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1.
Int J Circumpolar Health ; 71: 1-7, 2012 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-22564468

RESUMO

OBJECTIVES: Treatment with pegylated interferon and ribavirin may prevent progression of liver disease among patients with chronic hepatitis C virus infection (HCV). Treatment initiation is based on published clinical eligibility criteria, patients' willingness to undergo treatment and likelihood of success. We examined treatment eligibility in a cohort of Alaska Native and American Indian persons with chronic HCV infection. STUDY DESIGN: Retrospective cohort study. METHODS: Medical records of all treatment naïve HCV RNA positive patients given an appointment by hepatology specialty clinic staff in 2003 and 2007 were evaluated by a hepatology provider to investigate documented reasons for treatment deferral. RESULTS: Treatment was initiated in 4 of 94 patients (4%) in 2003 and 14 of 146 patients (10%) in 2007. Major reasons for treatment deferral in 2003 versus 2007 included inconsistent appointment attendance (36% of deferrals vs. 18%), active substance abuse (17% vs. 22%), patient decision (17% vs. 27%), liver biopsy without fibrosis or normal ALT (8% vs. 3%), uncontrolled psychiatric condition (7% vs. 7%) and concurrent medical condition (6% vs. 9%). There was significant improvement in proportion of appointments attended in 2007 versus 2003 (76% vs. 67%, p = 0.04) and the percentage of patients attending at least 1 appointment (84% vs. 66%, p = 0.002). CONCLUSIONS: Multiple reasons for treatment deferral were documented. Despite a significant improvement in hepatology clinic attendance and an increase in the number of patients started on treatment in 2007 compared to 2003, the overall percentage of those treated remained low.


Assuntos
Definição da Elegibilidade/estatística & dados numéricos , Hepatite C/tratamento farmacológico , Indígenas Norte-Americanos/estatística & dados numéricos , Adulto , Alaska/epidemiologia , Antivirais/uso terapêutico , Estudos de Coortes , Quimioterapia Combinada , Feminino , Hepatite C/etnologia , Humanos , Interferons/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ribavirina/uso terapêutico
2.
World J Gastroenterol ; 17(42): 4682-8, 2011 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-22180710

RESUMO

AIM: To evaluate the accuracy of two non-invasive tests in a population of Alaska Native persons. High rates of Helicobacter pylori (H. pylori) infection, H. pylori treatment failure, and gastric cancer in this population necessitate documentation of infection status at multiple time points over a patient's life. METHODS: In 280 patients undergoing endoscopy, H. pylori was diagnosed by culture, histology, rapid urease test, (13)C urea breath test (UBT), and immunoglobulin G antibodies to H. pylori in serum. The performances of (13)C-UBT and antibody test were compared to a gold standard defined by a positive H. pylori test by culture or, in case of a negative culture result, by positive histology and a positive rapid urease test. RESULTS: The sensitivity and specificity of the (13)C-UBT were 93% and 88%, respectively, relative to the gold standard. The antibody test had an equivalent sensitivity of 93% with a reduced specificity of 68%. The false positive results for the antibody test were associated with previous treatment for an H. pylori infection [relative risk (RR) = 2.8]. High levels of antibodies to H. pylori were associated with chronic gastritis and male gender, while high scores in the (13)C-UBT test were associated with older age and with the H. pylori bacteria load on histological examination (RR = 4.4). CONCLUSION: The (13)C-UBT outperformed the antibody test for H. pylori and could be used when a non-invasive test is clinically necessary to document treatment outcome or when monitoring for reinfection.


Assuntos
Testes Diagnósticos de Rotina/normas , Infecções por Helicobacter/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Alaska/epidemiologia , Anticorpos Antibacterianos/sangue , Testes Respiratórios/métodos , Endoscopia Gastrointestinal , Feminino , Infecções por Helicobacter/complicações , Infecções por Helicobacter/epidemiologia , Helicobacter pylori/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Populacionais , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/etiologia , Ureia/metabolismo , Urease/metabolismo , Adulto Jovem
3.
J Clin Microbiol ; 49(10): 3638-43, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21813726

RESUMO

Helicobacter pylori infection is more common in Alaska Native persons than in the general U.S. population, with seroprevalence to H. pylori approaching 75%. Previous studies in Alaska have demonstrated elevated proportions of antimicrobial resistance among H. pylori isolates. We analyzed H. pylori data from the Centers for Disease Control and Prevention's sentinel surveillance in Alaska from January 2000 to December 2008 to determine the proportion of culture-positive biopsy specimens with antimicrobial resistance from Alaska Native persons undergoing endoscopy. The aim of the present study was to monitor antimicrobial resistance of H. pylori isolates over time and by region in Alaska Native persons. Susceptibility testing of H. pylori isolates to metronidazole, clarithromycin, amoxicillin, and tetracycline was performed using agar dilution. Susceptibility testing for levofloxacin was performed by Etest. Overall, 45% (532/1,181) of persons undergoing upper endoscopy were culture positive for H. pylori. Metronidazole resistance was demonstrated in isolates from 222/531 (42%) persons, clarithromycin resistance in 159/531 (30%) persons, amoxicillin resistance in 10/531 (2%) persons, and levofloxacin resistance in 30/155 (19%) persons; no tetracycline resistance was documented. The prevalence of metronidazole, clarithromycin, and levofloxacin resistance varied by region. Female patients were more likely than male patients to demonstrate metronidazole (P < 0.05) and clarithromycin (P < 0.05) resistance. No substantial change in the proportion of persons with resistant isolates was observed over time. Resistance to metronidazole, clarithromycin, and levofloxacin is more common among H. pylori isolates from Alaska Native persons than those from elsewhere in the United States.


Assuntos
Infecções por Helicobacter/epidemiologia , Helicobacter pylori/isolamento & purificação , Grupos Populacionais , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Alaska/epidemiologia , Antibacterianos/farmacologia , Biópsia , Criança , Pré-Escolar , Farmacorresistência Bacteriana , Feminino , Mucosa Gástrica/microbiologia , Helicobacter pylori/efeitos dos fármacos , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Prevalência , Vigilância de Evento Sentinela , Adulto Jovem
4.
Can J Gastroenterol ; 24(7): 445-51, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20652161

RESUMO

BACKGROUND: Various factors influence the development and rate of fibrosis progression in chronic hepatitis C virus (HCV) infection. OBJECTIVES: To examine factors associated with fibrosis in a longterm outcomes study of Alaska Native/American Indian persons who underwent liver biopsy, and to examine the rate of fibrosis progression in persons with subsequent biopsies. METHODS: A cross-sectional analysis of the demographic, inflammatory and viral characteristics of persons undergoing liver biopsy compared individuals with early (Ishak fibrosis score of lower than 3) with those with advanced (Ishak score of 3 or greater) fibrosis. Persons who underwent two or more biopsies were analyzed for factors associated with fibrosis progression. RESULTS: Of 253 HCV RNA-positive persons who underwent at least one liver biopsy, 76 (30%) had advanced fibrosis. On multivariate analysis, a Knodell histological activity index score of 10 to 14 and an alpha-fetoprotein level of 8 ng/mL or higher were found to be independent predictors of advanced liver fibrosis (P<0.0001 for each). When surrogate markers of liver inflammation (alanine aminotransferase, aspartate aminotransferase/alanine aminotransferase ratio and alpha-fetoprotein) were removed from the model, type 2 diabetes mellitus (P=0.001), steatosis (P=0.03) and duration of HCV infection by 10-year intervals (P=0.02) were associated with advanced fibrosis. Among 52 persons who underwent two or more biopsies a mean of 6.2 years apart, the mean Ishak fibrosis score increased between biopsies (P=0.002), with progression associated with older age at initial biopsy and HCV risk factors. CONCLUSIONS: The presence of type 2 diabetes mellitus, steatosis and duration of HCV infection were independent predictors of advanced fibrosis in the present cohort, with significant fibrosis progression demonstrated in persons who underwent serial biopsies.


Assuntos
Hepatite C Crônica/complicações , Cirrose Hepática/patologia , Adulto , Alaska/epidemiologia , Biópsia , Distribuição de Qui-Quadrado , Comorbidade , Estudos Transversais , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/etnologia , Diabetes Mellitus/patologia , Progressão da Doença , Fígado Gorduroso/epidemiologia , Fígado Gorduroso/etnologia , Fígado Gorduroso/patologia , Feminino , Hepatite C Crônica/epidemiologia , Hepatite C Crônica/etnologia , Humanos , Indígenas Norte-Americanos , Inuíte , Cirrose Hepática/epidemiologia , Cirrose Hepática/etnologia , Cirrose Hepática/virologia , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Estatísticas não Paramétricas
5.
J Infect Dis ; 199(5): 652-60, 2009 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-19125674

RESUMO

BACKGROUND: Helicobacter pylori infection treatment was found not to reduce the prevalence of iron deficiency or anemia among Alaska Native children at 14 months after treatment initiation. We hypothesized that 14 months was to early to resolve H. pylori-induced gastric damage. Consequently, we conducted a 40-month follow-up. METHODS: We enrolled 219 children 7-11 years old who had H. pylori infection (as diagnosed by (13)C-labeled urea breath test) and iron deficiency (serum ferritin level, <22.47 pmol/L) in a controlled, household-randomized trial of the effect of treatment of H. pylori on iron deficiency and anemia (hemoglobin level, <115 g/L). At 40 months, 176 children were evaluated. RESULTS: Forty-four (52%) of 85 children in the intervention group and 53 (58%) of 91 in the control group had iron deficiency (adjusted relative risk [ARR], 0.92 [95% confidence interval {CI}, 0.68-1.26]), versus 4 (5%) and 17(19%), respectively, with both iron deficiency and anemia (ARR, 0.25 [95% CI, 0.09-0.73]). Reinfection occurred among 33 (52%) of 64 children who had cleared their infection. H. pylori-negative children had lower prevalences of iron deficiency (ARR, 0.62 [95% CI, 0.38-1.01]) and iron deficiency and anemia (ARR, 0.22 [95% CI, 0.03-1.50]), compared with H. pylori -positive children. CONCLUSIONS: The resolution of H. pylori infection for >14 months modestly reduced the prevalence of iron deficiency and substantially reduced the prevalence of iron deficiency and anemia. H. pylori likely plays a casual role in hematological outcomes for some children.


Assuntos
2-Piridinilmetilsulfinilbenzimidazóis/uso terapêutico , Anemia Ferropriva/complicações , Antibacterianos/uso terapêutico , Compostos Ferrosos/uso terapêutico , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , 2-Piridinilmetilsulfinilbenzimidazóis/administração & dosagem , Alaska/epidemiologia , Anemia Ferropriva/epidemiologia , Anemia Ferropriva/prevenção & controle , Antibacterianos/administração & dosagem , Antiulcerosos/administração & dosagem , Antiulcerosos/uso terapêutico , Criança , Feminino , Compostos Ferrosos/administração & dosagem , Seguimentos , Infecções por Helicobacter/complicações , Infecções por Helicobacter/epidemiologia , Humanos , Lansoprazol , Masculino , Prevalência , Fatores de Tempo
6.
Helicobacter ; 11(6): 581-8, 2006 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17083381

RESUMO

BACKGROUND: Previous studies in Alaska have demonstrated elevated proportions of antimicrobial resistance among Helicobacter pylori isolates. MATERIALS AND METHODS: We analyzed H. pylori data from the Centers for Disease Control and Prevention (CDC)'s sentinel surveillance in Alaska from July 1999 to June 2003 to determine the proportion of culture-positive biopsies from Alaska Native persons undergoing routine upper-endoscopy, and the susceptibility of H. pylori isolates to metronidazole [minimum inhibitory concentration (MIC) of > 8 g metronidazole/mL), clarithromycin (MIC > or = 1), tetracycline (MIC > or = 2) and amoxicillin (MIC > or = 1)] using agar dilution. RESULTS: Nine-hundred sixty-four biopsy specimens were obtained from 687 participants; 352 (51%) patients tested culture positive. Mean age of both culture-positive and culture-negative patients was 51 years. Metronidazole resistance was demonstrated in isolates from 155 (44%) persons, clarithromycin resistance from 108 (31%) persons, amoxicillin resistance from 8 (2%) persons, and 0 for tetracycline resistance. Metronidazole and clarithromycin resistance varied by geographic region. Female patients were more likely than male subjects to show metronidazole resistance (p < .01) and clarithromycin resistance (p = .05). CONCLUSIONS: Resistance to metronidazole and clarithromycin is more common among H. pylori isolates from Alaska Native persons when compared with those from elsewhere in the USA.


Assuntos
Amoxicilina/farmacologia , Antibacterianos/farmacologia , Anti-Infecciosos/farmacologia , Claritromicina/farmacologia , Infecções por Helicobacter/microbiologia , Helicobacter pylori/efeitos dos fármacos , Metronidazol/farmacologia , Tetraciclina/farmacologia , Adulto , Idoso , Alaska/epidemiologia , Biópsia , Farmacorresistência Bacteriana Múltipla , Feminino , Infecções por Helicobacter/epidemiologia , Infecções por Helicobacter/patologia , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Grupos Populacionais , Vigilância de Evento Sentinela , Estômago/microbiologia , Estômago/patologia
7.
J Clin Microbiol ; 43(7): 3494-6, 2005 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16000488

RESUMO

A commercially available rapid fluorescent in situ hybridization (FISH) test, (seaFAST H. pylori Combi-Kit; SeaPro Theranostics International, Lelystad, The Netherlands) was used to simultaneously detect the presence of Helicobacter pylori and determine clarithromycin susceptibility in paraffin-embedded biopsy sections. The FISH method was found to be 97% sensitive, 94% specific for the detection of H. pylori and comparable to agar dilution for the detection of resistance to clarithromycin.


Assuntos
Antibacterianos/farmacologia , Claritromicina/farmacologia , Farmacorresistência Bacteriana , Helicobacter pylori/isolamento & purificação , Hibridização in Situ Fluorescente/métodos , Kit de Reagentes para Diagnóstico , Biópsia , Meios de Cultura , Corantes Fluorescentes , Infecções por Helicobacter/microbiologia , Helicobacter pylori/efeitos dos fármacos , Helicobacter pylori/genética , Humanos , Testes de Sensibilidade Microbiana , Inclusão em Parafina , Sensibilidade e Especificidade , Estômago , Fatores de Tempo
8.
Ann Intern Med ; 139(6): 463-9, 2003 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-13679322

RESUMO

BACKGROUND: The relationship between previous antimicrobial treatments and infection with drug-resistant Helicobacter pylori is unknown. OBJECTIVES: To determine whether previous use of antimicrobial agents predicts subsequent antibiotic resistance of H. pylori and whether resistance affects treatment outcome. DESIGN: Retrospective cohort analysis of adults recruited sequentially from a clinical practice. SETTING: A referral hospital in Anchorage, Alaska. PATIENTS: 125 adults infected with H. pylori. MEASUREMENTS: Medical records were reviewed for antimicrobial agents prescribed in the 10 years before diagnosis with H. pylori infection. Antimicrobial susceptibility of H. pylori isolates obtained from endoscopic gastric biopsy was determined by using agar dilution. Cure was determined by using the urea breath test 2 months after antimicrobial treatment. RESULTS: Among the 125 patients, 37 (30%) were found to have H. pylori isolates resistant to clarithromycin and 83 (66%) were found to have H. pylori isolates resistant to metronidazole. Resistance to clarithromycin was associated with previous use of any macrolide antibiotic (P < 0.001), and resistance to metronidazole was associated with previous use of metronidazole (P < 0.001). The odds of isolates being resistant to clarithromycin increased in relation to the number of courses of macrolides received (P < 0.001). Among 53 persons treated with clarithromycin-based regimens, treatment failed in 77% of those carrying clarithromycin-resistant H. pylori (10 of 13) and 13% of those with clarithromycin-susceptible strains (5 of 40) (relative risk, 6.2 [95% CI, 1.9 to 37.1]; P < 0.001). CONCLUSIONS: Previous use of macrolides and metronidazole is associated with H. pylori resistant to these antimicrobial agents. Clarithromycin resistance is associated with a greater risk for failure with clarithromycin-based treatments.


Assuntos
Antibacterianos/efeitos adversos , Claritromicina/efeitos adversos , Farmacorresistência Bacteriana , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori/efeitos dos fármacos , Metronidazol/efeitos adversos , Adulto , Idoso , Estudos de Coortes , Feminino , Seguimentos , Infecções por Helicobacter/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
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