Hepatitis C and Injection Drug Use: Testing and Linkage to Care

Background: The recent outbreak of HIV infection in Indiana linked to injection drug use demonstrates the importance of timely HIV and Hepatitis C surveillance and rapid response to interrupt disease transmission. An estimated 2.7 – 3.9 million Americans have chronic hepatitis C virus (HCV) infection. Of those, 50 – 70% are unaware of their infection. People who inject drugs account for more than half of new HCV cases. Within 5 years of beginning injection drug use, 50 – 80% of injection drug users (IDUs) become infected with HCV. Since 2007, HCV-related deaths have surpassed HIV-related deaths. CDC reported 19,368 death certificates listing HCV as a cause of death in 2013, adding that this figure represents a fraction of deaths attributable to HCV. Method: Imagine Hope, supported by a grant from a pharmaceutical company, initiated HCV rapid testing in April 2015. The Georgia-wide project includes 10 agencies serving substance-using populations, including 4 methadone clinics. The project offers free, routine HCV testing and linkage to care. Results: Over the first 12 months of testing, 3,226 clients received HCV antibody testing. Of those, 344 (10.7%) were HCV antibody positive (Ab+), with 186 completing confirmatory RNA testing. Confirmatory tests yielded 132 (71%) RNA positive cases; 56 (42.4%) of these were linked to care. Five clients have achieved sustained viral load suppression which is considered a cure for hepatitis C. Numerous others have begun direct acting antiviral regimens. Conclusion: HCV testing in substance abuse facilities is feasible. Among substance users, HCV prevalence is high and awareness of infection risk is low. Linkage to care is enhanced by the use of a navigator. RNA screening prior to the 1st medical appointment expedites linkage to care; RNA positive clients are more motivated to keep appointments and RNA negative clients do not clog an already burdened system of care for the uninsured

Characterization of four cell lines persistently infected with measles virus

Persistently infected cell lines were established by infecting Vero cells with four different strains of measles virus: Edmonston “wild type”, Schwarz vaccine strain passaged at high multiplicity of infection, Hallé SSPE strain, and a temperature sensitive mutant of Edmonston strain, designated ts 841. The four cell lines have continued to produce virus at a constant low level over a period of more than two years, although cytopathology and hemagglutinating ability have varied with cell passage. Only virus from cells originally infected with ts 841 appears to be temperature sensitive. In each of the cell lines a sizable population of low density, interfering virus particles was generated, indicating that this is an important mechanism for these four cell lines in maintenance of the measles virus persistent infection.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41690/1/705_2005_Article_BF01314863.pd

‘This In-Between’: How Families Talk about Death in Relation to Severe Brain Injury and Disorders of Consciousness

These comments encapsulate some common themes in how people describe having a severely brain-injured relative in a coma-like condition, medically known as a ‘disorder of consciousness’. In the past it was highly unusual for such individuals to survive very long after the initial trauma that caused their injury. However, the emergence of modern medical technologies, and how they are deployed, has led to the creation of new long-term conditions including the ‘vegetative state’ (in which the patient shows no awareness at all) and the ‘minimally conscious state’ (in which the the patient displays some intermittent and minimal awareness). These conditions are modern phenomena — the vegetative diagnostic category was first created in the early 1970s (Jennett and Plum, 1972) and the ‘minimally conscious state’ [MCS] was only defined in 2002 (Giacino et al., 2002). Patients with disorders of consciousness disrupt previous ways of understanding life. The family may experience their vegetative or minimally conscious relative as ‘present but absent’, ‘living, but dead’, making comments such as ‘this is no life’ and ‘my son is gone’ — and experiencing a sense of loss and grief that may be ‘like a death’, although not a death