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Testing and diagnosis of hepatitis B (HBV) and C (HCV) infection is the gateway for access to both prevention and treatment services, and is a crucial component of an effective response to the hepatitis epidemic. Early identification of persons with chronic HBV or HCV infection enables them to receive the necessary care and treatment to prevent or delay progression of liver disease. Testing also provides an opportunity to link people to interventions to reduce transmission, through counselling on risk behaviors and provision of prevention commodities (such as sterile needles and syringes) and hepatitis B vaccination. These are the first WHO guidelines on testing for chronic HBV and HCV infection and complement published guidance by WHO on the prevention, care and treatment of chronic hepatitis C and hepatitis B infection. These guidelines outline the public health approach to strengthening and expanding current testing practices for HBV and HCV, and are intended for use across age groups and populations.
This policy brief focuses on the new recommendations on treatment of adolescents and children ages ≥3 years with chronic HCV infection. The new treatment recommendations that extend the 2018 “treat all” recommendation for adults with chronic HCV infection to include adolescents and children down to 3 years, and to align the existing recommended pangenotypic DAA regimens (SOF/DCV, SOF/VEL and G/P) for adults, to those for adolescents and children. This alignment is expected to simplify procurement, promote access to treatment among children in LMICs and contribute to global efforts to eliminate the disease.
Chronic Hepatitis C Virus: Lessons from the Past, Promise for the Future documents the monumental advances that have been made in our understanding of chronic HCV during the past decade. The first section reviews the natural history of chronic HCV, how this virus can affect other organs in addition to the liver, and whether treating chronic HCV alters the natural history of this disease. Section 2 reviews the advances that have been made in the treatment of chronic HCV during the past decade with interferon based therapy. Separate chapters on response guided therapy and how to manage the adverse events associated with these medications provide the physician with the concepts required to more effectively treat chronic HCV now and in the future. As the genetics of virologic response have recently been elucidated, a chapter is devoted to helping the clinician understand how genes that modulate disease processes and their treatment are identified and utilized in clinical care. Section 3 deals with the future of HCV treatment and specific inhibitors of HCV. Specific chapters explain how targets for drugs are identified and how drugs are then developed and tested; how mutations of HCV develop and how anti-viral agents will affect this process; the most up to date data regarding the treatment of chronic HCV with peginterferon, ribavirin and anti-viral agents; and the potential to treat chronic HCV with just oral anti-viral agents and without peginterferon and ribavirin in the future. The final section of this book covers issues related to liver transplantation in patients with chronic HCV. Separate chapters review the natural history of chronic HCV in liver transplant recipients and the impact of utilizing HCV positive donors. The volume concludes with chapters that cover the treatment of chronic HCV both prior to and after liver transplantation with potent anti-viral agents. Chronic Hepatitis C Virus: Lessons from the Past, Promise for the Future is a valuable resource for all physicians caring for patients with chronic HCV.
The global epidemic of hepatitis B and C is a serious public health problem. Hepatitis B and C are the major causes of chronic liver disease and liver cancer in the world. In the next 10 years, 150,000 people in the United States will die from liver disease or liver cancer associated with chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections. Today, between 800,000 and 1.4 million people in the United States have chronic hepatitis B and between 2.7 and 3.9 million have chronic hepatitis C. People most at risk for hepatitis B and C often are the least likely to have access to medical services. Reducing the rates of illness and death associated with these diseases will require greater awareness and knowledge among health care workers, improved identification of at-risk people, and improved access to medical care. Hepatitis B is a vaccine-preventable disease. Although federal public health officials recommend that all newborns, children, and at-risk adults receive the vaccine, about 46,000 new acute cases of the HBV infection emerge each year, including 1,000 in infants who acquire the infection during birth from their HBV-positive mothers. Unfortunately, there is no vaccine for hepatitis C, which is transmitted by direct exposure to infectious blood. Hepatitis and Liver Cancer identifies missed opportunities related to the prevention and control of HBV and HCV infections. The book presents ways to reduce the numbers of new HBV and HCV infections and the morbidity and mortality related to chronic viral hepatitis. It identifies priorities for research, policy, and action geared toward federal, state, and local public health officials, stakeholder, and advocacy groups and professional organizations.
Hepatitis B and C cause most cases of hepatitis in the United States and the world. The two diseases account for about a million deaths a year and 78 percent of world's hepatocellular carcinoma and more than half of all fatal cirrhosis. In 2013 viral hepatitis, of which hepatitis B virus (HBV) and hepatitis C virus (HCV) are the most common types, surpassed HIV and AIDS to become the seventh leading cause of death worldwide. The world now has the tools to prevent hepatitis B and cure hepatitis C. Perfect vaccination could eradicate HBV, but it would take two generations at least. In the meantime, there is no cure for the millions of people already infected. Conversely, there is no vaccine for HCV, but new direct-acting antivirals can cure 95 percent of chronic infections, though these drugs are unlikely to reach all chronically-infected people anytime soon. This report, the first of two, examines the feasibility of hepatitis B and C elimination in the United States and identifies critical success factors. The phase two report will outline a strategy for meeting the elimination goals discussed in this report.
Completely revised new edition of the premier reference on pediatric liver disease. Liver Disease in Children, 3rd Edition provides authoritative coverage of every aspect of liver disease affecting infants, children, and adolescents. The book offers an integrated approach to the science and clinical practice of pediatric hepatology and charts the substantial progress in understanding and treating these diseases. Chapters are written by international experts and address the unique pathophysiology, manifestations, and management of these disorders in the pediatric population. The third edition has been thoroughly updated and features new contributions on liver development, cholestatic and autoimmune disorders, fatty liver disease, and inborn errors of metabolism. With the continued evolution of pediatric hepatology as a discipline, this text remains an essential reference for all physicians involved in the care of children with liver disease.
This User’s Guide is intended to support the design, implementation, analysis, interpretation, and quality evaluation of registries created to increase understanding of patient outcomes. For the purposes of this guide, a patient registry is an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure, and that serves one or more predetermined scientific, clinical, or policy purposes. A registry database is a file (or files) derived from the registry. Although registries can serve many purposes, this guide focuses on registries created for one or more of the following purposes: to describe the natural history of disease, to determine clinical effectiveness or cost-effectiveness of health care products and services, to measure or monitor safety and harm, and/or to measure quality of care. Registries are classified according to how their populations are defined. For example, product registries include patients who have been exposed to biopharmaceutical products or medical devices. Health services registries consist of patients who have had a common procedure, clinical encounter, or hospitalization. Disease or condition registries are defined by patients having the same diagnosis, such as cystic fibrosis or heart failure. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews.
WHO has set a global goal to eliminate HCV as a public health problem by 2030. WHO estimates that 58 million people had chronic hepatitis C virus (HCV) infection globally in 2019, and less than a quarter of them were diagnosed. New and innovative approaches are needed to accelerate progress toward the HCV elimination targets. Self-testing is one such approach. These guidelines provide a new recommendation and guidance on HCV self-testing to complement existing HCV testing services in countries. These guidelines also highlight operational considerations to support strategic implementation and scale up of HCV self-testing.
Pediatric Inflammatory Bowel Disease, Second Edition provides an essential reference with an emphasis on the unique pediatric issues of IBD. Chapters focus on complications of IBD specific to children and adolescents. Treatment recommendations are based on the latest clinical research available. The textbook also presents sections dedicated to the aspects of participation in clinical research unique to children and adolescents and the complicated yet vital process of successfully transitioning a patient from a pediatric to adult specialist. Controversies in pediatric IBD care such as the off-label use of medications are also covered. The format incorporates multiple tables, graphs, and figures to improve readability and make for an efficient reference for clinicians to use. Thoroughly revised and updated from the first edition, the volumes includes new therapies that are currently being used or tested for treatment of IBD, important areas regarding incidence and prevalence, immunization and response to vaccine administration as well as advancements in our understanding of growth and development with particular to the use of growth hormone therapy. Other new areas covered include important topics of complementary and alternative medicine use in IBD, immunization, and liver disease in IBD. Pediatric Inflammatory Bowel Disease, Second Edition is a valuable resource for pediatric gastroenterologists as well as adult gastroenterologists.