Excess liver-related morbidity of chronic hepatitis C patients, who achieve a sustained viral response, and are discharged from care

Innes, Hamish; Hutchinson, Sharon; Allen, Samuel H.; Bhattacharyya, Diptendu; Bramley, Peter; Delahooke, Toby; Dillon, John; Forrest, Ewan; Fraser, Andrew; Gillespie, R; Goldberg, David J.; Kennedy, N.; McDonald, Scott; McLeod, Allan; Mills, Peter R.; Morris, Joseph E.; Hayes, Peter

doi:10.1002/hep.24561

Cited by 58 publications

(56 citation statements)

References 24 publications

(31 reference statements)

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“…3 Sustained virological response (SVR) synonymous with HCV cure can now be achieved using antiviral treatment. 4 It is important that cases of HCV infection are identified early and treated to prevent disease complications and reduce the spread of infection. 5 The HPSC reported an 11% increase in 2014 in the number of people newly diagnosed with HIV, compared with 2013 with 49% of those newly diagnosed presenting at either late or advanced stage.…”

Section: Introductionmentioning

confidence: 99%

Opt-out testing for blood-borne viruses in primary care: a multicentre, prospective study

et al. 2016

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BackgroundHepatitis B (HBV), hepatitis C (HCV), and HIV blood-borne viruses (BBV) are associated with chronic ill health and mortality. Early diagnosis reduces disease transmission, delays progression, and improves outcomes. Routine opt-out testing for BBV in primary care may be viable in identifying unknown disease. AimTo assess the viability and yield of routine optout testing for BBV. Design and settingA multicentre, prospective, routine opt-out testing study of BBV in primary care between September 2014 and February 2015 across four sites in Dublin, Ireland. MethodAll adult patients attending for routine blood tests were offered an additional BBV test during a 6-month period. All individuals were given an information leaflet before phlebotomy and were given the choice to opt out of BBV testing. ResultsIn total, 1188 patients were invited to participate in the study and 1063 (89.5%) opted to be tested (95% confidence interval [CI] = 87.7% to 91.2%). A total of 125 patients (10.5%) opted out. There were 10 positive results, four new diagnoses, and six previously known. There were two new HBV and two new HCV diagnoses, a yield of four per 1000 (95% CI = 0.9 to 7.5 cases per 1000). No new HIV cases were diagnosed. ConclusionThis study indicates that testing for BBV in patients presenting for routine blood tests in primary care is viable. The yield of HBV and HCV suggests that opt-out testing should be considered in primary care to increase detection rates of BBV.

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Section: Introductionmentioning

confidence: 99%

Opt-out testing for blood-borne viruses in primary care: a multicentre, prospective study

et al. 2016

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“…Inclusion criteria for the study was a history of injection drug use, SVR attained by June 2012, and sufficient identifiers for record-linkage (n=1,259). To enable further database linkage (described below), the HCV Clinical Database was first linked to the Scottish HCV Diagnosis Database, as previously described (Innes, et al, 2011); this linkage also allowed for scrutiny of patient record accuracy, such that patients were dropped if flaws in treatment records were detected (e.g. nonsensical diagnosis and treatment dates).…”

Section: Study Population Data Sources and Linkage Proceduresmentioning

confidence: 99%

Evidence of continued injecting drug use after attaining sustained treatment-induced clearance of the hepatitis C virus: Implications for reinfection

Valerio

Goldberg

Lewsey

et al. 2015

Drug and Alcohol Dependence

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Background: People who inject drugs (PWID) are at the greatest risk of hepatitis C virus (HCV) infection, yet are often denied immediate treatment due to fears of on-going risk behaviour. Our principle objective was to examine evidence of continued injecting drug use among PWID following successful treatment for HCV and attainment of a sustained viral response (SVR). Methods: PWID who attained SVR between 1992 and June 2012 were selected from the National Scottish Hepatitis C Clinical Database. Hospitalisation and mortality records were sourced for these patients using record-linkage techniques. Our primary outcome variable was any hospitalisation or death which was indicative of injecting drugs post-SVR. Results: The cohort comprised 1170 PWID (mean age at SVR 39.6y; 76% male). The Kaplan Meier estimate of incurring the primary outcome after three years of SVR was 10.6% (95% CI, 8.8-12.8) After adjusting for confounding, the risk of an injection related hospital episode or death post-SVR was significantly increased with advancing year of SVR: AHR:1.1 per year (95% CI, 1.0-1.2), having a pre-SVR acute alcohol-related hospital episode: AHR:1.8 (95% CI, 1.3 -2.6), and having a pre-SVR opiate or injection-related hospital episode: AHR:2.6 (95% CI, 1.9 -3.7). Conclusion: Despite attaining the optimal treatment outcome, these data indicate that an increasing significant number of PWID continue to inject post-SVR at an intensity which leads to either hospitalisation or death and potential increased risk of reinfection.Pg|2

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“…We read with interest the recent article by Ngu et al 1 that reports a population-based study examining mortality and the risk of hepatobiliary and nonhepatobiliary malignancy in patients with autoimmune liver disease. During the 7-year study period a total of 130 autoimmune hepatitis (AIH), 70 primary biliary cirrhosis (PBC), and 81 primary sclerosing cholangitis patients were identified.…”

Section: Mortality and The Risk Of Malignancy In Autoimmune Liver Dismentioning

confidence: 99%

“…We thank Dr. Shariff and colleagues for their interest in our study 1 and for their helpful comments. We are more than happy to provide further detailed information on our cohorts and results in relation to the risk of hepatocellular carcinoma (HCC) development in patients with autoimmune liver diseases (AiLD) as requested.…”

Section: Replymentioning

confidence: 99%

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Excess liver-related morbidity of chronic hepatitis C patients, who achieve a sustained viral response, and are discharged from care

Cited by 58 publications

References 24 publications

Opt-out testing for blood-borne viruses in primary care: a multicentre, prospective study

Opt-out testing for blood-borne viruses in primary care: a multicentre, prospective study

Evidence of continued injecting drug use after attaining sustained treatment-induced clearance of the hepatitis C virus: Implications for reinfection

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