DDWScreening Baby Boomers for HCV Would Triple Diagnosis RateMay 9, 2011 (Chicago, Illinois) —Age-based screening for hepatitis C virus (HCV) infection, especially targeting baby boomers, would lead to fewer cases of advanced liver disease and related deaths than the current risk-based screening practice, researchers have demonstrated using a Markov model. They presented their findings here at Digestive Disease Week 2011. "Current risk-based HCV screening practices are often limited to people who have symptoms of liver disease or who are considered high risk," said Lisa McGarry, MPH, lead author and director of health economics and outcomes research at Ingenix Life Sciences — a health, technology, and consultant service headquartered in Somerset, New Jersey. "A shortcoming of this approach is that symptoms of HCV infection might not appear for 20 years or more, which is one reason for the high percentage of undiagnosed cases of HCV," she noted. The US Preventive Services Task Force currently does not recommend screening the general population, but advocates screening for HCV risk factors in primary care and testing people at high risk. However, approximately three quarters of HCV-infected people in the United States are unaware of their condition, the Institute of Medicine has determined, according to Ms. McGarry. "Considering the particularly high HCV infection rates among baby boomers, it was important to explore the implications of a targeted age-based birth-cohort screening approach," she said, noting that risk-based screening "has not been very successful." Epidemiologically Based Mathematical Model Revealed Projections A Markov model of the natural history of HCV and subsequent liver disease was developed to determine the distribution of undiagnosed people with HCV infection and their disease progression in 2010. The investigators then ran the model forward to produce a lifetime estimate of HCV-related outcomes under each screening scenario. This included the number of people screened, diagnosed, treated, and achieving sustained viral response, and the number of cases of liver disease and death resulting from advanced liver disease. The model was very detailed, Ms. McGarry noted. For example, it accounted for faster disease progression in males, in patients older at baseline, and in patients older at diagnosis. The researchers then compared the implications of targeted screening of adults born between 1946 and 1970 with the current practice of risk-based screening. The model suggested the following:
Age-based screening would lead to higher overall costs nationally ($45.1 billion vs. $32 billion), Ms. McGarry acknowledged, but would yield lower costs related to advanced liver disease ($21.7 billion vs. $25.8 billion). The cost of extending the lives of the affected individuals would be $25,279 per quality-adjusted life-year gained (QALY), she said. "This approach appears to provide good value for the money, in addition to preventing advanced clinical outcomes," she suggested. Commenting on the findings, Zobair M. Younossi, MD, MPH, director of the Center for Liver Diseases at Inova Fairfax Hospital in Falls Church, Virginia, noted that the study, the first to examine birth-cohort screening outcomes for HCV, "provides compelling evidence for putting age-based screening guidelines into practice." "The cost of just over $25,000 per QALY gained through earlier detection and treatment is below the [American] willingness-to-pay thresholds and compares favorably with the economics of screening for many other serious diseases." He added that the findings are especially encouraging, given the potential impact of new antiviral treatments for HCV, "which were not even considered in the study." Adrian Di Bisceglie, MD, from St. Louis University School of Medicine, in Missouri, moderated a press briefing on the topic, and noted that the US Department of Health and Human Services will soon release an action plan for viral hepatitis. "Last year, the Institute of Medicine issued a report on screening, so the government has been thinking about this topic and is poised to announce an action plan. I think this study will be important in that context. Healthcare providers and third-party payers will need to be looking at strategies such as this one," he said. "Screening this birth cohort makes sense. There is no approach that will allow us to capture every infected person, unless we screen everyone, but this would allow the highest probability of capturing the greatest proportion of affected persons, and it's doable." Support for the study was provided by Vertex Pharmaceuticals. Ms. McGarry, Dr. Younossi, and Dr. Di Bisceglie have disclosed no relevant financial relationships. Digestive Disease Week (DDW) 2011: Abstract 477. Presented May 8, 2011. Authors and Disclosures Journalist Caroline Helwick Liver Disease: Identifying and Improving Screening and Treatment CHICAGO -- This exclusive broadcast focuses on screening for hepatitis C based on age instead of conventional risk factors and the rate of vaccination against viral hepatitis in patients with chronic liver disease and type 2. From HIV and Hepatitis: Longer Interferon Treatment Raises Hepatitis C Cure Rate Meta-analysis finds that extending pegylated interferon plus ribavirin to 72 weeks may improve sustained response rates for late-responder genotype 1 hepatitis C patients. Treatment of Hepatitis C in HIV Outpatient Study Only about 1 in 5 HIV/HCV coinfected participants in the HOPS cohort received hepatitis C treatment, though the proportion increased over time. Viral Hepatitis: Cutting Edge Update. Action Needed to Reach Out to Silent Sufferers of Hepatitis Red Orbit — Health and Medical Writers Invited to Attend Viral Hepatitis Workshop to Help Inform Silent Sufferers of Hepatitis Washington, D.C. (PRWEB) May 09, 2011 Join the Hepatitis Foundation International as they discuss current issues in viral hepatitis, including forthcoming therapies, shortcomings and improvements to existing treatment and prevention initiatives, and the need to identify the missing millions... Hepatitis B Routine Antenatal Screening For Hepatitis B In An Urban NYC Population 11 May 2011 According to new research at Columbia Presbyterian Medical Center, high rates of chronic hepatitis B infection (HBV) are found in pregnant minority and immigrant women in the New York City area, and most of them do not... From NATAP; Managing hepatitis B/HIV co-infected: adding entecavir to truvada (tenofovir disoproxil/emtricitabine) experienced patients Virological breakthrough and resistance in patients with chronic hepatitis B receiving nucleos(t)ide analogs in clinical practice - pdf attached | ||
Characterizing hepatitis B stigma in Chinese immigrants
S. J. Cotler1, S. Cotler2, H. Xie3, B. J. Luc1, T. J. Layden1, S. S. Wong1Article first published online: 4 MAY 2011
DOI: 10.1111/j.1365-2893.2011.01462.x
© 2011 Blackwell Publishing Ltd
Issue
Journal of Viral Hepatitis
S. J. Cotler1, S. Cotler2, H. Xie3, B. J. Luc1, T. J. Layden1, S. S. Wong1Article first published online: 4 MAY 2011
DOI: 10.1111/j.1365-2893.2011.01462.x
© 2011 Blackwell Publishing Ltd
Issue
Journal of Viral Hepatitis
Early View (Online Version of Record published before inclusion in an issue)
Summary.
Summary.
Health-related stigma is a cause of stress, alienation and discrimination that can serve as a barrier to prevention and care for infectious diseases such as HIV. Hepatitis B virus (HBV)-related stigma is common in Asian immigrants, but has not been formally evaluated. The aim of this study was to develop and validate the first HBV stigma instrument and to begin to evaluate HBV stigma in Chinese immigrants. The HBV stigma instrument was developed based on constructs from validated HIV stigma scales and organized into five domains. A written survey was compiled to include demographic data, HBV knowledge questions and stigma items. The survey was pilot tested in English and Chinese and then finalized. Data were obtained from 201 patients seen in an urban Chinatown Internal Medicine practice. The stigma items showed a high degree of reliability when assessed in aggregate (α = 0.85) as well as within individual domains. Stigma was greatest in the Fear of Contagion domain. Knowledge questions showed a corresponding deficit in understanding of modes of HBV transmission. An inverse relationship between stigma scores and familiarity with HBV provided evidence of construct validity. In multivariable analysis, having a family member with HBV and higher HBV knowledge subset scores were associated with lower degrees of stigma. In conclusion, the hepatitis B stigma instrument showed reliability and construct validity. The relationship identified between familiarity and knowledge regarding HBV with lower stigma scores provides the basis for the development of interventions to reduce HBV stigma.
State health officials say living kidney donor passed Hepatitis C virus to UPMC organ patient
PITTSBURGH — The Pennsylvania Department of Health is investigating a living kidney donor who had Hepatitis C that was passed on to a transplant recipient at the University of Pittsburgh Medical Center.
The Pittsburgh Tribune-Review says UPMC is citing federal privacy laws in declining to discuss the case reported Wednesday, a day after the newspaper first reported that UPMC had voluntarily and temporarily shut down its living donor transplant program.
Health Department spokeswoman Yasmin Coleman says an investigation is ongoing concerning the transplant case, but says she can't provide more details.
UPMC spokeswoman Jennifer Yates say the hospital network still expects to reopen its living donor program soon, though she could not provide a specific time frame.
UPMC surgeons performed 62 adult living-donor transplants and 90 using kidneys from deceased donors in 2010.
__Information from: Pittsburgh Tribune-Review, http://pghtrib.com/
Healthy You
Wednesday, May 11, 2011
If you can find some other way of dealing with that annoying headache besides reaching for your favorite over-the-counter painkiller, use it.
That's one lesson people might take from a new study that suggests frequent users of acetaminophen are at slightly higher risk of developing certain blood cancers, said blood specialists John Lister of the West Penn Allegheny Health System and David Claxton of the Penn State Hershey Cancer Institute.
Acetaminophen is sold under the brand name Tylenol.
Complementary Medicine / Alternative Medicine
Ohm. Did you know that more than a third of Americans use some form of complementary and alternative medicine (CAM) and that number continues to rise attributed mostly to increases in the use of mind-body therapies (MBT)...
From Scope;
By Michelle Brandt
A study published yesterday in the Archives of Internal Medicine found that some three percent of Americans, who responded to a government health survey, were practicing some sort of mind-body therapy as a result of a physician referral.That's still far less than the more than 15 percent of respondents surveyed who said they initiated these therapies on their own. But, hey, it's a start, considering how resistant doctors have been to adopting alternative remedies that veer away from mainstream medicine."To me this indicates that the use of mind-body therapies in the conventional medical setting is becoming more widely accepted -- absolutely," says study author Dr. Aditi Nerurkar, a fellow in integrative medicine at Beth Israel Deaconess Medical Center.
Nerurkar's research can be found here.
Off The Cuff
Investigation into infected surgeon
A GYNAECOLOGIST from Boston's Pilgrim Hospital is 'devastated' after it emerged an investigation is under way into his practices.
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