The aim of this study was to evaluate the baseline demographics and real-life efficacy of direct acting antivirals (DAAs) in HIV-HCV-positive patients as compared to patients with HCV monoinfection. ...The analysis included 5690 subjects who were treated with DAAs: 5533 were HCV-positive and 157 were HIV-HCV-positive. Patients with HCV-monoinfection were older (p < .0001) and in HIV-HCV group there were more men (p < .0001). Prevalence of genotype 1a (p = .002), as well as of genotypes 3 and 4 (p < .0001) was higher in HIV-HCV-coinfected patients. Genotype 1b was more frequent (p < .0001) in the HCV-mono-infection group. Patients with HCV-monoinfection had a higher proportion of fibrosis F4 (p = .0004) and lower proportion of fibrosis F2 (p < .0001). HIV-HCV-coinfected individuals were more often treatment-naïve (p < .0001). Rates of sustained viral response after 12 weeks did not differ significantly between both groups (95.9% versus 97.3% in coinfection and monoinfection group, respectively; p > .05). They were, however, influenced by HCV genotype (p < .0001), stage of hepatic fibrosis (p < .0001), male sex (p < .0001), BMI (p = .0001) and treatment regimen modifications (p < .0001). Although factors associated with worse response to therapy (male sex, genotype 3) occurred more often in the HIV coinfection group, real-life results of DAAs did not differ significantly between both populations.
Summary
The aim of the EpiTer‐2 study was to analyse patient characteristics and their medication for HCV infection in Poland at the beginning of the interferon‐free era. Analysis of data of HCV ...infected patients treated during the initial period of availability of interferon‐free regimens in Poland, who started therapy after 1 July 2015 and had available an efficacy evaluation report before 30 June 2017 was undertaken. A total of 2879 patients with chronic hepatitis C were entered, including 46% with liver cirrhosis. The most common was genotype 1b (86.8%). The study population was gender balanced, the majority of patients were overweight or obese and 69% presented comorbidities, with the highest prevalence that for hypertension. More than half of patients were retreated due to failure of previous therapy with pegylated interferon and ribavirin. Almost two‐third of patients received current therapy with ombitasvir/paritaprevir/ritonavir±dasabuvir (OPrD) ±ribavirin. Other patients received mostly sofosbuvir‐based regimens including combination with ledipasvir and pegylated interferon and ribavirin for genotype 3‐infected patients. Efficacy of treatment in the whole study population measured as intent‐to‐treat analysis was 95%. The most frequent regimen, administered for patients infected with genotype 1b, was 12 weeks of OPrD, resulting in an SVR rate of 98%. At least one adverse event was reported in 38% of patients, and the death rate was 0.8%. In conclusion, data from the EpiTer‐2 study confirmed the excellent efficacy and safety profile of the real‐world experience with recently introduced therapeutic options for genotype 1 HCV infection, but demonstrated weakness of the current therapeutic programme regarding genotype 3 infections.
Inpatient palliative care programs can improve care of patients with serious illness. We developed the California Hospital Initiative in Palliative Services (CHIPS) program to assist hospitals in ...establishing these programs. CHIPS included an introductory conference followed by 10 months of mentoring with telephone calls, e-mails, on-site consultation at the hospital, and a reunion conference.
To evaluate CHIPS and the factors associated with establishing inpatient palliative care programs, we conducted a cross-sectional telephone survey of leaders from the 38 hospitals that participated in CHIPS. We assessed the number of inpatient palliative care consultation services established by hospitals that participated in CHIPS (success) and hospital characteristics associated with success.
Participants gave CHIPS high ratings. Six hospitals (16%) had a palliative care consultation service at enrollment in CHIPS and 19 hospitals (60%) established one after participation in CHIPS (P<.001). In bivariable comparisons, successful hospitals were more likely to have a hospitalist program (P = .003) or to be located in an urban setting (P = .03).
CHIPS seemed to help many hospitals establish inpatient palliative care programs. Hospitals with hospitalists and those in an urban setting were more likely to succeed in developing palliative care programs. Future studies should focus on the quantity and quality of care provided by these programs.
A novel pathophysiology-based method to subphenotype individuals at elevated risk for type 2 diabetes has recently identified 6 subgroups, 2 of which constitute obese, high-risk subpopulations with ...different glycemic, renal, cardiovascular and all-cause mortality risk profiles. The aim of our study was to evaluate differences in response to weight-loss surgery between these clusters, termed clusters 5 & 6 by Wagner et al. We performed this clustering on the Bialystok Bariatric Surgery Study Cohort consisting of nondiabetic patients with at least one year of follow-up data who underwent sleeve gastrectomy surgery. We used generalized linear models to test for differences between clusters in baseline parameters and changes after one year. At baseline, 48 (47%) patients were classified as cluster 5 and 54 (53%) as cluster 6. Before the surgery, cluster 5 subjects had significantly (q-value<0.05) higher levels of fasting and 2-hour glucose and insulin, HbA1c, triglycerides and visceral fat mass, and lower levels of HDL-cholesterol and Matsuda Index. There were no significant differences in age, weight, BMI or body composition. Further, we found that cluster 5 presented a greater reduction in fasting and 2-h glucose, but lesser in hip and waist circumferences, compared to cluster 6. However, after adjusting for baseline values of these parameters, only change in hip and waist circumferences remained significant. We did not find any differences in body composition or lipid parameter responses between clusters. Our study confirms that cluster 5 shows more severe glycemic and lipid deterioration compared to cluster 6 despite their shared obese phenotypes. However, bariatric surgery seems to be equally beneficial in both clusters, except for small differences in hip and waist circumference response.
Disclosure
L. Szczerbinski: None. J. Goscik: None. W. Kwedlo: None. G.E.P. Wojciechowska: None. A. Citko: None. P. Konopka: None. A. Paszko: None. M. Taylor: None. H.R. Hady: None. A.J. Kretowski: None.
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