Eliminating the Public Health Problem of Hepatitis B and C in the United States Phase One Report (2016) / Chapter Skim
Currently Skimming:
Summary
Summary
Pages 1-12
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 1... ...
The goals are the special purview of the Divi 1 In this document sustained virologic response is used synonymously with cure. When interferon treatments were standard of care for hepatitis C this was defined as negative viral load 24 weeks after cessation of therapy, though with direct-acting antivirals negative viral load after 12 weeks is considered sustained virologic response.
|
From page 2... ...
New direct-acting antivirals can cure nearly all chronic infections, though cost of these drugs and the burden of undiagnosed HCV infection mean that only a small fraction of all chronically infected people can access them. The committee considered these questions in its assessment of the feasibility of hepatitis B and C elimination in the United States, weighing the motivational power of a disease elimination goal against the danger of over-promising.
|
From page 3... ...
Support for immunization, especially in the HBV endemic countries of Asia and sub- Saharan Africa could do much to reduce the world's pool of chronic hepatitis B Action in endemic countries would also reduce future disease burden in the United States since most chronic HBV infections are imported.
|
From page 4... ...
Reducing Morbidity and Mortality Attributable to Chronic Infection The at least 700,000 to 1.4 million people in the United States with chronic HBV infection need lifelong monitoring for disease progression. In the immune tolerant phase, hepatitis B does not require antiviral therapy, but still needs regular monitoring to ensure the patient has not entered the immune active phase when treatment is beneficial.
|
From page 5... ...
Foreigners must reside in the United States for 5 years to qualify for many state Medicaid programs; the Affordable Care Act also restricts care for temporary residents and undocumented arrivals. Screening puts an onus on the screener to link infected patients to care, something that some HBV-infected people will not have access to.
|
From page 6... ...
Treating people who inject drugs with curative HCV therapies could also reduce transmission, and elicit a reduction in disease prevalence of 20 to 80 percent. But only a fraction of people with chronic HCV infection actually transmit the virus.
|
From page 7... ...
Curing HCV before progression to advanced fibrosis can prevent deaths from chronic infection. New curative treatments can elicit sustained virological response in 94 to 99 percent of patients, likely reducing the risk of cirrhosis and hepatocellular carcinoma.
|
From page 8... ...
People who inject drugs are difficult to reach with traditional screening methods; surveys tend to systematically undercount them and other marginalized groups including the homeless and incarcerated. Community screening could improve the proportion of chronically infected people diagnosed, but requires a way to enroll patients in care with minimal losses to follow-up.
|
From page 9... ...
Although ending the public health problem of hepatitis B and C in the United States is feasible, it is not necessarily likely without considerable attention to the barriers discussed in this report. The strategy needed to address the critical factors and mitigate the barriers laid out in Tables S-1 and S-2 will be discussed in phase two of this project, in a report to be released in 2017.
|
From page 10... ...
• Undiagnosed, asymptomatic • Much of the burden for chronic infections a reservoir managing chronic hepatitis B for infection falls on overworked primary Reducing morbidity and Slowing progression to Feasible • Need for physicians trained care providers. mortality attributable to cirrhosis in the management of • There is a need to better ongoing infection chronic HBV infection understand the virus and • The threat of reactivation in the management of chronic Reducing deaths chronic or resolved infection hepatitis B
|
From page 11... ...
Reducing morbidity and Slowing progression to Feasible • Problems assessing and staging • The high cost of directmortality attributable to cirrhosis fibrosis acting antiviral drugs ongoing infection • Obesity, HIV, alcohol use can makes universal treatment aggravate disease progression unfeasible. • Eradicating the virus before • Hepatitis C is not a public Reducing deaths progression to advanced priority.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.