Hepatitis C infection (HCV) continues to disproportionately affect Hispanics/Latinos in the United States. Hispanic/Latino intravenous drug users (IDUs), because of their risky injection and sexual behaviors, are prone to HCV infection and rapid transmission of the virus to others via several routes. With a prevalence rate of approximately 75% among IDUs, it is imperative that transmission of HCV be prevented in this population. This study aims to examine the associations between demographic, injection and sexual risk factors to HCV infection in a group Hispanic/Latino IDUs in Miami-Dade County, Florida. Preliminary unadjusted results in this sample reveal that age (OR=4.592, p=0.004), weekly injection (OR=5.171, p=0.000), daily injection frequency (OR=3.856, p=0.000) and use of a dirty needle (OR=2.320, p= 0.006) were all significantly associated with HCV infection. Being born outside the U.S. was significantly negatively associated with HCV infection (OR=0.349, p=0.004). Additionally, having two or more sex partners in the past three months (OR=0.472, p=0.014) was negatively associated with HCV infection. After adjusting for all other variables, older age (AOR=7.470, p=0.006), weekly injection (AOR=3.238, p=0.007) and daily injection frequency (AOR=2.625, p=0.010) were all significantly associated with HCV infection. Being born outside the U.S. (AOR=0.369, p=0.019) was a significant protective factor for HCV infection, along with having two or more sex partners in the past three months (AOR=0.481, p=0.037). When analyzing the significant variables in a backward regression model, having 2 or more sex partners in the past three months was not significant at the p

Orientador: Helaine Maria Besteti Pires Mayer Milanez / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T21:43:52Z (GMT). No. of bitstreams: 1 Schweller_MarianaSalhabDall'Aqua_M.pdf: 1766000 bytes, checksum: e03c3a8a2bf2836ec2f7e49bc907e1fd (MD5) Previous issue date: 2015 / Resumo: Introdução: A Hepatite C é um dos maiores problemas atuais de saúde pública, com mais de 150 milhões de pessoas contaminadas. A evolução da doença geralmente é assintomática e suas complicações são cirrose, fibrose hepática e hepatocarcinoma. Na gestação o tratamento não é recomendado, com possível piora da doença no período. Objetivo: identificar a prevalência de Hepatite C em gestantes que realizaram acompanhamento pré-natal no Hospital da Mulher Professor José Aristodemo Pinotti - Centro de Atenção Integral à Saúde da Mulher (CAISM) da UNICAMP, analisando dados clínicos, epidemiológicos e resultados perinatais. Metodologia: estudo de corte transversal cuja amostra foi composta por gestantes atendidas nos ambulatórios de pré-natal do CAISM entre 2005 e 2014 com sorologia positiva para Hepatite C. As pacientes foram identificadas através de listas informatizadas do serviço, e seus prontuários levantados para análise de dados sociodemográficos, epidemiológicos e desfechos perinatais. A análise dos dados foi feita através da distribuição percentual ou de médias. Resultados: na população de 29.327 gestantes atendidas pelo pré-natal entre 2005 e 2014, a prevalência de Hepatite C foi de 0,2%. Das 47 mulheres incluídas no estudo, a idade média foi de 32,5 anos, houve 49% de prevalência de baixa escolaridade, metade das participantes não planejaram a gestação, sendo que 38% destas não faziam uso de métodos contraceptivos. Além disso, 34% apresentaram coinfecção pelo HIV e 34% relataram uso de drogas. O número médio de gestações por paciente foi 3. Não se observou um pior desfecho perinatal, com peso médio de 2827,5 gramas ao nascimento e idade gestacional média de 39 semanas e 4 dias. Conclusões: Entre as pacientes infectadas pelo vírus C, observamos maior prevalência da raça branca, baixa escolaridade e coinfecção com HIV. Como principais fatores de risco para contaminação pela doença, foram identificados o uso de drogas, histórico de transfusões sanguíneas e a coinfecção com o HIV. Além disso, foram observadas maiores taxas de aborto, cesáreas e prematuridade neonatal em relação a outros estudos, fatores relacionados ao aumento da morbimortalidade materna, fetal e neonatal / Abstract: Introduction: Hepatitis C is a leading public health problem, with more than 150 million people infected. Disease evolution is usually asymptomatic, and complications are cirrhosis, liver fibrosis and hepatocellular carcinoma. Treatment is not recommended during pregnancy, but it may influence disease evolution. Objective: To identify Hepatitis C prevalence in pregnant women attended at Professor Doctor José Aristodemo Pinotti Women's Integrated Healthcare Center (CAISM) of the UNICAMP Medical School during prenatal period, analyzing clinical and epidemiological data, including perinatal outcomes. Methods: Authors performed a cross-sectional study with pregnant women who tested positive for Hepatitis C and gave birth at CAISM, between 2005 and 2014. Demographic, epidemiological and perinatal data were extracted from each patient¿s hospital records. Data analysis was made through media or percentage distribution. Results: Among 29.327 women treated at CAISM between 2005 and 2014, Hepatitis C prevalence was 0,2%. The mean maternal age at delivery was 32.5 years, 49% had low education and 49% did not plan the pregnancy. Among them, 38% did not use contraceptive methods. In addition, 34% had coinfection with HIV and 34% reported use of drugs. The average number of pregnancies per woman was 3, and there was no significant evidence of disease influence in pregnancy outcomes. Newborns¿ average weight was 2,827.5 grams, and the average of the gestational age was 39 weeks and 4 days. Conclusions: Among patients infected with Hepatitis C, there was predominance of the white race, low education and HIV coinfection. Drug addiction, blood transfusions and HIV co-infection were the main risk factors for contamination. When compared with other similar studies, this study found higher rates of abortion, cesarean sections and neonatal prematurity. These factors are associated with perinatal morbidity and mortality / Mestrado / Saúde Materna e Perinatal / Mestra em Ciências da Saúde

Recentemente estudos demonstraram que os SNPs (polimorfismos de base única) rs8099917 e rs12979860 localizados próximos ao gene da IL28B explicam a variação de resposta à infecção e tratamento do paciente contra o genótipo 1 do HCV, porém não para o genótipo 3 deste vírus. Este trabalho encontrou associação significativa entre resposta à infecção devida ao genótipo 3 pelo tratamento (PEG-INF e RBV) e o polimorfismo rs8099917 em uma amostra da população de Santos - SP. Para o polimorfismo rs12979860, esta associação somente foi encontrada ao se parear indivíduos para sexo, idade e grau de fibrose hepática, demonstrando a importância da retirada de efeitos de estratificação neste tipo de análise. Estes resultados se confirmam ao se agregar dados de uma população proveniente da Bahia em uma meta-análise. Além disso, fez-se um estudo GWAS a fim de se conhecer outras variações genéticas envolvidas nessa resposta. Esta análise indicou a existência de alguns SNPs candidatos com sugestão de associação, dentre eles a tiroglobulina, relacionada aos hormônios da tireóide. / Recently, studies have shown that SNPs (single nucleotide polymorphisms) rs8099917 and rs12979860, located near the gene IL28B explain the changes in the response to infection and treatment of a patient against the HCV genotype 1, but not for the genotype 3 of the virus. This study found a significant association between response to infection due to treatment by genotype 3 (PEG-INF and RBV) and the rs8099917 polymorphism in a population sample from Santos - SP. To the rs12979860 polymorphism, this association was only found when individuals are paired for sex, age and degree of hepatic fibrosis, demonstrating the importance of the withdrawal effects of stratification in this type of analysis. These results confirm the aggregate data from a population of Bahia in a meta-analysis. In addition, a GWAS was made in order to search other genetic variations involved in this response. This analysis indicated the existence of some candidate SNPs with suggestion of association, including thyroglobulin, thyroid hormones related to.

acase@tulane.edu / Background It is estimated 3 to 5 million individuals in the U.S. are chronically infected with the Hepatitis C virus (HCV). (Durham DP, 2016) More than 12,000 deaths occur annually in the U.S. as a result of HCV-related liver disease. (Wieland A, 2015) The cost of treatment medication for an individual with HCV genotype-1 is approximately $100,000 for 12 weeks of therapy. (Reau N, 2014) The exorbitant cost of HCV treatment has led to fears that many who could benefit from treatment will not receive it considering many with HCV are uninsured or have Medicaid. Purpose The purpose of this study is to quantify the cost, cost-effectiveness, and adverse outcomes associated with denying or delaying HCV treatment among the Louisiana Medicaid (LA-Medicaid) HCV GT-1 population. Methodology This project evaluates the cost and cost-effectiveness of treating HCV compared to not treating; initiating early treatment compared to late treatment and HCV-related health outcomes. A decision tree and Markov model simulates progression through the various states of health involved in progressive HCV disease, including death (hepatic and other causes). Results Don’t Treat/Treat Comparison Treatment was generally cost-effective, exhibiting an incremental cost-effectiveness ratio (ICER) of $21,670/life-year and $37,067/QALY (Quality-Adjusted Life-Years) gained. Optimal Treatment Stage Comparison Treatment of a person at F0 was cost effective, exhibiting an ICER of $6,482/QALY and $6,194/year of life compared to not treating at all and treating at F1, F2, F3, F4 or after LT. Conclusion Treatment of HCV-infected patients without liver fibrosis or in early stages of liver fibrosis appear to be more cost-effective than treating in advance stages of liver fibrosis or denying treatment. / 1 / Dwana Green

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23415号 / 医博第4760号 / 新制||医||1052(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 武藤 学, 教授 浅野 雅秀, 教授 川口 義弥 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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The objectives of this study are: (1) To compare the effectiveness of two dosing schedules of hepatitis B vaccine in achieving compliance within the vaccines; (2) To determine the immunization requirements in U.S. pharmacy schools both at admission and before the students begin clinical clerkships; and, (3) To design an immunization program for pharmacy students at the University of the Pacific in an attempt to enhance compliance.

Orientador: Rejane Maria Tommasini Grotto / Resumo: A progressão da fibrose hepática somada à infecção pelo vírus da hepatite C (VHC) tem sido associada à resposta imunológica permanente. O estudo no repertório de anticorpos Anti-VHC na progressão da fibrose hepática foi explorado através de ferramentas de sequenciamento em larga escala (NGS) possibilitando uma análise de repertórios altamente variáveis como as porções variáveis VH (cadeia pesada) e Vk (cadeia leve) das imunoglobulinas, e a determinação de famílias e subfamílias dos genes V-D-J associadas à resposta humoral encontrada nas diferentes fases da doença proporcionam uma ferramenta importante no entendimento da resposta imune frente à infecção viral pelo VHC. As porções VH e Vk das imunoglobulinas foram obtidas a partir da amplificação de RNA de sangue de paciente VHC positivos e com diferentes graus de fibrose, e sequenciadas na plataforma Illumina® Miseq, fornecendo uma grande variabilidade de sequências que foram pré-processadas por ferramentas de bioinformática e analisadas em dois bancos de anticorpos diferentes: IgBlast (NCBI) e IMGT® quanto às famílias e subfamílias mais expressas. A expressão restrita de algumas famílias e subfamílias: IGHV1, IGHV3, IGHV4 e subfamílias já descritas em vários estudos associados ao VHC corrobora com nossos achados de que existe uma tendência do uso de algumas subfamílias como: IGHV1-2, IGHV1-8, IGVH1-69, IGHV3-11, IGHV3-21, IGHV3-23, IGVH3-30, IGHV4-4, IGHV4-34 IGHV4-39 na cadeia pesada; assim como IGkV3-15 e IGkV3-20 na cadei... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The progression of hepatic fibrosis in the hepatitis C virus (HCV) infection has been linked with permanent immune response. The study in the repertoire of Anti-HCV antibodies in the progression of hepatic fibrosis was analysed for large-scale sequencing (NGS) tools enabling a highly variable analysis such as the VH (heavy chain) and Vk (light chain) portions of immunoglobulins and the determination of families and subfamilies of the V-D-J genes in the humoral response found in the different phases of the disease, a great tool in the understanding of the immune response to HCV viral infection. The VH and V portions of the immunoglobulins were obtained from the amplification of HCV positive HCV patient blood with different degrees of fibrosis and sequenced on the Illumina® Miseq platform, providing a large sequence variability that was preprocessed by tools of bioinformatics and analyzed in two different antibody banks: IgBlast (NCBI) and IMGT® for the most expressed families and subfamilies. The restricted expression of some families: IGHV1, IGHV3, IGHV4 and subfamilies already described in several HCV-related studies confirm our findings that there is a tendency to use some subfamilies, such as: IGHV1-2, IGHV1-8, IGVH1- 69, IGHV3-11, IGHV3-21, IGHV3-23, IGVH3-30, IGHV4-4, IGHV4-34 IGHV4-39 in the heavy chain; as well as IGkV3-15 and IGkV3-20 in the light chain, but the subfamilies: IGHV1-8, IGHV3-11, IGHV4-39, IGkV1-5, IGkV1-12, IGkV1-39 were also among the most expressed, i... (Complete abstract click electronic access below) / Mestre

The natural history of hepatitis C virus infection differs between women and men. Women demonstrate a slow rate of disease progression until menopause. Older women are more likely to develop fibrosis and are less responsive than younger women to pegylated interferon and ribavirin. Women of childbearing age have higher rates of sustained virologic response, but current therapies are contraindicated during pregnancy. Vertical transmission of hepatitis C virus occurs, but data supporting recommendations for prevention of mother-to-infant transmission are limited.