Real-world Experience with Sofosbuvir-based Regimens for Chronic Hepatitis C, Including Patients with Factors Previously Associated with Inferior Treatment Response

The introduction of sofosbuvir, a direct acting antiviral, has revolutionized the treatment of chronic hepatitis C virus (HCV). Phase 3 clinical trials have demonstrated the efficacy, simplicity, and tolerability of sofosbuvir-based regimens and report high rates of sustained virological response (SVR) rates. The purpose of this study was to assess whether clinical trial findings translate into a real-world setting, particularly with treatment of chronic HCV in our diverse, multiethnic population of Hawai'i. Retrospective analysis was performed for 113 patients with genotype 1-6 HCV infection being treated at the Queen's Liver Center between January 2014 and March 2015. SVR rates for our cohort were slightly lower than the rates published by the clinical trials. Data analysis also suggested that most baseline characteristics previously associated with inferior response might not be as significant for sofosbuvir-based regimens; in our cohort, male gender was the only factor significantly related to increased risk of virologic relapse. Pacific Islanders also had higher rate of relapse compared to other ethnic groups, but the small number of patients treated in this subgroup make it difficult to validate this finding. While newer all-oral treatment regimens have been introduced since this study, we highlight the importance of comparing real-world versus clinical trial results for new treatments, and provide data analyses for treatment of chronic HCV in Hawai'i.

New triple therapy for chronic hepatitis C: real life clinical experience in a community setting

Recent advances in treatment of chronic hepatitis C virus have improved significantly due to the introduction of two new protease inhibitors-telaprevir and boceprevir. In combination with the previous standard of care, peginterferon and ribavirin, telaprevir and boceprevir have demonstrated improved sustained virologic response rates for HCV genotype 1 patients by approximately 30%. The purpose of this study was to assess the validity of large clinical trial data with respect to efficacy and side effects in a community setting in Honolulu, Hawai'i. This retrospective study was performed by reviewing the charts of 59 chronic HCV patients who were started on triple therapy from July 1, 2011 to July 7, 2012. Sustained virologic response was attained by 73% of patients treated with telaprevir and 46% of patients treated with boceprevir respectively. Our clinical experience with telaprevir demonstrates that SVR rates are compatible with published literature values. Rates of SVR in our cohort were also similar to those reported in cirrhotic patients - about 50%. Due to small number of patients treated with a boceprevir-based regimen, it is difficult to compare our experience with pivotal trial experience. The side effect profiles for the two protease inhibitors were similar to the literature values except for more rectal irritation and a higher incidence and severity of anemia on telaprevir therapy in the clinical setting. While not intended to be conclusive, our study demonstrates that clinical trial data are largely compatible with the outcomes obtained in our community setting.

Widows in retirement communities: the social context of subjective well-being

This study focuses on why some widows were satisfied in retirement communities and some were not. Satisfied widows were more socially active and were the majority in the community. Widows and married differed in social interactions contingent on which group was in the majority. The ratio of marrieds to widows in a community may lead to different social interaction in the two groups which, in turn, may influence widows' satisfaction.

The baby boom of the late 1980s: life course of a post-World War II cohort

"This study examines the 1980 surge in birthrates in the context of the life course of women of the post-World War II baby boom. It attempts to describe in more exact detail the role of these women in the 1980 baby boom. Additionally, the study contends that historical time, social time, and life time all have influence on the timing of their reproductive decisions. The data are compiled from reports issued by the U.S. Bureau of the Census, the U.S. Department of Health and Human Services, and the Population Reference Bureau. Some attitudinal data are obtained from the 1988 General Social Survey."