Pub Date : 2024-02-15DOI: 10.3138/canlivj-2023-0024
Rojin Kaviani, Frank Y Chou, Chenxi He, Vladimir Marquez
Since 2018, British Columbia (BC) has recommended chronic hepatitis C (HCV) screening for those born between 1945 and 1964, with a provincial prevalence of 2.31%. Combining HCV and colorectal cancer (CRC) screening can facilitate specialist referrals and follow-up. We assessed HCV screening uptake among CRC screening patients following the release of BC’s birth cohort guidelines and examined the COVID-19 pandemic’s impact on HCV screening practices. A retrospective review was conducted on patients referred to Vancouver Coastal Health Authority’s CRC screening program. Two groups, Cohort A (October–December 2019) and Cohort B (December 2021), were studied to identify pandemic-related changes. Data on demographics, liver disease history, hepatitis B or HIV co-infection rates, and initial anti-hepatitis C and ribonucleic acid (RNA) testing dates were collected. Statistical analyses were performed with Stata 15.1. A total of 579 patients were referred for the CRC screening program, of whom 465 were born between 1945 and 1964 and were included in the study. Among the 348 patients in cohort A, 144 (41%, 95% CI 36%–47%) were screened for HCV infection. Of these, four (1.2%) were positive for anti-hepatitis C, and one patient had positive RNA levels. Similar proportions of screenings were observed in cohort B (47.8%, 95% CI 39%–57%). Of those with liver disease, 66% had been screened for HCV. Birth cohort screening for HCV has been underutilized in British Columbia. Combining HCV and CRC screening could provide a practical approach to linking patients to healthcare.
自2018年起，不列颠哥伦比亚省（BC省）建议对1945年至1964年出生的人群进行慢性丙型肝炎（HCV）筛查，该省的患病率为2.31%。将HCV和结直肠癌（CRC）筛查结合起来可促进专科转诊和随访。我们评估了不列颠哥伦比亚省出生队列指南发布后 CRC 筛查患者接受 HCV 筛查的情况，并研究了 COVID-19 大流行对 HCV 筛查实践的影响。我们对转诊至温哥华海岸卫生局 CRC 筛查项目的患者进行了回顾性审查。研究了两组患者，即 A 组（2019 年 10 月至 12 月）和 B 组（2021 年 12 月），以确定与大流行相关的变化。研究收集了人口统计学、肝病史、乙型肝炎或艾滋病病毒合并感染率以及抗丙型肝炎和核糖核酸（RNA）初始检测日期等数据。统计分析使用 Stata 15.1 进行。共有 579 名患者被转介至 CRC 筛查项目，其中 465 人出生于 1945 年至 1964 年，被纳入研究范围。在队列 A 的 348 名患者中，有 144 人（41%，95% CI 36%-47%）接受了 HCV 感染筛查。其中，4 名患者（1.2%）的抗丙型肝炎抗体呈阳性，1 名患者的 RNA 水平呈阳性。在队列 B 中也观察到了类似的筛查比例（47.8%，95% CI 39%-57%）。在肝病患者中，66% 的人接受过丙型肝炎病毒筛查。在不列颠哥伦比亚省，出生队列中的丙型肝炎病毒筛查一直未得到充分利用。将 HCV 筛查与 CRC 筛查相结合，可为患者提供一种实用的医疗保健链接方法。
{"title":"Assessment of birth cohort screening of chronic hepatitis C in colorectal cancer screening patients in British Columbia","authors":"Rojin Kaviani, Frank Y Chou, Chenxi He, Vladimir Marquez","doi":"10.3138/canlivj-2023-0024","DOIUrl":"https://doi.org/10.3138/canlivj-2023-0024","url":null,"abstract":"Since 2018, British Columbia (BC) has recommended chronic hepatitis C (HCV) screening for those born between 1945 and 1964, with a provincial prevalence of 2.31%. Combining HCV and colorectal cancer (CRC) screening can facilitate specialist referrals and follow-up. We assessed HCV screening uptake among CRC screening patients following the release of BC’s birth cohort guidelines and examined the COVID-19 pandemic’s impact on HCV screening practices. A retrospective review was conducted on patients referred to Vancouver Coastal Health Authority’s CRC screening program. Two groups, Cohort A (October–December 2019) and Cohort B (December 2021), were studied to identify pandemic-related changes. Data on demographics, liver disease history, hepatitis B or HIV co-infection rates, and initial anti-hepatitis C and ribonucleic acid (RNA) testing dates were collected. Statistical analyses were performed with Stata 15.1. A total of 579 patients were referred for the CRC screening program, of whom 465 were born between 1945 and 1964 and were included in the study. Among the 348 patients in cohort A, 144 (41%, 95% CI 36%–47%) were screened for HCV infection. Of these, four (1.2%) were positive for anti-hepatitis C, and one patient had positive RNA levels. Similar proportions of screenings were observed in cohort B (47.8%, 95% CI 39%–57%). Of those with liver disease, 66% had been screened for HCV. Birth cohort screening for HCV has been underutilized in British Columbia. Combining HCV and CRC screening could provide a practical approach to linking patients to healthcare.","PeriodicalId":505573,"journal":{"name":"Canadian Liver Journal","volume":"3 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139774531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-15DOI: 10.3138/canlivj-2023-0024
Rojin Kaviani, Frank Y Chou, Chenxi He, Vladimir Marquez
Since 2018, British Columbia (BC) has recommended chronic hepatitis C (HCV) screening for those born between 1945 and 1964, with a provincial prevalence of 2.31%. Combining HCV and colorectal cancer (CRC) screening can facilitate specialist referrals and follow-up. We assessed HCV screening uptake among CRC screening patients following the release of BC’s birth cohort guidelines and examined the COVID-19 pandemic’s impact on HCV screening practices. A retrospective review was conducted on patients referred to Vancouver Coastal Health Authority’s CRC screening program. Two groups, Cohort A (October–December 2019) and Cohort B (December 2021), were studied to identify pandemic-related changes. Data on demographics, liver disease history, hepatitis B or HIV co-infection rates, and initial anti-hepatitis C and ribonucleic acid (RNA) testing dates were collected. Statistical analyses were performed with Stata 15.1. A total of 579 patients were referred for the CRC screening program, of whom 465 were born between 1945 and 1964 and were included in the study. Among the 348 patients in cohort A, 144 (41%, 95% CI 36%–47%) were screened for HCV infection. Of these, four (1.2%) were positive for anti-hepatitis C, and one patient had positive RNA levels. Similar proportions of screenings were observed in cohort B (47.8%, 95% CI 39%–57%). Of those with liver disease, 66% had been screened for HCV. Birth cohort screening for HCV has been underutilized in British Columbia. Combining HCV and CRC screening could provide a practical approach to linking patients to healthcare.
自2018年起，不列颠哥伦比亚省（BC省）建议对1945年至1964年出生的人群进行慢性丙型肝炎（HCV）筛查，该省的患病率为2.31%。将HCV和结直肠癌（CRC）筛查结合起来可促进专科转诊和随访。我们评估了不列颠哥伦比亚省出生队列指南发布后 CRC 筛查患者接受 HCV 筛查的情况，并研究了 COVID-19 大流行对 HCV 筛查实践的影响。我们对转诊至温哥华海岸卫生局 CRC 筛查项目的患者进行了回顾性审查。研究了两组患者，即 A 组（2019 年 10 月至 12 月）和 B 组（2021 年 12 月），以确定与大流行相关的变化。研究收集了人口统计学、肝病史、乙型肝炎或艾滋病病毒合并感染率以及抗丙型肝炎和核糖核酸（RNA）初始检测日期等数据。统计分析使用 Stata 15.1 进行。共有 579 名患者被转介至 CRC 筛查项目，其中 465 人出生于 1945 年至 1964 年，被纳入研究范围。在队列 A 的 348 名患者中，有 144 人（41%，95% CI 36%-47%）接受了 HCV 感染筛查。其中，4 名患者（1.2%）的抗丙型肝炎抗体呈阳性，1 名患者的 RNA 水平呈阳性。在队列 B 中也观察到了类似的筛查比例（47.8%，95% CI 39%-57%）。在肝病患者中，66% 的人接受过丙型肝炎病毒筛查。在不列颠哥伦比亚省，出生队列中的丙型肝炎病毒筛查一直未得到充分利用。将 HCV 筛查与 CRC 筛查相结合，可为患者提供一种实用的医疗保健链接方法。
{"title":"Assessment of birth cohort screening of chronic hepatitis C in colorectal cancer screening patients in British Columbia","authors":"Rojin Kaviani, Frank Y Chou, Chenxi He, Vladimir Marquez","doi":"10.3138/canlivj-2023-0024","DOIUrl":"https://doi.org/10.3138/canlivj-2023-0024","url":null,"abstract":"Since 2018, British Columbia (BC) has recommended chronic hepatitis C (HCV) screening for those born between 1945 and 1964, with a provincial prevalence of 2.31%. Combining HCV and colorectal cancer (CRC) screening can facilitate specialist referrals and follow-up. We assessed HCV screening uptake among CRC screening patients following the release of BC’s birth cohort guidelines and examined the COVID-19 pandemic’s impact on HCV screening practices. A retrospective review was conducted on patients referred to Vancouver Coastal Health Authority’s CRC screening program. Two groups, Cohort A (October–December 2019) and Cohort B (December 2021), were studied to identify pandemic-related changes. Data on demographics, liver disease history, hepatitis B or HIV co-infection rates, and initial anti-hepatitis C and ribonucleic acid (RNA) testing dates were collected. Statistical analyses were performed with Stata 15.1. A total of 579 patients were referred for the CRC screening program, of whom 465 were born between 1945 and 1964 and were included in the study. Among the 348 patients in cohort A, 144 (41%, 95% CI 36%–47%) were screened for HCV infection. Of these, four (1.2%) were positive for anti-hepatitis C, and one patient had positive RNA levels. Similar proportions of screenings were observed in cohort B (47.8%, 95% CI 39%–57%). Of those with liver disease, 66% had been screened for HCV. Birth cohort screening for HCV has been underutilized in British Columbia. Combining HCV and CRC screening could provide a practical approach to linking patients to healthcare.","PeriodicalId":505573,"journal":{"name":"Canadian Liver Journal","volume":"425 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139834257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-05DOI: 10.3138/canlivj-2023-0027
L. A. Thompson, S. Plitt, Ran Zhuo, Carmen L. Charlton
Prior to the COVID-19 pandemic, Alberta was on track to meet national HCV elimination targets by 2030. However, it is unclear how the pandemic has affected progress. Here, we aim to assess the impact of first-wave COVID-19 restrictions on Alberta HCV testing trends. HCV testing information was extracted from the provincial public health laboratory from 2019 to 2022. HCV antibody and RNA testing were categorized into: (1) number ordered, (2) number positive, and (3) percent positivity, and stratified by HCV history status. Testing trends were evaluated across locations engaging high-risk individuals and priority demographics. An interrupted time-series analysis was used to identify average monthly testing rates before, during, and after first-wave COVID-19 restrictions. Overall, HCV testing trends were significantly affected by COVID-19 restrictions in April 2020. Average monthly rates decreased by 98.39 antibody tests ordered per 100,000 among individuals without an HCV history and by 1.78 RNA tests ordered per 100,000 among those with an HCV history. While antibody and RNA testing trends started to rebound in the follow-up period relative to pre-restriction period, testing levels in the follow-up period remained below pre-restriction levels for all groups, except for addiction/recovery centers and emergency room/acute care facilities, which increased. If rates are to return to pre-restriction levels and elimination goals are to be met, more work is needed to engage individuals in HCV testing. As antibody testing rates are rebounding, reengaging those with a history of HCV for viral load monitoring and treatment should be prioritized.
{"title":"The effect of first-wave COVID-19 restrictions on HCV testing in Alberta, Canada: A trend analysis from 2019 to 2022","authors":"L. A. Thompson, S. Plitt, Ran Zhuo, Carmen L. Charlton","doi":"10.3138/canlivj-2023-0027","DOIUrl":"https://doi.org/10.3138/canlivj-2023-0027","url":null,"abstract":"Prior to the COVID-19 pandemic, Alberta was on track to meet national HCV elimination targets by 2030. However, it is unclear how the pandemic has affected progress. Here, we aim to assess the impact of first-wave COVID-19 restrictions on Alberta HCV testing trends. HCV testing information was extracted from the provincial public health laboratory from 2019 to 2022. HCV antibody and RNA testing were categorized into: (1) number ordered, (2) number positive, and (3) percent positivity, and stratified by HCV history status. Testing trends were evaluated across locations engaging high-risk individuals and priority demographics. An interrupted time-series analysis was used to identify average monthly testing rates before, during, and after first-wave COVID-19 restrictions. Overall, HCV testing trends were significantly affected by COVID-19 restrictions in April 2020. Average monthly rates decreased by 98.39 antibody tests ordered per 100,000 among individuals without an HCV history and by 1.78 RNA tests ordered per 100,000 among those with an HCV history. While antibody and RNA testing trends started to rebound in the follow-up period relative to pre-restriction period, testing levels in the follow-up period remained below pre-restriction levels for all groups, except for addiction/recovery centers and emergency room/acute care facilities, which increased. If rates are to return to pre-restriction levels and elimination goals are to be met, more work is needed to engage individuals in HCV testing. As antibody testing rates are rebounding, reengaging those with a history of HCV for viral load monitoring and treatment should be prioritized.","PeriodicalId":505573,"journal":{"name":"Canadian Liver Journal","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139865152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-05DOI: 10.3138/canlivj-2023-0027
L. A. Thompson, S. Plitt, Ran Zhuo, Carmen L. Charlton
Prior to the COVID-19 pandemic, Alberta was on track to meet national HCV elimination targets by 2030. However, it is unclear how the pandemic has affected progress. Here, we aim to assess the impact of first-wave COVID-19 restrictions on Alberta HCV testing trends. HCV testing information was extracted from the provincial public health laboratory from 2019 to 2022. HCV antibody and RNA testing were categorized into: (1) number ordered, (2) number positive, and (3) percent positivity, and stratified by HCV history status. Testing trends were evaluated across locations engaging high-risk individuals and priority demographics. An interrupted time-series analysis was used to identify average monthly testing rates before, during, and after first-wave COVID-19 restrictions. Overall, HCV testing trends were significantly affected by COVID-19 restrictions in April 2020. Average monthly rates decreased by 98.39 antibody tests ordered per 100,000 among individuals without an HCV history and by 1.78 RNA tests ordered per 100,000 among those with an HCV history. While antibody and RNA testing trends started to rebound in the follow-up period relative to pre-restriction period, testing levels in the follow-up period remained below pre-restriction levels for all groups, except for addiction/recovery centers and emergency room/acute care facilities, which increased. If rates are to return to pre-restriction levels and elimination goals are to be met, more work is needed to engage individuals in HCV testing. As antibody testing rates are rebounding, reengaging those with a history of HCV for viral load monitoring and treatment should be prioritized.
{"title":"The effect of first-wave COVID-19 restrictions on HCV testing in Alberta, Canada: A trend analysis from 2019 to 2022","authors":"L. A. Thompson, S. Plitt, Ran Zhuo, Carmen L. Charlton","doi":"10.3138/canlivj-2023-0027","DOIUrl":"https://doi.org/10.3138/canlivj-2023-0027","url":null,"abstract":"Prior to the COVID-19 pandemic, Alberta was on track to meet national HCV elimination targets by 2030. However, it is unclear how the pandemic has affected progress. Here, we aim to assess the impact of first-wave COVID-19 restrictions on Alberta HCV testing trends. HCV testing information was extracted from the provincial public health laboratory from 2019 to 2022. HCV antibody and RNA testing were categorized into: (1) number ordered, (2) number positive, and (3) percent positivity, and stratified by HCV history status. Testing trends were evaluated across locations engaging high-risk individuals and priority demographics. An interrupted time-series analysis was used to identify average monthly testing rates before, during, and after first-wave COVID-19 restrictions. Overall, HCV testing trends were significantly affected by COVID-19 restrictions in April 2020. Average monthly rates decreased by 98.39 antibody tests ordered per 100,000 among individuals without an HCV history and by 1.78 RNA tests ordered per 100,000 among those with an HCV history. While antibody and RNA testing trends started to rebound in the follow-up period relative to pre-restriction period, testing levels in the follow-up period remained below pre-restriction levels for all groups, except for addiction/recovery centers and emergency room/acute care facilities, which increased. If rates are to return to pre-restriction levels and elimination goals are to be met, more work is needed to engage individuals in HCV testing. As antibody testing rates are rebounding, reengaging those with a history of HCV for viral load monitoring and treatment should be prioritized.","PeriodicalId":505573,"journal":{"name":"Canadian Liver Journal","volume":"5 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139805347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.3138/canlivj-2023-0019
Alexandra Cohen, Fernando Alvarez
Pediatric acute liver failure (PALF) is a potentially lethal and rapidly progressive clinical syndrome, with a large proportion of cases remaining indeterminate despite extensive investigations. In this case report, we describe two male children with indeterminate PALF and a family history of autoimmune disease, both of whom were lymphopenic with necrosis, inflammation, and lymphocytic infiltrates on their liver biopsies. One of these patients subsequently developed hepatitis-associated aplastic anemia. Notably, in addition to receiving standard liver failure care, both patients were successfully treated off-label with anti-thymocyte globulin (ATG), as well as a more prolonged course of cyclosporine and corticosteroids. The fact that these medications all suppress T lymphocytes further supports the theory that T-cell activation plays a prominent role in the pathophysiology of indeterminate hepatitis. Further research should examine the short-term and long-term effects of ATG in this population, as well as the necessary duration of treatment with immune-suppressing agents.
小儿急性肝功能衰竭（PALF）是一种潜在的致命性、进展迅速的临床综合征，尽管进行了广泛的检查，但仍有很大一部分病例无法确定。在本病例报告中，我们描述了两名患有不确定的 PALF 并有自身免疫性疾病家族史的男性患儿，他们的肝脏活检组织都有淋巴细胞坏死、炎症和淋巴细胞浸润。其中一名患者后来患上了肝炎相关性再生障碍性贫血。值得注意的是，除了接受标准的肝衰竭治疗外，这两名患者还成功地接受了抗胸腺细胞球蛋白（ATG）的标签外治疗，以及更长时间的环孢素和皮质类固醇治疗。事实上，这些药物都能抑制 T 淋巴细胞，这进一步支持了 T 细胞活化在不确定型肝炎的病理生理学中扮演重要角色的理论。进一步的研究应该探讨 ATG 对这类人群的短期和长期影响，以及免疫抑制药物治疗的必要持续时间。
{"title":"Immunosuppression in two cases of indeterminate hepatitis","authors":"Alexandra Cohen, Fernando Alvarez","doi":"10.3138/canlivj-2023-0019","DOIUrl":"https://doi.org/10.3138/canlivj-2023-0019","url":null,"abstract":"Pediatric acute liver failure (PALF) is a potentially lethal and rapidly progressive clinical syndrome, with a large proportion of cases remaining indeterminate despite extensive investigations. In this case report, we describe two male children with indeterminate PALF and a family history of autoimmune disease, both of whom were lymphopenic with necrosis, inflammation, and lymphocytic infiltrates on their liver biopsies. One of these patients subsequently developed hepatitis-associated aplastic anemia. Notably, in addition to receiving standard liver failure care, both patients were successfully treated off-label with anti-thymocyte globulin (ATG), as well as a more prolonged course of cyclosporine and corticosteroids. The fact that these medications all suppress T lymphocytes further supports the theory that T-cell activation plays a prominent role in the pathophysiology of indeterminate hepatitis. Further research should examine the short-term and long-term effects of ATG in this population, as well as the necessary duration of treatment with immune-suppressing agents.","PeriodicalId":505573,"journal":{"name":"Canadian Liver Journal","volume":"13 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139687777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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