Hepatitis C-infected Patients Research Articles

Patterns and sociodemographic characteristics of substance abuse among hepatitis C virus-infected patients in Iraq: a cross-sectional study

BackgroundSubstance use disorders are a widely recognized problem among hepatitis C-infected patients; moreover, substance abuse by intravenous injection is a common mode of transmission of the hepatitis C virus worldwide. The frequency of substance use disorders and their relation to hepatitis C infection are still unknown in Iraq. This cross-sectional study, conducted among a sample of hepatitis C- infected patients attending the Gastrointestinal Tract Center in Baghdad Medical City, aimed to examine the prevalence of substance use disorders, the sociodemographic characteristics of the abusers, and the relation between intravenous drug abuse and hepatitis C virus infection. All participants were subjected to an Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) questionnaire and a data form to determine sociodemographic characteristics and hepatitis C virus-related risk factors.ResultsIn a total of 300 hepatitis C virus-infected patients, the prevalence of substance use disorders was 53.6%. Among these patients, 43.6% abused nicotine, 6% abused licit drugs, and 4% abused alcohol. No one reported illicit drug abuse. Intravenous drug abuse was rare, and there was no relationship found between intravenous drug abuse and hepatitis C infection. Cupping (23%) and blood transfusion (20.3%) were both significantly associated with hepatitis C transmission in this study (p > 0.001).ConclusionThis study revealed a high prevalence (53.6%) of substance abuse in this sample of hepatitis C-infected patients, with nicotine being the most commonly abused substance. However, there was no relationship between hepatitis C infection and intravenous drug abuse. Common risk factors that might contribute to hepatitis C transmission among this population include cupping and blood transfusion.

Cytokines in hepatitis C-infected patients with or without opioid maintenance therapy.

Both chronic hepatitis C virus (HCV) infection and opioids cause altered blood levels of cytokines. Previous studies have investigated levels of selected groups of cytokines in patients on opioid maintenance treatment. Little is known about the levels of multiple cytokines in patients with chronic HCV infection on opioid maintenance treatment. Our aim was to investigate the cytokine profile in patients with active HCV infection with and without opioid maintenance treatment. We conducted a cross-sectional study in an out-patients population included upon referral for antiviral hepatitis C infection treatment. The level of 27 cytokines was measured in serum using multiplex technology. Patients were interviewed using a modified version of the European addiction severity index. Data pertaining to weight, height, current medication, smoking habits, allergies, previous medical history and ongoing withdrawal symptoms were collected. Non-parametric testing was used to investigate differences in levels of cytokines between the two groups. A 3-model hierarchical regression analysis was used to analyse associations between cytokines and confounding variables. Out of 120 included patients, 53 were on opioid maintenance treatment. Median duration of opioid treatment was 68.4 months. There were no demographical differences between the two groups other than age. IL-1β was lower and eotaxin-1 higher in the group on opioid maintenance treatment than in the non-opioid group. No other inter-group differences in the remaining cytokine levels were found. In HCV infection patients, the impact of chronic opioid administration on peripheral circulating cytokine level is minimal.

Evaluation of circulating CD4+CD25+CD127−/low regulatory T cells in newly diagnosed hepatitis C-infected patients

Evaluation of circulating CD4⁺CD25⁺CD127^−/low regulatory T cells in newly diagnosed hepatitis C-infected patients

Hepatitis C virus point-of-care microelimination approach in a vulnerable population in the South of Spain.

Since the introduction of direct-acting antivirals, thousands of chronic hepatitis C patients have been successfully treated. However, vulnerable populations have a higher prevalence of hepatitis C virus (HCV) infection and face barriers that impede their access to antivirals. We carried out an HCV microelimination program focused on vulnerable population groups in Malaga. People in drug addiction treatment centers and homeless shelters in Malaga who participated in the program between October 2020 and October 2021 were included. After providing participants with educational information on HCV, a dry drop test (DDT) was used to collect blood for subsequent screening for HCV infection. The participants who were diagnosed with HCV infection were scheduled for comprehensive healthcare assessments, including blood tests, ultrasonography, elastography, and the prescription of antivirals, all conducted in a single hospital visit. Sustained viral response (SVR) was analysed 12 weeks after end of treatment. Of the 417 persons invited to participate, 271 (65%) agreed to participate in the program. These participants were screened for HCV infection and 28 of them were diagnosed with HCV infection (10%). These hepatitis C-infected patients had a mean age of 53 ± 9 years; 86% were males and 93% were or had been drug users. Among 23 patients with HCV infection, HCV genotype 1a predominated (74%). Medical exams showed that 19% (4/21) had advanced fibrosis (F3-4), and 5% (1/21) had portal hypertension. Finally, 23 infected patients received treatment with glecaprevir/pibrentasvir or sofosbuvir/velpatasvir and SVR was confirmed in 22 patients (96%). Drug users and homeless people have a higher prevalence of HCV infection than the general population. The microelimination program with educational activity and screening tools achieved a high participation rate, easy healthcare access, and a high rate of SVR despite the SARS-CoV-2 pandemic.

The efficacy of administering elbasvir/grazoprevir as hepatitis C therapy in hemodialysis patients with comorbid of hypertension and diabetes mellitus

Background: Hepatitis C and chronic kidney disease (CKD) are significant global health burdens. Hemodialysis therapy can pose a risk of hepatitis C infection. Conditions related to Hepatitis C, such as hypertension and diabetes, have morbidity and mortality rates and can impact the outcomes of hepatitis C treatment. Objective: This study aimed to assess the efficacy of Elbasvir/Grazoprevir as hepatitis C therapy in hemodialysis patients with comorbid hypertension and diabetes mellitus. Methods: The target population for this study consists of hepatitis C-infected patients undergoing routine hemodialysis with comorbid hypertension and diabetes mellitus who were treated with Elbasvir/Grazoprevir. The data collected included demographic characteristics, comorbid conditions (hypertension and diabetes mellitus), cirrhosis status, and whether patients achieved Sustained Virologic Response (SVR). Multinomial logistic regression was used to calculate the odds ratio (OR). Results: From the population profile of the study, a total of 164 individuals were included, with the majority being under 60 years old. Patients with comorbid hypertension or diabetes mellitus achieved SVR rates of 95% and 83.3%, respectively, while patients with both comorbid conditions, hypertension, and diabetes mellitus, had an SVR rate of 74.07%. The multinomial logistic regression analysis showed that patients with both comorbid conditions (HT and DM) had a higher risk of failing to achieve SVR compared to patients without comorbid conditions, with an OR of 22.4, p = 0.005. Conclusion: Administering Elbasvir/Grazoprevir for hepatitis C therapy in hemodialysis patients with comorbid hypertension and/or diabetes mellitus carries a higher risk of SVR failure compared to those without comorbid conditions.

The effect of different direct antivirals on hepatic steatosis in nondiabetic and naïve hepatitis C-infected Egyptian patients

BackgroundHepatitis C is associated with metabolic effects and fatty liver disease. The effect of different direct antivirals on the liver steatosis, and the metabolic profile, still needs to be established. The aim of this study is to determine the effect of achieving the sustained virological response after 12 weeks (SVR-12 weeks) with different combinations of direct antiviral drugs, on the hepatic steatosis, and fibrosis presented by laboratory and transient elastography parameters. Our study population is nondiabetic, chronically infected HCV Egyptian patients and naïve to any form of HCV treatment.MethodsThis cohort study was carried on 100 nondiabetic HCV treatment-naïve patients attending the Hepatology Clinic, in the Gastroenterology and Hepatology Department, Ain Shams University, and Kobry El Koba Military Hospital. The patients were divided into four groups according to their treatment regimens as follows: group A: 25 patients who received sofosbuvir (400 mg) and daclatasvir (60 mg) daily for 12 weeks; group B: 25 patients who received sofosbuvir (400 mg) and ledipasvir (90 mg) daily for 12 weeks; group C: 25 patients who received ombitasvir (12.5 mg), paritaprevir (75 mg), and ritonavir (50 mg) daily for 12 weeks; and group D: 25 patients who received sofosbuvir (400 mg) and simeprevir (150 mg) daily for 12 weeks. All patients were subjected to the following investigations: HCV quantitative PCR before and after 12 weeks of treatment, clinical and laboratory metabolic evaluation including alfa-fetoprotein level, thyroid profile assessment, ferritin level, pelvi-abdominal ultrasound, and FibroScan examination.ResultsAll patients achieved SVR after 12 weeks. FibroScan median decreased (P < 0.001) from 19.29 ± 6.97 kPa at baseline to 14.15 ± 6.48 kPa at SVR12. NAFLD score median increased from 1.88 (1.49–2.22) at baseline to 2.01 (1.61–2.33) after 12 weeks of treatment. The highest level of NAFLD score was in group C, and the lowest was in group B. The BMI mean decreased from 28.31 ± 1.53 at baseline to 28.07 ± 1.52 at SVR12. HbA1C level mean decreased from 5.73 ± 0.23 at baseline to 5.40 ± 0.24 at SVR12. In addition, liver enzymes, cholesterol, triglycerides, APRI score (AST-platelet ratio index), and HBA1C decreased after 12-week treatment with a statistically significant difference, while the mean LDL increased after 12 weeks of treatment.ConclusionsDAAs affect the metabolic profile of the treated patients. There is a noticed improvement in the FibroScan, NAFLD score, and lipid profile after achieving the SVR-12 weeks. However, LDL is increased after viral cure, mostly due to viral-host molecular interaction.

The impact of sofosbuvir/ledipasvir on chronic hepatitis C-infected paediatric patients: a Middle East single-centre experience

The impact of sofosbuvir/ledipasvir on chronic hepatitis C-infected paediatric patients: a Middle East single-centre experience

Achieving High Sustained Viral Response in Difficult-to-Treat Hepatitis C-Infected Transfusion-Dependent Thalassemia Patients with Direct-Acting Antivirals

Achieving High Sustained Viral Response in Difficult-to-Treat Hepatitis C-Infected Transfusion-Dependent Thalassemia Patients with Direct-Acting Antivirals

Plasma Insulin/Erythrocytic Aldose Reductase Ratio as a Predictor for Hepatocellular Carcinoma among Type II Diabetics and Hepatitis C Virus-Iinfected Patients

Hepatocellular carcinoma (HCC) is a possible oncogenic progression during persistent hepatitis C-infection +/- type II diabetes mellitus (DM). We aim to investigate the plasma insulin, erythrocytic aldose reductase (AR) and sorbitol dehydrogenase (SDH) as possible predictive tools for HCC in hepatitis C-infected patients (HCV) +/- DM. Erythrocytes (RBCs) were adopted as a possible vehicle for pre-malignant variations being of short life span. Methods: The study included 20 healthy control and 100 patients of 48-64 years old, divided into 5 equal groups as; type II DM, HCC, HCC with DM, DM- HCV infected and non-DM HCV infected. Plasma levels of AFP and insulin were measured. It showed an elevated AR, significant reduction of SDH in RBCs and plasma of DM patients. These values were greatly elevated among HCV, HCC, diabetic HCV, and diabetic HCC patients. All DM patients showed elevated insulin levels than normoglycemic controls. The study substantiated the use of RBCs as a vehicle for early diagnostic markers better than plasma. We recommend the use of insulin/ erythrocytic AR ratio as a new laboratory marker for predicting HCC among type II diabetics or non-treated HCV-infected patients with control insulin/ erythrocytic AR ratio by each laboratory.

Cannabis Use Is Inversely Associated with Metabolic Disorders in Hepatitis C-Infected Patients (ANRS CO22 Hepather Cohort).

Background and Aims. Hepatitis C virus (HCV) infection is associated with the onset of metabolic disorders which constitute risk factors for liver disease progression. Their impact may persist after the HCV infection has been cured. Cannabis use is associated with a lower risk of obesity and diabetes in both general and HCV populations. The associations between cannabis use and both dyslipidemia and hypertension have not yet been studied in persons with chronic HCV infection. Methods. Using cross-sectional data from the French ANRS CO22 Hepather cohort, we used regression models to test for an inverse relationship between cannabis use and (i) dyslipidemia, (ii) hypertension, and (iii) the total number of metabolic disorders. Results. Among the 6364 participants in the study population, both former and current cannabis use were associated with a lower risk of hypertension and fewer metabolic disorders. These results were independent of central obesity. Cannabis use was not associated with dyslipidemia. Conclusions. In people chronically infected with HCV, cannabis use was associated with a lower risk of hypertension and a lower number of metabolic disorders. Post-HCV cure studies are needed to confirm these findings using longitudinal data and to test whether they translate into reduced mortality in this population.

Healthcare resource utilization in Hepatitis C-infected patients completing eight versus twelve weeks of treatment: A retrospective cohort study

BackgroundThe objective of this study was to examine differences in healthcare utilization among patients receiving eight vs. 12-weeks of treatment for infection with the Hepatitis C Virus (HCV).MethodsWe conducted a retrospective cohort study among 282 treatment-naïve, HCV-infected patients. Those eligible were uninfected with the Human Immunodeficiency Virus, non-cirrhotic, and treated between 2016 and 2019 as part of an extensive, urban, university-affiliated healthcare system. Electronic medical data were abstracted starting from HCV treatment initiation and up to one year post-initiation or achievement of post-treatment sustained virologic response, whichever occurred first. The primary outcome of interest was healthcare utilization, defined by the number and type of healthcare encounters. Differences in healthcare utilization between those receiving eight vs. 12-weeks of treatment were examined using Student’s t-test, Fisher’s exact test, Pearson’s chi-square test, and the Wilcoxon rank-sum test.ResultsA total of 282 eligible patients were analyzed. At baseline, the average age was 59 years (standard deviation=12), and the majority were male (55%) and white/Caucasian (58%). There were no baseline demographic or clinical differences between those completing 8 (n=59) or 12 (n=223) weeks of treatment. While no overall difference in healthcare encounters was observed between those receiving the 8-weeks (median encounters 6; IQR 4-11) and 12-weeks of treatment (median encounters 8; IQR 5-12; P value=0.07), a notable difference was seen in the number of laboratory visits between the groups (median 1 vs. 2; P value=0.04).ConclusionsOur findings indicate modest reductions in healthcare utilization among those receiving shorter treatment regimens for HCV infection, specifically regarding laboratory testing. These findings suggest that shorter treatment regimens may improve treatment expansion in settings that are otherwise too resource-constrained to deliver HCV care successfully.

Assessment of IL-23 serum levels on hepatitis-C infected patients

This study includes 100 total samples divided into 40 control, 60 patients suffering from HCV infection from Al-Saddar Medical City in Najaf governorate from December 2020 to May 2021, aging (20-70) years old and has shown higher frequency of hepatitis C infection in males 35sample (58 %), also the age group of (40-50) years more frequency. Moreover, it was observed that the concentration of Interleukin 23 (IL-23) (pg/ml) in (60) patients with diabetic foot ulcer infection was increase significantly over (P value was (&lt; 0.0001)

FRI311 - Macroeconomic assessment of overall and per-patient healthcare costs of Hepatitis C-infected patients in an integrated health system in the era of direct-acting antiviral therapy

FRI311 - Macroeconomic assessment of overall and per-patient healthcare costs of Hepatitis C-infected patients in an integrated health system in the era of direct-acting antiviral therapy

Cannabis use as a factor of lower corpulence in hepatitis C-infected patients: results from the ANRS CO22 Hepather cohort

BackgroundPatients with chronic hepatitis C virus (HCV) infection are at greater risk of developing metabolic disorders. Obesity is a major risk factor for these disorders, and therefore, managing body weight is crucial. Cannabis use, which is common in these patients, has been associated with lower corpulence in various populations. However, this relationship has not yet been studied in persons with chronic HCV infection.MethodsUsing baseline data from the French ANRS CO22 Hepather cohort, we used binary logistic and multinomial logistic regression models to test for an inverse relationship between cannabis use (former/current) and (i) central obesity (i.e., large waist circumference) and (ii) overweight and obesity (i.e., elevated body mass index (BMI)) in patients from the cohort who had chronic HCV infection. We also tested for relationships between cannabis use and both waist circumference and BMI as continuous variables, using linear regression models.ResultsAmong the 6348 participants in the study population, 55% had central obesity, 13.7% had obesity according to their BMI, and 12.4% were current cannabis users. After multivariable adjustment, current cannabis use was associated with lower risk of central obesity (adjusted odds ratio, aOR [95% confidence interval, CI]: 0.45 [0.37–0.55]), BMI-based obesity (adjusted relative risk ratio (aRRR) [95% CI]: 0.27 [0.19–0.39]), and overweight (aRRR [95% CI]: 0.47 [0.38–0.59]). This was also true for former use, but to a lesser extent. Former and current cannabis use were inversely associated with waist circumference and BMI.ConclusionsWe found that former and, to a greater extent, current cannabis use were consistently associated with smaller waist circumference, lower BMI, and lower risks of overweight, obesity, and central obesity in patients with chronic HCV infection. Longitudinal studies are needed to confirm these relationships and to assess the effect of cannabis use on corpulence and liver outcomes after HCV cure.Trial registrationClinicalTrials.gov identifier: NCT01953458.

Relation of phosphatase and tensin homolog gene polymorphism with hepatocellular carcinoma among hepatitis C-infected patients

Objective To study the significance of two phosphatase and tensin homolog (PTEN) gene polymorphisms, PTEN IVS4 rs3830675 and rs701848, as a risk factor for hepatocellular carcinoma (HCC) in chronic hepatitis C-infected patients. Background PTEN polymorphisms have been reported to be involved in multiple cancers. There are few reports concerning the linkage between the PTEN gene and liver cancer risk. Patients and methods The study was conducted on 200 participants. Of them, 80 had proven HCC, 60 were cirrhotic patients with no evidence of focal lesion, and 60 were healthy age-matched and sex-matched volunteers, enrolled in the study as a control group. PTEN IVS4 rs3830675 and rs701848 assessments by PCR-restricted fragment length polymorphism technique were done for all participants. Results The frequency of IVS4 rs3830675(––) genotype in patients with HCC was 56%, which is significantly increased compared with cirrhotic group (11.7%) and control group (10%). The combined dominant model (––/–+) was significantly higher than (++) genotype in patients with HCC compared with cirrhotic and control groups. The PTEN rs701848 polymorphisms (TT, TC, or CC) showed no significant difference among the three studied groups as well as allele distributions (T or C). Conclusion PTEN (IVS4 rs3830675) deletion (––) genotype may be a risk factor for HCC in chronic hepatitis C-infected patients more than (++) genotype. However, PTEN polymorphism (rs701848) was of no significance.

Assessment of erectile function and sexual hormones in chronic hepatitis C-infected patients treated with direct-acting antiviral agents

Objective To assess the erectile function, serum total testosterone, and serum prolactin levels in naive chronic hepatitis C virus (HCV)-infected patients before and after administration of direct-acting antiviral agents (sofosbuvir with daclatasvir). Design A descriptive cross-sectional study was conducted. Patients and methods A total of 50 married patients less than 60 years old with regular marital life having naive chronic HCV infection for a minimum of 1 year confirmed by positive serum HCV RNA by PCR who were going to receive 'sofosbuvir and daclatasvir' regimen for 3 months were included in the study. Intervention(s) Serum total testosterone and serum prolactin levels before and after the treatment course were assessed. Main outcome measure(s) The abridged form of International Index of Erectile Function questionnaire (IIEF-5) – Arabic version was fulfilled by the patients before starting the treatment course and 6 months afterward. Result(s) Before starting the treatment course, 28% of the study population complained of erectile dysfunction (IIEF-5 score ≤21). After the treatment course, the total IIEF-5 score was statistically significantly higher and the serum levels of total testosterone and prolactin hormones were statistically significantly lower than their levels before starting the treatment course. Conclusion(s) Direct-acting antiviral agents (sofosbuvir and daclatasvir) have demonstrated tolerability and safety regarding the erectile function; furthermore, there was significant improvement in the erectile function after the end of the treatment course.

An updated systematic review and meta-analysis on efficacy of Sofosbuvir in treating hepatitis C-infected patients with advanced chronic kidney disease.

Sofosbuvir seems to be a revolutionary treatment for Hepatitis C-infected patients with advanced chronic kidney disease (CKD) but existing evidence is not quite adequate. The aim of this study was to evaluate the efficacy and safety of Sofosbuvir-based therapy without Ribavirin for all hepatitis C virus genotypes among patients with advanced CKD. We conducted an updated systematic literature search from the beginning of 2013 up to June 2020. Sustained virologic response (SVR) rate at 12 and/or 24 weeks after the end of treatment, and adverse events in HCV-infected patients with advanced CKD were pooled using random effects models. We included 27 published articles in our meta-analyses, totaling 1,464 HCV-infected patients with advanced CKD. We found a substantial heterogeneity based on the I2 index (P = 0.00, I2 = 56.1%). The pooled SVR rates at 12 and 24 weeks after the end of Sofosbuvir-based treatment were 97% (95% Confidence Interval: 95-99) and 95% (89-99) respectively. The pooled SVR12 rates were 98% (96-100) and 94% (90-97) in patients under 60 and over 60 years old respectively. The pooled incidence of severe adverse events was 0.11 (0.04-0.19). The pooled SVR12 rate after completion of the half dose regimen was as high as the full dose treatment but it was associated with less adverse events (0.06 versus 0.14). The pooled SVR12 rate was 98% (91-100) in cirrhotic patients and 100% (98-100) in non-cirrhotic patients. The endorsement of Sofosbuvir-based regimen can improve the treatment of hepatitis C virus infection in patients with advanced CKD.

A subset of liver resident natural killer cells is expanded in hepatitis C-infected patients with better liver function

Viral hepatitis leads to immune-mediated liver injury. The rate of disease progression varies between individuals. We aimed to phenotype immune cells associated with preservation of normal liver function during hepatitis C virus (HCV) infection. Clinical data and specimens were obtained from 19 HCV-infected patients undergoing liver transplantation. Liver and peripheral blood mononuclear cells were isolated and eight subsets of innate immune cells were delineated by multiparameter flow cytometry. Cytokine assays and microarrays were performed. Intrahepatic CD56Bright/CD16- natural killer (NK) cells comprised the only subset correlating with better liver function, i.e., lower bilirubin (p = 0.0002) and lower model for end stage of liver disease scores (p = 0.03). The signature of liver NK cells from HCV-infected patients included genes expressed by NK cells in normal liver and by decidual NK cells. Portal vein blood had a higher concentration of interleukin (IL)-10 than peripheral blood (p = 0.03). LMCs were less responsive to toll-like receptor (TLR) stimulation than PBMCs, with fewer pro-inflammatory gene-expression pathways up-regulated after in vitro exposure to lipopolysaccharide and a TLR-7/8 agonist. Hepatic CD56Bright/CD16- NK cells may be critical for maintaining liver homeostasis. Portal vein IL-10 may prime inhibitory pathways, attenuating TLR signaling and reducing responsiveness to pro-inflammatory stimuli.

Insulin receptor substrate-1 G972R single nucleotide polymorphism in Egyptian patients with chronic hepatitis C virus infection and type 2 diabetes mellitus

BackgroundInsulin receptor substrate-1 (IRS1) plays a critical role in insulin signaling. IRS-1 gene polymorphism with glycine to arginine substitution (GGG ↔ AGG substitutions) in codon 972 (G972R) (rs1801278) is a common polymorphism of the IRS-1 gene, which may have a pathogenic role in the development of type 2 diabetes mellitus (type 2 DM) due to insulin resistance and impaired insulin secretion. In hepatitis C virus infection (HCV), the IRS proteins might be counter-regulated by degradation, differential expression, or modification by phosphorylation in cells expressing HCV core protein, which inhibits the interactions of IRS-1 with both the insulin receptor and the downstream effectors of IRS-1. The present retrospective case–control study aimed to evaluate IRS-1 G972R (rs 1801278) SNP in Egyptian patients with HCV and type 2 DM, two hundred and two subjects including 100 males and 102 females The present work is a retrospective case–control study aimed to detect IRS-1 G972R (rs 1801278) SNP in Egyptian patients with chronic HCV infection and DM. The subjects were divided into the control group (group I) which included 50 apparently healthy volunteers of comparable age, gender, and socioeconomic status to patients; group II included 50 type 2 diabetic patients without chronic hepatitis C infection; group III included 52 chronic HCV-infected patients without type 2 diabetes mellitus; and group IV included 50 chronic hepatitis C-infected patients with type 2 diabetes mellitus. IRS-1 G972R (rs 1801278) genotyping was done by using polymerase chain reaction (PCR-RFLP) technique with restriction enzymes BstNI.ResultsHOMA-IR and QUICKI index was significantly higher in the patient groups (groups II, III, and IV) than controls (P < 0.001, P = 0.019, and P < 0.001 respectively). There was a significant increase in minor allele (A) in groups II, III, and IV than controls (P = 0.007, P = 0.017, and P = 0.007 respectively). There was increased frequency of mutant allele (A) than wild allele (G) of IRS-1 G972R polymorphism in type 2 diabetic patients with BMI < 25 kg/m2. The DM patients without HCV infection (group II), HCV patients without DM (group III), and HCV patients with DM (group IV) showed a significant decrease in GG genotypes and a significant increase in AA genotypes than the controls (P = 0.017, P = 0.019, and P = 0.009 respectively). Body mass index and waist to hip ratio were significantly higher in DM patients without chronic hepatitis C infection (group II) and in HCV patients with type 2 diabetes (group IV) than controls, in hepatitis C patients with type 2 diabetes (group IV) than controls, and in group IV than group III (P < 0.001).ConclusionIRS-1 G972R (rs 1801278) polymorphism might be a contributing risk factor for the development of type 2 DM. The mutant allele (A) of IRS-1 suggests the role of this SNP as risk factors for type 2 diabetes mellitus even in subjects with normal body weight. The increase of body mass index may be an independent risk factor for the development of type 2 diabetes mellitus.

Impact of a Nurse Care Coordinator Supporting a Clinical Pharmacist Practitioner in Further Managing HCV-Infected Patients.

Patients undergoing chronic hepatitis C treatment require monitoring to ensure that treatment is both safe and effective. However, many of these patients are lost to follow-up. The aim of this study was to investigate the impact of implementing a Nurse Care Coordinator's role in a pharmacy-based collaborative team to enhance the care of hepatitis C-infected patients. This was a 6-month retrospective chart review from July 2018 to January 2019, where 116 patients receiving hepatitis C treatment were referred to the Nurse Care Coordinator for further management. The Nurse Care Coordinator provided more than a 5-fold increase in contact method by telephone call. Of the 116 referred hepatitis C-infected patients, 44.8% (n = 52) of patients were referred due to a missed post-treatment Week 12 follow-up appointment to assess for cure. The Nurse Care Coordinator successfully rescheduled 96.2% (50/52) of follow-up appointments to assess for cure; 90% (45/50) of those patients adhered to scheduled appointment; and 97.8% (44/45) of patients had undetectable hepatitis C virus RNA, indicating cure. The primary success rate of the intended Nurse Care Coordinator arrangement was 97.4% (n = 113), where 89.4% (101/113) of patients successfully adhered to the intervention. This study demonstrates the positive impact the Nurse Care Coordinator had in successfully re-engaging previously lost to follow-up patients back into clinic.