Erin C. Wilson ,Caitlin Turner ,Jess Lin ,Willi McFarland ,Katie Burk ,Henry Fisher Raymond

Posted on March 4, 2019Researchers assessed hepatitis C virus (HCV) prevalence among transwomen in San Francisco via performing a cross-sectional survey. Further, they assessed the indicators of engagement in HCV care. They interviewed a total of 315 transwomen who were then tested for HCV antibodies. Outcomes revealed an overall HCV seroprevalence of 23.6%. Transwomen who had injected drugs (48.2% vs 9.9%), smoked crack or methamphetamine (30.8% vs 12.5%), used intranasal drugs (28.4% vs 15.8%), and had been incarcerated (27.9% vs 9.9%) displayed significantly higher HCV seroprevalence. Overall, transwomen are at high risk for HCV infection, but many in San Francisco do have access to testing and treatment services, which may allow for HCV control and elimination.
Source:  MD LINX

​TO CONTINUE READING:https://onlinelibrary.wiley.com/doi/full/10.1111/jvh.13089
​

By Joel Wolfram August 13, 2018 WHYY Listen Live. Morning Edition

Addiction researchers at the University of Pennsylvania say it’s time to stop using “addict” and “alcoholic” when talking about people with substance use disorders. The recommendation comes out of a new study that found the terms are associated with a strong negative bias.
Researchers studied how people responded to several addiction-related terms including “addict,” “alcoholic,” and “substance abuser.” Those terms elicited the strongest negative biases of the lot, said lead study author Robert D. Ashford.
“Terms that seem to label the person — and invoke the negative attitudes toward the person rather than the disease — those are the ones that have the higher levels of bias,” said Ashford, a research assistant at the University of Pennsylvania and doctoral candidate in health policy at the University of the Sciences.
Participants were asked questions about their willingness to associate with people depicted in fictional vignettes who were described with such terms. But the study also used a word-association task to test whether any “implicit bias” was lurking in the language.
“So ‘implicit’ is … think of ‘subconscious,’ what’s going on in the recesses of my mind that I may not be consciously aware of,” Ashford explained.
TO CONTINUE READING:
​https://whyy.org/articles/dont-call-people-addicts-penn-researchers-say/?utm_source=facebook&utm_medium=social&utm_campaign=evergreen&fbclid=IwAR1uaN2nnPkP4blZs6BmG9WexQ4wDf-crGOnRVycSDKMLE6n4OUtJEe2frI

Known as the 'silent killer,' hepatitis C can cause serious damage to your liver without showing symptoms.

​US NEWS HEALTH
By Ruben Castaneda, Staff Writer March 14, 2019, at 1:43 p.m. 

WHILE MOST OF THE estimated 3.5 million people in the U.S. infected with hepatitis C are baby boomers, the virus is spreading at a greater rate among young people, according for the Centers for Disease Control and Prevention. Overall, the highest rate of new hepatitis C infections is among people between ages 20 and 29, according to a 2017 CDC press statement. Increasing IV drug use propelled by the opioid epidemic is the primary factor fueling this increase among young people, according to the CDC; sharing infected needles is a key mode of transmission. Research suggests the rate of hepatitis C infections is also rising among women of child-bearing age. Hepatitis C is associated with cirrhosis, which is potentially fatal, so it's important to get screened and treated.

If you should be diagnosed with hepatitis C, whatever your age, here are steps you should take:

• Don't panic.
• Don't obsess about when and how you were infected.
• Stop drinking alcohol.
• Talk about it.

TO CONTINUE READING:https://health.usnews.com/conditions/hepatitis-c/living-with-hepatitis-c

Arnold Doyle
Feb 10

​One in a Series of Commentaries on the US Healthcare SystemIf looking at this infographic gives you a headache, you’re not alone. A simplified rendering of the brand drug distribution chain, it’s still exasperatingly complicated. It also exemplifies the difficulty inherent in understanding how the distribution system works, who profits, and where along the chain there may be opportunities for reducing drug costs.
As mentioned in Part I, there is an array of middlemen who — literally or figuratively — touch a prescription drug before it gets to you. Each intermediary profits from this interaction. Therefore, drug companies pad the price of each drug up front so that this skimming along the way doesn’t lower a drug’s expected profitability for the company.
Drug companies make separate, confidential price discount or rebate agreements with each intermediary. Therefore, external parties (e.g., other companies, consumers, government agencies) do not know the amount of the discount nor how much profit each middleman earns per transaction. In an attempt to bring additional clarity to this process, the following is a description of the middlemen in the commercial (i.e., private, employer-sponsored and Medicare) insurance market, and how each profits from drug sales:

• Drug Wholesalers- these entities purchase product from the drug companies, and eventually sell them to pharmacies, hospitals and doctors that then dispense them to consumers. Wholesalers charge the purchasers a marginally higher price than what they paid for the drugs in the first place, thus making a profit.
• Insurers- your health insurer (e.g., Aetna, Cigna) processes claims when you visit a doctor, emergency room, etc. They determine how much the doctor gets paid and how much you must pay. However, when it comes to prescription drugs, most insurers hire a third-party entity, known as a pharmacy benefits manager (PBM), to process claims. Some insurers (e.g., Humana) own a PBM, and therefore do not need to hire externally. Insurers themselves can receive payments from drug companies in the form of drug rebates. The company may provide such rebates if the insurer confidentially agrees to make the company’s drug easier for patients to access than a competitor’s drug (e.g., not requiring physicians to obtain written prior authorization from the insurer before prescribing the company’s drug).
• PBMs- the initial purpose of PBMs was to process a rapidly growing number of prescription drug claims for insurers. PBMs, such as the largest, Express Scripts, have evolved to play a much more expansive and lucrative role that includes setting up an insurer’s pharmacy network, deciding which drugs the insurer will make available to consumers and negotiating drug company rebates. Drug companies provide rebates in order to gain preferential status — and therefore more sales — for their drugs through a PBM’s pharmacy network. PBMs make their profits by pocketing drug company rebates, instead of passing the savings on to consumers.
• Pharmacies- traditional brick and mortar pharmacies purchase drugs from wholesalers. When consumers come in with a prescription, they pay the pharmacy a co-pay that’s determined by their insurer’s PBM. The PBM reimburses the pharmacy for the dispensed drug at a negotiated rate — a rate that reflects a discount off the artificially padded price mentioned above. The PBM reimbursement plus the consumer co-pay, minus what the pharmacy paid the wholesaler, equals the pharmacy’s profit.

Outside this commercial system, drugs also flow to consumers who are beneficiaries of certain government-run programs that have tighter control over drug costs. For example, the federal government mandates that drug companies sell their products to Medicaid, a publicly-funded health insurance program for lower income and disabled people, at a lower cost than is available to commercial insurers. Most of the middlemen described above also profit from drugs bought and sold in this program.
Ultimately, an incredibly complex picture of the brand drug prescription pricing system emerges when looking at all the factors and players involved. Understanding this complexity is crucial as our lawmakers; drug company insurance and PBM lobbyists; physician and hospital associations; and consumer groups continue to debate drug pricing. As these discussions progress, here are a few key considerations drawn from what we know about the current system:
First, brand drug companies utilize a business model that results in ever-higher prices, not only for new drugs but for older brand drugs. The companies’ challenge will be to fundamentally alter this business model, while ensuring continued investment in new and truly innovative treatments. To date, companies have been reluctant to tinker with a system that has ensured them sustained growth and high profitability for so long. That said, I think even brand drug companies are recognizing that the current business model is unsustainable for political and socio-economic reasons. Their long-term business success may depend on their willingness and ability to change.
Second, any significant shift in drug company pricing practices will impact the distribution middlemen, and vice versa. Relatively speaking, wholesalers, pharmacies and physicians profit only marginally from brand drug sales. Among the intermediaries, PBMs have the highest financial stake in the current system. Altering their business practices could have the greatest — and potentially the most positive — impact on moderating drug costs. While PBMs do get drug companies to provide rebates, these “savings” are exactly what constitute PBM profits. And, rather perversely, higher initial drug prices also mean higher profits for PBMs. True, they may pass on some rebate dollars to the insurers who hire them, but consumers do not realize any meaningful savings.
Third, consumers (often called “patients” in the healthcare context) are usually at the bottom of the list of key considerations when it comes to reining in drug or other healthcare costs. While all the players claim that consumers are their №1 priority, many drug cost-reducing proposals — sometimes as an unintended consequence — may reduce patients’ access to the medicines that will help them the most. Consumer advocacy groups must have an equal voice at the table.
Finally, everyone who has a stake in this ongoing debate, especially our political leaders, should be wary of what seem like sweeping, easy fixes to the drug cost problem. There are no solutions that won’t require careful consideration and implementation; and there will always be trade-offs. In Part III of this series, we’ll look at a few current drug cost-containment proposals and their potential ramifications in the context of our larger, expensive but inefficient healthcare system.

One in a Series of Commentaries on the US Healthcare System
If looking at this infographic gives you a headache, you’re not alone. A simplified rendering of the brand drug distribution chain, it’s still exasperatingly complicated. It also exemplifies the difficulty inherent in understanding how the distribution system works, who profits, and where along the chain there may be opportunities for reducing drug costs.
As mentioned in Part I, there is an array of middlemen who — literally or figuratively — touch a prescription drug before it gets to you. Each intermediary profits from this interaction. Therefore, drug companies pad the price of each drug up front so that this skimming along the way doesn’t lower a drug’s expected profitability for the company.
Drug companies make separate, confidential price discount or rebate agreements with each intermediary. Therefore, external parties (e.g., other companies, consumers, government agencies) do not know the amount of the discount nor how much profit each middleman earns per transaction. In an attempt to bring additional clarity to this process, the following is a description of the middlemen in the commercial (i.e., private, employer-sponsored and Medicare) insurance market, and how each profits from drug sales:

• Drug Wholesalers- these entities purchase product from the drug companies, and eventually sell them to pharmacies, hospitals and doctors that then dispense them to consumers. Wholesalers charge the purchasers a marginally higher price than what they paid for the drugs in the first place, thus making a profit.
• Insurers- your health insurer (e.g., Aetna, Cigna) processes claims when you visit a doctor, emergency room, etc. They determine how much the doctor gets paid and how much you must pay. However, when it comes to prescription drugs, most insurers hire a third-party entity, known as a pharmacy benefits manager (PBM), to process claims. Some insurers (e.g., Humana) own a PBM, and therefore do not need to hire externally. Insurers themselves can receive payments from drug companies in the form of drug rebates. The company may provide such rebates if the insurer confidentially agrees to make the company’s drug easier for patients to access than a competitor’s drug (e.g., not requiring physicians to obtain written prior authorization from the insurer before prescribing the company’s drug).
• PBMs- the initial purpose of PBMs was to process a rapidly growing number of prescription drug claims for insurers. PBMs, such as the largest, Express Scripts, have evolved to play a much more expansive and lucrative role that includes setting up an insurer’s pharmacy network, deciding which drugs the insurer will make available to consumers and negotiating drug company rebates. Drug companies provide rebates in order to gain preferential status — and therefore more sales — for their drugs through a PBM’s pharmacy network. PBMs make their profits by pocketing drug company rebates, instead of passing the savings on to consumers.
• Pharmacies- traditional brick and mortar pharmacies purchase drugs from wholesalers. When consumers come in with a prescription, they pay the pharmacy a co-pay that’s determined by their insurer’s PBM. The PBM reimburses the pharmacy for the dispensed drug at a negotiated rate — a rate that reflects a discount off the artificially padded price mentioned above. The PBM reimbursement plus the consumer co-pay, minus what the pharmacy paid the wholesaler, equals the pharmacy’s profit.

Outside this commercial system, drugs also flow to consumers who are beneficiaries of certain government-run programs that have tighter control over drug costs. For example, the federal government mandates that drug companies sell their products to Medicaid, a publicly-funded health insurance program for lower income and disabled people, at a lower cost than is available to commercial insurers. Most of the middlemen described above also profit from drugs bought and sold in this program.
Ultimately, an incredibly complex picture of the brand drug prescription pricing system emerges when looking at all the factors and players involved. Understanding this complexity is crucial as our lawmakers; drug company insurance and PBM lobbyists; physician and hospital associations; and consumer groups continue to debate drug pricing. As these discussions progress, here are a few key considerations drawn from what we know about the current system:
First, brand drug companies utilize a business model that results in ever-higher prices, not only for new drugs but for older brand drugs. The companies’ challenge will be to fundamentally alter this business model, while ensuring continued investment in new and truly innovative treatments. To date, companies have been reluctant to tinker with a system that has ensured them sustained growth and high profitability for so long. That said, I think even brand drug companies are recognizing that the current business model is unsustainable for political and socio-economic reasons. Their long-term business success may depend on their willingness and ability to change.
Second, any significant shift in drug company pricing practices will impact the distribution middlemen, and vice versa. Relatively speaking, wholesalers, pharmacies and physicians profit only marginally from brand drug sales. Among the intermediaries, PBMs have the highest financial stake in the current system. Altering their business practices could have the greatest — and potentially the most positive — impact on moderating drug costs. While PBMs do get drug companies to provide rebates, these “savings” are exactly what constitute PBM profits. And, rather perversely, higher initial drug prices also mean higher profits for PBMs. True, they may pass on some rebate dollars to the insurers who hire them, but consumers do not realize any meaningful savings.
Third, consumers (often called “patients” in the healthcare context) are usually at the bottom of the list of key considerations when it comes to reining in drug or other healthcare costs. While all the players claim that consumers are their №1 priority, many drug cost-reducing proposals — sometimes as an unintended consequence — may reduce patients’ access to the medicines that will help them the most. Consumer advocacy groups must have an equal voice at the table.
Finally, everyone who has a stake in this ongoing debate, especially our political leaders, should be wary of what seem like sweeping, easy fixes to the drug cost problem. There are no solutions that won’t require careful consideration and implementation; and there will always be trade-offs. In Part III of this series, we’ll look at a few current drug cost-containment proposals and their potential ramifications in the context of our larger, expensive but inefficient healthcare system.
​https://medium.com/@slavcelt/drug-pricing-demystified-part-ii-the-intermediaries-d92

Arnold Doyle
Jan 29One in a Series of Commentaries on the US Healthcare System



Why do prescription drugs cost so much? Or do they?
The never-ending debate over prescription drug prices suggests how little most of us know about drug industry pricing practices. The pricing process, and what a drug ultimately costs, is hidden under a mountain of technical jargon, corporate anti-competitive secrecy and government law and policy — some created with beneficial intent; some not. However, our collective ignorance is not going to help us have realistic debates nor aid us in developing more equitable solutions.
There has been much focus on the high prices of newly available brand name drugs for decades and, recently, it has intensified. There is also the seemingly counter-intuitive drug company practice of raising prices at least annually on existing brand drugs. After all, shouldn’t the price of an older drug go down? Especially if a new drug that treats the same condition is approved? Or if a drug’s patent expires and generic forms of the drug become available?
The logical answer would seem to be “yes,” if the brand drug industry business model were comparable, for example, to the automotive industry. Like automakers, drug makers are for-profit businesses. As such, the driving motivation for both is to make profits and provide returns to shareholders. Beyond this basic fact, further comparisons are difficult.
Let’s get some insight into pricing practices that are common across the brand drug industry:

• A company has a potentially promising drug candidate. This candidate must pass through a series of clinical trials; these are designed to evaluate the drug’s optimal dosage, safety profile, side effects, and how effectively it treats a specific disease. Typically, well-designed trials include hundreds of patients, and compare the candidate drug to an already tested and proven product. Ultimately, the goal is that the US Food and Drug Administration (FDA) approve the drug so it can be legally marketed and sold. This process takes several years and is costly and financially risky — most drug candidates fail to deliver on their promise, and further testing is abandoned. Money invested in a failed drug candidate goes down the drain.
• Early on in a candidate drug’s life, companies start running the numbers on its potential profitability at different price points. The starting comparison point is usually close to drugs already on the market that treat the same or similar conditions. Companies also consider important demographic and financial factors: How many people have the disease the candidate drug may treat? In which countries do they reside? Who will be paying for the drug: government programs, private insurance or individual consumers (i.e., “self-pay”)? What is the expected duration of treatment (a week, month, lifetime)? Are other companies developing similar drugs, and how far along are they in the process? All these factors impact potential profitability.
• Whether the candidate drug is a “me-too” (i.e., very similar to an existing drug), the first of its kind or somewhere in between, companies give significant weight to what public (e.g., Medicare, Veterans Administration) and private insurers will be willing to pay. The companies determine this by confidentially (and legally) sharing basic information about the drug with insurers; the insurers in turn indicate, within a range, what they’ll be willing to pay.
• Companies do consider the actual cost of the materials, the physical plant, equipment and people needed to make a high-quality product. However, to the surprise and consternation of many of us, this “cost of goods” has little bearing on a drug’s ultimate price.
• Companies tend to set the initial list price of a drug at the upper range of what insurers will ultimately pay, and often close — if not higher — than the prices of existing competitor drugs. Critics of the industry decry this practice as “pricing at what the market will bear” — basically as high as possible.
• Many companies suggest that they set initial prices at least in part according to the value that a drug will bring to consumers and the healthcare system. This includes the very real impact drugs may have on reducing costs in other parts of the healthcare system, e.g., preventing hospitalization. There is also the potential to extend life and reduce human suffering. However, companies have difficulty quantifying these values in ways that are uniformly accepted by payers — or in ways that directly support their pricing decisions.
• For the drug company, a drug’s job is to remain as profitable as possible for as long as possible — certainly until the drug’s patent expires. Hence, the fact that a brand drug’s price tends to increase over time instead of going down. Companies bake price increases into a drug’s annual and longer-term economic forecasts. They plow profits back into the company to support the drug’s marketing costs, research and development of future drugs, and to cover the myriad of other expenses common to most large businesses — including financially rewarding shareholders.

It’s important to note that a drug’s price is just the starting point for that drug’s cost: what your insurance and/or you ultimately pay for the drug. After all, none of us walks into a prescription drug manufacturing plant and buys a bottle of pills off the assembly line. In between the point that a drug company establishes a drug’s price and the point where the drug ends up in your medicine cabinet, an opaque process unfolds that determines a drug’s final cost.
At this point, an array of other players enters the equation. The players include drug wholesalers, pharmacy benefit managers (PBMs), pharmacies, health insurance companies, government agencies— and sometimes doctors and hospitals if the drug must be administered by a healthcare professional. Drug companies make separate, confidential discount or rebate agreements with many of these middlemen.
How and why these negotiations occur figures centrally in the drug pricing and cost story that I’ll delve into in Part II of this commentary. For now, let’s just say that the lack of transparency around these discount and rebate negotiations draws the ire, speculation and investigation of politicians and public citizens alike. It’s just another piece of the story that makes drug pricing such a challenging component of our expensive and inefficient US healthcare system.

https://medium.com/@slavcelt/drug-pricing-demystified-223a17ca0e8d?source=friends_link&sk=928add1e8dad8f395a020d0f04557264
 
 

New liver transplant guidelines improve odds for patients in Northeast
Dr. Adel Bozorgzadeh chief of the Division of Organ Transplantation at UMass Memorial Medical Center - University Campus in Worcester, discusses what changes in organ transplant rules will mean for patients locally. [T&G Staff/Steve Lanava]

​By Susan Spencer 
Telegram & Gazette Staff 

Posted Jan 31, 2019 at 6:00 PMUpdated Jan 31, 2019 at 6:00 PM
  WORCESTER - For 30 years, the chance that someone who needed a liver transplant would actually get an appropriate liver in time depended at least as much on geography as on how sick the patient was.
But under a policy change approved in December by the board of directors of the Organ Procurement and Transplantation Network/United Network for Organ Sharing, patient severity of illness will weigh more heavily in allocating available organs to waiting patients.
As a result, after the policy change goes into effect April 30, patients with end-stage liver disease in places such as New England and New York, which have a lower supply of available organs relative to the need, will fare better than under the current rules.
“This really has been a long overdue change,” said Dr. Adel Bozorgzadeh, chief of the division of organ transplantation at UMass Memorial Medical Center.
UMass Memorial has been a center for liver transplants since the 1990s. In 2018, 66 liver transplants were performed there, according to U.S. Health and Human Services data.
There were 274 liver transplants in Massachusetts last year, out of 8,250 performed nationwide.
Dr. Bozorgzadeh said, “These new rules are going to level the playing field. Hopefully it’s going to decrease the risk of waitlist mortality, so that really is different.”
The current long-standing distribution policy grew out of enactment of the National Organ Transplant Act in 1984, which was passed to address the nation’s critical organ donation shortage and improve the organ matching and placement process.
The law established the Organ Procurement and Transplantation Network, which maintains a national registry for organ matching. OPTN contracts with the nonprofit United Network for Organ Sharing, or UNOS, to operate the matching network.
The policy was based on 11 geographic regions set up across the country. Because organs from deceased donors can only be kept alive and usable for a few hours - it’s about 10 hours for livers - the idea was to place available organs with the closest patients in need.
The expectation was that the incidence of disease and availability of organs would match, Dr. Bozorgzadeh said. “In reality, over the next three decades we would see nothing farther from the truth.”
He said patients would be gravely ill in intensive care units at UMass Memorial or other transplant centers in the region, but no liver would be available. At the same time, someone in Pittsburgh or Indiana, for example, who was only half as sick, would get a liver.
“There’s a significant strain on our population,” Dr. Bozorgzadeh said.
The reasons for the mismatch reflect geographic differences in population age and causes of death, according to Dr. Bozorgzadeh.
TO CONTINUE STORY: https://www.telegram.com/news/20190131/new-liver-transplant-guidelines-improve-odds-for-patients-in-northeast

December 19, 20185:00 AM ET
​MICHELLE ANDREWS



When people seek help at a drug treatment center for an opioid addiction, concerns about having contracted hepatitis C are generally low on their list.
They've often reached a crisis point in their lives, says Marie Sutton, the CEO of Imagine Hope, a consulting group that provides staff training and technical assistance to facilitate testing for the liver-damaging virus at more than 30 drug treatment centers in Georgia.
"They just want to handle [their drug problem]," Sutton says. "Sometimes they don't have the bandwidth to take on too many other things."
And although health care facilities that serve people who use drugs are well-positioned to initiate screening, studies show that often doesn't happen.

SHOTS - HEALTH NEWSTreating Prisoners With Hepatitis C May Be Worth The Hefty PriceIt's an enormous missed opportunity, say public health specialists.
"It's a disease that can be cured the moment we identify somebody," says Tom Nealon, president and CEO of the American Liver Foundation. "Not testing is incomprehensible when you look at what hepatitis C does to their bodies and their livers."
As the number of people who inject drugs has soared, the rate of infection with hepatitis C — which is frequently tied to sharing needles — has climbed steeply, too.
People with a hepatitis C infection can go for years without symptoms, so may have no inkling they're sick. That delayed onset makes screening important, say health researchers, since infected people may unwittingly infect others.
Still, while screening people who misuse drugs can break the cycle of transmission, public health advocates say a number of obstacles — a lack of money, staff or other resources — may keep substance abuse facilities from going that route.
​TO CONTINUE READING: https://www.npr.org/sections/health-shots/2018/12/19/676417852/why-arent-more-

December 19, 20185:00 AM ET MICHELLE ANDREWS

When people seek help at a drug treatment center for an opioid addiction, concerns about having contracted hepatitis C are generally low on their list.
They've often reached a crisis point in their lives, says Marie Sutton, the CEO of Imagine Hope, a consulting group that provides staff training and technical assistance to facilitate testing for the liver-damaging virus at more than 30 drug treatment centers in Georgia.
"They just want to handle [their drug problem]," Sutton says. "Sometimes they don't have the bandwidth to take on too many other things."
And although health care facilities that serve people who use drugs are well-positioned to initiate screening, studies show that often doesn't happen.

SHOTS - HEALTH NEWSTreating Prisoners With Hepatitis C May Be Worth The Hefty PriceIt's an enormous missed opportunity, say public health specialists.
"It's a disease that can be cured the moment we identify somebody," says Tom Nealon, president and CEO of the American Liver Foundation. "Not testing is incomprehensible when you look at what hepatitis C does to their bodies and their livers."
As the number of people who inject drugs has soared, the rate of infection with hepatitis C — which is frequently tied to sharing needles — has climbed steeply, too.
People with a hepatitis C infection can go for years without symptoms, so may have no inkling they're sick. That delayed onset makes screening important, say health researchers, since infected people may unwittingly infect others.
Still, while screening people who misuse drugs can break the cycle of transmission, public health advocates say a number of obstacles — a lack of money, staff or other resources — may keep substance abuse facilities from going that route.

​TO CONTINUE READING: https://www.npr.org/sections/health-shots/2018/12/19/676417852/why-arent-more-users-of-opioids-or-meth-screened-for-hepatitis-c

​DECEMBER 16, 2018
Jared Kaltwasser MD Magazine

One-third (32%) of people who contract hepatitis C virus (HCV) as a child will go on to develop cirrhosis at a median of 33 years post-infection, according to new research.

The study, highlighting the importance of testing and early intervention in young patients with HCV, helps clinicians quantify the means by which infection is occurring in children.

Investigators from Birmingham Women and Children’s Hospital and Nottingham University Hospital NHS Trust analyzed data from the HCV Research UK database, finding 1049 enrollees who were diagnosed with HCV as a child. They found that most of the patients had contracted the virus through the use of intravenous drugs (52%), and the next-largest category contracted the disease via blood products (24%). Another 11% contracted the virus through perinatal infection.

William L. Irving, PhD, a professor of virology at the University of Nottingham, said he was surprised to see that liver disease appears to progress at the same rate regardless of whether the person is infected at an advanced age, or at birth.

“There would be reasons for thinking this might not be true, because those individuals [infected at birth] would not have the same co-factors for disease progression as older children and adults, most obviously alcohol consumption,” he told MD Magazine®, “and yet for the small numbers of cases that we were able to follow, cirrhosis developed at roughly the same interval after infection as it did for the children who acquired infection through drug use.”

Among the patients enrolled in the study and diagnosed in childhood, 663 patients received treatment and three-quarters of those achieved sustained virological response (SVR). Of those receiving treatment, 55% were given interferon/Peg interferon therapy, and 40% were given direct-acting antivirals (DAAs).

Achieving SVR was shown to be a significant milestone in terms of later health outcomes. Mortality rates among patients achieving SVR was just 1%, versus 5% for patients without SVR.

Line Modin, MD, PhD, who at the time was at Birmingham Women and Children’s Hospital but who now works at the Hans Christian Andersen Children’s Hospital, in Denmark, noted that regulators in the US and Europe have approved certain HCV therapies for children. Sofosbuvir and ribavirin were approved by the US Food and Drug Administration (FDA) and European Medicines Agency (EMA) earlier this year for the treatment of children ages 12-17. The EMA has also approved ledipasvir/sofosbuvir (Harvoni) for children over 12.

However, she noted that that approval has not yet translated into access everywhere in Europe.

TO CONTINUE READING:
​https://www.mdmag.com/medical-news/young-people-with-hepatitis-c-face-cirrhosis-at-younger-age

Public Health
​·  ·  ·  December 6, 201812:36 AM ET
Elana Gordon 

​

The U.S. drug crisis does not appear to be letting up. The nation experienced a shattering 47,000 opioid-related overdose deaths in 2017.
Driving the surge are potent, cheap synthetics like fentanyl that have spread into the illicit drug supply. In response, communities have been trying a range of interventions, from increasing the availability of the antidote naloxone to upping treatment resources.
But an analysis released Thursday by the Rand Corporation, a policy think tank, concludes it's time to pilot an approach from outside the U.S.: offering pharmaceutical-grade heroin — yes, heroin — as a form of treatment for longtime heroin users who haven't had success with other treatments. It's already happening in several European countries and Canada. But prescribing heroin would challenge culture, laws and practice in the U.S.
"These are controversial interventions," says lead author Beau Kilmer, who co-directs RAND's drug policy research center. "There are some people that don't even want to have conversations about this. But given where we are with opioid deaths near 50,000 and fentanyl deaths near 30,000, it's important that we have discussions about these interventions that are grounded in the research and grounded in the experiences of other countries."
​Here's how programs that offer prescription heroin, or heroin-assisted treatment, work. Patients typically get a regular, measured dose of pharmaceutical-grade heroin — also known as diacetylmorphine or diamorphine — and inject it under close medical supervision inside a designated clinic. The idea is if people have a legal source of heroin, they'll be less likely to overdose on tainted street drugs, spend less time and energy trying to get their next fix, and instead be able to focus on the underlying drivers of their addiction.
"This is just another treatment that could help stabilize lives,"says Kilmer.
It's not meant for everyone. Medications like methadone, buprenorphine and naltrexone are highly effective treatments that function in different ways to address cravings and withdrawal symptoms or block the effects of drugs. But these first-line treatments don't work for some longtime opioid users. In Canada's main study of prescription heroin, eligible patients had already tried quitting heroin an average of 11 times.
Prescription heroin as a form of maintenance therapy dates back to the early 1920s in the UK, and revved up in the 1990s in other parts of Europe. (It was even allowed in the U.S. before the sweeping federal drug laws of the early 20th century.)
Heroin-assisted treatment is different from the concept of supervised consumption sites, where patients bring their own illicit drugs and then inject them while medical staff are present, ready to respond in case of an overdose. These are increasingly debated in the U.S. as at least a dozen cities consider them.
Kilmer says prescription heroin has been researched with more rigorous methods. Several randomized controlled trials in Canada, the United Kingdom and the Netherlands found that people addicted to heroin benefited from the approach, according to RAND's analysis. They were more likely to stay in treatment compared with those who took methadone, and they were less likely to revert to using illicit heroin. Evidence also suggests that prescription heroin may be more effective than methadone in reducing criminal activity and improving patients' physical and mental health.
For Dr. Chinazo Cunningham, an addiction specialist at Albert Einstein College of Medicine and Montefiore Medical Center in the Bronx, alternative approaches are important, but she thinks it's more imperative in the U.S. to focus on what she sees as the most pressing issue right now: "We have treatment that works, we just need to provide it in a way that is accessible to people," she says.
As it stands, a vast majority of people who could benefit from first line treatments for opioid use disorder aren't getting it, a problem that's even driving a black market for treatment.
"It's hard for me to imagine heroin-assisted treatment because I think right now even talking about getting more mainstream treatment like methadone, buprenorphine and naltrexone to people, there's already so much stigma around it," says Cunningham.
As part of the analysis, RAND conducted focus groups and interviews in several New Hampshire and Ohio counties hit hard by the overdose crisis. The idea of prescription heroin was new to many and was met with skepticism over its acceptability from health professionals, local leaders, and those in treatment. People worried that heroin-assisted treatment "would enable drug use" and face community resistance.

​Elana Gordon is a health reporter and a 2018-2019 Knight Science Journalism Fellow at MIT. You can follow her on Twitter: @elana_gordon.

TO CONTINUE READING:https://www.npr.org/sections/health-shots/2018/12/06/673986164/is-america-read