ABSTRACT
A nationwide programme for the treatment of all patients infected with hepatitis C virus (HCV) was launched in Iceland in January 2016. By providing universal access to direct-acting antiviral agents to the entire patient population, the two key aims of the project were to (i) offer a cure to patients and thus reduce the long-term sequelae of chronic hepatitis C, and (ii) to reduce domestic incidence of HCV in the population by 80% prior to the WHO goal of HCV elimination by the year 2030. An important part of the programme is that vast majority of cases will be treated within 36 months from the launch of the project, during 2016-2018. Emphasis is placed on early case finding and treatment of patients at high risk for transmitting HCV, that is people who inject drugs (PWID), as well as patients with advanced liver disease. In addition to treatment scale-up, the project also entails intensification of harm reduction efforts, improved access to diagnostic tests, as well as educational campaigns to curtail spread, facilitate early detection and improve linkage to care. With these efforts, Iceland is anticipated to achieve the WHO hepatitis C elimination goals well before 2030. This article describes the background and organization of this project. Clinical trial number: NCT02647879.
Subject(s)
Antiviral Agents/therapeutic use , Hepatitis C/drug therapy , Hepatitis C/prevention & control , Benzimidazoles/therapeutic use , Carcinoma, Hepatocellular/epidemiology , Carcinoma, Hepatocellular/prevention & control , Carcinoma, Hepatocellular/virology , Drug Therapy, Combination , Fluorenes/therapeutic use , Hepatitis C/epidemiology , Humans , Iceland/epidemiology , Incidence , Liver Cirrhosis/epidemiology , Liver Cirrhosis/prevention & control , Liver Cirrhosis/virology , Liver Neoplasms/epidemiology , Liver Neoplasms/prevention & control , Liver Neoplasms/virology , Mass Screening , Needle-Exchange Programs , Population Surveillance , Ribavirin/therapeutic use , Sofosbuvir , Substance Abuse, Intravenous/epidemiology , Uridine Monophosphate/analogs & derivatives , Uridine Monophosphate/therapeutic useABSTRACT
OBJECTIVE: To evaluate the prevalence of thyrotoxicosis and coexistent diseases in patients with atrial fibrillation admitted to a general medicine ward. MATERIAL AND METHODS: All patients with the discharge diagnosis of atrial fibrillation were studied. The study design was retrospective for the years 1993-1994 and prospective from April 1995 through December 1997. Information on thyroid function tests was obtained from medical records in the retrospective part, but TSH, T4 and T3 were measured for patients admitted during the prospective part. Coexistent diseases were recorded. RESULTS: Atrial fibrillation was diagnosed in 167 patients (58 in the retrospective part and 109 in the prospective part). Males were predominant (59.3%) and the average age was 73.7 years (span 26-100). Adequate information on thyroid function tests was available for 135 patients (58.6% of the retrospective part and 92.7% of the prospective part). 24 (17.8%) had abnormal thyroid function tests, predominantly women (71%). Ten had an isolated elevation of TSH, seven an isolated depression of TSH, two hypothyroidism and five other abnormalities. Hypertension was the most common coexistent disease (76 of 167 patients (45.5%). Ischemic heart disease was found in 44 (26.3%) and valvular heart disease in 27 (16.2%). No known coexistent disease was found in 32 (19.2%). CONCLUSIONS: 1) Thyrotoxicosis is rare in patients with atrial fibrillation who are admitted to a general medicine ward. Routine measurement of thyroid function tests in this patient population is therefore not warrented. 2) Unspecific abnormalities of thyroid function tests are common and are most likely due to diseases outside the thyroid gland or medications. 3) Hypertension, ischemic heart disease and heart valve disease are the most common coexistent diseases in this group of patients.