Hepatitis C diagnosis and treatment in people who use drugs: mind the gap in the linkage to care.

OBJECTIVE: The objective of this study is to identify a simplified rapid screening and linkage-to-care model for HCV among PWUD. PATIENTS AND METHODS: The study stems from a collaborative project bringing together two local Italian Centers for Drug Addiction and the Hepatology-Infectious Diseases Department of Lazzaro Spallanzani. A research physician analyzed the available medical records seeking to identify HCV and HIV infected patients in care in the addiction centers. Between March 2018 and January 2020 subjects were selected from among a cohort of 720 PWUD in the two Centers' care. The study comprises three steps: first, screening for HCVAb; second, the linkage to care; third, clinical assessment to treatment. The research physician recruited patients for the first two steps directly in their local addiction center. The third step was conducted in the Spallanzani. The characteristics of those subjects who adhered to the three-step study program were then compared to those of the non-adhering PWUD. RESULTS: 194 were known HCVAb positive patients. Of the 505 PWUD in the care of the two Centers eligible for screening, 364 were enrolled in the study. 144 resulted HCVAb positive. 269 were tested for HCVRNA. 101 underwent a full assessment. 96 patients started antiviral therapy with DAA. Patients who refused first step screening were older patients and mainly heroin users; in the second step, almost all the HIV/HCV co-infected patients agreed to a viremia test; in the third step all the HIV/HCV co-infected patients refused HCV treatment. CONCLUSIONS: The study suggests an on-site specialist approach conducted directly in the addiction centers themselves starting from screening; it can bring the goal of HCV PWUD microelimination closer.

Doppler sonography measurement of portal blood flow velocity after glucagon injection in patients with chronic HCV infection.

Doppler sonography measurement of portal flow velocity (PFV) after glucagon injection was performed in 45 patients with chronic hepatitis C virus (HCV) infection. Patients were divided into three groups: group 1 = no or mild liver fibrosis; group 2 = moderate to severe liver fibrosis, and group 3 = liver cirrhosis. All patients were examined using a Doppler ultrasound (US) multipurpose equipment and a convex 3.5-MHz probe, 10 min before (baseline), as well as 5 and 10 min after, IV administration of 1 mg of glucagon chloride. No significant differences were found in mean baseline PFV among group 1 (19.4 +/- 2.4 cm/s), group 2 (20.1 +/- 3.6 cm/s) and group 3 (17.5 +/- 3.7 cm/s). Five minutes after glucagon injection, all three groups showed significantly increased values of mean PFV (25.6 +/- 4.8, 23.7 +/- 4.0 and 19.5 +/- 5.0 cm/s, respectively; p < 0.05 vs. baseline). The mean increase of PFV above baseline was significantly higher in group 1 (7.9 +/- 3.7 cm/s) than in group 2 (4.5 +/- 3.9 cm/s) (p < 0.05) or in group 3 (2.7 +/- 2.3 cm/s) (p < 0.05). A significant inverse correlation was found between individual values of fibrosis score and of individual increase of PFV. In patients with chronic HCV infection, Doppler sonography measurement of PFV after glucagon injection could be useful in assessing the severity of liver histological damage.

Leukocyte and platelet lowering by some interferon types during viral hepatitis treatment.

BACKGROUND/AIMS: The hematologic toxicity (leukothrombocytopenia) of interferon therapy is well known and frequently observed; it may vary, however, according to the type of interferon administered. METHODOLOGY: We retrospectively assessed 158 patients with chronic viral hepatitis treated for 6-12 months with alpha (recombinant, lymphoblastoid or leukocyte) or beta interferon to monitor leukothrombocytopenia. RESULTS: During treatment, a significant decrease in leukocyte and platelet counts was detected in 48% and 43% of patients, respectively. The maximum decrease (31% and 26% of pre-treatment values; p<0.01) occurred after 4.9 and 4.2 months of treatment. No patient showed clinical symptoms of leukopenia or thrombocytopenia. Beta-interferon yielded the smallest decreases in leukocyte and platelet counts (-21% and -16% of pre-treatment values, respectively). Among alpha interferons, the lymphoblastoid (9 MU/week) produced the largest decrease both in leukocyte (38%; p<0.05 vs any other type) and in platelet (32%) number. The same dose of leukocyte interferon had the smallest effect (leukocytes: -27%; platelets: -2%), while recombinant interferon showed intermediate toxicity (-32% and -26% respectively). CONCLUSIONS: From this retrospective study, the hematologic toxicity of alpha and alpha interferons usually emerges as mild. However, leukopenia and thrombocytopenia may be induced more frequently by some of these interferon types.