Publications by authors named "David Iser"
Article Synopsis
- Prisons in Victoria, Australia, have implemented a statewide nurse-led model of care since 2015 to enhance hepatitis C testing and treatment among inmates, crucial for elimination efforts.
- From 2015 to 2021, 3,133 DAA treatment courses were prescribed to 2,768 inmates, with a significant increase in prescriptions over the years and a median age of treated individuals being 39.
- The program achieved a 93% success rate in sustained viral response (SVR12), demonstrating the effectiveness of decentralized, nurse-led initiatives in tackling hepatitis C in high-prevalence settings like prisons.
Background & Aims: Short duration treatment may aid HCV elimination among key populations. This study evaluated the efficacy of glecaprevir-pibrentasvir for 4 weeks among people with recent HCV infection.
Methods: In this single-arm multicentre international trial, adults with recent HCV (duration of infection <12 months) received glecaprevir-pibrentasvir 300 mg-120 mg daily for 4 weeks.
Background: Despite subsidised access to direct-acting antivirals (DAAs), hepatitis C (HCV) treatment uptake in Australia is declining. Interventions are needed to link people living with HCV to care and treatment. We implemented and measured effectiveness of a state-wide, health department-led, enhanced case management through the primary care practitioner for all HCV notifications, aiming to encourage and support treatment commencement.
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- People in prison can get treated for hepatitis C, but many don't receive treatment before they are released.
- * When they get out, they have a lot of other important things to deal with, so they often miss out on getting help for hepatitis C.
- * A study showed that having a care navigator helped more people get their hepatitis C medicine soon after leaving prison compared to just the usual care.
Background: Hepatitis C virus (HCV) reinfection after successful treatment may reduce the benefits of cure among people who inject drugs.
Objective: To evaluate the rate of HCV reinfection for 3 years after successful treatment among people receiving opioid agonist therapy (OAT).
Design: A 3-year, long-term, extension study of persons enrolled in the CO-STAR (Hepatitis C Patients on Opioid Substitution Therapy Antiviral Response) study (ClinicalTrials.
Background: In people with chronic hepatitis C virus (HCV) infection, viral eradication is associated with improved health-related quality of life (HRQOL).
Objective: To assess changes in HRQOL among participants receiving opioid agonist therapy undergoing treatment for HCV infection.
Methods: COSTAR (NCT02251990) was a randomized, double-blind, placebo-controlled study.
Virological failure occurs in a small proportion of people treated for hepatitis C virus (HCV) with direct-acting antiviral (DAA) therapies. This study assessed retreatment for virological failure in a large real-world cohort. REACH-C is an Australian observational study (n=10843) evaluating treatment outcomes of sequential DAA initiations across 33 health services between March 2016 to June 2019.
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- Australia aims to eliminate hepatitis C (HCV) as a public health threat by subsidizing direct acting antivirals (DAAs), but uptake has declined, necessitating new engagement strategies for affected individuals.
- The study involves a randomized controlled trial that contrasts enhanced case management of HCV notifications by health specialists with standard care, assessing the support needs of general practitioners (GPs) using a structured complexity model.
- The primary goal is to measure the proportion of HCV cases starting DAAs within 12 weeks post-notification, along with tracking secondary outcomes like completion of testing and treatment, while ensuring ethical compliance under the university's oversight.
Introduction: The prevalence of hepatitis B virus (HBV) infection in Australia is nearly 1%. In certain well defined groups the prevalence is far greater, yet an estimated 27% of people living with HBV infection remain undiagnosed. Appropriate screening improves detection, increases opportunity for treatment, and ultimately reduces the significant morbidity and mortality associated with the development of liver fibrosis and hepatocellular carcinoma (HCC).
View Article and Find Full Text PDFBackground: Hepatitis C virus (HCV) treatment through primary care and community-based services will be a critical component of HCV elimination. We evaluated a nurse-coordinated programme providing care across eight sites and analysed progression through the HCV care cascade.
Methods: People-accessing services from six primary care clinics, a homeless crisis accommodation provider and a mental health service were directly referred to nurses or engaged by nurses during regular clinic visits.
Australia was one of the first countries with unrestricted access to government subsidized direct-acting antiviral (DAA) therapy for adults with chronic hepatitis C virus. This study assessed real-world DAA treatment outcomes across a diverse range of Australian clinical services and evaluated factors associated with successful treatment and loss to follow-up. Real-world Effectiveness of Antiviral therapy in Chronic Hepatitis C (REACH-C) consisted a national observational cohort of 96 clinical services including specialist clinics and less traditional settings such as general practice.
View Article and Find Full Text PDFBackground: Direct acting antiviral (DAA) therapy is highly effective for hepatitis C virus (HCV) infection, but reinfection following treatment may compromise benefits of cure. This study assessed the real-world effectiveness of treatment for reinfection.
Methods: Real-world effectiveness of antiviral therapy in chronic hepatitis C (REACH-C) is an observational study evaluating treatment outcomes following sequential DAA initiations across 33 health services in Australia between March 2016-June 2019.
An estimated 18% of people living with chronic hepatitis B (CHB) in Australia were born in China. While guideline-based care, including regular clinical monitoring and timely treatment, prevent CHB-related cirrhosis, cancer and deaths, over three-quarters of people with CHB do not receive guideline-based care in Australia. This qualitative study aimed to identify enablers to engagement in CHB clinical management among ethnic Chinese people attending specialist care.
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- Low treatment rates for Hepatitis C (HCV) in prisons are due to barriers like the need for testing methods to determine cirrhosis.
- A study analyzed two scoring systems, APRI and FIB-4, in a large group of prisoners to see how effectively they could indicate the absence of cirrhosis compared to the standard transient elastography.
- Results showed that both scores had high negative predictive values, suggesting they could reduce the need for more invasive tests by about 71%, thus streamlining care for incarcerated individuals with HCV.
Background: Gay and bisexual men (GBM) are a key population affected by human immunodeficiency virus (HIV) and hepatitis C virus (HCV) coinfection. We aimed to measure HCV treatment effectiveness and to determine the population impact of treatment scale-up on HCV prevalence and incidence longitudinally among GBM.
Methods: The co-EC Study (Enhancing Care and Treatment Among HCV/HIV Coinfected Individuals to Eliminate Hepatitis C Transmission) was an implementation trial providing HCV direct-acting antiviral treatment in Melbourne, Australia, during 2016-2018.
The Impact of Markers of HIV Infection on Change in Liver Stiffness in People With HIV and Hepatitis C Virus Co-infection After Treatment and Cure of Hepatitis C.
J Acquir Immune Defic Syndr
December 2020
Background: Markers of HIV disease severity are associated with increased liver fibrosis in HIV/Hepatitis C virus (HCV) co-infected individuals. HCV treatment may reverse liver fibrosis, but evidence among HIV/HCV-co-infected populations and the impact of HIV parameters on fibrosis regression is limited. We aimed to assess the influence of surrogate markers of HIV-infection and other determinants of liver stiffness before HCV treatment and changes after HCV cure in people living with HIV.
View Article and Find Full Text PDFIntroduction: Despite highly effective direct-acting antiviral (DAA) therapies for chronic hepatitis C virus (HCV) infection, some patients experience virological relapse. Salvage regimens should include multiple agents to suppress emergence of resistance-associated substitutions (RAS) and minimise treatment failure. The combination of sofosbuvir (SOF) and elbasvir/grazoprevir (ELB/GZR) ±ribavirin (RBV) is an effective retreatment strategy for HCV genotype (GT)1 and 4 infection.
View Article and Find Full Text PDFBackground: To achieve the World Health Organization hepatitis C virus (HCV) elimination targets, it is essential to increase access to direct-acting antivirals (DAAs), especially among people who inject drugs (PWID). We aimed to determine the effectiveness of providing DAAs in primary care, compared with hospital-based specialist care.
Methods: We randomized PWID with HCV attending primary care sites in Australia or New Zealand to receive DAAs at their primary care site or local hospital (standard of care [SOC]).
Background & Aims: Treatment programs for people who inject drugs (PWID), including prisoners, are important for achieving hepatitis C elimination targets. There are multiple barriers to treatment of hepatitis C in prisons, including access to specialist physicians, testing and antiviral therapy, short prison sentences, and frequent inter-prison transfer. We aimed to assess the effectiveness of a nurse-led model of care for the treatment of prisoners with hepatitis C.
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- Researchers wanted to see how liver health changed over 10 years in people with chronic hepatitis C, especially those who had treatment that worked (SVR).
- They looked at 131 patients, many of whom had their liver checked twice: once before 2004 and then again over a decade later.
- The study found that while some patients who achieved SVR maintained their liver health, more people overall developed serious liver issues over time.
Article Synopsis
- The study focuses on how hepcidin and ferroportin work together in the body and how this affects iron-related health problems.
- Researchers created special tools to better understand how a new mutation in ferroportin affects its ability to move iron in cells.
- Findings show that the mutation disrupts normal iron transport and that the new tools can help improve treatments for iron-related diseases.
Background: Limited data exist on the outcomes of ritonavir-boosted paritaprevir with ombitasvir and dasabuvir (PrOD) ± ribavirin in a real-world setting. The aim of this study was to compare the efficacy and safety of PrOD-based therapy in hepatitis C genotype 1 patients with and without cirrhosis, and to explore pre-treatment factors predictive of sustained viral response (SVR) and serious adverse events (SAEs) on treatment.
Methods: 451 patients with hepatitis C genotype 1 treated in 20 centres across Australia were included.