An approach to carboplatin dosing in children with bilateral nephrectomy using a renal function-based dosing formula with a glomerular filtration rate of zero was investigated in the current study. ...Carboplatin exposure was determined in a total of nine courses of chemotherapy in four patients with Wilms' tumour. Carboplatin exposures following initial dosing were less than 50% of the defined target area under the plasma concentration-time curve (AUC) in all four patients studied, with actual AUC values of between 31% and 45% of the target exposures. The use of real-time pharmacokinetic monitoring to guide dosing within a course of carboplatin treatment resulted in exposures within 15% of the target AUC in all patients. Using this information to guide dosing on additional courses of treatment in the same patient resulted in consistent exposures without the need for further monitoring or dose adjustment. These results indicate that real-time pharmacokinetic monitoring of carboplatin treatment plays a key role in ensuring that an appropriate exposure to carboplatin is achieved in children with bilateral nephrectomy. Carboplatin dosing based on patient body weight, or use of a fixed dose of carboplatin, would both be predicted to result in individual patients receiving unsatisfactory drug exposures. Further studies are warranted to further elucidate the relationship between non-renal clearance of carboplatin and patient body weight in this and other patient subpopulations where there remains concern about the optimal way to use this anticancer drug.
There is limited research on health-related quality of life (HRQoL) among people who inject drugs (PWID). We evaluated the HRQoL and associated factors among a cohort of PWID in Australia.
...Participants were enrolled in an observational cohort study (the Enhancing Treatment of Hepatitis C in Opioid Substitution Settings Engage Study) from May 2018 to September 2019 (wave 1) and November 2019 to June 2021 (wave 2). Participants completed the EQ-5D-5L survey at enrolment. Two-part models were used to assess the association of clinical and socioeconomic characteristics with EQ-5D-5L scores.
Among 2395 participants (median age, 43 years; 66% male), 65% reported injecting drug use in the past month, 20% had current hepatitis C virus (HCV) infection, and 68% had no/mild liver fibrosis (F0/F1). Overall, the mean EQ-5D-5L and EQ-visual analog scale scores were 0.78 and 57, respectively. In adjusted analysis, factors associated with significantly lower EQ-5D-5L scores include older ages, female (marginal effect = −0.03, P = .014), being homeless (marginal effect = −0.04, P = .040), and polysubstance use (marginal effect = −0.05, P < .001). Factors associated with significantly higher EQ-5D-5L scores were being Aboriginal/Torres Strait Islander (marginal effect = 0.03, P = .021) and recent injecting drug use in the past 12 months. Current HCV infection and liver fibrosis stage were not associated with reduced HRQoL among the study participants.
PWID experienced a lower HRQoL compared with the general population. Further research is needed to understand HRQoL in this population to facilitate the development of multifaceted care models for PWID beyond HCV cure and inform health economic analyses for identifying optimal health strategies for PWID.
•There is limited research on health-related quality of life (HRQoL) among people who inject drugs (PWID). Previous studies reporting health utility scores for PWID have been limited by either small sample sizes or the lack of health utility information stratified by important subgroups, such as hepatitis C virus (HCV) infection status and liver disease staging.•PWID in this study experienced a lower HRQoL compared with the general population. Factors associated with lower EQ-5D-5L scores included older ages, being female, being homeless and polysubstance use. However, EQ-5D-5L could not discriminate between participants with different stages of liver disease, nor between participants with and without HCV infection.•This study has provided health utility scores among PWID to inform health economic analyses for identifying optimal health strategies to enhance HCV elimination and improve health outcomes among this population. Further research is needed to validate the use of EQ-5D-5L among PWID and understand factors associated with lower HRQoL.
Introduction
Understanding needle/syringe sharing is crucial for reducing hepatitis C virus (HCV) infection and reinfection. This study aimed to assess the prevalence and factors associated with ...needle/syringe sharing among people who inject drugs in Australia, including those previously receiving HCV treatment.
Methods
The ETHOS Engage study was an observational cohort study which collected self‐reported survey data on demographic and drug use information from people who inject drugs attending drug treatment clinics and needle and syringe programs over two waves between May 2018 and June 2021. Logistic regression was used to identify factors associated with needle/syringe sharing.
Results
Overall, 1555/2395 people enrolled in ETHOS Engage (65%) injected drugs in the past month. Among these, 432 (28%) reported needle/syringe sharing in the past month and 276 (18%) reported receptive sharing. Factors associated with receptive sharing included younger age (adjusted odds ratio aOR 1.72; 95% confidence interval CI 1.28–2.30), recent incarceration (aOR 2.04; 95% CI 1.40–2.94), more frequent injecting (≥daily vs. less than weekly; aOR 2.59; 95% CI 1.75–3.84) and unstable housing (aOR 1.78; 95% CI 1.26–2.52). Among 560 participants with prior HCV treatment, 87 (16%) reported receptive sharing with younger age (aOR 2.42; 95% CI 1.45–4.05) and daily or greater injection frequency (aOR 2.51; 95% CI 1.31–4.83) associated with receptive sharing.
Discussion and Conclusions
Needle/syringe sharing was common among this population accessing harm reduction services. This study identifies high‐risk populations with needle/syringe sharing. Research is needed to optimise HCV treatment to ensure people with ongoing risk behaviours receive adequate harm reduction following treatment to prevent reinfection.
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