1,721,157 research outputs found
Case Management to Improve Uptake for Screening and Therapy of Hepatitis C viral infection in People Who Inject Drugs
No full textHepatitis C viral infection (HCV) has become a curable disease due to the development of direct acting antivirals (DAA). Therefore, the World Health Organization (WHO) has set a target to eliminate HCV. The largest group at risk for HCV at present are people who inject drugs (PWID), especially in the western world. Due to various barriers, this risk group is still underserved for HCV. Our goal was to study if a case management policy of a known PWID cohort could improve uptake for screening and treatment.This trial was supported by Gilead Sciences. No direct or indirect benefits were granted to Gilead Sciences BVBA
Case Management to Improve Uptake for Screening and Therapy of Hepatitis C viral infection in People Who Inject Drugs.
No full textIntroduction
Hepatitis C viral infection (HCV) has become a curable disease due to the development of direct acting antivirals (DAA). Therefore, the World Health Organization (WHO) has set a target to eliminate HCV. The largest group at risk for HCV at present are people who inject drugs (PWID), especially in the western world. Due to various barriers, this risk group is still underserved for HCV. Our goal was to study if a case management policy could improve uptake for screening and treatment for HCV in PWID.
Methods
We performed a prospective, interventional cohort study, evaluating the effect of case management on screening and treatment for HCV in PWID in an opiate substitution treatment (OST) setting in Limburg (Belgium). The goal was to address the PWID at this setting and to provide all the steps of the continuum of care, proposed by Meyer JP et al. (Int J Drug Policy, 2015). The cohort existed of four groups of PWID: firstly, a large group who received methadone at their local pharmacy. A second large group received methadone at the OST setting. Thirdly a smaller a group who were active users in a needle exchange program. And finally a small group who were recruited after referral to the hospital (former PWID).
Results
The results are presented in Figure 1. In all of the groups more than 80% of the cases were screened, except in the pharmacy group: these presented only a few times a year in the OST setting which could explain the lower screening rate. However, when addressed, more than 85% of the PWID in the pharmacy group were tested. In our PWID cohort, approximately 29% was HCV RNA positive. From these chronically infected PWID, 62% were assessed for treatment. 95% of them were eligible for antiviral treatment. However, treatment could only be started within the Belgian reimbursement criteria (requirement of F3 or F4 Metavir fibrosis score). As such, 51% were ruled out for therapy at present and treatment was started in 43%.
Conclusion
Case management is an effective way to screen a well-defined cohort of high-risk individuals for HCV and also improves treatment uptake
Clinical audit of quality of care among patients with viral hepatitis in primary care in a low endemic region
No full textBACKGROUND: The current hepatitis B (HBV) and hepatitis C virus (HCV) screening practices may fail to detect many infected patients who could benefit from new therapeutic agents to limit progression to cirrhosis and hepatocellular carcinoma. OBJECTIVES: This study assessed the test positivity rate and cascade of care of viral hepatitis patients in primary care in a low endemic region as well as the testing policy of abnormal alanine aminotransferase (ALT) level. METHODS: This is a retrospective clinical audit among primary health care practices in Flanders, Belgium, assessing patients with an active medical file between 2019 and 2021. RESULTS: A total of 84/89 (94.4%) primary health care practices participated representing 621,573 patients of which 1069 patients (0.17%) were registered as having viral hepatitis, not further specified. Detailed information was available from 38 practices representing 243,723/621,573 (39.2%) patients of which 169 (0.07%) were HBsAg positive and 99 (0.04%) anti-HCV positive. A total of 96/134(71.6%) chronic HBV-infected and 31/77(40.3%) chronic HCV-infected patients were referred to a hepatologist. A total of 30,573/621,573(4.9%) patients had an abnormal ALT level, and by at random selection, more detailed information was obtained on 211 patients. Information on high-risk groups was missing in up to 60%. In patients with abnormal ALT level, HBsAg and anti-HCV testing were conducted in 37/211(17.5%) and 25/211(11.8%), respectively. CONCLUSION: In a low endemic region, the testing rate and cascade of care of HBV and HCV-infected patients can be improved in primary care, especially in high-risk groups and patients with abnormal ALT levels.</p
FIRST RESULTS OF THE EVOLUTION AND THE INFLUENCE OF STATIN TREATMENT ON NAFLD IN A PRIMARY CARE COHORT OVER A 2-YEAR PERIOD
No full textBackground: A novel term, metabolic dysfunction-associated fatty liver disease (MAFLD), was proposed by a group of experts. However, it remains unclear whether hepatic steatosis per se in MAFLD contributes to an elevated risk of mortality in individual's with overweight/obesity, metabolic dysregulation, or type 2 diabetes mellitus (DM) (referred to as the metabolic dysfunction-association (MA) group), which are known significant risk factors for increased mortality. This study aimed to compare all-cause and cause-specific mortality between the 'MAFLD' group and the 'MA without fatty liver' group. Methods: A total of 10,052 participants from NHANES III were included. Fatty liver was diagnosed using ultrasound, and MAFLD was defined based on the criteria proposed by an international panel of experts. Mortality risks were compared between the 'MAFLD' group and the 'MA without fatty liver' group using the Cox proportional hazards model with complex survey design weights, adjusted for demographic and anthropometry factors (age, sex, race, body mass index and waist circumference), social history (education, marriage status, smoking and alcohol history and exercise) and comorbidity variables (hypertension, DM and hyperlipidemia). Linked mortality data, including all-cause, cancer, cardiovascular, and other causes-related mortality, were examined from 1988 through 2019. For liver-related mortality, data were evaluated from 1988 through 2006. Results: Over an average follow-up period of 23.0 years, the 'MAFLD' group did not exhibit a significant increase in all-cause mortality (adjusted hazard ratio [95% confidence interval], 1.07 [0.99-1.16], P = 0.100), cancer mortality (1.08 [0.86-1.36], P = 0.508), or cardiovascular mortality (0.89 [0.78-1.02], P = 0.084) compared to the 'MA without fatty liver' group. However, other causes-related mortality , which included liver-related mortality, was higher in the MAFLD group (1.36 [1.14-1.62], P = 0.001). This trend persisted in sensitivity analyses conducted on participants without viral hepatitis or heavy alcohol consumption. No significant effect modification was observed according to subgroups. Liver-related mortality , assessed over a 13.8-year follow-up period, showed a marginal increase in the 'MAFLD' group (2.49 [0.99-6.23], P = 0.052) compared to the 'MA without fatty liver' group. Conclusion: The 'MAFLD' group did not demonstrate an elevated risk of all-cause, cardiovas-cular, or cancer mortality when compared to the 'MA without fatty liver' group. However, there was a trend toward an increased risk of liver-related mortality in the MAFLD group
FIRST RESULTS OF THE EVOLUTION AND THE INFLUENCE OF STATIN TREATMENT ON NAFLD IN A PRIMARY CARE COHORT OVER A 2-YEAR PERIOD
No full textBackground: A novel term, metabolic dysfunction-associated fatty liver disease (MAFLD), was proposed by a group of experts. However, it remains unclear whether hepatic steatosis per se in MAFLD contributes to an elevated risk of mortality in individual's with overweight/obesity, metabolic dysregulation, or type 2 diabetes mellitus (DM) (referred to as the metabolic dysfunction-association (MA) group), which are known significant risk factors for increased mortality. This study aimed to compare all-cause and cause-specific mortality between the 'MAFLD' group and the 'MA without fatty liver' group. Methods: A total of 10,052 participants from NHANES III were included. Fatty liver was diagnosed using ultrasound, and MAFLD was defined based on the criteria proposed by an international panel of experts. Mortality risks were compared between the 'MAFLD' group and the 'MA without fatty liver' group using the Cox proportional hazards model with complex survey design weights, adjusted for demographic and anthropometry factors (age, sex, race, body mass index and waist circumference), social history (education, marriage status, smoking and alcohol history and exercise) and comorbidity variables (hypertension, DM and hyperlipidemia). Linked mortality data, including all-cause, cancer, cardiovascular, and other causes-related mortality, were examined from 1988 through 2019. For liver-related mortality, data were evaluated from 1988 through 2006. Results: Over an average follow-up period of 23.0 years, the 'MAFLD' group did not exhibit a significant increase in all-cause mortality (adjusted hazard ratio [95% confidence interval], 1.07 [0.99-1.16], P = 0.100), cancer mortality (1.08 [0.86-1.36], P = 0.508), or cardiovascular mortality (0.89 [0.78-1.02], P = 0.084) compared to the 'MA without fatty liver' group. However, other causes-related mortality , which included liver-related mortality, was higher in the MAFLD group (1.36 [1.14-1.62], P = 0.001). This trend persisted in sensitivity analyses conducted on participants without viral hepatitis or heavy alcohol consumption. No significant effect modification was observed according to subgroups. Liver-related mortality , assessed over a 13.8-year follow-up period, showed a marginal increase in the 'MAFLD' group (2.49 [0.99-6.23], P = 0.052) compared to the 'MA without fatty liver' group. Conclusion: The 'MAFLD' group did not demonstrate an elevated risk of all-cause, cardiovas-cular, or cancer mortality when compared to the 'MA without fatty liver' group. However, there was a trend toward an increased risk of liver-related mortality in the MAFLD group
The effect of standard of care lifestyle advice by a hepatologist in a routine clinical practice on steatosis and fibrosis development among NAFLD patients
No full textBackground and aims: Weight loss through lifestyle modifications remains the mainstay for NAFLD treatment; however, implementing effective lifestyle interventions in clinical practice has been challenging due to time and cost constraints. Having a comprehensive approach to weight loss in patients with NAFLD that can be scaled and provided at low cost is a key unmet need. The objective of this study is to assess the effects of a mobile weight management program on weight loss and liver health biomarkers in adults with obesity and NAFLD. Method: Adults with obesity (BMI 30 to 49.9 kg/m 2 inclusive) and evidence of NAFLD based on Fibroscan CAP ≥274 dB/m were included. Patients were given access to the Noom Weight program for 16 weeks (midpoint) and then were followed for an additional 8 weeks (week 24 or end point). Measurements completed at baseline, midpoint, and end point included: weight/BMI, Fibroscan, routine labs (Complete Metabolic Panel and CBC), and the exploratory biomarker cytokeratin 18 fragment (CK18f). All tests of significance were performed at alpha = 0.05, two sided. Results: 40 subjects were enrolled and 82.5% (33/40) completed the study. The mean age was 55.9 years (range 29-79) with a mean BMI of 38 kg/m2 (30.5-49.8) and a mean baseline CAP score of 331.9 db/m 2 (276-396) and a mean LSM of 7.54 kPa (4.9-13.3). The average change in body weight from baseline was a 4.0% reduction and 32.4% (11/34) achieved total body weight reduction by 5% or more. There was a significant reduction in the CAP score by end point of 21.35 dB/ m (p = 0.024). The ALT decreased by 10 U/L or more in 27.3% (9/33). There was moderate correlation between BMI decrease and reduction in the CAP score (R = 0.533). There was no change in the LSM at the end point, and 62% (21) of subjects achieved >5% drop in CK18f. The change in CK18f correlated weakly (R = 0.215) with BMI drop but more strongly with Fibroscan CAP score (R = 0.468) and LSM (R = 0.764). Conclusion: The Noom Weight program had beneficial effects in patients with obesity and NAFLD, including significant reduction in the CAP score and one third of patients achieving 5% or more reduction in their weight. Steatosis of the liver was affected by weight loss as a result of engagement with the Noom Weight program. Fibrosis was not significantly affected by the Noom Weight program in the timeframe of the study. Fibrosis may require a longer timeframe for changes to be measured. FRI-526 The effect of standard of care lifestyle advice by a hepatologist in a routine clinical practice on steatosis and fibrosis development among NAFLD patients Background and aims: Non-alcoholic fatty liver disease (NAFLD) has become the most frequent cause of chronic liver disease. The leading cause of NAFLD has been defined as a behavioural phenotype comprising low physical activity and an obesogenic diet. The primary therapeutic advice is lifestyle changes leading to weight loss. Previous studies indicated that a weight reduction of 5% or more could induce regression of steatosis or fibrosis. However, hepatolo-gists only have time during consultations to give a short outline of the optimal lifestyle. As no data is available on the outcome of this routine practice, we evaluated the effect of this lifestyle advice on steatosis and fibrosis development among NAFLD patients. Figure: (abstract: FRI-524) The median change in clinic-laboratory parameters POSTER PRESENTATIONS S828 Journal of Hepatology 2023 vol. 78(S1) | S100-S1212 Method: Data were collected retrospectively using the electronic patient files of NAFLD patients in whom a baseline and a follow-up FibroScan® measurement (for assessment of steatosis by CAP™ and of liver stiffness (LSM) as a surrogate for fibrosis) were performed between November 2019 and 2022 at Ziekenhuis Oost-Limburg, Genk, Belgium. At the start, patients received Mediterranean diet related-advice, tips on improving exercise, and an information brochure concerning NAFLD from the hepatologist. Clinically meaningful weight loss was defined as a loss of at least 1 kg. Results: Of the 218 NAFLD patients evaluated, 130 (59.6%) were excluded due to the usage of semaglutide, not fasting, IQR/MED>30%, or bariatric surgery. In total, 88 (40.4%) patients were included, of whom 53 (60.2%) were men and 38 (43.2%) had type 2 diabetes mellitus (T2DM). The mean age, median BMI, and mean waist circumference were 54 ± 13 years, 31.0 (28.4-34.9) kg/m² and 105.2 ± 12.7 cm, respectively. On average, there were 186 (124-280) days between the measurements. The median weight loss between measurements was −1.2 (−4.1;1.4) kg. The decrease in LSM and CAP™ were −1.2 (−3.1;0.3) kPa and −7.0 (−50.5;8.8) dB/m, respectively. Within this group, 47 (53.4%) had clinically meaningful weight loss, while 41 (46.6%) did not lose any weight or gained weight. The group with weight loss developed a significantly (p 50 years), or having T2DM or not (p > 0.05). Conclusion: To the best of our knowledge, this is the first study to assess the effect of routine lifestyle advice by a hepatologist on body weight, steatosis, and fibrosis, measured by FibroScan®. The lifestyle advice leads to a weight reduction of at least −1 kg in almost half of NAFLD patients and a significant reduction in steatosis over six months in those patients. However, the recommended reduction in body weight (at least 5%) is not reached. Other measures to support the advice on lifestyle change given by the hepatologist are hence necessary to improve efficacy. Background and aims: Anti-obesity drugs are known to improve hepatic inflammation in patients with non-alcoholic fatty liver disease (NAFLD). We aimed to compare the effect of liraglutide and phentermine/topiramate in obese NAFLD patients. Method: We retrospectively enrolled 65 obese NAFLD patients without type 2 diabetes mellitus (liraglutide group [n = 30], phen-termine/topiramate group [n = 35]) who were treated with liraglutide or phentermine/topiramate for 12 months. Changes in laboratory data, body weight, degree of steatosis and fibrosis were compared between two groups. Steatosis was assessed using the fatty liver index, NAFLD liver fat score, and controlled attenuation parameter (CAP). Fibrosis was assessed using fibrosis index based on four factors (FIB4) and liver stiffness. Results: The mean body weight (80.3 ± 12.3 kg) and body mass index (29.4 ± 3.2) were similar between two groups. After 12 month of treatment, phentermine/topiramate group showed significantly greater effect in weight loss than liraglutide group (−8.4 ± 0.6 vs. −6.3 ± 0.4 kg, p = 0.003). Both group showed similar effect showing significant steatosis reduction (phentermine/topiramate vs. liraglu-tide; Δfatty liver index: −8.9 ± 2.3 vs. −8.4 ± 1.7, p = 0.449; ΔNAFLD liver fat score: −0.5 ± 0.2 vs. −0.4 ± 0.2, p = 0.835; ΔCAP: −9.2 ± 6.9 vs. −8.3 ± 4.6 dB/m 2 , p = 0.129). Fibrosis improvement was noted in bot
Case Management to Improve Uptake for Screening and Therapy of Hepatitis C viral infection in People Who Inject Drugs
No full textHepatitis C viral infection (HCV) has become a curable disease due to the development of direct acting antivirals (DAA). Therefore, the World Health Organization (WHO) has set a target to eliminate HCV. The largest group at risk for HCV at present are people who inject drugs (PWID), especially in the western world. Due to various barriers, this risk group is still underserved for HCV. Our goal was to study if a case management policy of a known PWID cohort could improve uptake for screening and treatment.This trial was supported by Gilead Sciences. No direct or indirect benefits were granted to Gilead Sciences BVBA
The effect of standard of care lifestyle advice by a hepatologist in a routine clinical practice on steatosis and fibrosis development among NAFLD patients
No full textBackground and aims: Weight loss through lifestyle modifications remains the mainstay for NAFLD treatment; however, implementing effective lifestyle interventions in clinical practice has been challenging due to time and cost constraints. Having a comprehensive approach to weight loss in patients with NAFLD that can be scaled and provided at low cost is a key unmet need. The objective of this study is to assess the effects of a mobile weight management program on weight loss and liver health biomarkers in adults with obesity and NAFLD. Method: Adults with obesity (BMI 30 to 49.9 kg/m 2 inclusive) and evidence of NAFLD based on Fibroscan CAP ≥274 dB/m were included. Patients were given access to the Noom Weight program for 16 weeks (midpoint) and then were followed for an additional 8 weeks (week 24 or end point). Measurements completed at baseline, midpoint, and end point included: weight/BMI, Fibroscan, routine labs (Complete Metabolic Panel and CBC), and the exploratory biomarker cytokeratin 18 fragment (CK18f). All tests of significance were performed at alpha = 0.05, two sided. Results: 40 subjects were enrolled and 82.5% (33/40) completed the study. The mean age was 55.9 years (range 29-79) with a mean BMI of 38 kg/m2 (30.5-49.8) and a mean baseline CAP score of 331.9 db/m 2 (276-396) and a mean LSM of 7.54 kPa (4.9-13.3). The average change in body weight from baseline was a 4.0% reduction and 32.4% (11/34) achieved total body weight reduction by 5% or more. There was a significant reduction in the CAP score by end point of 21.35 dB/ m (p = 0.024). The ALT decreased by 10 U/L or more in 27.3% (9/33). There was moderate correlation between BMI decrease and reduction in the CAP score (R = 0.533). There was no change in the LSM at the end point, and 62% (21) of subjects achieved >5% drop in CK18f. The change in CK18f correlated weakly (R = 0.215) with BMI drop but more strongly with Fibroscan CAP score (R = 0.468) and LSM (R = 0.764). Conclusion: The Noom Weight program had beneficial effects in patients with obesity and NAFLD, including significant reduction in the CAP score and one third of patients achieving 5% or more reduction in their weight. Steatosis of the liver was affected by weight loss as a result of engagement with the Noom Weight program. Fibrosis was not significantly affected by the Noom Weight program in the timeframe of the study. Fibrosis may require a longer timeframe for changes to be measured. FRI-526 The effect of standard of care lifestyle advice by a hepatologist in a routine clinical practice on steatosis and fibrosis development among NAFLD patients Background and aims: Non-alcoholic fatty liver disease (NAFLD) has become the most frequent cause of chronic liver disease. The leading cause of NAFLD has been defined as a behavioural phenotype comprising low physical activity and an obesogenic diet. The primary therapeutic advice is lifestyle changes leading to weight loss. Previous studies indicated that a weight reduction of 5% or more could induce regression of steatosis or fibrosis. However, hepatolo-gists only have time during consultations to give a short outline of the optimal lifestyle. As no data is available on the outcome of this routine practice, we evaluated the effect of this lifestyle advice on steatosis and fibrosis development among NAFLD patients. Figure: (abstract: FRI-524) The median change in clinic-laboratory parameters POSTER PRESENTATIONS S828 Journal of Hepatology 2023 vol. 78(S1) | S100-S1212 Method: Data were collected retrospectively using the electronic patient files of NAFLD patients in whom a baseline and a follow-up FibroScan® measurement (for assessment of steatosis by CAP™ and of liver stiffness (LSM) as a surrogate for fibrosis) were performed between November 2019 and 2022 at Ziekenhuis Oost-Limburg, Genk, Belgium. At the start, patients received Mediterranean diet related-advice, tips on improving exercise, and an information brochure concerning NAFLD from the hepatologist. Clinically meaningful weight loss was defined as a loss of at least 1 kg. Results: Of the 218 NAFLD patients evaluated, 130 (59.6%) were excluded due to the usage of semaglutide, not fasting, IQR/MED>30%, or bariatric surgery. In total, 88 (40.4%) patients were included, of whom 53 (60.2%) were men and 38 (43.2%) had type 2 diabetes mellitus (T2DM). The mean age, median BMI, and mean waist circumference were 54 ± 13 years, 31.0 (28.4-34.9) kg/m² and 105.2 ± 12.7 cm, respectively. On average, there were 186 (124-280) days between the measurements. The median weight loss between measurements was −1.2 (−4.1;1.4) kg. The decrease in LSM and CAP™ were −1.2 (−3.1;0.3) kPa and −7.0 (−50.5;8.8) dB/m, respectively. Within this group, 47 (53.4%) had clinically meaningful weight loss, while 41 (46.6%) did not lose any weight or gained weight. The group with weight loss developed a significantly (p 50 years), or having T2DM or not (p > 0.05). Conclusion: To the best of our knowledge, this is the first study to assess the effect of routine lifestyle advice by a hepatologist on body weight, steatosis, and fibrosis, measured by FibroScan®. The lifestyle advice leads to a weight reduction of at least −1 kg in almost half of NAFLD patients and a significant reduction in steatosis over six months in those patients. However, the recommended reduction in body weight (at least 5%) is not reached. Other measures to support the advice on lifestyle change given by the hepatologist are hence necessary to improve efficacy. Background and aims: Anti-obesity drugs are known to improve hepatic inflammation in patients with non-alcoholic fatty liver disease (NAFLD). We aimed to compare the effect of liraglutide and phentermine/topiramate in obese NAFLD patients. Method: We retrospectively enrolled 65 obese NAFLD patients without type 2 diabetes mellitus (liraglutide group [n = 30], phen-termine/topiramate group [n = 35]) who were treated with liraglutide or phentermine/topiramate for 12 months. Changes in laboratory data, body weight, degree of steatosis and fibrosis were compared between two groups. Steatosis was assessed using the fatty liver index, NAFLD liver fat score, and controlled attenuation parameter (CAP). Fibrosis was assessed using fibrosis index based on four factors (FIB4) and liver stiffness. Results: The mean body weight (80.3 ± 12.3 kg) and body mass index (29.4 ± 3.2) were similar between two groups. After 12 month of treatment, phentermine/topiramate group showed significantly greater effect in weight loss than liraglutide group (−8.4 ± 0.6 vs. −6.3 ± 0.4 kg, p = 0.003). Both group showed similar effect showing significant steatosis reduction (phentermine/topiramate vs. liraglu-tide; Δfatty liver index: −8.9 ± 2.3 vs. −8.4 ± 1.7, p = 0.449; ΔNAFLD liver fat score: −0.5 ± 0.2 vs. −0.4 ± 0.2, p = 0.835; ΔCAP: −9.2 ± 6.9 vs. −8.3 ± 4.6 dB/m 2 , p = 0.129). Fibrosis improvement was noted in bot
Influence of the ethnic status in chronic hepatitis B patients: comparing the Netherlands, Belgium and Turkey
No full text- …
