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Background: Chronic hepatitis B virus (HBV) infection is a major health problem for all Indigenous Australians. Post‐2000, Hepatitis B surface antigen prevalence has decreased, although remaining four times higher among Indigenous compared with non‐Indigenous people. Aims: This study aimed to characterise the HBV from Indigenous populations in Queensland and the Torres Strait Islands. Methods: Serum samples were collected, with consent, from people within Queensland Indigenous communities prior to 1990 as part of the Queensland Health vaccination programme. Ethics approval was subsequently obtained to further characterise the HBV from 93 of these stored samples. HBV DNA was extracted and genotype was obtained from 82 samples. HBV full genome sequencing was carried out for a subset of 14 samples. Results: Seventy‐eight samples were identified as genotype C (2 × C12, 3 × C13 and 73 × C14), one sample as genotype A (A2) and three samples as genotype D (1 × D2, 1 × D3 and 1 × D4). The HBV/C sequences identified were most closely related to sequences isolated from Papua New Guinea and Indonesia (Papua Province). Conclusions: The HBV isolated from the Torres Strait Islanders was notably different to the HBV/C4 strain isolated from Indigenous people of mainland northern Australia, with no evidence of recombination. This reflects the differences in culture and origin between Torres Strait Islanders and mainland Indigenous people. [ABSTRACT FROM AUTHOR]

The efficacy and safety of pegylated interferon alpha plus lamivudine, pegylated alfa without lamivudine, and lamivudine alone for the treatment of hepatitis B e antigen (HBeAg)-positive hepatitis B are compared. It is concluded that in patients with HBeAg-positive chronic hepatitis B, peginterferon alfa-2a offers superior efficacy over lamivudine, on the basis of HBeAg seroconversion, HBV DNA suppression and HBsAg seroconversion.

BACKGROUND: Sustained virological response (SVR) is the primary objective in the treatment of chronic hepatitis C (CHC). Results from a recent clinical trial of patients with previously untreated CHC demonstrate that the combination of peginterferonα-2a and ribavirin produces a greater SVR than interferonα-2b and ribavirin combination therapy. However, the cost-effectiveness of peginterferonα-2a plus ribavirin in the U.S. setting has not been investigated.METHODS: A Markov model was developed to investigate cost-effectiveness in patients with CHC using genotype to guide treatment duration. SVR and disease progression parameters were derived from the clinical trials and epidemiologic studies. The impact of treatment on life expectancy and costs were projected for a lifetime. Patients who had an SVR were assumed to remain virus-free for the rest of their lives. In genotype 1 patients, the SVRs were 46% for peginterferonα-2a plus ribavirin and 36% for interferonα-2b plus ribavirin. In genotype 2/3 patients, the SVRs were 76% for peginterferonα-2a plus ribavirin and 61% for interferonα-2b plus ribavirin. Quality of life and costs were based on estimates from the literature. All costs were based on published U.S. medical care costs and were adjusted to 2003 U.S. dollars. Costs and benefits beyond the first year were discounted at 3%.RESULTS: In genotype 1, peginterferonα-2a plus ribavirin increases quality-adjusted life expectancy (QALY) by 0.70 yr compared to interferonα-2b plus ribavirin, producing a cost-effectiveness ratio of$2,600 per QALY gained. In genotype 2/3 patients, peginterferonα-2a plus ribavirin increases QALY by 1.05 yr in comparison to interferonα-2b plus ribavirin. Peginterferonα-2a combination therapy in patients with HCV genotype 2 or 3 is dominant (more effective and cost saving) compared to interferonα-2b plus ribavirin. Results weighted by genotype prevalence (75% genotype 1; 25% genotype 2 or 3) also show that peginterferonα-2a plus ribavirin is dominant. Peginterferonα-2a and ribavirin remained cost-effective (below$16,500 per QALY gained) under sensitivity analyses on key clinical and cost parameters.CONCLUSION: Peginterferonα-2a in combination with ribavirin with duration of therapy based on genotype, is cost-effective compared with conventional interferonα-2b in combination with ribavirin when given to treatment-naïve adults with CHC. [ABSTRACT FROM AUTHOR]

Study Objectives: Recent results from the PTSD Initiative, a cross-sectional cohort study in Australian Vietnam veterans (VV) with and without posttraumatic stress disorder (PTSD), demonstrated an increased prevalence of self-reported sleep disturbances in those with PTSD. This study aimed to objectively assess the prevalence of sleep disorders in the same cohort using detailed polysomnography (PSG)., Methods: Participants from the PTSD Initiative were recruited to undergo PSG. PTSD status was determined with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5). Subjective sleep information was attained via structured questionnaires. Data from single night PSG were compared between trauma-exposed VV with and without PTSD., Results: A total of 74 trauma-exposed male VV (40 with PTSD) underwent PSG (prospective n = 59, retrospective n = 15). All PSG parameters were similar between groups. No difference was seen in PSG-diagnosed obstructive sleep apnea (OSA) or periodic limb movements of sleep (PLMS). VV with PTSD showed a trend toward increased duration of sleep with oxygen saturations < 90% (10% versus 1.8%; P = .07). VV with PTSD reported increased sleep onset latency (42.4 versus 13.3 minutes; P < .01); were less likely to report sleeping well (32.5% versus 67.5%; P < .01); had higher OSA risk using Berlin Questionnaire (BQ) (70% versus 38.2%; P < .01); and had higher rates of partner-reported limb movements (56.4% versus 17.6%; P < .01). No association between PSG-diagnosed OSA and PTSD severity was evident., Conclusions: In Australian VV with and without PTSD, no difference was seen across all PSG parameters including the diagnosis and severity of OSA and PLMS. However, VV with PTSD demonstrated an increased perception of sleep disturbances., (© 2018 American Academy of Sleep Medicine.)