Transplantation followed by antiviral therapy cured hepatitis C

August 06, 2018

1. Transplantation followed by antiviral therapy cured hepatitis C in 100 percent of patients receiving kidneys from infected donors

Abstract: http://annals.org/aim/article/doi/10.7326/M18-0749

Editorial: http://annals.org/aim/article/doi/10.7326/M18-1781

URLs go live when the embargo lifts

Twenty patients who received kidneys transplanted from hepatitis C virus (HCV)-infected donors experienced HCV cure, good quality of life, and excellent renal function at one year. These findings offer additional evidence that kidneys from HCV-infected donors may be a valuable transplant resource. Results from the single-group trial are published in Annals of Internal Medicine.

Organs from HCV-infected deceased donors are often discarded. However, preliminary data from two small trials suggest that HCV-infected kidneys could be safely transplanted into HCV-negative patients.

Researchers from Penn Medicine report 12-month HCV treatment outcomes, estimated glomerular filtration rate, and quality of life for 10 kidney recipients in the THINKER-1 (Transplanting Hepatitis C kidneys Into Negative KidnEy Recipients) trial, and 6-month data on 10 additional recipients. All of the participants underwent lifesaving transplant with kidneys infected with genotype 1 HCV and received antiviral therapy on day 3 after transplantation. The 20 recipients achieved a 100 percent cure rate, excellent renal function, and stable to improved quality of life.

According to the researchers, these findings suggest that kidneys from HCV-infected donors may represent an important opportunity to expand the donor pool. Patients without HCV should be well-informed about the benefits and risks so that they may engage in shared decision-making.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, Peter P. Reese, MD, MSCE, please contact Abbey Anderson Hunton at Abbey.Anderson@uphs.upenn.edu.

2. Women internists earn less than men whether they are generalists, hospitalists, or sub-specialists
ACP Research Report Calls for Gender Equity in Physician Compensation and Career Advancement

Abstract: http://annals.org/aim/article/doi/10.7326/M18-0693

Editorial: http://annals.org/aim/article/doi/10.7326/M18-1879

URLs go live when the embargo lifts

Women internists earn less than men whether they are generalists, hospitalists, or subspecialists. Factors that contribute to disparities in compensation may include choice of occupation, time taken away from work due to family obligations, gender discrimination, and productivity levels. A brief research report from the American College of Physicians (ACP) is published in Annals of Internal Medicine.

Women comprise over one third of the active U.S. physician workforce, an estimated 46 percent of all physicians-in-training, and more than half of all medical students. Despite progress toward gender diversity in the U.S. physician workforce, disparities in compensation and career advancement persist.

Researchers for ACP conducted a cross-sectional survey of a nationally representative panel of ACP nonstudent members in the U.S. to describe physician compensation by gender. They found that female internists earn less than their male counterparts. The disparities existed even when controlling for specialty, number of hours worked, and practice characteristics. Median annual salary for men was on average $50,000 higher than women--with females earning 80 cents for every dollar earned by men. Further, the data highlighted that female physicians earned less than men in every specialty, ranging from a salary difference of $29,000 for internal medicine specialists to $45,000 for subspecialists.

According to the authors, this research is a step forward in ensuring that physicians are compensated equally and fairly at all stages of their professional careers in accordance with their skills, knowledge, competencies, and expertise regardless of their characteristics or gender.

Promoting gender equity and eliminating the inequities in compensation physicians can face is a longstanding goal of ACP. In April, the College published a paper, Achieving Gender Equity in Physician Compensation and Career Advancement, in the Annals of Internal Medicine calling for the adoption of equitable compensation policies in all organizations that employ physicians, investment in leadership development, negotiation and career development programs, and parental and family leave policies.

Media contact: For an embargoed PDF or to speak with an author from ACP, please contact Julie Hirschhorn at jhirschhorn@acponline.org.

3. Bariatric surgery linked to significant reduction in microvascular complications of type 2 diabetes

Abstract: http://annals.org/aim/article/doi/10.7326/M17-2383

URLs go live when the embargo lifts

Compared with usual care, bariatric surgery was associated with half the incidence of microvascular disease at 5 years for adults with type 2 diabetes. These findings add to a growing body of evidence suggesting that bariatric surgery not only improves glucose, blood pressure, and lipid control, but is likely to reduce macrovascular and microvascular complications, as well as improve survival in patients with severe obesity and type 2 diabetes. Results from a matched cohort study are published in Annals of Internal Medicine.

Research has shown that about half of people with diabetes and severe obesity who get bariatric surgery maintain long-term glucose control without medication. But for many patients, avoiding microvascular complications affecting the nerves of the feet and hands (neuropathy), the kidneys (nephropathy), and the eyes (retinopathy) is of greater concern.

Researchers from Kaiser Permanente Washington Health Research Institute studied more than 4,000 obese patients with type 2 diabetes who underwent bariatric surgery to determine its effect on microvascular complications. They found that the risk of all microvascular complications at 5 years after surgery was less than half that of a matched control group of more than 11,000 obese patients who received usual medical care for their diabetes that did not include surgery. Overall, bariatric surgery was associated with a two-thirds decrease in neuropathy, one-half decrease in nephropathy, and one-third decrease in retinopathy.

According to the researchers, these results suggest that everyone with diabetes and severe obesity should have a conversation with their doctor about whether bariatric surgery is a reasonable treatment option for them, weighing the risks and benefits.

Media contact: For an embargoed PDF or author contact information, please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, David Arterburn, MD, MPH, please contact Rebecca Hughes at Rebecca.F.Hughes@kp.org.

4. Patient characteristics an important factor in determining optimal blood pressure target
Clinicians go 'Beyond the Guidelines' to debate treatment for an elderly patient who does not fit neatly within parameters of current guidelines

Abstract: http://annals.org/aim/article/doi/10.7326/M18-1312

URLs go live when the embargo lifts

Current guidelines differ on the optimum threshold above which to begin antihypertensive therapy and what the target blood pressure should be after treatment has begun. A primary care physician and a gerontologist, both from Beth Israel Deaconess Medical Center (BIDMC), debate care for an elderly patient with hypertension in a multicomponent educational article being published in Annals of Internal Medicine.

Hypertension is prevalent and the most important risk factor for cardiovascular disease. Guidelines from the American College of Physicians/American Academy of Family Physicians recommend initiating antihypertensive therapy for patients aged 60 or older if systolic blood pressure is 150 mm Hg or higher and to treat to the same target. However, they recommend a lower threshold for high-risk patients and these patients should begin therapy at 140 mm Hg. The American College of Cardiology/American Heart Association guideline, which is based largely on SPRINT (Systolic Blood Pressure Intervention Trial), advises a target systolic blood pressure of 130 mm Hg for patients 65 years or older.

In a recent BIDMC Grand Rounds, two experts debated care for a 79-year-old man with a mean blood pressure value of 157/68 over 2 years of readings. The patient was overweight with some comorbidities, but felt that he was in relatively good health. The patient reported than in the past he had taken a blood pressure medication and did not tolerate it well. Internist Jennifer Beach, MD, and gerontologist Lewis Lipsitz, MD, both considered the patient's diagnosis, comorbidities, and cardiovascular risk factors before suggesting a target blood pressure and treatment strategy. Dr. Beach recommended a target blood pressure below 140 mm Hg, considering the patient's risk for adverse events. However, Dr. Lipsitz felt that the patient's risk for cardiovascular disease warranted a lower blood pressure target of 130 mm Hg. Both Dr. Beach and Dr. Lipsitz agreed that if treatment were needed, an ACE inhibitor or ARB should be the first line therapy.

All 'Beyond the Guidelines' papers are based on the Department of Medicine Grand Rounds at BIDMC in Boston and include print, video, and educational components. A list of topics is available at http://www.annals.org/grandrounds.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To speak with someone regarding BIDMC Beyond the Guidelines, please contact Jennifer Kritz at jkritz@bidmc.harvard.edu.

Also new in this issue:

Value-Based Health Care Meets Cost-Effectiveness Analysis

Joel Tsevat, MD, MPH, and Christopher Moriates, MD

Medicine and Public Issues

Abstract: http://annals.org/aim/article/doi/10.7326/M18-0342
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American College of Physicians

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