Therapy of chronic hepatitis C in people who inject drugs: focus on adherence

Abstract Background Intravenous drug use (IVDU) represents the major factor of HCV transmission, but the treatment uptake among people who inject drugs (PWID) remains low owing to a false presumption of low efficacy. The aim of our study was to assess treatment efficacy in PWID and factors determining adherence to therapy. Methods A total of 278 consecutive patients starting DAA (direct-acting antivirals) therapy were included, divided into two groups: individuals with a history of IVDU, PWID group (N = 101) and the control group (N = 177) without a history of IVDU. Results Sustained virological response 12 weeks after the end of therapy (SVR12) was achieved by 99/101 (98%) and 172/177 (98%) patients in the PWID and control group, respectively; in PWID group, two patients were lost to follow-up, and in the control group, four patients relapsed and one was lost to follow-up. PWID patients postponed appointments significantly more often, 29 (28.7%) in PWID versus 7 (4%) in the control group, p = 0.001. Thirteen of 101 (12.9%) and six of 177 (3.4%) patients in the PWID and in the control group, respectively, missed at least one visit (p < 0.01). However, postponing visits led to a lack of medication in only one PWID. In the PWID group, older age (p < 0.05; OR 1.07, 95% CI 1.00–1.20) and stable housing (p < 0.01; OR 9.70, 95% CI 2.10–56.20) were factors positively contributing to adherence. Contrarily, a stable job was a factor negatively influencing adherence (p < 0.05; OR 0.24, 95% CI 0.06–0.81). In the control group, none of the analyzed social and demographic factors had an impact on adherence to therapy. Conclusions In PWID, treatment efficacy was excellent and was comparable with SVR of the control group. Stable housing and older age contributed to a better adherence to therapy.

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Risk Factors Associated with Lost to Follow up Among Multidrug Resistance Tuberculosis Patients Registered for Treatment in Programmatic Management of Drug Resistant Tuberculosis Sites of Punjab, Pakistan

Journal of Biostatistics and Epidemiology ◽

10.18502/jbe.v6i3.5099 ◽

2021 ◽

Author(s):

Shamsa Kanwal ◽

Abdul Majeed Akhtar

Keyword(s):

Risk Factors ◽

Multidrug Resistance ◽

Older Age ◽

First Line ◽

Long Distance ◽

Case Record ◽

Mdr Tb ◽

History Of ◽

Lost To Follow Up

Introduction: Pakistan, a country with a 27 high burden countries of multidrug resistance tuberculosis. To predict the associated risk factors and proportion of loss to follow up among MDR-TB patients treated at PMDT sites of Punjab from 2017 to 2019. Methodology: This case control study based on the standardized reporting and recording case record forms called as Electronic Nominal Review System (ENRS) of National TB Control Program, Pakistan. A logistic regression model was used to assess risk factors of lost to follow up MDR-TB patients. Results: A total of 539 patients with MDR-TB were included in the final analysis. Among them, 207 patients (7.5%) had lost to follow up outcome at the end of the study. MDR-TB lost to follow up patients were more likely to report older age (AOR: 1.40, CI: 1.14-1.71, p=0.000), history of lost to follow up from first line drugs treatment (AOR: 0.39, CI: 0.28-0.56, p=0.000), co-morbid (AOR:1.54, CI: 1.24-1.91, p=0.000), adverse reaction of second line drugs (AOR: 0.45, CI: 0.37-0.56, p=0.000), long distance between patient’s home and PMDT site (AOR: 0.68, CI: 0.52-0.89, p=0.001). Conclusion: The history of lost to follow up from first line drugs treatment, co-morbid, older age and long distance were independent risk factors of MDR-TB. Proper training for PMDT sites staff, friendly follow up services and psychological counseling may help to reduce lost to follow up.

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Massive stone burden in an ileocecal pouch: A preventable condition?

Canadian Urological Association Journal ◽

10.5489/cuaj.1537 ◽

2014 ◽

Vol 8 (5-6) ◽

pp. 358

Author(s):

Anne Sophie Valiquette ◽

Diego Barrieras ◽

Michael McCormack

Keyword(s):

Surgical Complications ◽

Late Complication ◽

Bladder Exstrophy ◽

Stone Burden ◽

History Of ◽

Lost To Follow Up ◽

Efficient Transfer

The challenges of transition from the pediatric to the adult setting have been reported. We describe a case of massive stone burden in the ileocecal pouch of a patient lost to follow-up after his transfer from a pediatric to an adult institution. Although we successfully managed the patient and retrieved the pouch stones without any complications, several surgical complications may occur in a patient with a history of extensive abdominal surgeryand bladder exstrophy. This patient’s late complication might have been prevented with a more efficient transfer from a pediatric to an adult institution.

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Hepatitis C elimination in the Netherlands (CELINE): study protocol for nationwide retrieval of lost to follow-up patients with chronic hepatitis C

BMJ Open Gastroenterology ◽

10.1136/bmjgast-2020-000396 ◽

2020 ◽

Vol 7 (1) ◽

pp. e000396 ◽

Cited By ~ 2

Author(s):

Cas J Isfordink ◽

Sylvia M Brakenhoff ◽

Marleen van Dijk ◽

Marc van der Valk ◽

Rob J de Knegt ◽

...

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C ◽

The Netherlands ◽

Chronic Hepatitis C ◽

Hcv Rna ◽

Ethical Approval ◽

Hcv Transmission ◽

Chronic Hcv ◽

Lost To Follow Up

BackgroundThe Netherlands has a low hepatitis C virus (HCV) prevalence, estimated at 0.16%. Previous studies have shown that up to 30% of the diagnosed HCV population in the Netherlands has been lost to follow-up (LTFU). Retrieval of these patients could halt progression of liver disease in infected patients, reduce the number of infected individuals and limit HCV transmission. Several regional Dutch retrieval projects have already been executed, which demonstrated that retrieval is feasible. Therefore, we initiated a nationwide retrieval project, aiming to achieve microelimination in previously diagnosed but LTFU patients with chronic HCV through retrieval.MethodsLaboratory records will be used to identify possible patients with chronic hepatitis C, defined as either a positive most recent HCV RNA or positive HCV antibodies without known RNA result. Reviewing patient records and obtaining current contact information from municipality databases will identify LTFU patients who are eligible for retrieval. These patients will be invited for outpatient clinic care. The primary outcome of the study is the total number of LTFU patients who have been successfully linked to care.DiscussionHepatitis C ELimination In the NEtherlands (CELINE) is within the remit of WHO elimination targets and the Dutch National Hepatitis Plan. The methodology of CELINE is based on previously conducted regional retrieval projects and is designed to overcome some of their limitations. After ethical approval was obtained in 2018, the first centre initiated retrieval in 2018 and the project is expected to finish in 2021.Trial registration numberNCT04208035.

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Olfactory Dysfunction in β Thalassemia Major Patients Treated With Iron-Chelating Agents

Ear Nose & Throat Journal ◽

10.1177/0145561319840079 ◽

2019 ◽

Vol 98 (8) ◽

pp. NP125-NP130

Author(s):

Serhan Derin ◽

Selvet Erdogan ◽

Murat Sahan ◽

Mehmet Fatih Azik ◽

Hatice Derin ◽

...

Keyword(s):

Chelating Agents ◽

Thalassemia Major ◽

Olfactory Dysfunction ◽

Facial Trauma ◽

Control Group ◽

Control Groups ◽

History Of ◽

And Control ◽

Iron Chelating Agents

Ocular and ophthalmological adverse effects may be seen in β-thalassemia major (BTM) patients treated with regular blood transfusions and iron-chelating agents. We hypothesized that olfactory dysfunction may be present in this population. In this study, we aimed to investigate olfactory dysfunction in patients with BTM and determine the etiological factors. A total of 43 patients with BTM were included in the study. Forty-three patients without any nasal complaints, history of facial trauma, or nasal surgery were included as the controls. All participants had nasal endoscopy. The iron-chelating agents used, their duration of use, as well as hemoglobin and ferritin levels of the BTM patients were recorded. Sniffin’ Sticks test (SST) was used to assess olfactory functions, and BTM and control groups were compared for the results. The correlations of SST scores with the other study parameters were analyzed. Eight (18.6%) of 43 patients in the BTM group had hyposmia while none of the patients in the control group had hyposmia ( P < .001). Older age, low-hemoglobin level, and longer use of deferoxamine were found to be correlated with olfactory dysfunction. Olfactory dysfunction may be seen in BTM patients treated with iron-chelating agents. The results of this study suggest that screening for olfactory function may be needed in routine follow-up of BTM patients.

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Development of new cold antibodies in a patient with a history of warm autoimmune haemolytic anaemia

BMJ Case Reports ◽

10.1136/bcr-2019-232224 ◽

2020 ◽

Vol 13 (6) ◽

pp. e232224 ◽

Cited By ~ 1

Author(s):

Meghan Anderson ◽

Megan Winter ◽

Vinicius Jorge ◽

Claudia Dourado

Keyword(s):

Chest Pain ◽

Haemolytic Anaemia ◽

Acute Treatment ◽

Autoimmune Disorder ◽

Shortness Of Breath ◽

History Of ◽

Mixed Pattern ◽

Lost To Follow Up ◽

Record Review

A 31-year-old male presented to our facility with complaints of shortness of breath and left-sided chest pain. On record review, it was revealed that he had been seen in 2014 for an almost identical presentation and had been found to have haemolytic anaemia with warm autoantibodies. Following his acute treatment during that hospital admission, he was lost to follow-up. During his subsequent admission, 5 years later, he was found to have a systemic autoimmune disorder with a superimposed acute bacterial infection leading to a second case of haemolytic anaemia and at this time with both cold and warm antibodies present. While his diagnosis was initially difficult to make due to both derangements in expected laboratory values and the mixed pattern of the haemolytic anaemia, he was promptly treated with intravenous immune globulin and steroids and was able to make a full recovery.

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Virological and Clinical Outcome of DAA Containing Regimens in a Cohort of Patients in Calabria Region (Southern Italy)

Medicina ◽

10.3390/medicina56030101 ◽

2020 ◽

Vol 56 (3) ◽

pp. 101

Author(s):

Vincenzo Scaglione ◽

Maria Mazzitelli ◽

Chiara Costa ◽

Vincenzo Pisani ◽

Giuseppe Greco ◽

...

Keyword(s):

Southern Italy ◽

Liver Stiffness ◽

Age Group ◽

Intention To Treat ◽

Liver Decompensation ◽

End Of Treatment ◽

History Of ◽

Lost To Follow Up ◽

Treat Analysis

Background and objectives: In Italy, Hepatitis C Virus (HCV) infections are most prevalent in people older than 50 years of age, who often experience multi-morbidities, take co-medications, and have a long history of liver disease. These characteristics could potentially affect tolerability of HCV treatments and adherence in this subgroup. After achievement of sustained virological response (SVR), retention into care is very important both to detect the onset of possible complications and prevent further infections. In this study, SVR rates and retention into care of patients treated with directly acting antivirals (DAAs) of a single-center cohort in Southern Italy were evaluated. Materials and Methods: Patients treated with directly acting antivirals from 2014 to 2018 were included. Patients were stratified by age (i.e., <65 vs. ≥65 years) and by cirrhosis presence (i.e., liver stiffness >14.6 KPa or clinical/ultrasound cirrhosis vs. absence of these criteria). Primary outcome was availability of SVR at Weeks 12–24 after the end of treatment. Inter- and intra-group comparisons were performed along the follow-up for significant laboratory parameters. Results: In total, 212 patients were treated; 184 (87%) obtained SVR after the first treatment course and 4 patients after retreatment. Twenty-two (10.4%) patients were lost to follow-up before assessment of SVR, and two patients died before the end of treatment for liver decompensation. Considering only the first treatment episode, per protocol analysis (i.e., excluding patients lost to follow-up) showed the following rates of SVR: 97% (overall), 97% (older age group), 96% (age group <65 years), 94% (cirrhotics), and 100% (non-cirrhotics). By contrast, at the intention to treat analysis (i.e., patients lost were computed as failures), SVR percentages were significantly lower for patients <65 years of age (80%) and for non-cirrhotics (85%). Conclusions: High rates of SVR were obtained. However, younger patients and those without cirrhosis displayed an apparent high risk of being lost to follow-up. This may have important implications: since those who are lost may transmit HCV in case SVR is not achieved, these subpopulations should receive appropriate counselling during treatment.

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Manganese and Lipoflavonoid Plus® to Treat Tinnitus: A Randomized Controlled Trial

Journal of the American Academy of Audiology ◽

10.3766/jaaa.15106 ◽

2016 ◽

Vol 27 (08) ◽

pp. 661-668 ◽

Cited By ~ 2

Author(s):

Eveling Rojas-Roncancio ◽

Richard Tyler ◽

Hyung-Jin Jun ◽

Tang-Chuan Wang ◽

Haihong Ji ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Control Group ◽

Randomized Controlled ◽

Data Collection And Analysis ◽

Loudness Match ◽

Minimal Masking Level ◽

Lost To Follow Up ◽

To Receive

Background: Several tinnitus sufferers suggest that manganese has been helpful with their tinnitus. Purpose: We tested this in a controlled experiment where participants were committed to taking manganese and Lipoflavonoid Plus® to treat their tinnitus. Research Design: Randomized controlled trial. Study Sample: 40 participants were randomized to receive both manganese and Lipoflavonoid Plus® for 6 months, or Lipoflavonoid Plus® only (as the control). Data Collection and Analysis: Pre- and postmeasures were obtained with the Tinnitus Handicap Questionnaire, Tinnitus Primary Functions Questionnaire, and tinnitus loudness and annoyance ratings. An audiologist performed the audiogram, the tinnitus loudness match, and minimal masking level. Results: Twelve participants were dropped out of the study because of the side effects or were lost to follow-up. In the manganese group, 1 participant (out of 12) showed a decrease in the questionnaires, and another showed a decrease in the loudness and annoyance ratings. No participants from the control group (total 16) showed a decrease in the questionnaires ratings. Two participants in the control group reported a loudness decrement and one reported an annoyance decrement. Conclusions: We were not able to conclude that either manganese or Lipoflavonoid Plus® is an effective treatment for tinnitus.

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Dedicated Tracking of Patients with Retrievable Inferior Vena Cava Filters Improves Retrieval Rates

The American Surgeon ◽

10.1177/000313481207800822 ◽

2012 ◽

Vol 78 (8) ◽

pp. 870-874 ◽

Cited By ~ 12

Author(s):

Donald J. Lucas ◽

James R. Dunne ◽

Carlos J. Rodriguez ◽

Kathleen M. Curry ◽

Eric Elster ◽

...

Keyword(s):

Vena Cava ◽

Control Group ◽

Trauma Patients ◽

Loss To Follow Up ◽

Filter Retrieval ◽

Ivc Filters ◽

Vena Cava Filters ◽

Baseline Characteristics ◽

Lost To Follow Up

Retrievable IVC filters (R-IVCF) are associated with multiple complications, including filter migration and deep venous thrombosis. Unfortunately, most series of R-IVCF show low retrieval rates, often due to loss to follow-up. This study demonstrates that actively tracking R-IVCF improves retrieval. Trauma patients at one institution with R-IVCF placed between January 2007 and January 2011 were tracked in a registry with a goal of retrieval. These were compared to a control group who had R-IVCF placed previously (December 2005 to December 2006). Outcome measures include filter retrieval, retrieval attempts, loss to follow-up, and time to filter retrieval. We compared 93 tracked patients with R-IVCF with 20 controls. The baseline characteristics of the groups were similar. Tracked patients had significantly higher rates of filter retrieval (60% vs 30%, P = 0.02) and filter retrieval attempts (70% vs 30%, P = 0.002) and were significantly less likely to be lost to follow-up (5% vs 65%, P < 0.0001). Time to retrieval attempt was 84 days in the registry versus 210 days in the control group, which trended towards significance ( P = 0.23). Tracking patients with R-IVCF leads to improved retrieval rates, more retrieval attempts, and decreased loss to follow up. Institutions should consider tracking R-IVCF to maximize retrieval rates.

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Medication Event Monitoring System for Infectious Tuberculosis Treatment in Morocco: A Retrospective Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16030412 ◽

2019 ◽

Vol 16 (3) ◽

pp. 412 ◽

Cited By ~ 2

Author(s):

Seup Park ◽

Ilham Sentissi ◽

Seung Gil ◽

Won-Seok Park ◽

ByungKwon Oh ◽

...

Keyword(s):

Success Rate ◽

Monitoring System ◽

Treatment Success ◽

Treatment Success Rate ◽

Control Group ◽

Event Monitoring ◽

Tb Treatment ◽

The Mean ◽

Lost To Follow Up

Non-adherence to tuberculosis (TB) treatment is a barrier to effective TB control. We investigated the effectiveness of a Medication Event Monitoring System (MEMS) as a tailored adherence-promoting intervention in Morocco. We compared patients who received a MEMS (n = 206) with patients who received standard TB care (n = 141) among new active TB patients with sputum smear-positive. The mean total medication days were 141.87 ± 29.5 in the control group and 140.85 ± 17.9 in the MEMS group (p = 0.7147), and the mean age and sex were not different between the two groups (p > 0.05). The treatment success rate was significantly higher in the MEMS group than in the control group (odds ratio (OR): 4.33, 95% confidence interval (CI): 2.13–8.81, p < 0.001), and the lost to follow-up rate was significantly lower in the MEMS group than in the control group (OR: 0.03, 95% CI: 0.05–0.24, p < 0.001) after adjusting for sex, age, and health centers. The mean drug adherence rate in the first month was significantly higher in the MEMS group than in the control group (p = 0.023). MEMS increased TB treatment success rate and decreased the lost to follow-up rate overall for infectious TB patients in a Moroccan rural area.

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BCG In the treatment of recurrent. Genital condyloma accuminatum

Revista de Medicina ◽

10.11606/issn.1679-9836.v97i3p283-286 ◽

2018 ◽

Vol 97 (3) ◽

pp. 283-286

Author(s):

Chen Jen Shan ◽

Antonio Marmo Lucon ◽

Miguel Srougi

Keyword(s):

Control Group ◽

High Recurrence Rate ◽

Cure Rate ◽

Clinical Recurrence ◽

Collateral Effects ◽

Collateral Effect ◽

History Of ◽

Electro Coagulation ◽

And Control

Introduction: The Human Papilloma Virus (HPV) is the most prevalent sexually transmissible disease. The treatment of Condyloma Accuminatum is a great challenge because of the high recurrence rate and of the lack of any drug efficient in its elimination. Objective: To assess the efficacy of the treatment with Imuno BCG (Bacillus Calmette-Guérin) for bearers of condylomas recurrent for more than 2 years. Patients and Methods: Patients with age between 18 and 60 years, having a history of more than 2 years of genital warts, were included, attended as from 01-08-2011; bearers of serious diseases, immunodeficiency or users of immune-suppressors, being excluded. The procedure adopted began with a biopsy of the wart(s) with local anesthetic, followed by the electro-coagulation of all the warts and bases of the biopsies, a solution with 80 mg of Imuno BCG dissolved in 2 ml of saline solution 0.9% was applied to all the genital area, including the cauterized areas. The area was covered with plastic for 2 hours and afterwards washed with water. The local application of Imuno BCG was repeated for 8 consecutive weeks. At the end of the second month the cases were re-assessed. When there was clinical recurrence a new procedure with the same drug was undertaken, but with 3 weekly applications made by the patient himself for 8 weeks. Result: Sixteen patients completed 2-year follow-up. The cure rate was of 62.5%. Of the 10 patients cured, 6 (37.5%) used one series of Imuno BCG, 1 (6.25%) used 2 series, and 3 (18.75%) used 3 series. Of the 6 patients who were not cured, there was a reduction in the number of cauterizations from 5.5 times (over an average period of the disease of 51.6 months) to 2.4 cauterizations (over an average follow-up period of 52.3 months) after the use Imuno BCG. The collateral effects of the use of Imuno BCG were insignificant. Conclusion: Topical BCG is a good option for the treatment of recurrent condylomas, with minimal collateral effect. It may be used even on PPD-negative patients. However, this result must be confirmed with larger sample populations and control-group studies.

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