ABSTRACT
Background and Aim: Drug-induced liver injury (DILI) can involve serious adverse reactions to many drug classes, causing a wide clinical and biochemical spectrum of liver injury. Despite a rise in prevalence and it being the most common cause of acute liver failure in the Western world, it is often unrecognized. There are limited recent data on the common causes of DILI in Australia. Fourteen liver units in Australia agreed to collaborate. We present here the interim results from the first center. Methods: A prospective clinical audit was done of patients with reported DILI between June 2018 and April 2021, inclusive. Results: The interim results for the first 93 patients are shown in Table 1. Only seven patients (7.5%) had underlying liver disease. Thirty patients (32%) had some form of treatment, although 12 (13%) were already using corticosteroids for pre-existing illnesses. The liver injury became chronic (lasted >6 months) in 10% of cases. Five of 17 patients (29%) prescribed remdesivir for coronavirus disease 2019 developed DILI, despite four (80%) concurrently receiving dexamethasone. Conclusion: DILI remains a significant cause of morbidity and mortality, with new agents like remdesivir and old agents like antibiotics comprising the main causes.
ABSTRACT
Background and Aim: Regional and rural populations with chronic hepatitis C virus (HCV) infection remain undertreated due to low primary care uptake, combined with limited access to specialist care and follow-up. Telehealth (TH) addresses many barriers to treatment access, has previously proven successful for HCV management in rural and prison settings, and has been proposed as an alternative for patients who remain geographically and socioeconomically disadvantaged, particularly in the coronavirus 2019 era. We aimed to report the clinical outcomes and the cascade of care of a novel nurse-led HCV TH clinic set in regional Victoria. Methods: We performed a retrospective cohort analysis of all patients referred to a regional HCV TH service between 1 April 2017 and 10 June 2020. Data were collated from outpatient and electronic medical records, as well as prospectively collected qualitative patient surveys. Results: A total of 55 patients were booked into the HCV TH clinic, and the outcomes are shown in Figure 1. Twenty-five patients (54%) had a history of alcohol use disorder, 24 (52%) had psychiatric comorbidity, and five (11%) had obesity. Thirteen of the 14 (93%) who received treatment achieved sustained virological response. We additionally demonstrated successful TH-driven hepatocellular carcinoma surveillance among the subgroup of patients with cirrhosis. An average of 46.48 km of travel, 54.64 min, and A$30.67 was saved per patient for each visit. Overall patient satisfaction gathered via Likert scale surveys was positive, with observed benefits including increased medical engagement, adherence to treatment, and improvement in long-term health outcomes at a personal and cohort level. Conclusion: Nurse-led HCV management via TH has allowed access for a marginalized regional population with high levels of substance misuse and psychiatric comorbidity. Clinical outcomes were comparable to those previously reported from tertiary and community-based cohorts, with additional cost benefit, efficiency gains, and carbon footprint reduction among a previously unreported regional Victorian population with HCV.