The American Association for the Study of Liver Diseases and the Infectious Diseases Society of America recently released updated guidance on testing, treating, and managing hepatitis C.
The updated guidance, published online in Clinical Infectious Disease on July 23, 2023, is focused on recommendations for addressing nonadherence; treatment options for children as young as 3 years old; hepatitis C virus (HCV)–positive organ donation; eligibility changes for a simplified treatment approach; and therapy in vulnerable populations, including incarcerated persons.
Treatment nonadherenceHCV can be treated with direct acting antivirals (DAA). Though the course of therapy is considered to be complete at 8 or 12 weeks, the guidance specifies that up to 40% of patients do not adhere to their treatment regimen.
To address this, the guidance panel developed a new treatment algorithm for patients that considers the timing and duration of nonadherence. The algorithm is broken down into two categories: interruptions prior to receiving 28 days of DAA therapy and interruptions after receiving 28 or more days of DAA therapy.
For all patients who are first nonadherent to their DAA therapy before 28 days, the panel recommends immediately restarting the course of treatment. If a patient misses 7 or fewer days, no other action is needed. If a patient misses 8 or more days, they should immediately receive an HCV RNA test after restarting therapy. If the test returns a negative reading, the patient should complete the medication for the full duration. If positive, the treatment should be extended by 4 weeks.
For patients whose nonadherence occurs after 28 days of treatment and who miss 7 or fewer days, they can immediately restart DAA and continue for the full duration. If a patient misses 8 to 20 consecutive days, they should immediately restart therapy and receive an HCV RNA test.
A negative test indicates that a patient should complete the full duration of therapy, which can be extended in certain circumstances. A positive test indicates stopping treatment and instead following a separate set of recommendations that is laid out in the retreatment section of the guidance document. Patients who miss 21 consecutive days of therapy or more should follow the same steps as a patient with a positive HCV RNA test.
TO CONTINUE READING: https://pharmacist.com/Publications/Pharmacy-Today/Article/national-infectious-disease-organizations-update-guidance-on-hepatitis-c
Tuesday, September 26, 2023
Designation, new research program and update to NIH mission are actions to ensure inclusion of people with disabilities.
Today, Eliseo J. Pérez-Stable, M.D., director of the National Institute on Minority Health and Health Disparities (NIMHD), designated people with disabilities as a population with health disparities for research supported by the National Institutes of Health. The decision was made in consultation with Robert Otto Valdez, Ph.D., the director of the Agency for Healthcare Research and Quality, after careful consideration of a report delivered by an NIMHD advisory council, input from the disability community and a review of the science and evidence. A report issued in December 2022 by the Advisory Committee to the (NIH) Director (ACD), informed by the work of the Subgroup on Individuals with Disabilities, explored similar issues faced by people with disabilities. The designation is one of several steps NIH is taking to address health disparities faced by people with disabilities and ensure their representation in NIH research.
"This designation recognizes the importance and need for research advances to improve our understanding of the complexities leading to disparate health outcomes and multilevel interventions,” said Dr. Pérez-Stable. “Toward this effort, NIMHD and other NIH institutes launched a new research program to better understand the health disparities faced by people with disabilities who are also part of other populations designated as having health disparities.”
NIMHD is the lead NIH institute on monitoring minority health and health disparities research. Designated populations experience significant disparities in their rates of illness, morbidity, mortality and survival, driven by social disadvantage, compared to the health status of the general population. A health disparity designation helps to encourage research specific to the health issues and unmet health needs of these populations. Other NIH-designated populations with health disparities include racial and ethnic minority groups, people with lower socioeconomic status, underserved rural communities and sexual and gender minority groups.
TO CONTINUE READING:https://www.nih.gov/news-events/news-releases/nih-designates-people-disabilities-population-health-disparities
by Elana Gotkine, August 22, 2023
In a clinical practice guideline issued by the American College of Obstetricians and Gynecologists and published online Aug. 17 in Obstetrics & Gynecology, recommendations are presented for hepatitis B and C virus screening in pregnancy, for management of patients with infection, and for vaccination.
Brenna L. Hughes, M.D., from the American College of Obstetricians and Gynecologists, and colleagues developed guidelines for pregnant or postpartum women and individuals who screen positive for viral hepatitis infection.
The authors recommend early universal prenatal screening for hepatitis B surface antigen (HBsAg) of all pregnant patients, regardless of history of testing or vaccination status. Triple panel screening (HBsAg, anti-HBs, and total anti-HBc) is recommended for all pregnant patients who do not have a documented negative triple screen result after age 18 years, those who did not complete vaccination, or those with ongoing risks for hepatitis B infection, regardless of vaccination status or testing history. In each pregnancy, all patients should be screened for hepatitis C virus antibodies. Prepregnancy screening for hepatitis C virus infection and treatment is recommended before pregnancy when possible. Women with hepatitis B or C virus infection should have prepregnancy counseling, including the effects of pregnancy on maternal disease and risks to the fetus and neonate. Recommended groups should undergo vaccination for hepatitis A virus, hepatitis B virus, or both during pregnancy.