ABSTRACT
While the coronavirus disease 2019 (COVID-19) pandemic has profoundly impacted pediatric mental health, the impact of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection on youth with anxiety disorders has not been prospectively examined. Further, there are limited prospective data on post-acute sequelae COVID-19, including symptoms that constitute the long COVID neuropsychiatric syndrome. In December 2019, we began a longitudinal study of adolescents aged 12-17 years with DSM-5 primary anxiety disorders treated with either duloxetine or escitalopram. Assessments included all items from the Generalized Anxiety Disorder-7 (GAD-7) and Quick Inventory of Depressive Symptomatology (QIDS) scales at each week and a weekly clinician-rated Clinical Global Impressions-Severity (CGI-S) scale. We examined the longitudinal course of anxiety, including following laboratory-confirmed SARS-CoV-2 infection in affected adolescents. This prospective study of the longitudinal impact of COVID-19 in pediatric anxiety disorders reveals that COVID-19 is associated with worsening anxiety symptoms and a disquieting 33% worsening in syndromic severity. Further, these data raise the possibility that, in anxious youth, COVID-19 is associated with a surfeit of neuropsychiatric symptoms.
Subject(s)
COVID-19 , Adolescent , Humans , Child , Prospective Studies , Post-Acute COVID-19 Syndrome , Longitudinal Studies , SARS-CoV-2 , Anxiety Disorders/psychology , Anxiety/psychology , Depression/psychologyABSTRACT
Importance: Between 2 and 3.5 million people live with chronic hepatitis C virus (HCV) infection in the US, most of whom (approximately 75%) are not aware of their disease. Despite the availability of effective HCV treatment in the early stages of infection, HCV will result in thousands of deaths in the next decade in the US. Objective: To investigate the cost-effectiveness of universal screening for all US adults aged 18 years or older for HCV in the US and of targeted screening of people who inject drugs. Design, Setting, and Participants: This simulated economic evaluation used cohort analyses in a Markov model to perform a 10â¯000-participant Monte Carlo microsimulation trail to evaluate the cost-effectiveness of HCV screening programs, and compared screening programs targeting people who inject drugs with universal screening of US adults age 18 years or older. Data were analyzed in December 2019. Exposures: Cost per quality-adjusted life-year (QALY). Main Outcomes and Measures: Cost per QALY gained. Results: In a 10â¯000 Monte Carlo microsimulation trail that compared a baseline of individuals aged 40 years (men and women) and people who inject drugs in the US, screening and treatment for HCV were estimated to increase total costs by $10â¯457 per person and increase QALYs by 0.23 (approximately 3 months), providing an incremental cost-effectiveness ratio of $45â¯465 per QALY. Also, universal screening and treatment for HCV are estimated to increase total costs by $2845 per person and increase QALYs by 0.01, providing an incremental cost-effectiveness ratio of $291â¯277 per QALY. Conclusions and Relevance: The findings of this study suggest that HCV screening for people who inject drugs may be a cost-effective intervention to combat HCV infection in the US, which could potentially decrease the risk of untreated HCV infection and liver-related mortality.
Subject(s)
Health Care Costs/statistics & numerical data , Hepatitis C, Chronic , Mass Screening , Substance Abuse, Intravenous , Adult , Cohort Studies , Cost-Benefit Analysis , Female , Hepacivirus/isolation & purification , Hepatitis C, Chronic/diagnosis , Hepatitis C, Chronic/drug therapy , Hepatitis C, Chronic/economics , Hepatitis C, Chronic/epidemiology , Humans , Male , Markov Chains , Mass Screening/economics , Mass Screening/methods , Mass Screening/statistics & numerical data , Monte Carlo Method , Preventive Health Services , Quality-Adjusted Life Years , Substance Abuse, Intravenous/complications , Substance Abuse, Intravenous/epidemiology , United States/epidemiologyABSTRACT
INTRODUCTION: Dolutegravir (DGV) is the newest integrase inhibitor approved for the treatment of HIV-1 infection in both treatment-naive and experienced adults and adolescents. This article reviews the safety of DGV for the treatment of HIV-1 infection. AREAS COVERED: The PubMed database was searched using the keywords 'DGV' and 'HIV'. In addition, conference proceedings from Conference on Retroviruses and Opportunistic Infections, International AIDS Society and European AIDS Clinical Society meetings were searched for presentations on DGV clinical studies. EXPERT OPINION: DGV has demonstrated a favorable safety profile and is well tolerated for the treatment of HIV-1 infection. Unlike raltegravir, DGV can be given once daily, and unlike elvitegravir, it does not require pharmacologic boosting to achieve consistent blood levels.
