Delays in fibrosis staging reduce the likelihood of achieving hepatitis C treatment and cure

BACKGROUND

Updated 2021 hepatitis C virus (HCV) treatment guidelines no longer recommend fibrosis staging for treatment-naïve patients without cirrhosis; however, numerous US state Medicaid plans continue to restrict initiation of HCV therapy by fibrosis stage. The study objective was to determine whether delays from HCV diagnosis to fibrosis staging impact the likelihood of initiating/completing HCV treatment and achieving sustained virologic response (SVR).

METHODS

A retrospective cohort study was performed among patients diagnosed with chronic HCV by an urban US emergency department who subsequently underwent fibrosis staging. Time elapsed from HCV diagnosis to hepatic fibrosis staging was evaluated on the likelihood of treatment initiation, treatment completion and SVR.

RESULTS

Among fibrosis staging modalities, hepatic ultrasounds occurred more quickly following HCV diagnosis (3.5 months, IQR = 12.4 months), compared to FibroSure (8.5 months, IQR = 20.4 months) and FibroScan (9.9 months, IQR = 18.0 months) (p<.001). Each six-month delay in fibrosis staging decreased the likelihood of initiating treatment by 5% (adjusted relative risk (aRR)=0.95; 95% confidence interval (CI)=0.91-0.998; p=.04) and the likelihood of SVR by 7% (aRR = 0.93; 95% CI = 0.87-0.995; p=.04) after adjusting for insurance, race/ethnicity and history of HIV testing.

CONCLUSIONS

Delays in hepatitis fibrosis staging were significantly associated with decreased likelihood of HCV treatment initiation and SVR.

Lassa Fever Induced Hearing Loss: The Neglected Disability of Hemorrhagic Fever

OBJECTIVE

Lassa fever (LF) a hemorrhagic fever endemic to Western has an incidence of approximately 500,000 cases per year. Here, we evaluate hearing loss and other sequelae following LF.

METHODS

This case-control study enrolled laboratory confirmed LF survivors, non-LF Febrile controls and Matched Community controls with no history of LF or recent hospitalization for a febrile illness. Study participants completed a symptom questionnaire. Pure-tone audiometry was completed by a subset of participants.

RESULTS

One hundred forty-seven subjects were enrolled aged from 3-66 years (mean = 23.3). LF survivors were significantly more likely to report balance difficulties (55% vs 20%, p < 0.001), hair loss (32% vs 7%, p < 0.001), difficulty speaking (19% vs 1%, p < 0.001), social isolation (50% vs 0%, p < 0.001), and hearing loss (17% vs 1%, p = 0.002) in comparison to Matched-Community Controls. Similar trends were noted in comparison to Febrile Controls, although these findings were non-significant. Fifty subjects completed audiometry. Audiometry found that LF survivors had significantly more bilateral hearing loss in comparison to Matched-Community Controls (30% vs 4%, p = 0.029).

CONCLUSION

This study characterizes the sequelae of LF and highlights the need for increased access to hearing care in West Africa.

Loneliness in older chinese adults: a risk factor for elder mistreatment

OBJECTIVES

To examine loneliness as a risk factor for elder mistreatment in an urban, community-dwelling Chinese population.

DESIGN

Cross-sectional descriptive study.

SETTING

Major urban medical center in NanJing, China.

PARTICIPANTS

Four hundred twelve subjects aged 60 and older who presented to the general medical clinic. The mean age of the participants was 70, and 34% were female. Mean education level was 8.5 years of schooling.

MEASUREMENTS

Loneliness was assessed using validated instruments, and direct questions were asked regarding mistreatment experienced by older adults.

RESULTS

Elder mistreatment was found in 35.2% of the participants. After adjusting for confounding factors, feeling of often lacking companionship (odds ratio (OR)=4.06; 95% confidence interval (CI)=1.49-11.10) and feeling of sometimes being left out in life (OR=1.69; 95% CI=1.01-2.84) were positively associated with the risk of mistreatment. Risk of mistreatment was also correlated with higher total loneliness scores (OR=2.74; 95% CI=1.19-6.26).

CONCLUSION

Loneliness appeared to be a risk factor associated with elder mistreatment in this older Chinese population. Further prospective studies are needed to confirm this finding. An exploration of Chinese culture and tradition may yield insight into shaping a prevention framework for mistreatment of older Chinese people.