Hepatitis

A protective effect was seen with regard to hepatitis C virus (HCV) transmission among individuals who “reversed transitioned” to noninjected drug use and in persons who used noninjected drugs in addition to injecting, according to an interview study of 846 drug users.

©andrewsafonov/Thinkstock

Data were collected between January 2007 and December 2017 as part of a long-running study of persons entering Mount Sinai Beth Israel drug detoxification and methadone maintenance programs, reported Don C. Des Jarlais, MD, of the Icahn School of Medicine at Mount Sinai, New York, and his colleagues.

Among the 846 individuals studied, men comprised 79%; 41% were white, 15% African American, and 40% Hispanic, with a mean age of 35 years. They were all currently persons who injected drugs (PWID), according to the report published in Drug and Alcohol Dependence.

A total of 97 persons (11%) “reverse transitioned” back to noninjected drug use, according to the researchers; this reverse transitioning was strongly associated with lower HCV positivity, compared with those who continued injecting (30% vs. 47%, respectively; P less than .005).

There was a substantial difference in the HCV prevalence between PWID who reported noninjected use of heroin (43%) versus PWID who did not report noninjected use of heroin (53%) (P = .005).

Distributive needle sharing was common in HCV seropositives who were injecting cocaine in the 6 months prior to the interview: 28% of the HCV seropositives injecting cocaine reported distributive sharing versus 14% of the HCV seropositives not injecting cocaine (P = .001).

“Harm reduction for PWID has been largely defined in terms of ‘safer injection,’ using sterile injection equipment, proper preparation of the injecting site, etc. We would like to suggest that harm reduction for PWID be broadened to include reverse transitions back to exclusive noninjecting use and frequent substitution of noninjecting for injecting use,” the investigators suggested.

The study was funded by the U.S. National Institute on Drug Abuse. The authors reported that they had no conflicts of interest.

[email protected]

SOURCE: Des Jarlais DC et al. Drug Alcohol Depend. 2018 Sep 12. doi: 10.1016/j.drugalcdep.2018.07.034.

A protective effect was seen with regard to hepatitis C virus (HCV) transmission among individuals who “reversed transitioned” to noninjected drug use and in persons who used noninjected drugs in addition to injecting, according to an interview study of 846 drug users.

©andrewsafonov/Thinkstock

Data were collected between January 2007 and December 2017 as part of a long-running study of persons entering Mount Sinai Beth Israel drug detoxification and methadone maintenance programs, reported Don C. Des Jarlais, MD, of the Icahn School of Medicine at Mount Sinai, New York, and his colleagues.

Among the 846 individuals studied, men comprised 79%; 41% were white, 15% African American, and 40% Hispanic, with a mean age of 35 years. They were all currently persons who injected drugs (PWID), according to the report published in Drug and Alcohol Dependence.

A total of 97 persons (11%) “reverse transitioned” back to noninjected drug use, according to the researchers; this reverse transitioning was strongly associated with lower HCV positivity, compared with those who continued injecting (30% vs. 47%, respectively; P less than .005).

There was a substantial difference in the HCV prevalence between PWID who reported noninjected use of heroin (43%) versus PWID who did not report noninjected use of heroin (53%) (P = .005).

Distributive needle sharing was common in HCV seropositives who were injecting cocaine in the 6 months prior to the interview: 28% of the HCV seropositives injecting cocaine reported distributive sharing versus 14% of the HCV seropositives not injecting cocaine (P = .001).

“Harm reduction for PWID has been largely defined in terms of ‘safer injection,’ using sterile injection equipment, proper preparation of the injecting site, etc. We would like to suggest that harm reduction for PWID be broadened to include reverse transitions back to exclusive noninjecting use and frequent substitution of noninjecting for injecting use,” the investigators suggested.

The study was funded by the U.S. National Institute on Drug Abuse. The authors reported that they had no conflicts of interest.

[email protected]

SOURCE: Des Jarlais DC et al. Drug Alcohol Depend. 2018 Sep 12. doi: 10.1016/j.drugalcdep.2018.07.034.

A protective effect was seen with regard to hepatitis C virus (HCV) transmission among individuals who “reversed transitioned” to noninjected drug use and in persons who used noninjected drugs in addition to injecting, according to an interview study of 846 drug users.

©andrewsafonov/Thinkstock

Data were collected between January 2007 and December 2017 as part of a long-running study of persons entering Mount Sinai Beth Israel drug detoxification and methadone maintenance programs, reported Don C. Des Jarlais, MD, of the Icahn School of Medicine at Mount Sinai, New York, and his colleagues.

Among the 846 individuals studied, men comprised 79%; 41% were white, 15% African American, and 40% Hispanic, with a mean age of 35 years. They were all currently persons who injected drugs (PWID), according to the report published in Drug and Alcohol Dependence.

A total of 97 persons (11%) “reverse transitioned” back to noninjected drug use, according to the researchers; this reverse transitioning was strongly associated with lower HCV positivity, compared with those who continued injecting (30% vs. 47%, respectively; P less than .005).

There was a substantial difference in the HCV prevalence between PWID who reported noninjected use of heroin (43%) versus PWID who did not report noninjected use of heroin (53%) (P = .005).

Distributive needle sharing was common in HCV seropositives who were injecting cocaine in the 6 months prior to the interview: 28% of the HCV seropositives injecting cocaine reported distributive sharing versus 14% of the HCV seropositives not injecting cocaine (P = .001).

“Harm reduction for PWID has been largely defined in terms of ‘safer injection,’ using sterile injection equipment, proper preparation of the injecting site, etc. We would like to suggest that harm reduction for PWID be broadened to include reverse transitions back to exclusive noninjecting use and frequent substitution of noninjecting for injecting use,” the investigators suggested.

The study was funded by the U.S. National Institute on Drug Abuse. The authors reported that they had no conflicts of interest.

[email protected]

SOURCE: Des Jarlais DC et al. Drug Alcohol Depend. 2018 Sep 12. doi: 10.1016/j.drugalcdep.2018.07.034.

An adenine mutation in the MUTYH base repair excision gene increased the risk of developing hepatocellular carcinoma (HCC) in patients with chronic hepatitis C virus (HCV). The mutation was discovered in an analysis of 19 tagging single-nucleotide polymorphism (SNP) variants examined for multiple base repair excision genes (MUTYH, OGG1, and MTH1), according to the results of a retrospective analysis of patient genotypes reported in Free Radical Biology and Medicine (2018;129:88-96).

©Gio_tto/Thinkstock.com

In addition, the researchers examined MUTYH-null mice to assess the involvement of oxidative stress and DNA repair enzymes in hepatocarcinogenesis.

One significant SNP was found and confirmed from 93 Japanese patients with chronic HCV (38 with HCC and 55 controls), according to Akira Sakurada, MD, of Sapporo (Japan) Medical University, and his colleagues.

Patients diagnosed as having chronic HCV between 2007 and 2015 were enrolled. All patients were 45 years of age or older with detectable anti-HCV antibodies and HCV-RNA, as well as histopathological evidence of chronic hepatitis on liver biopsy. An exploratory cohort of 40 patients was first used before the 93 patient confirmatory analysis.

Genomic DNA was extracted from peripheral mononuclear cells of all of the patients studied.

Dr. Sakurada and his colleagues found significant associations for the single intron SNP (rs3219487) in the MUTYH gene. Human MutY homolog (MUTYH) protein is responsible for recognition and removal of an inappropriately inserted adenine (A).

The risk of developing HCC in patients with A/A or G/A genotypes was higher than in those with the G/G genotype (odds ratio = 9.27, 95% confidence interval = 2.39-32.1, P = .0005). In addition, they found that MUTYH mRNA levels were significantly lower in G/A or A/A genotyped subjects as compared with the wild type (G/G) (P = .0157 and P = .0108, respectively).

In their mouse model, the investigators found that liver tumors developed in MUTYH-null mice. As a physiological confirmation of their results, the researchers investigated a MUTYH-null mouse model. They found that decreased MUTYH activity in the null mice resulted in the development of HCC in these animals after 12 months of a high iron diet, but no tumors were observed when a dietary antioxidant (N-Acetyl-L-cysteine) was also provided.

“HCC may develop even in patients with an SVR [sustained virologic response]. This may be a problem especially for the numerous elderly patients. Our study suggests that SNP genotyping may predict the risk of developing HCC in such patients. We propose that in the setting of appropriate screening intervals, stratification of patients for whom antioxidant treatment would be appropriate could be achieved in this manner,” the researchers concluded.

The study was supported by grants from the Japan Society for Scientific Research. The authors reported they had nothing to disclose.

[email protected]

SOURCE: Sakurada A et al. Free Radic Biol Med. 2018;129:88-96.

An adenine mutation in the MUTYH base repair excision gene increased the risk of developing hepatocellular carcinoma (HCC) in patients with chronic hepatitis C virus (HCV). The mutation was discovered in an analysis of 19 tagging single-nucleotide polymorphism (SNP) variants examined for multiple base repair excision genes (MUTYH, OGG1, and MTH1), according to the results of a retrospective analysis of patient genotypes reported in Free Radical Biology and Medicine (2018;129:88-96).

©Gio_tto/Thinkstock.com

In addition, the researchers examined MUTYH-null mice to assess the involvement of oxidative stress and DNA repair enzymes in hepatocarcinogenesis.

One significant SNP was found and confirmed from 93 Japanese patients with chronic HCV (38 with HCC and 55 controls), according to Akira Sakurada, MD, of Sapporo (Japan) Medical University, and his colleagues.

Patients diagnosed as having chronic HCV between 2007 and 2015 were enrolled. All patients were 45 years of age or older with detectable anti-HCV antibodies and HCV-RNA, as well as histopathological evidence of chronic hepatitis on liver biopsy. An exploratory cohort of 40 patients was first used before the 93 patient confirmatory analysis.

Genomic DNA was extracted from peripheral mononuclear cells of all of the patients studied.

Dr. Sakurada and his colleagues found significant associations for the single intron SNP (rs3219487) in the MUTYH gene. Human MutY homolog (MUTYH) protein is responsible for recognition and removal of an inappropriately inserted adenine (A).

The risk of developing HCC in patients with A/A or G/A genotypes was higher than in those with the G/G genotype (odds ratio = 9.27, 95% confidence interval = 2.39-32.1, P = .0005). In addition, they found that MUTYH mRNA levels were significantly lower in G/A or A/A genotyped subjects as compared with the wild type (G/G) (P = .0157 and P = .0108, respectively).

In their mouse model, the investigators found that liver tumors developed in MUTYH-null mice. As a physiological confirmation of their results, the researchers investigated a MUTYH-null mouse model. They found that decreased MUTYH activity in the null mice resulted in the development of HCC in these animals after 12 months of a high iron diet, but no tumors were observed when a dietary antioxidant (N-Acetyl-L-cysteine) was also provided.

“HCC may develop even in patients with an SVR [sustained virologic response]. This may be a problem especially for the numerous elderly patients. Our study suggests that SNP genotyping may predict the risk of developing HCC in such patients. We propose that in the setting of appropriate screening intervals, stratification of patients for whom antioxidant treatment would be appropriate could be achieved in this manner,” the researchers concluded.

The study was supported by grants from the Japan Society for Scientific Research. The authors reported they had nothing to disclose.

[email protected]

SOURCE: Sakurada A et al. Free Radic Biol Med. 2018;129:88-96.

An adenine mutation in the MUTYH base repair excision gene increased the risk of developing hepatocellular carcinoma (HCC) in patients with chronic hepatitis C virus (HCV). The mutation was discovered in an analysis of 19 tagging single-nucleotide polymorphism (SNP) variants examined for multiple base repair excision genes (MUTYH, OGG1, and MTH1), according to the results of a retrospective analysis of patient genotypes reported in Free Radical Biology and Medicine (2018;129:88-96).

©Gio_tto/Thinkstock.com

In addition, the researchers examined MUTYH-null mice to assess the involvement of oxidative stress and DNA repair enzymes in hepatocarcinogenesis.

One significant SNP was found and confirmed from 93 Japanese patients with chronic HCV (38 with HCC and 55 controls), according to Akira Sakurada, MD, of Sapporo (Japan) Medical University, and his colleagues.

Patients diagnosed as having chronic HCV between 2007 and 2015 were enrolled. All patients were 45 years of age or older with detectable anti-HCV antibodies and HCV-RNA, as well as histopathological evidence of chronic hepatitis on liver biopsy. An exploratory cohort of 40 patients was first used before the 93 patient confirmatory analysis.

Genomic DNA was extracted from peripheral mononuclear cells of all of the patients studied.

Dr. Sakurada and his colleagues found significant associations for the single intron SNP (rs3219487) in the MUTYH gene. Human MutY homolog (MUTYH) protein is responsible for recognition and removal of an inappropriately inserted adenine (A).

The risk of developing HCC in patients with A/A or G/A genotypes was higher than in those with the G/G genotype (odds ratio = 9.27, 95% confidence interval = 2.39-32.1, P = .0005). In addition, they found that MUTYH mRNA levels were significantly lower in G/A or A/A genotyped subjects as compared with the wild type (G/G) (P = .0157 and P = .0108, respectively).

In their mouse model, the investigators found that liver tumors developed in MUTYH-null mice. As a physiological confirmation of their results, the researchers investigated a MUTYH-null mouse model. They found that decreased MUTYH activity in the null mice resulted in the development of HCC in these animals after 12 months of a high iron diet, but no tumors were observed when a dietary antioxidant (N-Acetyl-L-cysteine) was also provided.

“HCC may develop even in patients with an SVR [sustained virologic response]. This may be a problem especially for the numerous elderly patients. Our study suggests that SNP genotyping may predict the risk of developing HCC in such patients. We propose that in the setting of appropriate screening intervals, stratification of patients for whom antioxidant treatment would be appropriate could be achieved in this manner,” the researchers concluded.

The study was supported by grants from the Japan Society for Scientific Research. The authors reported they had nothing to disclose.

[email protected]

SOURCE: Sakurada A et al. Free Radic Biol Med. 2018;129:88-96.

Cetuximab plus radiation therapy has worse outcomes than the current standard of radiation and cisplatin for patients with human papillomavirus-positive (HPV+) oropharyngeal cancer. In fact, the researchers, who reported preliminary findings from a phase 3 study funded by the National Cancer Institute (NCI), were “surprised by the loss of tumor control with cetuximab.”

Cetuximab with radiation is an accepted standard of care, especially for patients who cannot tolerate cisplatin, and it is approved for patients with head and neck cancer, including oropharyngeal cancer. Researchers and the NCI are looking for more ways to “de-escalate” therapies for cancers that have a good prognosis, such as HPV+ cancer of the oropharynx. The goal of this trial was to find an alternative to cisplatin that would control the cancer as effectively but with fewer side effects.

The researchers enrolled 849 patients to randomly receive either cetuximab or cisplatin with radiation. The third, final interim analysis, after a median follow-up of 4.5 years, found that overall survival on the cetuximab arm was significantly inferior to the cisplatin arm. Moreover, serious adverse events were similar in both groups, although toxic side effects were more common in the cisplatin arm.

The study is the first randomized clinical trial specifically designed for patients with HPV+ oropharyngeal cancer, and “it establishes cisplatin with radiation as the standard of care.”

Cetuximab plus radiation therapy has worse outcomes than the current standard of radiation and cisplatin for patients with human papillomavirus-positive (HPV+) oropharyngeal cancer. In fact, the researchers, who reported preliminary findings from a phase 3 study funded by the National Cancer Institute (NCI), were “surprised by the loss of tumor control with cetuximab.”

Cetuximab with radiation is an accepted standard of care, especially for patients who cannot tolerate cisplatin, and it is approved for patients with head and neck cancer, including oropharyngeal cancer. Researchers and the NCI are looking for more ways to “de-escalate” therapies for cancers that have a good prognosis, such as HPV+ cancer of the oropharynx. The goal of this trial was to find an alternative to cisplatin that would control the cancer as effectively but with fewer side effects.

The researchers enrolled 849 patients to randomly receive either cetuximab or cisplatin with radiation. The third, final interim analysis, after a median follow-up of 4.5 years, found that overall survival on the cetuximab arm was significantly inferior to the cisplatin arm. Moreover, serious adverse events were similar in both groups, although toxic side effects were more common in the cisplatin arm.

The study is the first randomized clinical trial specifically designed for patients with HPV+ oropharyngeal cancer, and “it establishes cisplatin with radiation as the standard of care.”

Cetuximab plus radiation therapy has worse outcomes than the current standard of radiation and cisplatin for patients with human papillomavirus-positive (HPV+) oropharyngeal cancer. In fact, the researchers, who reported preliminary findings from a phase 3 study funded by the National Cancer Institute (NCI), were “surprised by the loss of tumor control with cetuximab.”

Cetuximab with radiation is an accepted standard of care, especially for patients who cannot tolerate cisplatin, and it is approved for patients with head and neck cancer, including oropharyngeal cancer. Researchers and the NCI are looking for more ways to “de-escalate” therapies for cancers that have a good prognosis, such as HPV+ cancer of the oropharynx. The goal of this trial was to find an alternative to cisplatin that would control the cancer as effectively but with fewer side effects.

The researchers enrolled 849 patients to randomly receive either cetuximab or cisplatin with radiation. The third, final interim analysis, after a median follow-up of 4.5 years, found that overall survival on the cetuximab arm was significantly inferior to the cisplatin arm. Moreover, serious adverse events were similar in both groups, although toxic side effects were more common in the cisplatin arm.

The study is the first randomized clinical trial specifically designed for patients with HPV+ oropharyngeal cancer, and “it establishes cisplatin with radiation as the standard of care.”

The average cost of outpatient care for Medicare recipients with chronic hepatitis B (CH-B) rose by 400% from 2005 to 2014, according to investigators.

utah778/Thinkstock

Inpatient costs also increased, although less dramatically, reported lead author Min Kim, MD, of the Inova Fairfax Hospital Center for Liver Diseases in Falls Church, Virginia, and her colleagues. The causes of these spending hikes may range from policy changes and expanded screening to an aging immigrant population.

“According to the National Health and Nutrition Examination Survey, from 1988 to 2012 most people with CH-B in the United States were foreign born and accounted for up to 70% of all CH-B infections,” the authors wrote in the Journal of Clinical Gastroenterology. “The Centers for Disease Control [and Prevention] estimates that Asians, who comprise 5% of the U.S. population, account for 50% of all chronic CH-B infections.” Despite these statistics, the clinical and economic impacts of an aging immigrant population are unknown. The investigators therefore assessed patient characteristics associated with increased 1-year mortality and the impact of demographic changes on Medicare costs.

The retrospective study began with a random sample of Medicare beneficiaries from 2005 to 2014. From this group, 18,603 patients with CH-B were identified by ICD-9 codes V02.61, 070.2, 070.3, 070.42, and 070.52. Patients with ICD-9-CM codes of 197.7, 155.1, or 155.2 were excluded, as were records containing insufficient information about year, region, or race. Patients were analyzed collectively and as inpatients (n = 6,550) or outpatients (n = 13,648).

Cost of care (per patient, per year) and 1-year mortality were evaluated. Patient characteristics included age, sex, race/ethnicity, geographic region, type of Medicare eligibility, length of stay, Charlson comorbidity index, presence of decompensated cirrhosis, and/or hepatocellular carcinoma (HCC).

Most dramatically, outpatient charges rose more than 400% during the study period, from $9,257 in 2005 to $47,864 in 2014 (P less than .001). Inpatient charges increased by almost 50%, from $66,610 to $94,221 (P less than .001). (All values converted to 2016 dollars.)

Although the increase in outpatient costs appears seismic, the authors noted that costs held steady from 2005 to 2010 before spiking dramatically, reaching a peak of $58,450 in 2013 before settling down to $47,864 the following year. This spike may be caused by changes in screening measures and policies. In 2009, the American Association for the Study of Liver Diseases expanded screening guidelines to include previously ineligible patients with CH-B, and in 2010, the Centers for Medicare & Medicaid Services expanded ICD-9 and ICD-10 codes for CH-B from 9 to 25.

“It seems plausible that the increase in CH-B prevalence, and its associated costs, might actually be a reflection of [these factors],” the authors noted. Still, “additional studies are needed to clarify this observation.”

Turning to patient characteristics, the authors reported that 1-year mortality was independently associated most strongly with decompensated cirrhosis (odds ratio, 3.02) and hepatocellular carcinoma (OR, 2.64). In comparison with white patients, Asians were less likely to die (OR, 0.47).

“It is possible that this can be explained through differences in transmission mode and disease progression of CH-B between these two demographics,” the authors wrote. “A majority of Asian Medicare recipients with CH-B likely acquired it perinatally and did not develop significant liver disease. In contrast, whites with CH-B generally acquired it in adulthood, increasing the chance of developing liver disease.”

Over the 10-year study period, Medicare beneficiaries with CH-B became more frequently Asian and less frequently male. While the number of outpatient visits and average Charlson comorbidity index increased, decreases were reported for length of stay, rates of 1-year mortality, hospitalization, and HCC – the latter of which is most closely associated with higher costs of care.

The investigators suggested that the decreased incidence of HCC was caused by “better screening programs for HCC and/or more widespread use of antiviral treatment for CH-B.”

“Although advances in antiviral treatment have effectively reduced hospitalization and disease progression,” the authors wrote, “vulnerable groups – especially immigrants and individuals living in poverty – present an important challenge for better identification of infected individuals and their linkage to care. In this context, it is vital to target these cohorts to reduce further mortality and resource utilization, as well as optimize long-term public health and financial benefits.”

Study funding was provided by Seattle Genetics. One coauthor reported compensation from Gilead Sciences, AbbVie, Intercept Pharmaceuticals, GlaxoSmithKline, and Bristol-Myers Squibb.

SOURCE: Kim M et al. J Clin Gastro. 2018 Aug 13. doi: 10.1097/MCG.0000000000001110.

The average cost of outpatient care for Medicare recipients with chronic hepatitis B (CH-B) rose by 400% from 2005 to 2014, according to investigators.

utah778/Thinkstock

Inpatient costs also increased, although less dramatically, reported lead author Min Kim, MD, of the Inova Fairfax Hospital Center for Liver Diseases in Falls Church, Virginia, and her colleagues. The causes of these spending hikes may range from policy changes and expanded screening to an aging immigrant population.

“According to the National Health and Nutrition Examination Survey, from 1988 to 2012 most people with CH-B in the United States were foreign born and accounted for up to 70% of all CH-B infections,” the authors wrote in the Journal of Clinical Gastroenterology. “The Centers for Disease Control [and Prevention] estimates that Asians, who comprise 5% of the U.S. population, account for 50% of all chronic CH-B infections.” Despite these statistics, the clinical and economic impacts of an aging immigrant population are unknown. The investigators therefore assessed patient characteristics associated with increased 1-year mortality and the impact of demographic changes on Medicare costs.

The retrospective study began with a random sample of Medicare beneficiaries from 2005 to 2014. From this group, 18,603 patients with CH-B were identified by ICD-9 codes V02.61, 070.2, 070.3, 070.42, and 070.52. Patients with ICD-9-CM codes of 197.7, 155.1, or 155.2 were excluded, as were records containing insufficient information about year, region, or race. Patients were analyzed collectively and as inpatients (n = 6,550) or outpatients (n = 13,648).

Cost of care (per patient, per year) and 1-year mortality were evaluated. Patient characteristics included age, sex, race/ethnicity, geographic region, type of Medicare eligibility, length of stay, Charlson comorbidity index, presence of decompensated cirrhosis, and/or hepatocellular carcinoma (HCC).

Most dramatically, outpatient charges rose more than 400% during the study period, from $9,257 in 2005 to $47,864 in 2014 (P less than .001). Inpatient charges increased by almost 50%, from $66,610 to $94,221 (P less than .001). (All values converted to 2016 dollars.)

Although the increase in outpatient costs appears seismic, the authors noted that costs held steady from 2005 to 2010 before spiking dramatically, reaching a peak of $58,450 in 2013 before settling down to $47,864 the following year. This spike may be caused by changes in screening measures and policies. In 2009, the American Association for the Study of Liver Diseases expanded screening guidelines to include previously ineligible patients with CH-B, and in 2010, the Centers for Medicare & Medicaid Services expanded ICD-9 and ICD-10 codes for CH-B from 9 to 25.

“It seems plausible that the increase in CH-B prevalence, and its associated costs, might actually be a reflection of [these factors],” the authors noted. Still, “additional studies are needed to clarify this observation.”

Turning to patient characteristics, the authors reported that 1-year mortality was independently associated most strongly with decompensated cirrhosis (odds ratio, 3.02) and hepatocellular carcinoma (OR, 2.64). In comparison with white patients, Asians were less likely to die (OR, 0.47).

“It is possible that this can be explained through differences in transmission mode and disease progression of CH-B between these two demographics,” the authors wrote. “A majority of Asian Medicare recipients with CH-B likely acquired it perinatally and did not develop significant liver disease. In contrast, whites with CH-B generally acquired it in adulthood, increasing the chance of developing liver disease.”

Over the 10-year study period, Medicare beneficiaries with CH-B became more frequently Asian and less frequently male. While the number of outpatient visits and average Charlson comorbidity index increased, decreases were reported for length of stay, rates of 1-year mortality, hospitalization, and HCC – the latter of which is most closely associated with higher costs of care.

The investigators suggested that the decreased incidence of HCC was caused by “better screening programs for HCC and/or more widespread use of antiviral treatment for CH-B.”

“Although advances in antiviral treatment have effectively reduced hospitalization and disease progression,” the authors wrote, “vulnerable groups – especially immigrants and individuals living in poverty – present an important challenge for better identification of infected individuals and their linkage to care. In this context, it is vital to target these cohorts to reduce further mortality and resource utilization, as well as optimize long-term public health and financial benefits.”

Study funding was provided by Seattle Genetics. One coauthor reported compensation from Gilead Sciences, AbbVie, Intercept Pharmaceuticals, GlaxoSmithKline, and Bristol-Myers Squibb.

SOURCE: Kim M et al. J Clin Gastro. 2018 Aug 13. doi: 10.1097/MCG.0000000000001110.

The average cost of outpatient care for Medicare recipients with chronic hepatitis B (CH-B) rose by 400% from 2005 to 2014, according to investigators.

utah778/Thinkstock

Inpatient costs also increased, although less dramatically, reported lead author Min Kim, MD, of the Inova Fairfax Hospital Center for Liver Diseases in Falls Church, Virginia, and her colleagues. The causes of these spending hikes may range from policy changes and expanded screening to an aging immigrant population.

“According to the National Health and Nutrition Examination Survey, from 1988 to 2012 most people with CH-B in the United States were foreign born and accounted for up to 70% of all CH-B infections,” the authors wrote in the Journal of Clinical Gastroenterology. “The Centers for Disease Control [and Prevention] estimates that Asians, who comprise 5% of the U.S. population, account for 50% of all chronic CH-B infections.” Despite these statistics, the clinical and economic impacts of an aging immigrant population are unknown. The investigators therefore assessed patient characteristics associated with increased 1-year mortality and the impact of demographic changes on Medicare costs.

The retrospective study began with a random sample of Medicare beneficiaries from 2005 to 2014. From this group, 18,603 patients with CH-B were identified by ICD-9 codes V02.61, 070.2, 070.3, 070.42, and 070.52. Patients with ICD-9-CM codes of 197.7, 155.1, or 155.2 were excluded, as were records containing insufficient information about year, region, or race. Patients were analyzed collectively and as inpatients (n = 6,550) or outpatients (n = 13,648).

Cost of care (per patient, per year) and 1-year mortality were evaluated. Patient characteristics included age, sex, race/ethnicity, geographic region, type of Medicare eligibility, length of stay, Charlson comorbidity index, presence of decompensated cirrhosis, and/or hepatocellular carcinoma (HCC).

Most dramatically, outpatient charges rose more than 400% during the study period, from $9,257 in 2005 to $47,864 in 2014 (P less than .001). Inpatient charges increased by almost 50%, from $66,610 to $94,221 (P less than .001). (All values converted to 2016 dollars.)

Although the increase in outpatient costs appears seismic, the authors noted that costs held steady from 2005 to 2010 before spiking dramatically, reaching a peak of $58,450 in 2013 before settling down to $47,864 the following year. This spike may be caused by changes in screening measures and policies. In 2009, the American Association for the Study of Liver Diseases expanded screening guidelines to include previously ineligible patients with CH-B, and in 2010, the Centers for Medicare & Medicaid Services expanded ICD-9 and ICD-10 codes for CH-B from 9 to 25.

“It seems plausible that the increase in CH-B prevalence, and its associated costs, might actually be a reflection of [these factors],” the authors noted. Still, “additional studies are needed to clarify this observation.”

Turning to patient characteristics, the authors reported that 1-year mortality was independently associated most strongly with decompensated cirrhosis (odds ratio, 3.02) and hepatocellular carcinoma (OR, 2.64). In comparison with white patients, Asians were less likely to die (OR, 0.47).

“It is possible that this can be explained through differences in transmission mode and disease progression of CH-B between these two demographics,” the authors wrote. “A majority of Asian Medicare recipients with CH-B likely acquired it perinatally and did not develop significant liver disease. In contrast, whites with CH-B generally acquired it in adulthood, increasing the chance of developing liver disease.”

Over the 10-year study period, Medicare beneficiaries with CH-B became more frequently Asian and less frequently male. While the number of outpatient visits and average Charlson comorbidity index increased, decreases were reported for length of stay, rates of 1-year mortality, hospitalization, and HCC – the latter of which is most closely associated with higher costs of care.

The investigators suggested that the decreased incidence of HCC was caused by “better screening programs for HCC and/or more widespread use of antiviral treatment for CH-B.”

“Although advances in antiviral treatment have effectively reduced hospitalization and disease progression,” the authors wrote, “vulnerable groups – especially immigrants and individuals living in poverty – present an important challenge for better identification of infected individuals and their linkage to care. In this context, it is vital to target these cohorts to reduce further mortality and resource utilization, as well as optimize long-term public health and financial benefits.”

Study funding was provided by Seattle Genetics. One coauthor reported compensation from Gilead Sciences, AbbVie, Intercept Pharmaceuticals, GlaxoSmithKline, and Bristol-Myers Squibb.

SOURCE: Kim M et al. J Clin Gastro. 2018 Aug 13. doi: 10.1097/MCG.0000000000001110.

The reported prevalence of occult hepatitis B infection (OBI) varies widely: from < 1% to as high as 89.5% in HIV patients. Among patients with chronic hepatitis, the prevalence—again—ranges widely, from 0% to 52% but is highest in patients with chronic hepatitis C (CHC).

The clinical impact of OBI on patients with CHC has been extensively investigated, say researchers from the Institute of Liver and Biliary Sciences in New Delhi, India, but the available data are conflicting. In fact, when they conducted their study to assess the prevalence of OBI and evaluate its impact on clinical outcomes and response to antiviral therapy in CHC, the findings were “largely inconclusive.”

The study included 80 patients, of whom 32 (40%) had seropositive OBI. Hepatitis C virus genotype information was available for 59 patients, revealing that genotype 3 was most common.

However, analysis of clinical, biochemical, histopathologic and treatment response based on seropositivity and semiquantitative estimate of anti-HBc did not yield statistically significant results. Plasma samples of 14 were reactive for anti-HBc, 12 for anti-HBs, and 6 for both antibodies. Hepatitis B virus DNA (34 IU/mL) was detected in the plasma sample of only 1 patient by quantitative polymerase chain reaction.  Therefore, the researchers say, the prevalence of OBI was 1.25%.

Anti-HBc total antibody levels did not influence clinical outcomes and response to directly acting antiviral therapy. Nor did genotype make a significant difference: 90.7% of genotype 3 patients and 92.8% of genotype 1 patients attained sustained virologic response.

More prospective studies should be conducted, the researchers urge, to further explore “this seemingly enigmatic issue.” 

Source:
Bhatia M, Gupta E, Choudhary MC, Jindal A, Sarin SK. J Lab Physicians. 2018;10(3):304-308.
doi:  10.4103/JLP.JLP_12_18.

The reported prevalence of occult hepatitis B infection (OBI) varies widely: from < 1% to as high as 89.5% in HIV patients. Among patients with chronic hepatitis, the prevalence—again—ranges widely, from 0% to 52% but is highest in patients with chronic hepatitis C (CHC).

The clinical impact of OBI on patients with CHC has been extensively investigated, say researchers from the Institute of Liver and Biliary Sciences in New Delhi, India, but the available data are conflicting. In fact, when they conducted their study to assess the prevalence of OBI and evaluate its impact on clinical outcomes and response to antiviral therapy in CHC, the findings were “largely inconclusive.”

The study included 80 patients, of whom 32 (40%) had seropositive OBI. Hepatitis C virus genotype information was available for 59 patients, revealing that genotype 3 was most common.

However, analysis of clinical, biochemical, histopathologic and treatment response based on seropositivity and semiquantitative estimate of anti-HBc did not yield statistically significant results. Plasma samples of 14 were reactive for anti-HBc, 12 for anti-HBs, and 6 for both antibodies. Hepatitis B virus DNA (34 IU/mL) was detected in the plasma sample of only 1 patient by quantitative polymerase chain reaction.  Therefore, the researchers say, the prevalence of OBI was 1.25%.

Anti-HBc total antibody levels did not influence clinical outcomes and response to directly acting antiviral therapy. Nor did genotype make a significant difference: 90.7% of genotype 3 patients and 92.8% of genotype 1 patients attained sustained virologic response.

More prospective studies should be conducted, the researchers urge, to further explore “this seemingly enigmatic issue.” 

Source:
Bhatia M, Gupta E, Choudhary MC, Jindal A, Sarin SK. J Lab Physicians. 2018;10(3):304-308.
doi:  10.4103/JLP.JLP_12_18.

The reported prevalence of occult hepatitis B infection (OBI) varies widely: from < 1% to as high as 89.5% in HIV patients. Among patients with chronic hepatitis, the prevalence—again—ranges widely, from 0% to 52% but is highest in patients with chronic hepatitis C (CHC).

The clinical impact of OBI on patients with CHC has been extensively investigated, say researchers from the Institute of Liver and Biliary Sciences in New Delhi, India, but the available data are conflicting. In fact, when they conducted their study to assess the prevalence of OBI and evaluate its impact on clinical outcomes and response to antiviral therapy in CHC, the findings were “largely inconclusive.”

The study included 80 patients, of whom 32 (40%) had seropositive OBI. Hepatitis C virus genotype information was available for 59 patients, revealing that genotype 3 was most common.

However, analysis of clinical, biochemical, histopathologic and treatment response based on seropositivity and semiquantitative estimate of anti-HBc did not yield statistically significant results. Plasma samples of 14 were reactive for anti-HBc, 12 for anti-HBs, and 6 for both antibodies. Hepatitis B virus DNA (34 IU/mL) was detected in the plasma sample of only 1 patient by quantitative polymerase chain reaction.  Therefore, the researchers say, the prevalence of OBI was 1.25%.

Anti-HBc total antibody levels did not influence clinical outcomes and response to directly acting antiviral therapy. Nor did genotype make a significant difference: 90.7% of genotype 3 patients and 92.8% of genotype 1 patients attained sustained virologic response.

More prospective studies should be conducted, the researchers urge, to further explore “this seemingly enigmatic issue.” 

Source:
Bhatia M, Gupta E, Choudhary MC, Jindal A, Sarin SK. J Lab Physicians. 2018;10(3):304-308.
doi:  10.4103/JLP.JLP_12_18.

As patients with HIV, hepatitis B (HBV), and hepatitis C (HCV) live longer, more active lives with the help of antiviral treatments, they are now more often having joint replacement surgeries. But HIV, HBV, and HCV can increase the risk of postoperative complications, say researchers from Duke University in North Carolina.

The researchers studied 16,338 patients in 4 cohorts: those with HIV, HBV, HCV, and HIV plus HBV or HCV. They evaluated the patients at 30 days, 90 days, and 2 years after total joint arthroplasty (TJA), comparing their progress with that of a control group.

Patients with HBV and HCV were at risk of both acute and long-term medical and surgical complications. At 90 days and 2 years, the participants had increased risk of pneumonia, sepsis, joint infection, and revision surgery. They also had a greater risk of complications than did patients with HIV, especially for infection, within the first 90 days postsurgery.

Notably, after TJA, patients with HCV had increased risk of acute kidney injury, sepsis, and transfusion at 30 and 90 days. After hip replacement, patients with HBV had a higher risk of acute kidney injury, pneumonia, and transfusion at 30 and 90 days.

Only 364 patients in the study had both HIV and HBV or HBC, but they did have a greater risk of transfusion at 30 and 90 days following both knee and hip surgery.

Following total hip arthroplasty, patients with HIV were more at risk for deep vein thrombosis and transfusion rather than infection. The lower incidence of infection is likely to be related to effective  highly active antiretroviral therapy, the researchers say. HIV patients also were more likely to have mechanical complications, such as loosening, periprosthetic fracture, and revision at 90 days, but not at 2 years. Patients with HIV who underwent total knee arthroplasty (TKA) had a higher risk of death at 30 days and medical complications at 90 days. At 2 years, they had a higher risk of periprosthetic joint infection, irrigation and debridement, and revision. The researchers say the higher incidence of mechanical complications can be explained by the younger, more active, and healthy HIV patients in the cohort—the majority were aged younger than 65 years. They also emphasize that the only risk of infection following TJA in their study was 2 years after TKA.

The researchers suggest that their findings could help prompt future guidelines supporting routine screening prior to elective TJA.

Source:
Kildow BJ, Politzer CS, DiLallo M, Bolognesi MP, Seyler TM. J Arthroplasty. 2018;33(suppl 7):S86-S92.
doi: 10.1016/j.arth.2017.10.061.

As patients with HIV, hepatitis B (HBV), and hepatitis C (HCV) live longer, more active lives with the help of antiviral treatments, they are now more often having joint replacement surgeries. But HIV, HBV, and HCV can increase the risk of postoperative complications, say researchers from Duke University in North Carolina.

The researchers studied 16,338 patients in 4 cohorts: those with HIV, HBV, HCV, and HIV plus HBV or HCV. They evaluated the patients at 30 days, 90 days, and 2 years after total joint arthroplasty (TJA), comparing their progress with that of a control group.

Patients with HBV and HCV were at risk of both acute and long-term medical and surgical complications. At 90 days and 2 years, the participants had increased risk of pneumonia, sepsis, joint infection, and revision surgery. They also had a greater risk of complications than did patients with HIV, especially for infection, within the first 90 days postsurgery.

Notably, after TJA, patients with HCV had increased risk of acute kidney injury, sepsis, and transfusion at 30 and 90 days. After hip replacement, patients with HBV had a higher risk of acute kidney injury, pneumonia, and transfusion at 30 and 90 days.

Only 364 patients in the study had both HIV and HBV or HBC, but they did have a greater risk of transfusion at 30 and 90 days following both knee and hip surgery.

Following total hip arthroplasty, patients with HIV were more at risk for deep vein thrombosis and transfusion rather than infection. The lower incidence of infection is likely to be related to effective  highly active antiretroviral therapy, the researchers say. HIV patients also were more likely to have mechanical complications, such as loosening, periprosthetic fracture, and revision at 90 days, but not at 2 years. Patients with HIV who underwent total knee arthroplasty (TKA) had a higher risk of death at 30 days and medical complications at 90 days. At 2 years, they had a higher risk of periprosthetic joint infection, irrigation and debridement, and revision. The researchers say the higher incidence of mechanical complications can be explained by the younger, more active, and healthy HIV patients in the cohort—the majority were aged younger than 65 years. They also emphasize that the only risk of infection following TJA in their study was 2 years after TKA.

The researchers suggest that their findings could help prompt future guidelines supporting routine screening prior to elective TJA.

Source:
Kildow BJ, Politzer CS, DiLallo M, Bolognesi MP, Seyler TM. J Arthroplasty. 2018;33(suppl 7):S86-S92.
doi: 10.1016/j.arth.2017.10.061.

As patients with HIV, hepatitis B (HBV), and hepatitis C (HCV) live longer, more active lives with the help of antiviral treatments, they are now more often having joint replacement surgeries. But HIV, HBV, and HCV can increase the risk of postoperative complications, say researchers from Duke University in North Carolina.

The researchers studied 16,338 patients in 4 cohorts: those with HIV, HBV, HCV, and HIV plus HBV or HCV. They evaluated the patients at 30 days, 90 days, and 2 years after total joint arthroplasty (TJA), comparing their progress with that of a control group.

Patients with HBV and HCV were at risk of both acute and long-term medical and surgical complications. At 90 days and 2 years, the participants had increased risk of pneumonia, sepsis, joint infection, and revision surgery. They also had a greater risk of complications than did patients with HIV, especially for infection, within the first 90 days postsurgery.

Notably, after TJA, patients with HCV had increased risk of acute kidney injury, sepsis, and transfusion at 30 and 90 days. After hip replacement, patients with HBV had a higher risk of acute kidney injury, pneumonia, and transfusion at 30 and 90 days.

Only 364 patients in the study had both HIV and HBV or HBC, but they did have a greater risk of transfusion at 30 and 90 days following both knee and hip surgery.

Following total hip arthroplasty, patients with HIV were more at risk for deep vein thrombosis and transfusion rather than infection. The lower incidence of infection is likely to be related to effective  highly active antiretroviral therapy, the researchers say. HIV patients also were more likely to have mechanical complications, such as loosening, periprosthetic fracture, and revision at 90 days, but not at 2 years. Patients with HIV who underwent total knee arthroplasty (TKA) had a higher risk of death at 30 days and medical complications at 90 days. At 2 years, they had a higher risk of periprosthetic joint infection, irrigation and debridement, and revision. The researchers say the higher incidence of mechanical complications can be explained by the younger, more active, and healthy HIV patients in the cohort—the majority were aged younger than 65 years. They also emphasize that the only risk of infection following TJA in their study was 2 years after TKA.

The researchers suggest that their findings could help prompt future guidelines supporting routine screening prior to elective TJA.

Source:
Kildow BJ, Politzer CS, DiLallo M, Bolognesi MP, Seyler TM. J Arthroplasty. 2018;33(suppl 7):S86-S92.
doi: 10.1016/j.arth.2017.10.061.

Up to 40% of hepatitis C virus (HCV)–infected individuals clear their infection spontaneously, based on the results of a new mathematical model of HCV transmission and clearance, according to a report published online in the International Journal of Infectious Diseases.

Houssein H. Ayoub, PhD, of Cornell University, New York, and his colleagues conducted a study on HCV clearance. Previous estimates using empirical data indicated that the HCV clearance rate was about 25% after and acute infection duration of 16.5 weeks, according to Dr. Ayoub and his colleagues.

They developed a model to describe HCV transmission and a virus clearance rate (f_clearance), defined as the proportion of HCV-infected persons who spontaneously clear their infection after the acute stage. The rest of the infected population (1–f_clearance) become chronically infected and positive for both HCV antibodies and HCV RNA.This was estimated by fitting the model to probability-based and nationally representative, population-based data from Egypt (2008 and 2015), and the U.S. National Health and Nutrition Examination Surveys (NHANES A and NHANES B) data. Their model showed that f_clearance was related to the HCV viremic rate approximately as f_clearance = 1.16 x (1–HCV viremic rate). The HCV viremic rate was defined as the proportion of individuals who were positive for HCV antibodies and HCV RNA out of all who were positive for HCV antibodies positive, regardless of RNA status, as measured in a cross-sectional survey.

Antibody prevalence in Egypt was estimated at 14.7% in 2008 and 10.0% in 2015, while the viremic rate was assessed as 67.1% and 70.2%, respectively. For the United States, the pooled antibody prevalence from the NHANES A data between 1999 and 2012 was an estimated 1.4% and the pooled viremic rate was estimated at around 74%. The NHANES B data used as the denominator for HCV viremic rate both individuals confirmed as HCV Ab positive and those with an undetermined HCV antibody status. (NHANES laboratory procedures can provide this added information because of their subsequent testing of undetermined HCV antibody results for HCV RNA positivity.) This change to the formula yielded a viremic rate of 64.6%.

They found that fclearan_ce was an estimated at 39.9% and 33.5% for Egypt in 2008 and 2015, respectively, and 29.6% and 49.9% for NHANES A and NHANES B, respectively.

“Empirical measures from longitudinal cohort studies may have underestimated the ability of the host immune system to clear HCV infection. This finding may have also implications for our understanding of the biological determinants of HCV spontaneous clearance. It may hint that a strategy for HCV vaccine development could be a vaccine that does not necessarily prevent infection, but modulates immune response towards conditions that increase the capacity of the host immune system to clear HCV infection spontaneously,” the researchers concluded.

The study was funded by the Qatar National Research Fund and Cornell University. The authors reported no conflicts of interest.

[email protected]

SOURCE: Ayoub HH et al. Int J Infect Dis. 2018 Jul 18. doi: 10.1016/j.ijid.2018.07.013.

Up to 40% of hepatitis C virus (HCV)–infected individuals clear their infection spontaneously, based on the results of a new mathematical model of HCV transmission and clearance, according to a report published online in the International Journal of Infectious Diseases.

Houssein H. Ayoub, PhD, of Cornell University, New York, and his colleagues conducted a study on HCV clearance. Previous estimates using empirical data indicated that the HCV clearance rate was about 25% after and acute infection duration of 16.5 weeks, according to Dr. Ayoub and his colleagues.

They developed a model to describe HCV transmission and a virus clearance rate (f_clearance), defined as the proportion of HCV-infected persons who spontaneously clear their infection after the acute stage. The rest of the infected population (1–f_clearance) become chronically infected and positive for both HCV antibodies and HCV RNA.This was estimated by fitting the model to probability-based and nationally representative, population-based data from Egypt (2008 and 2015), and the U.S. National Health and Nutrition Examination Surveys (NHANES A and NHANES B) data. Their model showed that f_clearance was related to the HCV viremic rate approximately as f_clearance = 1.16 x (1–HCV viremic rate). The HCV viremic rate was defined as the proportion of individuals who were positive for HCV antibodies and HCV RNA out of all who were positive for HCV antibodies positive, regardless of RNA status, as measured in a cross-sectional survey.

Antibody prevalence in Egypt was estimated at 14.7% in 2008 and 10.0% in 2015, while the viremic rate was assessed as 67.1% and 70.2%, respectively. For the United States, the pooled antibody prevalence from the NHANES A data between 1999 and 2012 was an estimated 1.4% and the pooled viremic rate was estimated at around 74%. The NHANES B data used as the denominator for HCV viremic rate both individuals confirmed as HCV Ab positive and those with an undetermined HCV antibody status. (NHANES laboratory procedures can provide this added information because of their subsequent testing of undetermined HCV antibody results for HCV RNA positivity.) This change to the formula yielded a viremic rate of 64.6%.

They found that fclearan_ce was an estimated at 39.9% and 33.5% for Egypt in 2008 and 2015, respectively, and 29.6% and 49.9% for NHANES A and NHANES B, respectively.

“Empirical measures from longitudinal cohort studies may have underestimated the ability of the host immune system to clear HCV infection. This finding may have also implications for our understanding of the biological determinants of HCV spontaneous clearance. It may hint that a strategy for HCV vaccine development could be a vaccine that does not necessarily prevent infection, but modulates immune response towards conditions that increase the capacity of the host immune system to clear HCV infection spontaneously,” the researchers concluded.

The study was funded by the Qatar National Research Fund and Cornell University. The authors reported no conflicts of interest.

[email protected]

SOURCE: Ayoub HH et al. Int J Infect Dis. 2018 Jul 18. doi: 10.1016/j.ijid.2018.07.013.

Up to 40% of hepatitis C virus (HCV)–infected individuals clear their infection spontaneously, based on the results of a new mathematical model of HCV transmission and clearance, according to a report published online in the International Journal of Infectious Diseases.

Houssein H. Ayoub, PhD, of Cornell University, New York, and his colleagues conducted a study on HCV clearance. Previous estimates using empirical data indicated that the HCV clearance rate was about 25% after and acute infection duration of 16.5 weeks, according to Dr. Ayoub and his colleagues.

They developed a model to describe HCV transmission and a virus clearance rate (f_clearance), defined as the proportion of HCV-infected persons who spontaneously clear their infection after the acute stage. The rest of the infected population (1–f_clearance) become chronically infected and positive for both HCV antibodies and HCV RNA.This was estimated by fitting the model to probability-based and nationally representative, population-based data from Egypt (2008 and 2015), and the U.S. National Health and Nutrition Examination Surveys (NHANES A and NHANES B) data. Their model showed that f_clearance was related to the HCV viremic rate approximately as f_clearance = 1.16 x (1–HCV viremic rate). The HCV viremic rate was defined as the proportion of individuals who were positive for HCV antibodies and HCV RNA out of all who were positive for HCV antibodies positive, regardless of RNA status, as measured in a cross-sectional survey.

Antibody prevalence in Egypt was estimated at 14.7% in 2008 and 10.0% in 2015, while the viremic rate was assessed as 67.1% and 70.2%, respectively. For the United States, the pooled antibody prevalence from the NHANES A data between 1999 and 2012 was an estimated 1.4% and the pooled viremic rate was estimated at around 74%. The NHANES B data used as the denominator for HCV viremic rate both individuals confirmed as HCV Ab positive and those with an undetermined HCV antibody status. (NHANES laboratory procedures can provide this added information because of their subsequent testing of undetermined HCV antibody results for HCV RNA positivity.) This change to the formula yielded a viremic rate of 64.6%.

They found that fclearan_ce was an estimated at 39.9% and 33.5% for Egypt in 2008 and 2015, respectively, and 29.6% and 49.9% for NHANES A and NHANES B, respectively.

“Empirical measures from longitudinal cohort studies may have underestimated the ability of the host immune system to clear HCV infection. This finding may have also implications for our understanding of the biological determinants of HCV spontaneous clearance. It may hint that a strategy for HCV vaccine development could be a vaccine that does not necessarily prevent infection, but modulates immune response towards conditions that increase the capacity of the host immune system to clear HCV infection spontaneously,” the researchers concluded.

The study was funded by the Qatar National Research Fund and Cornell University. The authors reported no conflicts of interest.

[email protected]

SOURCE: Ayoub HH et al. Int J Infect Dis. 2018 Jul 18. doi: 10.1016/j.ijid.2018.07.013.

With drug overdoses being the leading cause of accidental death in the United States, knowing the predictors of opioid overdose may help target treatment and prevention efforts to deal with this growing problem, according to Samantha Schiavon, MA, a graduate student in medical and clinical psychology, and her colleagues at the University of Alabama at Birmingham.

Hailshadow/iStock/Getty Images

They performed a study that found a variety of factors associated with increased risk of opioid overdose, including witnessing an overdose (a friend or others), chronic hepatitis C virus (HCV) infection, and a higher frequency of distinct buprenorphine treatment episodes.

Data were acquired during Nov. 2015-July 2017 from an ongoing study to determine the impact of the distribution of naloxone kits to individuals at high risk for opioid overdose. All 247 participants included were considered at high risk of opioid overdose because they were recruited from sites providing opioid addiction treatment, including a residential drug treatment facility (43%), inpatient treatment following ED admittance (25%), and criminal justice supervision (32%). Of the participants, 57% were male, with a mean age of around 34 years; most were white (89%).

Participants were assessed using a self-reporting 30-item questionnaire regarding chronic medical conditions, STIs, past and current opioid misuse, nonfatal opioid overdose experiences, and frequency of every distinct opioid treatment episode including buprenorphine, methadone maintenance clinics, residential drug rehabilitation programs, and intensive outpatient treatment. All variables were answered on a 5-point scale ranging from 0 (never) to 4 (more than three times), according to the researchers.

Participants who witnessed a friend’s overdose (odds ratio, 4.21; 95% confidence interval, 1.99-8.89) showed the highest risk of personal overdose, while having witnessed others overdose at a higher frequency carried a lower increased risk (OR, 1.42; 95% CI, 1.11-1.82).

HCV infection was associated with a more than twofold increase in overdose risk (OR, 2.44; 95% CI, 1.20-4.97), likely because of the strong association between HCV and heroin injection drug use, according to the researchers. They added that this association may be an indicator of higher-risk injection behavior, including needle sharing. They also suggested that, given the current epidemiology of HCV infection, identifying HCV infections may benefit younger populations who may be at risk of an overdose from riskier injection practices or where injection drug risk is not yet known.

The researchers reported that a higher frequency of distinct buprenorphine treatment episodes also led to increased risk (OR, 1.55; 95% CI, 1.17-2.07), whereas a greater frequency of distinct methadone treatment episodes was related to decreased odds of experiencing a nonfatal overdose (OR, 0.67; 95% CI, 0.49-0.91) according to their report published in Addictive Behavior (2018;86:51-5).

In addition, those who experienced a past opioid overdose were more likely to have obtained methadone illicitly (65%; P less than or equal to .001) or have a friend who died from an overdose (90%; P = .001) compared with those who have not experienced an overdose, according to the researchers.

“The current study strongly contributes to our understanding of risk factors of experiencing an opioid overdose. The knowledge gained from this study may enable targeted treatment interventions to reduce preventable deaths from opioid overdose,” according to the researchers. In particular, they pointed out the increased risk of overdose with the use of illicitly obtained methadone and suggested that expanded access to medication-assisted treatments be made available to all patients. “Opioid antagonist medications such as naltrexone may be particularly helpful in preventing opioid overdose for patients leaving controlled environments such as hospital, drug treatment, and correctional facilities,” they concluded.

The researchers reported that they had no conflicts of interest.
 

[email protected]
 

SOURCE: Schiavon S et al. Addict Behav. 2018;86:51-5.

With drug overdoses being the leading cause of accidental death in the United States, knowing the predictors of opioid overdose may help target treatment and prevention efforts to deal with this growing problem, according to Samantha Schiavon, MA, a graduate student in medical and clinical psychology, and her colleagues at the University of Alabama at Birmingham.

Hailshadow/iStock/Getty Images

They performed a study that found a variety of factors associated with increased risk of opioid overdose, including witnessing an overdose (a friend or others), chronic hepatitis C virus (HCV) infection, and a higher frequency of distinct buprenorphine treatment episodes.

Data were acquired during Nov. 2015-July 2017 from an ongoing study to determine the impact of the distribution of naloxone kits to individuals at high risk for opioid overdose. All 247 participants included were considered at high risk of opioid overdose because they were recruited from sites providing opioid addiction treatment, including a residential drug treatment facility (43%), inpatient treatment following ED admittance (25%), and criminal justice supervision (32%). Of the participants, 57% were male, with a mean age of around 34 years; most were white (89%).

Participants were assessed using a self-reporting 30-item questionnaire regarding chronic medical conditions, STIs, past and current opioid misuse, nonfatal opioid overdose experiences, and frequency of every distinct opioid treatment episode including buprenorphine, methadone maintenance clinics, residential drug rehabilitation programs, and intensive outpatient treatment. All variables were answered on a 5-point scale ranging from 0 (never) to 4 (more than three times), according to the researchers.

Participants who witnessed a friend’s overdose (odds ratio, 4.21; 95% confidence interval, 1.99-8.89) showed the highest risk of personal overdose, while having witnessed others overdose at a higher frequency carried a lower increased risk (OR, 1.42; 95% CI, 1.11-1.82).

HCV infection was associated with a more than twofold increase in overdose risk (OR, 2.44; 95% CI, 1.20-4.97), likely because of the strong association between HCV and heroin injection drug use, according to the researchers. They added that this association may be an indicator of higher-risk injection behavior, including needle sharing. They also suggested that, given the current epidemiology of HCV infection, identifying HCV infections may benefit younger populations who may be at risk of an overdose from riskier injection practices or where injection drug risk is not yet known.

The researchers reported that a higher frequency of distinct buprenorphine treatment episodes also led to increased risk (OR, 1.55; 95% CI, 1.17-2.07), whereas a greater frequency of distinct methadone treatment episodes was related to decreased odds of experiencing a nonfatal overdose (OR, 0.67; 95% CI, 0.49-0.91) according to their report published in Addictive Behavior (2018;86:51-5).

In addition, those who experienced a past opioid overdose were more likely to have obtained methadone illicitly (65%; P less than or equal to .001) or have a friend who died from an overdose (90%; P = .001) compared with those who have not experienced an overdose, according to the researchers.

“The current study strongly contributes to our understanding of risk factors of experiencing an opioid overdose. The knowledge gained from this study may enable targeted treatment interventions to reduce preventable deaths from opioid overdose,” according to the researchers. In particular, they pointed out the increased risk of overdose with the use of illicitly obtained methadone and suggested that expanded access to medication-assisted treatments be made available to all patients. “Opioid antagonist medications such as naltrexone may be particularly helpful in preventing opioid overdose for patients leaving controlled environments such as hospital, drug treatment, and correctional facilities,” they concluded.

The researchers reported that they had no conflicts of interest.
 

[email protected]
 

SOURCE: Schiavon S et al. Addict Behav. 2018;86:51-5.

With drug overdoses being the leading cause of accidental death in the United States, knowing the predictors of opioid overdose may help target treatment and prevention efforts to deal with this growing problem, according to Samantha Schiavon, MA, a graduate student in medical and clinical psychology, and her colleagues at the University of Alabama at Birmingham.

Hailshadow/iStock/Getty Images

They performed a study that found a variety of factors associated with increased risk of opioid overdose, including witnessing an overdose (a friend or others), chronic hepatitis C virus (HCV) infection, and a higher frequency of distinct buprenorphine treatment episodes.

Data were acquired during Nov. 2015-July 2017 from an ongoing study to determine the impact of the distribution of naloxone kits to individuals at high risk for opioid overdose. All 247 participants included were considered at high risk of opioid overdose because they were recruited from sites providing opioid addiction treatment, including a residential drug treatment facility (43%), inpatient treatment following ED admittance (25%), and criminal justice supervision (32%). Of the participants, 57% were male, with a mean age of around 34 years; most were white (89%).

Participants were assessed using a self-reporting 30-item questionnaire regarding chronic medical conditions, STIs, past and current opioid misuse, nonfatal opioid overdose experiences, and frequency of every distinct opioid treatment episode including buprenorphine, methadone maintenance clinics, residential drug rehabilitation programs, and intensive outpatient treatment. All variables were answered on a 5-point scale ranging from 0 (never) to 4 (more than three times), according to the researchers.

Participants who witnessed a friend’s overdose (odds ratio, 4.21; 95% confidence interval, 1.99-8.89) showed the highest risk of personal overdose, while having witnessed others overdose at a higher frequency carried a lower increased risk (OR, 1.42; 95% CI, 1.11-1.82).

HCV infection was associated with a more than twofold increase in overdose risk (OR, 2.44; 95% CI, 1.20-4.97), likely because of the strong association between HCV and heroin injection drug use, according to the researchers. They added that this association may be an indicator of higher-risk injection behavior, including needle sharing. They also suggested that, given the current epidemiology of HCV infection, identifying HCV infections may benefit younger populations who may be at risk of an overdose from riskier injection practices or where injection drug risk is not yet known.

The researchers reported that a higher frequency of distinct buprenorphine treatment episodes also led to increased risk (OR, 1.55; 95% CI, 1.17-2.07), whereas a greater frequency of distinct methadone treatment episodes was related to decreased odds of experiencing a nonfatal overdose (OR, 0.67; 95% CI, 0.49-0.91) according to their report published in Addictive Behavior (2018;86:51-5).

In addition, those who experienced a past opioid overdose were more likely to have obtained methadone illicitly (65%; P less than or equal to .001) or have a friend who died from an overdose (90%; P = .001) compared with those who have not experienced an overdose, according to the researchers.

“The current study strongly contributes to our understanding of risk factors of experiencing an opioid overdose. The knowledge gained from this study may enable targeted treatment interventions to reduce preventable deaths from opioid overdose,” according to the researchers. In particular, they pointed out the increased risk of overdose with the use of illicitly obtained methadone and suggested that expanded access to medication-assisted treatments be made available to all patients. “Opioid antagonist medications such as naltrexone may be particularly helpful in preventing opioid overdose for patients leaving controlled environments such as hospital, drug treatment, and correctional facilities,” they concluded.

The researchers reported that they had no conflicts of interest.
 

[email protected]
 

SOURCE: Schiavon S et al. Addict Behav. 2018;86:51-5.

Young adults who inject drugs and are infected with hepatitis C virus “face unique barriers to HCV testing, counseling, and treatment,” according to Margie R. Skeer, ScD, of Tufts University, Boston, and her fellow researchers.

©andrewsafonov/Thinkstock

Dr. Skeer and her colleagues found five themes in 24 in-depth interviews with people aged 22-30 years who inject drugs and have HCV infection. At the time of the interviews, none of the patients had received the newer HCV treatment regimens (Drug Alcohol Depend. 2018 Sep 1;190:246-54).

These themes captured the knowledge of and experience of HCV along the continuum of care:

1. Deservingness of HCV treatment and stigma.

2. Dissatisfaction with provider interactions.

3. Perceived lack of referral to treatment and care continuity.

4. Disincentives around HCV treatment for PWID.

5. Perceived need for treatment.

The interviewees were largely uninformed about HCV prior to diagnosis and reported learning more about the virus after their diagnosis. They also tended to affirm the belief that they did not deserve treatment. They felt stigmatized by insurance companies and clinicians, thereby reducing their engagement in the care continuum. And, at the time, insurance companies enforced “sobriety” restrictions dictating the length of time patients had to be off drugs before qualifying for HCV treatment. In the words of one interviewee: “[Caregivers] have a big stigma when it comes to addicts. ... Their whole demeanor changes. They rush you, they slam things, they are very impatient with you, and it is very saddening to see.”

Interviewees reported no or incomplete referrals or being given pamphlets and flyers. They reported little follow-up as to whether they sought additional care, and experienced a lack of confidence from medical professionals that they could be counted on to adhere to an HCV treatment regimen.

Interviewees stated that injection drug use and HCV are inevitably linked, and that IV drug users will eventually contract HCV infections.

“Hep C’s no big deal, Hep C’s like the common cold for the junkie. ... It might take 5 years away from your, you know, life but, you know, we’re not even gonna live that long anyways, so who cares about it anyway,” remarked a 28-year old woman, who was not currently injecting drugs.

The study authors said there is an increased need to provide patient-oriented care for young injection drug users and described the potential benefits of some insurance companies reducing their sobriety and disease severity restrictions.

“Reducing stigma among healthcare professionals, which cuts across the different levels of the HCV care continuum, improving referral patterns and continuity of care, better informing people about their HCV status through patient-oriented testing and disclosure experiences, and reducing perceptions of personal responsibility for disease are crucial next steps to increasing treatment as prevention,” Dr. Skeer and her colleagues concluded.

The authors reported that they had no conflicts of interest.

[email protected]

Young adults who inject drugs and are infected with hepatitis C virus “face unique barriers to HCV testing, counseling, and treatment,” according to Margie R. Skeer, ScD, of Tufts University, Boston, and her fellow researchers.

©andrewsafonov/Thinkstock

Dr. Skeer and her colleagues found five themes in 24 in-depth interviews with people aged 22-30 years who inject drugs and have HCV infection. At the time of the interviews, none of the patients had received the newer HCV treatment regimens (Drug Alcohol Depend. 2018 Sep 1;190:246-54).

These themes captured the knowledge of and experience of HCV along the continuum of care:

1. Deservingness of HCV treatment and stigma.

2. Dissatisfaction with provider interactions.

3. Perceived lack of referral to treatment and care continuity.

4. Disincentives around HCV treatment for PWID.

5. Perceived need for treatment.

The interviewees were largely uninformed about HCV prior to diagnosis and reported learning more about the virus after their diagnosis. They also tended to affirm the belief that they did not deserve treatment. They felt stigmatized by insurance companies and clinicians, thereby reducing their engagement in the care continuum. And, at the time, insurance companies enforced “sobriety” restrictions dictating the length of time patients had to be off drugs before qualifying for HCV treatment. In the words of one interviewee: “[Caregivers] have a big stigma when it comes to addicts. ... Their whole demeanor changes. They rush you, they slam things, they are very impatient with you, and it is very saddening to see.”

Interviewees reported no or incomplete referrals or being given pamphlets and flyers. They reported little follow-up as to whether they sought additional care, and experienced a lack of confidence from medical professionals that they could be counted on to adhere to an HCV treatment regimen.

Interviewees stated that injection drug use and HCV are inevitably linked, and that IV drug users will eventually contract HCV infections.

“Hep C’s no big deal, Hep C’s like the common cold for the junkie. ... It might take 5 years away from your, you know, life but, you know, we’re not even gonna live that long anyways, so who cares about it anyway,” remarked a 28-year old woman, who was not currently injecting drugs.

The study authors said there is an increased need to provide patient-oriented care for young injection drug users and described the potential benefits of some insurance companies reducing their sobriety and disease severity restrictions.

“Reducing stigma among healthcare professionals, which cuts across the different levels of the HCV care continuum, improving referral patterns and continuity of care, better informing people about their HCV status through patient-oriented testing and disclosure experiences, and reducing perceptions of personal responsibility for disease are crucial next steps to increasing treatment as prevention,” Dr. Skeer and her colleagues concluded.

The authors reported that they had no conflicts of interest.

[email protected]

Young adults who inject drugs and are infected with hepatitis C virus “face unique barriers to HCV testing, counseling, and treatment,” according to Margie R. Skeer, ScD, of Tufts University, Boston, and her fellow researchers.

©andrewsafonov/Thinkstock

Dr. Skeer and her colleagues found five themes in 24 in-depth interviews with people aged 22-30 years who inject drugs and have HCV infection. At the time of the interviews, none of the patients had received the newer HCV treatment regimens (Drug Alcohol Depend. 2018 Sep 1;190:246-54).

These themes captured the knowledge of and experience of HCV along the continuum of care:

1. Deservingness of HCV treatment and stigma.

2. Dissatisfaction with provider interactions.

3. Perceived lack of referral to treatment and care continuity.

4. Disincentives around HCV treatment for PWID.

5. Perceived need for treatment.

The interviewees were largely uninformed about HCV prior to diagnosis and reported learning more about the virus after their diagnosis. They also tended to affirm the belief that they did not deserve treatment. They felt stigmatized by insurance companies and clinicians, thereby reducing their engagement in the care continuum. And, at the time, insurance companies enforced “sobriety” restrictions dictating the length of time patients had to be off drugs before qualifying for HCV treatment. In the words of one interviewee: “[Caregivers] have a big stigma when it comes to addicts. ... Their whole demeanor changes. They rush you, they slam things, they are very impatient with you, and it is very saddening to see.”

Interviewees reported no or incomplete referrals or being given pamphlets and flyers. They reported little follow-up as to whether they sought additional care, and experienced a lack of confidence from medical professionals that they could be counted on to adhere to an HCV treatment regimen.

Interviewees stated that injection drug use and HCV are inevitably linked, and that IV drug users will eventually contract HCV infections.

“Hep C’s no big deal, Hep C’s like the common cold for the junkie. ... It might take 5 years away from your, you know, life but, you know, we’re not even gonna live that long anyways, so who cares about it anyway,” remarked a 28-year old woman, who was not currently injecting drugs.

The study authors said there is an increased need to provide patient-oriented care for young injection drug users and described the potential benefits of some insurance companies reducing their sobriety and disease severity restrictions.

“Reducing stigma among healthcare professionals, which cuts across the different levels of the HCV care continuum, improving referral patterns and continuity of care, better informing people about their HCV status through patient-oriented testing and disclosure experiences, and reducing perceptions of personal responsibility for disease are crucial next steps to increasing treatment as prevention,” Dr. Skeer and her colleagues concluded.

The authors reported that they had no conflicts of interest.

[email protected]

Marked differences were seen in the composition of hepatitis C virus hypervariable region 1 (HVR1) when comparing HIV-coinfected (CIP) with HCV-monoinfected (MIP) individuals, according to the results of a genetic analysis of nearly 300 patients.

Courtesy NIH

Intrahost HCV HVR1 evolution varies between these two groups, which suggests that HIV-inflicted changes in the host environment exact a strong HCV genetic response, according to a report published online in Infection, Genetics, and Evolution.

“A high prevalence of HIV-HCV coinfection and its impact on mortality among such populations groups as PWID [people who inject drugs] and MSM [men who have sex with men] is of major concern to public health,” according to the researchers.

Previous studies using the Global Hepatitis Outbreak and Surveillance Technology, a Web-based system for the detection of HCV transmission developed by the researchers, analyzed sequences of intrahost variants of the HVR1 region using next-generation sequencing. They found that genetic variation in the HVR1 of intrahost HCV variants was strongly associated with host sex and ethnicity, resistance to interferon, and stages of HCV infection.

In this particular study, the researchers assessed 28,622 nucleotide sequences of intrahost HCV HVR1 variants from 113 CIP and 176 MIP individuals.

They examined 148 physical-chemical indexes of DNA nucleotide dimers and found that there were significant differences in the means and frequency distributions of seven physical-chemical properties between HVR1 variants from both groups.

The significant majority of these profiles (98%-99%) were found to be specific to CIP or MIP, indicating that coevolution among HVR1 sites reflects HCV adaptation to HIV among coinfected individuals. “This observation suggests substantial differences in fitness between HVR1 variants circulating in infected hosts in the presence or absence of HIV, according to the researchers from the Centers for Disease Control and Prevention.

“HCV strains circulating in high-risk groups need to be carefully monitored for the identification of potentially new traits of clinical and public health relevance,” the researchers concluded.

This study was supported by CDC intramural funding. The authors reported that they had no disclosures.

[email protected]

SOURCE: Lara J et al. doi: 10.1016/j.meegid.2018.07.039.

Marked differences were seen in the composition of hepatitis C virus hypervariable region 1 (HVR1) when comparing HIV-coinfected (CIP) with HCV-monoinfected (MIP) individuals, according to the results of a genetic analysis of nearly 300 patients.

Courtesy NIH

Intrahost HCV HVR1 evolution varies between these two groups, which suggests that HIV-inflicted changes in the host environment exact a strong HCV genetic response, according to a report published online in Infection, Genetics, and Evolution.

“A high prevalence of HIV-HCV coinfection and its impact on mortality among such populations groups as PWID [people who inject drugs] and MSM [men who have sex with men] is of major concern to public health,” according to the researchers.

Previous studies using the Global Hepatitis Outbreak and Surveillance Technology, a Web-based system for the detection of HCV transmission developed by the researchers, analyzed sequences of intrahost variants of the HVR1 region using next-generation sequencing. They found that genetic variation in the HVR1 of intrahost HCV variants was strongly associated with host sex and ethnicity, resistance to interferon, and stages of HCV infection.

In this particular study, the researchers assessed 28,622 nucleotide sequences of intrahost HCV HVR1 variants from 113 CIP and 176 MIP individuals.

They examined 148 physical-chemical indexes of DNA nucleotide dimers and found that there were significant differences in the means and frequency distributions of seven physical-chemical properties between HVR1 variants from both groups.

The significant majority of these profiles (98%-99%) were found to be specific to CIP or MIP, indicating that coevolution among HVR1 sites reflects HCV adaptation to HIV among coinfected individuals. “This observation suggests substantial differences in fitness between HVR1 variants circulating in infected hosts in the presence or absence of HIV, according to the researchers from the Centers for Disease Control and Prevention.

“HCV strains circulating in high-risk groups need to be carefully monitored for the identification of potentially new traits of clinical and public health relevance,” the researchers concluded.

This study was supported by CDC intramural funding. The authors reported that they had no disclosures.

[email protected]

SOURCE: Lara J et al. doi: 10.1016/j.meegid.2018.07.039.

Marked differences were seen in the composition of hepatitis C virus hypervariable region 1 (HVR1) when comparing HIV-coinfected (CIP) with HCV-monoinfected (MIP) individuals, according to the results of a genetic analysis of nearly 300 patients.

Courtesy NIH

Intrahost HCV HVR1 evolution varies between these two groups, which suggests that HIV-inflicted changes in the host environment exact a strong HCV genetic response, according to a report published online in Infection, Genetics, and Evolution.

“A high prevalence of HIV-HCV coinfection and its impact on mortality among such populations groups as PWID [people who inject drugs] and MSM [men who have sex with men] is of major concern to public health,” according to the researchers.

Previous studies using the Global Hepatitis Outbreak and Surveillance Technology, a Web-based system for the detection of HCV transmission developed by the researchers, analyzed sequences of intrahost variants of the HVR1 region using next-generation sequencing. They found that genetic variation in the HVR1 of intrahost HCV variants was strongly associated with host sex and ethnicity, resistance to interferon, and stages of HCV infection.

In this particular study, the researchers assessed 28,622 nucleotide sequences of intrahost HCV HVR1 variants from 113 CIP and 176 MIP individuals.

They examined 148 physical-chemical indexes of DNA nucleotide dimers and found that there were significant differences in the means and frequency distributions of seven physical-chemical properties between HVR1 variants from both groups.

The significant majority of these profiles (98%-99%) were found to be specific to CIP or MIP, indicating that coevolution among HVR1 sites reflects HCV adaptation to HIV among coinfected individuals. “This observation suggests substantial differences in fitness between HVR1 variants circulating in infected hosts in the presence or absence of HIV, according to the researchers from the Centers for Disease Control and Prevention.

“HCV strains circulating in high-risk groups need to be carefully monitored for the identification of potentially new traits of clinical and public health relevance,” the researchers concluded.

This study was supported by CDC intramural funding. The authors reported that they had no disclosures.

[email protected]

SOURCE: Lara J et al. doi: 10.1016/j.meegid.2018.07.039.