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1.
Wiad Lek ; 72(11 cz 2): 2222-2227, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31860841

RESUMO

This article aims to review the treatment strategy of Hepatitis C in compelling indications and provide the literature update, mainly discussing the EASL (European Association for the Study of the Liver) recommendations, which described the current optimal management of patients with acute and chronic HCV infections. The review will focus on HCV infection in selected clinical settings including patients with immune complex-mediated manifestations of chronic hepatitis C, patients with chronic kidney disease (CKD) or renal end-stage renal disease (ESRD), and solid organ transplant recipients.


Assuntos
Hepatite C , Antivirais , Hepatite C/terapia , Humanos , Falência Renal Crônica , Transplante de Rim
2.
N C Med J ; 80(6): 352-355, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31685570

RESUMO

Prisoners in the United States are disproportionately affected by hepatitis C. Addressing the disease behind bars is crucial for curtailing the epidemic in the greater population. Effective strategies for testing and treatment are elucidated here. Recommendations for changes in hepatitis C health care policy in North Carolina prisons are also described.


Assuntos
Política de Saúde , Hepatite C/terapia , Prisioneiros , Humanos , North Carolina , Estados Unidos
3.
Rev Bras Epidemiol ; 22Suppl 1(Suppl 1): e190010, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31576986

RESUMO

INTRODUCTION: Care continuum models have supported recent strategies against sexually transmitted diseases, such as HIV and Hepatitis C (HCV). METHODS: HIV, HCV, and congenital syphilis care continuum models were developed, including all stages of care, from promotion/prevention to clinical control/cure. The models supported the intervention QualiRede, developed by a University-Brazilian National Health System (SUS) partnership focused on managers and other professionals from six priority health regions in São Paulo and Santa Catarina. Indicators were selected for each stage of the care continuum from the SUS information systems and from the Qualiaids and QualiAB facility's process evaluation questionnaires. The indicators acted as the technical basis of two workshops with professionals and managers in each region: the first one to identify problems and to create a Regional Technical Group; and the second one to design action plans for improving regional performance. RESULTS: The indicators are available at www.qualirede.org. The workshops took place in the regions of Alto Tietê, Baixada Santista, Grande ABC, and Registro (São Paulo) and of Foz do Rio Itajaí (Santa Catarina), which resulted in regional action plans in São Paulo, but not in Santa Catarina. A lack of awareness was observed regarding the new HIV and HCV protocols, as well as an incipient use of indicators in routine practices. CONCLUSION: Improving the performance of the care continuum requires appropriation of performance indicators and coordination of care flows at local, regional, and state levels of management.


Assuntos
Continuidade da Assistência ao Paciente/estatística & dados numéricos , Infecções por HIV/terapia , Pesquisa sobre Serviços de Saúde/estatística & dados numéricos , Hepatite C/terapia , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Sífilis Congênita/terapia , Brasil , Infecções por HIV/epidemiologia , Promoção da Saúde/métodos , Promoção da Saúde/estatística & dados numéricos , Hepatite C/epidemiologia , Humanos , Programas Nacionais de Saúde , Inquéritos e Questionários , Sífilis Congênita/epidemiologia
4.
Lancet ; 394(10207): 1451-1466, 2019 10 19.
Artigo em Inglês | MEDLINE | ID: mdl-31631857

RESUMO

Hepatitis C is a global health problem, and an estimated 71·1 million individuals are chronically infected with hepatitis C virus (HCV). The global incidence of HCV was 23·7 cases per 100 000 population (95% uncertainty interval 21·3-28·7) in 2015, with an estimated 1·75 million new HCV infections diagnosed in 2015. Globally, the most common infections are with HCV genotypes 1 (44% of cases), 3 (25% of cases), and 4 (15% of cases). HCV transmission is most commonly associated with direct percutaneous exposure to blood, via blood transfusions, health-care-related injections, and injecting drug use. Key high-risk populations include people who inject drugs, men who have sex with men, and prisoners. Approximately 10-20% of individuals who are chronically infected with HCV develop complications, such as cirrhosis, liver failure, and hepatocellular carcinoma over a period of 20-30 years. Direct-acting antiviral therapy is now curative, but it is estimated that only 20% of individuals with hepatitis C know their diagnosis, and only 15% of those with known hepatitis C have been treated. Increased diagnosis and linkage to care through universal access to affordable point-of-care diagnostics and pangenotypic direct-acting antiviral therapy is essential to achieve the WHO 2030 elimination targets.


Assuntos
Hepatite C/epidemiologia , Hepatite C/terapia , Hepatite C/diagnóstico , Humanos
5.
J Gastroenterol Hepatol ; 34 Suppl 1: 5-15, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31282011

RESUMO

Clinical Cases in Hepatitis 2018 was an interactive educational program for Australian physicians (gastroenterologists, hepatologists, and infectious disease specialists) actively involved in the treatment of liver diseases including hepatitis C virus, hepatitis B virus, and non-alcoholic steatohepatitis. This educational program sponsored by Gilead Sciences took place on October 12-13, 2018, and provided timely, informative case-based, and practical education to Australian physicians. This report summarizes keynote lectures from international leaders in the field of hepatitis C virus, hepatitis B virus, and non-alcoholic steatohepatitis and practical clinical case studies designed to inform and educate Australian physicians on managing challenging patients.


Assuntos
Gerenciamento Clínico , Educação Médica Continuada , Hepatopatias/terapia , Austrália , Educação , Feminino , Hepatite B/terapia , Hepatite C/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/terapia
6.
Workplace Health Saf ; 67(8): 399-413, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31179906

RESUMO

In the United States, approximately one half of individuals with chronic hepatitis C virus (HCV) are not aware of their status. Current HCV treatment is highly successful and is associated with a decrease in all-cause mortality. Occupational health nurses (OHNs) are often the sole health care providers at worksites and have a unique opportunity to provide HCV education, screening, and linkage to care. This project measured changes in OHN HCV competency and outreach, and identified barriers to screening. In June 2017, Survey 1 was emailed to 3,414 American Association of Occupational Health Nurse (AAOHN) members. For HCV competence, HCV knowledge and confidence in educating and counseling employees regarding HCV were assessed. HCV outreach and barriers to screening were identified. The HCV educational campaign launched in October 2017 with a webinar, a webpage/toolkit, and educational emails. Survey 2 was emailed in January 2018 to assess for changes in HCV competency and outreach. A total of 445 OHNs responded to Survey 1, and 111 completed both surveys, and participant demographics represented AAOHN membership base (95% female, mean age 56.4). The average HCV knowledge pretest score was 76% and posttest score was 77%. Confidence in educating/counseling employees about HCV increased from 2.6 to 2.9 (on a 1-5 scale; p = .052). Higher pretest scores were associated with bachelor's degree (BS/BA) education or above, greater confidence in HCV education/counseling of employees, and HCV education participation within the prior 12 months. There are ongoing HCV learning needs for OHNs and greater opportunities for HCV outreach in worksites.


Assuntos
Competência Clínica/normas , Hepatite C/terapia , Enfermagem do Trabalho/normas , Adulto , Feminino , Hepatite C/diagnóstico , Hepatite C/fisiopatologia , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados Unidos
7.
Clin Liver Dis ; 23(2): 345-361, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30947881

RESUMO

Liver diseases during pregnancy pose a unique clinical challenge because they can affect the lives of both the mother and unborn child. Although severe liver disease is rare, pregnancy-related liver disease affects approximately 3% of pregnancies and can be fatal. Timely recognition and diagnosis are essential in order to institute appropriate management strategies. This article provides an overview of liver diseases during pregnancy and is divided into 2 sections: (1) liver diseases specific to pregnancy, and (2) preexisting or coincident liver diseases during pregnancy.


Assuntos
Hipertensão Induzida pela Gravidez/diagnóstico , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Hepatopatias/diagnóstico , Hepatopatias/terapia , Colestase Intra-Hepática/sangue , Colestase Intra-Hepática/diagnóstico , Colestase Intra-Hepática/tratamento farmacológico , Fígado Gorduroso/diagnóstico , Feminino , Hepatite B/diagnóstico , Hepatite B/terapia , Hepatite B/transmissão , Hepatite C/diagnóstico , Hepatite C/terapia , Hepatite C/transmissão , Hepatite Autoimune/tratamento farmacológico , Humanos , Hiperêmese Gravídica/sangue , Hipertensão Induzida pela Gravidez/terapia , Cirrose Hepática/complicações , Cirrose Hepática/terapia , Hepatopatias/sangue , Testes de Função Hepática , Transplante de Fígado , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/tratamento farmacológico
8.
Health Res Policy Syst ; 17(1): 42, 2019 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-30992014

RESUMO

BACKGROUND: Hepatitis C virus (HCV) infection is a major public health challenge worldwide. Implementing policies to cope with this challenge requires commitment from all stakeholders at various levels, and all necessary resources should be mobilised. Support for various HCV-related stakeholders can reduce the challenges and obstacles that can be encountered during the programme implementation. The present study aims to identify all stakeholders involved with HCV-related policy-making in Iran at different steps (policy development, implementation and evaluation) and to characterise them in terms of interest, position, power and influence, in order to provide valuable information for appropriate decision-making and design. The present study can also serve as a case study for healthcare systems in other countries. METHOD: An approach based on social network analysis was utilised. Data collected included relevant document searches and in-depth interviews to a sample of 18 key informants. RESULTS: Various stakeholders were found to be involved with HCV-related policies in Iran. The extent of their participation and support in policy-making varied. Specifically, international agencies had a high interest for HCV-related policy-making, whereas media and members of the private sector were characterised by a medium interest and governmental and non-governmental bodies by a highly variable interest, ranging from low to high, depending on the specific organism. Moreover, media and members of the private sector, non-governmental institutions and international agencies were rated low in terms of position, whereas governmental actors were rated low to high. Media were rated medium in terms of power, whereas international agencies and members of the private sector were respectively rated low to medium and low. Non-governmental actors were rated low, whilst governmental bodies were rated low to high. Finally, media, members of the private sector and international agencies were rated medium in terms of influence, whereas non-governmental and governmental actors were respectively rated low to medium and low to high. CONCLUSION: Policy-making involves trust, negotiation and integration of the different views of all stakeholders. Social network analysis was critical for identifying stakeholders and showing that, in Iran, involvement in HCV-related policy-making is generally low. This information is of practical implication for policy- and decision-makers regarding the adoption of more favourable and effective strategies.


Assuntos
Assistência à Saúde , Política de Saúde , Hepatite C/terapia , Formulação de Políticas , Participação dos Interessados , Pessoal Administrativo , Tomada de Decisões , Países em Desenvolvimento , Governo , Hepacivirus , Hepatite C/virologia , Humanos , Cooperação Internacional , Irã (Geográfico) , Meios de Comunicação de Massa , Organizações , Setor Privado , Saúde Pública , Rede Social , Inquéritos e Questionários
9.
PLoS One ; 14(4): e0216123, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31034530

RESUMO

Hepatitis C virus (HCV) infection is a significant public health concern worldwide. Georgia is among the countries with a high burden of HCV infection. People who inject drugs (PWID) have the highest burden of infection in Georgia. In 2015, the Government of Georgia, with partners' support, initiated one of the world's first Hepatitis C Elimination Programs. Despite notable progress, challenges to achieving targets persist. This qualitative study is aimed to better understand some of the barriers and facilitators to HCV testing and treatment services for PWID to inform HCV treatment policies and practices. The study instrument examined social, structural, and individual factors influencing HCV testing and treatment practices. We started with key informant interviews to guide the study instrument development and compare the study findings against health care planners' and health care providers' views. Forty PWID with various HCV testing and treatment experiences were recruited through the snowball method. The study found that along with structural factors such as political commitment, co-financing of diagnostic and monitoring tests, and friendly clinic environments, knowledge about HCV infection and elimination program benefits, and support from family and peers also play facilitating roles in accessing testing and treatment services. On the other hand, inability to co-pay for diagnostic tests, fear of side effects associated with treatment, poor knowledge about HCV infection, and lack of social support hampered testing and treatment practices among PWID. Findings from this study are important for increasing the effectiveness of this unique program that targets a population at high risk of HCV infection.


Assuntos
Erradicação de Doenças , Hepatite C/epidemiologia , Pesquisa Qualitativa , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Custos e Análise de Custo , Utilização de Instalações e Serviços , Feminino , República da Geórgia/epidemiologia , Hepatite C/economia , Hepatite C/prevenção & controle , Hepatite C/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Cooperação e Adesão ao Tratamento
10.
BMC Med ; 17(1): 71, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30929642

RESUMO

BACKGROUND: Peer support can enable patient engagement with healthcare services, particularly for marginalised populations. In this randomised controlled trial, the efficacy of a peer support intervention at promoting successful engagement with clinical services for chronic hepatitis C was assessed. METHODS: In London, UK, potential participants were approached through outreach services for problematic drug use and homelessness. Individuals positive for hepatitis C virus (HCV) after confirmatory testing were randomised using an online service to the intervention (peer support) or standard of care. The primary outcome of interest was successful engagement with clinical hepatitis services. The study was non-blinded. Absolute differences were calculated using a generalised linear model and the results compared to logistic regression. RESULTS: Three hundred sixty-four individuals consented to participate. One hundred one had chronic hepatitis C and were randomised, 63 to receive the intervention (peer support). A successful outcome was achieved by 23 individuals in this arm (36.5%) and seven (18.4%) receiving the standard of care, giving an absolute increase of 18.1% (95% confidence interval 1.0-35.2%, p value = 0.04). This was mirrored in the logistic regression (odds ratio 2.55 (0.97-6.70), p = 0.06). No serious adverse events were reported. CONCLUSIONS: Peer support can improve the engagement of patients with chronic HCV with healthcare services. TRIAL REGISTRATION: ISRCTN24707359 . Registered 19th October 2012.


Assuntos
Hepatite C/terapia , Aceitação pelo Paciente de Cuidados de Saúde , Defesa do Paciente , Participação do Paciente/métodos , Grupo Associado , Sistemas de Apoio Psicossocial , Adulto , Aconselhamento , Feminino , Hepatite C/epidemiologia , Hepatite C/psicologia , Pessoas em Situação de Rua/psicologia , Pessoas em Situação de Rua/estatística & dados numéricos , Humanos , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Defesa do Paciente/psicologia , Defesa do Paciente/normas , Participação do Paciente/estatística & dados numéricos , Grupos de Autoajuda/organização & administração , Grupos de Autoajuda/normas , Padrão de Cuidado/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/terapia
11.
Health Res Policy Syst ; 17(1): 30, 2019 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-30917837

RESUMO

BACKGROUND: Hepatitis C virus (HCV) infection causes a large number of deaths annually worldwide. Policies play an important role in regulating healthcare agendas and prioritising of health-related issues. Understanding these priorities is very important in health. The objective of this study was to investigate HCV-related issues and their influence on agenda-setting in Iran. METHODS: A qualitative design was used. Data were collected by carrying out a review of documents and interviews. A comprehensive search was conducted to identify documents related to HCV-related policies in Iran. Semi-structured interviews were conducted with both purposive and snowball sampling of 14 interviewees related to the HCV programme in Iran, including government officials, civil society, development partnership members and academicians. Documents and interview data were analysed manually and using MAXQDA Version 10 software. Kingdon's multiple streams framework was used to guide data analysis. RESULTS: The factors which influenced HCV-related agenda-setting were lack of proper information of the HCV epidemiology before the 1990s, lack of diagnostic facilities, neighbouring countries with high HCV prevalence, the stigma of HCV, high prevalence in prisoners, international evidence and high costs generated by HCV. The factors related to policy were effective treatment methods, drug production inside Iran, Iran Hepatitis Network, support outside government group elites and academicians. The factors related to political will were international influence, changes in the government and parliament support. CONCLUSION: The findings of this study showed that there are various national and international factors that play a role in shaping HCV-related policies. It seems that, if HCV is put into the agenda, it can be eliminated in Iran by 2030 by supporting and implementing appropriate programmes from decision- and policy-makers.


Assuntos
Tomada de Decisões , Política de Saúde , Hepatite C , Formulação de Políticas , Pessoal Administrativo , Custos e Análise de Custo , Hepatite C/terapia , Humanos , Irã (Geográfico) , Política , Estigma Social , Inquéritos e Questionários
13.
Gastroenterol. hepatol. (Ed. impr.) ; 42(3): 164-170, mar. 2019. graf, tab
Artigo em Inglês | IBECS | ID: ibc-182131

RESUMO

Introduction: In the interferon era, the treatment of hepatitis C virus (HCV) infection in patients on haemodialysis (HD) was limited due to the significant number of treatment-related adverse events (AEs). Direct-acting antivirals (DAAs) have demonstrated their efficacy and safety in the treatment of HCV in patients with advanced chronic kidney disease on haemodialysis. The objective of the study was to evaluate the success in eliminating HCV infection from our dialysis unit using DAAs, and to assess the impact of HCV elimination on clinical and analytical outcomes. Patients and methods: This is a prospective, interventional, single-center study at Hospital Clínic de Barcelona. All HCV-RNA positive patients who received antiviral therapy with DAAs within a 3-year period (2014-2017) were analyzed (n=20). Data on virologic response, adverse events, and biochemical and hematological parameters during and after DAA therapy were analyzed. Results: All patients achieved sustained virologic response (SVR) and only 40% of patients presented with mild AEs. None of the patients presented with HCV reinfection after a 1-year follow-up period, and thus HCV was eliminated from our HD unit. SVR was associated with a significant increase in hemoglobin and hematocrit, and a tendency toward the need for lower doses of iron supplementation with no changes in darbepoetin dose. Conclusion: HCV infection can be safely eliminated from HD units with the use of DAAs, preventing new infections in patients and healthcare staff. In the short term, the achievement of SVR is associated with an improvement in the control of anemia


Introducción: En la época del interferón, el tratamiento del virus de la hepatitis C (VHC) en pacientes en hemodiálisis (HD) se veía limitado por la presencia de efectos adversos relacionados con el tratamiento. Los agentes antivirales directos (AAD) han demostrado ser seguros y eficaces en el tratamiento del VHC en pacientes con insuficiencia renal crónica en hemodiálisis. El objetivo del estudio fue evaluar el éxito en eliminar la infección por VHC de nuestra unidad de diálisis con el uso de AAD, y determinar el impacto clínico y analítico de la curación de la infección. Pacientes y métodos: Para ello se realizó un estudio prospectivo de intervención en el Hospital Clinic de Barcelona y su centro de diálisis. Se incluyeron todos los pacientes (n=20) con ARN-VHC positivo que recibieron tratamiento antiviral con AAD durante un periodo de 3 años (2014-2017). Se analizaron los datos de respuesta virológica, efectos adversos y parámetros hematológicos y bioquímicos durante y después del tratamiento. Resultados: Todos los pacientes alcanzaron una respuesta viral sostenida (RVS) y solo una 40% presentaron efectos adversos leves. Ningún paciente presentó reinfección por el VHC y por ello tras un año de seguimiento se consideró la eliminación del VHC de nuestra unidad de diálisis. La RVS se asoció con aumento significativo de la hemoglobina y el hematocrito, y una tendencia a la necesidad de una dosis más baja de suplemento de hierro sin cambios en la dosis de darbepoetina. Conclusión: Con la utilización de AAD, la infección por el VHC puede ser eliminada de forma segura de las unidades de diálisis, previniendo la transmisión de la infección a pacientes y personal sanitario. A corto plazo, la RVS se asoció con una mejoría en el control de la anemia


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Hepatite C/terapia , Anemia/terapia , Antivirais/administração & dosagem , Resposta Viral Sustentada , Resultado do Tratamento , Anemia/prevenção & controle , Unidades Hospitalares de Hemodiálise , Estudos Prospectivos , Antivirais/efeitos adversos
14.
BMC Public Health ; 19(1): 30, 2019 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-30621658

RESUMO

BACKGROUND: Prisoners have a high prevalence of hepatitis C virus (HCV) infection but may find it difficult to access healthcare services. This may be related to risk behaviour including history of injecting drugs and marginalisation related to problem drug use/ opioid use disorder (OUD). Direct-acting antiviral products with superior efficacy and safety compared to interferon-based regimens offer HCV cure. Many citizens in Europe have been treated, although few received therapy in prisons. METHODS: Analysis of prisoner HCV treatment need and policy determinants of clinical practice was completed for 5 EU countries. Evidence was collected from national statistical sources and peer-reviewed publications to describe prison populations and HCV prevalence, to map national prison/ HCV health policy or guidance. A consensus of important principles for prisoner HCV care was developed. RESULTS: Data from published sources describing prisoner HCV prevalence is limited. Prisoner population requiring HCV treatment is not known; estimated numbers based on analysis of evidence: England and Wales, 9000, France, 8000, Spain, 6000, Italy, 6000, Germany, 6000. Treatment access: national law defines right to equivalent care in all countries implying access to HCV therapy in prison similar to community; useful prisoner HCV guidance facilitating treatment decisions present in: 4 of 5 national/ regional HCV policy documents, 4 of 5 national prison healthcare policies. Four of five had practical prison HCV clinical guidelines. Despite existence of policy, implementation of guidance, and so HCV treatment, is suboptimal in many locations. CONCLUSIONS: Prison is an important location to detect, address and treat HCV infection in people who may be underserved for healthcare and find it difficult to navigate community treatment pathways. This is often related to problems with OUD and resulting social inequity. HCV management in prisons must be improved. Policy and clinical practice guidance must be set to promote treatment, and practical steps to make treatment easy should be followed including education to promote engagement, set-up of optimal screening and work up processes with modern tools to reduce time needed/ achieve efficiency; programs to make it easier to get specialists' input include remote working and nurse-led services.


Assuntos
Hepatite C/terapia , Prisioneiros , Prisões/organização & administração , Antivirais/uso terapêutico , Europa (Continente)/epidemiologia , Política de Saúde , Acesso aos Serviços de Saúde , Hepatite C/epidemiologia , Humanos , Guias de Prática Clínica como Assunto , Prevalência
15.
Drug Alcohol Depend ; 195: 114-120, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30611979

RESUMO

BACKGROUND: To describe the "continuum of care" for hepatitis C virus (HCV) and related health service utilization among persons who inject drugs (PWID) in the Seattle metropolitan area. METHODS: The study analyzed data from the 2015 National HIV Behavioral Surveillance system focused on PWID, which included local questions on HCV treatment and testing. We calculated respondent driven sampling (RDS)-adjusted percentages of participants who had completed each step of the care continuum and compared healthcare harm reduction services among participants who were HCV + vs. HCV- using bivariate analyses. RESULTS: 513 PWID were screened for HCV antibodies (Ab). Of those, 59.7% were HCV Ab+. Among those HCV Ab+, 86.4% had been tested for HCV at least once; 69.9% reported a previous diagnosis. Of those diagnosed, 55.9% had received a confirmatory test, 17.2% had ever received any medications for HCV, and 7.2% had completed treatment. The majority of HCV Ab + participants had seen a health care provider in the past 12 months (85.6%). CONCLUSIONS: There is a large gap between HCV screening and treatment among Seattle area PWID.


Assuntos
Continuidade da Assistência ao Paciente/tendências , Redução do Dano , Hepatite C/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adolescente , Adulto , Feminino , Hepatite C/diagnóstico , Hepatite C/terapia , Humanos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/tendências , Pessoa de Meia-Idade , Abuso de Substâncias por Via Intravenosa/diagnóstico , Abuso de Substâncias por Via Intravenosa/terapia , Inquéritos e Questionários , Washington/epidemiologia , Adulto Jovem
16.
Semin Dial ; 32(2): 99-107, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30549107

RESUMO

Hepatitis C virus (HCV) infection has been demonstrated to result in several adverse hepatic outcomes and has been associated with a number of important extrahepatic manifestations. The scope of extrahepatic clinical possibilities includes systemic diseases such as vasculitis and lymphoproliferative disorders, cardiovascular disease, myalgia, arthritis, and sicca syndrome. These end-organ effects of HCV may dominate the clinical course beyond the hepatic complications and significantly worsen the long-term prognosis of infected patients. Until several years ago, the standard of care for the treatment of HCV infection had been interferon-alpha-based regimens, which not only had limited effectiveness in achieving a cure but were often poorly tolerated, especially in patients with kidney disease. In those HCV-infected patients with significant systemic manifestations, the interferon-based regimens were problematic given their association with a wide variety of toxicities. The development of highly effective direct-acting antiviral agents to treat HCV infection presented an opportunity to improve the HCV care cascade with the eradication of HCV in most infected patients and by reducing the burden of both hepatic and extrahepatic complications.


Assuntos
Hepatite C/complicações , Hepatite C/terapia , Humanos
17.
J Matern Fetal Neonatal Med ; 32(20): 3464-3469, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29656685

RESUMO

Introduction: Hepatitis C virus (HCV) infection is a serious health problem. It is a major contributor to end-stage liver disease. Worldwide, 1-8% of all pregnant women were infected. Women with viral hepatitis may be at an increased risk of pregnancy complications. There are several obstetrics intervention acts as risk factors, which are specific to women pertaining the HCV infection; anti-D immunoglobulin (Ig) therapy may be one of them. Our objectives were to estimate the prevalence of HCV antibodies (anti-HCV), RNA, and genotype distribution among women with anti-D Ig therapy. Materials and methods: A cross sectional study was conducted. A sample of 154 Rhesus negative (Rh - ve) pregnant women regardless of the anti-D Ig therapy was collected. Anti-HCV were tested using third generation enzyme immunoassay (EIA-3) and immunoblot assay (Lia Tek-111), subsequently. In addition, 89 serum samples were subjected to molecular analysis using RT-PCR and DNA enzyme immunoassay (DEIA) method for the detection of HCV-RNA and genotypes. Results: Anti-HCV, and HCV-RNA seroprevalence were significantly higher (17.1, 35.5%) among women with anti-D Ig than their counter group (6.4, 13.16%), p = .038, .018, respectively. Significant direct positive dose response correlation (r = 0.78, p = .005) had been seen between number of anti-D Ig therapy and anti-HCV seropositive rate. Anti-D Ig therapy act as a risk factor (odds ratio (OR) = 3.01, 95%CI: 1.01-8.9) especially from the third dose onward. Women with anti-D Ig therapy were at higher risk (3.6 times more) of positive HCV-RNA (OR =3.6, 95%CI =1.19-10.837). Genotype HCV-1b showed higher prevalent (52.9%) among the recipients of anti-D Ig therapy while genotype HCV-3a (6.6%) was the lowest. Conclusions: Our study showed that Anti-D immunoglobulin therapy acts as a risk factor for acquiring HCV infection. Screening for HCV should be recommended for all recipients of anti-D Ig. Not only HCV antibodies but HCV-RNA detection being recommended for the diagnosis of HCV infection. A brief rational: Pregnant women with HCV infection are at risk of adverse obstetric outcome. Anti-D Ig therapy may be a risk factor for HCV infection. Hence, we conducted a cross sectional study with the objectives to estimate the prevalence of HCV antibodies (anti-HCV), RNA, and genotype distribution among women with anti-D Ig therapy. We found that anti-HCV and HCV-RNA seroprevalence were significantly higher in women with anti-D Ig. In addition, women with anti-D Ig therapy were 3.6 times more at risk of positive HCV-RNA with genotype HCV-1b showed higher prevalence. Therefore, anti-D Ig therapy is a risk factor for acquiring HCV infection and we recommend screening for HCV for all recipients of anti-D Ig. In addition, the diagnosis of HCV infection, should be made with HCV antibodies and HCV-RNA detection.


Assuntos
Hepacivirus , Hepatite C/terapia , Complicações Infecciosas na Gravidez/terapia , Imunoglobulina rho(D)/uso terapêutico , Adolescente , Adulto , Estudos Transversais , Feminino , Genótipo , Técnicas de Genotipagem , Hepacivirus/genética , Hepacivirus/imunologia , Hepatite C/sangue , Hepatite C/imunologia , Anticorpos Anti-Hepatite C/análise , Anticorpos Anti-Hepatite C/sangue , Humanos , Imunização Passiva/métodos , Técnicas Imunoenzimáticas/métodos , Iraque , Tipagem Molecular , Gravidez , Complicações Infecciosas na Gravidez/sangue , Complicações Infecciosas na Gravidez/imunologia , RNA Viral/análise , RNA Viral/genética , Imunoglobulina rho(D)/análise , Imunoglobulina rho(D)/sangue , Estudos Soroepidemiológicos , Adulto Jovem
18.
J Acquir Immune Defic Syndr ; 80(2): 145-151, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30422912

RESUMO

BACKGROUND: HIV, hepatitis C virus (HCV), and alcohol-related diagnoses (ARD) independently contribute increased risk of all-cause hospitalization. We sought to determine annual medical intensive care unit (MICU) admission rates and relative risk of MICU admission between 1997 and 2014 among people with and without HIV, HCV, and ARD, using data from the largest HIV and HCV care provider in the United States. SETTING: Veterans Health Administration. METHODS: Annual MICU admission rates were calculated among 155,550 patients in the Veterans Aging Cohort Study by HIV, HCV, and ARD status. Adjusted rate ratios and 95% confidence intervals (CIs) were estimated with Poisson regression. Significance of trends in age-adjusted admission rates were tested with generalized linear regression. Models were stratified by calendar period to identify shifts in MICU admission risk over time. RESULTS: Compared to HIV-/HCV-/ARD- patients, relative risk of MICU admission decreased among HIV-mono-infected patients from 61% (95% CI: 1.56 to 1.65) in 1997-2009% to 21% (95% CI: 1.16 to 1.27) in 2010-2014, increased among HCV-mono-infected patients from 22% (95% CI: 1.16 to 1.29) in 1997-2009% to 54% (95% CI: 1.43 to 1.67) in 2010-2014, and remained consistent among patients with ARD only at 46% (95% CI: 1.42 to 1.50). MICU admission rates decreased by 48% among HCV-uninfected patients (P-trend <0.0001) but did not change among HCV+ patients (P-trend = 0.34). CONCLUSION: HCV infection and ARD remain key contributors to MICU admission risk. The impact of each of these conditions could be mitigated with combination of treatment of HIV, HCV, and interventions targeting unhealthy alcohol use.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Infecções por HIV/epidemiologia , Hepatite C/epidemiologia , Unidades de Terapia Intensiva , Admissão do Paciente/estatística & dados numéricos , Adulto , Consumo de Bebidas Alcoólicas/terapia , Coinfecção , Feminino , Infecções por HIV/terapia , Hepatite C/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
19.
Semin Dial ; 32(2): 187-195, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30496617

RESUMO

KDIGO recently updated its clinical practice guideline for the prevention, diagnosis, evaluation, and treatment of hepatitis C virus (HCV) infection in patients with chronic kidney disease (CKD). The management of HCV in patients with CKD has dramatically shifted over the past 10 years with the development of direct-acting antiviral (DAA) agents and subsequent demonstration of their efficacy in CKD populations. The opportunity to cure HCV with DAA treatment has impacted all aspects of the KDIGO guideline on HCV in CKD including: (a) HCV diagnosis in CKD populations; (b) HCV treatment in CKD populations; (c) preventing HCV transmission in HD units; (d) management of HCV before and after kidney transplantation; and (e) management of HCV-associated glomerular disease. This review summarizes and discusses the major recommendations, along with the implication of the guideline on clinical practice.


Assuntos
Hepatite C/terapia , Insuficiência Renal Crônica/virologia , Antivirais/uso terapêutico , Hepatite C/complicações , Hepatite C/transmissão , Humanos , Transplante de Rim , Guias de Prática Clínica como Assunto , Diálise Renal , Insuficiência Renal Crônica/terapia
20.
Semin Dial ; 32(2): 108-118, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30496620

RESUMO

Hepatitis C virus (HCV) infection is not only an important cause of chronic liver disease, but extrahepatic manifestations are common and include chronic kidney disease (CKD). HCV is classically associated with cryoglobulinemic glomerulonephritis in the context of mixed cryoglobulinemia syndrome, but other glomerular diseases also occur and may be significantly under-recognized. HCV may cause glomerular disease by immune complex deposition; however, other potential mechanisms by which HCV promotes CKD include a direct cytopathic effect of the virus on renal tissue, and by its association with accelerated atherosclerosis, insulin resistance, and chronic inflammation. Epidemiologic studies show HCV infection confers an increased risk of incident CKD and accelerates progression of CKD to end-stage renal disease (ESRD) in the general population, as well as subpopulations including diabetic patients, those coinfected with human immunodeficiency virus (HIV), and kidney transplant recipients. Patients with CKD and HCV infection experience inferior clinical outcomes, including poorer quality of life and an increased risk of mortality. Treatment with interferon-based regimens is associated with decreased risk of incident CKD and ESRD, though prior studies are limited by the small number of patients with HCV and CKD who underwent treatment. With the advent of new, well-tolerated direct-acting antiviral combinations that are not cleared by the kidneys, it is possible to treat all genotypes of HCV infection in patients with CKD and ESRD. More data on the effect of direct-acting antivirals on CKD incidence and progression are necessary. However, there is every expectation that with improved access to HCV treatment, the burden of CKD in patients with HCV could significantly decline.


Assuntos
Hepatite C/complicações , Falência Renal Crônica/virologia , Hepatite C/diagnóstico , Hepatite C/terapia , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/terapia
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