High real-world effectiveness of 12-week elbasvir/grazoprevir without resistance testing in the treatment of patients with HCV genotype 1a infection in Norway.

BACKGROUND AND AIMS: The recommended treatment duration of hepatitis C virus (HCV) genotype 1a (GT1a) infection with elbasvir/grazoprevir (EBR/GZR) in the presence of a high baseline viral load and resistance associated substitutions (RAS) is 16 weeks with ribavirin added. The objective of this study was to evaluate the real-world effectiveness of 12 weeks of EBR/GZR without ribavirin and regardless of baseline viral load and RAS testing. METHOD: This retrospective, observational cohort study was performed at five Norwegian hospitals that did not systematically utilize RAS testing. All adult patients with chronic HCV GT1a and compensated liver disease who had received 12 weeks of EBR/GZR without ribavirin and baseline RAS testing, were included. The primary endpoint was sustained virologic response at week 12 (SVR12), or if not available, at week 4 (SVR4). RESULTS: We included 433 patients and attained SVR data on 388. The mean age was 45.7 years (22-73 years). 67.2% were male. HIV co-infection was present in 3.8% (16/424) and cirrhosis in 4% (17/424). The viral load was >800 000 IU/mL in 55.0% (235/427) of patients. Overall SVR was achieved in 97.2% (377/388). SVR was achieved in 98.3% (169/172) of those with viral load ≤800 000 IU/mL and in 96.2% (202/210) of those with viral load >800 000 IU/mL. CONCLUSION: We observed high SVR rates among patients with HCV GT1a infection treated with EBR/GZR for 12 weeks without ribavirin, with no regard to baseline viral load and no RAS testing.

Hospitalised patients with suspected 2009 H1N1 influenza A in a hospital in Norway, July - December 2009.

BACKGROUND: The main objective of this study was to describe the patients who were hospitalised at Oslo University Hospital Aker during the first wave of pandemic Influenza A (H1N1) in Norway. METHODS: Clinical data on all patients hospitalised with influenza-like illness from July to the end of November 2009 were collected prospectively. Patients with confirmed H1N1 Influenza A were compared to patients with negative H1N1 tests. RESULTS: 182 patients were hospitalised with suspected H1N1 Influenza A and 64 (35%) tested positive. Seventeen patients with positive tests (27%) were admitted to an intensive care unit and four patients died (6%). The H1N1 positive patients were younger, consisted of a higher proportion of non-ethnic Norwegians, had a higher heart rate on admission, and fewer had pre-existing hypertension, compared to the H1N1 negative patients. However, hypertension was the only medical condition that was significantly associated with a more serious outcome defined as ICU admission or death, with a univariate odds ratio of the composite endpoint in H1N1 positive and negative patients of 6.1 (95% CI 1.3-29.3) and 3.2 (95% CI 1.2-8.7), respectively. Chest radiography revealed pneumonia in 24/59 H1N1 positive patients. 63 of 64 H1N1 positive patients received oseltamivir. CONCLUSIONS: The extra burden of hospitalisations was relatively small and we managed to admit all the patients with suspected H1N1 influenza without opening new pandemic isolation wards. The morbidity and mortality were similar to reports from comparable countries. Established hypertension was associated with more severe morbidity and patients with hypertension should be considered candidates for vaccination programs in future pandemics.

Low prevalence of high-density lipoprotein cholesterol level < 1 mmol/L in non-nucleoside reverse transcriptase inhibitor recipients.

Our objective was to compare the prevalence of high-density lipoprotein-cholesterol (HDL-c) level < 1 mmol/L in non-nucleoside reverse transcriptase inhibitor (NNRTI) and protease inhibitor (PI) recipients in an unselected HIV-positive population. All HIV-positive patients living in Oslo who attended our outpatient clinic from April 1, 2000 to April 1, 2001 were invited to a study of cardiovascular risk factors. In this substudy, 40 NNRTI recipients and 124 PI recipients were included. Prevalence of HDL-c <1 mmol/L was 7.5% in the NNRTI recipients compared with 35.5% in the PI recipients (P <0.001). In the multivariate analyses, use of NNRTI was a significant protective factor (odds ratio [OR] 0.17; 95% confidence interval [CI] 0.05-0.66; P = 0.01) and elevated triglycerides a significant risk factor (OR 3.40; 95% CI 1.47-7.86; P = 0.004) for low HDL-c level. Our study shows that NNRTI recipients have a more favourable HDL-c profile than PI recipients, even when possible confounding factors are taken into account.

Body composition changes in 308 Norwegian HIV-positive patients.

This is the first study where HIV-associated body composition changes are described in a Scandinavian cohort. All HIV-positive patients living in Oslo who attended our outpatient clinic (n = 407) were invited to participate. 308 patients (78%) were included. Lipodystrophy (LD) prevalence was 37.3% in patients on antiretroviral therapy (ART+) compared to 10.9% in patients without ART (p < 0.001). Prominent veins and combined fat atrophy/accumulation were exclusively found in the ART+ group. Determinants of prominent veins were skin fold thickness, duration of nucleoside reverse transcriptase inhibitor treatment, duration of protease inhibitor treatment and current use of stavudine. When patients with and without LD were compared, breast circumference was 10.6 cm larger in LD+ women than in LD- women (p = 0.003). Chest pain was reported in 26.5% of LD+ compared to 3.9% (p < 0.001) of LD- patients. This may be associated with an increased level of creatin kinase in LD+ compared to LD- patients (161 +/- 179 U/I vs 102 +/- 68, p = 0.004). Eight years after HIV diagnosis 59.1% of the patients with LD had a regular job and 59.4% reported no or small problems with ART.