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.
July 26, 20232:33 PM ET By Bec Roldan
How do viruses do their job of infecting humans? Some of them are experts at evading the immune system so that it won't knock them out.
Take hepatitis C, a sneaky and potentially deadly viral infection of the liver that is transmitted by contact with human blood – for example, through needles, sex and childbirth.
Scientists have known for a long time that hep C can hide from our immune system. While the immune system might attack the invading virus at first, leading to mild symptoms like fever or fatigue, the virus eventually hides so the immune system gives up the chase. Which is why most patients with hep C never show symptoms.
That gives hep C plenty of time to replicate and spread throughout healthy liver cells, leading to a chronic case of hepatitis C.
"We have this constant battle going on with these viruses," says Jeppe Vinther, a professor of biology at the University of Copenhagen who studies hepatitis C. "We are trying to defeat them and they are trying to avoid being detected and defeated."
But scientists didn't know how hep C pulled off its hiding trick. A new study led by Vinther and published in the journal Nature offers an explanation.
The cap is the keySo how does hep C do it? The virus uses standard villain fare to evade detection: a mask.
Hepatitis C is an RNA virus – one of several viruses that rely on their RNA instead of their DNA to carry information needed to take over the body's healthy cells. Other RNA viruses include measles, mumps, influenza and SARS-CoV-2.
RNA molecules in our body have a protecting group of DNA building blocks at their end known as a cap. These caps have various functions, including sending a message to our immune system: Leave us alone! Do not destroy us!
Since RNA viruses lack caps, once they invade our body, says Vinther, the cell control alarm bells go off and the immune system is activated to kill the foreign RNA.
This new study shows that when your body is infected with hep C, the virus attracts a cap for its RNA – like the protective cap on the body's own RNA. The researchers don't know exactly how the hep C virus does this — one of the many mysteries about viruses.
TO CONTINUE READING: https://www.npr.org/sections/goatsandsoda/2023/07/26/1187040969/hep-c-has-a-secret-strategy-to-evade-the-immune-system-and-now-we-know-what-it-i
JULY IS BIPOC MENTAL HEALTH MONTH AND A GOOD TIME TO REFLECT ON HOW WE USE THESE TERMS, AND THEIR IMPACT ON PEOPLE OF COLOR.
BY ISHA WEERASINGHE July 31st 2023
At least twice a day, I hear the phrases “It’s driving me insane!” or “That was crazy” to describe everyday occurrences.
Words like “crazy,” “mad,” “insane,” and “nuts” have been completely absorbed into our lexicon, and we don’t think twice about using them. Casual use of these terms, however, can be stigmatizing and dehumanizing for people with mental health conditions.
People often don’t think about the origin of these phrases or their true meaning. They often reinforce society’s negative view of people struggling with their mental health and can lead to fatal consequences.
Casual use of these terms, however, can be stigmatizing and dehumanizing for people with mental health conditions.
Several decades ago my mother was diagnosed with a serious mental health condition — undifferentiated schizophrenia — bringing this issue close to my heart. Her experiences motivated me to pursue a career in mental health policy and devote my energy to eradicating stigma and expanding access to culturally responsive care.
When someone casually says, “she’s so crazy” in an off-handed way, they could be talking about someone like my mom.
TO CONTINUE READING: https://wordinblack.com/2023/07/the-damage-we-do-when-we-throw-around-terms-like-crazy/
BY ANNA LUCENTE STERLING NEW YORK CITY
PUBLISHED 5:22 PM ET JAN. 13, 2023
Overdose deaths in the city continued to climb in 2021, reaching new record highs that topped record overdose deaths the previous year, according to provisional data released on Thursday by the Department of Health.
There were 2,668 drug overdose deaths across the five boroughs in 2021, an increase of 78% since 2019 and 27% since 2020, the report found.
“These deaths are heartbreaking and many, if not most, are absolutely preventable,” Dr. Ashwin Vasan, health commissioner, said in a statement.
The report found disparities by age, race, poverty level, and neighborhood of residence.
According to the provisional data, overdose deaths among males in 2021 were about three times as high as deaths among females.
Black New Yorkers had the highest rate of overdose deaths among ethnic groups, as well as the largest increase of ethnic groups from 2020 to 2021, city provisional data shows.
Fentanyl was detected in 80% of the drug overdose deaths in 2021 and was the most common substance involved in overdose deaths for the fifth year in a row, according to the city. The opioid is 50 to 100 times stronger than morphine.
New Yorkers ages 55 to 64 years old, and Bronx residents, also had the highest rate of overdose deaths compared to other age groups and boroughs.
TO READ: https://www.ny1.com/nyc/all-boroughs/news/2023/01/13/drug-overdoses-continue-to-climb-in-2021--provisional-city-data-shows?cid=share_email
By Alan Mozes Updated on July 21, 2023
Cases of hepatitis C, a liver infection spread by blood contact, have skyrocketed during the U.S. opioid epidemic
The upshot: Cases of the disease are rising exponentially among pregnant women.
HCV drives up the risk for poor fetal development and preterm birth
Hepatitis C Rates Soar Among Pregnant WomenBy Alan Mozes,Updated on July 21, 2023
Cases of hepatitis C, a liver infection spread by blood contact, have skyrocketed during the U.S. opioid epidemic
The upshot: Cases of the disease are rising exponentially among pregnant women
HCV drives up the risk for poor fetal development and preterm birth
FRIDAY, July 21, 2023 (HealthDay News) – In the two decades since the opioid epidemic took off, the addiction crisis has claimed the lives of hundreds of thousands of Americans.
Now, new research points to another grim outgrowth of the crisis on American health: a skyrocketing risk in pregnant women for hepatitis infection (HCV).
That's because the main risk factor for contracting hepatitis C — a liver infection spread by blood contact -- is injection drug use.
Between 1998 and 2018, prevalence of HCV among pregnant women shot up 16-fold, researchers found, driving up the risk for poor fetal development and fetal distress, as well as preterm birth.
And that's just the broad picture among pregnant women of all ages. Among those between 21 and 30, hepatitis C risk shot up more than 3000%.
"We do think the increase in HCV infections among pregnant women in our data is concerning," noted lead author Dr. Po-Hung (Victor) Chen, an assistant professor of medicine Johns Hopkins University School of Medicine's Comprehensive Transplant Center in Baltimore.
TO CONTINUE READING:
Written by Lindsay Kalter WebMD Health News
May 17, 2023 – Jose Martinez spent several years unhoused, jobless, and trapped in a cycle of addiction to synthetic marijuana – a lab-created drug that affected his mind and behavior and is dangerous and sometimes deadly.
His life changed when the Bronx, NY, resident began recovery in 2017, which he credits in large part to what is now an overdose prevention site in New York City’s Harlem neighborhood – one of two official so-called safe injection sites in the United States, where people can use illicit drugs under supervision of trained staff to prevent death and illness.
The other is in the city’s Washington Heights neighborhood. At the time, both locations were needle exchanges, which merged and added supervised injection to create OnPoint NYC in 2021.
Though Martinez did not inject drugs, he took advantage of the other resources there, including laundry facilities and showers.
“People can access safer supplies, but also mental health services, and I used those,” said Martinez, 35. “Before that, I tried rehab and detox, and they didn’t work for me. The [site] helped me get there when I was ready.”
I tried rehab and detox, and they didn’t work for me. The [site] helped me get there when I was ready.
Former addict Jose MartinezHe added, “We were a community, like a family.”
The federal government will, for the first time, bankroll a study of how well overdose prevention sites work, according to an announcement on May 8.
A grant of more than $5 million over 4 years will go to New York University and Brown University in Providence, RI, to study 1,000 people at New York’s two sites, along with one set to open in Providence next year.
The announcement comes as deadly overdoses continue to claim lives across the country. There were more than 106,000 overdose deaths in 2021.
The approach is controversial, with critics claiming it enables illegal drug use and brings crime into surrounding areas. But overdose prevention sites already operate in 14 countries, including Canada. There are efforts to open these facilities in Colorado, New Mexico, and Nevada.
TO CONTINUE READING: https://www.webmd.com/mental-health/addiction/news/20230517/us-will-fund-study-of-safe-injection-sites-despite-pushback
Eliminating viral hepatitis by 2030 requires support and funding from organizations large and small.
May 22, 2023 • By Laura Schmidt, hep magazine
In an opinion piece, author and global health advocate Chelsea Clinton emphasized the importance of education, vaccination and treatment for people living with viral hepatitis, which affects almost 400 million people worldwide and kills more than 1 million each year, according to the World Health Organization (WHO). The article was cowritten by Finn Jarle Rose, the executive director of The Hepatitis Fund.
Almost 90% of people living with hepatitis do not know their status. Clinton compared the testing rates for hepatitis C virus (HCV) with those for HIV during the early years of that epidemic. “But it doesn’t have to be this way,” she wrote.
The WHO’s goal of eliminating viral hepatitis by 2030 is achievable. In fact, Egypt, which once had one of the highest rates of hepatitis C virus in the world, recently succeeded in eliminating HCV in its entire population. It did so “through a partnership approach that engaged civil society, the private sector, and philanthropic organizations to mobilize the community and increase rates of screening, diagnosis, and treatment,” wrote Clinton.
TO CONTINUE: https://www.hepmag.com/article/chelsea-clinton-weighs-viral-hepatitis-elimination-goal
MAY 18, 2023 THE WHITE HOUSE - BRIEFING ROOM- PRESiDENTIAL ACTIONS
Thousands of Americans die every year of viral hepatitis — infections of the liver that can be managed or cured if patients know they are infected and can get treatment. On National Hepatitis Testing Day, we urge Americans to get tested and recommit to ensuring that those who are diagnosed can receive lifesaving care. Viral hepatitis is a hidden epidemic. For those with hepatitis C, which spreads through contact with infected blood and is the most common strain, it can be years between the time someone is infected and when they first present symptoms, leaving far too many unaware that they are sick. This can further spread the virus, delay treatment, and lead to serious liver disease — including cirrhosis, liver failure, liver cancer, and even death. Pregnant women with untreated hepatitis C can also pass the virus on to their newborns. It disproportionately affects Black Americans and Native Americans, who too often cannot access quality health care, and it is more common among those experiencing homelessness and those who are incarcerated as more than a third of people in a jail or prison can be positive at a given time. The good news is that we now have a cure for hepatitis C that is 95 percent effective — but its high cost, among other factors, has kept it from many of the more than 2 million Americans in need.
My new Budget includes a bold plan to change that this decade — ending hepatitis C as a public health threat by expanding testing, slashing the high cost of treatment, and promoting awareness of the risks and the cure. It draws on work that the Department of Veterans Affairs has done in treating more than 100,000 affected veterans since 2014. My plan would make testing quicker and simpler with more point-of-care diagnostic tests so patients can be tested and treated in a single visit, rather than having to return several times before determining their infection status. It would pioneer innovative approaches to treating hepatitis C, including a national antiviral subscription model, so more Americans can get affordable care and taxpayers can save billions of dollars through prevention and the reduced need for treatment of advanced liver diseases. My plan would also support grassroots public health groups; train more health care professionals; and expand mobile, telehealth, and community sites focused on hepatitis testing and care. And it would boost progress toward a hepatitis C vaccine.