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Hepatitis: HELP
Articles by Douglas T. Dieterich
Based on 72 articles published since 2009
(Why 72 articles?)

Between 2009 and 2019, Douglas Dieterich wrote the following 72 articles about Hepatitis.
+ Citations + Abstracts
Pages: 1 · 2 · 3
51 Article Real-World Sustained Virologic Response Rates of Sofosbuvir-Containing Regimens in Patients Coinfected With Hepatitis C and HIV. 2016

Del Bello, David / Cha, Agnes / Sorbera, Maria / Bichoupan, Kian / Levine, Calley / Doyle, Erin / Harty, Alyson / Patel, Neal / Ng, Michel / Gardenier, Donald / Odin, Joseph / Schiano, Thomas D / Fierer, Daniel S / Berkowitz, Leonard / Perumalswami, Ponni V / Dieterich, Douglas T / Branch, Andrea D. ·Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai. · Department of Pharmacotherapy, Brooklyn Hospital Center. · Division of Liver Diseases. · Department of Medicine, Icahn School of Medicine at Mount Sinai. · Faculty Practice Associates, Mount Sinai Hospital. · Division of Infectious Diseases, Brooklyn Hospital Center. · Division of Liver Diseases, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York City, New York. ·Clin Infect Dis · Pubmed #26936665.

ABSTRACT: BACKGROUND: Patients with hepatitis C virus (HCV) with or without human immunodeficiency virus (HIV) achieve high sustained virological response (SVR) rates on sofosbuvir (SOF)-containing regimens in clinical trials. Real world data on patients coinfected with HCV and HIV treated with SOF-based regimens are lacking. METHODS: This observational cohort study included HIV/HCV-coinfected adults with genotype 1 HCV who initiated treatment with a SOF-containing regimen between December 2013 and December 2014 (n = 89) at the Mount Sinai Hospital or the Brooklyn Hospital Center. The primary outcome was SVR at 12 weeks after the end of treatment. The secondary outcomes were risk factors for treatment failure, serious adverse events, and side effects. A post hoc per protocol analysis of SVR was performed on patients who completed treatment and follow-up. RESULTS: In an intention-to-treat analysis, SVR rates were 76% (31/41) for simeprevir (SMV)/SOF, 94% (16/17) for SMV/SOF/ribavirin (RBV), and 52% (16/31) for SOF/RBV. The SVR rates of SMV/SOF/RBV and SMV/SOF did not differ significantly in this small study (P = .15). However the SVR rate of SMV/SOF/RBV was higher than that of SOF/RBV (P < .01). In a per protocol analysis, SMV/SOF/RBV had a higher SVR rate than SOF/RBV: 100% (16/16) vs 57% (16/28) (P < .01). The most commonly reported adverse effects were rash, pruritus, fatigue, and insomnia. One patient who had decompensated cirrhosis prior to treatment initiation died after receiving SMV/SOF. CONCLUSIONS: SMV/SOF ± RBV is an effective option with minimal adverse effects for most HIV-positive patients with genotype 1 HCV. SMV should be used with caution in patients with decompensated cirrhosis.

52 Article Re-re-treatment of hepatitis C virus: Eight patients who relapsed twice after direct-acting-antiviral drugs. 2015

Hartman, Joshua / Bichoupan, Kian / Patel, Neal / Chekuri, Sweta / Harty, Alyson / Dieterich, Douglas / Perumalswami, Ponni / Branch, Andrea D. ·Joshua Hartman, Department of Medicine, Icahn School of Medicine at the Mount Sinai Medical Center, New York, NY 10029, United States. ·World J Gastroenterol · Pubmed #26604650.

ABSTRACT: AIM: To determine risk factors associated with hepatitis C virus (HCV) treatment failure after direct acting antivirals in patients with complex treatment histories. METHODS: All HCV mono-infected patients who received treatment at our institution were queried. Analysis was restricted to patients who previously failed treatment with boceprevir (BOC) or telaprevir (TVR) and started simeprevir (SMV) and sofosbuvir (SOF) ± ribavirin (RBV) between December 2013 and June 2014. Patients with human immunodeficiency virus (HIV)/HCV co-infection or patients who received a liver transplant in the past were excluded. Viral loads were recorded while on treatment and after treatment. Data collection continued until December, 31(st) 2014 when data analysis was initiated. Patients missing virologic outcomes data were not included in the analysis. Analysis of 35 patients who had virologic outcome data available resulted in eight patients who were viral load negative at the end of treatment with SMF/SOF but later relapsed. Data related to patient demographics, HCV infection, and treatment history was collected in order to identify risk factors shared among patients who failed treatment with SMF/SOF. RESULTS: Eight patients who were treated with the first generation HCV protease inhibitors BOC or TVR in combination with pegylated-interferon (PEG) and RBV who failed this triple therapy were subsequently re-treated with an off-label all-oral regimen of SMV and SOF for 12 wk, with RBV in seven cases. Treatment was initiated before the Food and Drug Administration approved a 24-wk SMV/SOF regimen for patients with liver cirrhosis. All eight patients had an end of treatment response, but later relapsed. Eight (100%) patients were male. Mean age was 56 (range, 49-64). Eight (100%) patients had previously failed PEG/RBV dual therapy at least once in addition to prior failure with triple therapy. Total number of times treated ranged from 3-6 (mean 3.8). Eight (100%) patients were male had liver cirrhosis as determined by Fibroscan or MRI. Seven (87.5%) patients had genotype 1a HCV. Seven (87.5%) patients had over 1 million IU/mL HCV RNA at the time of re-treatment. CONCLUSION: This study identifies factors associated with SMV/SOF treatment failure and provides evidence that twleve weeks of SMV/SOF/RBV is insufficient in cirrhotics with high-titer genotype 1a HCV.

53 Article Broad Hepatitis C Treatment Scenarios Return Substantial Health Gains, But Capacity Is A Concern. 2015

Van Nuys, Karen / Brookmeyer, Ronald / Chou, Jacquelyn W / Dreyfus, David / Dieterich, Douglas / Goldman, Dana P. ·Karen Van Nuys is a senior research economist at Precision Health Economics, in Los Angeles, California. · Ronald Brookmeyer is a professor of biostatistics at the University of California, Los Angeles. · Jacquelyn W. Chou is an associate director and research scientist at Precision Health Economics. · David Dreyfus is a data scientist at Arete Analytics, in Andover, Massachusetts. · Douglas Dieterich is a professor of medicine in the Division of Liver Diseases at the Icahn School of Medicine at Mount Sinai, in New York City. · Dana P. Goldman (dana.goldman@usc.edu) is the Leonard D. Schaeffer Chair and director of the Schaeffer Center for Health Policy and Economics at the University of Southern California, in Los Angeles. ·Health Aff (Millwood) · Pubmed #26438742.

ABSTRACT: Treatment of hepatitis C virus, the most common chronic viral infection in the United States, has historically suffered from challenges including serious side effects, low efficacy, and ongoing transmission and reinfection. Recent innovations have produced breakthrough therapies that are effective in more than 90 percent of patients. These treatments could dramatically reduce the virus's prevalence but are costly. To quantify the benefit of these treatments to society, including the value of reduced transmission, we estimated the effects of several hepatitis C treatment strategies on cost and population health. Treating patients at all disease stages could generate $610-$1,221 billion in additional quality-adjusted life-years, plus an additional $139 billion in saved medical expenditures over fifty years, and minimize the disease burden, but up-front treatment costs would exceed $150 billion. An intermediate scenario--treating 5 percent of the infected population annually, regardless of patients' disease stages--would also return substantial benefits and would be much more affordable under current financing schemes.

54 Article Low adherence of HIV providers to practice guidelines for hepatocellular carcinoma screening in HIV/hepatitis B coinfection. 2015

Hearn, Bevin / Chasan, Rachel / Bichoupan, Kian / Suprun, Maria / Bagiella, Emilia / Dieterich, Douglas T / Perumalswami, Ponni / Branch, Andrea D / Huprikar, Shirish. ·Department of Medicine, Division of Infectious Diseases, Carolinas HealthCare System, Charlotte, North Carolina. · Department of Medicine, Division of Infectious Diseases. · Department of Medicine, Division of Liver Diseases. · Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, New York. ·Clin Infect Dis · Pubmed #26240206.

ABSTRACT: BACKGROUND: In the era of combination therapy for human immunodeficiency virus (HIV), liver disease, and hepatocellular carcinoma (HCC) are major causes of death for patients coinfected with HIV and hepatitis B virus (HBV). This study compared HIV provider and hepatologist awareness of and adherence to the American Association for the Study of Liver Diseases (AASLD) practice guidelines for chronic HBV management. The primary endpoint of HIV provider adherence to HCC screening recommendations was compared to that of hepatologists at a large metropolitan academic medical center. METHODS: Medical record database searches by ICD-9 codes were used to identify HIV/HBV coinfected (n = 144) and HBV monoinfected (n = 225) patients who were seen at least twice over a 2-year period in outpatient clinics. Adherence to AASLD guidelines was assessed by chart review. Provider awareness was evaluated through a voluntary anonymous survey with knowledge-based questions. RESULTS: Over a 2-year period, only 36.0% of HIV/HBV coinfected patients seen in HIV practices completed HCC screening compared to 81.8% of HBV monoinfected patients in hepatology practices (P < .00001). Similarly, HIV providers less frequently monitored HBV viral load (P < .0001), HBeAg/anti-HBe (P < .00001), HBsAg/anti-HBs (P < .00001) than hepatologists but screened more often for hepatitis A immunity (P = .028). Self-reported adherence and knowledge scores were similar among 19 HIV providers and 16 hepatologists. CONCLUSIONS: HIV providers ordered significantly fewer HCC screening and HBV monitoring tests than hepatologists within a single academic medical center. In the setting of increased reliance on quality indicators for care, both patients and providers will benefit from greater adherence to established guidelines.

55 Article Daclatasvir plus Sofosbuvir for HCV in Patients Coinfected with HIV-1. 2015

Wyles, David L / Ruane, Peter J / Sulkowski, Mark S / Dieterich, Douglas / Luetkemeyer, Anne / Morgan, Timothy R / Sherman, Kenneth E / Dretler, Robin / Fishbein, Dawn / Gathe, Joseph C / Henn, Sarah / Hinestrosa, Federico / Huynh, Charles / McDonald, Cheryl / Mills, Anthony / Overton, Edgar Turner / Ramgopal, Moti / Rashbaum, Bruce / Ray, Graham / Scarsella, Anthony / Yozviak, Joseph / McPhee, Fiona / Liu, Zhaohui / Hughes, Eric / Yin, Philip D / Noviello, Stephanie / Ackerman, Peter / Anonymous700837. ·From the University of California, San Diego, La Jolla (D.L.W.), Ruane Medical and Liver Health Institute (P.J.R.), the Jeffrey Goodman Clinic, Los Angeles LGBT Center (C.H.), and Southern California Men's Medical Group-Men's Health Foundation (A.M.), Los Angeles, the University of California, San Francisco, San Francisco (A.L.), Veterans Affairs Long Beach Healthcare System, Long Beach (T.R.M.), and Pacific Oaks Medical Group, Beverly Hills (A.S.) - all in California · Johns Hopkins University, Lutherville, MD (M.S.S.) · Icahn School of Medicine at Mount Sinai, New York (D.D.) · University of Cincinnati College of Medicine, Cincinnati (K.E.S.) · Infectious Disease Specialists of Atlanta, Decatur, GA (R.D.) · MedStar Washington Hospital Center (D.F.), Whitman-Walker Health (S.H.), and Capital Medical Associates (B.R.) - all in Washington, DC · the Cure C Consortium, Houston (J.C.G.), and Tarrant County Infectious Disease Associates, Fort Worth (C.M.) - both in Texas · Orlando Immunology Center, Orlando (F.H.), and Midway Immunology and Research Center, Fort Pierce (M.R.) - both in Florida · the University of Alabama at Birmingham, Birmingham (E.T.O.) · the University of Colorado, Denver (G.R.) · Lehigh Valley Health Network, Allentown, PA (J.Y.) · and Bristol-Myers Squibb, Wallingford, CT (F.M., P.D.Y., P.A.), and Princeton, NJ (Z.L., E.H., S.N.). ·N Engl J Med · Pubmed #26196502.

ABSTRACT: BACKGROUND: The combination of daclatasvir, a hepatitis C virus (HCV) NS5A inhibitor, and the NS5B inhibitor sofosbuvir has shown efficacy in patients with HCV monoinfection. Data are lacking on the efficacy and safety of this combination in patients coinfected with human immunodeficiency virus type 1 (HIV-1). METHODS: This was an open-label study involving 151 patients who had not received HCV treatment and 52 previously treated patients, all of whom were coinfected with HIV-1. Previously untreated patients were randomly assigned in a 2:1 ratio to receive either 12 weeks or 8 weeks of daclatasvir at a standard dose of 60 mg daily (with dose adjustment for concomitant antiretroviral medications) plus 400 mg of sofosbuvir daily. Previously treated patients were assigned to undergo 12 weeks of therapy at the same doses. The primary end point was a sustained virologic response at week 12 after the end of therapy among previously untreated patients with HCV genotype 1 who were treated for 12 weeks. RESULTS: Patients had HCV genotypes 1 through 4 (83% with genotype 1), and 14% had compensated cirrhosis; 98% were receiving antiretroviral therapy. Among patients with genotype 1, a sustained virologic response was reported in 96.4% (95% confidence interval [CI], 89.8 to 99.2) who were treated for 12 weeks and in 75.6% (95% CI, 59.7 to 87.6) who were treated for 8 weeks among previously untreated patients and in 97.7% (95% CI, 88.0 to 99.9) who were treated for 12 weeks among previously treated patients. Rates of sustained virologic response across all genotypes were 97.0% (95% CI, 91.6 to 99.4), 76.0% (95% CI, 61.8 to 86.9), and 98.1% (95% CI, 89.7 to 100), respectively. The most common adverse events were fatigue, nausea, and headache. There were no study-drug discontinuations because of adverse events. HIV-1 suppression was not compromised. CONCLUSIONS: Among previously untreated HIV-HCV coinfected patients receiving daclatasvir plus sofosbuvir for HCV infection, the rate of sustained virologic response across all genotypes was 97.0% after 12 weeks of treatment and 76.0% after 8 weeks. (Funded by Bristol-Myers Squibb; ALLY-2 ClinicalTrials.gov number, NCT02032888.).

56 Article MELD score and antibiotics use are predictors of length of stay in patients hospitalized with hepatic encephalopathy. 2014

Martel-Laferrière, Valérie / Homberger, Caitlin / Bichoupan, Kian / Dieterich, Douglas T. ·Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, One Gustave L, Levy Place, New York, NY 10029, USA. valerie.martel-laferriere.chum@ssss.gouv.qc.ca. ·BMC Gastroenterol · Pubmed #25326084.

ABSTRACT: BACKGROUND: Hepatic encephalopathy (HE) represents a significant burden to the healthcare system. The aim of this study was to determine factors influencing the hospital length of stay among patients hospitalized with HE. METHODS: A data warehouse query was performed to identify 316 patients with a first hospitalization during which HE occurred, between April 2010 and February 2012. Baseline and hospitalization characteristics were collected with IRB approval. A negative binomial multivariable model was used to control for potential confounders on the length of hospitalization. RESULTS: Median age was 59 years, and 60.4% of admitted patients were male. The median MELD score was 22 (IQR: 17-28). Median length of stay was 8 days (IQR: 3.25-14.25). After controlling for MELD score, female gender (2.2 days; p = 0.04), being initially admitted for a reason other than HE (liver-related: 7.6 days; p < 0.01 and non liver-related 10.7 days; p < 0.01) and receiving antibiotics other than rifaximin (10.5 days; p < 0.01) were associated with longer length of stay whereas hepatitis C (-3.1 days; p < 0.01) was associated with a shorter length of stay. CONCLUSIONS: MELD score, gender, use of antibiotics other than rifaximin, reason for admission and hepatitis C are predictors readily available in clinic that can help identify patients at risk for longer length of stay.

57 Article Costs of telaprevir-based triple therapy for hepatitis C: $189,000 per sustained virological response. 2014

Bichoupan, Kian / Martel-Laferriere, Valerie / Sachs, David / Ng, Michel / Schonfeld, Emily A / Pappas, Alexis / Crismale, James / Stivala, Alicia / Khaitova, Viktoriya / Gardenier, Donald / Linderman, Michael / Perumalswami, Ponni V / Schiano, Thomas D / Odin, Joseph A / Liu, Lawrence / Moskowitz, Alan J / Dieterich, Douglas T / Branch, Andrea D. ·Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY. ·Hepatology · Pubmed #25065814.

ABSTRACT: CONCLUSIONS: TVR and Peg-IFN accounted for 85% of costs. Pharmaceutical prices and the low (44%) SVR rate, in this real-world study, were major contributors to the high cost per SVR.

58 Article DCE-MRI of the liver: effect of linear and nonlinear conversions on hepatic perfusion quantification and reproducibility. 2014

Aronhime, Shimon / Calcagno, Claudia / Jajamovich, Guido H / Dyvorne, Hadrien Arezki / Robson, Philip / Dieterich, Douglas / Fiel, M Isabel / Martel-Laferriere, Valérie / Chatterji, Manjil / Rusinek, Henry / Taouli, Bachir. ·Translational and Molecular Imaging Institute and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA. ·J Magn Reson Imaging · Pubmed #24923476.

ABSTRACT: PURPOSE: To evaluate the effect of different methods to convert magnetic resonance (MR) signal intensity (SI) to gadolinium concentration ([Gd]) on estimation and reproducibility of model-free and modeled hepatic perfusion parameters measured with dynamic contrast-enhanced (DCE)-MRI. MATERIALS AND METHODS: In this Institutional Review Board (IRB)-approved prospective study, 23 DCE-MRI examinations of the liver were performed on 17 patients. SI was converted to [Gd] using linearity vs. nonlinearity assumptions (using spoiled gradient recalled echo [SPGR] signal equations). The [Gd] vs. time curves were analyzed using model-free parameters and a dual-input single compartment model. Perfusion parameters obtained with the two conversion methods were compared using paired Wilcoxon test. Test-retest and interobserver reproducibility of perfusion parameters were assessed in six patients. RESULTS: There were significant differences between the two conversion methods for the following parameters: AUC60 (area under the curve at 60 s, P < 0.001), peak gadolinium concentration (Cpeak, P < 0.001), upslope (P < 0.001), Fp (portal flow, P = 0.04), total hepatic flow (Ft, P = 0.007), and MTT (mean transit time, P < 0.001). Our preliminary results showed acceptable to good reproducibility for all model-free parameters for both methods (mean coefficient of variation [CV] range, 11.87-23.7%), except for upslope (CV = 37%). Among modeled parameters, DV (distribution volume) had CV <22% with both methods, PV and MTT showed CV <21% and <29% using SPGR equations, respectively. Other modeled parameters had CV >30% with both methods. CONCLUSION: Linearity assumption is acceptable for quantification of model-free hepatic perfusion parameters while the use of SPGR equations and T1 mapping may be recommended for the quantification of modeled hepatic perfusion parameters.

59 Article Diabetes mellitus and advanced liver fibrosis are risk factors for severe anaemia during telaprevir-based triple therapy. 2014

Crismale, James F / Martel-Laferrière, Valérie / Bichoupan, Kian / Schonfeld, Emily / Pappas, Alexis / Wyatt, Christina / Odin, Joseph A / Liu, Lawrence U / Schiano, Thomas D / Perumalswami, Ponni V / Bansal, Meena / Dieterich, Douglas T / Branch, Andrea D. ·Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA. ·Liver Int · Pubmed #24118693.

ABSTRACT: BACKGROUND & AIMS: Adding telaprevir to pegylated-interferon and ribavirin increased both response rates and side effects of hepatitis C virus (HCV) treatment. We identified variables associated with severe anaemia during telaprevir-based triple therapy. METHODS: An observational study was performed on 142 HCV-infected patients between June 2011 and March 2012. All subjects completed 12 weeks of telaprevir-based triple therapy or discontinued early because of anaemia. Severe anaemia was defined by a haemoglobin≤8.9 g/dl; advanced fibrosis was determined by Fib-4≥3.25. RESULTS: The 47 (33%) patients who developed severe anaemia were similar to those who did not in sex, race, and prior response to dual therapy, but they were more likely to have diabetes (23.4% vs. 6.3%, P<0.01), advanced fibrosis (46.8% vs. 29.5%, P=0.04) and a history of anaemia during previous dual therapy (29.7% vs. 11.4%, P=0.02). Patients developing severe anaemia were older (59 vs. 56 years, P=0.02), had lower baseline platelet counts (134 vs. 163×10(9) /L, P=0.04), haemoglobin (14.0 vs. 15.0 g/dl, P<0.01), estimated glomerular filtration rate (79 vs. 90 ml/min/1.73 m2, P=0.03) and a higher median ribavirin/weight ratio (14.9 vs. 13.2 mg/kg, P<0.01). In multivariable logistic regression, presence of diabetes (OR=5.61, 95% CI: 1.59-19.72), Fib-4≥3.25 (OR=3.09, 95% CI: 1.28-7.46), higher ribavirin/weight ratio (OR=1.31 per mg/kg, 95% CI: 1.13-1.52) and lower baseline haemoglobin (OR=0.57 per g/dl, 95% CI, 0.41-0.80) were independently associated with developing severe anaemia. CONCLUSIONS: Severe anaemia occurred in one-third of patients receiving telaprevir-based triple therapy. Risk was greater in patients with diabetes, advanced liver fibrosis, higher ribavirin/weight ratio and lower baseline haemoglobin.

60 Article Hepatitis C screening beyond CDC guidelines in an Egyptian immigrant community. 2014

Perumalswami, Ponni V / DeWolfe Miller, F / Orabee, Hesham / Regab, Amgad / Adams, Mohamed / Kapelusznik, Luciano / Aljibawi, Faozia / Pagano, William / Tong, Virginia / Dieterich, Douglas T. ·Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA. ·Liver Int · Pubmed #23890188.

ABSTRACT: BACKGROUND & AIMS: Many Egyptian-born persons in the U.S. are at high risk of chronic hepatitis C virus (HCV) infection, yet are not aware of their infection and lack healthcare coverage or linkage to care. In this study, we target Egyptian-born persons living in the New York City area for screening and link to care. METHODS: A unique partnership, the Hepatitis Outreach Network (HONE), combines the expertise and resources of the Mount Sinai School of Medicine, the NYC Department of Health and Mental Hygiene and community-based organizations, to provide education, screening and link to care in communities with high prevalence of chronic viral hepatitis. RESULTS: Through four community-based screening events, 192 Egyptian-born persons were screened for HCV. Thirty (15.6%) persons were HCV positive. HCV antibody prevalence in those, whose national origin was Egypt, increased strongly with age and was associated with increasing number of years resident in Egypt and rural residents. Of the 30 Egyptian persons with HCV infection, 18 (60%) received a medical evaluation (2 with local providers and 16 at Mount Sinai). Of the HCV-infected persons evaluated, treatment was recommended in four and begun in three (75%). CONCLUSION: Egyptian-born persons living in the New York City area have a high burden of HCV disease. HONE has successfully established targeted HCV screening in Egyptian-born persons through use of several unique elements that effectively link them to care.

61 Article Evaluation of hepatitis C virus as a risk factor for HIV-associated neuroretinal disorder. 2013

Branch, Andrea D / Drye, Lea T / Van Natta, Mark L / Sezgin, Efe / Fishman, Sarah L / Dieterich, Douglas T / Meinert, Curtis L / Jabs, Douglas A. ·Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. ·Clin Infect Dis · Pubmed #24081683.

ABSTRACT: BACKGROUND: Both hepatitis C virus (HCV) and human immunodeficiency virus (HIV) penetrate the central nervous system. HIV-associated neuroretinal disorder (HIV-NRD), a visual impairment of reduced contrast sensitivity and reading ability, is associated with cytokine dysregulation and genetic polymorphisms in the anti-inflammatory interleukin 10 (IL-10) signaling pathway. We investigated associations between HCV and HIV-NRD and between HCV and single-nucleotide polymorphisms (SNPs) in the IL-10 receptor 1 (IL10R1) gene. METHODS: Logistic and Cox regression analysis were used to analyze risk factors for HIV-NRD in 1576 HIV-positive patients who did not have an ocular opportunistic infection at enrollment. Median follow-up was 4.9 years (interquartile range, 2.4-8.8 years). Four IL10R1 SNPs were examined in a subset of 902 patients. RESULTS: The group included 290 patients with chronic HCV infection, 74 with prior infection, and 1212 with no HCV markers. There were 244 prevalent cases of HIV-NRD and 263 incident cases (rate = 3.9/100 person-years). In models adjusted for demographics, HIV treatment and status, liver function, and immune status, both the prevalence and incidence of HIV-NRD were significantly higher in patients with chronic HCV infection (odds ratio = 1.54; 95% confidence interval [CI], 1.03-2.31 and hazard ratio = 1.62; 95% CI, 1.13-2.34, respectively), compared to patients with no HCV markers. Chronic HCV was associated with rs2228055 and 2 additional IL-10R1 SNPs expected to reduce IL-10 signaling. HIV-NRD was not significantly associated with these SNPs. CONCLUSIONS: HCV is a possible risk factor for HIV-NRD. Genetic analysis suggests that alterations in the IL-10 signaling pathway may increase susceptibility to HIV-NRD and HCV infection. Inflammation may link HCV and HIV-NRD.

62 Article Genetic analysis of interferon induced thyroiditis (IIT): evidence for a key role for MHC and apoptosis related genes and pathways. 2013

Hasham, Alia / Zhang, Weijia / Lotay, Vaneet / Haggerty, Shannon / Stefan, Mihaela / Concepcion, Erlinda / Dieterich, Douglas T / Tomer, Yaron. ·Division of Endocrinology, Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA. ·J Autoimmun · Pubmed #23683877.

ABSTRACT: Autoimmune thyroid diseases (AITD) have become increasingly recognized as a complication of interferon-alpha (IFNα) therapy in patients with chronic Hepatitis C virus (HCV) infection. Interferon-induced thyroiditis (IIT) can manifest as clinical thyroiditis in approximately 15% of HCV patients receiving IFNα and subclinical thyroiditis in up to 40% of patients, possibly resulting in either dose reduction or discontinuation of IFNα treatment. However, the exact mechanisms that lead to the development of IIT are unknown and may include IFNα-mediated immune-recruitment as well as direct toxic effects on thyroid follicular cells. We hypothesized that IIT develops in genetically predisposed individuals whose threshold for developing thyroiditis is lowered by IFNα. Therefore, our aim was to identify the susceptibility genes for IIT. We used a genomic convergence approach combining genetic association data with transcriptome analysis of genes upregulated by IFNα. Integrating results of genetic association, transcriptome data, pathway, and haplotype analyses enabled the identification of 3 putative loci, SP100/110/140 (2q37.1), HLA (6p21.3), and TAP1 (6p21.3) that may be involved in the pathogenesis of IIT. Immune-regulation and apoptosis emerged as the predominant mechanisms underlying the etiology of IIT.

63 Article Hepatitis Outreach Network: a practical strategy for hepatitis screening with linkage to care in foreign-born communities. 2013

Perumalswami, Ponni V / Factor, Stephanie H / Kapelusznik, Luciano / Friedman, Scott L / Pan, Calvin Q / Chang, Charissa / Di Clemente, Frances / Dieterich, Douglas T. ·Division of Liver Diseases, The Mount Sinai Medical Center, Mount Sinai School of Medicine, NY 10029, United States. ponni.perumalswami@mountsinai.org ·J Hepatol · Pubmed #23333446.

ABSTRACT: BACKGROUND & AIMS: Many foreign-born persons in the US are at high risk of chronic hepatitis B (HBV) and C (HCV) infections, yet are not aware of their infection, and lack healthcare coverage or linkage to care. METHODS: A unique partnership, the Hepatitis Outreach Network, combines the expertise and resources of the Mount Sinai School of Medicine, the NYC Department of Health and Mental Hygiene, and community-based organizations, to provide education, screening and link to care in communities with high prevalence of chronic viral hepatitis. Comprehensive HBV and HCV screening identifies infected patients, who then receive further evaluation from either local or Mount Sinai physicians, combined with patient-navigators who organize follow-up visits. RESULTS: Of 1603 persons screened, 76 had HBV and 75 had HCV. Importantly, screening for HCV based on traditional risk factors would have missed 67% of those who tested positive. Of the 76 persons with HCV infection, 49 (64%) received a medical evaluation (26 with local providers and 23 at Mount Sinai). Of the 49 HCV-infected persons evaluated, treatment was recommended in 11 and begun in 8 (73%). Of the 76 persons with HBV infection, 43 (57%) received a medical evaluation (31 with local providers and 12 at Mount Sinai). Of the 43 HBV-infected persons evaluated, treatment was recommended and begun in 5 (100%). CONCLUSIONS: Hepatitis Outreach Network has successfully established novel proof of concept for identifying HBV and HCV infections in foreign-born persons through use of several unique elements that effectively link them to care.

64 Article Rapid progression to decompensated cirrhosis, liver transplant, and death in HIV-infected men after primary hepatitis C virus infection. 2013

Fierer, Daniel S / Dieterich, Douglas T / Fiel, M Isabel / Branch, Andrea D / Marks, Kristen M / Fusco, Dahlene N / Hsu, Ricky / Smith, Davey M / Fierer, Joshua. ·Divisions of Infectious Diseases, Mount Sinai School of Medicine, New York, NY, USA. daniel.fierer@mssm.edu ·Clin Infect Dis · Pubmed #23264364.

ABSTRACT: BACKGROUND: We and others have shown that primary hepatitis C (HCV) infection in men infected with human immunodeficiency virus (HIV) causes early-onset liver fibrosis; however, little is known about the long-term natural history of the liver disease in these HIV-infected men. METHODS: We followed a cohort of HIV-infected men with primary HCV infection in New York City. RESULTS: Four men who were not cured after their primary HCV infection developed decompensated cirrhosis within 17 months to 6 years after primary HCV infection. Three died within 8 years of primary HCV infection, and 1 survived after liver transplant done 2 years after primary HCV infection. Three of the 4 men had AIDS at the time of primary HCV infection, and the most rapid progression occurred in the 2 men with the lowest CD4 counts at the time of HCV infection. Liver histopathology was most consistent with HCV-induced damage even though some had exposures to other potential hepatotoxins. CONCLUSIONS: Primary HCV infection resulted in decompensated cirrhosis and death within 2-8 years in 4 HIV-infected men. The rapid onset of fibrosis due to primary HCV infection in HIV-infected men cannot therefore be considered benign. The rate of continued progression to liver failure may be proportional to the degree of underlying immunocompromise caused by HIV infection. More research is needed to better define the mechanisms behind accelerated liver damage.

65 Article Mortality in hepatitis C virus-infected patients with a diagnosis of AIDS in the era of combination antiretroviral therapy. 2012

Branch, Andrea D / Van Natta, Mark L / Vachon, Marie-Louise / Dieterich, Douglas T / Meinert, Curtis L / Jabs, Douglas A / Anonymous2930724. ·Division of Liver Diseases, Mount Sinai School of Medicine, New York, New York 10029, USA. andrea.branch@mssm.edu ·Clin Infect Dis · Pubmed #22534149.

ABSTRACT: BACKGROUND: Before the introduction of combination antiretroviral therapy (cART), patients infected with the human immunodeficiency virus (HIV) rarely died of liver disease. In resource-rich countries, cART dramatically increased longevity. As patients survived longer, hepatitis C virus (HCV) infection became a leading cause of death; however, because patients with AIDS continue to have 5-fold greater mortality than non-AIDS patients, it is unclear whether HCV infection increases mortality in them. METHODS: In this investigation, which is part of the Longitudinal Studies of the Ocular Complications of AIDS, plasma banked at enrollment from 2025 patients with AIDS as defined by the Centers for Disease Control and Prevention were tested for HCV RNA and antibodies. RESULTS: Three hundred thirty-seven patients had HCV RNA (chronic infection), 91 had HCV antibodies and no HCV RNA (cleared infection), and 1597 had no HCV markers. Median CD4(+) T-cell counts/µL were 200 (chronic), 193 (cleared), and 175 (no markers). There were 558 deaths. At a median follow-up of 6.1 years, patients with chronic HCV had a 50% increased risk of mortality compared with patients with no HCV markers (relative risk [RR], 1.5; 95% confidence interval [CI], 1.2-1.9; P = .001) in an adjusted model that included known risk factors. Mortality was not increased in patients with cleared infection (RR, 0.9; 95% CI, .6-1.5; P = .82). In patients with chronic HCV, 20.4% of deaths were liver related compared with 3.8% in patients without HCV. CONCLUSIONS: Chronic HCV infection is independently associated with a 50% increase in mortality among patients with a diagnosis of AIDS, despite competing risks. Effective HCV treatment may benefit HIV/HCV-coinfected patients with AIDS.

66 Article A sustained virologic response is durable in patients with chronic hepatitis C treated with peginterferon alfa-2a and ribavirin. 2010

Swain, Mark G / Lai, Ming-Yang / Shiffman, Mitchell L / Cooksley, W Graham E / Zeuzem, Stefan / Dieterich, Douglas T / Abergel, Armand / Pessôa, Mário G / Lin, Amy / Tietz, Andreas / Connell, Edward V / Diago, Moisés. ·Health Research Innovation Center, University of Calgary, Calgary, Alberta, Canada. swain@ucalgary.ca ·Gastroenterology · Pubmed #20637202.

ABSTRACT: BACKGROUND & AIMS: A sustained virologic response (SVR) to therapy for hepatitis C virus (HCV) infection is defined as the inability to detect HCV RNA 24 weeks after completion of treatment. Although small studies have reported that the SVR is durable and lasts for long periods, it has not been conclusively shown. METHODS: The durability of treatment responses was examined in patients originally enrolled in one of 9 randomized multicenter trials (n = 1343). The study included patients who received pegylated interferon (peginterferon) alfa-2a alone (n = 166) or in combination with ribavirin (n = 1077, including 79 patients with normal alanine aminotransferase levels and 100 patients who were coinfected with human immunodeficiency virus and HCV) and whose serum samples were negative for HCV RNA (<50 IU/mL) at their final assessment. Patients were assessed annually, from the date of last treatment, for a mean of 3.9 years (range, 0.8-7.1 years). RESULTS: Most patients (99.1%) who achieved an SVR had undetectable levels of HCV RNA in serum samples throughout the follow-up period. Serum samples from 0.9% of the patients contained HCV RNA a mean of 1.8 years (range, 1.1-2.9 years) after treatment ended. It is not clear if these patients were reinfected or experienced a relapse. CONCLUSIONS: In a large cohort of patients monitored for the durability of an SVR, the SVR was maintained for almost 4 years after treatment with peginterferon alfa-2a alone or in combination with ribavirin. In patients with chronic hepatitis C infection, the SVR is durable and these patients should be considered as cured.

67 Minor Trends in Liver Transplantation in Hepatitis C Virus-Infected Persons, United States. 2016

Perumpail, Ryan B / Wong, Robert J / Liu, Andy / Jayasekera, Channa R / Dieterich, Douglas T / Younossi, Zobair M / Ahmed, Aijaz. · ·Emerg Infect Dis · Pubmed #26889625.

ABSTRACT: -- No abstract --

68 Minor Telaprevir activity in treatment-naive patients infected with hepatitis C virus genotype 4. 2014

Sefcik, Roberta K / Bichoupan, Kian / Martel-Laferrière, Valérie / Odin, Joseph A / Liu, Lawrence U / Perumalswami, Ponni / Bansal, Meena / Dieterich, Douglas T / Ahmad, Jawad / Schiano, Thomas D / Branch, Andrea D. ·Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York. ·J Infect Dis · Pubmed #24970848.

ABSTRACT: -- No abstract --

69 Minor Septic bursitis, a potential complication of protease inhibitor use in hepatitis C virus. 2013

Burke, Caitlin C / Martel-Laferriere, Valerie / Dieterich, Douglas T. · ·Clin Infect Dis · Pubmed #23413416.

ABSTRACT: -- No abstract --

70 Minor Successful desensitization to ribavirin in a patient with chronic hepatitis C. 2012

Ladd, Antonio Mendoza / Martel-Laferriere, Valerie / Dieterich, Douglas. · ·J Clin Gastroenterol · Pubmed #22739224.

ABSTRACT: -- No abstract --

71 Minor Early-onset liver fibrosis due to primary hepatitis C virus infection is higher over time in HIV-infected men. 2012

Fierer, Daniel S / Mullen, Michael P / Dieterich, Douglas T / Isabel Fiel, M / Branch, Andrea D. · ·Clin Infect Dis · Pubmed #22677713.

ABSTRACT: -- No abstract --

72 Minor The critical role of medication adherence in the success of boceprevir and telaprevir in clinical practice. 2012

Weiss, Jeffrey J / Alcorn, Marlene C / Rabkin, Judith G / Dieterich, Douglas T. · ·J Hepatol · Pubmed #21718669.

ABSTRACT: -- No abstract --