Management of Hepatitis C in the Older Adult.

OBJECTIVE: To provide a review of the epidemiology, clinical presentation, screening, diagnosis, treatment, and prevention of hepatitis C with an emphasis on older adults. DATA SOURCES: PubMed and Google Scholar were searched for relevant literature using a combination of the following terms: hepatitis C, epidemiology, hepatitis C virus (HCV), diagnosis, treatment, direct-acting antivirals (DAAs), and older adults. In addition, websites of the hepatitis C guidelines, Centers for Disease Control and Prevention (CDC), and manufacturers of DAAs were also reviewed for relevant information. (The authors reviewed the literature through May 2019. STUDY SELECTION/DATA EXTRACTION: The key resources reviewed were the CDC website, American Association for the Study of Liver Diseases/Infectious Diseases Society of America hepatitis C guidelines, prescribing information of DAAs, and pivotal clinical trials of DAAs. DATA SYNTHESIS: Hepatitis C disproportionately affects baby boomers and people who inject drugs (PWID). CDC recommends screening adults born from 1945 to 1965 and high-risk patients for the presence of hepatitis C antibody. The goal of therapy is to achieve sustained virologic response, defined as undetectable HCV ribonucleic acid 12 weeks after treatment completion. Treatment for those who are treatment-naive with or without compensated cirrhosis consists of administration of DAAs orally for 8 to 12 weeks. Regimen selection depends on HCV genotype, presence or absence of cirrhosis, comorbid conditions, and concurrent medications. Currently recommended DAAs are highly effective, well tolerated, and can be associated with significant drug interactions particularly in older adults. Access to DAAs remains an obstacle for many patients. CONCLUSION: Hepatitis C is common among baby boomers and PWID. Screening is recommended in these patient populations. Treatment with DAAs is curative and well tolerated.

Who Wants to Switch? Gauging Patient Interest in Novel Antiretroviral Therapies.

Study participants were asked about their interest in switching to novel drug delivery systems that reduce the dosing frequency of antiretroviral regimens. Across a diverse, treatment-experienced cohort, we describe greatest interest in switching to an oral regimen taken once weekly, followed by injections taken every other month and twice-annual implants.

Association between chronic hemodialysis and bloodstream infections caused by chromosomally mediated AmpC-producing Enterobacteriaceae.

BACKGROUND: The combination of inherent antimicrobial resistance and high mortality after bloodstream infections (BSIs) caused by chromosomally mediated AmpC-producing Enterobacteriaceae (CAE) emphasizes the importance of identifying patients at risk of BSI because of these bacteria. This retrospective case-control study examines chronic hemodialysis among other risk factors for BSI caused by CAE. METHODS: Hospitalized adults with Enterobacteriaceae BSI from January 1, 2010-June 30, 2014, at 2 large community hospitals in the Southeastern United States were identified. Multivariate logistic regression was used to examine risk factors for CAE BSI. RESULTS: Among 831 Enterobacteriaceae bloodstream isolates, 106 (13%) met the phenotypic definition of CAE. Enterobacter spp accounted for 47% (50/106) of CAE BSIs. Chronic hemodialysis was an independent risk factor for CAE BSI (adjusted odds ratio [aOR], 2.34; 95% confidence interval [CI], 1.21-4.44). Other predictors of CAE BSI included nosocomial acquisition (aOR, 1.72; 95% CI, 1.02-2.87) and exposure to ß-lactam antibiotics within the last 30 days (aOR, 2.39; 95% CI, 1.37-4.14). CONCLUSIONS: To our knowledge, this is the first study to demonstrate an increased risk of CAE BSI in patients with end-stage renal disease undergoing chronic hemodialysis. This highlights the importance of effective infection prevention and antimicrobial stewardship interventions in hemodialysis clinics. Further studies to examine the impact of antibiotics on intestinal microbiota and rates of CAE colonization in this patient population are warranted.