV. Results from the middle stages of the cascade in this large healthcare system are encouraging; however, entry into the cascade-HCV testing-was performed for only 11% of the birth cohort, and the endpoint-HCV cure-accounted for only 22% of all infected. Action is needed to align current practice with recommendations for HCV testing and treatment given that these are significant barriers toward elimination.
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Affiliation(s)
- Alexander G. Geboy
- MedStar Health Research Institute, Hyattsville, MD, United States of America
| | - Whitney L. Nichols
- MedStar Health Research Institute, Hyattsville, MD, United States of America
| | | | - Sameer Desale
- MedStar Health Research Institute, Hyattsville, MD, United States of America
| | - Peter Basch
- MedStar Health Research Institute, Hyattsville, MD, United States of America
- MedStar Institute for Innovation, Washington, DC, United States of America
- MedStar Quality and Safety Institute, Washington, DC, United States of America
| | - Dawn A. Fishbein
- MedStar Health Research Institute, Hyattsville, MD, United States of America
- MedStar Washington Hospital Center, Washington, DC, United States of America
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Plant A, Snow EG, Montoya JA, Young S, Javanbakht M, Klausner JD. Test4HepC: Promoting Hepatitis C Testing to Baby Boomers Using Social Media. Health Promot Pract 2019; 21:780-790. [PMID: 30854905 DOI: 10.1177/1524839919833987] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Individuals born between 1945 and 1965 ("baby boomers") account for an estimated three quarters of all hepatitis C (HCV) infections in the United States. This article describes the evaluation of Test4HepC, a program that uses social media and a website to promote HCV testing to baby boomers in Los Angeles County, California. The first 16 months of Test4HepC were evaluated using an online survey (n = 302), qualitative interviews (n = 20), website and social media analytics, and records of free testing offered though the program. Test4HepC.org had 6,919 visitors; 48 individuals used the free testing offered. Within 1 month of visiting the website, 24.5% (74) of survey participants tested for HCV, 67.6% (50) received a negative HCV antibody test result, 2.7% (2) received a positive HCV antibody test result, and 25.7% (19) had not received their results as of taking the survey. Most of those not tested (60.5%) reported intention to test. In multivariable analysis, male sex and high perceived usefulness of the program website were associated with HCV testing. Qualitative interviews suggested that Test4HepC increased baby boomers' HCV risk perception and encouraged testing. Social media is a promising strategy for promoting HCV testing to baby boomers. Expanding Test4HepC to other areas and prioritizing the highest risk baby boomers could enable many people with HCV to benefit from new treatments.
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Affiliation(s)
- Aaron Plant
- Sentient Research, Inc., Los Angeles, CA, USA
| | | | | | - Sean Young
- University of California, Los Angeles, CA, USA
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Lamoury FM, Hajarizadeh B, Soker A, Martinez D, Quek C, Cunningham P, Catlett B, Cloherty G, Marks P, Amin J, Grebely J, Dore GJ, Applegate TL. Evaluation of a Hepatitis C Virus Core Antigen Assay in Plasma and Dried Blood Spot Samples. J Mol Diagn 2018; 20:621-627. [DOI: 10.1016/j.jmoldx.2018.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 04/19/2018] [Accepted: 05/07/2018] [Indexed: 01/20/2023] Open
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Yeboah-Korang A, Beig MI, Khan MQ, Goldstein JL, Macapinlac DM, Maurer D, Sonnenberg A, Fimmel CJ. Hepatitis C Screening in Commercially Insured U.S. Birth-cohort Patients: Factors Associated with Testing and Effect of an EMR-based Screening Alert. J Transl Int Med 2018; 6:82-89. [PMID: 29984203 PMCID: PMC6032190 DOI: 10.2478/jtim-2018-0012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Hepatitis C virus (HCV) testing rates among U.S. birth-cohort patients have been studied extensively, limited data exists to differentiate birth-cohort screening from risk- or liver disease-based testing. This study aims to identify factors associated with HCV antibody (HCV-Ab) testing in a group of insured birth cohort patients, to determine true birth cohort testing rates, and to determine whether an electronic medical record (EMR)-driven Best Practice Alert (BPA) would improve birth cohort testing rates. METHODS All birth-cohort outpatients between 2010 and 2015 were identified. HCV-Ab test results, clinical, and demographic variables were extracted from the EMR, and factors associated with testing were analyzed by logistic regression. True birth-cohort HCV screening rates were determined by detailed chart review for all outpatient visits during one calendar month. An automated Best Practice Alert was used to identify unscreened patients at the point of care, and to prompt HCV testing. Screening rates before and after system-wide implementation of the BPA were compared. RESULTS The historic HCV-Ab testing rate was 11.2% (11,976/106,753). Younger age, female gender, and African American, Asian, or Hispanic ethnicity, and medical comorbidities such as chronic hemodialysis, HIV infection, and rheumatologic and psychiatric comorbidities were associated with higher testing rates. However, during the one-month sampling period, true age cohort-based testing was performed in only 69/10,089 patients (0.68%). Following the system-wide implementation of the HCV BPA, testing rates increased from 0.68% to 10.76% (P<0.0001). CONCLUSIONS We documented low HCV-Ab testing rates in our baby boomers population. HCV testing was typically performed in the presence of known risk factors or established liver disease. The implementation of an EMR-based HCV BPA resulted in a marked increase in testing rates. Our study highlights current HCV screening gaps, and the utility of the EMR to improve screening rates and population health.
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Affiliation(s)
| | | | | | | | | | | | - Amnon Sonnenberg
- Portland VA Medical Center and Oregon Health & Science University, Portland, OR, USA
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Mahajan R, Midha V, Goyal O, Mehta V, Narang V, Kaur K, Singh A, Singh D, Bhanot R, Sood A. Clinical profile of hepatitis C virus infection in a developing country: India. J Gastroenterol Hepatol 2018; 33:926-933. [PMID: 28921677 DOI: 10.1111/jgh.13995] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 08/20/2017] [Accepted: 09/11/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM The epidemiology and clinical profile of hepatitis C virus (HCV) varies worldwide, and data from developing countries are sparse. The aim of the present study was to assess the clinical profile of HCV infection in a developing country in South-East Asia (India). METHODS This observational study assessed patient demographics, viral characteristics, risk factors for virus acquisition, and disease characteristics in HCV patients diagnosed between January 2004 and December 2015. RESULTS Of 8035 patients who were diagnosed with HCV infection, a majority were men (68.3%), middle aged (52.2%), and from low (34%) to middle (46%) socioeconomic status and rural population (69.8%). Eighty-two percent had identifiable risk factors, the most common being history of dental treatment (52%) and therapeutic injections with reusable syringes/needles (45%). Household contacts of index patients had high prevalence of HCV (15.3%). Common genotypes were genotype 3 (70.4%) and genotype 1 (19.3%). Although a majority of patients were either asymptomatic (54.8%) or had non-specific symptoms (6.7%) at presentation, a significant proportion (9.3%) had advanced liver disease. Presentation with cirrhosis (38.8%) was associated with male gender, higher age at time of virus detection, rural residence, alcohol or opium intake, and coinfections with hepatitis B virus or human immunodeficiency virus. CONCLUSIONS Hepatitis C virus infection in northern India is seen more commonly in men, the middle aged and people from rural background and low to middle socioeconomic status. The common possible risk factors are dental treatment and exposure to reused syringes and needles. Although the most common presentation is incidental detection, a large number of patients present with advanced liver disease.
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Affiliation(s)
- Ramit Mahajan
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Vandana Midha
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Omesh Goyal
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Varun Mehta
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Vikram Narang
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Kirandeep Kaur
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Arshdeep Singh
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Dharmatma Singh
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Rishu Bhanot
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ajit Sood
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Willis SJ, Cole SR, Westreich D, Edmonds A, Hurt CB, Albrecht S, Anastos K, Augenbraun M, Fischl M, French AL, Kalapila AG, Karim R, Peters MG, Plankey M, Seaberg EC, Tien PC, Adimora AA. Chronic hepatitis C virus infection and subsequent HIV viral load among women with HIV initiating antiretroviral therapy. AIDS 2018; 32:653-661. [PMID: 29334550 PMCID: PMC6024258 DOI: 10.1097/qad.0000000000001745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES One in four persons living with HIV is coinfected with hepatitis C virus (HCV). Biological and behavioral mechanisms may increase HIV viral load among coinfected persons. Therefore, we estimated the longitudinal effect of chronic HCV on HIV suppression after ART initiation among women with HIV (WWH). DESIGN HIV RNA was measured every 6 months among 441 WWH in the Women's Interagency HIV Study who initiated ART from 2000 to 2015. METHODS Log-binomial regression models were used to compare the proportion of study visits with detectable HIV RNA between women with and without chronic HCV. Robust sandwich variance estimators accounted for within-person correlation induced by repeated HIV RNA measurements during follow-up. We controlled for confounding and selection bias (because of loss to follow-up and death) using inverse probability-of-exposure-and-censoring weights. RESULTS One hundred and fourteen women (25%) had chronic HCV before ART initiation. Overall, the proportion of visits with detectable HIV RNA was similar among women with and without chronic HCV [relative risk (RR) 1.19 (95% CI 0.72, 1.95)]. Six months after ART initiation, the proportion of visits with detectable HIV RNA among women with chronic HCV was 1.88 (95% CI 1.41-2.51) times that among women without HCV, at 2 years, the ratio was 1.60 (95% CI 1.17-2.19), and by 6 years there was no difference (1.03; 95% CI 0.60-1.79). CONCLUSION Chronic HCV may negatively impact early HIV viral response to ART. These findings reaffirm the need to test persons with HIV for HCV infection, and increase engagement in HIV care and access to HCV treatment among persons with HIV/HCV coinfection.
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Affiliation(s)
- Sarah J Willis
- Department of Epidemiology, Gillings School of Global Public Health
| | - Stephen R Cole
- Department of Epidemiology, Gillings School of Global Public Health
| | - Daniel Westreich
- Department of Epidemiology, Gillings School of Global Public Health
| | - Andrew Edmonds
- Department of Epidemiology, Gillings School of Global Public Health
| | - Christopher B Hurt
- Institute for Global Health & Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Svenja Albrecht
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx
| | - Michael Augenbraun
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York
| | - Margaret Fischl
- Miller School of Medicine, University of Miami, Miami, Florida
| | - Audrey L French
- Division of Infectious Diseases, Stroger Hospital of Cook County, Chicago, Illinois
| | - Aley G Kalapila
- Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia
| | - Roksana Karim
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Marion G Peters
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Michael Plankey
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC
| | - Eric C Seaberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Adaora A Adimora
- Department of Epidemiology, Gillings School of Global Public Health
- Institute for Global Health & Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Hossain N, Puchakayala B, Kanwar P, Verma S, Abraham G, Ivanov Z, Niaz MO, Mohanty SR. Risk Factor Analysis Between Newly Screened and Established Hepatitis C in GI and Hepatology Clinics. Dig Dis Sci 2017; 62:3193-3199. [PMID: 28913613 DOI: 10.1007/s10620-017-4754-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 06/11/2017] [Indexed: 12/09/2022]
Abstract
BACKGROUND Several studies show inconsistencies in the rate of hepatitis C virus (HCV) detection among baby boomers (born 1945-1965). We conducted a cross-sectional HCV screening followed by a case-controlled comparison of the newly screened population with established HCV subjects. METHOD Enrollment was offered to subjects aged 40-75 at our gastroenterology and hepatology clinics. Demographic data and potential risk factors were obtained, and HCV antibody test was offered to those who had never been screened and compared with a group with established HCV. Logistic regression analysis and Fisher's exact test were performed. RESULTS Six hundred and seventy-five patients were offered participation, of whom 128 declined while 50 consented to participate but did not perform the HCV antibody test. Of 497 enrolled subjects, 252 patients had HCV, while 245 subjects (188 patients among "baby boomer") underwent screening for HCV. There were more females (62.4 vs. 41.7%) and immigrants (34.7 vs. 22.2%) among the newly screened group. Among the screened population, five patients had HCV antibody (2.04%), and two of them had positive viral load (0.82%) of whom only one fell in the baby boomer category (0.53%). Compared to HCV group, screened group had significantly lower-risk factors, such as IV drug use (1.22 vs. 43.3%), intranasal cocaine use (14.3 vs. 49.6%), and blood transfusion (18.8 vs. 32.5%). CONCLUSION We found a slightly lower but similar prevalence of HCV antibody when screening based on birth cohort as compared to larger baby boomer studies. Future studies evaluating addition of other screening strategies or possibly universal screening may be needed.
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Affiliation(s)
- Newaz Hossain
- Department of Gastroenterology and Hepatobiliary Disease, New York Presbyterian Brooklyn Methodist Hospital, 506, 6th Street, Brooklyn, NY, 11215, USA
| | - Bharat Puchakayala
- Department of Gastroenterology and Hepatobiliary Disease, New York Presbyterian Brooklyn Methodist Hospital, 506, 6th Street, Brooklyn, NY, 11215, USA
| | - Pushpjeet Kanwar
- Department of Gastroenterology and Hepatobiliary Disease, New York Presbyterian Brooklyn Methodist Hospital, 506, 6th Street, Brooklyn, NY, 11215, USA
| | - Siddharth Verma
- Department of Gastroenterology and Hepatobiliary Disease, New York Presbyterian Brooklyn Methodist Hospital, 506, 6th Street, Brooklyn, NY, 11215, USA.,Department of Gastroenterology and Hepatology, Icahn School of Medicine at Mt Sinai, Queens Hospital Center, 82-68, 164th Street, Queens, NY, 11432, USA
| | - George Abraham
- Department of Gastroenterology and Hepatobiliary Disease, New York Presbyterian Brooklyn Methodist Hospital, 506, 6th Street, Brooklyn, NY, 11215, USA
| | - Zhanna Ivanov
- Department of Gastroenterology and Hepatobiliary Disease, New York Presbyterian Brooklyn Methodist Hospital, 506, 6th Street, Brooklyn, NY, 11215, USA
| | - Muhammad Obaid Niaz
- Department of Gastroenterology and Hepatobiliary Disease, New York Presbyterian Brooklyn Methodist Hospital, 506, 6th Street, Brooklyn, NY, 11215, USA
| | - Smruti R Mohanty
- Department of Gastroenterology and Hepatobiliary Disease, New York Presbyterian Brooklyn Methodist Hospital, 506, 6th Street, Brooklyn, NY, 11215, USA.
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Norton BL, Fleming J, Bachhuber MA, Steinman M, DeLuca J, Cunningham CO, Johnson N, Laraque F, Litwin AH. High HCV cure rates for people who use drugs treated with direct acting antiviral therapy at an urban primary care clinic. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 47:196-201. [PMID: 28811158 DOI: 10.1016/j.drugpo.2017.07.021] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/06/2017] [Accepted: 07/21/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Though direct acting antivirals (DAAs) promise high cure rates, many providers and payers remain concerned about successful treatment for people who use drugs (PWUD), even among those engaged in opioid agonist treatment (OAT). The efficacy of DAAs among PWUD in real-world settings is unclear. METHODS We conducted a cohort study of patients initiating HCV treatment between January 2014 and August 2015 (n=89) at a primary care clinic in the Bronx, NY. Onsite HCV treatment with DAAs was performed by an HCV specialist, with support from a care coordinator funded by the NYC Department of Health. We identified four categories of drug use and drug treatment: (1) no active drug use/not receiving OAT (defined as non-PWUD); (2) no active drug use/receiving OAT; (3) active drug use/not receiving OAT; and (4) active drug use/receiving OAT. The primary outcome was SVR at 12 weeks post-treatment. RESULTS Overall SVR rates were 95% (n=41/43) for non-PWUD and 96% (n=44/46) for patients actively using drugs and/or receiving OAT [p=0.95]. There were no differences in SVR rates by drug use or drug treatment category. Compared to non-PWUD, those with no active drug use/receiving OAT had 100% SVR (n=15/15; p=1.0), those actively using drugs/not receiving OAT had 90% SVR (n=9/10; p=0.47), and those actively using drugs/receiving OAT had 95% SVR (20/21; p=1.0). CONCLUSION Regardless of active drug use or OAT, patients who received DAA therapy at an urban primary care clinic achieved high HCV cure rates. We found no clinical evidence to justify restricting access to HCV treatment for patients actively using drugs and/or receiving OAT.
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Affiliation(s)
- Brianna L Norton
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States.
| | - Julia Fleming
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States
| | - Marcus A Bachhuber
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States
| | | | - Joseph DeLuca
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States
| | - Chinazo O Cunningham
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States
| | - Nirah Johnson
- New York City Department of Health, Viral Hepatitis Program, New York, NY, United States
| | - Fabienne Laraque
- New York City Department of Health, Viral Hepatitis Program, New York, NY, United States
| | - Alain H Litwin
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States
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Patel RC, Vellozzi C, Smith BD. Results of Hepatitis C Birth-Cohort Testing and Linkage to Care in Selected U.S. Sites, 2012-2014. Public Health Rep 2017; 131 Suppl 2:12-9. [PMID: 27168656 DOI: 10.1177/00333549161310s203] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Following its recommendation for one-time hepatitis C virus (HCV) testing of people born between 1945 and 1965, CDC implemented the Hepatitis Testing and Linkage to Care (HepTLC) initiative to conduct birth-cohort hepatitis testing in U.S. health-care settings. We describe demographic characteristics, HCV infection prevalence, and HCV-related risk factors among people born between 1945 and 1965 who were tested as part of the program, which ran from 2012 to 2014. METHODS As part of the HepTLC initiative, 14 grantees supporting 104 health-care sites in 21 U.S. municipalities tested participants born between 1945 and 1965 for HCV antibody (anti-HCV). Demographic characteristics and HCV risk factors were reported for people tested for anti-HCV and who were anti-HCV or HCV RNA positive. We evaluated outcomes along the HCV testing-to-care continuum using the following indicators: anti-HCV positive, HCV RNA test offered, HCV RNA positive, referred to care, and attended first medical appointment. RESULTS Among 24,966 people tested for HCV infection, 2,900 (11.6%) were anti-HCV positive. Anti-HCV positivity was highest among those who self-identified as non-Hispanic black (n=1,701 of 12,202, 13.9%), men (n=2,073 of 12,130, 17.1%), and people born between 1951 and 1955 (n=795 of 5,768, 13.8%). Of the 2,900 people testing anti-HCV positive, 2,108 (72.7%) received an HCV RNA test, 1,497 (51.6%) were HCV RNA positive, 1,201 (41.4%) were referred to care, and 938 (32.3%) attended their first appointment. CONCLUSION Testing for HCV infection among those born between 1945 and 1965 without soliciting HCV risk factors was successful. Providers implementing birth-cohort testing should develop and evaluate strategies to improve outcomes along the testing-to-care continuum.
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Affiliation(s)
- Rajiv C Patel
- Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | - Claudia Vellozzi
- Centers for Disease Control and Prevention, Division of Viral Hepatitis, Atlanta, GA
| | - Bryce D Smith
- Centers for Disease Control and Prevention, Division of Viral Hepatitis, Atlanta, GA; Current affiliation: Centers for Disease Control and Prevention, Division of Diabetes Translation, Translation, Health Education, and Evaluation Branch, Atlanta, GA
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Laraque F, Varma JK. A Public Health Approach to Hepatitis C in an Urban Setting. Am J Public Health 2017; 107:922-926. [PMID: 28426310 DOI: 10.2105/ajph.2017.303718] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The clinical consequences of HCV infection are increasing because the population with the highest prevalence of the infection, persons born between 1945 and 1965, is aging. As a result, health care expenditures are expected to increase. Now that a cure for HCV infection is the norm, a public health approach is necessary to identify, link to care, and treat infected persons and prevent new infections. We believe that the success of public health interventions, such as those for tuberculosis, can be translated to HCV infection. New York City has many HCV-infected residents and has developed a public health approach to controlling the HCV epidemic. It encompasses surveillance and monitoring, case finding, linkage to care, care coordination, increasing clinical provider capacity for screening and treatment, increasing public awareness, and primary prevention.
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Affiliation(s)
- Fabienne Laraque
- At the time of study, Fabienne Laraque and Jay K. Varma were with the Division of Disease Control, New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Jay K Varma
- At the time of study, Fabienne Laraque and Jay K. Varma were with the Division of Disease Control, New York City Department of Health and Mental Hygiene, Long Island City, NY
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Norton BL, Beitin A, Glenn M, DeLuca J, Litwin AH, Cunningham CO. Retention in buprenorphine treatment is associated with improved HCV care outcomes. J Subst Abuse Treat 2017; 75:38-42. [PMID: 28237052 DOI: 10.1016/j.jsat.2017.01.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 01/26/2017] [Accepted: 01/27/2017] [Indexed: 12/19/2022]
Abstract
Persons who inject drugs, most of whom are opioid dependent, comprise the majority of the HCV infected in the United States. As the national opioid epidemic unfolds, increasing numbers of people are entering the medical system to access treatment for opioid use disorder, specifically with buprenorphine. Yet little is known about HCV care in patients accessing buprenorphine-based opioid treatment. We sought to determine the HCV prevalence, cascade of care, and the association between patient characteristics and completion of HCV cascade of care milestones for patients initiating buprenorphine treatment. We reviewed electronic health records of all patients who initiated buprenorphine treatment at a primary-care clinic in the Bronx, NY between January 2009 and January 2014. Of the 390 patients who initiated buprenorphine treatment, 123 were confirmed to have chronic HCV infection. The only patient characteristic associated with achieving HCV care milestones was retention in opioid treatment. Patients retained (vs. not retained) in buprenorphine treatment were more likely to be referred for HCV specialty care (63.1% vs. 34.0%, p<0.01), achieve an HCV-specific evaluation (40.8% vs. 21.3%, p<0.05), be offered HCV treatment (22.4% vs. 8.5%, p<0.05), and initiate HCV treatment (9.2% vs. 6.4%, p=0.6). Given the current opioid epidemic in the US and the growing number of people receiving buprenorphine treatment, there is an unprecedented opportunity to access and treat persons with HCV, reducing HCV transmission, morbidity and mortality. Retention in opioid treatment may improve linkage and retention in HCV care; innovative models of care that integrate opioid drug treatment with HCV treatment are essential.
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Affiliation(s)
- B L Norton
- Montefiore Medical Center, Albert Einstein College of Medicine, Division of General Internal Medicine, Bronx, NY, United States.
| | - A Beitin
- Montefiore Medical Center, Albert Einstein College of Medicine, Division of General Internal Medicine, Bronx, NY, United States
| | - M Glenn
- Montefiore Medical Center, Albert Einstein College of Medicine, Division of General Internal Medicine, Bronx, NY, United States
| | - J DeLuca
- Montefiore Medical Center, Albert Einstein College of Medicine, Division of General Internal Medicine, Bronx, NY, United States
| | - A H Litwin
- Montefiore Medical Center, Albert Einstein College of Medicine, Division of General Internal Medicine, Bronx, NY, United States
| | - C O Cunningham
- Montefiore Medical Center, Albert Einstein College of Medicine, Division of General Internal Medicine, Bronx, NY, United States
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16
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Norton B, Southern WN, Steinman M, Smith BD, Deluca J, Rosner Z, Litwin AH. No Differences in Achieving Hepatitis C Virus Care Milestones Between Patients Identified by Birth Cohort or Risk-Based Screening. Clin Gastroenterol Hepatol 2016; 14:1356-60. [PMID: 27108792 PMCID: PMC5822431 DOI: 10.1016/j.cgh.2016.04.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 04/04/2016] [Accepted: 04/05/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS National hepatitis C virus (HCV) screening guidelines recommended 1-time testing of persons born between 1945 and 1965. METHODS We performed a retrospective study to compare care milestones achieved by HCV-infected patients identified by birth cohort versus risk-based screens. RESULTS We determined the proportions of patients newly identified with HCV infection who met care milestones (viral load, referral to and evaluation by a specialist, offer of treatment, initiation of treatment, and sustained viral response) and the time it took to reach them. We found no differences in HCV care milestones for patients identified via birth cohort testing versus risk-based screening. Overall, only 43% of HCV antibody-positive patients were referred to care, and less than 4% started treatment. The time to each care milestone was lengthy and varied greatly; treatment was initiated in a median of 308 days. CONCLUSIONS Although birth cohort testing will likely increase identification of patients with HCV infection, it does not seem to increase the number of patients that meet management milestones. New methods are needed to increase access to care and establish efficient models of health care delivery.
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Affiliation(s)
- Brianna Norton
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York,Division of General Internal Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - William N. Southern
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York,Division of Hospital Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Meredith Steinman
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York,Division of General Internal Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Bryce D. Smith
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, National Center for HIV/Viral Hepatitis/STD/TB Prevention, Atlanta, Georgia
| | - Joseph Deluca
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York,Division of General Internal Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Zachary Rosner
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York,Division of General Internal Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Alain H. Litwin
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York,Division of General Internal Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
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17
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Yan M, Ha J, Aguilar M, Bhuket T, Liu B, Gish RG, Cheung R, Wong RJ. Birth cohort-specific disparities in hepatocellular carcinoma stage at diagnosis, treatment, and long-term survival. J Hepatol 2016; 64:326-332. [PMID: 26386160 DOI: 10.1016/j.jhep.2015.09.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 08/05/2015] [Accepted: 09/09/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Individuals born between 1945 and 1965 account for nearly 75% of hepatitis C virus (HCV) infections in the United States. As this cohort ages, progressive HCV-related liver disease leading to cirrhosis and hepatocellular carcinoma (HCC) will place a significant burden on the healthcare system. We aim to evaluate birth cohort-specific disparities in HCC stage at diagnosis, treatment rates, and overall survival with a focus on the 1945-1965 birth cohort. METHODS A population-based retrospective cohort study of adult patients with HCC identified in the Surveillance, Epidemiology, and End Results 2003-2011 registry evaluated birth cohort-specific disparities in the prevalence and outcomes of HCC, including multivariate logistic regression models to evaluate disparities in HCC stage at diagnosis and HCC treatment received. Birth cohort-specific survival was evaluated with Kaplan-Meier methods and multivariate Cox proportional hazard models. RESULTS The proportion of HCC represented by the 1945-1965 cohort increased by 64% from 2003-2011, and accounted for 57.4% of all HCC in 2011. Compared to patients born after 1965, the 1945-1965 cohort were more likely to have HCC within Milan criteria (OR, 3.66; 95% CI, 3.13-4.28; p<0.001). However, among patients with HCC within Milan criteria, the 1945-1965 cohort had no difference in receipt of surgical treatment, but had higher overall long-term survival (HR, 0.82; 95% CI, 0.69-0.97; p<0.03). CONCLUSIONS The 1945-1965 birth cohort accounts for the majority of HCC in the United States. Despite earlier HCC stage at diagnosis, no difference in receipt of surgical treatment was observed, but higher overall survival was achieved.
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Affiliation(s)
- Melissa Yan
- Department of Medicine, Alameda Health System - Highland Hospital, Oakland, CA, United States
| | - John Ha
- Department of Medicine, Alameda Health System - Highland Hospital, Oakland, CA, United States
| | - Maria Aguilar
- Department of Medicine, Alameda Health System - Highland Hospital, Oakland, CA, United States
| | - Taft Bhuket
- Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, Oakland, CA, United States
| | - Benny Liu
- Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, Oakland, CA, United States
| | - Robert G Gish
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, United States
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, United States; Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Robert J Wong
- Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, Oakland, CA, United States.
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18
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Southern WN, Norton B, Steinman M, DeLuca J, Drainoni ML, Smith BD, Litwin AH. A Birth-cohort testing intervention identified hepatitis c virus infection among patients with few identified risks: a cross-sectional study. BMC Infect Dis 2015; 15:553. [PMID: 26626449 PMCID: PMC4667399 DOI: 10.1186/s12879-015-1283-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 11/19/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND International guidelines and U.S. guidelines prior to 2012 only recommended testing for hepatitis C virus (HCV) infection among patients at risk, but adherence to guidelines is poor, and the majority of those infected remain undiagnosed. A strategy to perform one-time testing of all patients born during 1945-1965, birth cohort testing, may diagnose HCV infection among patients whose risk remains unknown. We sought to determine if a birth-cohort testing intervention for HCV antibody positivity helped identify patients with fewer documented risk factors or medical indications than a pre-intervention, risk-based testing strategy. METHODS We used a cross-sectional design with retrospective electronic medical record review to examine patients identified with HCV antibody positivity (Ab+) during a pre-intervention (risk-based) phase, the standard of care at the time, vs. a birth-cohort testing intervention phase. We compared demographic and clinical characteristics and HCV risk-associated factors among patients whose HCV Ab + was identified during the pre-intervention (risk-based testing) vs. post birth-cohort intervention phases. Study subjects were patients identified as HCV-Ab + in the baseline (risk-based) and birth-cohort testing phases of the Hepatitis C Assessment and Testing (HepCAT) Project. RESULTS Compared to the risk-based phase, patients newly diagnosed with HCV Ab + after the birth-cohort intervention were significantly less likely to have a history of any substance abuse (30.5% vs. 49.5%, p = 0.02), elevated alanine transaminase levels of > 40 U/L (22.0% vs. 46.7%, p = 0.002), or the composite any risk-associated factor (55.9% vs. 79.0%, p = 0.002). CONCLUSIONS Birth-cohort testing is an useful strategy for identifying previously undiagnosed HCV Ab + because it does not require providers ask risk-based questions, or patients to disclose risk behaviors, and appears to identify HCV Ab + in patients who would not have been identified using a risk-based testing strategy.
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Affiliation(s)
- William N Southern
- Division of Hospital Medicine, 111 East 210th Street, Bronx, 10467, NY, USA.
- Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA.
- Department of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA.
| | - Brianna Norton
- Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA.
- Division of General Internal Medicine, 111 East 210th Street, Bronx, 10467, NY, USA.
| | - Meredith Steinman
- Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA.
- Division of General Internal Medicine, 111 East 210th Street, Bronx, 10467, NY, USA.
| | - Joseph DeLuca
- Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA
- Division of General Internal Medicine, 111 East 210th Street, Bronx, 10467, NY, USA
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, 72 East Concord Street, Boston, MA, 02118, USA.
| | - Bryce D Smith
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, National Center for HIV/Viral Hepatitis/STD/TB Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA.
| | - Alain H Litwin
- Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA.
- Division of General Internal Medicine, 111 East 210th Street, Bronx, 10467, NY, USA.
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Ditah I, Al Bawardy B, Gonzalez HC, Saberi B, Ditah C, Kamath PS, Charlton M. Lack of health insurance limits the benefits of hepatitis C virus screening: insights from the National Health and Nutrition Examination Hepatitis C follow-up study. Am J Gastroenterol 2015; 110:1126-33. [PMID: 25756239 DOI: 10.1038/ajg.2015.31] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 01/02/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Identifying barriers to access to hepatitis C virus (HCV) treatment among screen detected subjects is critical for any public health strategy aimed at controlling HCV infection in the general population. METHODS Data from the National Health and Nutrition Examination Survey HCV Follow-up study from 2001 to 2010 were used. Participants who tested positive for HCV were sent a letter informing them of their test results and advised to pursue further evaluation. Information on HCV transmission and its potential complications was also provided to all positive participants. These subjects were recontacted 6 months after notification to determine what action they had taken regarding the positive result. RESULTS Of 38,025 participants, 502 tested positive for HCV infection, giving a prevalence of 1.3% (95% confidence interval (CI) 0.8%, 1.8%). A total of 205 subjects participated in the 6-month follow-up interview. Those who could not be reached were more likely to be less educated, injecting drugs, and not to have health insurance. Half (50.2%) of the positive individuals were not aware of their status before notification. A total of 166 (81%) had pursued further evaluation. Only 18 (26.9%) received therapy. The main reason for not receiving treatment was high cost (19.4%). In adjusted analysis, the only barrier to pursuing downstream HCV care was the lack of health insurance (2.76, 95% CI 1.54, 7.69; P=0.007). CONCLUSIONS This study suggests that the lack of health insurance may attenuate the theoretical benefits of a screening program that identifies asymptomatic HCV-infected individuals who are less likely to pursue downstream care.
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Affiliation(s)
- Ivo Ditah
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Badr Al Bawardy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Humberto C Gonzalez
- Department of Transplant Surgery, Methodist University Hospital, University of Tennessee, Memphis, Tennessee, USA
| | - Behnam Saberi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Callistus Ditah
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Patrick S Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael Charlton
- Hepatology and Liver Transplantation, Intermountain Medical Center, Salt Lake City, Utah, USA
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Fisher DG, Hess KL, Erlyana E, Reynolds GL, Cummins CA, Alonzo TA. Comparison of Rapid Point-of-Care Tests for Detection of Antibodies to Hepatitis C Virus. Open Forum Infect Dis 2015; 2:ofv101. [PMID: 26269795 PMCID: PMC4531224 DOI: 10.1093/ofid/ofv101] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/03/2015] [Indexed: 12/15/2022] Open
Abstract
OraSure had the highest sensitivity at 92.7% followed closely by Chembio's three blood tests. False results were associated with HIV, and hepatitis B core antibody. The OraSure and Chembio blood tests have good performance characteristics. Background. Hepatitis C is one of the most prevalent blood-borne diseases in the United States. Despite the benefits of early screening, among 3.2 million Americans who are infected with hepatitis C virus (HCV), 50%–70% are unaware of their infection status. Methods. Data were collected between 2011 and 2014, from 1048 clients who were in the following groups: (1) injection drug users, (2) women at sexual risk, (3) gay and bisexual men, and (4) transgender individuals. The sensitivity and specificity of point-of-care tests included (1) the MedMira rapid human immunodeficiency virus (HIV)/HCV antibody test, (2) MedMira hepatitis B (HBV)/HIV/HCV antibody test, (3) Chembio HCV Screen Assay used with both whole blood and (4) oral specimens, (5) Chembio HIV-HCV Assay also used with both whole blood and (6) oral specimens, (7) Chembio HIV-HCV-Syphilis Assay, and (8) OraSure HCV Rapid Antibody Test used with whole blood. The gold standard for the HCV tests were HCV enzyme immunoassay (EIA) 2.0. Results. OraSure had the highest sensitivity at 92.7% (95% confidence interval [CI] = 88.8%–96.5%) followed closely by Chembio's 3 blood tests at 92.1% (95% CI = 87.7%–96.4%), 91.5% (95% CI = 87.2%–95.7%), and 92.3% (95% CI = 88.4%–96.2%). The sensitivities of MedMira HIV/HCV and MedMira HIV/HCV/HBV tests were the lowest, at 79.1% (95% CI = 72.6%–85.5%), and 81.5% (95% CI = 75.2%–87.8%), respectively. Specificity for the OraSure was 99.8% (95% CI = 99.4%–100%); specificity for the Chembio blood tests was 99.2% (95% CI = 98.6%–99.9%), 99.4% (95% CI = 98.8%–99.9%), and 99.3% (95% CI = 98.8%–99.9%); and specificity for the MedMira was100% and 100%. False-negative results were associated with HIV and hepatitis B core antibody serostatus. Conclusions. The OraSure and Chembio blood tests (including those multiplexed with HIV and syphilis) appear to good performance characteristics. This study has identified potential limitations of rapid testing in those testing positive for HIV and HBcAb. There should be discussion of updates to the 2013 CDC guidance.
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Affiliation(s)
- Dennis G Fisher
- Center for Behavioral Research and Services ; Psychology Department
| | | | - Erlyana Erlyana
- Center for Behavioral Research and Services ; Department of Health Care Administration
| | - Grace L Reynolds
- Center for Behavioral Research and Services ; Department of Health Care Administration
| | | | - Todd A Alonzo
- Department of Preventive Medicine , University of Southern California , Los Angeles
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El-Ghitany EM, Abdel Wahab MM, Abd El-Wahab EW, Hassouna S, Farghaly AG. A comprehensive hepatitis C virus risk factors meta-analysis (1989-2013): do they differ in Egypt? Liver Int 2015; 35:489-501. [PMID: 24923487 DOI: 10.1111/liv.12617] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/05/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS The prevention and control of HCV infection is complex and challenging in terms of describing risk factors and modes of transmission. This meta-analysis was conducted to summarize the best available data on HCV risk factors worldwide and in Egypt. METHODS Through exhaustive literature searches (1989-2013) of HCV risk factors, 357 original eligible articles were included in this study. RESULTS The highest detected risk was intravenous drug users (IDUs) (OR = 9.6) followed by HIV infection (OR = 4.9), having an IDU partner (OR = 4.1), HBV infection (OR = 3.5), Caesarean section (CS) (OR = 3.35), blood transfusion (OR = 3.2) and having an HCV+ partner (OR = 3). Organ transplantation, hospital admission, haemodialysis and having a sexually transmitted infection carry 2.96, 2.4, 2.18 and 2 risks of having HCV respectively. Other significant risk factors included poor education, older age, sharing sharp or blunt objects, MSM, tattooing, hijama, body piercing, minor operations and medical procedures. Some risks showed a decrease over the previous decade, including blood transfusion, organ transplantation, IDUs, IDU partner and CS. Others showed rising risks, including having an HCV+ partner, MSM and suffering from STI. In Egypt, male gender, rural residence, acupuncture and receiving parenteral antischistosomal treatment were significant risks, while neither HIV nor HBV were found to carry a risk of HCV infection. CONCLUSION Blood transfusion, organ transplantation, CS, IDUs, haemodialysis, minor operations and medical procedures are established risk factors. Attention and urgent intervention should be given to the sexual route of transmission, as well as that through minor operations and medical procedures.
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Affiliation(s)
- Engy Mohamed El-Ghitany
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
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Smith BD, Yartel AK, Krauskopf K, Massoud OI, Brown KA, Fallon MB, Rein DB. Hepatitis C virus antibody positivity and predictors among previously undiagnosed adult primary care outpatients: cross-sectional analysis of a multisite retrospective cohort study. Clin Infect Dis 2015; 60:1145-52. [PMID: 25595745 DOI: 10.1093/cid/civ002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) testing guidance issued by the Centers for Disease Control and Prevention in 1998 recommends HCV antibody (anti-HCV) testing for persons with specified risk factors. The purpose of this study was to determine the prevalence and predictors of anti-HCV positivity among primary care outpatients and estimate the proportion of unidentified anti-HCV-positive (anti-HCV+) persons using risk-based testing. METHODS We analyzed electronic medical record data from a 4-site retrospective study. Patients were aged ≥18 years, utilized ≥1 outpatient primary care service(s) between 2005 and 2010, and had no documented evidence of prior HCV diagnosis. Among persons tested for anti-HCV, we fit a multilevel logistic regression model to identify patient-level independent predictors of anti-HCV positivity. We estimated the proportion of unidentified anti-HCV+ persons by using multiple imputation to assign anti-HCV results to untested patients. RESULTS We observed 209 076 patients for a median of 5 months (interquartile range, 1-23 months). Among 17 464 (8.4%) patients who were tested for anti-HCV, 6.4% (n=1115) were positive. We identified history of injection drug use (adjusted odds ratio [95% confidence interval], 6.3 [5.2-7.6]), 1945-1965 birth cohort (4.4 [3.8-5.1]), and elevated alanine aminotransferase levels (4.8 [4.2-5.6]) as independently associated with anti-HCV positivity. We estimated that 81.5% (n=4890/6005) of anti-HCV+ patients were unidentified using risk-based testing. CONCLUSIONS In these outpatient primary care settings, risk-based testing may have missed 4 of 5 newly enrolled patients who are anti-HCV+. Without knowing their status, unidentified anti-HCV+ persons cannot receive further clinical evaluation or antiviral treatment, and are unlikely to benefit from secondary prevention recommendations to limit disease progression and mortality.
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Affiliation(s)
- Bryce D Smith
- Division of Viral Hepatitis, Centers for Disease Control and Prevention
| | - Anthony K Yartel
- Centers for Disease Control and Prevention Foundation, Atlanta, Georgia
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Perlman DC, Des Jarlais DC, Feelemyer J. Can HIV and Hepatitis C Virus Infection be Eliminated Among Persons Who Inject Drugs? J Addict Dis 2015; 34:198-205. [PMID: 26075647 PMCID: PMC4550554 DOI: 10.1080/10550887.2015.1059111] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
HIV and hepatitis C virus (HCV) infection are readily transmitted among persons who inject drugs. The HIV and HCV epidemics have expanded rapidly, becoming global health issues. Combined prevention has been implemented to reduce injection and sexual transmission of HIV and HCV among persons who inject drugs. Reductions in risky injection and sexual behavior have led to dramatic reductions in HIV in many countries. Whether comparable reductions in HCV transmission can be achieved has yet to be determined. Eliminating HIV and HCV among persons who inject drugs will require considerable resources and commitment, particularly in low and middle income countries.
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Affiliation(s)
- David C. Perlman
- Department of Medicine, Mount Sinai Beth Israel, New York, NY
- Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, New York, NY
| | - Don C. Des Jarlais
- Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, New York, NY
| | - Jonathan Feelemyer
- Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, New York, NY
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Beckwith CG, Kurth AE, Bazerman L, Solomon L, Patry E, Rich JD, Kuo I. Survey of US Correctional Institutions for Routine HCV Testing. Am J Public Health 2015; 105:68-71. [PMID: 25393180 PMCID: PMC4265939 DOI: 10.2105/ajph.2014.302071] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2014] [Indexed: 12/19/2022]
Abstract
To ascertain HCV testing practices among US prisons and jails, we conducted a survey study in 2012, consisting of medical directors of all US state prisons and 40 of the largest US jails, that demonstrated a minority of US prisons and jails conduct routine HCV testing. Routine voluntary HCV testing in correctional facilities is urgently needed to increase diagnosis, enable risk-reduction counseling and preventive health care, and facilitate evaluation for antiviral treatment.
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Affiliation(s)
- Curt G Beckwith
- Curt G. Beckwith and Josiah D. Rich are with the Alpert Medical School of Brown University/The Miriam Hospital, Providence, RI. Ann E. Kurth is with the College of Nursing, New York University, New York, NY. Lauri Bazerman and Emily Patry are with The Miriam Hospital. Liza Solomon is with Abt Associates, Bethesda, MD. Irene Kuo is with the School of Public Health, George Washington University, Washington, DC
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Shahid I, ALMalki WH, Hafeez MH, Hassan S. Hepatitis C virus infection treatment: An era of game changer direct acting antivirals and novel treatment strategies. Crit Rev Microbiol 2014; 42:535-47. [PMID: 25373616 DOI: 10.3109/1040841x.2014.970123] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Chronic hepatitis C virus infection and associated liver diseases represent a major health care burden all over the world. The current standard of care, i.e. peginterferon-alfa (PEG-IFNα) plus ribavirin (RBV) are associated with frequent and sometimes serious adverse effects and contraindications, which further limit their therapeutic efficacy. The approval of first and second generation HCV protease inhibitors represents a major breakthrough in the development of novel direct acting antivirals (DAAs) against different HCV genotypes and establishes a new standard of care for chronically infected HCV genotypes 1 patients. Similarly, next generation protease inhibitors and HCV RNA polymerase inhibitors have shown better pharmacokinetics and pharmacodynamics in terms of broader HCV genotypes coverage, better safety profile, fewer drug interactions and possible once daily administration than first generation direct acting antivirals. The testing of adenovirus-based vector vaccines, which escalates the innate and acquired immune responses against the most conserved regions of the HCV genome in chimpanzees and humans, may be a promising therapeutic approach against HCV infection in coming future. This review article presents up-to-date knowledge and recent developments in HCV therapeutics, insights the shortcomings of current HCV therapies and key lessons from the therapeutic potential of improved anti-HCV treatment strategies.
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Affiliation(s)
- Imran Shahid
- a Department of Molecular Biology , Applied and Functional Genomics Lab, CEMB, University of the Punjab , Near Thokar Niaz Baig , Lahore , Pakistan .,b Department of Pharmacology and Toxicology , College of Pharmacy, Umm Al Qura University , Al-Abidiyah , Makkah , Saudi Arabia
| | - Waleed Hassan ALMalki
- b Department of Pharmacology and Toxicology , College of Pharmacy, Umm Al Qura University , Al-Abidiyah , Makkah , Saudi Arabia
| | - Muhammad Hassan Hafeez
- c Department of Gastroenterology and Hepatology , Fatima Memorial Hospital and College of Medicine and Dentistry , Shadman , Lahore , Pakistan , and
| | - Sajida Hassan
- a Department of Molecular Biology , Applied and Functional Genomics Lab, CEMB, University of the Punjab , Near Thokar Niaz Baig , Lahore , Pakistan .,d Viral Hepatitis Program, Laboratory of Medicine, University of Washington , Seattle , WA , USA
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W. ABD EL-WAHAB E, MIKHEAL A, SIDKEY F, SHATAT HZ. Factors Associated with Hepatitis C Infection among Chronic HCV Egyptian Patients. IRANIAN JOURNAL OF PUBLIC HEALTH 2014; 43:1510-8. [PMID: 26060718 PMCID: PMC4449500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 10/27/2014] [Indexed: 10/26/2022]
Abstract
BACKGROUND Identification of risk factors of acute hepatitis C virus (HCV) infection in Egypt is crucial for developing appropriate prevention strategies. There are few community-based studies on the epidemiology and risk factors of hepatitis C infection in Egypt, which could not provide enough information. Clear identification of past and current risk factors for infection is of utmost importance so that intervention programs can be appropriately focused. This study aims to provide up-to-date information about changes in the incidence of individual risk factors for HCV infection transmission in Egypt. METHODS A total of 396 chronic HCV patients on follow-up treatment at liver center in El-Qabbary General Hospital in Alexandria were evaluated retrospectively regarding the potential iatrogenic, community acquired and behavioral HCV risk factors. Risk factors for HCV transmission were found in all study populations. RESULTS At least three identifiable risk factors were reported by each participant. Some behavioral and community-acquired exposures that entail several risky behaviors particularly, unsafe sexual practices were exclusively established among males. We report a significant decline in prevalence of HCV transmission through blood transfusion, parenteral treatment, hospitalization, surgery, non medicalized circumcision, Hijiama done by informal practitioner, tattooing, folk body piercing and threading, sharing hygiene and sharp items, and the use of communal barber or manicure sets among younger age cluster. CONCLUSION The pattern of risk differed among older patients compared to younger age group suggesting improved medical care and infection control measures and raised public health awareness regarding the different modes of viral transmission.
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Affiliation(s)
- Ekram W. ABD EL-WAHAB
- 1. Dept. of Tropical Health, High Institute of Public Health, Alexandria University, Egypt,* Corresponding Author: Tel: 0020110456072
| | - Ashraf MIKHEAL
- 1. Dept. of Tropical Health, High Institute of Public Health, Alexandria University, Egypt,3. Damanhour Fever Hospital, Ministry of Health and Population, Damanhour, Egypt
| | - Fathallah SIDKEY
- 2. Dept. of Internal Medicine, Faculty of Medicine, Alexandria University, Egypt
| | - Hanan Z. SHATAT
- 1. Dept. of Tropical Health, High Institute of Public Health, Alexandria University, Egypt
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Backus LI, Belperio PS, Loomis TP, Mole LA. Impact of race/ethnicity and gender on HCV screening and prevalence among U.S. veterans in Department of Veterans Affairs Care. Am J Public Health 2014; 104 Suppl 4:S555-61. [PMID: 25100421 DOI: 10.2105/ajph.2014.302090] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES We assessed HCV screening and prevalence among veterans and estimated the potential impact of complete birth cohort screening, accounting for the disparate HCV disease burden by race/ethnicity and gender. METHODS We used the Department of Veterans Affairs (VA) Corporate Data Warehouse to identify birth dates, gender, race/ethnicity, and laboratory tests for veterans with at least 1 VA outpatient visit in 2012. We calculated HCV screening rates, prevalence, and HCV infection incident diagnosis. RESULTS Among 5,499,743 veterans, 54.7% had HCV screening through the VA. In more than 2.9 million veterans screened, HCV prevalence was 6.1% overall and highest among Blacks (11.8%), particularly Black men born in 1945 to 1965 (17.7%). HCV infection incident diagnosis in 2012 was 5.9% for men and 2.3% for women. An estimated additional 48,928 male veterans, including 12,291 Black men, and 1484 female veterans would potentially be identified as HCV infected with full birth cohort screening. CONCLUSIONS HCV prevalence was markedly elevated among veterans born in 1945 to 1965, with substantial variation by race/ethnicity and gender. Full adoption of birth cohort screening may reveal substantial numbers of veterans with previously unknown HCV infection.
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Affiliation(s)
- Lisa I Backus
- Lisa I. Backus, Pamela S. Belperio, Timothy P. Loomis, and Larry A. Mole are with the Department of Veterans Affairs, Office of Public Health/Population Health, Washington, DC. Lisa Backus is also with the Department of Medicine, VA Palo Alto Health Care System, Palo Alto, CA. Pamela S. Belperio is also with the Department of Pharmacy, VA Greater Los Angeles Health Care System, Los Angeles, CA
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Smith BD, Yartel AK. Comparison of hepatitis C virus testing strategies: birth cohort versus elevated alanine aminotransferase levels. Am J Prev Med 2014; 47:233-41. [PMID: 25145616 PMCID: PMC5759754 DOI: 10.1016/j.amepre.2014.05.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 04/12/2014] [Accepted: 05/06/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is unidentified in an estimated 40%-85% of infected adults. Surveillance and modeling data have found significant increases in HCV-associated morbidity and mortality. PURPOSE To compare two HCV antibody (anti-HCV) testing strategies based on (1) elevated alanine aminotransferase levels (ALT) and (2) a birth cohort approach for people born during 1945-1965. METHODS Data from 19,055 adults aged 20-70 years who completed the National Health and Nutrition Examination Survey in 1999-2008 were analyzed in 2013. Two independent models were evaluated, based on membership in the 1945-1965 birth cohort or elevated ALT, to compare the number of identified anti-HCV-positive (anti-HCV+) individuals; proportion of total identified cases; and the number of people that would be tested using either strategy. RESULTS The prevalence of anti-HCV among adults aged 20-70 years was estimated at 2.0% (95% CI=1.8%, 2.3%), representing about 3.6 million people. The birth cohort strategy would result in testing about 85.4 million people and identifying nearly 2.8 million anti-HCV+ people with a sensitivity of 76.6%. The ALT strategy would test about 21.5 million adults and identify approximately 1.8 million anti-HCV+ people with a sensitivity of 50.0%. Implementing both strategies concurrently would identify 87.3% of anti-HCV+ adults. CONCLUSIONS The birth cohort strategy, which is recommended by both the CDC and the U.S. Preventive Services Task Force, would identify 1 million more anti-HCV+ people than the elevated ALT approach. Concurrent implementation would identify an even larger number of individuals ever infected.
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Cartwright EJ, Rentsch C, Rimland D. Hepatitis C virus screening practices and seropositivity among US veterans born during 1945 - 1965. BMC Res Notes 2014; 7:449. [PMID: 25023159 PMCID: PMC4105869 DOI: 10.1186/1756-0500-7-449] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 07/01/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The Centers for Disease Control and Prevention (CDC) and the United States Preventive Services Task Force (USPSTF) recently augmented risk-based hepatitis C (HCV) screening guidelines with a recommendation to perform one-time screening in all persons born during 1945 - 1965, a birth cohort known to have a higher prevalence of HCV. We sought to estimate the proportion of veterans seen at the Atlanta VA Medical Center (AVAMC) who had ever been screened for HCV infection by birth year. METHODS We used an administrative database of all veterans seen at the AVAMC between January 1, 2011 and December 31, 2011, and a laboratory generated list of all HCV antibody tests and HCV RNA viral loads that were performed at the AVAMC to determine receipt of screening and HCV antibody positivity. Odds ratios and 95% confidence intervals were estimated using SAS version 9.2 (SAS institute, Cary, North Carolina). RESULTS HCV antibody testing had ever been performed on 48% (41,556) of the veterans seen in 2011; 10% of those tested had a positive antibody. Confirmatory viral loads were performed in 96% of those with a positive antibody screen. Those born during 1945 - 1965 were more likely to have a HCV antibody performed when compared with those born in other years (54% vs. 41%, odds ratio [OR] 1.70, 95% Confidence Interval [CI] 1.65-1.74). Among veterans ever tested for HCV antibody (n = 41,556), those born during 1945 - 1965 were 6 times more likely to have a positive HCV antibody (15% vs. 3%, OR 5.87, 95% CI 5.32-6.78), and 3 times more likely to have chronic HCV infection (76% vs. 50%, OR 3.25, 95% CI 2.65-4.00). CONCLUSIONS Nearly half of the veterans seen in 2011 at the AVAMC had ever been tested for HCV infection. When examined by birth cohort, over half of the veterans born during 1945 - 1965 had been screened for HCV and 15% of those screened had a positive HCV antibody. Our findings confirm the increased prevalence of HCV infection in persons born during 1945 - 1965 as identified in the updated CDC and USPSTF recommendations.
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Affiliation(s)
- Emily J Cartwright
- Division of Infectious Diseases, Emory University School of Medicine, 49 Jesse Hill Dr, Atlanta, Georgia 30303, USA.
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Lack of Access to Treatment as a Barrier to HCV Screening. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2014; 20:420-3. [DOI: 10.1097/phh.0b013e31829e05b8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Scalioni LDP, Cruz HM, de Paula VS, Miguel JC, Marques VA, Villela-Nogueira CA, Milagres FAP, Cruz MS, Bastos FI, Andrade TM, Motta-Castro ARC, Lewis-Ximenez LL, Lampe E, Villar LM. Performance of rapid hepatitis C virus antibody assays among high- and low-risk populations. J Clin Virol 2014; 60:200-5. [PMID: 24794796 DOI: 10.1016/j.jcv.2014.04.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 03/18/2014] [Accepted: 04/02/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Rapid tests for the detection of antibodies to hepatitis C virus (anti-HCV) can facilitate access to diagnosis. OBJECTIVES This study aimed to evaluate the performance of rapid tests for anti-HCV detection in the sera, whole blood, and oral fluid samples from individuals with different endemicity profiles and risk behaviors. STUDY DESIGN Three groups donated biological samples that were tested using three anti-HCV rapid tests (WAMA, Bioeasy and OraSure): (I) suspected cases of hepatitis C, (II) individuals who were living in remote areas in Brazil and (III) crack users and beauty professionals. Reproducibility, repeatability and cross-reactivity to other infectious agents (dengue, HIV, malaria, and syphilis) were also evaluated. RESULTS In group I, specificities varied from 93.75% to 100% and sensitivities varied from 76.03% to 93.84% according to the EIA results. When anti-HCV/HCV RNA-reactive sera samples were considered true-positive HCV cases, the sensitivities and specificities varied from 86.3% to 99.09% and 93.75% to 100%, respectively. In group II, the OraSure rapid test presented the best performance. In group III, the Bioeasy assay performed best using saliva and whole blood and the OraSure assay performed best using oral fluid samples. The reproducibility and repeatability of the WAMA and Bioeasy tests were excellent. The level of concordance between the HCV EIAs and the rapid tests using samples that were reactive for other infectious agents varied from 82.35% to 100% for the WAMA assay and 94.11% to 100% for the Bioeasy assay. CONCLUSION All of the rapid tests could be used to identify active HCV infection among individuals with different endemicity profiles and risk behaviors.
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Affiliation(s)
| | - Helena Medina Cruz
- Laboratory of Viral Hepatitis, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
| | - Vanessa Salete de Paula
- Laboratory of Tecnhological Development of Virology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
| | | | - Vanessa Alves Marques
- Laboratory of Viral Hepatitis, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
| | | | | | - Marcelo Santos Cruz
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Francisco Inácio Bastos
- Institute of Communication and Scientific Information & Technology for Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | | | | | - Elisabeth Lampe
- Laboratory of Viral Hepatitis, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
| | - Livia Melo Villar
- Laboratory of Viral Hepatitis, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil.
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Calderon Y, Cowan E, Schramm C, Stern S, Brusalis C, Iscoe M, Rahman S, Verma R, Leider J. HCV and HBV testing acceptability and knowledge among urban emergency department patients and pharmacy clients. Prev Med 2014; 61:29-33. [PMID: 24382298 DOI: 10.1016/j.ypmed.2013.12.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 12/16/2013] [Accepted: 12/21/2013] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Hepatitis C and hepatitis B are public health problems in the United States and remain largely undiagnosed. In response to the availability of rapid, point of care hepatitis tests, we assessed hepatitis knowledge and acceptability of hepatitis testing during an emergency department (ED) or pharmacy visit. METHODS From June 2010 to May 2011, an anonymous prospective survey was administered to a convenience sample of New York City ED patients and pharmacy clients. RESULTS The study population (N=2078) was 54% female, 36% Hispanic and 41% black. Mean age was 39, SD ± 15 years. The majority (72%;1480/2,2060) of the participants responded that they would get tested if free testing were offered, and 67% (1272/1912) of those responded that they would test for hepatitis B/C in conjunction with HIV. Participants who had previously tested for hepatitis had higher mean knowledge scores than those who had never tested. Pharmacy clients, those of black race, and those with higher mean knowledge scores would be more willing to accept hepatitis B/C testing if offered. CONCLUSIONS Urban ED patients and pharmacy clients were receptive to hepatitis testing. Most individuals would elect to be tested for hepatitis with HIV, which raises the possibility of integrated testing.
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Affiliation(s)
- Yvette Calderon
- Department of Emergency Medicine, Jacobi Medical Center, Bronx, NY, USA; Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Ethan Cowan
- Department of Emergency Medicine, Jacobi Medical Center, Bronx, NY, USA; Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Sam Stern
- Department of Emergency Medicine, Jacobi Medical Center, Bronx, NY, USA
| | | | - Mark Iscoe
- Department of Emergency Medicine, Jacobi Medical Center, Bronx, NY, USA
| | - Sara Rahman
- Department of Emergency Medicine, Jacobi Medical Center, Bronx, NY, USA
| | - Rajesh Verma
- Department of Emergency Medicine, Jacobi Medical Center, Bronx, NY, USA
| | - Jason Leider
- Internal Medicine, Jacobi Medical Center, Bronx, NY, USA; Internal Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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Ditah I, Ditah F, Devaki P, Ewelukwa O, Ditah C, Njei B, Luma HN, Charlton M. The changing epidemiology of hepatitis C virus infection in the United States: National Health and Nutrition Examination Survey 2001 through 2010. J Hepatol 2014; 60:691-8. [PMID: 24291324 DOI: 10.1016/j.jhep.2013.11.014] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 11/09/2013] [Accepted: 11/19/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS In light of the dramatically changing hepatitis C therapeutic landscape, knowledge of the current burden of HCV infection in the general population of the United States is critical. METHODS The National Health and Nutrition Examination survey collects nationally representative data on HCV infection in the civilian population of the United States. Data from 2001 to 2010 were combined for this study. HCV testing was completed in 38,025 participants. RESULTS The prevalence of anti-HCV in the United Sates decreased from 1.9% (95% CI 1.5%-2.5%) in 2001-2002 to 1.3% (95% CI 0.9%-1.8%) in 2005-2006, and remained stable up to 2010. About 67% of all infected persons were positive for HCV RNA, indicating 2.3 million people with chronic HCV infection, of whom 68% have genotype 1. Seventy percent of infected persons were born between 1945 and 1965, with prevalence of 3.5% (95% CI 2.2%-4.8%). The stable rate since 2006 is mostly related to prevalent cases and foreign born persons migrating into US. Other important risk factors include less education and low economic status. Race, HIV status, number of sexual partners, and blood transfusions are no longer associated with HCV infection. CONCLUSIONS As of 2010, approximately 2.3 million persons were chronically infected with Hepatitis C in the US. Most of those infected are prevalent, rather than incident cases. The prevalence of HCV was on the decline, but has stabilized since 2006. Future studies should explore reasons for no decline in HCV prevalence since 2006.
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Affiliation(s)
- Ivo Ditah
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States.
| | - Fausta Ditah
- Division of Gastroenterology Hepatology, and Nutrition, Vanderbilt University School of Medicine, United States
| | | | | | | | - Basile Njei
- University of Connecticut School of Medicine, Birmingham, CT, United States
| | | | - Michael Charlton
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States
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Smith BD, Beckett GA, Yartel A, Holtzman D, Patel N, Ward JW. Previous exposure to HCV among persons born during 1945-1965: prevalence and predictors, United States, 1999-2008. Am J Public Health 2014; 104:474-81. [PMID: 24432883 DOI: 10.2105/ajph.2013.301549] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES We examined HCV exposure prevalence and predictors among persons in the United States born during 1945-1965. METHODS With data from the 1999-2008 National Health and Nutrition Examination Survey, we calculated the proportion of persons born during 1945-1965 who tested positive for HCV antibody (anti-HCV) and analyzed the prevalence by sociodemographic and behavioral risk factors. RESULTS Anti-HCV prevalence in the 1945-1965 birth cohort was 3.2% (95% confidence interval [CI] = 2.8%, 3.8%), substantially higher than among other adults (0.9%). Within the cohort, anti-HCV prevalence was higher among non-Hispanic Blacks (6.4%; 95% CI = 5.3%, 7.7%), persons with injection drug use histories (56.8%; 95% CI = 48.4%, 64.8%), and persons with elevated alanine aminotransferase levels (12.7%; 95% CI = 10.7%, 15.1%). Injection drug use (adjusted odds ratio = 98.4; 95% CI = 58.8, 164.5) was the strongest anti-HCV prevalence predictor. Among anti-HCV-positive persons, 57.8% reported having 2 or more alcoholic drinks daily. CONCLUSIONS With the high prevalence of HCV among persons born during 1945-1965, the increasing morbidity and mortality associated with HCV, and reductions in liver cancer and HCV-related mortality when HCV is eradicated, it is critically important to identify persons with HCV and link them to appropriate care.
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Affiliation(s)
- Bryce D Smith
- Bryce D. Smith, Geoff A. Beckett, Deborah Holtzman, and John W. Ward are with the Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA. Anthony Yartel and Nita Patel are with the Centers for Disease Control and Prevention Foundation, Atlanta, GA
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Kuniholm MH, Jung M, Everhart JE, Cotler S, Heiss G, McQuillan G, Kim RS, Strickler HD, Thyagarajan B, Youngblood M, Kaplan RC, Ho GYF. Prevalence of hepatitis C virus infection in US Hispanic/Latino adults: results from the NHANES 2007-2010 and HCHS/SOL studies. J Infect Dis 2014; 209:1585-90. [PMID: 24423693 DOI: 10.1093/infdis/jit672] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Prevalence of hepatitis C virus (HCV) antibody has been reported in Mexican Americans, but its prevalence in other US Hispanic/Latino groups is unknown. We studied 2 populations of US Hispanic/Latino adults; 3210 from the National Health and Nutrition Examination Survey (NHANES) 2007-2010 and 11 964 from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Age-standardized prevalence of HCV antibody was similar in NHANES 2007-2010 (1.5%) and HCHS/SOL (2.0%) but differed significantly by Hispanic/Latino background in HCHS/SOL (eg, 11.6% in Puerto Rican men vs 0.4% in South American men). These findings suggest that the HCV epidemic among US Hispanics/Latinos is heterogeneous.
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Affiliation(s)
- Mark H Kuniholm
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
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Education and counseling in the methadone treatment setting improves knowledge of viral hepatitis. J Subst Abuse Treat 2013; 46:528-31. [PMID: 24462241 DOI: 10.1016/j.jsat.2013.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 10/18/2013] [Accepted: 10/29/2013] [Indexed: 12/11/2022]
Abstract
The aim of this study was to evaluate the effectiveness of an educational method of providing viral hepatitis education for methadone maintenance patients. Four hundred forty participants were randomly assigned to either a control or a motivationally-enhanced viral hepatitis education and counseling intervention. Viral hepatitis A (HAV), B (HBV), and C (HCV) knowledge tests were administered at baseline, following each of two education sessions (post-education), and at a 3-month follow-up assessment. Results indicated a significant increase in knowledge of HAV, HBV, and HCV over time. No differences were found in knowledge between the intervention groups in knowledge acquisition regarding any of the hepatitis viruses suggesting that a motivational interviewing style may not augment hepatitis knowledge beyond standard counseling. A two-session viral hepatitis education intervention effectively promotes hepatitis knowledge and can be integrated in methadone treatment settings.
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Afdhal NH, Zeuzem S, Schooley RT, Thomas DL, Ward JW, Litwin AH, Razavi H, Castera L, Poynard T, Muir A, Mehta SH, Dee L, Graham C, Church DR, Talal AH, Sulkowski MS, Jacobson IMFTNPOHCVTMP. The new paradigm of hepatitis C therapy: integration of oral therapies into best practices. J Viral Hepat 2013; 20:745-60. [PMID: 24168254 PMCID: PMC3886291 DOI: 10.1111/jvh.12173] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 08/24/2013] [Indexed: 12/12/2022]
Abstract
Emerging data indicate that all-oral antiviral treatments for chronic hepatitis C virus (HCV) will become a reality in the near future. In replacing interferon-based therapies, all-oral regimens are expected to be more tolerable, more effective, shorter in duration and simpler to administer. Coinciding with new treatment options are novel methodologies for disease screening and staging, which create the possibility of more timely care and treatment. Assessments of histologic damage typically are performed using liver biopsy, yet noninvasive assessments of histologic damage have become the norm in some European countries and are becoming more widespread in the United States. Also in place are new Centers for Disease Control and Prevention (CDC) initiatives to simplify testing, improve provider and patient awareness and expand recommendations for HCV screening beyond risk-based strategies. Issued in 2012, the CDC recommendations aim to increase HCV testing among those with the greatest HCV burden in the United States by recommending one-time testing for all persons born during 1945-1965. In 2013, the United States Preventive Services Task Force adopted similar recommendations for risk-based and birth-cohort-based testing. Taken together, the developments in screening, diagnosis and treatment will likely increase demand for therapy and stimulate a shift in delivery of care related to chronic HCV, with increased involvement of primary care and infectious disease specialists. Yet even in this new era of therapy, barriers to curing patients of HCV will exist. Overcoming such barriers will require novel, integrative strategies and investment of resources at local, regional and national levels.
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Affiliation(s)
- N H Afdhal
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical SchoolBoston, MA, USA
| | - S Zeuzem
- Department of Medicine, J.W. Goethe University HospitalFrankfurt, Germany
| | - R T Schooley
- Division of Infectious Diseases, San Diego School of Medicine, University of CaliforniaLa Jolla, CA, USA
| | - D L Thomas
- Division of Infectious Diseases, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - J W Ward
- Division of Viral Hepatitis, Centers for Disease Control and PreventionAtlanta, GA, USA
| | - A H Litwin
- Departments of Medicine and Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of MedicineBronx, NY, USA
| | - H Razavi
- Center for Disease AnalysisLouisville, CO, USA
| | - L Castera
- Service d'Hepatologie, Hopital Beaujon, Assistance Publique Hopitaux de ParisClichy, France
| | - T Poynard
- Service d'Hepatologie, Groupe Hospitalier Pitie-SalpetriereParis, France
| | - A Muir
- Gastroenterology and Hepatology Research Group, Duke Clinical Research InstituteDurham, NC, USA
| | - S H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public HealthBaltimore, MD, USA
| | - L Dee
- Fair Pricing Coalition and AIDS Action BaltimoreBaltimore, MD, USA
| | - C Graham
- Division of Infectious Disease, Beth Israel Deaconess Medical CenterBoston, MA, USA
| | - D R Church
- Massachusetts Department of Public Health, Bureau of Infectious DiseaseBoston, MA, USA
| | - A H Talal
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University at BuffaloBuffalo, NY, USA
| | - M S Sulkowski
- Department of Medicine, Johns Hopkins University School of MedicineBaltimore, MD, USA
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Smith BD, Jewett A, Burt RD, Zibbell JE, Yartel AK, DiNenno E. "To share or not to share?" Serosorting by hepatitis C status in the sharing of drug injection equipment among NHBS-IDU2 participants. J Infect Dis 2013; 208:1934-42. [PMID: 24136794 DOI: 10.1093/infdis/jit520] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Persons who inject drugs (PWID) are at high risk for acquiring hepatitis C virus (HCV) infection. The Centers for Disease Control and Prevention estimates there are 17 000 new infections per year, mainly among PWID. This study examines injection equipment serosorting-considering HCV serostatus when deciding whether and with whom to share injection equipment. OBJECTIVE To examine whether injection equipment serosorting is occurring among PWID in selected cities. METHODS Using data from the National HIV Behavioral Surveillance System-Injection Drug Users (NHBS-IDU2, 2009), we developed multivariate logistic regression models to examine the extent to which participants' self-reported HCV status is associated with their injection equipment serosorting behavior and knowledge of last injecting partner's HCV status. RESULTS Participants who knew their HCV status were more likely to know the HCV status of their last injecting partner, compared to those who did not know their status (HCV+: adjusted odds ratio [aOR] 4.1, 95% confidence interval [CI], 3.4-4.9; HCV-: aOR 2.5, 95% CI, 2.0-3.0). Participants who reported being HCV+, relative to those of unknown HCV status, were 5 times more likely to share injection equipment with a partner of HCV-positive status (aOR 4.8, 95% CI, 3.9-6.0). CONCLUSIONS Our analysis suggests PWID are more likely to share injection equipment with persons of concordant HCV status.
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Affiliation(s)
- Bryce D Smith
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
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Lohia P, Jinjuvadia R, May E. Profound jaundice in a patient with acute hepatitis C. BMJ Case Rep 2013; 2013:bcr2013200233. [PMID: 24031074 PMCID: PMC3794154 DOI: 10.1136/bcr-2013-200233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 52-year-old African-American woman with overall good health and medical history of asthma and depression presented with right lower quadrant abdominal pain, vomiting and icterus for 3 weeks. Her physical examination was remarkable for only sclera icterus and mild tenderness on palpation in the right lower quadrant. Investigations revealed marked hyperbilirubinemia and transaminitis, with other serological and radiological studies unremarkable and a hepatitis A, B and C panel negative 3 weeks before presentation. Repeat hepatitis panel showing hepatitis C antibody positive with viral load 20 739 524 IU/mL. Liver biopsy supported the diagnosis of acute hepatitis C infection.
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Affiliation(s)
- Prateek Lohia
- Department of Internal Medicine, Wayne State University School of Medicine/Detroit Medical Center, Detroit, Michigan, USA
| | - Raxitkumar Jinjuvadia
- Department of Internal Medicine, Wayne State University School of Medicine/Detroit Medical Center, Detroit, Michigan, USA
| | - Elizabeth May
- Department of Gastroenterology, Wayne State University School of Medicine/Detroit Medical Center, Detroit, Michigan, USA
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McEwan P, Ward T, Yuan Y, Kim R, L'italien G. The impact of timing and prioritization on the cost-effectiveness of birth cohort testing and treatment for hepatitis C virus in the United States. Hepatology 2013; 58:54-64. [PMID: 23389841 DOI: 10.1002/hep.26304] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 01/17/2013] [Indexed: 01/12/2023]
Abstract
UNLABELLED Recent United States guidelines recommend one-time birth cohort testing for hepatitis C infection in persons born between 1945 and 1965; this represents a major public health policy undertaking. The purpose of this study was to assess the role of treatment timing and prioritization on predicted cost-effectiveness. The MONARCH hepatitis C lifetime simulation model was used in conjunction with a testing and treatment decision tree to estimate the cost-effectiveness of birth cohort versus risk-based testing incorporating information on age, fibrosis stage and treatment timing. The study used a 1945-1965 birth cohort and included disease progression, testing and treatment-related parameters. Scenario analysis was used to evaluate the impact of hepatitis C virus (HCV) prevalence, treatment eligibility, age, fibrosis stage and timing of treatment initiation on total costs, quality-adjusted life years (QALYs), HCV-related complications and cost-effectiveness. The cost-effectiveness of birth cohort versus risk-based testing was $28,602. Assuming 91% of the population is tested, at least 278,000 people need to be treated for birth cohort testing to maintain cost-effectiveness. Prioritizing treatment toward those with more advanced fibrosis is associated with a decrease in total cost of $7.5 billion and 59,035 fewer HCV-related complications. Total QALYs and complications avoided are maximized when treatment initiation occurs as soon as possible after testing. CONCLUSION This study confirms that birth cohort testing is, on average, cost-effective. However, this remains true only when enough tested and HCV-positive subjects are treated to generate sufficient cost offsets and QALY gains. Given the practical and financial challenges associated with implementing birth cohort testing, the greatest return on investment is obtained when eligible patients are treated immediately and those with more advanced disease are prioritized.
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Affiliation(s)
- Phil McEwan
- Centre for Health Economics, Swansea University, Wales, UK; Health Economics & Outcomes Research Ltd., Wales, UK.
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Liang TJ. Current progress in development of hepatitis C virus vaccines. Nat Med 2013; 19:869-78. [PMID: 23836237 PMCID: PMC6263146 DOI: 10.1038/nm.3183] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 02/22/2013] [Indexed: 12/14/2022]
Abstract
Despite major advances in the understanding and treatment of hepatitis C, a preventive vaccine remains elusive. The marked genetic diversity and multiple mechanisms of persistence of hepatitis C virus, combined with the relatively poor immune response of the infected host against the virus, are major barriers. The lack of robust and convenient model systems further hampers the effort to develop an effective vaccine. Advances in our understanding of virus-host interactions and protective immunity in hepatitis C virus infection provide an important roadmap to develop potent and broadly directed vaccine candidates targeting both humoral and cellular immune responses. Multiple approaches to generating and testing viral immunogens have met with variable success. Several candidates have advanced to clinical trials based on promising results in chimpanzees. The ultimate path to a successful preventive vaccine requires comprehensive evaluations of all aspects of protective immunity, innovative application of state-of-the-art vaccine technology and properly designed vaccine trials that can affirm definitive endpoints of efficacy.
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Affiliation(s)
- T Jake Liang
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, US National Institutes of Health, Bethesda, Maryland, USA.
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Mahajan R, Liu SJ, Klevens RM, Holmberg SD. Indications for testing among reported cases of HCV infection from enhanced hepatitis surveillance sites in the United States, 2004-2010. Am J Public Health 2013; 103:1445-9. [PMID: 23763404 DOI: 10.2105/ajph.2013.301211] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Centers for Disease Control and Prevention has recommended a 1-time HCV test for persons born from 1945 through 1965 to supplement current risk-based screening. We examined indications for testing by birth cohort (before 1945, 1945-1965, and after 1965) among persons with past or current HCV. METHODS Cases had positive HCV laboratory markers reported by 4 surveillance sites (Colorado, Connecticut, Minnesota, and New York) to health departments from 2004 to 2010. Health department staff abstracted demographics and indications for testing from cases' medical records and compiled this information into a surveillance database. RESULTS Of 110, 223 cases of past or current HCV infection reported during 2004-2010, 74, 578 (68%) were among persons born during 1945-1965. Testing indications were abstracted for 45, 034 (41%) cases; of these, 29 ,544 (66%) identified at least 1 Centers for Disease Control and Prevention-recommended risk factor as a testing indication. Overall, 74% of reported cases were born from 1945 to 1965 or had an injection drug use history. CONCLUSIONS These data support augmenting the current HCV risk-based screening recommendations by screening adults born from 1945 to 1965.
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Affiliation(s)
- Reena Mahajan
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Mailstop G37, 1600 Clifton Rd, NE, Atlanta, GA 30333, USA.
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Kanwal F, Lok AS, El-Serag HB. CDC and USPSTF 2012 recommendations for screening for hepatitis C virus infection: overview and take-home messages. Clin Gastroenterol Hepatol 2013; 11:200-3. [PMID: 23432900 DOI: 10.1016/j.cgh.2013.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Fasiha Kanwal
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA.
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Kanwal F, Lok AS, El-Serag HB. CDC and USPSTF 2012 recommendations for screening for hepatitis C virus infection: overview and take-home messages. Gastroenterology 2013; 144:478-81. [PMID: 23419454 DOI: 10.1053/j.gastro.2013.01.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Fasiha Kanwal
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA.
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The epidemiology of chronic hepatitis C and one-time hepatitis C virus testing of persons born during 1945 to 1965 in the United States. Clin Liver Dis 2013. [PMID: 23177279 DOI: 10.1016/j.cld.2012.09.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Hepatitis C virus (HCV) is the most common blood-borne infection in the United States. HCV infection is a leading cause of chronic liver disease, end-stage liver disease, and liver transplantation. Newly available therapies can clear HCV in most infected persons who receive treatment. However, many persons living with HCV infection are unaware of their infection status, including those born during 1945-1965 (a population at increased risk for chronic hepatitis C in the United States). This review highlights the epidemiology of hepatitis C and the importance of HCV testing and linkage to care in an era of more effective antiviral therapies.
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Ward JW. The hidden epidemic of hepatitis C virus infection in the United States: occult transmission and burden of disease. TOPICS IN ANTIVIRAL MEDICINE 2013; 21:15-19. [PMID: 23596274 PMCID: PMC6148892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Society faces an immense burden of hepatitis C virus (HCV) infection-related morbidity and mortality. Transmission of HCV is ongoing, and the incidence of HCV infection has been increasing in recent years. New therapies for treating HCV infection hold considerable promise for increasing cure rates and thus reducing HCV transmission. However, many persons with HCV infection in the United States are unaware of their infection status. The Centers for Disease Control and Prevention (CDC) recently expanded its HCV testing recommendations to include 1-time HCV testing for individuals born between 1945 and 1965, a population with a 3% prevalence of infection. Linkage to care and treatment for those identified with infection through testing would have a profound impact in reducing HCV disease burden. Coordinated efforts by public health agencies, clinical care providers, laboratories, and payers are necessary to improve primary and secondary prevention of HCV disease. This article summarizes a presentation by John W. Ward, MD, at the IAS-USA live continuing medical education program held in Atlanta, Georgia, in October 2012.
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Affiliation(s)
- John W Ward
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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48
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Smith BD, Jewett A, Drobeniuc J, Kamili S. Rapid diagnostic HCV antibody assays. Antivir Ther 2012; 17:1409-13. [PMID: 23322678 PMCID: PMC5791540 DOI: 10.3851/imp2470] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2012] [Indexed: 10/27/2022]
Abstract
Approximately 4.1 million Americans have been infected with HCV and 45-85% of chronically infected persons are unaware of their status. Rapid anti-HCV assays can assist and expedite the identification of those unaware of their infection. Performance characteristics of pre-market rapid anti-HCV assays (Chembio, MedMira and OraSure) have been evaluated. Their sensitivity (78.9-99.3%) and specificity (80-100%) varied. Future investigations could include evaluation of rapid anti-HCV tests in persons who are coinfected with HCV and HIV, and development of rapid HCV-antigen tests and nucleic acid tests.
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Affiliation(s)
- Bryce D Smith
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Smith BD, Morgan RL, Beckett GA, Falck-Ytter Y, Holtzman D, Ward JW. Hepatitis C virus testing of persons born during 1945-1965: recommendations from the Centers for Disease Control and Prevention. Ann Intern Med 2012; 157:817-22. [PMID: 22910836 PMCID: PMC5777166 DOI: 10.7326/0003-4819-157-9-201211060-00529] [Citation(s) in RCA: 235] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
DESCRIPTION The Centers for Disease Control and Prevention (CDC) and a group of governmental and private sector partners developed these evidence-based recommendations to increase the proportion of hepatitis C virus (HCV)-infected persons who know their status and are linked to appropriate care and treatment. The recommendations also address brief alcohol screening, as alcohol accelerates progression of liver disease among HCV-infected individuals. These recommendations augment CDC's 1998 and 1999 recommendations based on risk and medical indications and are not meant to replace those recommendations. METHODS These recommendations are based on systematic reviews of evidence published from 1995 through February 2012 in MEDLINE, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials, Sociological Abstracts, and Database of Abstracts of Reviews of Effects. Selected studies included cross-sectional and cohort studies that addressed either prevalence of hepatitis C in the United States or clinical outcomes (for example, hepatocellular carcinoma and serious adverse events) among treated patients and systematic reviews of trials that assessed effectiveness of brief screening interventions for alcohol consumption. The Grading of Recommendations Assessment, Development, and Evaluation framework was used to assess quality of the evidence. RECOMMENDATION 1: Adults born during 1945-1965 should receive 1-time testing for HCV without prior ascertainment of HCV risk. (Grade: strong recommendation; moderate-quality evidence). RECOMMENDATION 2: All persons with identified HCV infection should receive a brief alcohol screening and intervention as clinically indicated, followed by referral to appropriate care and treatment services for HCV infection and related conditions (Grade: strong recommendation; moderate-quality evidence).
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Affiliation(s)
- Bryce D Smith
- Centers for Disease Control and Prevention, Division of Viral Hepatitis, Atlanta, Georgia, USA
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50
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Smith BD, Jorgensen C, Zibbell JE, Beckett GA. Centers for Disease Control and Prevention initiatives to prevent hepatitis C virus infection: a selective update. Clin Infect Dis 2012; 55 Suppl 1:S49-53. [PMID: 22715214 DOI: 10.1093/cid/cis363] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) infection is a complex public health problem, characterized by a high prevalence of chronic infection, an increasing burden of HCV-associated disease, low rates of testing and treatment, and the prospect of increasing incidence associated with the epidemic of injection drug use. Three-quarters of chronic HCV infections occur among persons born from 1945 through 1965. Prevention efforts are complicated by limited knowledge among health care professionals, persons at risk and in the public at large. At the Centers for Disease Control and Prevention, efforts to improve primary and secondary prevention effectiveness center on policy development, education and training initiatives, and applied research. This report provides a brief overview of some of these efforts, including the development of testing recommendations for the 1945-1965 birth cohort, research and evaluation studies in settings where persons who inject drugs receive services, and a national viral hepatitis education campaign that targets health care professionals, the public, and persons at risk.
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Affiliation(s)
- Bryce D Smith
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA
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