Abstract:
BACKGROUND:In Switzerland, intravenous drug use accounts for the majority of hepatitis C virus (HCV) infections. Early HCV treatment prevents further transmissions and reduces morbidity and mortality due to decompensated liver cirrhosis and hepatocellular carcinoma. Nevertheless, patients in drug substitution programmes are often insufficiently screened and treated. AIM:The aim was to compare the current state of HCV management in centralised and decentralised drug substitution programmes of the canton Aargau. Objectives were human immunodeficiency virus (HIV) and HCV prevalence, compliance with guidelines and gaps in the HCV cascade, as well as feasibility/acceptance/validity of HIV/HCV rapid tests on finger-prick blood and noninvasive liver fibrosis assessment with Fibroscan®. METHODS:For the cross-sectional study, in June 2013, questionnaires and free rapid tests for HIV (Determine®) and HCV (OraQuick®) that used capillary blood (finger-stick) were sent to 161 physicians providing drug substitution treatment for 631 patients. Free liver fibrosis assessment with Fibroscan® by a member of the study team was offered to all patients. Additionally, patients were directly recruited by the study team in the heroin substitution programme and several addiction clinics visited every 4-6 months, as well as in the Infectious Diseases Outpatient Clinic (questionnaire, rapid tests and Fibroscan® in the same session). RESULTS:Between July 2013 and July 2015, 205 (32.5%) of the 631 patients receiving opioid substitution in the canton Aargau were enrolled, 192 (93.7%) with HIV/HCV rapid tests and 167 (81.5%) with Fibroscan®. Acceptance of Fibroscan® was higher when offered in the same session (94.1 vs 69.2%). Overall, 77.8% had ever used intravenous drugs. HCV seroprevalence was 53.7% (109/203), HCV RNA prevalence 27.8%. Overall, 7.4% (15/202) were HIV infected, all of whom were HCV co-infected and under antiretroviral treatment. Of the 205 patients included, 104 (50.7%) were recruited in a decentralised setting (family practice / pharmacy) and 101 (49.3%) in a centralised setting (heroin programme, addiction clinic, Infectious Diseases Outpatient Clinic). Compliance with guidelines (regular HIV/HCV screening, workup of HCV-positive patients, availability of HAV/HBV serology) was consistently lower in the decentralised setting, characterised by a higher proportion of females, longer median time in the programme, lower percentage of daily attendance, ever-use of intravenous drugs and HIV and HCV infections. We identified several gaps in the HCV cascade: 23.9% (49/205) had never been HCV screened; 18.9% (18/95) of the HCV positive patients had no HCV RNA test. Of the 61 patients developing chronic HCV infection, 19.7% (12) were not HCV genotyped, 52.5% (32) had no liver fibrosis assessment (liver biopsy) and 54.1% (33) never received treatment; 25.0% (7/28) did not achieve a sustained virological response with interferon-based treatment. The 192 HCV rapid tests showed a sensitivity of 90.4% (94/104; 95% confidence interval 84.7-96.1%) and a specificity of 100% (88/88), and provided 14 new HCV diagnoses. Eight of ten patients with a false-negative HCV rapid test were HCV RNA negative (2 unknown). Among the 88.6% (39/44) currently HCV RNA-positive individuals with valid Fibroscan® results, 24 (61.5%) had a liver stiffness <7.5 kPa. Both HIV co-infection and alcohol overconsumption doubled the risk of severe fibrosis/cirrhosis in HCV positive patients. CONCLUSION:In contrast to HIV, HCV transmission among intravenous drug users is still ongoing. The management of hepatitis C in drug substitution patients needs improvement, especially in family practices. Minimally invasive "point-of-care" diagnostics such as the HCV antibody rapid test using capillary blood and mobile Fibroscan® can close some of the gaps in the HCV cascade. HCV RNA determination in capillary blood is still an unmet need. A "one-stop strategy" might improve linkage to care. Restricting the new, highly efficient (90-100% sustained virological response for all genotypes) direct-acting antivirals to patients with at least stage F2 fibrosis withholds treatment from two thirds of the chronically infected and prevents us from reaching the WHO goal of 80% treatment uptake necessary to eliminate hepatitis C by 2030.
journal_name
Swiss Med Wklyjournal_title
Swiss medical weeklyauthors
Bregenzer A,Conen A,Knuchel J,Friedl A,Eigenmann F,Näf M,Ackle P,Roth M,Fux CAdoi
10.4414/smw.2017.14544subject
Has Abstractpub_date
2017-11-20 00:00:00pages
w14544eissn
1424-7860issn
1424-3997pii
smw-14544journal_volume
147pub_type
杂志文章abstract:BACKGROUND:Renal replacement therapy for paediatric end-stage renal disease (ESRD) has developed steadily since its introduction five decades ago. Continuous and long-term analysis of patient outcomes is essential for quality control. METHODS:The Swiss Paediatric Renal Registry, founded in 1970, includes patients diag...
journal_title:Swiss medical weekly
pub_type: 杂志文章
doi:10.4414/smw.2020.20300
更新日期:2020-07-27 00:00:00
abstract:OBJECTIVE:To provide population-based, gestational age (GA) stratified incidence of mortality and morbidities. METHODS:Population-based prospective observational study of infants born between 23 0/7 and 31 6/7 weeks GA in the years 2000-2004 in all Swiss neonatal intensive care units. Outcomes measured were: mortality...
journal_title:Swiss medical weekly
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doi:10.4414/smw.2011.13212
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abstract:OBJECTIVES:To assess adherence to recommended standards of diabetes care by Swiss primary care physicians. METHODS:Medical files of community-based primary care physician were reviewed to assess adherence to recommended standards of diabetes care. These standards of care were based on a uniform set of definitions addr...
journal_title:Swiss medical weekly
pub_type: 杂志文章
doi:2007/11/smw-11592
更新日期:2007-03-24 00:00:00
abstract::Metallothioneins (MTs) are a family of small proteins containing 61-68 amino acids with an unusually high concentration of cysteine. MT-1, the most functional and active MT in humans, has the ability to react with and enhance the detoxification of a number of metals including zinc, mercury, copper and cadmium. MT dysf...
journal_title:Swiss medical weekly
pub_type: 杂志文章
doi:
更新日期:2008-02-09 00:00:00
abstract:AIM:To test the hypothesis that rationing of medical management mainly based on age exists in our health care system today. METHODS:We studied 303 consecutive patients hospitalised for acute coronary syndrome (ACS) and 163 consecutive patients hospitalised with congestive heart failure (CHF). They were divided into tw...
journal_title:Swiss medical weekly
pub_type: 杂志文章
doi:2001/43/smw-09823
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abstract::The atherogenic lipoprotein phenotype is characterised by a moderate increase in plasma triglycerides, a decrease in high density lipoprotein cholesterol and the prevalence of smaller denser low density lipoprotein particles. The prevalence of this partially inheritable phenotype is approximately 30% and is a feature ...
journal_title:Swiss medical weekly
pub_type: 杂志文章,评审
doi:2004/49/smw-10813
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journal_title:Swiss medical weekly
pub_type: 杂志文章,评审
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doi:10.4414/smw.2011.13221
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abstract:BACKGROUND:Epidemiological studies focusing on first-ever seizures have been carried out mainly on community based populations. However, since hospital populations may display varying clinical features, we prospectively analysed patients with first-ever seizure in a hospital based community to evaluate prognosis and th...
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doi:2004/39/smw-10738
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pub_type: 杂志文章,多中心研究
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journal_title:Swiss medical weekly
pub_type: 杂志文章
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journal_title:Swiss medical weekly
pub_type: 杂志文章
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journal_title:Swiss medical weekly
pub_type: 杂志文章,评审
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pub_type: 杂志文章,评审
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更新日期:2003-03-08 00:00:00
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pub_type: 杂志文章,随机对照试验
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更新日期:2014-06-25 00:00:00