Less than one third of infants born to mothers with the virus were screened for HCV.
​January 26, 2023 • By Sukanya Charuchandra

Active hepatitis C virus (HCV) infection during pregnancy is associated with premature birth, and a high viral load increases the risk of vertical transmission, according to findings published in the Journal of Hepatology. However, only a minority of infants born to mothers with HCV are screened for the infection, as is recommended by treatment guidelines.
Previous studies have shown that the mother-to-child HCV transmission rate is around 6%. But the viral load level needed for transmission and the impact of hepatitis C on pregnancy outcomes are not well understood.
Tatyana Kushner, MD, of the Icahn School of Medicine at Mount Sinai in New York City, and colleagues conducted a retrospective study to better understand vertical transmission of hepatitis C and its impact on pregnancy outcomes.
Using administrative healthcare data, the team identified 2,170 pregnancies among 1,636 women in Ontario who acquired hepatitis C before pregnancy. In 1,780 of these cases (82%), the women continued to test positive for HCV RNA during their pregnancies, indicating active infection.
Women who tested positive for HCV RNA during pregnancy were more likely to deliver their babies prematurely than those who did not have active HCV infection (18% versus 12%, respectively). The former group was also at greater risk for intrahepatic cholestasis of pregnancy (blocked bile flow) and postpartum hemorrhage. However, women with active HCV infection during pregnancy were less likely to develop gestational diabetes than those who had cleared the virus.
Less than a third (29%) of the newborns born to women with hepatitis C were screened for HCV after birth. Of those who were screened, the mother-to-child transmission rate was 3.5%. Women with an HCV RNA level of at least 6.0 log, or about 1,000,000 copies, had more than a threefold greater likelihood of vertical transmission.

​TO CONTINUE READING: https://www.hepmag.com/article/hepatitis-c-pregnancy-linked-worse-outcomes

By Jules Murtha | Fact-checked by Barbara Bekiesz  MD Linx
| Updated December 20, 2022

Key Takeaways

• Those who struggle with substance use disorders often deal with the stigma of being perceived as dangerous, incapable of recovering, or blamed for the state of their condition.
  
• To help destigmatize patients who deal with substance misuse, clinicians can use person-first language and scientifically accurate terminology when talking about addiction.
  
• Examples of non-stigmatizing language include “return to use” (instead of “relapse”), “drug misuse” (instead of “drug abuse”), and “person in active use” (instead of “junkie”).
  

“The only constant in life is change.”
This quote from Heraclitus didn’t specifically refer to the evolving nature of medical terminology, or the consequences of stigmatizing language. Yet, it perfectly applies to research on the language of addiction, which urges clinicians to rethink how they speak about the disease.
The link between language and stigmaThe US government has recognized the harsh effects of stigmatizing language on patients with substance use disorders.
A 2017 memo written by Michael P. Botticelli, the former director of the White House Office of National Drug Control Policy, recognized how stigmatizing language may negatively alter societal perceptions of people with substance use disorders.[1]
According to Botticelli, although people with substance use disorders are capable of recovery, “sometimes the terminology used in the discussion of substance use can suggest that problematic use of substances and substance use disorders are the result of a personal failing; that people choose the disorder, or they lack the willpower or character to control their substance use.”
This, along with the perception that those who use substances are dangerous, could converge to create a stigma associated with substance use that can do real damage. This is especially true for women and mothers, who often have poor self-esteem, depression, fear, and anxiety as a result of addiction-related stigma.
A 2021 article published by the NIH stated that stigma has the power to prevent patients with substance use disorders from seeking proper treatment, as well as negatively affecting physicians’ understanding of them.[2] This may ultimately influence the quality of care they receive.
Person-first languageResearchers urge doctors to adapt their terminology by using person-first language.
Person-first language is defined by the NIH as language that “maintains the integrity of individuals as whole human beings by removing language that equates people to their condition or has negative connotations.”[3]
But what does person-first language sound like? What vocabulary should be used in the hallways and the exam room, when referring to substance use disorders and the patients who struggle with them?
Read Next: Identifying drug-seeking behaviors in your patients

Different ways to describe substance useWhen it comes to changing the language of addiction, there are a few concrete terms and phrases to use in place of potentially stigmatizing ones.
According to the NIH and an article published by StatNews.com, this list of revised, person-first terms is as follows:[4]

• Abuse → Use, misuse, or used other than prescribed
  
• Addict → Person with substance use disorder
  
• Alcoholic → Person with alcohol use disorder
  
• Junkie → Person in active use
  
• Relapse → Return to use
  
• Former addict → Person in recovery or person in long-term recovery
  
  ​TO CONTINUE: https://www.mdlinx.com/article/the-evolving-language-of-addiction-your-words-matter-to-your-patients/4OhHwgrWfLUbSlXjBw7RHa?show_order=2&article_
  
  

Too many Americans are missing out on a cure for hepatitis C
ByLAURAN NEERGAARD AP Medical Writer   ABC News-  December 20, 2022, 12:35 PM

WASHINGTON -- Too many Americans are missing out on a cure for hepatitis C, and a study underway in a hard-hit corner of Kentucky is exploring a simple way to start changing that.
The key: On-the-spot diagnosis to replace today's multiple-step testing.
In about an hour and with just a finger-prick of blood, researchers can tell some of the toughest-to-treat patients — people who inject drugs — they have hepatitis C and hand over potentially life-saving medication.
Waiting for standard tests “even one or two days for someone who’s actively using drugs, we can lose touch with them,” said Jennifer Havens of the University of Kentucky, who's leading the study in rural Perry County. To start treatment right away "that’s huge, absolutely huge.”
Single-visit hepatitis C diagnosis already is offered in other countries, and now the White House wants to make it a priority here.
​
​“It’s frankly an embarrassment” that the U.S. doesn’t have such an option, said Jeffrey Weiss of New York’s Mount Sinai health system, who works with a community hepatitis C outreach program. “We have many people we’ve tested and want to give their results to and can’t find them.”
At least 2.4 million Americans are estimated to have hepatitis C, a virus that silently attacks the liver, leading to cancer or the need for an organ transplant. It leads to more than 14,000 deaths a year. That's even though a daily pill taken for two to three months could cure nearly everyone with few side effects.
Yet in the U.S., more than 40% of people with hepatitis C don't know they're infected. Fewer than 1 in 3 insured patients who are diagnosed go on to get timely treatment. And new infections are surging among younger adults who share drug needles.

​“This is a travesty,” said Dr. Francis Collins, the former National Institutes of Health director who’s now a White House adviser devising a new national strategy to tackle hepatitis C.
Most likely to fall through the cracks are “people in tough times” -- those who inject drugs, are uninsured or on Medicaid, or are homeless or incarcerated -- who can’t navigate what Collins calls the “clunky” diagnosis process and other barriers to the pricey pills.

“It’s frankly an embarrassment” that the U.S. doesn’t have such an option, said Jeffrey Weiss of New York’s Mount Sinai health system, who works with a community hepatitis C outreach program. “We have many people we’ve tested and want to give their results to and can’t find them.”

​At least 2.4 million Americans are estimated to have hepatitis C, a virus that silently attacks the liver, leading to cancer or the need for an organ transplant. It leads to more than 14,000 deaths a year. That's even though a daily pill taken for two to three months could cure nearly everyone with few side effects.
Yet in the U.S., more than 40% of people with hepatitis C don't know they're infected. Fewer than 1 in 3 insured patients who are diagnosed go on to get timely treatment. And new infections are surging among younger adults who share drug needles.

“This is a travesty,” said Dr. Francis Collins, the former National Institutes of Health director who’s now a White House adviser devising a new national strategy to tackle hepatitis C.
Most likely to fall through the cracks are “people in tough times” -- those who inject drugs, are uninsured or on Medicaid, or are homeless or incarcerated -- who can’t navigate what Collins calls the “clunky” diagnosis process and other barriers to the pricey pills.

​TO CONTINUE STORY: https://abcnews.go.com/Health/wireStory/us-starts-grappling-travesty-untreated-hepatitis-95611164

DEATH SENTENCE

There is a simple, outright cure for hepatitis C. But state prisons across the country are failing to save hundreds of people who die each year from the virus and related complications.
 
A STAT investigation has found that more than 1,000 incarcerated people died from hepatitis C-related complications in the six years after a curative drug hit the market. The death rate in 2019 was double that of the broader U.S. population.In the stories on this page, reporter Nicholas Florko documents prisons’ blatant refusal to test and treat people with the condition, even, in some cases, in the face of legal orders to do so. He introduces incarcerated people who watched their health deteriorate or lost their lives because of the rationing of hepatitis C drugs. Prisons say the medicine, even as its price drops, is too expensive for them to distribute widely. But incarcerated people are fighting back: Some have fought for the treatment in the courts and won, forcing the system to care for them and, in some cases, other incarcerated hepatitis C patients.
​
TO READ MORE:​ https://www.statnews.com/death-sentence/?utm_source=email_nns&utm_campaign=hep_investigation_launch&utm_medium=email&utm_source=STAT+Newsletters&utm_campaign=6315953c4e-EMAIL_CAMPAIGN_2022_12_08_08_25&utm_medium=email&utm_term=0_-6315953c4e-%5BLIST_EMAIL_ID%5D

By Joe Hannan | Medically reviewed by Kristen Fuller, MD 
| Updated November 17, 2022    MDLinx

Key Takeaways

• Overdose deaths stemming from opioid addiction remain a leading cause of the death in the US.
  
• Clinicians find themselves awash with the third wave (as documented by the CDC) of opioid addiction, which is driven in large part by synthetic opioids such as fentanyl.
  
• Medication for opioid use disorder is an effective treatment modality, but access—as well as patient, public, and clinical attitudes—have a decisive impact on its utilization.
  

Opioid addiction has gone from a relic of bygone eras to an epidemic raging in American homes and communities. No spot on the US map is untouched by the addiction crisis, and it's common to know someone who has been struck by this tragedy.
But much has changed in the fight against opioid addiction. New diagnostic approaches and treatments, as well as shifting attitudes, are hopefully poised to lay this problem to rest.
How we got hereChart out the pattern of opioid overdose deaths in the US, beginning in 1999, and you get a hockey-stick graph.[1]
Between 1999 and 2020, an estimated 546,000 people died from opioid overdoses.
The CDC charts the rise of opioid addiction and its deadly wake in three distinct waves. Wave 1 began to crest in the 1990s with the wide distribution of prescription opioids. Wave 2 marked a shift toward fatal heroin overdoses beginning in 2010.
Clinicians find themselves struggling to stay afloat as Wave 3 pummels the US healthcare system. Driving this surge are synthetic opioids such as fentanyl. Increasingly, fentanyl and its synthetic analogs (acetylfentanyl, furanylfentanyl, and carfentanil) have made their way into combinations with heroin, cocaine, and counterfeit pills—all with deadly implications, including accidental overdose.
The CDC estimates that 187 people are dying each day from opioids.
TO CONTINUE: ​https://www.mdlinx.com/article/opioid-crisis-update-whats-changed-and-where-are-we/2iqSkO3VbVT9WwLQNq0Ae?show_order=2&article_type=selected&tag=Morning&utm_campaign=daily-alert_all-specialties_221118_malert_a90&ipost_environment=m3usainc&utm_medium=email&utm_source=iPost&iqs=9z2zrtc58f4bcnhgjr6g5vi8bpasbkbcjtrb1g1lomg

ROLLCALL POLICY -    By Sandhya Raman, Posted October 25, 2022 at 11:15am
The plan would streamline testing and treatment and secure an agreement with drugmakers to bring down the cost of treatment of the disease, which has spiked during the pandemic
The Biden administration is preparing a comprehensive initiative to fight hepatitis C that would streamline testing and treatment and secure an agreement with drugmakers to bring down the cost of treatment of the disease, which has spiked during the pandemic.
Francis Collins, special project adviser to President Joe Biden and former longtime director of the National Institutes of Health, said Monday the administration hopes to secure some funding this year for the yet to be formally unveiled initiative.
He said he has briefed Biden on the plan, and the Office of Management and Budget is “enthusiastic about figuring out how to fit this into the budgetary requests.”
The plan, he said, would include agencies including the Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Administration, the Indian Health Service, Food and Drug Administration and the Federal Bureau of Prisons.
“It would certainly involve virtually all of the government agencies that have a major role to play,” he said.

​TO CONTINUE: https://rollcall.com/2022/10/25/administration-eyes-national-hepatitis-c-treatment-plan/

​By Nicholas Florko Sept. 13, 2022

WASHINGTON — For nearly a decade, many experts assumed the biggest obstacle to eliminating hepatitis C was the sky-high cost of the new cures.
So when Washington state and Louisiana signed flashy, unprecedented deals with the pharmaceutical companies that make the medicines back in 2019, and dedicated personnel and money toward the lofty goal, many celebrated. Just last week, the White House held the states up as a potential model for a forthcoming multibillion-dollar national effort with the same aim.
But those states are nowhere near achieving the overarching goals they set, a new STAT investigation reveals. In Washington, the rate of treatment for the state’s Medicaid program now is actually lower than it was before the initiative began.

The rocky roads in each state underscore that eliminating hepatitis C will likely be far more difficult than it seems, as STAT’s interviews with more than two dozen experts, including current and formerly incarcerated people, drug industry officials, the intellectual architects of the Washington and Louisiana deals, and a U.S. senator show.
Though we have now had a miracle cure for the condition for nearly a decade — and though its cost is falling — there are more intractable problems than mere access. The condition often affects people who don’t see doctors regularly and might miss the infection, or who don’t even have a safe place to store medication. Big goals and a stockpile of pills, experts told STAT, aren’t enough.

TO CONTINUE READING: ​https://www.statnews.com/2022/09/13/louisiana-washington-hep-c-investigation/?utm_source=STAT+Newsletters&utm_campaign=a418d40f4b-Pharmalot&utm_medium=email&utm_term=0_8cab1d7961-a418d40f4b-151392865
​

Team Takes on Virus Behind Liver Disease in Tens of Millions Globally

By Nicole Tenly Aug 24, 2022

The National Institute of Allergy and Infectious Disease (NIAID) awarded $6.9 million to researchers at the Institute for Bioscience and Biotechnology Research (IBBR) to design a vaccine to combat the virus that causes Hepatitis C (HCV), which affects an estimated 71 million people worldwide and puts them at risk for severe liver disease, including cancer.
This five-year award will support a multidisciplinary research team based at IBBR, a joint research enterprise of the University of Maryland, College Park (UMCP), the University of Maryland, Baltimore (UMB) and the National Institute of Standards and Technology (NIST). The researchers aim to develop a vaccine to induce broadly neutralizing antibodies and long-term memory T cell responses to help prevent HCV infection. This recent award follows a $6 million grant awarded to the IBBR research team in 2017 based on its significant progress in the field.

​TO CONTINUE: https://today.umd.edu/6-9m-niaid-award-to-fund-design-testing-of-hepatitis-c-vaccine

Key Takeaways

• The Supreme Court of the United States has ruled that doctors must show intent to mis-prescribe opioids in order to face criminal charges.
  
• Despite the drop in opioid prescriptions in recent years, opioid overdoses and deaths are on the rise, largely because of street drugs.
  
• The CDC’s position is that physicians can better serve patients by focusing on when to initiate and continue opioid treatment, what type and dosage of opioid to use, and how to address risk of drug abuse when prescribing opioids.
  
  TO CONTINUE:  https://www.mdlinx.com/article/scotus-ruled-on-opioid-prescriptions-here-and-8217-s-what-you-need-to-know/x1FOFNp2YHlJFJNM75UF3?show_
  
  

By Jules Murtha | Medically reviewed by Kristen Fuller, MD 
 Updated August 24, 2022   MDLinx

Key Takeaways

• The rise of anti-trans legislation, which limits access to or criminalizes gender-affirming care, may contribute to poorer mental and physical health outcomes and increased suicidality in trans youth, according to studies and medical experts.
• Prominent medical societies including the American Medical Association (AMA), American Psychiatric Association (APA), and the American Academy of Pediatrics (AAP) have issued public statements recognizing the importance and necessity of evidence-based, gender-affirming care for trans and gender-diverse youth.
• Physicians may feel caught in the middle of this controversy. They can care for trans youth by studying the evidence, educating themselves on the debate, and offering gender-affirming care as indicated. A collaborative approach between clinicians, mental health professionals, and families is advised.

A wave of federal and state legislation that bans or criminalizes gender-affirming services for transgender youth has spilled over into the exam room, leaving doctors to wonder how to care for these patients without landing in hot water—or even prison.
Their fear is real.
On Aug. 19, Rep. Marjorie Taylor Green (R-Ga) introduced a bill that would make it a class C felony to provide gender-affirming medical care such as puberty blockers or gender confirmation surgery to trans youth—punishable by up to 25 years in prison. She referred to this type of care as “child abuse.”
A number of states including Texas, Alabama, Arkansas, and Arizona, recently enacted laws or policies restricting youth access to gender-affirming care and, in some cases, imposing harsh penalties on doctors and parents who facilitate access (several of these laws have been temporarily blocked by court rulings). Similar policies have been proposed in dozens of other states.[1][2]
Restrictions like these may contribute to the mental health issues so many trans kids are experiencing, according to many medical experts, trans youth advocates, and many of the nation's most prominent medical societies, including the AMA, APA, AAP, and others.[3]
Mental illness among trans and questioning youthIt's becoming increasingly common for children to openly express gender identities that are incompatible with their assigned gender at birth—to come out as transgender.
Being transgender does not make one mentally ill, the Cleveland Clinic noted.[4] But transgender individuals face unique challenges like discrimination, bullying, and gender dysphoria, which can set the stage for mental illness or suicidal thoughts.
In 2021, 52% of transgender and non-binary youth reportedly considered taking their own lives, according to the Trevor Project’s 2022 national survey on LGBTQ+ youth mental health.[5]
Moreover, 60% of LGBTQ+ kids weren’t able to attain the mental healthcare they wanted, and less than one-third of trans children reported living in gender-affirming homes.
Trans youth have struggled to attain quality healthcare for years. A study published by Pediatrics stated that 62.1% of trans and gender-nonconforming students reported having “poor,” “fair,” or “good” health, as opposed to “very good” or “excellent health.”[6]
Only 33.1% of cisgender youth showed similar results (cisgender refers to individuals whose gender identity aligns with the sex they were assigned at birth).
While clinicians agree that further studies and a wider range of treatment options are needed to better support transgender youth, they are concerned that politicization of this issue harms trans youth and medical professionals.
Response from major medical associationsIn the heat of this controversy, a wide consensus is growing among major medical associations, which are speaking out against efforts to ban or make it a crime to provide these services.
The AMA, the APA, the AAP, the American Academy of Child and Adolescent Psychiatry, the American Psychological Association and the Endocrine Society, among others, have issued public statements that recognize the medical necessity of gender-affirming care for youth and outline the negative impacts of denying access to these services. They also decry the intrusion of government into medical practice.
“Evidence has demonstrated that forgoing gender-affirming care can have tragic consequences,” the AMA wrote in an April 2021 letter to the National Governors Association.
“Transgender individuals are up to three times more likely than the general population to report or be diagnosed with mental health disorders, with as many as 41.5 percent reporting at least one diagnosis of a mental health or substance use disorder,” the letter said, pointing to stigma and discrimination as linked causes.
“Because of this stress, transgender minors also face a significantly heightened risk of suicide.”
— AMA

TO CONTINUE READING: ​ww.mdlinx.com/article/caring-for-trans-youth-in-a-contentious-political-climate/6fWtDWxxXcPrORNc6bA832?show_order=1&article_type=selected&utm_campaign=malert_082522_misc_specialties&tag=Morning&ipost_environment=m3usainc&utm_source=iPost&utm_medium=email&iqs=9z2zqdnk0hdkjqkpnhaq9eakln5kplhfa0tb9cfse9g