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7. Liver Disease and Poor Adherence Limit Hepatitis C Cure: A Real-World Australian Treatment Cohort

Author

Clark, Paul J., Valery, Patricia C., Strasser, Simone I., Weltman, Martin, Thompson, Alexander J., Levy, Miriam, Leggett, Barbara, Zekry, Amany, Rong, Julian, Angus, Peter, George, Jacob, Bollipo, Steven, McGarity, Bruce, Sievert, William, Macquillan, Gerry, Tse, Edmund, Nicoll, Amanda, Wade, Amanda, Chu, Geoff, Harding, Damian, Cheng, Wendy, Farrell, Geoff, and Roberts, Stuart K.

Published
2023
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15. Hepatitis C treatment outcomes for Australian First Nations Peoples: equivalent SVR rate but higher rates of loss to follow-up

Author

Clark, Paul J., Valery, Patricia C., Ward, James, Strasser, Simone I., Weltman, Martin, Thompson, Alexander, Levy, Miriam T., Leggett, Barbara, Zekry, Amany, Rong, Julian, Angus, Peter, George, Jacob, Bollipo, Steven, McGarity, Bruce, Sievert, William, Macquillan, Gerry, Tse, Edmund, Nicoll, Amanda, Wade, Amanda, Chu, Geoff, Harding, Damian, Cheng, Wendy, Farrell, Geoff, and Roberts, Stuart K.

Published
2022
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17. Alcohol does not impact chronic hepatitis C treatment outcomes but increases risk for progressive liver disease: Findings from a prospective multicentre Australian study (OPERA‐C).

Author

Clark, Paul J., Valery, Patricia C., Strasser, Simone I., Weltman, Martin, Thompson, Alex, Levy, Miriam T., Leggett, Barbara, Zekry, Amany, Rong, Julian, Sinclair, Marie, George, Jacob, Sievert, William, MacQuillan, Gerry, Tse, Edmund, Nicoll, Amanda, Wade, Amanda, Cheng, Wendy, and Roberts, Stuart K.

Subjects
*HEPATIC fibrosis, *CHRONIC hepatitis C, *ALCOHOLISM, *ALCOHOL drinking, *HEPATITIS C virus
Abstract

Introduction: Alcohol use is common in patients with chronic hepatitis C virus (HCV) infection. We examined the impact of alcohol use on direct‐acting antiviral (DAA) therapy outcome and the clinical course of liver disease and 2‐year survival for patients receiving HCV DAA therapy. Methods: Adults (n = 2624) recruited from 26 Australian hospital liver clinics during 2016–2021 were followed up for 2 years. Risky alcohol use was defined by a combination of self‐report (≥40 g/day of ethanol), physician‐reported history of problematic alcohol use, and anti‐craving medication prescription via population‐based database linkage. We examined factors associated with advanced liver fibrosis and survival using multivariable logistic and Cox regression. Results: Among 1634 patients (62.3%) with risky alcohol use, 24.6% reported consuming ≥40 g/day of alcohol, 98.3% physician‐reported problematic alcohol use; only 4.1% were dispensed naltrexone/acamprosate. One hundred and forty‐three patients with cirrhosis reported ≥40 g/day of alcohol, 6 (4.3%) were prescribed naltrexone/acamprosate. Risky alcohol use was associated with advanced fibrosis (adjusted‐odds ratio 1.69, 95% confidence interval 1.32–2.17) and patients were over‐represented for cirrhosis (45.1% vs. 25.6% in no‐risky alcohol use [p < 0.001]) and hepatocellular carcinoma (5.7% vs. 2.5% [p < 0.001]). Sustained viral response (p = 0.319) and 2‐year survival (adjusted‐hazard ratio 1.98, 95% confidence interval 0.84–4.63) after DAA therapy were not associated with risky alcohol use. Discussion and Conclusions: Risky alcohol use in HCV patients was prevalent, but did not reduce HCV cure. Treatment for alcohol dependence was low. Risky alcohol use may be under‐recognised in liver clinics. Better integration of addiction medicine into liver services and increased resourcing and addiction medicine training opportunities for hepatologists may help address this. [ABSTRACT FROM AUTHOR]

Published
2024
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21. Australians with metabolic dysfunction‐associated steatotic liver disease have a twofold increase in the incidence of cancer.

Author

Powell, Elizabeth E, Roche, Shruti, Sarraf, Babak, Hartel, Gunter, Skoien, Richard, Leggett, Barbara, O'Beirne, James, and Valery, Patricia C

Subjects
LIVER diseases, TYPE 2 diabetes, CONSCIOUSNESS raising, STOMACH cancer, DISEASE risk factors
Abstract

Background and Aim: Metabolic dysfunction‐associated steatotic liver disease (MASLD) is associated with an increased risk of extrahepatic morbidity. We compared the incidence of cancers in adults admitted to Queensland hospitals with MASLD with that for the Queensland population and examined the association between cirrhosis and type 2 diabetes and the development of extrahepatic cancers. Methods: In this retrospective study, we identified all cancers (Queensland Cancer Registry) after the first hospitalization with MASLD during Jul‐2007 to Dec‐2019, estimated age‐standardized incidence (ASI) of cancers, and compared that with the ASI in the Queensland population (incidence rate ratios [IRR]). Among the MASLD cohort, we examined the association between diabetes and cancer risk (Cox regression). Median follow‐up was 3.8 years (54 204 person‐years). Results: Totally 1104 new cancers were diagnosed in 1018 patients (8.9% of 9771 non‐cirrhotic and 1712 adults with cirrhosis). The ASI (all cancers) of 1668.2 per 100 000 person‐years in men (95% CI 1523.7–1827.4) and 1284.0 per 100 000 person‐years in women (95% CI 1169.6–1408.2) was 2‐fold higher than that of the Queensland population (IRR = 1.94, 95% CI 1.75–2.16 and IRR = 1.99, 95% CI 1.78–2.22, respectively). Incidence of stomach cancer, unknown primary, and pancreas was 3‐ to 5‐fold higher compared to the general population (all P < 0.001). In multivariable analysis of the MASLD cohort, older age (e.g. ≥70 years adjusted hazard ratio [adj‐HR] = 4.59, 95% CI 3.61–5.83), male gender (adj‐HR = 1.20, 95% CI 1.05–1.37), and cirrhosis (adj‐HR = 1.37, 95% CI 1.11–1.70) were independently associated with extrahepatic cancer risk, while diabetes was not. Conclusions: Our findings will help to raise awareness among clinicians about the importance of cancer vigilance in this patient group. [ABSTRACT FROM AUTHOR]

Published
2024
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22. Broadening and strengthening the health providers caring for patients with chronic hepatitis C may improve continuity of care

Author

Clark, Paul J, primary, Valery, Patricia C, additional, Strasser, Simone I, additional, Weltman, Martin, additional, Thompson, Alex, additional, Levy, Miriam T, additional, Leggett, Barbara, additional, Zekry, Amany, additional, Rong, Julian, additional, Sinclair, Marie, additional, George, Jacob, additional, Bollipo, Steven, additional, McGarity, Bruce, additional, Sievert, William, additional, MacQuillan, Gerry, additional, Tse, Edmund, additional, Nicoll, Amanda, additional, Wade, Amanda, additional, Cheng, Wendy, additional, and Roberts, Stuart K, additional

Published
2023
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26. Broadening and strengthening the health providers caring for patients with chronic hepatitis C may improve continuity of care.

Author

Clark, Paul J, Valery, Patricia C, Strasser, Simone I, Weltman, Martin, Thompson, Alex, Levy, Miriam T, Leggett, Barbara, Zekry, Amany, Rong, Julian, Sinclair, Marie, George, Jacob, Bollipo, Steven, McGarity, Bruce, Sievert, William, MacQuillan, Gerry, Tse, Edmund, Nicoll, Amanda, Wade, Amanda, Cheng, Wendy, and Roberts, Stuart K

Subjects
*CHRONIC hepatitis C, *HEPATITIS C, *MENTAL illness, *DRUG abuse, *CONTINUUM of care, *DRUG abuse treatment
Abstract

Background: Direct‐acting antiviral (DAA) therapies for hepatitis C virus infection (HCV) lead to excellent rates of sustained virological response (SVR). However, loss to follow‐up (LTFU) for SVR testing remains a challenge. We examine factors associated with LTFU in a real‐world setting. Methods: Adults who received DAA therapy for HCV in one of 26 centers across Australia during 2016–2021 were followed up for 2 years. Data sources included the patient medical records and the national Pharmaceutical and Medicare Benefits Schemes. Linkage to Medicare provided utilization data of other health‐care providers and re‐treatment with DAAs. LTFU was defined as no clinic attendance for SVR testing by at least 52 weeks after DAA treatment commencement. Multivariable logistic regression assessed factors associated with LTFU. Results: In 3619 patients included in the study (mean age 52.0 years; SD = 10.5), 33.6% had cirrhosis (69.4% Child–Pugh class B/C), and 19.3% had HCV treatment prior to the DAA era. Five hundred and fifteen patients (14.2%) were LTFU. HCV treatment initiation in 2017 or later (adj‐OR = 2.82, 95% confidence interval [CI] 2.25–3.54), younger age (adj‐OR = 2.63, 95% CI 1.80–3.84), Indigenous identification (adj‐OR = 1.99, 95% CI 1.23–3.21), current injection drug use or opioid replacement therapy (adj‐OR = 1.66, 95% CI 1.25–2.20), depression treatment (adj‐OR = 1.49, 95% CI 1.17–1.90), and male gender (adj‐OR = 1.31, 95% CI 1.04–1.66) were associated with LTFU. Conclusions: These findings stress the importance of strengthening the network of providers caring for patients with HCV. In particular, services targeting vulnerable groups of patients such as First Nations Peoples, youth health, and those with addiction and mental health disorders should be equipped to treat HCV. [ABSTRACT FROM AUTHOR]

Published
2024
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37. Low Prevalence of Use of Allied Health and Community Services for Patients with Cirrhosis in Australia: A Need for Greater Engagement

Author

Powell,Elizabeth E, Stuart,Katherine A, Finnigan,Simon, Hinson,Jan, Bernardes,Christina M, Hartel,Gunter, Valery,Patricia C, Powell,Elizabeth E, Stuart,Katherine A, Finnigan,Simon, Hinson,Jan, Bernardes,Christina M, Hartel,Gunter, and Valery,Patricia C

Abstract

Elizabeth E Powell,1,2 Katherine A Stuart,1 Simon Finnigan,3 Jan Hinson,4 Christina M Bernardes,5 Gunter Hartel,6 Patricia C Valery2,5 1Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia; 2Centre for Liver Disease Research, Faculty of Medicine, the University of Queensland, Woolloongabba, Queensland, Australia; 3Community and Oral Health, Metro North Health, Chermside, Queensland, Australia; 4Faculty of Health Sciences, School of Allied Health, Australian Catholic University, Banyo, Queensland, Australia; 5Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia; 6Statistics, QIMR Berghofer Medical Research Institute, Herston, Queensland, AustraliaCorrespondence: Patricia C Valery, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Queensland, 4006, Australia, Tel +61 07 3362 0376, Email Patricia.Valery@qimrberghofer.edu.auBackground: Psychosocial, lifestyle and practical needs are not routinely attended to during outpatient hepatology management, and little is known about the type and effectiveness of support services accessed by patients with cirrhosis. We quantified the type and use of community and allied health services in patients with cirrhosis.Methods: The study included 562 Australian adults with a diagnosis of cirrhosis. Health service use was assessed via questionnaire and via linkage to the Australian Medicare Benefits Schedule. Patient needs were assessed using the Supportive Needs Assessment tool for Cirrhosis (SNAC).Results: Although most patients (85.9%) used at least one community/allied health service for support with their liver disease, many reported requiring additional help with psychosocial (67.4%), lifestyle (34.3%) or practical needs (21.9%) that were not met by available services, or patients did not access services. A multidisciplinary care plan or case conference (in the 12 months prior to recruitment) was access

Published
2023

39. A Discrete Choice Experiment to Elicit Preferences for a Liver Screening Programme in Queensland, Australia: A Mixed Methods Study to Select Attributes and Levels

Author

Allen, Michelle, primary, Doran, Rachael, additional, Brain, David, additional, Powell, Elizabeth E, additional, O’Beirne, James, additional, Valery, Patricia C, additional, Barnett, Adrian, additional, Hettiarachchi, Ruvini, additional, Hickman, Ingrid J, additional, and Kularatna, Sanjeewa, additional

Published
2022
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