by PWeekly | Aug 31, 2016 | Articles, Emergency Medicine, Hospital Medicine, Infectious Disease, Recent Features, Slider, Tablet
An ED screening and diagnostic testing program found a high prevalence of hepatitis C. Results suggest that continued efforts are needed to develop and evaluate policies for ED-based hepatitis C screening. Hepatitis C virus affects about 3 million Americans and is a leading cause of end-stage liver disease, hepatocellular carcinoma, and liver transplants. National recommendations endorse using risk-based hepatitis C screening, which includes screening patients with a history of injection drug use as well as one-time screenings of “baby boomers,” or patients born between 1945 and 1965. Current data suggest that the baby boomer generation accounts for 75% of people infected with hepatitis C, but 1.25 to 1.75 million of them are unaware that they are infected. “Hepatitis C screening has long been considered impractical for EDs, but advances in rapid testing technology, the development of new therapies, and improvements in reimbursement for selective screening has created new opportunities to implement these screenings in the ED setting,” says Douglas A.E. White, MD. Despite these advances, clinical experience with hepatitis C virus screening in EDs is limited. Testing a New Program Recently, Dr. White and colleagues at Alameda Health System implemented an ED-based screening program for both HIV and hepatitis C into the triage process according to recommendations from the CDC and United States Preventive Services Task Force. As an adjunct to screening, physicians could order HIV and hepatitis C testing when clinically indicated. For a study published in Annals of Emergency Medicine, the research team reported results of the hepatitis C portion of this screening program. The primary objective was to determine the prevalence of hepatitis C...
by TimH | Jul 25, 2014 | Articles, Guidelines, Hospital Medicine, Infectious Disease, Opinion Article, Primary Care, Recent Features, Slider
According to recent reports, an estimated 3 to 4 million Americans are chronically infected with the hepatitis C virus (HCV), and about half of these people are unaware of their status. These patients can progress to advanced liver disease and/or hepatocellular cancer. With early treatment, however, these outcomes can be prevented, and therapies for HCV are rapidly emerging and improving. With more treatment options becoming available, clinicians can potentially cure more patients than what has been previously possible. Several new direct-acting oral agents for HCV have been recently approved for use in the United States. The initial direct-acting agents were approved in 2011, and more oral agents are expecting approval within the next few years. “These treatments have the potential to cure most patients with HCV, but the rapid pace of drug development has left healthcare providers unsure about optimal treatments,” says David L. Thomas, MD, MPH. “We need credible resources with unbiased guidance on how best to treat patients with HCV.” A Helpful New Resource In 2014, the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA), in collaboration with the International Antiviral Society-USA (IAS-USA), launched HCVguidelines.org, a website that provides up-to-date guidance for the treatment of HCV. The collaboration is the result of ongoing work from the AASLD, IDSA, and IAS-USA. A panel of 26 liver disease and infectious diseases specialists and a patient advocate developed evidenced-based, consensus recommendations for screening, treating, and managing HCV. HCVguidelines.org has been made available to any healthcare provider who treats the disease and for others who need updated information on best practices. “The...
by JonN | Feb 1, 2013 | Articles, Guidelines, HIV/AIDS, Infectious Disease, Primary Care, Recent Features, Slider
Nearly 5 million Americans are infected with hepatitis C, and more than 80% of these individuals are baby boomers. Alarmingly, 75% of people with hepatitis C aren’t aware they are infected. In August 2012, the CDC issued new guidelines recommending that all baby boomers (those born between 1945 and 1965) have a onetime test for hepatitis C. This could detect another 800,000 of those infected and potentially save 120,000 lives. Characterizing Hepatitis C Hepatitis C remains the only viral infection that can be cured, and this move toward broader testing comes at an important time as therapy continues to improve. Cure rates with protease inhibitors recently approved by the FDA range between 68% and 79%. For many patients, these therapies will cut treatment time in half. With more than 50 drugs in development, the cure rate is likely to improve to greater than 90% over the next 5 to 10 years, and therapy will be easier to tolerate and take less time to become effective. Testing Baby Boomers for Hepatitis C Testing for hepatitis C has been shown in studies to be cost-effective, especially as the epidemic costs the U.S. an estimated $30 billion per year. That number is projected to rise to $80 billion per year by 2025. Curing the majority of those affected will dramatically reduce those costs. Physicians should recognize that routine physical exams may not detect hepatitis C. Up to 40% of infected people will have normal liver blood tests, so a specific antibody test must be conducted. In addition to talking to baby boomers about hepatitis C testing, physicians should also discuss testing with...
by Physicians Weekly | Aug 23, 2012 | Articles, Conference Coverage, HIV/AIDS, Infectious Disease, Recent Features, Slider
New research was presented at AIDS 2012, the 19th International AIDS Conference, from July 22-27 in Washington, DC. The features below highlight just some of the studies that emerged from the conference. Multiple Benefits With Early HIV Treatment The Particulars: Research has indicated that early treatment of HIV helps prevent various adverse outcomes. A landmark trial (HPTN 052) recently found that effective early treatment of HIV appears to help prevent transmission among heterosexuals. Data Breakdown: Two analyses of HPTN 052 were conducted. The first reviewed HIV patients who underwent immediate therapy when compared with those whose treatment began after CD4 counts fell below 250 cells/mm3. Immediate therapy was associated with longer time to an AIDS-defining event and to tuberculosis. The second analysis, conducted in similar patients, found that early HIV treatment was cost-effective, and in some cases, perhaps less expensive than delaying therapy. Take Home Pearls: Early treatment of HIV appears to reduce the risk of AIDS-defining events and tuberculosis. Early treatment also appears to be cost-effective. HIV/HCV Co-Infection & Outcomes The Particulars: HIV has been shown in previous studies to accelerate hepatitis C virus (HCV) progression. Whether antiretroviral therapy (ART) slows this progression has not been explored in clinical trials. Data Breakdown: In a study, the outcomes of patients with HIV/HCV co-infection—all of whom were on ART—were compared with those of patients with HCV only. Co-infected patients had a 6.3% rate of hepatic decompensation, compared with 5.0% for those with HCV only. Hepatocellular carcinoma developed in 1.2% of co-infected patients, compared with 0.9% of HCV patients. The mortality rate was 32.9% for co-infected patients, compared with 15.4% for...
by admin | Mar 6, 2012 | Articles, HIV/AIDS, Infectious Disease, Recent Features, Slider
According to national estimates, about 15% to 30% of people with HIV in the United States are coinfected with hepatitis C virus (HCV). Reports also show that as many as 90% of those with HIV secondary to injection drug use are coinfected with HCV. The rate of progression to cirrhosis for people coinfected with HCV/HIV is about three times higher than the rate for people who only have HCV infection. This accelerated rate is magnified in patients with low CD4 counts. “HCV/HIV coinfection can result in chronic liver diseases, most notably cirrhosis but also liver cancer,” explains David L. Thomas, MD, MPH. “The coinfection can lead to significant morbidity and mortality.” Compounding the problem is that chronic HCV infection can complicate HIV treatment because it increases the frequency of antiretroviral therapy (ART)-associated hepatotoxicity. “The accelerated rate of liver disease progression associated with HCV/HIV coinfection is an important factor to consider.” Several clinical investigations have shown that the prognosis is poorer for HCV/HIV coinfected persons than for persons with just HIV in the era of combination ART. It is unknown if ART reduces morbidity and mortality from untreated HCV. What is known is that ART does not reduce liver mortality enough. In some centers, liver failure is one of the leading causes of death in HIV-infected persons. As a result, treatments for HCV/HIV coinfection must be individualized based on several important patient factors (Table 1). Managing Coinfection & Using ART Guidelines from the U.S. Department of Health and Human Services (HHS) indicate that HIV-infected patients should be screened for HCV infection with immunoassays prior to initiation of ART. Patients with...
