Excellent hepatitis C virus cure rates despite increasing complexity of people who use drugs: Integrated-Test-stage Treat study final outcomes.

Achieving hepatitic C virus (HCV) elimination requires linking people who use drugs (PWUD) into care. We report final direct-acting antivirals (DAAs)-based outcomes from the Integrated-Test-stage -Treat (ITTREAT) study. Project ITTREAT (2013-2021), based at an addiction centre, was a 'one-stop' service with innovative linkage to care strategies. Primary outcome was sustained virological response (SVR12) (intention to treat ITT) including whether individuals were recruited in first (period 1) versus last four (period 2 included the COVID-19 pandemic) years of the study. Number recruited were n = 765, mean age 40.9 ± 10.1 years, 78% males, history of current/past injecting drug use (IDU) and alcohol use being 77% and 90%, respectively. Prevalence of a positive HCV PCR was 84% with 19% having cirrhosis. Comparing those recruited in period 2 versus period 1, there was increasing prevalence of IDU, 90% versus 72% (p < .001); homelessness, 67% versus 50% (p < .001); psychiatric diagnosis, 84% versus 50% (p < .001); overdose history 71% versus 31% (p < .001), receiving opioid agonist treatment (OAT) 75% versus 52% (p < .001) and comorbidity 44% versus 25% (p < .001). Of those treated with DAAs (n = 272), ITT SVR rates were 86% (95% CI: 81%-90%), being similar in period 2 versus period 1. Predictors of non-SVR were receiving OAT (OR 0.33, 95% CI: 0.12-0.87, p = .025) and ≥80% adherence (OR 0.01, 95% CI: 0.003-0.041, p < .001). Reinfection rates period 2 versus period 1 (per 100 person-years) were 1.84 versus 1.70, respectively. In the treated cohort, mortality was 15%, being mostly drug-related. Despite increasing complexity of PWUD, high SVR12 rates are achievable with use of OAT and good adherence.

Palliative clinical trials in advanced chronic liver disease: Challenges and opportunities.

Patients with advanced chronic liver disease have a complex symptom burden and many are not candidates for curative therapy. Despite this, provision of palliative interventions remains woefully inadequate, with an insufficient evidence base being a contributory factor. Designing and conducting palliative interventional trials in advanced chronic liver disease remains challenging for a multitude of reasons. In this manuscript we review past and ongoing palliative interventional trials. We identify barriers and facilitators and offer guidance on addressing these challenges. We hope that this will reduce the inequity in palliative care provision in advanced chronic liver disease.

UK-wide survey of gastroenterology and hepatology trainees in 2022: endoscopy, workforce planning and the Shape of things to come.

Objective: Shape of Training has shortened the gastroenterology curriculum in the UK from a 5 to 4-year programme. There are ongoing concerns that this will negatively impact training and the attainment of competencies expected at consultant level. We undertook a UK-wide survey of gastroenterology trainees to establish their views. Method: The British Society of Gastroenterology Trainees Section collected anonymised survey responses from trainees between June and September 2022 via an online platform. Results: 40.3% of trainees responded. Strikingly, only 10% of respondents felt they could achieve certificate of completion of training (CCT) within a 4-year programme. Furthermore, 31% were not confident they would attain the required expertise in their subspecialist interest during training. 70.8% reported spending a quarter or more of their training in general internal medicine (GIM) and 71.6% felt this negatively impacted on their gastroenterology training. Only 21.6% of respondents plan to pursue a consultant post with GIM commitments.Regarding endoscopy, only 36.1% of ST7s had provisional and 22.2% full accreditation in colonoscopy. Although 92.3% of respondents wanted exposure to a 'bleed rota', this was the case for only 16.2%. Teaching quality was judged to be insufficient by 45.9% of respondents. Conclusion: Respondents had struggled to achieve the necessary competencies for CCT even prior to the newly reduced 4-year curriculum. While still maintaining service provision, we must safeguard gastroenterology training from encroaching GIM commitments. This will be critical in order to provide capable consultants of the future and prevent UK standards from falling behind internationally.

Does regulating the sale of high-strength beer and cider impact hospital admissions with decompensated alcohol-related liver disease: A retrospective cohort study.

OBJECTIVE: 'Sensible on Strength' (SoS), a local public health initiative, is aimed at reducing high-strength beer and cider availability. The objective of this study was to assess its impact on local hospital admissions with alcohol-related liver disease (ALD) and on drinking behaviour. DESIGN: This was a retrospective cohort study in patients admitted with decompensated ALD, 3 years before and 3 years after the introduction of the SoS initiative.Hospital records of 143 index admissions with decompensated ALD were reviewed. Outcomes measures were the severity of liver disease on admission and mortality (inpatient and long-term), and change (if any) in alcohol drinking behaviour. RESULTS: Comparing patients admitted in both phases, there were no significant differences in liver prognostic scores, liver-related complications, length of stay and inpatient/long-term mortality (p>0.05). However, the SoS initiative was associated with a 33% move away from beer and cider consumption (36.3% vs 54.0%; p=0.034), but without a significant change in units of alcohol consumed. The Model for End-stage Liver Disease (MELD) score was the only independent predictor of inpatient mortality (odds ratio 1.25; p=0.025). CONCLUSION: Despite having no apparent impact on the clinical spectrum of local ALD admissions, it is conceivable that longer follow-up is needed to determine the true impact of this initiative.

A pain in the joints.

Arthralgia is a rare but recognised complication of meningococcal septicaemia. We report a case of a 29-year-old man presenting with a 24 h history of fever, joint swelling and subsequent development of a non-blanching, petechial rash. He was treated for probable meningococcal septicaemia and the causative pathogen was later identified as Neisseria meningitidis. He was treated with ceftriaxone and after 10 days the pain and swelling in his joints improved.