Programs that give injection drug users clean needles or safer drug substitutes may help cut their odds of contracting the liver infection hepatitis C, a new study suggests.
The hepatitis C virus is passed through contact with infected blood. Health care workers are particularly vulnerable, as are people who get tattoos in unclean environments. But in the U.S., most of the roughly 18,000 new infections each year occur when people who inject opiates, like heroin, share tainted needles or syringes.
Studies have found that clean-needle programs do reduce needle-sharing, and they seem to curb drug users' risk of infection with HIV, the virus that causes AIDS. The same appears true of programs that get addicts into treatment with opiate "substitutes" like methadone, which is taken orally instead of injected.
But there has been little evidence that these programs help cut the spread of hepatitis C.
A problem with the hepatitis C virus is that it's much easier to transmit than HIV. Even a faint amount of blood on a shared needle, for example, might be enough to infect another person.
But the new findings, published in the journal Addiction, suggest that needle and opiate-substitution programs can make a difference in hepatitis C risk, according to senior researcher Matthew Hickman, a professor of public health at the University of Bristol in the UK.
Combining the results from six previous studies of UK programs, Hickman's team found that drug users with the highest "coverage" from clean-needle programs were about half as likely to contract hepatitis C as other users.
Among users who said they got enough clean needles to cover all of their injections, just under 4 percent tested positive for hepatitis C during the studies, which lasted up to a year. That compared with 7 percent of drug users who didn't get clean needles for all their injections.
Similarly, the rate of new hepatitis C infection was 3 percent among drug users who were currently taking an opiate substitute (usually oral methadone), versus 7 percent among those not on treatment.
Drug users participating in both types of programs fared best of all, with a new infection rate of 2 percent.
"The implication is that hepatitis C transmission can be reduced by opiate substitution therapy and needle and syringe programs, especially their combination," Hickman told Reuters Health in an email.
While the study looked only at UK programs, it's likely the results would be similar in other countries, he said.
The study has its limits. It combined the results of several observational studies, where researchers "observed" groups of injection drug users who chose to use or not use the needle and opiate substitution programs.
Leaving the choice to the individual makes it hard to show that the programs are what caused hepatitis C infection rates to go down. There may be other differences between people who used the programs and those who didn't that would explain the results.
The findings are also based on small numbers, Hickman's team points out. The researchers had usable information on 919 program participants across the six study sites, and there were 40 cases of new hepatitis C infection.
Still, Hickman said the study starts to fill a gap in the knowledge of how well injection drug use programs are working.
In the U.S., new cases of hepatitis C infection have fallen sharply since the 1980s, according to Centers for Disease Control and Prevention. In the early 1990s, doctors found a way to detect the virus in blood, which meant they could make sure it wasn't transmitted in blood transfusions.
But chronic hepatitis C infection, the agency says, remains a major public health problem.
Between 75 and 85 percent of people infected with hepatitis C develop chronic infection, which can eventually cause serious liver diseases like cirrhosis (scarring of the liver) and liver cancer. Hepatitis C presently accounts for about a third of the liver transplants done in the U.S. each year.
An estimated 3.2 million Americans have chronic hepatitis C, about half of whom are unaware of it. (The initial infection most often causes no symptoms.)
There are medications for treating chronic hepatitis C, although they are not effective for everyone and have side effects like fatigue, nausea, headache and sleep problems.
According to Hickman, one question for future studies is whether treating chronic hepatitis C in injection drug users helps reduce transmission.
2011年6月29日星期三
2011年5月22日星期日
Patients urged to test for infections after Chambersburg urology practice admits reusing instruments
Patients of a Chambersburg urology practice recently received a potentially unsettling letter, advising them to get tested for HIV and hepatitis because reused instruments had been used for their prostate biopsies.
Medical and legal experts say reusing biopsy needles is not recommended for several reasons, and that Urology Associates of Chambersburg could now face a range of legal repercussions.
While the risk of infection is statistically very low, experts advise that every man who received a letter should be tested. The tests are being conducted at Chambersburg Hospital and paid for by the urology practice.
A 68-year-old Chambersburg area man told Public Opinion that he received his letter in the past week and went in for the blood work Friday. Due to the potentially sensitive nature of his situation, Public Opinion agreed to keep him anonymous.
He had his biopsy done about four years ago by Dr. Christopher Klinko. While the procedure was typically less than comfortable, he was pleased with the doctor's care and said everything seemed to be done very professionally.
"Everything looked very sterile and clean, very efficient," he said.
When he received the letter, Klinko's patient wasn't too concerned at first. His wife convinced him to go for the test. A phlebotomist at the hospital told him there have been a significant number of other men getting the same test done in recent weeks.
"I hadn't given it much thought. My feeling
Quantcast was, with the time that elapsed, something would have shown up already," he said. "Then I realized it could take a long time for HIV to show up."
Dr. Jay Raman, a urological surgeon and assistant professor of surgery at Penn State Hershey Medical Center, said in some cases it takes between seven and 10 years for HIV to become apparent in an infected person. Symptoms of hepatitis typically appear within two to four years after initial infection.
"The most aggressive strains will show up early, but being asymptomatic does not mean you're in the clear," Raman said.
According to the letter sent to Urology Associates' patients, the practice used biopsy needles and guides that are labeled "single use only."
"We have recently discovered that some prostate biopsy instruments were reprocessed using a detergent scrub, sterilized and then re-used in our office," the letter states. "Corrective action was immediately taken and instrument reprocessing has been terminated."
Raman explained that an ultrasound probe and a tubular device called a cannula used in the procedure are not disposable. They are disinfected and sterilized after each use in a special liquid formulated to kill bacteria.
Since biopsy needles or "needle guns" actually pierce the patient's rectal wall and the prostate to collect tissue samples, they should not be reused, he said. At his hospital, the needles are immediately placed in a "sharps" container and disposed of as biohazardous waste.
Raman said chemical sterilization is "more than adequate to kill all conventional bacteria," but HIV and hepatitis are considered "more hardy viral agents." He was unable to provide a statistical likelihood of patients being infected by "reprocessed" instruments, but said it is a very low.
His personal risk of contracting hepatitis if he is accidentally stuck with a bloody needle during surgery is about 1 in 500,000, Raman said. The risk of catching HIV the same way is about 1 in a million.
Add to those long odds the fact that the needles at Urology Associates went through some form of sterilization, and the likelihood of infection becomes quite rare. Still, Raman recommends getting tested to anyone who received a letter.
"If it was me, I would. I think the risk is overall very low, but certainly it's higher than zero," he said. "In that case, I think it's worthwhile to be better safe than sorry."
There is another reason why reusing biopsy needles is not a very good idea, Raman said. Each use would make the device a little less sharp. Performing biopsies with a blunt needle decreases the procedure's accuracy and increases the risk of complications.
He said this is the first case of reused biopsy needles that he has heard of. Asked why any medical practice might do such a thing, he suggested that saving money was probably the motivating factor.
According to the website for a medical supply company based in New Jersey, urological biopsy needles range in price from about $100 to $240 for a box of 10. The instruments are typically 1-2 millimeters in diameter and 10-15 centimeters long, Raman said.
Public Opinion was unable to determine how many patients received letters from Urology Associates. A receptionist answering the phone at the office said the doctors are declining to comment on the matter.
According to their letter, Klinko and Dr. Louis Glass are practicing urology at the office on Fifth Avenue in Chambersburg. Some patients told Public Opinion they had been treated there in the past by Dr. William Haren, who apparently no longer works there.
A fourth urologist, Dr. Kambiz Tajkarimi, reportedly left Urology Associates earlier this year. He is now practicing exclusively with Summit Health, which operates hospitals in Chambersburg and Waynesboro, according to the organization's spokesperson, Jessica Walter.
After Glass and Klinko sent their letter, Tajkarimi mailed a letter to about 800 of his own former Urology Associates patients on May 11.
"I had no knowledge of the conduct described in that letter and resigned from employment with the practice when I learned of this matter," his letter states.
Medical and legal experts say reusing biopsy needles is not recommended for several reasons, and that Urology Associates of Chambersburg could now face a range of legal repercussions.
While the risk of infection is statistically very low, experts advise that every man who received a letter should be tested. The tests are being conducted at Chambersburg Hospital and paid for by the urology practice.
A 68-year-old Chambersburg area man told Public Opinion that he received his letter in the past week and went in for the blood work Friday. Due to the potentially sensitive nature of his situation, Public Opinion agreed to keep him anonymous.
He had his biopsy done about four years ago by Dr. Christopher Klinko. While the procedure was typically less than comfortable, he was pleased with the doctor's care and said everything seemed to be done very professionally.
"Everything looked very sterile and clean, very efficient," he said.
When he received the letter, Klinko's patient wasn't too concerned at first. His wife convinced him to go for the test. A phlebotomist at the hospital told him there have been a significant number of other men getting the same test done in recent weeks.
"I hadn't given it much thought. My feeling
Quantcast was, with the time that elapsed, something would have shown up already," he said. "Then I realized it could take a long time for HIV to show up."
Dr. Jay Raman, a urological surgeon and assistant professor of surgery at Penn State Hershey Medical Center, said in some cases it takes between seven and 10 years for HIV to become apparent in an infected person. Symptoms of hepatitis typically appear within two to four years after initial infection.
"The most aggressive strains will show up early, but being asymptomatic does not mean you're in the clear," Raman said.
According to the letter sent to Urology Associates' patients, the practice used biopsy needles and guides that are labeled "single use only."
"We have recently discovered that some prostate biopsy instruments were reprocessed using a detergent scrub, sterilized and then re-used in our office," the letter states. "Corrective action was immediately taken and instrument reprocessing has been terminated."
Raman explained that an ultrasound probe and a tubular device called a cannula used in the procedure are not disposable. They are disinfected and sterilized after each use in a special liquid formulated to kill bacteria.
Since biopsy needles or "needle guns" actually pierce the patient's rectal wall and the prostate to collect tissue samples, they should not be reused, he said. At his hospital, the needles are immediately placed in a "sharps" container and disposed of as biohazardous waste.
Raman said chemical sterilization is "more than adequate to kill all conventional bacteria," but HIV and hepatitis are considered "more hardy viral agents." He was unable to provide a statistical likelihood of patients being infected by "reprocessed" instruments, but said it is a very low.
His personal risk of contracting hepatitis if he is accidentally stuck with a bloody needle during surgery is about 1 in 500,000, Raman said. The risk of catching HIV the same way is about 1 in a million.
Add to those long odds the fact that the needles at Urology Associates went through some form of sterilization, and the likelihood of infection becomes quite rare. Still, Raman recommends getting tested to anyone who received a letter.
"If it was me, I would. I think the risk is overall very low, but certainly it's higher than zero," he said. "In that case, I think it's worthwhile to be better safe than sorry."
There is another reason why reusing biopsy needles is not a very good idea, Raman said. Each use would make the device a little less sharp. Performing biopsies with a blunt needle decreases the procedure's accuracy and increases the risk of complications.
He said this is the first case of reused biopsy needles that he has heard of. Asked why any medical practice might do such a thing, he suggested that saving money was probably the motivating factor.
According to the website for a medical supply company based in New Jersey, urological biopsy needles range in price from about $100 to $240 for a box of 10. The instruments are typically 1-2 millimeters in diameter and 10-15 centimeters long, Raman said.
Public Opinion was unable to determine how many patients received letters from Urology Associates. A receptionist answering the phone at the office said the doctors are declining to comment on the matter.
According to their letter, Klinko and Dr. Louis Glass are practicing urology at the office on Fifth Avenue in Chambersburg. Some patients told Public Opinion they had been treated there in the past by Dr. William Haren, who apparently no longer works there.
A fourth urologist, Dr. Kambiz Tajkarimi, reportedly left Urology Associates earlier this year. He is now practicing exclusively with Summit Health, which operates hospitals in Chambersburg and Waynesboro, according to the organization's spokesperson, Jessica Walter.
After Glass and Klinko sent their letter, Tajkarimi mailed a letter to about 800 of his own former Urology Associates patients on May 11.
"I had no knowledge of the conduct described in that letter and resigned from employment with the practice when I learned of this matter," his letter states.
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