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Showing posts with label hepatitis. Show all posts
Showing posts with label hepatitis. Show all posts
Tuesday, May 31, 2016
Saturday, May 7, 2016
A Budget Impact Analysis of Newly Available Hepatitis C Therapeutics and the Financial Burden on a State Correctional System
Hepatitis C virus (HCV)
infection continues to disproportionately affect incarcerated populations. New HCV
drugs present opportunities and challenges to address HCV in corrections.
The
goal of this study was to evaluate the impact of the treatment costs for HCV
infection in a state correctional population through a budget impact analysis
comparing differing treatment strategies. Electronic and paper medical records
were reviewed to estimate the prevalence of hepatitis C within the Rhode Island
Department of Corrections.
Three treatment strategies were evaluated as
follows:
- treating all chronically infected persons,
- treating only patients with demonstrated fibrosis, and
- treating only patients with advanced fibrosis.
Budget impact was computed as the percentage of pharmacy and
overall healthcare expenditures accrued by total drug costs assuming entirely
interferon-free therapy. Sensitivity analyses assessed potential variance in
costs related to variability in HCV prevalence, genotype, estimated variation
in market pricing, length of stay for the sentenced population, and uptake of
newly available regimens.
Chronic HCV prevalence was estimated at 17% of the
total population. Treating all sentenced inmates with at least 6 months
remaining of their sentence would cost about $34 million-13 times the pharmacy
budget and almost twice the overall healthcare budget. Treating inmates with
advanced fibrosis would cost about $15 million. A hypothetical 50% reduction in
total drug costs for future therapies could cost $17 million to treat all
eligible inmates.
With immense costs projected with new treatment, it is
unlikely that correctional facilities will have the capacity to treat all those
afflicted with HCV. Alternative payment strategies in collaboration with
outside programs may be necessary to curb this epidemic. In order to improve
care and treatment delivery, drug costs also need to be seriously reevaluated
to be more accessible and equitable now that HCV is more curable.
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By:
- 1Brown University School of Public Health, Providence, RI, USA.
- J Urban Health. 2015 Aug;92(4):635-49. doi: 10.1007/s11524-015-9953-4.
More at: https://twitter.com/hiv insight
Wednesday, March 23, 2016
A Cross Section Study to Determine the Prevalence of Antibodies against HIV Infection among Hepatitis B and C Infected Individuals
BACKGROUND:
There are limited
data regarding human immunodeficiency virus (HIV) prevalence among hepatitis B
virus (HBV) or hepatitis C virus (HCV) infected individuals. The aim of this
cross-sectional study is to determine the prevalence of HBV and HCV infection
among HIV individuals;
METHODS:
A total of 409
patients (126 HBV+ and 283 HCV+) referred to the Brazilian Reference Laboratory
for Viral Hepatitis from 2010 to 2013 donated serum samples. Anti-HIV, HBsAg,
anti-HBc, anti-HBs, anti-HBcIgM, anti-HBe, HBeAg, and anti-HCV antibodies were
measured, and anti-HCV positive samples were tested for viral RNA and genotype;
RESULTS:
The anti-HIV
antibody prevalence was 10.31% and 4.59% among HBV+ and HCV+ patients,
respectively. The HCV mean (SD) viral load was log 5.14 ± 1.64 IU/mL, and
genotype I was most prevalent (163/283). Anti-HBs and anti-HBc were detected in
40% and 26% of HCV+ individuals, respectively. Among the HBV+ population, the
presence of anti-HIV antibodies was associated with male gender, marital status
(married), tattoo, sexual orientation, sexual practices (oral sex and anal
sex), history of sexually transmitted diseases (STDs), history of viral
hepatitis treatment, and a sexual partner with hepatitis or HIV. For the HCV+
group, the presence of anti-HIV antibodies was associated with female gender,
marital status (married), anal intercourse, previous history of STDs, and
number of sexual partners;
CONCLUSION:
A high prevalence
of anti-HIV antibodies was found among individuals with HBV and HCV, showing
the importance of education programmes towards HIV infection among HBV- and
HCV-infected individuals.
Full article at: http://goo.gl/7pJhyw
By:
- 1Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 210360-040, Brazil. geane@ioc.fiocruz.br.
- 2Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 210360-040, Brazil. adilsonjoal@ioc.fiocruz.br.
- 3Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 210360-040, Brazil. julicm@ioc.fiocruz.br.
- 4Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 210360-040, Brazil. h.medina@ioc.fiocruz.br.
- 5Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 210360-040, Brazil. moyramp@ioc.fiocruz.br.
- 6Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 210360-040, Brazil. lescali@ioc.fiocruz.br.
- 7Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 210360-040, Brazil. vmarques@ioc.fiocruz.br.
- 8Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 210360-040, Brazil. llewis@ioc.fiocruz.br.
- 9Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 210360-040, Brazil. elampe@ioc.fiocruz.br.
- 10Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 210360-040, Brazil. lvillar@ioc.fiocruz.br.
- Int J Environ Res Public Health. 2016 Mar 11;13(3). pii: E314. doi: 10.3390/ijerph13030314.
More at: https://twitter.com/hiv insight
Thursday, March 3, 2016
Risk of Late Relapse or Reinfection with Hepatitis C Virus After Achieving a Sustained Virological Response: A Systematic Review and Meta-analysis
Background.
Treatment
for hepatitis C virus (HCV) can lead to sustained virological response (SVR) in
over 90% of people. Subsequent recurrence of HCV, either from late relapse or
reinfection, reverses the beneficial effects of SVR.
Methods.
A
search identified studies analysing HCV recurrence post-SVR. The recurrence
rate for each study was calculated using events/person years of follow-up
(PYFU). Results were pooled using a random-effects model and used to calculate
5-year recurrence risk. Three patient groups were analysed: (1) Mono-HCV
infected “low-risk” patients; (2) Mono-HCV infected “high-risk” patients
(injecting drug users or prisoners); (3) human immunodeficiency virus (HIV)/HCV
coinfected patients. Recurrence was defined as confirmed HCV RNA detectability
post-SVR.
Results.
In
the 43 studies of HCV mono-infected “low-risk” patients (n = 7969) the pooled
recurrence rate was 1.85/1000 PYFU (95% confidence interval [CI], .71–3.35; I2 = 73%) leading to a summary 5-year
recurrence risk of 0.95% (95% CI, .35%–1.69%). For the 14 studies of HCV
monoinfected “high-risk” patients (n = 771) the pooled recurrence rate was
22.32/1000 PYFU (95% CI, 13.07–33.46; I2 =
27%) leading to a summary 5-year risk of 10.67% (95% CI, 6.38%–15.66%). For the
4 studies of HIV/HCV coinfected patients the pooled recurrence rate was
32.02/1000 PYFU (95% CI, .00–123.49; I2 =
96%) leading to a summary 5-year risk of 15.02% (95% CI, .00%–48.26%). The
higher pooled estimates of recurrence in the high-risk and coinfected cohorts
were driven by an increase in reinfection rather than late relapse.
Conclusions.
SVR
appears durable in the majority of patients at 5 years post-treatment. The
large difference in 5 year event rate by risk group is driven mainly by an
increased reinfection risk.
Below: Summary 5-year risk (95%
confidence interval) of recurrence post-sustained virological response (SVR),
by risk group. Presented are the pooled estimates for the 5-year risk of
recurrence after achieving an SVR. Also shown are the number of studies that were
included to derive each estimate. Abbreviations: HCV, hepatitis C virus; HIV,
human immunodeficiency virus.
Full article at: http://goo.gl/7iLF2K
By:
1Division of Medicine, Imperial College
London
2Pharmacology and Therapeutics, Liverpool
University
3Research Institute of Primary Care and
Health Sciences, Keele University, Staffordshire, United Kingdom
Correspondence: B. Simmons, St Mary's Campus, Imperial
College London, Norfolk Place, London W2 1PG, UK (Email:ku.ca.lairepmi.inmula@31snommis.ynoyrb).
More at: https://twitter.com/hiv insight
Sunday, February 28, 2016
Prospects for Ending the HIV Epidemic among Persons Who Inject Drugs in Haiphong, Vietnam
Highlights
- We assessed prospects for ending the HIV epidemic among persons who inject drugs in Haiphong Vietnam.
- HIV prevalence declined from 68% in 2006 to 25% in 2014 among persons who inject drugs.
- Self-reported injecting “risk behavior” was quite low.
- Estimated HIV incidence among persons who recently (<5 years) began injecting drugs was 1/100 person-years at risk.
- The greatest gap in combined prevention and care services was in the low coverage of ART among HIV seropositive PWID. Scaling up ART for HIV seropositives should greatly accelerate the decline in the HIV epidemic. Ending the HIV epidemic among PWID in Haiphong is an achievable public health goal.
Abstract
Background
To
examine the prospects for “ending the HIV epidemic” among persons who inject
drugs (PWID) in Haiphong, Vietnam. Reaching an incidence of < 0.5/100
person-years at risk (PY) was used as an operational definition for “ending the
epidemic.”
Methods
A
respondent driven sampling study of 603 PWID was conducted from September to
October 2014. Current heroin use (verified with urine testing and marks of
injection) was an eligibility requirement. A structured questionnaire was
administered by trained interviewers to obtain demographic, drug use, and risk
behavior data; HIV counseling and testing and HCV testing was also conducted.
Two methods (by assuming all new injectors were HIV negative at first injection
and by slope of prevalence by years injecting) were used for estimating HIV
among persons injecting for < 5 years (“new injectors”). Comparisons were
made to the HIV epidemic among PWID in New York City and modeling of the HIV
epidemic in Can Tho province.
Results
HIV
prevalence was 25% in 2014, down from 68% in 2006 and 48% in 2009; overall HCV
prevalence in the study was 67%. Among HIV seropositive PWID, 33% reported
receiving antiretroviral treatment. The great majority (83%) of subjects
reported pharmacies as their primary source of needles and syringes and
self-reported receptive and distributive syringe sharing were quite low (<
6%). Estimating HIV incidence among non-MSM male new injectors with the
assumption that all were HIV negative at first injection gave a rate of 1.2/100
person-years (95% CI -0.24, 3.4). Estimating HIV incidence by the slope of
prevalence by years injecting gave a rate of 0.8/100 person-years at risk (95%
CI -0.9, 2.5)
Conclusions
The
current HIV epidemic among PWID in Haiphong is in a declining phase, but
estimated incidence among non-MSM new injectors is approximately 1/100
person-years and there is a substantial gap in provision of ART for HIV
seropositives. Scaling up interventions, particularly HIV counseling and testing
and antiretroviral treatment for all seropositive PWID, should accelerate the
decline. Ending the epidemic is an attainable public health goal.
Purchase full article at: http://goo.gl/zwC4tq
By:
Affiliations
- Mount Sinai Beth Israel, New York City, USA
Correspondence
- Corresponding author at; The Baron Edmond de Rothschild Chemical Dependency Institute Mount Sinai Beth Israel 160 Water Street, 24th Floor New York, NY 10038 212.256.2548.
More at: https://twitter.com/hiv insight
Saturday, February 27, 2016
Friday, February 26, 2016
Tuesday, February 23, 2016
Baseline HCV Antibody Prevalence and Risk Factors among Drug Users in China’s National Methadone Maintenance Treatment Program
Background
Hepatitis
C virus (HCV) is the most common viral infection among injecting drug users
worldwide. We aimed to assess HCV antibody prevalence and associated risk
factors among clients in the Chinese national methadone maintenance treatment
(MMT) program.
Methods
Data
from 296,209 clients who enrolled in the national MMT program between March
2004 and December 2012 were analyzed to assess HCV antibody prevalence,
associated risk factors, and geographical distribution.
Results
Anti-HCV
screening was positive for 54.6% of clients upon MMT entry between 2004 and
2012. HCV antibody prevalence at entry declined from 66.8% in 2005 to 45.9% in
2012. The most significant predictors of HCV seropositivity were injecting drug
use (adjusted odds ratio [AOR]: 8.34, 95% confidence interval [CI]: 8.17–8.52,
p<0.0001) and a history of drug use ≥9 years (AOR: 2.01, 95% CI: 1.96–2.06,
p<0.0001). Being female, of Uyghur or Zhuang ethnicity, and unmarried were
identified as demographic risk factors (all p-values<0.0001). Of the 28
provincial-level divisions included in the study, we found that 5 divisions had
HCV antibody prevalence above 70% and 20 divisions above 50%. The HCV screening
rate within 6 months after MMT entry greatly increased from 30.4% in 2004 to
93.1% in 2012.
Conclusions
The current HCV antibody prevalence remains alarmingly
high among MMT clients throughout most provincial-level divisions in China,
particularly among injecting drug users and females. A comprehensive prevention
strategy is needed to control the HCV epidemic among MMT clients in China.
Below: The geographical distribution of (A) HCV antibody prevalence and (B) proportion of injecting drug use among MMT clients with baseline HCV test results in China
Full article at: http://goo.gl/k897iv
By:
National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
More at: https://twitter.com/hiv insight
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