by PWeekly | Aug 31, 2016
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 PWeekly | Aug 23, 2012
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...