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American Journal of Gastroenterology ; 116(SUPPL):S513, 2021.
Article in English | EMBASE | ID: covidwho-1534718


Introduction: The COVID-19 pandemic has dramatically imperiled the health system worldwide. It may also negatively impact the cascade of care of hepatitis C virus (HCV) infection and the progress on WHO 2030 goal of HCV elimination. In this study, we used a multinational, multicenter cohort to estimate the change in the completion of DAA therapy, HCV RNA testing, and clinical encounter during pandemic. Methods: We collected data patients who underwent DAA therapy at three tertiary medical centers in Los Angeles (US), Xi'an (China), and Nanjing (China) between January 1, 2019 to June 30, 2020 and followed until November 30, 2020. We compared the proportions of HCV patients who completed DAA therapy as well as had HCV RNA testing and follow-up visits during and after the end of the HCV therapy between COVID-19 pandemic and the periods before pandemic. Additionally, we determined the frequency and predictive factors of utilization of telemedicine. Results: A total of 256 patients with HCV infection were included. Despite no significant reduction in the completion of DAA before and during the pandemic, the proportion of patients undergoing HCV RNA testing during DAA treatment decreased from about 80% before pandemic to 67% during the pandemic, with a more prominent decrease in the US. There were less than 10% of patients who had HCV RNA testing 12 weeks post-treatment during COVID-19 era. Compared to pre-pandemic period, post-treatment clinic encounter decreased significant in China but elevated in the US. Further analysis showed that the increase was due to the surge in utilization of telemedicine. However, the increased number of follow-up visits during COVID-19 pandemic period did not result in an increase in HCV RNA testing. Conclusion: COVID-19 pandemic carried profound impact on the cascade of care for HCV patients in both the US and China. Despite the increased use of telemedicine in the US, the adherence to recommendations for HCV RNA testing was still disappointingly low. Stakeholders should identify the modifiable barriers and reinforce the care while withstanding the pandemic.

Hepatology ; 74(SUPPL 1):341A-342A, 2021.
Article in English | EMBASE | ID: covidwho-1508738


Background: The COVID19 pandemic has affected persons dietary habits and life style, with effects on body weight. We have assessed the effect of the pandemic on the liver health by quantifying the changes in liver enzymes, hepatic steatosis and fibrosis in patients with chronic liver disease. Methods: This is a multi-center US study that included 3 tertiary clinical centers. Patients with chronic liver disease (51 NAFLD, 8 with resolved hepatitis C, 3 chronic hepatitis B, 5 primary biliary cholangitis and 36 combination of chronic liver disease), without evidence of an acute process (e.g. alcoholic hepatitis, alcohol abuse or new decompensation of cirrhosis), were enrolled. Patients were assessed between January and March 2020 and January and March 2021. Assessment included laboratory tests and controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) on vibration transient elastography (VCTE). Results: 103 patients were assessed twice during the two periods. Baseline mean alanine aminotransferase (ALT) was 37 ± 36 (SD) U/L;aspartate aminotransferase (AST) 30 ± 18 U/L;total bilirubin 0.6 ± 0.31 mg/dL;albumin, 4.2 ± 0.72 g/dL;CAP score 293 ± 70 dB/m;and LSM on VCTE 8.1 ±6.2 kPa. Weight gain occurred in 54% of the population, whereas 39% lost weight, and 7% had no weight change. LSM increased by >20% in 30% of subjects;decreased by 20% in 27%;and remained within the 20% range in 43%. LSM increase by 20% was associated with significant weight gain and ALT increase (+2.3 ± 6.5 kg, and +17 ± 49.U/L (p<0.05)), in comparison to subjects who had their LSM changes within 20% range (+1.1 (3.7) kg, and -5.3 ±22.0 U/L) or had >20% decrease in LSM (-0.3 ±5.8 kg, and -6.0 ±21 U/L). CAP score median change was -2.9 ±85 dB/m in those who had LSM increase by >20%, whereas the score changed by 0.0 ± 44 dB/m in those who had LSM changes within 20% or 1.0 ± 58 dB/m in those >20% decrease. Conclusion: During the COVID 19 pandemic in this U.S. population, more than half of subjects with chronic liver disease gained weight, but others had no change or decreased weight. Adverse liver changes (LSM>20% and increased ALT) occurred in one-third of the population.