Drug use from adolescence to later years: Persistence or progress?
Ilana B. Crome, Richard Williams, Roger Bloor, Xenofon Sgouros in Substance Misuse and Young People, 2019
There is also an issue with people injecting NPS, particularly synthetic cathinones (such as mephedrone). In most of Europe, there has been a relatively low prevalence of this practice, and it has been mostly confined to users who are primary injectors of other drugs (such as heroin). However, the widespread use of synthetic cathinone injection among high-risk drug users has been quite marked in Romania and Hungary (EMCDDA, 2015). This raises the spectre of new epidemics of blood-borne virus transmission (Mathers et al., 2008; Lafferty et al., 2016). The range of drugs available is substantial and a vast number more are likely to emerge in the future. This makes regulation an enormous problem for the governments and organisations involved with control. The presentations are a moving target for clinicians, and are likely to remain so.
Hepatitis B virus
Peter M. Lydyard, Michael F. Cole, John Holton, William L. Irving, Nino Porakishvili, Pradhib Venkatesan, Katherine N. Ward in Case Studies in Infectious Disease, 2010
Hepatitis C virus – this is a flavivirus, with a positive single-strand RNA genome. This virus bears many clinical and epidemiological similarities to HBV. It is a blood-borne virus, with risk groups being injecting drug users and recipients of contaminated blood or blood products. In contrast to HBV, mother to baby transmission only occurs in about 3% of cases, and there is very little evidence that HCV is transmitted sexually. HCV infection can become chronic – indeed it does so with greater frequency in adults than HBV, with only around 25% of acute infections being spontaneously cleared. Chronic infection predisposes the patient to the development of cirrhosis and also an increased risk of hepatocellular carcinoma. Diagnosis is first by detection of antibodies to HCV, which indicate that an individual has been infected with the virus. A subsequent test for HCV RNA (i.e. a genome detection test, usually the polymerase chain reaction (PCR) assay) distinguishes those individuals who have cleared the infection (HCV RNA-negative) from those who are chronic carriers (HCV RNA-positive).
The Health and Well-being of Asylum Seekers and New Refugees
James Matheson, John Patterson, Laura Neilson in Tackling Causes and Consequences of Health Inequalities, 2020
Consider a longer New Patient Check for new migrants [47] and include the following aspectsCatch up immunisation (WHO schedules).Medication review, including use of traditional medicines or those sent from home.Smoking, drugs and alcohol.Tuberculosis and blood-borne virus assessment.Sexual health and female genital mutilation.Vitamin D screen.Mental health assessment, including PTSD screen.Explanation of national screening programmes.Don’t forget dental health!
Management of hepatitis B and hepatitis C coinfection: an expert review
Published in Expert Review of Anti-infective Therapy, 2020
Dorota Zarębska-Michaluk, Robert Flisiak, Marta Flisiak-Jackiewicz
Hepatitis B and C viruses account for a significant proportion of liver-related morbidity globally. According to the most recent estimates, approximately 1% of the world population is infected with HCV, corresponding to 71 million active cases. Worldwide prevalence of HCV infection varies widely, with the highest number of infected patients in the WHO Eastern Mediterranean, European, and Western Pacific regions; however, data from Asia, Africa, and South America are limited. HCV is a blood-borne virus, and the most common modes of infection are: transfusion of infected blood or its products (before 1992), unsafe medical and non-medical procedures, included tattooing, piercing, and injecting drug use, with exposure to blood, and it can be passed from infected mother to baby. HCV can also be spread by sexual practices that lead to blood exposure; this mode of transmission is less frequent except for people living with human immunodeficiency virus (HIV) [1, Jin F, Matthews GV, Grulich AE. Sexual transmission of hepatitis C virus among gay and bisexual men: a systematic review. Sex Health. 2017 Feb;14(1):28–41.].
Modeling the fiscal costs and benefits of alternative treatment strategies in the United Kingdom for chronic hepatitis C
Published in Journal of Medical Economics, 2018
Mark P. Connolly, Nikos Kotsopoulos, Andrew Ustianowski
Hepatitis C infection is a global public health issue, and one of the main causes of chronic liver disease worldwide (with the global prevalence estimated to be >185 million (2.8%))1. The disease is often asymptomatic in the acute phase, and typically progresses slowly, with 15–45% of infections spontaneously resolving2. The major disease burden comes from chronic infections (55–85%), potentially resulting in the development of significant liver disease, including cirrhosis and liver cancer2. Low rates of early diagnosis due to the asymptomatic nature of this blood-borne virus often mean diagnosis occurs at more advanced stages, frequently decades after infection2. The World Health Organization (WHO) report worldwide deaths due to the hepatitis C virus (HCV) as 399,000 per year; it is, however, suspected that the actual number may be much higher due to under-diagnosis2.
How would China achieve WHO’s target of eliminating HCV by 2030?
Published in Expert Review of Anti-infective Therapy, 2019
Mingyang Li, Hui Zhuang, Lai Wei
Screening and treatment should be strengthened in other populations with high HCV prevalence or risk of transmission. This includes patients with hemophilia or other blood diseases, post-liver transplant patients, prisoners, HIV-positive MSMs, immigrants from areas with high HCV prevalence as well as birth cohorts with high HCV prevalence. In China, the latter includes the population born between 1960 and 1980 who were in their young adulthood or working in early 1990s when commercial plasma donation became popular in rural communities; therefore this population have the highest risk of HCV infection through unsafe blood and blood products [11]. With the implementation of a series of precautions to prevent blood-borne disease transmission since 1990s, the risk of disease transmission in blood donors and users has been substantially reduced [14].
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