235 results on '"Holmberg SD"'
Search Results
2. Using the Internet for partner notification of sexually transmitted diseases--Los Angeles County, California, 2003
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Pioquinto, RM, Tupas, EA, Kerndt, PR, Taylor, MM, Holmberg, SD, and Patel, PA
- Abstract
An estimated one third of Internet visits by persons aged [greater than or equal to] 18 years oriented to sexually oriented websites, chat rooms, and news groups that enable users [...]
- Published
- 2004
3. Transmission of AIDS from Blood Screened Negative for Antibody to the Human Immunodeficiency Virus
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Conley Lj and Holmberg Sd
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Adult ,Male ,Human immunodeficiency virus (HIV) ,Blood Donors ,medicine.disease_cause ,law.invention ,Serology ,Acquired immunodeficiency syndrome (AIDS) ,law ,Immunopathology ,HIV Seropositivity ,medicine ,Humans ,Aged ,Acquired Immunodeficiency Syndrome ,biology ,business.industry ,AIDS Serodiagnosis ,Infant ,General Medicine ,Middle Aged ,medicine.disease ,Virology ,Blood donor ,Transmission (mechanics) ,Child, Preschool ,Immunology ,biology.protein ,Female ,Viral disease ,Antibody ,business - Published
- 1992
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4. No evidence of blood-borne transmission of idiopathic CD4+ T- lymphocytopenia
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Wortley, PM, primary and Holmberg, SD, additional
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- 1994
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5. The study to understand the natural history of HIV and AIDS in the era of effective therapy (SUN Study)
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Vellozzi C, Brooks JT, Bush TJ, Conley LJ, Henry K, Carpenter CC, Overton ET, Hammer J, Wood K, Holmberg SD, and SUN Study Investigators
- Abstract
Treatment of human immunodeficiency virus (HIV) infection with highly active combination antiretroviral therapy has increased survival and shifted the spectrum of HIV-associated morbidity and mortality from opportunistic infections toward a variety of other medical conditions. The prospective cohort Study to Understand the Natural History of HIV and AIDS in the Era of Effective Therapy (SUN Study) monitors the clinical course of HIV-infected individuals treated with combination antiretroviral therapy in 4 US cities. Every 6 months, clinical assessments, medical record abstraction, audio computer-assisted self-interview, and neurocognitive measurements are completed and blood and urine specimens are banked centrally. At enrollment and periodically thereafter, additional techniques such as anal cytology, dual energy x-ray absorptiometry, carotid ultrasonography, echocardiography, and abdominal and cardiac computed tomography are performed. From March 2004 through June 2006, 700 participants were enrolled; median age was 41 years, 76% were men, 58% were non-Hispanic white, 62% were men who have sex with men, 78% were taking combination antiretroviral therapy (of whom 86% had an HIV viral load of <400 copies/mL), and median CD4+ T-lymphocyte count was 459 cells/mm(3) (interquartile range: 324-660). The SUN Study provides a wealth of data that will inform and improve the clinical management of HIV-infected individuals in the modern era. [ABSTRACT FROM AUTHOR]
- Published
- 2009
6. Nonhospital health care-associated hepatitis B and C virus transmission: United States, 1998-2008.
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Thompson ND, Perz JF, Moorman AC, Holmberg SD, Thompson, Nicola D, Perz, Joseph F, Moorman, Anne C, and Holmberg, Scott D
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In the United States, transmission of hepatitis B virus (HBV) and hepatitis C virus (HCV) from health care exposures has been considered uncommon. However, a review of outbreak information revealed 33 outbreaks in nonhospital health care settings in the past decade: 12 in outpatient clinics, 6 in hemodialysis centers, and 15 in long-term care facilities, resulting in 448 persons acquiring HBV or HCV infection. In each setting, the putative mechanism of infection was patient-to-patient transmission through failure of health care personnel to adhere to fundamental principles of infection control and aseptic technique (for example, reuse of syringes or lancing devices). Difficult to detect and investigate, these recognized outbreaks indicate a wider and growing problem as health care is increasingly provided in outpatient settings in which infection control training and oversight may be inadequate. A comprehensive approach involving better viral hepatitis surveillance and case investigation, health care provider education and training, professional oversight, licensing, and public awareness is needed to ensure that patients are always afforded basic levels of protection against viral hepatitis transmission. [ABSTRACT FROM AUTHOR]
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- 2009
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7. Incidence of types of cancer among HIV-infected persons compared with the general population in the United States, 1992-2003.
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Patel P, Hanson DL, Sullivan PS, Novak RM, Moorman AC, Tong TC, Holmberg SD, Brooks JT, Adult and Adolescent Spectrum of Disease Project and HIV Outpatient Study Investigators, Patel, Pragna, Hanson, Debra L, Sullivan, Patrick S, Novak, Richard M, Moorman, Anne C, Tong, Tony C, Holmberg, Scott D, and Brooks, John T
- Abstract
Background: Persons who are HIV-infected may be at higher risk for certain types of cancer than the general population.Objective: To compare cancer incidence among HIV-infected persons with incidence in the general population from 1992 to 2003.Design: Prospective observational cohort studies.Setting: United States.Patients: 54,780 HIV-infected persons in the Adult and Adolescent Spectrum of HIV Disease Project (47,832 patients) and the HIV Outpatient Study (6948 patients), who contributed 157,819 person-years of follow-up from 1992 to 2003, and 334,802,121 records from the Surveillance, Epidemiology, and End Results program of 13 geographically defined, population-based, central cancer registries.Measurements: Standardized rate ratios (SRRs) to compare cancer incidence in the HIV-infected population with standardized cancer incidence in the general population.Results: The incidence of the following types of non-AIDS-defining cancer was significantly higher in the HIV-infected population than in the general population: anal (SRR, 42.9 [95% CI, 34.1 to 53.3]), vaginal (21.0 [CI, 11.2 to 35.9]), Hodgkin lymphoma (14.7 [CI, 11.6 to 18.2]), liver (7.7 [CI, 5.7 to 10.1]), lung (3.3 [CI, 2.8 to 3.9]), melanoma (2.6 [CI, 1.9 to 3.6]), oropharyngeal (2.6 [CI, 1.9 to 3.4]), leukemia (2.5 [CI, 1.6 to 3.8]), colorectal (2.3 [CI, 1.8 to 2.9]), and renal (1.8 [CI, 1.1 to 2.7]). The incidence of prostate cancer was significantly lower among HIV-infected persons than the general population (SRR, 0.6 [CI, 0.4 to 0.8]). Only the relative incidence of anal cancer increased over time.Limitations: Lower ascertainment of cancer in the HIV cohorts may result in a potential bias to underestimate rate disparities. Tobacco use as a risk factor and the effect of changes in cancer screening practices could not be evaluated.Conclusion: The incidence of many types of non-AIDS-defining cancer was higher among HIV-infected persons than among the general population from 1992 to 2003. [ABSTRACT FROM AUTHOR]- Published
- 2008
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8. Circuit parties: sexual behaviors and HIV disclosure practices among men who have sex with men at the White Party, Palm Springs, California, 2003.
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Patel P, Taylor MM, Montoya JA, Hamburger ME, Kerndt PR, and Holmberg SD
- Abstract
The syphilis epidemic among men who have sex with men (MSM) in major US cities and concomitant increases in high-risk sexual behavior, have raised concerns of increased HIV transmission in this population. Therefore, to provide information for health promotion and disease awareness efforts, we investigated sexual behaviors, partner selection preferences and HIV serostatus disclosure practices of MSM at the White Party in Palm Springs, California. Circuit party attendees reported engaging in unprotected anal sex, however, a high proportion reported disclosing their HIV status. These findings suggest that some gay men are serosorting as a risk reduction strategy or implementing sexual risk reduction strategies to protect themselves and their partners. In our study, HIV-negative men were nine times more likely to report a preference for a seroconcordant sexual partner. The self-protecting attitudes of HIV-negative men in our sample outweighed the partner-protecting attitudes of HIV-positive men. This suggests that prevention interventions focusing on HIV-positive persons are warranted. [ABSTRACT FROM AUTHOR]
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- 2006
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9. Evaluation of hypophosphataemia in tenofovir disoproxil fumarate (TDF)-exposed and TDF-unexposed HIV-infected out-patients receiving highly active antiretroviral therapy.
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Buchacz, K, Brooks, JT, Tong, T, Moorman, AC, Baker, RK, Holmberg, SD, and Greenberg, A
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FAMILIAL hypophosphatemia ,HIV-positive persons ,PLACEBOS ,HIGHLY active antiretroviral therapy ,CREATININE ,PHOSPHATES - Abstract
Objectives Cases of hypophosphataemia (often coincident with renal dysfunction) have been reported in HIV-infected patients taking tenofovir disoproxil fumarate (TDF), but randomized placebo-controlled trials of HIV-infected persons with normal baseline renal function have found a comparable incidence of hypophosphataemia in the TDF and placebo groups. We assessed the incidence of grade 2 and higher hypophosphataemia in the HIV Outpatient Study (HOPS). Methods We analysed a prospective cohort of patients who initiated either a TDF-containing highly active antiretroviral therapy (HAART) regimen [TDF-exposed (TDF+) group; n=165] or a TDF-sparing HAART regimen [TDF-unexposed (TDF–) group; n=90], and who had normal baseline phosphate and creatinine values. Results The TDF+and TDF−groups had comparable median follow-up times (10.9 vs 8.8 months, respectively; P=0.18) and number of phosphate measurements (median=3 for both) and were similar on most clinical and demographic factors. During follow up, 12.7% of TDF+vs 6.7% of TDF−patients developed grade 2 hypophosphataemia (2.0–2.4 mg/dL), and 2.4% of TDF+patients vs 0% of TDF−patients developed grade 3 hypophosphataemia (1.0–1.9 mg/dL); none developed grade 4 hypophosphataemia (<1.0 mg/dL). The incidence of grade 2 or higher hypophosphataemia was 16.7 per 100 person-years among TDF+patients vs 8.0 per 100 person-years among TDF−patients ( P=0.11). Conclusions The incidence of hypophosphataemia was somewhat elevated in HOPS patients who took TDF-containing HAART compared with those who took TDF-sparing HAART during the first 1 to 2 years of observation, but the difference was not statistically significant. Longer follow-up of a larger population is needed to determine if this trend towards an association achieves statistical significance and to evaluate the clinical consequences of hypophosphataemia. [ABSTRACT FROM AUTHOR]
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- 2006
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10. Short-term safety and tolerability of didanosine combined with high- versus low-dose tenofovir disproxil fumarate in ambulatory HIV-1-infected persons.
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Young B, Weidle PJ, Baker RK, Armon C, Wood KC, Moorman AC, Holmberg SD, and HIV Outpatient Study (HOPS) Investigators
- Abstract
Coadministration of didanosine (ddI) and tenofovir (TDF) results in increased ddI serum concentrations, which may lead to increased risk of ddI-associated toxicities. To evaluate the safety and tolerability of ddI/TDF, we performed a retrospective cohort analysis of patients seen in the HIV Outpatient Study, an ongoing dynamic cohort study of HIV-infected persons in clinical care. Study subjects were those who received at least 14 days of combined ddI/TDF before October 2003. Of 260 subjects who received ddI/TDF-based antiretroviral therapy, 155 (60%) received high-dose ddI (400 mg daily dose) and 105 (40%) received low-dose ddI (100-250 mg daily). Forty-two of the high-dose ddI recipients were later switched to low-dose ddI. The median time of observation for those on high-dose ddI only was 5 months, high-dose ddI switched to low-dose ddI was 16 months, and low-dose ddI only was 5 months (p < 0.05). Discontinuations because of toxicity were more frequent on high-dose ddI regimens (34/155, 22%) than on low-dose ddI regimens (9/105, 9%) (unadjusted odds ratio [OR(unadj)] 3.0, 95% confidence interval [95% CI] 1.30-7.09; p = 0.007). Among subjects without preexisting peripheral neuropathy, 12 (12%) of 101 subjects ever on high-dose ddI regimens had treatment-emergent peripheral neuropathy compared to 2 (4%) of 55 subjects on low-dose ddI regimens (OR(unadj) 3.57; 95% CI, 0.72-24.1; p = 0.14). Among patients without a history of pancreatitis, 6 (4%) of 153 subjects developed pancreatitis after starting high-dose ddI regimens, compared to none of the 103 subjects on low-dose ddI regimens (OR(adj) and 95% CIs undefined; p = 0.08). Severe laboratory abnormalities of creatinine, phosphorous, and bicarbonate were not different between the groups. A summary variable for any event--discontinuation for toxicity, treatment- emergent adverse event or abnormal laboratory values--indicated that 44 (28%) of 155 of those on high-dose ddI versus 13 (12%) of 105 on low-dose ddI developed any event (OR(unadj) 2.81; 95% CI, 1.36-5.86; p = 0.004). In conclusion, high-dose ddI/TDF-based therapy was more frequently associated with drug-related toxicity, adverse events, and treatment discontinuation than low-dose ddI/TDF regimens; low-dose ddI with TDF was generally well tolerated in these HIV-infected persons. [ABSTRACT FROM AUTHOR]
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- 2006
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11. Survival benefit of initiating antiretroviral therapy in HIV-infected persons in different CD4+ cell strata.
- Author
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Palella FJ Jr., Deloria-Knoll M, Chmiel JS, Moorman AC, Wood KC, Greenberg AE, Holmberg SD, HIV Outpatient Study Investigators, Palella, Frank J Jr, Deloria-Knoll, Maria, Chmiel, Joan S, Moorman, Anne C, Wood, Kathleen C, Greenberg, Alan E, and Holmberg, Scott D
- Abstract
Background: Optimal timing of antiretroviral therapy (ART) initiation for HIV-infected persons remains unclear.Objective: To assess survival benefit of initiating ART at different CD4+ cell counts.Design: Prospective observational study.Setting: U.S. clinics in the HIV Outpatient Study (HOPS).Patients: HIV-infected patients with CD4+ cell counts, plasma HIV RNA viral load, and ART use recorded from January 1994 through March 2002.Measurements: Before initiation of ART, patients were grouped by their CD4+ cell counts into three subgroups: 0.201 to 0.350 x 10(9) cells/L (n = 399), 0.351 to 0.500 x 10(9) cells/L (n = 327), and 0.501 to 0.750 x 10(9) cells/L (n = 122). We compared mortality rates for each CD4+ subgroup among patients who initiated ART and patients who delayed ART until reaching a lower CD4+ subgroup.Results: Mortality rates for 340 patients who initiated ART and 59 who delayed ART in the CD4+ subgroup of 0.201 to 0.350 x 10(9) cells/L were 15.4 and 56.4 deaths per 1000 person-years, respectively (rate ratio, 0.27 [95% CI, 0.14 to 0.55]; P < 0.001). For the CD4+ subgroup of 0.351 to 0.500 x 10(9) cells/L, mortality rates for 240 patients who initiated ART and 887 who delayed ART were 10.0 and 16.6 deaths per 1000 person-years, respectively (rate ratio, 0.61 [CI, 0.22 to 1.67]; P = 0.17). For the CD4+ subgroup of 0.501 to 0.750 x 10(9) cells/L, mortality rates in 55 patients who initiated ART and 67 who delayed ART were 7.5 and 3.1 deaths per 1000 person-years, respectively (rate ratio, 1.20 [CI, 0.17 to 8.53]; P > 0.2). Patients in the 0.201 to 0.350 x 10(9) cells/L and 0.351 to 0.500 x 10(9) cells/L CD4+ subgroups who initiated ART were more likely than those who delayed ART to achieve an undetectable HIV viral load (P = 0.03 and 0.04, respectively).Conclusions: Among HIV-infected persons with CD4+ cell counts of 0.201 to 0.350 x 10(9) cells/L, initiating ART is associated with reduced mortality compared with delaying such therapy. Survival benefits of earlier ART initiation (at CD4+ cell counts of 0.351 to 0.500 x 10(9) cells/L) are possible. [ABSTRACT FROM AUTHOR]- Published
- 2003
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12. HIV infection in women in the United States: status at the Millennium.
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Hader SL, Smith DK, Moore JS, Holmberg SD, Hader, S L, Smith, D K, Moore, J S, and Holmberg, S D
- Abstract
Context: During the past decade, knowledge of human immunodeficiency virus (HIV) infection in women has expanded considerably but may not be easily accessible for use in understanding and prioritizing the clinical needs of HIV-infected women.Objectives: To perform a comprehensive review of epidemiologic, clinical, psychosocial, and behavioral information about HIV in women, and to recommend an agenda for future activities.Data Sources: A computerized search, using MEDLINE and AIDSline, of published literature was conducted; journal articles from January 1981 through July 2000 and scientific conference presentations from January 1999 through July 2000 were retrieved and reviewed for content; article reference lists were used to identify additional articles and presentations of interest.Study Selection: Data from surveillance and prospective cohort studies with at least 20 HIV-infected women and appropriate comparison groups were preferentially included.Data Extraction: Included studies of historical importance and subsequent refined analyses of topics covered therein; these and studies with more current data were given preference. Four studies involving fewer than 20 women were included; 2 studies were of men only.Data Synthesis: Women account for an increasing percentage of all acquired immunodeficiency syndrome (AIDS) cases, from 6.7% (1819/27 140 cases) in 1986 to 18% (119 810/724 656 cases) in 1999. By the end of 1998, of all newly reported AIDS cases among women, proportionally more were in the South (41%), among black women (61%), and from heterosexual transmission (38%). Of note, increasingly more women have no identified or reported risk, about half or more of whom are estimated to be infected heterosexually. It is estimated that a total of at least 54% of women newly reported with AIDS in 1998 acquired HIV through heterosexual sex, including women in the no identified or reported risk category estimated to have been infected heterosexually, meeting the surveillance heterosexual risk definition. Natural history, progression, survival, and HIV-associated illnesses-except for those of the reproductive tract-thus far appear to be similar in HIV-infected women and men. Although antiretroviral therapy has proven to be highly effective in improving HIV-related morbidity and mortality rates, women may be less likely than men to use these therapies. Drug use, high-risk sex behaviors, depression, and unmet social needs interfere with women's use of available HIV prevention and treatment resources.Conclusions: Continued research on HIV pathogenesis and treatment is needed; however, emphasis should also be placed on using existing knowledge to improve the clinical care of women by enhancing use of available services and including greater use of antiretroviral therapy options, treating depression and drug use, facilitating educational efforts, and providing social support for HIV-infected women. [ABSTRACT FROM AUTHOR]- Published
- 2001
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13. Transmission of human immunodeficiency virus (HIV) by blood transfusions screened as negative for HIV antibody.
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Ward JW, Holmberg SD, Allen JR, Cohn DL, Critchley SE, Kleinman SH, Lenes BA, Ravenholt O, Davis JR, Quinn MG, and Jaffe HW
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- 1988
14. HIV-1 and HIV-2 Infections Among U.S. Peace Corps Volunteers Returning from West Africa.
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Eng, Thomas R., O'Brien, Thomas R., Bernard, Kenneth W., Schable, Charles A., Vlugt, Theresa, Holmberg, Scott D., Eng, TR, O'Brien, TR, Bernard, KW, Schable, CA, van der Vlugt T, and Holmberg, SD
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- 1995
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15. Trends in rates of myocardial infarction among patients with HIV.
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Holmberg SD, Moorman AC, Greenberg AE, Friis-Møller N, Sabin C, and Lundgren JD
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- 2004
16. The global distribution of human immunodeficiency virus type 2 (HIV-2) infection
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Holmberg Sd and Horsburgh Cr
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Adult ,medicine.medical_specialty ,Immunology ,Population ,Disease ,Virus ,law.invention ,Acquired immunodeficiency syndrome (AIDS) ,law ,Risk Factors ,Epidemiology ,HIV Seropositivity ,medicine ,Immunology and Allergy ,Humans ,education ,Child ,education.field_of_study ,Acquired Immunodeficiency Syndrome ,business.industry ,Hematology ,medicine.disease ,Virology ,Europe ,Sexual intercourse ,Transmission (mechanics) ,Africa ,Female ,Viral disease ,business ,Brazil - Abstract
We reviewed published reports of infection with human immunodeficiency virus type 2 (HIV-2) to provide a picture of its geographic distribution, pathogenicity, modes of transmission, and risk to the blood supply. Since the first reports in 1986, 627 HIV-2-seropositive persons have been reported; 604 of these were in natives of West Africa. Acquired immunodeficiency syndrome (AIDS) had developed in 42 patients, while 8 patients had AIDS-related complex. Transmission by sexual intercourse was the usual reported mode of spread. The modes of transmission of HIV-2 are thought to be the same as those for HIV-1, but perinatal transmission and transmission by sharing of needles among intravenous drug abusers have not yet been reported. The virus has not been identified in blood donors in the United States or West Germany, but two HIV-2-infected blood donors were reported in France. Further epidemiologic studies are needed to define the spectrum of disease, modes of transmission, and risk of HIV-2 to the blood supply.
- Published
- 1988
17. Protease inhibitors and cardiovascular outcomes in patients with HIV-1.
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Holmberg SD, Moorman AC, Williamson JM, Tong TC, Ward DJ, Wood KC, Greenberg AE, Janssen RS, and HIV Outpatient Study (HOPS) Investigators
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- 2002
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18. Migration patterns following HIV diagnosis among adults residing in the nonurban Deep South.
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Agee BS, Funkhouser E, Roseman JM, Fawal H, Holmberg SD, and Vermund SH
- Abstract
Health care needs of those infected with the human immunodeficiency virus (HIV) and subsequent transmission dynamics are altered by migration after infection. We interviewed 760 HIV-infected persons attending HIV-specialty clinics living in non-urban Alabama and Mississippi to ascertain the likely geographic origins of their infections, determine their post-HIV diagnosis mobility, and identify predictors of this mobility. Most subjects (81%) were living in these two states when diagnosed and have not moved since learning of their HIV status (70%). Of those who moved their primary residence post-HIV diagnosis (25% of the entire study population), the majority in-migrated to Alabama or Mississippi from elsewhere. Persons who had moved post-HIV diagnosis were more likely to be male, an injection drug user, an urban resident at HIV diagnosis, have an AIDS-defining condition, and have moved prior to HIV diagnosis. We conclude that most HIV transmission in non-urban Alabama and Mississippi is acquired locally. These results underline the need to expand HIV prevention programs in the Deep South. [ABSTRACT FROM AUTHOR]
- Published
- 2006
19. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection.
- Author
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Palella FJ Jr., Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, Aschman DJ, Holmberg SD, and HIV Outpatient Study Investigators
- Published
- 1998
20. Low Uptake of Direct-acting Antiviral Therapy Among Hepatitis C Patients With Advanced Liver Disease and Access to Care, 2014-2017.
- Author
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Spradling PR, Xing J, Rupp LB, Moorman AC, Gordon SC, Lu M, Teshale EH, Boscarino JA, Schmidt MA, Daida YG, and Holmberg SD
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- Adult, Aged, Antiviral Agents therapeutic use, Health Services Accessibility, Hepacivirus, Humans, Middle Aged, United States, Hepatitis C drug therapy, Hepatitis C, Chronic drug therapy
- Abstract
Goals: To determine the proportion and characteristics of adults with hepatitis C at health care organizations in 4 US states who initiated direct-acting antivirals (DAAs)., Background: There are almost no data to assess the penetrance of treatment of the hepatitis C population in general US health care settings., Study: We conducted a prospective observational study using electronic clinical, pharmacy, and mortality data to determine the fraction of patients who initiated DAAs between January 2014 and December 2017, by start date and regimen. We used stepwise multivariate logistic regression analysis to identify sociodemographic and clinical characteristics associated with receipt of DAAs., Results: Of 8823 patients, 2887 (32.7%) received DAAs. Quarterly (Q) uptake ranged from 1.1% in Q3 2014 to a high of 5.6% in Q2 2015. Characteristics associated with receipt of DAAs included age 51 to 70 years, higher income, pre-2014 treatment failure, and higher noninvasive fibrosis score (FIB4); however, over one half of patients with FIB4 scores >3.25, consistent with severe liver disease, were not treated. A lower likelihood of initiation was associated with Medicaid coverage. Of 5936 patients who did not initiate treatment, 911 (15.3%) had died and 2774 (46.7%) had not had a clinical encounter in ≥12 months by the end of the study. Fewer than 1% of DAA prescriptions originated from nonspecialty providers., Conclusions: During 4 calendar years of follow-up, one third of patients initiated DAAs. Large fractions of untreated patients had advanced liver disease, died, or were lost to follow-up. Even among patients in integrated health care systems, receipt of DAAs was limited.
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- 2021
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21. Hepatocellular Carcinoma Surveillance in a Cohort of Chronic Hepatitis C Virus-Infected Patients with Cirrhosis.
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Abara WE, Spradling P, Zhong Y, Moorman A, Teshale EH, Rupp L, Gordon SC, Schmidt M, Boscarino JA, Daida YG, and Holmberg SD
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- Aged, Carcinoma, Hepatocellular pathology, Cohort Studies, Female, Humans, Liver Neoplasms pathology, Male, Mass Screening, Middle Aged, Prognosis, Carcinoma, Hepatocellular etiology, Hepatitis C, Chronic complications, Liver Cirrhosis complications, Liver Neoplasms etiology
- Abstract
Background: Six-monthly hepatocellular carcinoma (HCC) screening in cirrhotic patients has been recommended since 2011. HCC prognosis is associated with diagnosis at an early stage. We examined the prevalence and correlates of 6-monthly HCC surveillance in a cohort of HCV-infected cirrhotic patients., Methods: Data were obtained from the medical records of patients receiving care from four hospitals between January 2011 and December 2016. Frequencies and logistic regression were conducted., Results: Of 2,933 HCV-infected cirrhotic patients, most were ≥ 60 years old (68.5%), male (62.2%), White (65.8%), and had compensated cirrhosis (74.2%). The median follow-up period was 3.5 years. Among these patients, 10.9% were consistently screened 6 monthly and 21.4% were never screened. Patients with a longer history of cirrhosis (AOR = 0.86, 95% CI = 0.80-0.93) were less likely to be screened 6 monthly while decompensated cirrhotic patients (AOR = 1.39, 95% CI = 1.06-1.81) and cirrhotic patients between 18 and 44 years (AOR = 2.01, 95% CI = 1.07-3.74) were more likely to be screened 6 monthly compared to compensated cirrhotic patients and patients 60 years and older respectively. There were no significant differences by race, gender, or insurance type., Conclusion: The prevalence of consistent HCC surveillance remains low despite formalized recommendations. One in five patients was never surveilled. Patients with a longer history of cirrhosis were less likely to be surveilled consistently despite their greater HCC risk. Improving providers' knowledge about current HCC surveillance guidelines, educating patients about the benefits of consistent HCC surveillance, and systemic interventions like clinical reminders and standing HCC surveillance protocols can improve guideline-concordant surveillance in clinical practice.
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- 2020
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22. Trends in Diagnosed Chronic Hepatitis B in a US Health System Population, 2006-2015.
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Lu M, Zhou Y, Holmberg SD, Moorman AC, Spradling PR, Teshale EH, Boscarino JA, Daida YG, Schmidt MA, Li J, Rupp LB, Trudeau S, and Gordon SC
- Abstract
Background: Trends in the epidemiology of chronic hepatitis B (CHB) among routine clinical care patients in the United States are not well documented. We used data from the Chronic Hepatitis Cohort Study to investigate changes in prevalence and newly recorded cases of CHB from 2006 to 2015., Methods: Annual percentage changes (APCs) were estimated using join point Poisson regression. Analyses were adjusted by study site; when an interaction with the trend was observed, APCs were estimated by subgroups. Differences in rates based on race, age, and sex were calculated with rate ratios., Results: We identified 5492 patients with CHB within select health systems with total populations that ranged from 1.9 to 2.4 million persons. From 2006 to 2014, the prevalence of diagnosed CHB increased from 181.3 to 253.0 per 100 000 persons in the health system population; from 2014 to 2015, it declined to 237.0 per 100 000 persons. APC was +3.7%/y through 131 December 2014 ( P < .001) and -15.0%/y ( P < .001) thereafter. The rate of newly reported cases of CHB did not change significantly across the study period (APC, -1.1%/y; P = .07). The rates of newly reported cases were 20.5 times higher among patients in the Asian American/American Indian/Pacific Islander (ASINPI) category, compared with white patients, and 2.8 times higher among African American patients. The ratio of male to female patients was roughly 3:2., Conclusions: The prevalence of diagnosed CHB in this US patient population increased from 2006 to 2014, after which it decreased significantly. Rates declined most rapidly among patients ≤40 or 61-70 years old, as well as among ASINPI patients. The rate of newly reported cases remained steady over the study period.
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- 2019
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23. Sustained virological response does not improve long-term glycaemic control in patients with type 2 diabetes and chronic hepatitis C.
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Li J, Gordon SC, Rupp LB, Zhang T, Trudeau S, Holmberg SD, Moorman AC, Spradling PR, Teshale EH, Boscarino JA, Schmidt MA, Daida YG, and Lu M
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- Aged, Blood Glucose drug effects, Diabetes Mellitus, Type 2 complications, Female, Glycated Hemoglobin analysis, Hepacivirus drug effects, Humans, Logistic Models, Male, Middle Aged, Prospective Studies, Retrospective Studies, Time Factors, United States, Antiviral Agents therapeutic use, Diabetes Mellitus, Type 2 drug therapy, Hepatitis C, Chronic drug therapy, Sustained Virologic Response
- Abstract
Background: Sustained virological response to treatment for chronic hepatitis C virus may improve short-term glucose control among patients with type 2 diabetes, but the long-term impact remains largely unknown. We used data from the Chronic Hepatitis Cohort Study to investigate the impact of sustained virological response on long-term trends in haemoglobin A1c in patients with type 2 diabetes., Methods: "Index date" was defined as the date of treatment initiation (treated patients) or hepatitis C virus diagnosis (untreated patients). To address treatment selection bias, we used a propensity score approach. We used a piecewise, linear spline, mixed-effects model to evaluate changes in haemoglobin A1c over a 5-year period., Results: Our sample included 384 hepatitis C virus patients with type 2 diabetes (192 untreated, 192 treated, with sustained virological response or treatment failure). After adjusting for body mass index, haemoglobin A1c was stable among untreated and treatment failure patients. In sustained virological response patients, Hb1Ac trajectories evolved in three phases: (a) index through 6 months post-index, average haemoglobin A1c decreased significantly from 7.7% to 5.4% per 90 days (P < 0.001); (b) 6-30 months post-index, haemoglobin A1c rebounded at a rate of 1.5% every 90 days (P = 0.003); and (c) from 30 months onward, haemoglobin A1c stabilized at an average level of 7.9 (P-value = 0.34). Results from an analysis restricted to patients receiving direct-acting antivirals were consistent with the main findings., Conclusion: Successful hepatitis C virus treatment among patients with type 2 diabetes significantly reduces HbA1c shortly after treatment, but these decreases are not sustained long-term. Less than three years after sustained virological response, haemoglobin A1c rebounds to levels similar to untreated/treatment failure patients, and higher than recommended for type 2 diabetic maintenance., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
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- 2019
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24. Mortality Among Patients With Chronic Hepatitis B Infection: The Chronic Hepatitis Cohort Study (CHeCS).
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Bixler D, Zhong Y, Ly KN, Moorman AC, Spradling PR, Teshale EH, Rupp LB, Gordon SC, Boscarino JA, Schmidt MA, Daida YG, and Holmberg SD
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- Adolescent, Adult, Aged, Aged, 80 and over, Cause of Death, Female, Follow-Up Studies, Hepatitis B virus, Hepatitis B, Chronic epidemiology, Hepatitis B, Chronic virology, Humans, Male, Middle Aged, Public Health Surveillance, Risk Factors, Socioeconomic Factors, United States epidemiology, Young Adult, Hepatitis B, Chronic mortality
- Abstract
Background: According to death certificates, approximately 1800 persons die from hepatitis B annually in the United States; however, this figure may underestimate true mortality from chronic hepatitis B (CHB)., Methods: We analyzed data from CHB patients seen in the Chronic Hepatitis Cohort Study (CHeCS) between 1 January 2006 and 31 December 2013. We compared overall and cause-specific death rates and mean ages at death between CHeCS CHB decedents and U.S. decedents from the Multiple Cause of Death (MCOD) file., Results: Of 4389 CHB patients followed for a mean of 5.38 years, 492 (11%) CHB patients died after a mean follow-up of 3.00 years. Compared to survivors, decedents were older, more likely to be White (40.6%), African-American (27.1%), or male (74.2%); and more likely to have had cirrhosis (59.8%), diabetes (27.2%), alcohol abuse (17.7%), hepatocellular carcinoma (17.5%), or a liver transplant (5.7%); whereas survivors were more likely to be Asian (48.8%; all P < .001). CHB patients died at an average age of 59.8 years-14 years younger than the general U.S. population-and at higher rates for all causes (relative risk [RR] = 1.85, 95% confidence interval [CI], 1.851-1.857) and liver-related causes (RR = 15.91, 95% CI, 15.81-16.01). Only 19% of CHB decedents and 40% of those dying of liver disease had hepatitis B reported on their death certificates., Conclusions: Compared to the general population, CHB patients die at younger ages and higher rates from all causes and liver-related causes. Death certificates underrepresent the true mortality from CHB., (Published by Oxford University Press for the Infectious Diseases Society of America 2018.)
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- 2019
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25. Sustained virological response to hepatitis C treatment decreases the incidence of complications associated with type 2 diabetes.
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Li J, Gordon SC, Rupp LB, Zhang T, Trudeau S, Holmberg SD, Moorman AC, Spradling PR, Teshale EH, Boscarino JA, Schmidt MA, Daida YG, and Lu M
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- Aged, Antiviral Agents pharmacology, Cohort Studies, Diabetes Mellitus, Type 2 complications, Female, Hepacivirus drug effects, Humans, Incidence, Interferons pharmacology, Interferons therapeutic use, Male, Middle Aged, Prospective Studies, Retrospective Studies, Treatment Outcome, Antiviral Agents therapeutic use, Diabetes Mellitus, Type 2 drug therapy, Diabetes Mellitus, Type 2 epidemiology, Hepatitis C, Chronic drug therapy, Hepatitis C, Chronic epidemiology, Sustained Virologic Response
- Abstract
Background: The role of hepatitis C (HCV) eradication on the long-term complications of type 2 diabetes mellitus remains incompletely studied., Aim: To investigate whether antiviral treatment impacted risk of acute coronary syndrome, end-stage renal disease, ischaemic stroke, and retinopathy among diabetic patients from the four US health systems comprising the Chronic Hepatitis Cohort Study (CHeCS)., Methods: We included CHeCS HCV patients with diagnosis codes for type 2 diabetes who were on antidiabetic medications. Patients were followed until an outcome of interest, death, or last health system encounter. The effect of treatment on outcomes was estimated using the competing risk analysis (Fine-Gray subdistribution hazard ratio [sHR]), with death as a competing event., Results: Among 1395 HCV-infected patients with type 2 diabetes, 723 (52%) were treated with either interferon-based or direct-acting antivirals (DAAs); 539 (75% of treated) achieved sustained virological response (SVR). After propensity score adjustment to address treatment selection bias, patients with SVR demonstrated significantly decreased risk of acute coronary syndrome (sHR = 0.36; P < 0.001), end-stage renal disease (sHR = 0.46; P < 0.001), stroke (sHR = 0.34; P < 0.001), and retinopathy (sHR = 0.24; P < 0.001) compared to untreated patients. Results were consistent in subgroup analyses of DAA-treated patients and interferon-treated patients, an analysis of cirrhotic patients, as well as in sensitivity analyses considering cause-specific hazards, exclusion of patients with on-treatment retinopathy, and treatment status as a time-varying covariate., Conclusion: Successful HCV treatment among patients with type 2 diabetes significantly reduces incidence of acute coronary syndrome, end-stage renal disease, ischaemic stroke, and retinopathy, regardless of cirrhosis. Our findings support the importance of HCV antiviral therapy among patients with type 2 diabetes to reduce the risk of these extrahepatic outcomes., (© 2019 John Wiley & Sons Ltd.)
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- 2019
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26. Race, Age, and Geography Impact Hepatitis C Genotype Distribution in the United States.
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Gordon SC, Trudeau S, Li J, Zhou Y, Rupp LB, Holmberg SD, Moorman AC, Spradling PR, Teshale EH, Boscarino JA, Daida YG, Schmidt MA, and Lu M
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- Adult, Aged, Cohort Studies, Female, Genotype, Hepatitis C, Chronic ethnology, Hepatitis C, Chronic virology, Humans, Male, Middle Aged, Prevalence, United States epidemiology, Hepacivirus genetics, Hepatitis C, Chronic epidemiology, Racial Groups statistics & numerical data
- Abstract
Goals: To determine the impact of geography and patient characteristics on hepatitis C virus (HCV) genotype and subtype distribution in a large sample of patients under routine clinical care BACKGROUND:: HCV genotype impacts disease course and response to treatment. Although several studies have reported genotype distribution within specific US populations, there are no comprehensive descriptions in large, geographically diverse cohorts., Study: Using data from the Chronic Hepatitis Cohort Study, we present the distribution of HCV genotypes (GT) and subtypes (ST) among a racially diverse cohort of over 8000 HCV-infected patients from four large US health systems., Results: Genotype distribution varied significantly by geographic and demographic factors. In age-adjusted analyses, African American patients had significantly higher prevalence of GT1 (85%) than other racial categories, largely driven by a markedly higher proportion of GT1 subtype b (∼34%) than in Asian/other (24%) and white (21%) patients. GT3 represented an increasing proportion of infections as birth decade progressed, from 4% in patients born before 1946 to 18% of those born after 1976. Within the cohort of "living/uncured" patients, highly elevated alanine aminotransferase (>2 times the upper limit of normal) was significantly more common in GT3 patients, whereas Fibrosis-4 Index scores indicative of cirrhosis were most common in the combined group of GT4&6 patients., Conclusion: Distribution of HCV genotypes and subtypes in the United States is more variable than suggested by previous national-level estimates and single-center studies. "Real-world" prevalence data may improve targeting of prevention, screening, and treatment efforts for hepatitis C.
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- 2019
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27. Uptake of and Factors Associated With Direct-acting Antiviral Therapy Among Patients in the Chronic Hepatitis Cohort Study, 2014 to 2015.
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Spradling PR, Xing J, Rupp LB, Moorman AC, Gordon SC, Lu M, Teshale EH, Boscarino JA, Schmidt MA, Daida YG, and Holmberg SD
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- Adult, Black or African American, Aged, Antiviral Agents adverse effects, Coinfection, Drug Therapy, Combination, Female, Genotype, HIV Infections epidemiology, Hepacivirus genetics, Hepatitis C, Chronic diagnosis, Hepatitis C, Chronic epidemiology, Hepatitis C, Chronic virology, Humans, Income, Liver Cirrhosis diagnosis, Liver Cirrhosis epidemiology, Liver Cirrhosis virology, Male, Medicaid, Middle Aged, Risk Factors, Time Factors, Treatment Outcome, United States epidemiology, White People, Antiviral Agents therapeutic use, Health Services Accessibility, Hepacivirus drug effects, Hepatitis C, Chronic drug therapy, Liver Cirrhosis drug therapy, Patient Acceptance of Health Care
- Abstract
Background: Limited information is available describing the uptake of direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection among patients in general US health care settings. We determined the proportion of HCV-infected patients in the Chronic Hepatitis Cohort Study prescribed DAAs in 2014, who initiated treatment and identified characteristics associated with treatment initiation., Methods: Uptake was defined as the proportion of HCV-infected patients with at least 1 clinical encounter in 2013 who were prescribed a DAA regimen during 2014 and initiated the regimen by August 2015. Using multivariable analysis, we examined demographic and clinical characteristics associated with receipt of DAAs., Results: The cohort comprised 9508 patients; 544 (5.7%) started a DAA regimen. Higher annual income [adjusted odds ratios (aOR) 2.3 for income>$50K vs. <$30K], higher Fibrosis-4 score (aORs, 2.1, 2.0, and 1.4 for Fibrosis-4, >5.88, 3.25 to 5.88, 2.0 to 3.25, respectively, vs. <2.0), genotype 2 infection (aOR 2.2 vs. genotype 1), pre-2014 treatment failure (aOR 2.0 vs. treatment-naive), and human immunodeficiency virus (HIV) coinfection (aOR 1.8 vs. HCV monoinfection) were associated with DAA initiation. Black race/ethnicity (aOR 0.7 vs. whites) and Medicaid coverage (aOR 0.5 vs. private insurance) were associated with noninitiation. Sex, age, comorbidity, previous liver transplant, and duration of follow-up were not associated with receipt of DAAs., Conclusions: Among patients in these general US health care settings, uptake of DAA therapy was low in 2014, and especially so among minority and Medicaid patients. Systemic efforts to improve access to DAAs for all patients are essential to reduce morbidity and mortality from HCV infection.
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- 2018
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28. Impact of sustained virologic response on risk of type 2 diabetes among hepatitis C patients in the United States.
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Li J, Zhang T, Gordon SC, Rupp LB, Trudeau S, Holmberg SD, Moorman AC, Spradling PR, Teshale EH, Boscarino JA, Schmidt MA, Daida YG, and Lu M
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- Adolescent, Adult, Aged, Aged, 80 and over, Diabetes Mellitus, Type 2 prevention & control, Female, Humans, Incidence, Longitudinal Studies, Male, Middle Aged, Risk Assessment, United States epidemiology, Young Adult, Antiviral Agents therapeutic use, Diabetes Mellitus, Type 2 epidemiology, Hepatitis C, Chronic complications, Hepatitis C, Chronic drug therapy, Sustained Virologic Response
- Abstract
Data regarding the impact of hepatitis C (HCV) therapy on incidence of type 2 diabetes mellitus are limited. We used the data from the longitudinal Chronic Hepatitis Cohort Study-drawn from four large US health systems-to investigate how response to HCV treatment impacts the risk of subsequent diabetes. Among HCV patients without a history of type 2 diabetes mellitus or hepatitis B, we investigated the incidence of type 2 diabetes from 12 weeks post-HCV treatment through December 2015. Cox proportional hazards models were used to test the effect of treatment status (sustained virologic response [SVR] or treatment failure) and baseline risk factors on the development of diabetes, considering any possible risk factor-by-SVR interactions, and death as a competing risk. Among 5127 patients with an average follow-up of 3.7 years, diabetes incidence was significantly lower among patients who achieved SVR (231/3748; 6.2%) than among patients with treatment failure (299/1379; 21.7%; adjusted hazard ratio [aHR] = 0.79; 95% CI: 0.65-0.96). Risk of diabetes was higher among African American and Asian American patients than White patients (aHR = 1.82 and 1.75, respectively; P < .05), and among Hispanic patients than non-Hispanics (aHR = 1.86). Patients with BMI ≥ 30 and 25-30 (demonstrated higher risk of diabetes aHR = 3.62 and 1.72, respectively; P < .05) than those with BMI < 25; patients with cirrhosis at baseline had higher risk than those without cirrhosis (aHR = 1.47). Among a large US cohort of patients treated for HCV, patients who achieved SVR demonstrated a substantially lower risk for the development of type 2 diabetes mellitus than patients with treatment failure., (© 2018 John Wiley & Sons Ltd.)
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- 2018
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29. Long-Term Liver Disease, Treatment, and Mortality Outcomes Among 17,000 Persons Diagnosed with Chronic Hepatitis C Virus Infection: Current Chronic Hepatitis Cohort Study Status and Review of Findings.
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Moorman AC, Rupp LB, Gordon SC, Zhong Y, Xing J, Lu M, Boscarino JA, Schmidt MA, Daida YG, Teshale EH, Spradling PR, and Holmberg SD
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- Adult, Aged, Antiviral Agents therapeutic use, Cohort Studies, Female, Hepacivirus drug effects, Hepatitis C, Chronic complications, Hepatitis C, Chronic diagnosis, Humans, Liver Cirrhosis pathology, Male, Middle Aged, Observational Studies as Topic, Ribavirin therapeutic use, Time Factors, Young Adult, Hepatitis C, Chronic drug therapy, Hepatitis C, Chronic mortality, Liver Cirrhosis drug therapy, Liver Cirrhosis mortality, Patient Reported Outcome Measures
- Abstract
Chronic Hepatitis Cohort Study (CHeCS) publications using data from "real-world" patients with hepatitis C virus (HCV) have described demographic disparities in access to care; rates of advanced liver disease, morbidity, and mortality (2.5%-3.5% per year during 2006-10, although only 19% of all CHeCS decedents, and just 30% of those with deaths attributed to liver disease, had HCV listed on death certificate); substantial comorbidities, such as diabetes, advanced liver fibrosis (29% prevalence), renal disease, and depression, and partial reversal of all these with successful antiviral therapy; patient risk behaviors; and use of noninvasive markers to assess liver disease., (Published by Elsevier Inc.)
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- 2018
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30. The Predictive Value of International Classification of Disease Codes for Chronic Hepatitis C Virus Infection Surveillance: The Utility and Limitations of Electronic Health Records.
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Abara WE, Moorman AC, Zhong Y, Collier MG, Rupp LB, Gordon SC, Boscarino JA, Schmidt MA, Trinacty CM, and Holmberg SD
- Abstract
Surveillance of chronic hepatitis C virus (HCV) cases faces limitations that result in delays and under-reporting. With increasing use of electronic health records (EHRs), the authors evaluated the predictive value of using International Classification of Diseases, Ninth Revision (ICD-9) codes to identify chronic HCV cases from EHR data. Longitudinal EHR data from 4 health care systems during 2006-2012 were evaluated. Using chart abstraction and review to confirm chronic HCV cases ("gold standard" definition), the authors calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 2 case definitions: (1) ≥2 ICD-9 codes separated by ≥6 months and (2) ≥1 positive HCV RNA (ribonucleic acid) test. Among 2,718,995 patients, 20,779 (0.8%) with ICD-9 codes indicating a likely diagnosis of chronic HCV infection were identified; 13,595 (65.4%) of these were randomly selected for review. Case definition 1 (≥2 ICD-9 codes separated by ≥6 months) had 70.3% sensitivity, 91.9% PPV, 99.9% specificity, and 99.9% NPV while case definition 2 (≥1 positive HCV RNA test) had 74.1% sensitivity, 97.4% PPV, 99.9% specificity, and 99.9% NPV. The predictive values of these alternate EHR-derived ICD-9 code-based case definitions suggest that these measures may be useful in capturing the burden of diagnosed chronic HCV infections. Their use can augment current chronic HCV case surveillance efforts; however, their accuracy may vary by length of observation and completeness of EHR data.
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- 2018
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31. Hepatitis B Virus Infection and Hepatitis C Virus Treatment in a Large Cohort of Hepatitis C-Infected Patients in the United States.
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Moorman AC, Xing J, Rupp LB, Gordon SC, Spradling PR, Boscarino JA, Schmidt MA, Daida YG, Teshale EH, and Holmberg SD
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- Adult, Female, Hepacivirus pathogenicity, Hepatitis B diagnosis, Hepatitis B epidemiology, Hepatitis C diagnosis, Hepatitis C epidemiology, Hepatitis C virology, Humans, Male, Middle Aged, Risk Factors, Sustained Virologic Response, Time Factors, Treatment Outcome, United States epidemiology, Antiviral Agents therapeutic use, Coinfection, Hepacivirus drug effects, Hepatitis B virology, Hepatitis B virus pathogenicity, Hepatitis C drug therapy, Virus Activation
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- 2018
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32. Changing trends in complications of chronic hepatitis C.
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Lu M, Li J, Rupp LB, Zhou Y, Holmberg SD, Moorman AC, Spradling PR, Teshale EH, Boscarino JA, Daida YG, Schmidt MA, Trudeau S, and Gordon SC
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- Adult, Black or African American, Age Distribution, Age Factors, Asian, Cause of Death trends, Hepatitis C, Chronic ethnology, Hepatitis C, Chronic mortality, Hepatitis C, Chronic virology, Humans, Incidence, Liver Cirrhosis ethnology, Liver Cirrhosis mortality, Liver Cirrhosis virology, Middle Aged, Prevalence, Risk Factors, Sex Distribution, Sex Factors, Time Factors, United States epidemiology, White People, Hepatitis C, Chronic epidemiology, Liver Cirrhosis epidemiology
- Abstract
Background & Aims: Chronic hepatitis C virus (HCV)-related complications have increased over the past decade., Methods: We used join-point regression modelling to investigate trends in these complications from 2006 to 2015, and the impact of demographics on these trends. Using data from the Chronic Hepatitis Cohort Study (CHeCS), we identified points at which the trend significantly changed, and estimated the annual percent change (APC) in rates of cirrhosis, decompensated cirrhosis and all-cause mortality, adjusted by race, sex and age., Results: Among 11,167 adults with chronic HCV infection, prevalence of cirrhosis increased from 20.8% to 27.6% from 2006 to 2015, with adjusted annual percentage change (aAPC) of 1.2 (p <. 01). Although incidence of all-cause mortality increased from 1.8% in 2006 to 2.9% in 2015, a join-point was identified at 2010, with aAPCs of 9.6 before (2006 < 2010; p < .01) and -5.2 after (2010 ≤ 2015; p < .01), indicating a decrease in mortality from 2010 and onward. Likewise, overall prevalence of decompensated cirrhosis increased from 9.3% in 2006 to 10.4% in 2015, but this increase was confined to patients 60 or older (aAPC = 1.5; p = .023). Asian American and Black/African American patients demonstrated significantly higher rates of cirrhosis than White patients, while older patients and men demonstrated higher rates of cirrhosis and mortality., Conclusions: Although cirrhosis and mortality among HCV-infected patients in the US have increased over the past decade, all-cause mortality has decreased in recent years., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
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- 2018
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33. A Point System to Forecast Hepatocellular Carcinoma Risk Before and After Treatment Among Persons with Chronic Hepatitis C.
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Xing J, Spradling PR, Moorman AC, Holmberg SD, Teshale EH, Rupp LB, Gordon SC, Lu M, Boscarino JA, Schmidt MA, Trinacty CM, and Xu F
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- Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Alcohol Drinking adverse effects, Aspartate Aminotransferases blood, Biomarkers blood, Blood Platelets, Carcinoma, Hepatocellular diagnosis, Clinical Enzyme Tests, Hepatitis C, Chronic blood, Hepatitis C, Chronic diagnosis, Humans, Kaplan-Meier Estimate, Liver Neoplasms diagnosis, Middle Aged, Platelet Count, Predictive Value of Tests, Prognosis, Proportional Hazards Models, Reproducibility of Results, Risk Assessment, Risk Factors, Time Factors, United States, Young Adult, Carcinoma, Hepatocellular virology, Decision Support Techniques, Hepatitis C, Chronic complications, Liver Neoplasms virology
- Abstract
Background: Risk of hepatocellular carcinoma (HCC) may be difficult to determine in the clinical setting., Aim: Develop a scoring system to forecast HCC risk among patients with chronic hepatitis C., Methods: Using data from the Chronic Hepatitis Cohort Study collected during 2005-2014, we derived HCC risk scores for males and females using an extended Cox model with aspartate aminotransferase-to-platelet ratio index (APRI) as a time-dependent variables and mean Kaplan-Meier survival functions from patient data at two study sites, and used data collected at two separate sites for external validation. For model calibration, we used the Greenwood-Nam-D'Agostino goodness-of-fit statistic to examine differences between predicted and observed risk., Results: Of 12,469 patients (1628 with a history of sustained viral response [SVR]), 504 developed HCC; median follow-up was 6 years. Final predictors in the model included age, alcohol abuse, interferon-based treatment response, and APRI. Point values, ranging from -3 to 14 (males) and -3 to 12 (females), were established using hazard ratios of the predictors aligned with 1-, 3-, and 5-year Kaplan-Meier survival probabilities of HCC. Discriminatory capacity was high (c-index 0.82 males and 0.84 females) and external calibration demonstrated no differences between predicted and observed HCC risk for 1-, 3-, and 5-year forecasts among males (all p values >0.97) and for 3- and 5-year risk among females (all p values >0.87)., Conclusion: This scoring system, based on age, alcohol abuse history, treatment response, and APRI, can be used to forecast up to a 5-year risk of HCC among hepatitis C patients before and after SVR.
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- 2017
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34. Comparison of ICD-9 Codes for Depression and Alcohol Misuse to Survey Instruments Suggests These Codes Should Be Used with Caution.
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Boscarino JA, Moorman AC, Rupp LB, Zhou Y, Lu M, Teshale EH, Gordon SC, Spradling PR, Schmidt MA, Trinacty CM, Zhong Y, Holmberg SD, and Holtzman D
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- Adolescent, Adult, Aged, Alcoholism diagnosis, Depression diagnosis, Electronic Health Records, Female, Health Surveys, Hepatitis C, Chronic diagnosis, Humans, Male, Middle Aged, Prevalence, Time Factors, United States epidemiology, Young Adult, Alcoholism classification, Alcoholism epidemiology, Data Mining methods, Depression classification, Depression epidemiology, Hepatitis C, Chronic classification, Hepatitis C, Chronic epidemiology, International Classification of Diseases
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Background: Research suggests depression and alcohol misuse are highly prevalent among chronic hepatitis C (CHC) patients, which is of clinical concern., Aims: To compare ICD-9 codes for depression and alcohol misuse to validated survey instruments., Methods: Among CHC patients, we assessed how well electronic ICD-9 codes for depression and alcohol misuse predicted these disorders using validated instruments., Results: Of 4874 patients surveyed, 56% were male and 52% had a history of injection drug use. Based on the PHQ-8, the prevalence of depression was 30% compared to 14% based on ICD-9 codes within 12 months of survey, 37% from ICD-9 codes any time before or within 12 months after survey, and 48% from ICD-9 codes any time before or within 24 months after survey. ICD-9 codes predicting PHQ-8 depression had a sensitivity ranging from 59 to 88% and a specificity ranging from 33 to 65%. Based on the AUDIT-C, the prevalence of alcohol misuse was 21% compared to 3-23% using ICD-9 codes. The sensitivity of ICD-9 codes to predict AUDIT-C score ranged from 9 to 35% and specificity from 80 to 98%. Overall 39% of patients reported ever binge drinking, with a sensitivity of ICD-9 to predict binge drinking ranging from 7 to 33% and a specificity from 84 to 98%. More than half of patients had either an ICD-9 code for depression, a survey score indicating depression, or both (59%); more than one-third had the same patterns for alcohol misuse (36%)., Conclusions: ICD-9 codes were limited in predicting current depression and alcohol misuse, suggesting that caution should be exercised when using ICD-9 codes to assess depression or alcohol misuse among CHC patients.
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- 2017
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35. Hepatitis C Virus Infection Among Reproductive-Aged Women and Children in the United States, 2006 to 2014.
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Ly KN, Jiles RB, Teshale EH, Foster MA, Pesano RL, and Holmberg SD
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- Adolescent, Adult, Child, Child, Preschool, Female, Hepatitis C transmission, Humans, Incidence, Infant, Newborn, Infectious Disease Transmission, Vertical, Male, Population Surveillance, Pregnancy, Prevalence, United States epidemiology, Young Adult, Hepatitis C epidemiology
- Abstract
Background: In the United States, hepatitis C virus (HCV) infection has increased among young persons who inject drugs, but the extent of this epidemic among reproductive-aged women and their children is unknown., Objective: To estimate numbers and describe characteristics of reproductive-aged women with HCV infection and of their offspring., Design: Analysis of the National Notifiable Diseases Surveillance System (NNDSS) from 2006 to 2014 and the Quest Diagnostics Health Trends national database from 2011 to 2014., Setting: United States., Participants: 171 801 women (aged 15 to 44 years) and 1859 children (aged 2 to 13 years) with HCV infection reported to the NNDSS; 2.1 million reproductive-aged women and 56 684 children who had HCV testing by Quest Diagnostics., Measurements: NNDSS HCV case reports and Quest laboratory data regarding unique reproductive-aged women and children who were tested for HCV infection., Results: The number of reproductive-aged women with acute and past or present HCV infection in the NNDSS doubled, from 15 550 in 2006 to 31 039 in 2014. Of 581 255 pregnant women tested by Quest from 2011 to 2014, 4232 (0.73% [95% CI, 0.71% to 0.75%]) had HCV infection. Of children tested by Quest, 0.76% (CI, 0.69% to 0.83%) had HCV infection, but the percentage was 3.2-fold higher among children aged 2 to 3 years (1.62% [CI, 1.34% to 1.96%]) than those aged 12 to 13 years (0.50% [CI, 0.41% to 0.62%]). Applying the Quest HCV infection rate to annual live births from 2011 to 2014 resulted in an estimated average of 29 000 women (CI, 27 400 to 30 900 women) with HCV infection, who gave birth to 1700 infants (CI, 1200 to 2200 infants) with the infection each year., Limitations: Only a fraction of HCV infections is detected and reported to the NNDSS. Quest data are potentially biased, because women who are asymptomatic, do not access health care, or have unreported risks may be less likely to be tested for HCV infection., Conclusion: These data suggest a recent increase in HCV infection among reproductive-aged women and may inform deliberations regarding a role for routine HCV screening during pregnancy., Primary Funding Source: Centers for Disease Control and Prevention.
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- 2017
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36. Long-term progression of viral load and serum markers of fibrosis among treated and untreated patients with chronic hepatitis B.
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Li J, Gordon SC, Rupp LB, Zhang T, Trudeau S, Holmberg SD, Moorman AC, Spradling PR, Teshale EH, Boscarino JA, Daida YG, Schmidt MA, and Lu M
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- Adult, Antiviral Agents therapeutic use, Biomarkers blood, Cohort Studies, Female, Fibrosis, Hepatitis B, Chronic drug therapy, Hepatitis B, Chronic virology, Humans, Male, Middle Aged, Time Factors, Hepatitis B, Chronic diagnosis, Hepatitis B, Chronic pathology, Liver pathology, Viral Load
- Abstract
Background and Aims: Antiviral therapy for patients with hepatitis B (HBV) infection is generally deferred for "immune inactive" patients, although longitudinal changes in viral load and liver fibrosis remain understudied in this population. Likewise, in treated patients, the temporal relationship between changes in viral load and liver fibrosis is not well characterized. Using data from the chronic hepatitis cohort study, the study investigated viral load and the Fibrosis-4 index (FIB4, a serum-based marker of liver fibrosis) trajectories in both untreated and treated HBV patients., Materials and Methods: We applied a bivariate, piecewise, linear spline, mixed-effects modeling approach to data from 766 HBV patients (342 untreated, 424 treated). Treatment selection bias was adjusted using propensity scores. Multiple sensitivity analyses were used to confirm results in untreated patients., Results: Among all untreated patients, FIB4 began to increase by 0.9% per month (11% per year; P < 0.05) at 28 months post-index date, suggesting fibrosis progression. Significant FIB4 progression was also observed in a subgroup analysis of "immune inactive" untreated patients. In treated patients, viral load declined 31.8% per month (P < 0.05) for the first 5 months after treatment initiation, and 1.4-1.7% per month (P < 0.05) thereafter. At 5 months after treatment initiation, FIB4 began to decline 0.5% per month (P < 0.05), stabilizing at 28 months., Conclusion: Among untreated HBV patients, FIB4 gradually increases over time, suggesting fibrosis progression, even in those patients designated as immune inactive. In treated patients, antiviral therapy results in a rapid decline in viral load followed by a delayed decline in markers of liver fibrosis., (© 2016 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)
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- 2017
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37. Assessing the Effect of Potential Reductions in Non-Hepatic Mortality on the Estimated Cost-Effectiveness of Hepatitis C Treatment in Early Stages of Liver Disease.
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Leidner AJ, Chesson HW, Spradling PR, and Holmberg SD
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- Cost-Benefit Analysis, Disease Progression, Health Care Costs, Hepatitis C drug therapy, Hepatitis C mortality, Humans, Markov Chains, Models, Statistical, Quality-Adjusted Life Years, Hepatitis C economics, Mortality
- Abstract
Background: Most cost-effectiveness analyses of hepatitis C (HCV) therapy focus on the benefits of reducing liver-related morbidity and mortality., Objectives: Our objective was to assess how cost-effectiveness estimates of HCV therapy can vary depending on assumptions regarding the potential impact of HCV therapy on non-hepatic mortality., Methods: We adapted a state-transition model to include potential effects of HCV therapy on non-hepatic mortality. We assumed successful treatment could reduce non-hepatic mortality by as little as 0 % to as much as 100 %. Incremental cost-effectiveness ratios were computed comparing immediate treatment versus delayed treatment and comparing immediate treatment versus non-treatment., Results: Comparing immediate treatment versus delayed treatment, when we included a 44 % reduction in non-hepatic mortality following successful HCV treatment, the incremental cost per quality-adjusted life year (QALY) gained by HCV treatment fell by 76 % (from US$314,100 to US$76,900) for patients with no fibrosis and by 43 % (from US$62,500 to US$35,800) for patients with moderate fibrosis. Comparing immediate treatment versus non-treatment, assuming a 44 % reduction in non-hepatic mortality following successful HCV treatment, the incremental cost per QALY gained by HCV treatment fell by 64 % (from US$186,700 to US$67,300) for patients with no fibrosis and by 27 % (from US$35,000 to US$25,500) for patients with moderate fibrosis., Conclusion: Including reductions in non-hepatic mortality from HCV treatment can have substantial effects on the estimated cost-effectiveness of treatment.
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- 2017
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38. Frequency of and Factors Associated with Receipt of Liver-Related Specialty Care Among Patients with Hepatitis C in the Chronic Hepatitis Cohort Study.
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Foster MA, Xing J, Moorman AC, Boscarino J, Gordon SC, Lu M, Rupp L, Schmidt MA, Trinacty CM, Xu F, Holmberg SD, and Spradling PR
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- Adolescent, Adult, Aged, Alanine Transaminase blood, Cohort Studies, Comorbidity, Disease Management, Female, Hepatitis C, Chronic blood, Humans, Insurance, Health, Male, Medicaid, Medicare, Medicine, Middle Aged, Multivariate Analysis, Odds Ratio, Platelet Count, Time Factors, United States, Young Adult, Antiviral Agents therapeutic use, Gastroenterology statistics & numerical data, Hepatitis C, Chronic therapy, Referral and Consultation statistics & numerical data
- Abstract
Background: Linking persons with hepatitis C virus (HCV) to care and treatment is critical to reduction in disease burden; typically, this entailed referral to a specialist. However, data regarding the frequency and factors associated with referral among patients in healthcare organizations (HCOs) are lacking., Methods: Among persons in four US HCOs with newly diagnosed HCV during 2006-2011, we determined the frequency of liver-related specialist care after diagnosis. We also identified sociodemographic and clinical characteristics associated with such care by multivariate analysis, adjusted for all variables., Results: Among 3592 patients with newly diagnosed HCV, 57 % (range among sites 45-90 %) received specialist care; of these, 57 % received care within 90 days of diagnosis. Patient characteristics associated with receipt of specialist care included: affiliation with one of the study sites [adjusted odds ratio (aOR) 4.8 vs. the referent site); having Medicare plus private insurance (aOR 1.6 vs. Medicaid); and having elevated alanine aminotransferase (ALT) (aOR 1.6 vs. normal ALT) or lower platelet values (aOR 1.4 vs. normal platelet level). Specialist care within 90 days of diagnosis was associated with private insurance (aOR 1.5 vs. Medicaid), elevated ALT levels (aOR 1.3-2.3 vs. normal), and having ≥2 comorbid conditions (aOR 1.4 vs. no comorbid conditions). Compared to patients not referred, those referred were more likely to be treated (aOR 3.5)., Conclusions: Receipt of specialist care among persons with newly diagnosed HCV varied among HCOs. Clinical evidence of liver disease and having private insurance were associated with prompt receipt of specialist care and HCV treatment.
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- 2016
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39. Distribution of disease phase, treatment prescription and severe liver disease among 1598 patients with chronic hepatitis B in the Chronic Hepatitis Cohort Study, 2006-2013.
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Spradling PR, Xing J, Rupp LB, Moorman AC, Gordon SC, Teshale ET, Lu M, Boscarino JA, Schmidt MA, Trinacty CM, and Holmberg SD
- Subjects
- Adolescent, Adult, Cohort Studies, Female, Hepatitis B e Antigens blood, Hepatitis B, Chronic blood, Hepatitis B, Chronic drug therapy, Humans, Liver Cirrhosis blood, Liver Cirrhosis drug therapy, Liver Cirrhosis epidemiology, Male, Middle Aged, United States epidemiology, Young Adult, Hepatitis B, Chronic epidemiology
- Abstract
Background: Limited information exists regarding the distribution of disease phases, treatment prescription and severe liver disease among patients with chronic hepatitis B (CHB) in US general healthcare settings., Aim: To determine the distribution of disease phases, treatment prescription and severe liver disease among patients with CHB in general US healthcare settings., Methods: We analysed demographic and clinical data collected during 2006-2013 from patients with confirmed CHB in the Chronic Hepatitis Cohort Study, an observational cohort study involving patients from healthcare organisations in Michigan, Pennsylvania, Oregon and Hawaii. CHB phases were classified according to American Association for the Study of Liver Disease guidelines., Results: Of 1598 CHB patients with ≥12 months of follow-up (median 6.3 years), 457 (29%) were immune active during follow-up [11% hepatitis B e antigen (HBeAg)-positive, 16% HBeAg-negative, and 2% HBeAg status unknown], 10 (0.6%) were immune tolerant, 112 (7%) were inactive through the duration of follow-up and 886 (55%) were phase indeterminate. Patients with cirrhosis were identified within each group (among 21% of immune active, 3% of inactive and 9% of indeterminate phase patients) except among those with immune-tolerant CHB. Prescription of treatment was 59% among immune active patients and 84% among patients with cirrhosis and hepatitis B virus (HBV) DNA >2000 IU/mL., Conclusions: Approximately, one-third of the cohort had active disease during follow-up; 60% of eligible patients were prescribed treatment. Our findings underscore the importance of ascertainment of fibrosis status in addition to regular assessment of ALT and HBV DNA levels., (© 2016 John Wiley & Sons Ltd.)
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- 2016
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40. Infrequent Clinical Assessment of Chronic Hepatitis B Patients in United States General Healthcare Settings.
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Spradling PR, Xing J, Rupp LB, Moorman AC, Gordon SC, Teshale ET, Lu M, Boscarino JA, Trinacty CM, Schmidt MA, and Holmberg SD
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- Adolescent, Adult, Antiviral Agents therapeutic use, Cohort Studies, Continuity of Patient Care, Female, Follow-Up Studies, Hepatitis B, Chronic complications, Hepatitis B, Chronic drug therapy, Hepatitis B, Chronic physiopathology, Humans, Liver Cirrhosis virology, Male, Middle Aged, United States, Young Adult, Delivery of Health Care, Hepatitis B, Chronic therapy
- Abstract
Among 2338 chronic hepatitis B patients followed during 2006-2013 in the Chronic Hepatitis Cohort Study, 78% had ≥1 alanine aminotransferase and 37% had ≥1 hepatitis B virus DNA level assessed annually. Among cirrhotic patients, 46% never had hepatic imaging. Patients in this cohort were insufficiently monitored for disease activity and hepatocellular carcinoma., (Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.)
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- 2016
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41. Higher all-cause hospitalization among patients with chronic hepatitis C: the Chronic Hepatitis Cohort Study (CHeCS), 2006-2013.
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Teshale EH, Xing J, Moorman A, Holmberg SD, Spradling PR, Gordon SC, Rupp LB, Lu M, Boscarino JA, Trinacity CM, Schmidt MA, and Xu F
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Female, Hepatitis C, Chronic epidemiology, Humans, Incidence, Male, Middle Aged, Risk Assessment, United States epidemiology, Young Adult, Hepatitis C, Chronic complications, Hospitalization
- Abstract
In the United States, hospitalization among patients with chronic hepatitis C virus (HCV) infection is high. The healthcare burden associated with hospitalization is not clearly known. We analysed data from the Chronic Hepatitis Cohort Study, an observational cohort of patients receiving care at four integrated healthcare systems, collected from 2006 to 2013 to determine all-cause hospitalization rates of patients with chronic HCV infection and the other health system patients. To compare the hospitalization rates, we selected two health system patients for each chronic HCV patient using their propensity score (PS). Propensity score matching was conducted by site, gender, race, age and household income to minimize differences attributable to these characteristics. We also compared primary reason for hospitalization between chronic HCV patients and the other health system patients. Overall, 10 131 patients with chronic HCV infection and 20 262 health system patients were selected from the 1 867 802 health system patients and were matched by PS. All-cause hospitalization rates were 27.4 (27.0-27.8) and 7.4 (7.2-7.5) per 100 persons-year (PY) for chronic HCV patients and for the other health system patients, respectively. Compared to health system patients, hospitalization rates were significantly higher by site, gender, age group, race and household income among chronic HCV patients (P < 0.001). Compared to health system patients, chronic HCV patients were more likely to be hospitalized from liver-related conditions (RR = 24.8, P < 0.001). Hence, patients with chronic HCV infection had approximately 3.7-fold higher all-cause hospitalization rate than other health system patients. These findings highlight the incremental costs and healthcare burden of patients with chronic HCV infection associated with hospitalization., (© 2016 John Wiley & Sons Ltd.)
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- 2016
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42. Hepatitis C treatment failure is associated with increased risk of hepatocellular carcinoma.
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Lu M, Li J, Rupp LB, Holmberg SD, Moorman AC, Spradling PR, Teshale EH, Zhou Y, Boscarino JA, Schmidt MA, Lamerato LE, Trinacty C, Trudeau S, and Gordon SC
- Subjects
- Adult, Aged, Aged, 80 and over, Ethnicity, Female, Humans, Male, Middle Aged, Prospective Studies, Retrospective Studies, Risk Assessment, Treatment Failure, United States epidemiology, Young Adult, Antiviral Agents therapeutic use, Carcinoma, Hepatocellular epidemiology, Hepatitis C, Chronic complications, Hepatitis C, Chronic drug therapy
- Abstract
Sustained virological response (SVR) to antiviral therapy for hepatitis C (HCV) reduces risk of hepatocellular carcinoma (HCC), but there is little information regarding how treatment failure (TF) compares to lack of treatment. We evaluated the impact of treatment status on risk of HCC using data from the Chronic Hepatitis Cohort Study (CHeCS-an observational study based in four large US health systems, with up to 7 years of follow-up on patients). Multivariable analyses were used to adjust for bias in treatment selection, as well as other covariates, followed by sensitivity analyses. Among 10 091 HCV patients, 3681 (36%) received treatment, 2099 (57%) experienced treatment failure (TF), and 1582 (43%) of these achieved sustained virological response (SVR). TF patients demonstrated almost twice the risk of HCC than untreated patients [adjusted hazard ratio (aHR) = 1.95, 95% confidence interval (CI) 1.50-2.53]; this risk persisted across all stages of fibrosis. Several sensitivity analyses validated these results. Although African Americans were at increased risk of treatment failure, they were at lower risk for HCC and all-cause mortality compared to White patients. SVR patients had lower risk of HCC than TF patients (aHR = 0.48, CI 0.31-0.73), whereas treatment - regardless of outcome - reduced all-cause mortality (aHR = 0.45, CI 0.34-0.60 for SVR patients; aHR = 0.78, CI 0.65-0.93 for TF patients)., (© 2016 John Wiley & Sons Ltd.)
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- 2016
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43. Serum Biomarkers Indicate Long-term Reduction in Liver Fibrosis in Patients With Sustained Virological Response to Treatment for HCV Infection.
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Lu M, Li J, Zhang T, Rupp LB, Trudeau S, Holmberg SD, Moorman AC, Spradling PR, Teshale EH, Xu F, Boscarino JA, Schmidt MA, Vijayadeva V, and Gordon SC
- Subjects
- Adult, Aged, Female, Humans, Liver Cirrhosis epidemiology, Liver Cirrhosis pathology, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Retrospective Studies, Treatment Outcome, United States epidemiology, Antiviral Agents therapeutic use, Biomarkers blood, Hepatitis C, Chronic complications, Hepatitis C, Chronic drug therapy, Liver Cirrhosis prevention & control, Serum chemistry, Sustained Virologic Response
- Abstract
Background & Aims: Sustained virological response (SVR) to antiviral therapy for hepatitis C virus (HCV) correlates with changes in biochemical measures of liver function. However, little is known about the long-term effects of SVR on liver fibrosis. We investigated the effects of HCV therapy on fibrosis, based on the Fibrosis-4 (FIB4) score, over a 10-year period., Methods: We collected data from participants in the Chronic Hepatitis Cohort Study-a large observational multicenter study of patients with hepatitis at 4 US health systems-from January 1, 2006, through December 31, 2013. We calculated patients' FIB4 score and the aminotransferase-to-platelet ratio index (APRI) score over a 10-year period. Of 4731 patients with HCV infection, 1657 (35%) were treated and 755 (46%) of these patients achieved SVR., Results: In propensity score-adjusted analyses, we observed significant longitudinal changes in FIB4 score that varied with treatment and response to treatment. In patients achieving SVR, FIB4 scores decreased sharply, remaining significantly lower over the 10-year period than in untreated patients or patients with treatment failure (P < .001). In independent analyses, men and patients with HCV genotype 1 or 3 infections had higher FIB4 scores than women or patients with HCV genotype 2 infections (P < .01 for both). Findings were similar in a sensitivity analysis that substituted the APRI as the marker of fibrosis instead of the FIB4 score., Conclusions: SVR to HCV treatment appears to induce long-term regression of fibrosis based on FIB4 scores collected over 10 years from a large observational study of US hepatitis patients. Patients receiving no treatment or with treatment failure had progressive increases in FIB4 scores., (Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.)
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- 2016
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44. Prevalence of Renal Impairment and Associated Conditions Among HCV-Infected Persons in the Chronic Hepatitis Cohort Study (CHeCS).
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Moorman AC, Tong X, Spradling PR, Rupp LB, Gordon SC, Lu M, Teshale EH, Boscarino JA, Trinacty CM, Schmidt MA, Xu F, and Holmberg SD
- Subjects
- Adult, Aged, Female, Humans, Male, Middle Aged, Prevalence, Hepatitis C, Chronic complications, Renal Insufficiency complications
- Abstract
Background: Guidelines for the treatment of HCV-infected persons were updated in August 2015 with new recommendations for patients with renal impairment. Treatment is imperative for patients with severe, renal-associated extrahepatic manifestations of HCV infection., Aims: We sought to describe the prevalence of these conditions among current HCV-infected patients in a population-based prospective, observational cohort study at four large US health systems., Methods: Data from cohort patients with chronic HCV infection during 2012 were analyzed for the period from 2006 to 2013. We determined the prevalence of mild to moderately impaired renal function defined as having the most recent estimated glomerular filtration rate [eGFR] ≤ 80 ml/min/1.73 m(2), with severe impairment defined as eGFR < 30 ml/min/1.73 m(2), based on the treatment guidelines. Prevalence of extrahepatic conditions was ascertained using ICD9-codes., Results: Among 5772 persons, the prevalence of eGFR ≤ 80 was 33 % and eGFR < 30 was 2 %, including among patients with hepatic fibrosis. Diagnosed extrahepatic renal manifestations were rare: vasculitis- 0.2 %, nephrotic syndrome- 0.3 %, and cryoglobulinemia- 0.9 %., Conclusions: While the prevalence of severe renal impairment and diagnosed extrahepatic manifestations was low, mild-to-moderate renal impairment was common in HCV patients, including those with advanced liver fibrosis for whom the need for treatment is urgent.
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- 2016
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45. Rising Mortality Associated With Hepatitis C Virus in the United States, 2003-2013.
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Ly KN, Hughes EM, Jiles RB, and Holmberg SD
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- Cause of Death, Hepacivirus, Humans, Middle Aged, United States epidemiology, Hepatitis C mortality
- Abstract
In the United States, hepatitis C virus (HCV)-associated mortality is increasing. From 2003-2013, the number of deaths associated with HCV has now surpassed 60 other nationally notifiable infectious conditions combined. The increasing HCV-associated mortality trend underscores the urgency in finding, evaluating, and treating HCV-infected persons., (Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.)
- Published
- 2016
- Full Text
- View/download PDF
46. Reply to "Younger age at cancer diagnosis may be driven by age structure of the HCV population".
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Allison RD and Holmberg SD
- Subjects
- Female, Humans, Male, Hepatitis C, Chronic complications, Neoplasms epidemiology, SEER Program
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- 2016
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47. All-Cause Mortality and Progression Risks to Hepatic Decompensation and Hepatocellular Carcinoma in Patients Infected With Hepatitis C Virus.
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Xu F, Moorman AC, Tong X, Gordon SC, Rupp LB, Lu M, Teshale EH, Spradling PR, Boscarino JA, Trinacty CM, Schmidt MA, Holmberg SD, Holmberg SD, Teshale EH, Spradling PR, Moorman AC, Xing J, Tong X, Xu F, Gordon SC, Nerenz DR, Lu M, Lamerato L, Wang Y, Rupp LB, Akkerman N, Oja-Tebbe N, Zhang T, Li J, Sitarik A, Larkin D, Boscarino JA, Daar ZS, Curry PJ, Smith RE, Vijayadeva V, Parker JV, Schmidt MA, Donald JL, and Keast EM
- Subjects
- Adult, Aged, Biopsy, Cohort Studies, Disease Progression, Female, Humans, Liver Cirrhosis pathology, Male, Middle Aged, Risk Assessment, Severity of Illness Index, Survival Analysis, United States epidemiology, Young Adult, Carcinoma, Hepatocellular epidemiology, Hepatitis C, Chronic complications, Hepatitis C, Chronic mortality, Liver Failure epidemiology
- Abstract
Background: A key question in care of patients with chronic hepatitis C virus (HCV) infection is beginning treatment immediately vs delaying treatment. Risks of mortality and disease progression in "real world" settings are important to assess the implications of delaying HCV treatment., Methods: This was a cohort study of HCV patients identified from 4 integrated health systems in the United States who had liver biopsies during 2001-2012. The probabilities of death and progression to hepatocellular carcinoma, hepatic decompensation (hepatic encephalopathy, esophageal varices, ascites, or portal hypertension) or liver transplant were estimated over 1, 2, or 5 years by fibrosis stage (Metavir F0-F4) determined by biopsy at beginning of observation., Results: Among 2799 HCV-monoinfected patients who had a qualifying liver biopsy, the mean age at the time of biopsy was 50.7 years. The majority were male (58.9%) and non-Hispanic white (66.9%). Over a mean observation of 5.0 years, 261 (9.3%) patients died and 34 (1.2%) received liver transplants. At 5 years after biopsy, the estimated risk of progression to hepatic decompensation or hepatocellular carcinoma was 37.2% in stage F4, 19.6% in F3, 4.7% in F2, and 2.3% in F0-F1 patients. Baseline biopsy stage F3 or F4 and platelet count below normal were the strongest predictors of progression to hepatic decompensation or hepatocellular carcinoma., Conclusions: The risks of death and progression to liver failure varied greatly by fibrosis stage. Clinicians and policy makers could use these progression risk data in prioritization and in determining the timing of treatment for patients in early stages of liver disease., (Published by Oxford University Press for the Infectious Diseases Society of America 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.)
- Published
- 2016
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48. Prevalence of chronic hepatitis B virus (HBV) infection in U.S. households: National Health and Nutrition Examination Survey (NHANES), 1988-2012.
- Author
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Roberts H, Kruszon-Moran D, Ly KN, Hughes E, Iqbal K, Jiles RB, and Holmberg SD
- Subjects
- Adolescent, Adult, Child, Female, Humans, Male, Middle Aged, Nutrition Surveys, Prevalence, Time Factors, United States epidemiology, Young Adult, Hepatitis B, Chronic epidemiology
- Abstract
Unlabelled: The number of persons with chronic hepatitis B virus (HBV) infection in the United States is affected by diminishing numbers of young persons who are susceptible because of universal infant vaccination since 1991, offset by numbers of HBV-infected persons migrating to the United States from endemic countries. The prevalence of HBV infection was determined by serological testing and analysis among noninstitutionalized persons age 6 years and older for: antibody to hepatitis B core antigen (anti-HBc), indicative of previous HBV infection; hepatitis B surface antigen (HBsAg), indicative of chronic (current) infection; and antibody to hepatitis B surface antigen (anti-HBs), indicative of immunity from vaccination. These prevalence estimates were analyzed in three periods of the National Health and Nutrition Examination Survey (NHANES): 1988-1994 (21,260 persons); 1999-2008 (29,828); and 2007-2012 (22,358). In 2011-2012, for the first time, non-Hispanic Asians were oversampled in NHANES. For the most recent period (2007-2012), 3.9% had anti-HBc, indicating approximately 10.8 (95% confidence interval [CI]: 9.4-12.2) million noninstitutionalized U.S. residents having ever been infected with HBV. The overall prevalence of chronic HBV infection has remained constant since 1999: 0.3% (95% CI: 0.2-0.4), and since 1999, prevalence of chronic HBV infection among non-Hispanic blacks has been 2- to 3-fold greater than the general population. An estimated 3.1% (1.8%-5.2%) of non-Hispanic Asians were chronically infected with HBV during 2011-2012, which reflects a 10-fold greater prevalence than the general population. Adjusted prevalence of vaccine-induced immunity increased 16% since 1999, and the number of persons (mainly young) with serological evidence of vaccine protection from HBV infection rose from 57.8 (95% CI: 55.4-60.1) million to 68.5 (95% CI: 65.4-71.2) million., Conclusion: Despite increasing immune protection in young persons vaccinated in infancy, an analysis of chronic hepatitis B prevalence in racial and ethnic populations indicates that during 2011-2012, there were 847,000 HBV infections (which included ~400,000 non-Hispanic Asians) in the noninstitutionalized U.S. POPULATION., (Published 2015. This article is a U.S. Government work and is in the public domain in the USA.)
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- 2016
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49. Hepatitis A Infections Among Food Handlers in the United States, 1993-2011.
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Sharapov UM, Kentenyants K, Groeger J, Roberts H, Holmberg SD, and Collier MG
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- Hepatitis A etiology, Hepatitis A prevention & control, Hepatitis A Vaccines therapeutic use, Humans, Occupational Diseases etiology, Risk Factors, United States epidemiology, Food Handling statistics & numerical data, Hepatitis A epidemiology, Occupational Diseases epidemiology
- Abstract
We reviewed news reports of hepatitis A virus (HAV)-infected food handlers in the United States from 1993 to 2011 using the LexisNexis® search engine. Using U.S. news reports, we identified 192 HAV-infected food handlers who worked while infectious; of these HAV-infected individuals, 34 (18%) transmitted HAV to restaurant patrons. News reports of HAV-infected food handlers declined from 1993 to 2011. This analysis suggests that universal childhood vaccination contributed to the decrease in reports of HAV-infected food handlers, but mandatory vaccination of this group is unlikely to be cost-effective.
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- 2016
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50. Toward a more accurate estimate of the prevalence of hepatitis C in the United States.
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Edlin BR, Eckhardt BJ, Shu MA, Holmberg SD, and Swan T
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- Female, Hepatitis C Antibodies blood, Humans, Male, Prevalence, United States epidemiology, Hepatitis C epidemiology
- Abstract
Unlabelled: Data from the 2003-2010 National Health and Nutrition Examination Survey (NHANES) indicate that about 3.6 million people in the United States have antibodies to the hepatitis C virus, of whom 2.7 million are currently infected. NHANES, however, excludes several high-risk populations from its sampling frame, including people who are incarcerated, homeless, or hospitalized; nursing home residents; active-duty military personnel; and people living on Indian reservations. We undertook a systematic review of peer-reviewed literature and sought out unpublished presentations and data to estimate the prevalence of hepatitis C in these excluded populations and in turn improve the estimate of the number of people with hepatitis C in the United States. The available data do not support a precise result, but we estimated that 1.0 million (range 0.4 million-1.8 million) persons excluded from the NHANES sampling frame have hepatitis C virus antibody, including 500,000 incarcerated people, 220,000 homeless people, 120,000 people living on Indian reservations, and 75,000 people in hospitals. Most are men. An estimated 0.8 million (range 0.3 million-1.5 million) are currently infected. Several additional sources of underestimation, including nonresponse bias and the underrepresentation of other groups at increased risk of hepatitis C that are not excluded from the NHANES sampling frame, were not addressed in this study., Conclusion: The number of US residents who have been infected with hepatitis C is unknown but is probably at least 4.6 million (range 3.4 million-6.0 million), and of these, at least 3.5 million (range 2.5 million-4.7 million) are currently infected; additional sources of potential underestimation suggest that the true prevalence could well be higher., (© 2015 by the American Association for the Study of Liver Diseases.)
- Published
- 2015
- Full Text
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