To determine treatment regimens and epidemiological patterns in the occurrence of candidemia, a review of cases occurring from 1992 to 1996 in three large Canadian hospitals, University of Alberta Hospital (UAH) and Royal Alexandra Hospital (RAH), Edmonton, and Foothills Medical Center (FMC), Calgary, was carried out. Cases were detected by reviewing microbiology laboratory records. There were 202 cases in all (UAH 104, FMC 70, RAH 28). For the five study years the candidemia rate was 4.5/10 000 discharges (UAH 7.6, FMC 4.9, and RAH 1.7; P < 0.05 for all interhospital comparisons). The rate remained stable between 1992 and 1995 but rose dramatically in 1996 to 7.6/10 000 (P < 0.01 compared to 1995) as a result of increases at UAH and RAH. Of the 208 species identified, Candida albicans accounted for 135 (65%). During hospitalization 93 (46%) patients died. Species did not influence outcome. Antifungal treatment with fluconazole alone was given to 14% of patients, and increased in frequency throughout the study. No antifungal therapy was given to 47 patients (23%). This group had a much higher mortality (68%) than those who received treatment (39% P < 0.01). Twenty of the untreated patients had already died by the time the blood culture had been reported as growing a yeast. Candidemia rates vary significantly between hospitals and increased in some but not all over the five study years. As many patients with candidemia will have died by the time laboratory diagnosis is made, presumptive antifungal therapy in high-risk patients may be necessary if outcome is to be improved.
Among people actively using drugs treated with directly observed peg-IFN alfa-2a plus self-administered RBV, SVR is comparable to that seen in clinical trials of non-drug users, and the rate of HCV reinfection is low.
Unprecedented cure rates for people chronically infected with hepatitis C virus (HCV) have been achieved with interferon-free regimens. Results of phase III clinical trials of sofosbuvir-ledipasvir and of ombitasvir-paritaprevir-ritonavir and dasabuvir, with or without ribavirin, showed sustained viral response (SVR) rates of 94%-99%1-3 and 97%-99.5%, 4 respectively. With other hepatitis C treatments, real-world experiences 5 have not shown SVR rates equal to those achieved in clinical trials, including studies of simeprevir-sofosbuvir (81%-87%, 6 79%-88% 7 and 95% 8 ) and of interferon regimens containing telaprevir or boceprevir. 9 In addition, higher complication rates have been observed in real-world studies.
5,10Furthermore, results of direct-acting antiviral trials may have limited generalizability, since most people coinfected with HIV/HCV were excluded. In Canada, sofosbuvir-ledipasvir has been available since October 2014, and ombitasvir-paritaprevir-ritonavir and dasabuvir, since 2015. Both regimens were included on the Alberta drug benefits list (i.e., public reimbursement) in 2015. These Real-world data also indicate high sustained viral response (SVR) rates. Our objective was to determine real-world SVR rates for patients infected with hepatitis C virus (HCV) who were treated with second-generation direct-acting antivirals in the first 18 months of their availability in Canada.
BACKGROUND: Approximately 60% of incident hepatitis C virus (HCV) infections are due to intravenous drug use; therefore, understanding the socio-demographics of people who inject drugs (PWID) is necessary to achieve HCV elimination. METHODS: In this prospective cohort study of PWID, we determined patients’ baseline HCV antibody, hepatitis B virus (HBV), and HIV serological status. HCV antibody– negative (anti-HCV-negative) cases were followed for seroconversion (median 17 mo with q3m testing) as part of a larger study to develop a vaccine for HCV. An interviewer-administered baseline questionnaire completed with all patients evaluated socio-demographic and clinical characteristics. RESULTS: We tested 257 PWID (median age 40 [range 49–31]y, 81% men, 63% Caucasian, 28% Indigenous). Of these, 28% were positive for HCV antibodies (anti-HCV-positive) (median age 42 [range 49–36]y, 74% men, 69% Caucasian, 29% Indigenous). Compared with anti-HCV-negative PWID, anti-HCV-positive PWID reported injecting more morphine and hydromorphone, using more hydromorphone via non-injection routes, and were more likely to be enrolled in methadone programs. More than 60% reported previous HCV testing, but recent testing (<2 y) was more frequent in the anti-HCV-negative group ( p = 0.03). All were HBV negative, but more than 50% of the anti-HCV-positive group had anti-HBs titres more than 10 IU/L compared with 35% of the anti-HCV-negative group ( p = 0.01), and 3 of 257 were HIV positive (1 co-infected with HCV–HIV). CONCLUSIONS: In this prospective study, differences in age, timing of HCV testing and risk behaviours were found between anti-HCV-positive and anti-HCV-negative groups.
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