Liver Disease Monitoring Practices After Hepatitis C Cure in the Underserved Population.
Liver Disease Monitoring Practices After Hepatitis C Cure in the Underserved Population.
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DOI：
10.1002/hep4.1246
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发表时间：
2018-10
影响因子：
5.1
通讯作者：
Khalili M
中科院分区：
文献类型：
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作者：
Kim NJ;Magee C;Cummings C;Park H;Khalili M
最近的丙型肝炎病毒(HCV)指南建议对经直接作用抗病毒(DAA)治疗的持续病毒学应答(SVR)后的晚期纤维化患者进行疾病监测和肝细胞癌(HCC)筛查。然而，关于这种情况下的实践模式的数据是缺乏的。我们的目标是在服务不足的丙型肝炎病毒感染队列中描述SVR后的疾病监测和肝细胞癌筛查实践。回顾了2014年1月至2016年1月期间在旧金山安全网医疗系统接受DAA治疗的192名患者的记录，并在≥后对其进行了12个月的随访。患者特征为中位年龄58岁，男性61.5%，白人39.1%(黑人23.4%，拉丁裔16.7%，亚裔16.2%)，英语熟练78.1%，静脉用药48.9%，酗酒53.2%，晚期(F3和F4)纤维化41%(失代偿26.6%，肝细胞癌11.4%)。SVR术后中位随访时间为22个月。晚期肝纤维化患者接受肝门诊(平均1.94±2.03vs1.12±1.09vs1.12±1.09vs1.12±1.09vs.P=0.014)和肝脏显像(41.4%vs9.73%；P<；0.001)，但丙氨酸氨基转移酶(ALT)检测(72.2%vs.66.4%；P=0.4)与无肝纤维化的患者相比无差异。然而，20%的晚期纤维化患者没有进行肝细胞癌筛查，而35%的晚期纤维化患者进行了肝脏成像。3名肝硬变患者发展为新的肝细胞癌。结论：虽然在这个服务不足的队列中，大多数晚期纤维化患者接受了SVR后监测，但在短期的随访中，发现了肝细胞癌筛查中的空白，并出现了新的肝细胞癌病例。这突出了纳入最近加强的指导方针的重要性，以优化SVR后监测，特别是在难以参与的人群中。
Recent hepatitis C virus (HCV) guidelines recommend disease monitoring and hepatocellular carcinoma (HCC) screening in patients with advanced fibrosis after a sustained virologic response (SVR) with direct‐acting antiviral (DAA) therapy. However, data on practice patterns in this setting is lacking. We aimed to characterize disease monitoring and HCC screening practices post‐SVR in an underserved HCV‐infected cohort. Records of 192 patients who received DAA therapy at the San Francisco safety‐net health care system between January 2014 and January 2016 with ≥12 months of follow‐up post‐SVR were reviewed. Patient characteristics were median age 58 years, 61.5% men, 39.1% White (23.4% Black, 16.7% Latino, 16.2% Asian), 78.1% English proficient, 48.9% intravenous drug use, 53.2% alcohol use, and 41% advanced (F3 and F4) fibrosis (26.6% with decompensation, 11.4% with HCC). Median post‐SVR follow‐up time was 22 months. A higher proportion of patients with advanced fibrosis attended liver clinic visits (mean, 1.94 ± 2.03 versus 1.12 ± 1.09 visits; P = 0.014) and had liver imaging (41.4% versus 9.73%; P < 0.001) post‐SVR, but there was no difference in alanine aminotransferase (ALT) testing (72.2% versus 66.4%; P = 0.40) compared to those without advanced fibrosis. However, 20% with advanced fibrosis had no HCC screening while 35% with no advanced fibrosis had liver imaging. Three patients with cirrhosis developed new HCC. Conclusion: Although the majority of patients with advanced fibrosis in this underserved cohort received post‐SVR monitoring, gaps in HCC screening were identified and new cases of HCC occurred during a short follow‐up. This highlights the importance of incorporating recently enhanced guidelines to optimize post‐SVR monitoring, especially in difficult to engage populations.
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影响因子：
2.9
作者：
Mukhtar, Nizar A.;Kathpalia, Priya;Khalili, Mandana
通讯作者：
Khalili, Mandana
影响因子：
25.7
作者：
Conti, Fabio;Buonfiglioli, Federica;Brillanti, Stefano
通讯作者：
Brillanti, Stefano
影响因子：
3.4
作者：
Lee K;Sinn DH;Gwak GY;Cho HC;Jung SH;Paik YH;Choi MS;Lee JH;Koh KC;Paik SW
通讯作者：
Paik SW
DOI：
10.1111/liv.12150
发表时间：
2013-08
期刊：
Liver international : official journal of the International Association for the Study of the Liver
影响因子：
--
作者：
Lubega S;Agbim U;Surjadi M;Mahoney M;Khalili M
通讯作者：
Khalili M
影响因子：
4.4
作者：
Birkhead, Guthrie S.;Klein, Susan J.;Flanigan, Colleen A.
通讯作者：
Flanigan, Colleen A.