Guest guest Posted June 6, 2011 Report Share Posted June 6, 2011 J Infect Dis. 2011 Jul;204(1):74-83. A systematic review and meta-analysis of interventions to prevent hepatitis C virus infection in people who inject drugs. Hagan H, Pouget ER, Des Jarlais DC. Source New York University College of Nursing. Abstract Introduction. High rates of hepatitis C virus (HCV) transmission are found in samples of people who inject drugs (PWID) throughout the world. The objective of this paper was to meta-analyze the effects of risk-reduction interventions on HCV seroconversion and identify the most effective intervention types. Methods. We performed a systematic review and meta-analysis of published and unpublished studies. Eligible studies reported on the association between participation in interventions intended to reduce unsafe drug injection and HCV seroconversion in samples of PWID. Results. The meta-analysis included 26 eligible studies of behavioral interventions, substance-use treatment, syringe access, syringe disinfection, and multicomponent interventions. Interventions using multiple combined strategies reduced risk of seroconversion by 75% (pooled relative risk, .25; 95% confidence interval, .07-.83). Effects of single-method interventions ranged from .6 to 1.6. Conclusions. Interventions using strategies that combined substance-use treatment and support for safe injection were most effective at reducing HCV seroconversion. Determining the effective dose and combination of interventions for specific subgroups of PWID is a research priority. However, our meta-analysis shows that HCV infection can be prevented in PWID. PMID: 21628661 [PubMed - in process] Related citations ____________________________________________________________________ J Med Virol. 2011 May 26. doi: 10.1002/jmv.22115. [Epub ahead of print] Spontaneous loss of hepatitis C virus RNA from serum is associated with genotype 1 and younger age at exposure. Rolfe KJ, Curran MD, GJ, Woodall T, s N, HE. Source Microbiology Services Division, Cambridge Laboratory, Health Protection Agency, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom. kathryn.rolfe@.... Abstract A variety of factors have been associated with spontaneous loss of hepatitis C virus (HCV)-RNA from serum, including infecting HCV type, although results are conflicting. This study aimed to investigate further whether infecting HCV type was linked to spontaneous loss of HCV-RNA. Serum samples from 321 untreated HCV antibody positive patients presenting at the Hepatology clinic at Addenbrooke's Hospital, Cambridge between 2004 and 2007 were tested. These individuals were classified either as HCV antibody and HCV-RNA positive (viremic, n = 219) or HCV antibody positive and repeatedly HCV-RNA negative (non-viremic, n = 102). Infecting HCV type was identified by genotyping (viremic) or serotyping (non-viremic). Binomial regression analysis investigated the independent effect of HCV type on spontaneous loss of HCV-RNA from serum by comparing the two groups. Ninety-one percent of patients were found to be either genotype 1 or genotype 3. The prevalence of type 1 infection was greater among non-viremic (64.5%) than viremic individuals (45%). After controlling for the effects of potential confounding factors, multivariable analyses showed that individuals with type 1 infections were more likely to be non-viremic than genotype 3 infections (RR = 2.07; 95% CI: 1.25, 3.43; P = 0.005). Individuals infected at an older age were also less likely to become HCV-RNA negative spontaneously (RR = 0.42 comparing those infected at ≥20 years of age against those infected at <20 years of age, 95% CI: 0.25, 0.72; P = 0.002). In conclusion, the results suggest that HCV genotype 1 infections are more likely than genotype 3 infections to become spontaneously non-viremic, as are infections acquired at younger age. J. Med. Virol. © 2011 Wiley-Liss, Inc. Copyright © 2011 Wiley-Liss, Inc. PMID: 21618556 [PubMed - as supplied by publisher] ----------------------------------------------------------- N Engl J Med. 2011 Jun 1. [Epub ahead of print] Outcomes of Treatment for Hepatitis C Virus Infection by Primary Care Providers. Arora S, Thornton K, Murata G, Deming P, Kalishman S, Dion D, Parish B, Burke T, Pak W, Dunkelberg J, Kistin M, Brown J, Jenkusky S, Komaromy M, Qualls C. Source From the Department of Internal Medicine (S.A., K.T., G.M., P.D., S.K., D.D., B.P., T.B., W.P., M. Kistin., J.B., M. Komaromy) and the Clinical and Translational Science Center (C.Q.), University of New Mexico; and Presbyterian Healthcare Services, Adult and Geriatric Behavioral Health Clinic (S.J.) - both in Albuquerque; and the Department of Internal Medicine, University of Iowa, Iowa City (J.D.). Abstract Background The Extension for Community Healthcare Outcomes (ECHO) model was developed to improve access to care for underserved populations with complex health problems such as hepatitis C virus (HCV) infection. With the use of video-conferencing technology, the ECHO program trains primary care providers to treat complex diseases. Methods We conducted a prospective cohort study comparing treatment for HCV infection at the University of New Mexico (UNM) HCV clinic with treatment by primary care clinicians at 21 ECHO sites in rural areas and prisons in New Mexico. A total of 407 patients with chronic HCV infection who had received no previous treatment for the infection were enrolled. The primary end point was a sustained virologic response. Results A total of 57.5% of the patients treated at the UNM HCV clinic (84 of 146 patients) and 58.2% of those treated at ECHO sites (152 of 261 patients) had a sustained viral response (difference in rates between sites, 0.7 percentage points; 95% confidence interval, -9.2 to 10.7; P=0.89). Among patients with HCV genotype 1 infection, the rate of sustained viral response was 45.8% (38 of 83 patients) at the UNM HCV clinic and 49.7% (73 of 147 patients) at ECHO sites (P=0.57). Serious adverse events occurred in 13.7% of the patients at the UNM HCV clinic and in 6.9% of the patients at ECHO sites. Conclusions The results of this study show that the ECHO model is an effective way to treat HCV infection in underserved communities. Implementation of this model would allow other states and nations to treat a greater number of patients infected with HCV than they are currently able to treat. (Funded by the Agency for Healthcare Research and Quality and others.). PMID: 21631316 [PubMed - as supplied by publisher] Free Article Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 6, 2011 Report Share Posted June 6, 2011 J Infect Dis. 2011 Jul;204(1):74-83. A systematic review and meta-analysis of interventions to prevent hepatitis C virus infection in people who inject drugs. Hagan H, Pouget ER, Des Jarlais DC. Source New York University College of Nursing. Abstract Introduction. High rates of hepatitis C virus (HCV) transmission are found in samples of people who inject drugs (PWID) throughout the world. The objective of this paper was to meta-analyze the effects of risk-reduction interventions on HCV seroconversion and identify the most effective intervention types. Methods. We performed a systematic review and meta-analysis of published and unpublished studies. Eligible studies reported on the association between participation in interventions intended to reduce unsafe drug injection and HCV seroconversion in samples of PWID. Results. The meta-analysis included 26 eligible studies of behavioral interventions, substance-use treatment, syringe access, syringe disinfection, and multicomponent interventions. Interventions using multiple combined strategies reduced risk of seroconversion by 75% (pooled relative risk, .25; 95% confidence interval, .07-.83). Effects of single-method interventions ranged from .6 to 1.6. Conclusions. Interventions using strategies that combined substance-use treatment and support for safe injection were most effective at reducing HCV seroconversion. Determining the effective dose and combination of interventions for specific subgroups of PWID is a research priority. However, our meta-analysis shows that HCV infection can be prevented in PWID. PMID: 21628661 [PubMed - in process] Related citations ____________________________________________________________________ J Med Virol. 2011 May 26. doi: 10.1002/jmv.22115. [Epub ahead of print] Spontaneous loss of hepatitis C virus RNA from serum is associated with genotype 1 and younger age at exposure. Rolfe KJ, Curran MD, GJ, Woodall T, s N, HE. Source Microbiology Services Division, Cambridge Laboratory, Health Protection Agency, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom. kathryn.rolfe@.... Abstract A variety of factors have been associated with spontaneous loss of hepatitis C virus (HCV)-RNA from serum, including infecting HCV type, although results are conflicting. This study aimed to investigate further whether infecting HCV type was linked to spontaneous loss of HCV-RNA. Serum samples from 321 untreated HCV antibody positive patients presenting at the Hepatology clinic at Addenbrooke's Hospital, Cambridge between 2004 and 2007 were tested. These individuals were classified either as HCV antibody and HCV-RNA positive (viremic, n = 219) or HCV antibody positive and repeatedly HCV-RNA negative (non-viremic, n = 102). Infecting HCV type was identified by genotyping (viremic) or serotyping (non-viremic). Binomial regression analysis investigated the independent effect of HCV type on spontaneous loss of HCV-RNA from serum by comparing the two groups. Ninety-one percent of patients were found to be either genotype 1 or genotype 3. The prevalence of type 1 infection was greater among non-viremic (64.5%) than viremic individuals (45%). After controlling for the effects of potential confounding factors, multivariable analyses showed that individuals with type 1 infections were more likely to be non-viremic than genotype 3 infections (RR = 2.07; 95% CI: 1.25, 3.43; P = 0.005). Individuals infected at an older age were also less likely to become HCV-RNA negative spontaneously (RR = 0.42 comparing those infected at ≥20 years of age against those infected at <20 years of age, 95% CI: 0.25, 0.72; P = 0.002). In conclusion, the results suggest that HCV genotype 1 infections are more likely than genotype 3 infections to become spontaneously non-viremic, as are infections acquired at younger age. J. Med. Virol. © 2011 Wiley-Liss, Inc. Copyright © 2011 Wiley-Liss, Inc. PMID: 21618556 [PubMed - as supplied by publisher] ----------------------------------------------------------- N Engl J Med. 2011 Jun 1. [Epub ahead of print] Outcomes of Treatment for Hepatitis C Virus Infection by Primary Care Providers. Arora S, Thornton K, Murata G, Deming P, Kalishman S, Dion D, Parish B, Burke T, Pak W, Dunkelberg J, Kistin M, Brown J, Jenkusky S, Komaromy M, Qualls C. Source From the Department of Internal Medicine (S.A., K.T., G.M., P.D., S.K., D.D., B.P., T.B., W.P., M. Kistin., J.B., M. Komaromy) and the Clinical and Translational Science Center (C.Q.), University of New Mexico; and Presbyterian Healthcare Services, Adult and Geriatric Behavioral Health Clinic (S.J.) - both in Albuquerque; and the Department of Internal Medicine, University of Iowa, Iowa City (J.D.). Abstract Background The Extension for Community Healthcare Outcomes (ECHO) model was developed to improve access to care for underserved populations with complex health problems such as hepatitis C virus (HCV) infection. With the use of video-conferencing technology, the ECHO program trains primary care providers to treat complex diseases. Methods We conducted a prospective cohort study comparing treatment for HCV infection at the University of New Mexico (UNM) HCV clinic with treatment by primary care clinicians at 21 ECHO sites in rural areas and prisons in New Mexico. A total of 407 patients with chronic HCV infection who had received no previous treatment for the infection were enrolled. The primary end point was a sustained virologic response. Results A total of 57.5% of the patients treated at the UNM HCV clinic (84 of 146 patients) and 58.2% of those treated at ECHO sites (152 of 261 patients) had a sustained viral response (difference in rates between sites, 0.7 percentage points; 95% confidence interval, -9.2 to 10.7; P=0.89). Among patients with HCV genotype 1 infection, the rate of sustained viral response was 45.8% (38 of 83 patients) at the UNM HCV clinic and 49.7% (73 of 147 patients) at ECHO sites (P=0.57). Serious adverse events occurred in 13.7% of the patients at the UNM HCV clinic and in 6.9% of the patients at ECHO sites. Conclusions The results of this study show that the ECHO model is an effective way to treat HCV infection in underserved communities. Implementation of this model would allow other states and nations to treat a greater number of patients infected with HCV than they are currently able to treat. (Funded by the Agency for Healthcare Research and Quality and others.). PMID: 21631316 [PubMed - as supplied by publisher] Free Article Quote Link to comment Share on other sites More sharing options...
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