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WHO — Guidelines for the screening, care and treatment of persons with hepatitis C infection

May 1, 2014 Comments off

Guidelines for the screening, care and treatment of persons with hepatitis C infection
Source: World Health Organization

These are the first guidelines dealing with hepatitis C treatment produced by the World Health Organization (WHO) and complement existing guidance on the prevention of transmission of bloodborne viruses, including HCV. They are intended for policy-makers, government officials, and others working in low- and middleincome countries who are developing programmes for the screening, care and treatment of persons with HCV infection.

These guidelines serve as a framework that can allow the expansion of clinical services to patients with HCV infection, as they provide key recommendations in these areas and discuss considerations for implementation. The guidelines are also intended for health-care providers who care for persons with HCV infection in low- and middle-countries and provide them guidance in the management of patients infected with HCV.

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Locations and Reasons for Initial Testing for Hepatitis C Infection — Chronic Hepatitis Cohort Study, United States, 2006–2010

August 16, 2013 Comments off

Locations and Reasons for Initial Testing for Hepatitis C Infection — Chronic Hepatitis Cohort Study, United States, 2006–2010
Source: Morbidity and Mortality Weekly Report (CDC)

Chronic hepatitis C virus (HCV) infection causes substantial morbidity and mortality in the United States (1). Testing and treatment of asymptomatic persons might avert progression to more advanced disease. In 1998, CDC published guidelines for HCV testing based on risk factors for infection; however, recent studies indicate that at least one half of all persons living with HCV infection in the United States are unaware of their infection status (2–4). To increase testing rates, in 2012 CDC recommended one-time testing of all persons born during 1945–1965 (5). To better understand where and why persons with chronic HCV infection sought their initial testing, 2006–2010 data were analyzed from a survey conducted as part of the ongoing Chronic Hepatitis Cohort Study (6). Of 4,689 patients with HCV infection who responded to the survey, 60.4% reported that their initial HCV test occurred in a physician’s office. CDC’s risk-based indications (e.g., injection drug use and hemodialysis) were cited by 1,045 (22.3%) of the patients as reasons for testing, whereas clinical indications (e.g., abnormal liver function tests or liver-related symptoms such as jaundice) were cited by 2,121 (45.2%), suggesting that many HCV infections were identified only after the patient had become symptomatic. Promoting U. S. Preventive Services Task Force (7) and CDC recommendations for testing (5) and identifying strategies that help physicians implement HCV testing in their offices might help facilitate timely identification of HCV infection and reduce morbidity and mortality.

Hepatitis C: Testing baby boomers saves lives

May 22, 2013 Comments off

Hepatitis C: Testing baby boomers saves lives

Source: Centers for Disease Control and Prevention

Hepatitis C is a serious virus infection that over time can cause liver damage and even liver cancer. Early treatment can prevent this damage. Too many people with hepatitis C do not know they are infected, so they don’t get the medical care they need.

Once infected with the hepatitis C virus, nearly 8 in 10 people remain infected for life. A simple blood test, called a hepatitis C antibody test, can tell if you have ever been infected, but cannot tell whether you are still infected. Only a different follow-up blood test can determine if you are still infected. CDC data show only half of people with a positive hepatitis C antibody test had the follow-up test reported to the health department. The other half did not have a follow-up test reported, although some of them may have been tested. Without the follow-up test, a person will not know if they still have hepatitis C and cannot get the medical care they need.

Hepatitis C: A projection of the healthcare and economic burden in the UK

February 3, 2013 Comments off

Hepatitis C: A projection of the healthcare and economic burden in the UK

Source: RAND Corporation

Work presented in this report sought to assess the healthcare and economic burden of the hepatitis C virus (HCV) infection in the United Kingdom. It used a cohort simulation model to estimate the prevalence of HCV infection in the UK, including the number of persons who live with HCV infection at different disease stages, and the number of deaths that can be attributed to HCV infection through to 2035. It further assessed the healthcare and societal costs that are associated with HCV infection under different scenarios of diagnosis and treatment rates.

Recommendations for the Identification of Chronic Hepatitis C Virus Infection Among Persons Born During 1945–1965

August 18, 2012 Comments off

Recommendations for the Identification of Chronic Hepatitis C Virus Infection Among Persons Born During 1945–1965
Source: Morbidity and Mortality Weekly Report (CDC)

Hepatitis C virus (HCV) is an increasing cause of morbidity and mortality in the United States. Many of the 2.7–3.9 million persons living with HCV infection are unaware they are infected and do not receive care (e.g., education, counseling, and medical monitoring) and treatment. CDC estimates that although persons born during 1945–1965 comprise an estimated 27% of the population, they account for approximately three fourths of all HCV infections in the United States, 73% of HCV-associated mortality, and are at greatest risk for hepatocellular carcinoma and other HCV-related liver disease. With the advent of new therapies that can halt disease progression and provide a virologic cure (i.e., sustained viral clearance following completion of treatment) in most persons, targeted testing and linkage to care for infected persons in this birth cohort is expected to reduce HCV-related morbidity and mortality. CDC is augmenting previous recommendations for HCV testing (CDC. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR 1998;47[No. RR–19]) to recommend one-time testing without prior ascertainment of HCV risk for persons born during 1945–1965, a population with a disproportionately high prevalence of HCV infection and related disease. Persons identified as having HCV infection should receive a brief screening for alcohol use and intervention as clinically indicated, followed by referral to appropriate care for HCV infection and related conditions. These recommendations do not replace previous guidelines for HCV testing that are based on known risk factors and clinical indications. Rather, they define an additional target population for testing: persons born during 1945–1965. CDC developed these recommendations with the assistance of a work group representing diverse expertise and perspectives. The recommendations are informed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework, an approach that provides guidance and tools to define the research questions, conduct the systematic review, assess the overall quality of the evidence, and determine strength of the recommendations. This report is intended to serve as a resource for health-care professionals, public health officials, and organizations involved in the development, implementation, and evaluation of prevention and clinical services. These recommendations will be reviewed every 5 years and updated to include advances in the published evidence.

Updated CDC Recommendations for the Management of Hepatitis B Virus–Infected Health-Care Providers and Students

July 6, 2012 Comments off

Updated CDC Recommendations for the Management of Hepatitis B Virus–Infected Health-Care Providers and Students
Source: Morbidity and Mortality Weekly Report (CDC)

This report updates the 1991 CDC recommendations for the management of hepatitis B virus (HBV)–infected health-care providers and students to reduce risk for transmitting HBV to patients during the conduct of exposure-prone invasive procedures (CDC. Recommendations for preventing transmission of human immunodeficiency virus and hepatitis B virus to patients during exposure-prone invasive procedures. MMWR 1991;40[No. RR-8]). This update reflects changes in the epidemiology of HBV infection in the United States and advances in the medical management of chronic HBV infection and policy directives issued by health authorities since 1991.

The primary goal of this report is to promote patient safety while providing risk management and practice guidance to HBV-infected health-care providers and students, particularly those performing exposure-prone procedures such as certain types of surgery. Because percutaneous injuries sustained by health-care personnel during certain surgical, obstetrical, and dental procedures provide a potential route of HBV transmission to patients as well as providers, this report emphasizes prevention of operator injuries and blood exposures during exposure-prone surgical, obstetrical, and dental procedures.

These updated recommendations reaffirm the 1991 CDC recommendation that HBV infection alone should not disqualify infected persons from the practice or study of surgery, dentistry, medicine, or allied health fields. The previous recommendations have been updated to include the following changes: no prenotification of patients of a health-care provider’s or student’s HBV status; use of HBV DNA serum levels rather than hepatitis B e-antigen status to monitor infectivity; and, for those health-care professionals requiring oversight, specific suggestions for composition of expert review panels and threshold value of serum HBV DNA considered “safe” for practice (<1,000 IU/ml). These recommendations also explicitly address the issue of medical and dental students who are discovered to have chronic HBV infection. For most chronically HBV-infected providers and students who conform to current standards for infection control, HBV infection status alone does not require any curtailing of their practices or supervised learning experiences. These updated recommendations outline the criteria for safe clinical practice of HBV-infected providers and students that can be used by the appropriate occupational or student health authorities to develop their own institutional policies. These recommendations also can be used by an institutional expert panel that monitors providers who perform exposure-prone procedures.

Sexual Transmission of Hepatitis C Virus Among HIV-Infected Men Who Have Sex with Men — New York City, 2005–2010

July 23, 2011 Comments off

Sexual Transmission of Hepatitis C Virus Among HIV-Infected Men Who Have Sex with Men — New York City, 2005–2010
Source: Morbidity and Mortality Weekly Report (CDC)

In the United States, an estimated 3.2 million persons are living with hepatitis C virus (HCV) infection (1). HCV transmission occurs primarily through percutaneous exposure to blood, and persons who inject drugs are at greatest risk for infection. The role of sexual transmission of HCV has not been well defined. However, reports over the past decade, mainly from Europe, have implicated sexual transmission of HCV among human immunodeficiency virus (HIV)–infected men who have sex with men (MSM). In late 2005, two HIV-infected MSM, each with acute HCV infection that was suspected to have been acquired sexually, were evaluated at Mount Sinai Medical Center in New York City, prompting Mount Sinai to request referrals of similar patients (2). During 2005–2010, a total of 74 HIV-infected MSM with recently acquired HCV infection and no reported history of injection-drug use were evaluated. To examine the role of sexual transmission, a matched case-control study and viral analysis were conducted. Results from the case-control study showed that high-risk sexual behavior was the most likely mode of transmission among these men. Phylogenetic analyses revealed five clusters of closely related HCV variants, suggesting networks of transmission among these men. The findings underscore the importance of screening HIV-infected MSM for HCV, particularly those engaged in high-risk sexual behavior.

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