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Masood U, Venturini N, Nicoletti P, Dellinger A, Kleiner D, Bonkovsky HL, Barnhart H, Vuppalanchi R, Rossi S, Odin JA, Kushner T. Drug-Induced Liver Injury in Pregnancy: The U.S. Drug-Induced Liver Injury Network Experience. Obstet Gynecol 2024:00006250-990000000-01056. [PMID: 38626448 DOI: 10.1097/aog.0000000000005585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/14/2024] [Indexed: 04/18/2024]
Abstract
There are limited data on the causative agents and characteristics of drug-induced liver injury in pregnant individuals. Data from patients with drug-induced liver injury enrolled in the ongoing multicenter Drug-Induced Liver Injury Network between 2004 and 2022 and occurring during pregnancy or 6 months postpartum were reviewed and compared with cases of drug-induced liver injury in nonpregnant women of childbearing age. Among 325 individuals of childbearing age in the Drug-Induced Liver Injury Network, 16 cases of drug-induced liver injury (5%) occurred during pregnancy or postpartum. Compared with drug-induced liver injury in nonpregnant women, pregnancy-related drug-induced liver injury was more severe (P<.05). One elective termination and three miscarriages were documented; there were no maternal deaths. We recommend that isoniazid for latent tuberculosis be deferred to the postpartum period whenever feasible and that β-blockers or calcium channel blockers rather than methyldopa be used for hypertension management during pregnancy.
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Affiliation(s)
- Umair Masood
- Division of Liver Diseases and the Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York; Duke University School of Medicine and the Duke Clinical Research Institute, Durham, and Wake Forest University School of Medicine and Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina; National Institutes of Health, Bethesda, Maryland; Indiana University School of Medicine, Indianapolis, Indiana; and Albert Einstein Medical Center, Philadelphia, Pennsylvania
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Kushner T, Andrews RR. Addressing hepatitis delta in primary care practices in the US: a narrative review. Curr Med Res Opin 2024:1-8. [PMID: 38487951 DOI: 10.1080/03007995.2024.2318004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/07/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE Infection with the hepatitis delta virus (HDV), a unique RNA virus that requires hepatitis B virus (HBV) antigens for its assembly, replication, and transmission, causes severe viral hepatitis. Compared to HBV monoinfection, HDV infection increases the risk of severe liver disease, necessity for liver transplant, and mortality. Global HDV prevalence estimates vary from 5% to 15% among persons with HBV, but screening guidelines for HDV are inconsistent; some recommend risk-based screening, while others recommend universal screening for all people with HBV. Among primary care providers (PCPs) in the US, there is a lack of awareness and/or insufficient adherence to current recommendations for the screening of HDV infection and management of chronic HDV. METHODS Publications were obtained by conducting literature searches between July and August 2022 using the PubMed database and by manual searches of the retrieved literature for additional references. Information was synthesized to highlight HDV screening and management strategies for PCPs. Best practices for PCPs based on current guidelines and comanagement strategies for patients with HBV and HDV infection were summarized. RESULTS We recommend universal screening for HDV in patients positive for hepatitis B surface antigen. Confirmed HDV infection should prompt evaluation by a liver specialist, if available, with whom the PCP can comanage the patient. PCPs should counsel patients on the expected course of the disease, lifestyle factors that may influence liver health, need for consistent disease monitoring and follow-up, and risk of disease transmission. Screening is suggested for sexual partners, household contacts, and family members, with HBV immunization recommended for those found to be susceptible. There are currently no US Food and Drug Administration-approved therapies for HDV infection; thus, management is limited to treatments for chronic HBV infection plus long-term monitoring of liver health. CONCLUSIONS PCPs can be a valuable point of care for patients to access HDV/HBV screening, HBV immunization, and education, and can comanage patients with HBV and/or HDV infection.
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Affiliation(s)
- Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Foley MK, Djerboua M, Kushner T, Biondi MJ, Feld JJ, Terrault NA, Flemming JA. Maternal neighbourhood-level social determinants of health and their association with paediatric hepatitis C screening among children exposed to hepatitis C in pregnancy. Paediatr Perinat Epidemiol 2024; 38:152-160. [PMID: 38273801 DOI: 10.1111/ppe.13042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Current guidelines recommend HCV screening by 18 months of age for those exposed to HCV in utero; yet, screening occurs in the minority of children. OBJECTIVES To evaluate the association between maternal neighbourhood-level social determinants of health (SDOH) and paediatric HCV screening in the general population in a publicly funded healthcare system in Canada. METHODS Retrospective cohort study using administrative healthcare data held at ICES. Children born to individuals positive for HCV RNA in pregnancy from 2000 to 2016 were identified and followed for 2 years. Major SDOH were identified, and the primary outcome was HCV screening in exposed children (HCV antibody and/or RNA). Associations between SDOH and HCV screening were determined using multivariate Poisson regression models adjusting for confounding. RESULTS A total of 1780 children born to persons with +HCV RNA were identified, and 29% (n = 516) were screened for HCV by age two. Most mothers resided in the lowest income quintile (42%), and most vulnerable quintiles for material deprivation (41%), housing instability (38%) and ethnic diversity (26%) with 11% living in rural locations. After adjustment for confounding, maternal rural residence (risk ratio [RR] 0.82, 95% confidence interval [CI] 0.62, 1.07) and living in the highest dependency quintile (RR 0.83, 95% CI 0.65, 1.07) were the SDOH most associated with paediatric HCV screening. Younger maternal age (RR 0.98 per 1-year increase, 95% CI 0.97, 0.99), HIV co-infection (RR 1.69, 95% CI 1.16, 2.48) and GI specialist involvement (RR 1.18, 95% CI 1.00, 1.39) were associated with higher probabilities of screening. CONCLUSIONS Among children exposed to HCV during pregnancy, rural residences and living in highly dependent neighbourhoods showed a potential association with a lower probability of HCV screening by the age of 2. Future work evaluating barriers to paediatric HCV screening among rural residing and dependent residents is needed to enhance the screening.
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Affiliation(s)
- Mary K Foley
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | | | - Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine, New York, New York, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine, New York, New York, USA
| | - Mia J Biondi
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- School of Nursing, Faculty of Health Sciences, York University, Toronto, Ontario, Canada
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Sandra Rotman Centre for Global Health, University of Toronto, Toronto, Ontario, Canada
| | - Norah A Terrault
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine at University of Southern California, Los Angeles, California, USA
| | - Jennifer A Flemming
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
- ICES Queens, Kingston, Ontario, Canada
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada
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Kushner T, Lange M, Argiriadi PA, Meislin R, Sigel K, Terrault N. Prevalence, Risk Profiles, and National Implications of Nonalcoholic Fatty Liver Disease in Pregnant Individuals. Clin Gastroenterol Hepatol 2024; 22:194-196.e1. [PMID: 37031718 DOI: 10.1016/j.cgh.2023.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/31/2023] [Accepted: 03/24/2023] [Indexed: 04/11/2023]
Affiliation(s)
- Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Marcia Lange
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Pamela A Argiriadi
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rachel Meislin
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Keith Sigel
- Department of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Norah Terrault
- Division of Gastroenterology, Keck School of Medicine, University of Southern California, Los Angeles, California
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Noureddin M, Truong E, Mayo R, Martínez-Arranz I, Mincholé I, Banales JM, Arrese M, Cusi K, Arias-Loste MT, Bruha R, Romero-Gómez M, Iruzubieta P, Aller R, Ampuero J, Calleja JL, Ibañez-Samaniego L, Aspichueta P, Martín-Duce A, Kushner T, Ortiz P, Harrison SA, Anstee QM, Crespo J, Mato JM, Sanyal AJ. Serum identification of at-risk MASH: The metabolomics-advanced steatohepatitis fibrosis score (MASEF). Hepatology 2024; 79:135-148. [PMID: 37505221 PMCID: PMC10718221 DOI: 10.1097/hep.0000000000000542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 07/08/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Early identification of those with NAFLD activity score ≥ 4 and significant fibrosis (≥F2) or at-risk metabolic dysfunction-associated steatohepatitis (MASH) is a priority as these patients are at increased risk for disease progression and may benefit from therapies. We developed and validated a highly specific metabolomics-driven score to identify at-risk MASH. METHODS We included derivation (n = 790) and validation (n = 565) cohorts from international tertiary centers. Patients underwent laboratory assessment and liver biopsy for metabolic dysfunction-associated steatotic liver disease. Based on 12 lipids, body mass index, aspartate aminotransferase, and alanine aminotransferase, the MASEF score was developed to identify at-risk MASH and compared to the FibroScan-AST (FAST) score. We further compared the performance of a FIB-4 + MASEF algorithm to that of FIB-4 + liver stiffness measurements (LSM) by vibration-controlled transient elastography (VCTE). RESULTS The diagnostic performance of the MASEF score showed an area under the receiver-operating characteristic curve, sensitivity, specificity, and positive and negative predictive values of 0.76 (95% CI 0.72-0.79), 0.69, 0.74, 0.53, and 0.85 in the derivation cohort, and 0.79 (95% CI 0.75-0.83), 0.78, 0.65, 0.48, and 0.88 in the validation cohort, while FibroScan-AST performance in the validation cohort was 0.74 (95% CI 0.68-0.79; p = 0.064), 0.58, 0.79, 0.67, and 0.73, respectively. FIB-4+MASEF showed similar overall performance compared with FIB-4 + LSM by VCTE ( p = 0.69) to identify at-risk MASH. CONCLUSION MASEF is a promising diagnostic tool for the assessment of at-risk MASH. It could be used alternatively to LSM by VCTE in the algorithm that is currently recommended by several guidance publications.
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Affiliation(s)
- Mazen Noureddin
- Houston Methodist Hospital, Houston Research Institute Houston, Texas, USA
- Houston Research Institute, Houston, Texas, USA
| | - Emily Truong
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | | | | | - Jesus M. Banales
- Biodonostia Research Institute, Donostia University Hospital, University of the Basque Country (UPV-EHU), CIBERehd, IKERBASQUE, Donostia, Spain
- Department of Biochemistry and Genetics, School of Sciences, University of Navarra, Pamplona, Spain
| | - Marco Arrese
- Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Kenneth Cusi
- University of Florida, Gainesville, Florida, USA
| | | | - Radan Bruha
- General University Hospital and the First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Paula Iruzubieta
- Marqués de Valdecilla University Hospital, Cantabria University, IDIVAL, Santander, Spain
| | - Rocio Aller
- Clinic University Hospital, University of Valladolid, Valladolid, Spain
| | | | | | | | - Patricia Aspichueta
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, Leioa, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd, Instituto de Salud Carlos III), Madrid, Spain
| | | | - Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | | | | | - Quentin M. Anstee
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Javier Crespo
- Marqués de Valdecilla University Hospital, Cantabria University, IDIVAL, Santander, Spain
| | - José M. Mato
- National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd, Instituto de Salud Carlos III), Madrid, Spain
- CIC bioGUNE, Basque Research and Technology Alliance (BRTA), Derio, Spain
| | - Arun J. Sanyal
- Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
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Ahmed T, Vogel A, Owens T, Hussain FN, Alawad M, Thung S, Kushner T, Grinspan LT. Two DeLIVERies and a transplant: Case report of acute fatty liver of pregnancy requiring liver transplant. Clin Liver Dis (Hoboken) 2023; 22:233-237. [PMID: 38143808 PMCID: PMC10745251 DOI: 10.1097/cld.0000000000000095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/17/2023] [Indexed: 12/26/2023] Open
Affiliation(s)
- Taqwa Ahmed
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Alexander Vogel
- Division of Liver Diseases, Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Thomas Owens
- Department of Obstetrics, Division of Maternal Fetal Medicine, Gynecology, and Reproductive Science at Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Farrah Naz Hussain
- Department of Obstetrics, Division of Maternal Fetal Medicine, Gynecology, and Reproductive Science at Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Mouyed Alawad
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Swan Thung
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Tatyana Kushner
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Lauren T. Grinspan
- Division of Liver Diseases, Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, USA
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Lange M, Schmidt N, Kushner T. Hepatitis C in pregnancy. Clin Liver Dis (Hoboken) 2023; 22:200-205. [PMID: 38143816 PMCID: PMC10745245 DOI: 10.1097/cld.0000000000000093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/23/2023] [Indexed: 12/26/2023] Open
Affiliation(s)
- Marcia Lange
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Natalia Schmidt
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Lee JD, Gounko D, Lee JA, Mukherjee T, Kushner T. Assisted Reproductive Technology Treatment Outcomes in Women With Liver Disease. Am J Gastroenterol 2023; 118:2184-2190. [PMID: 36940434 DOI: 10.14309/ajg.0000000000002252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/01/2023] [Indexed: 03/22/2023]
Abstract
INTRODUCTION There is a need for evidence-based counseling for women with chronic liver disease (LD) who may experience impaired fertility. Currently, the literature on assisted reproductive technology (ART) treatment in women with LD has been limited to a single European case series. We evaluated ART treatment outcomes in patients with LD and compared with controls. METHODS The retrospective study evaluated women with and without LD who had normal ovarian reserve and underwent ART treatment in a high-volume fertility practice from 2002 to 2021. RESULTS We identified 295 women with LD (mean age 37.8 ± 5.2 years) who underwent 1,033 ART treatment cycles; of these women, 115 underwent 186 in vitro fertilization (IVF) cycles. Six women (2.0%) had cirrhosis, 8 (2.7%) were postliver transplantation, and 281 (95.3%) had chronic LD, with viral hepatitis (B and C) being the most prevalent. In the subgroup who underwent IVF and embryo biopsy, the median fibrosis-4 score was 0.81 (0.58-1.03), and there were no statistically significant differences in response to controlled ovarian stimulation, embryo fertilization rate, or ploidy outcome in patients with LD compared with controls. In those who subsequently underwent a single thawed euploid embryo transfer to achieve pregnancy, there were no statistically significant differences in rates of clinical pregnancy, clinical pregnancy loss, or live birth in patients with LD compared with controls. DISCUSSION To the best of our knowledge, this study is the largest to date to evaluate IVF efficacy in women with LD. Our study demonstrates that patients with LD have similar ART treatment outcomes compared with those without LD.
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Affiliation(s)
- Jessica D Lee
- Icahn School of Medicine at Mount Sinai (ISMMS), New York, New York, USA
| | - Dmitry Gounko
- Reproductive Medicine Associates of New York, New York, New York, USA
| | - Joseph A Lee
- Reproductive Medicine Associates of New York, New York, New York, USA
| | - Tanmoy Mukherjee
- Reproductive Medicine Associates of New York, New York, New York, USA
- Department of Obstetrics, Gynecology and Reproductive Science, ISMMS, New York, New York, USA
| | - Tatyana Kushner
- Department of Obstetrics, Gynecology and Reproductive Science, ISMMS, New York, New York, USA
- Division of Liver Diseases, ISMMS, New York, New York, USA
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Hussain FN, Rosenbluth E, Feldman KM, Strauss TS, Schneider E, Schmidt-Beauchat E, Rodriguez-Rivas C, Brustman L, Kushner T. Transient elastography and controlled attenuation parameter to evaluate hepatic steatosis and liver stiffness in postpartum patients. J Matern Fetal Neonatal Med 2023; 36:2190838. [PMID: 36935368 DOI: 10.1080/14767058.2023.2190838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 03/01/2023] [Accepted: 03/09/2023] [Indexed: 03/21/2023]
Abstract
INTRODUCTION Nonalcoholic fatty liver disease (NAFLD) affects 30% of adults in the United States. Transient elastography (TE) (Fibroscan, Echosens, Paris, France) with controlled attenuation parameter (CAP) is a noninvasive way to evaluate liver steatosis and liver stiffness. The primary objective of this study was to assess prevalence of elevated liver stiffness and steatosis immediately postpartum. Furthermore, we sought to evaluate whether there were differences in rates of metabolic disorders of pregnancy (gestational diabetes mellitus (GDM), gestational hypertension, and preeclampsia) and pre-pregnancy conditions (type 2 diabetes mellitus (DM), chronic hypertension, and obesity) in those with elevated postpartum liver steatosis/liver stiffness. METHODS IRB approved prospective cross-sectional study in which TE and liver function tests were performed 1-2 days postpartum. CAP ≥300 dB/m was classified as significant steatosis. Increased liver stiffness was defined as ≥7 kPa. Prevalence was determined by proportion of individuals undergoing TE/CAP who met criteria. Chi-square analysis was used to compare differences between groups. RESULTS Eighty-nine patients were included: 20 (22%) had GDM, 13 (15%) had gestational hypertension, and 15 (17%) had preeclampsia. Women with kPa ≥7 were more likely to have ALT ≥25, type 2 diabetes, and preeclampsia (p < .05). Pre-gravid BMI, BMI at delivery, and GDM were not associated with increased kPa. Pregravid BMI ≥25 and chronic hypertension were associated with CAP ≥ 300 dB/m (p < .05). GDM, preeclampsia, and gestational hypertension were not associated with CAP ≥300 dB/m. CONCLUSIONS Patients with preeclampsia, type 2 diabetes, and elevated ALT were more likely to have elevated postpartum liver stiffness. Pregravid BMI ≥25 and ≥30 were associated with increased liver steatosis, although did not impact liver stiffness. GDM was not associated with increased liver stiffness or steatosis. Consideration should be made for screening pregnant patients with preeclampsia, type 2 DM and overweight or obese BMI for liver disease in the postpartum period with potential for lifestyle intervention.
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Affiliation(s)
- Farrah Naz Hussain
- Department of Obstetrics, Gynecology and Reproductive Science, Division of Maternal Fetal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emma Rosenbluth
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kristina Martimucci Feldman
- Department of Obstetrics, Gynecology and Reproductive Science, Division of Maternal Fetal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tirtza Spiegel Strauss
- Department of Obstetrics, Gynecology and Reproductive Science, Division of Maternal Fetal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emily Schneider
- Department of Obstetrics, Gynecology and Reproductive Science, Division of Maternal Fetal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emily Schmidt-Beauchat
- Department of Obstetrics, Gynecology and Reproductive Science, Division of Maternal Fetal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Clara Rodriguez-Rivas
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lois Brustman
- Department of Obstetrics, Gynecology and Reproductive Science, Division of Maternal Fetal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tatyana Kushner
- Department of Obstetrics, Gynecology and Reproductive Science, Division of Maternal Fetal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Aliasi-Sinai L, Worthington T, Lange M, Kushner T. Maternal-to-Child Transmission of Hepatitis B Virus and Hepatitis Delta Virus. Clin Liver Dis 2023; 27:917-935. [PMID: 37778777 DOI: 10.1016/j.cld.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Maternal-to-child transmission of hepatitis B virus (HBV) and hepatitis delta virus (HDV) can lead to the risk of progressive liver disease in infants, but fortunately effective interventions exist to decrease transmission. Counseling on the risk of maternal-to-child transmission, care pathways to decrease transmission, and the implications of HBV and HDV on pregnancy outcomes are the key components of caring for pregnant people living with HBV and HDV.
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Affiliation(s)
| | - Theresa Worthington
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Marcia Lange
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, USA.
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Kushner T. A New Look at Perinatal Hepatitis C Virus Transmission: Results From the Maternal-Fetal Medicine Units Network Study. Obstet Gynecol 2023; 142:447-448. [PMID: 37535958 DOI: 10.1097/aog.0000000000005308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Affiliation(s)
- Tatyana Kushner
- Tatyana Kushner is from the Division of Liver Diseases in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the Icahn School of Medicine at Mount Sinai, New York, New York;
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Gross A, Lange M, Rosenbluth E, Carroll C, Sperling R, Juliano C, Sigel K, Friedman SL, Argiriadi PA, Chu J, Kushner T. Evaluation of 2-year outcomes in infants born to mothers with and without NAFLD in pregnancy. Eur J Pediatr 2023; 182:3765-3774. [PMID: 37310499 DOI: 10.1007/s00431-023-05044-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/12/2023] [Accepted: 05/28/2023] [Indexed: 06/14/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) affects an estimated 17% of pregnant patients in the USA. However, there are limited data on the impact of maternal NAFLD on pediatric outcomes. We prospectively evaluated outcomes in infants born to mothers with and without NAFLD in pregnancy over their first 2 years of life. Maternal subjects were identified through an ongoing prospective study in which pregnant individuals were screened for NAFLD. Pediatric outcomes of infants born to these mothers-including adverse neonatal outcomes and weight and weight-for-length percentile at 6, 12, 18, and 24 months-were prospectively evaluated. Multivariate logistic regression was performed to evaluate the association of maternal NAFLD with pediatric outcomes, as well as to adjust for potentially confounding maternal characteristics. Six hundred thirty-eight infants were included in our cohort. The primary outcomes assessed were weight and growth throughout the first 2 years of life. Maternal NAFLD was also not associated with increased infant birth weight or weight-for-gestational-age percentile or weight or weight-for-length percentile over the first 2 years of life. Maternal NAFLD was significantly associated with very premature delivery before 32 weeks, even after adjustment for confounding maternal characteristics (aOR = 2.83, p = 0.05). Maternal NAFLD was also significantly associated with neonatal jaundice, including after adjusting for maternal race (aOR = 1.67, p = 0.03). However, maternal NAFLD was not significantly associated with any other adverse neonatal outcomes. Conclusion: Maternal NAFLD may be independently associated with very premature birth and neonatal jaundice but was not associated with other adverse neonatal outcomes. Maternal NAFLD was also not associated with any differences in infant growth over the first 2 years of life. What is Known: • Maternal NAFLD in pregnancy may be associated with adverse pregnancy and neonatal outcomes, but the findings are inconsistent across the literature. What is New: • Maternal NAFLD is not associated with any differences in weight at birth or growth over the first 2 years of life. • Maternal NAFLD is associated with very premature delivery and neonatal jaundice, but is not associated with other adverse neonatal outcomes.
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Affiliation(s)
- Aliza Gross
- Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Marcia Lange
- Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Emma Rosenbluth
- Department of Internal Medicine, Northwestern Memorial Hospital, Chicago, USA
| | - Carin Carroll
- University of Miami Miller School of Medicine, Miami, USA
| | - Rhoda Sperling
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York City, USA
- Department of Pediatrics, Division of Newborn Medicine, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Courtney Juliano
- Department of Pediatrics, Division of Newborn Medicine, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Keith Sigel
- Department of Medicine, Division of Infectious Disease, Icahn School of Medicine at Mount Sinai, New York City, USA
- Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Scott L Friedman
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Pamela A Argiriadi
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Jaime Chu
- Department of Pediatrics, Division of Pediatric Hepatology, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Tatyana Kushner
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York City, USA.
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York City, USA.
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Lange M, Nadkarni D, Martin L, Newberry C, Kumar S, Kushner T. Intermittent fasting improves hepatic end points in nonalcoholic fatty liver disease: A systematic review and meta-analysis. Hepatol Commun 2023; 7:e0212. [PMID: 37534936 PMCID: PMC10552959 DOI: 10.1097/hc9.0000000000000212] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/01/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND AND AIMS Despite NAFLD being the most prevalent liver disease globally, currently there are no FDA-approved treatments, and weight loss through caloric restriction and enhanced physical activity is the recommended treatment strategy. Intermittent fasting (IF) has been proposed as an alternative strategy with additional cardiometabolic benefits. In this systematic review and meta-analysis, we evaluated the anthropometric, biochemical, and hepatic impacts of IF in patients with NAFLD. METHODS MEDLINE, EMBASE, Cochrane Central, and conference abstracts were searched for IF interventions in adults with NAFLD until April 2, 2023. Meta-analysis with a random effects model was used to compare pre-intervention and post-intervention changes in anthropometric, biochemical, and hepatic end points in the IF intervention group with the control group. Publication bias was assessed using Egger's test. RESULTS Fourteen studies were included in the systematic review and ten in the meta-analysis (n = 840 participants, 44.64% male). Studies varied in modalities for NAFLD diagnosis, duration of IF (4-52 weeks), and type of IF (5:2 diet, modern alternate-day fasting, time-restricted eating, or religious fasting). Body weight, body mass index, and waist to hip ratio all significantly improved following fasting intervention (p< 0.05). Adults with NAFLD showed an improvement in serum alanine transaminase, aspartate aminotransferase, hepatic steatosis (controlled attenuation parameter measured by vibration-controlled transient elastography), and hepatic stiffness (measured by vibration-controlled transient elastography) after fasting intervention (p < 0.05). CONCLUSIONS There is limited, but moderate- to high-quality evidence to suggest that IF can improve hepatic end points and promote weight loss in adults with NAFLD. Larger randomized controlled studies with extended duration are needed to further validate our findings.
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Affiliation(s)
- Marcia Lange
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Devika Nadkarni
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lily Martin
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Carolyn Newberry
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
| | - Sonal Kumar
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
| | - Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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14
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Kardashian A, Kushner T, Au JS, Flemming JA, Gripshover J, Muir AJ, Orloff SL, Villa E, Sarkar M. The key role of hepatology providers in optimizing reproductive care in patients with liver disease: A call to action. Hepatology 2023; 78:363-367. [PMID: 37142412 DOI: 10.1097/hep.0000000000000275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 11/28/2022] [Indexed: 05/06/2023]
Affiliation(s)
- Ani Kardashian
- Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, California, USA
| | - Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jennifer S Au
- Department of Organ and Cell Transplant, Scripps Clinic, La Jolla, California, USA
| | - Jennifer A Flemming
- Department of Medicine and Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Janet Gripshover
- Department of Liver and Small Bowel Transplant, University of California, Los Angeles, Los Angeles, California, USA
| | - Andrew J Muir
- Department of Medicine, Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Susan L Orloff
- Department of Surgery, Division of Abdominal Transplant Surgery, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Erica Villa
- Chimomo Department, Gastroenterology Division, University of Modena and Reggio Emilia, Modena, Italy
- IRCCS Saverio de Bellis, Castellana Grotte, Italy
| | - Monika Sarkar
- Department of Medicine, Division of Gastroenterology, University of California, San Francisco, San Francisco, California, USA
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15
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Kushner T. Pregnancy and Hepatitis C Virus. Gastroenterol Hepatol (N Y) 2023; 19:219-221. [PMID: 37705843 PMCID: PMC10496346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Affiliation(s)
- Tatyana Kushner
- Associate Professor of Medicine Division of Liver Diseases Department of Obstetrics, Gynecology, and Reproductive Sciences Icahn School of Medicine at Mount Sinai New York, New York
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16
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Karim G, Giri D, Kushner T, Reau N. Evaluation of Liver Disease in Pregnancy. Clin Liver Dis 2023; 27:133-155. [PMID: 36400462 DOI: 10.1016/j.cld.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Liver disease in pregnancy often requires diagnostic and therapeutic considerations that are unique to pregnancy. Liver disease in pregnancy is commonly thought of as either liver disease unique to pregnancy, chronic liver disease, or liver disease coincidental to pregnancy. This review summarizes the approach to evaluation of liver disease in pregnancy.
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Affiliation(s)
- Gres Karim
- Department of Medicine, Mount Sinai Beth Israel, 350 East 17th Street, 20th Floor, New York, NY 10003, USA
| | - Dewan Giri
- Department of Medicine, Mount Sinai Beth Israel, 350 East 17th Street, 20th Floor, New York, NY 10003, USA
| | - Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1123, New York, NY 10023, USA; Department of Obstetrics, Gynecology, and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1123, New York, NY 10023, USA.
| | - Nancy Reau
- Division of Hepatology, Rush University Medical Center, 1725 West Harrison Street
- Suite 319, Chicago, IL 60612, USA
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Kushner T, Nyabanga CT, Cotler SJ, Etzion O, Dahari H. Modeling-Based Response-Guided Hepatitis C Treatment During Pregnancy and Postpartum. Open Forum Infect Dis 2023; 10:ofad027. [PMID: 36776773 PMCID: PMC9907544 DOI: 10.1093/ofid/ofad027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/18/2023] [Indexed: 01/22/2023] Open
Abstract
Treating hepatitis C virus (HCV) in pregnancy would address HCV during prenatal care and potentially reduce the risk of vertical transmission. Response-guided therapy could provide a means to individualize and the reduce duration of HCV treatment during pregnancy. Data from a 27-year-old woman indicated that, pretreatment, HCV was stable and that it dropped in a biphasic manner during sofosbuvir/velpatasvir therapy, reaching target not detected at time of delivery-16 days post-initiation of therapy. Mathematical modeling of measured HCV at days 0, 7, and 14 predicted that cure could have been achieved after 7 weeks of sofosbuvir/velpatasvir, reducing the duration of therapy by 5 weeks.
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Affiliation(s)
- Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Custon T Nyabanga
- Department of Gastroenterology, Mount Sinai Beth Israel, New York, New York, USA
| | - Scott J Cotler
- The Program for Experimental & Theoretical Modeling, Division of Hepatology, Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Ohad Etzion
- Department of Gastroenterology and Liver Diseases, Soroka University Medical Center, Beer-Sheva, Israel
| | - Harel Dahari
- The Program for Experimental & Theoretical Modeling, Division of Hepatology, Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
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18
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Kushner T. Delta hepatitis epidemiology and the global burden of disease. J Viral Hepat 2023; 30 Suppl 1:4-10. [PMID: 36625781 DOI: 10.1111/jvh.13797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 11/25/2022] [Indexed: 01/11/2023]
Abstract
Delta Hepatitis is considered the most severe form of hepatitis, with varied prevalence, genotype distribution and risk factors worldwide. Current knowledge of global epidemiology is limited due to variable screening practices for HDV. Here, we summarize what is currently known about the prevalence of testing and prevalence of HDV positivity globally.
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Affiliation(s)
- Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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19
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Kushner T, Djerboua M, Biondi MJ, Feld JJ, Terrault N, Flemming JA. Influence of hepatitis C viral parameters on pregnancy complications and risk of mother-to-child transmission. J Hepatol 2022; 77:1256-1264. [PMID: 35643203 DOI: 10.1016/j.jhep.2022.05.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 05/05/2022] [Accepted: 05/16/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND & AIMS With the World Health Organization plan for hepatitis C elimination by the year 2030, and recent guideline recommendations to screen all women during pregnancy for HCV, data on HCV in pregnancy are needed to determine the association of HCV viremia with adverse pregnancy outcomes and mother-to-child transmission (MTCT). METHODS This retrospective cohort study was performed in Ontario, Canada, using population-based administrative healthcare data. Individuals were stratified based on whether they had active HCV viremia during pregnancy or resolved viremia at time of pregnancy. Peak HCV viral load was determined. Logistic regression was used to determine the association of viremia with adverse pregnancy outcomes; maternal HCV RNA levels were evaluated as a predictor of MTCT. RESULTS We identified a total of 2,170 pregnancies in 1,636 women who were HCV RNA positive prior to pregnancy; 1,780 (82%) pregnancies occurred in women who were HCV RNA positive during pregnancy. Patients who were HCV RNA positive during pregnancy were more likely to have preterm delivery (18% vs. 12%, p = 0.002), intrahepatic cholestasis of pregnancy (4% vs. <2%, p = 0.003), and post-partum hemorrhage (9% vs. 5%, p = 0.013), and less likely to have gestational diabetes (6% vs. 10%, p = 0.008) than those with resolved infection. Only 511 (29%) infants had screening consistent with guidelines after birth; there was an estimated 3.5% risk of MTCT. HCV RNA ≥6.0 log10 IU/ml was significantly associated with MTCT (exact odds ratio 3.4, p = 0.04). CONCLUSION Active HCV viremia among individuals with a history of HCV infection significantly increases adverse pregnancy outcomes. Few infants are screened for MTCT. Higher HCV RNA is associated with increased risk of MTCT. LAY SUMMARY The prevalence of hepatitis C has increased in women of child-bearing age and has important implications for women who become pregnant and their infants. We evaluated the effect that hepatitis C has on pregnancy outcomes as well as the rate of hepatitis C transmission to infants in a large database with linked mother-infant records. We found that active hepatitis C during pregnancy increased the risk of pregnancy complications. We also identified very low rates of testing of infants born to mothers with hepatitis C, but found higher rates of hepatitis C transmission to infants in mothers with higher virus levels.
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Affiliation(s)
- Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine, New York, NY USA; Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine, New York, NY USA.
| | | | - Mia J Biondi
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON Canada; School of Nursing, Faculty of Health Sciences, York University, Toronto ON Canada
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Sandra Rotman Centre for Global Health, University of Toronto, Toronto, Canada
| | - Norah Terrault
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA
| | - Jennifer A Flemming
- ICES, Queen's University, Kingston, Ontario, Canada; Departments of Medicine and Public Health Sciences, Queen's University, Kingston, Ontario, Canada
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20
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Kushner T, Lange M, Sperling R, Dieterich D. Treatment of Women With Hepatitis C Diagnosed in Pregnancy: a Co-Located Treatment Approach. Gastroenterology 2022; 163:1454-1456.e1. [PMID: 35863531 DOI: 10.1053/j.gastro.2022.07.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Marcia Lange
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rhoda Sperling
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Douglas Dieterich
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
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21
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Kushner T, Park C, Masand D, Rosenbluth E, Carroll C, Grace M, Rodriguez-Rivas C, De La Cruz H, Overbey J, Sperling R. Prevalence of elevated alanine aminotransferase (ALT) in pregnancy: A cross-sectional labor and delivery-based assessment. Medicine (Baltimore) 2022; 101:e30408. [PMID: 36221350 PMCID: PMC9542988 DOI: 10.1097/md.0000000000030408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Since liver tests are not routinely checked in pregnancy, the prevalence of abnormal liver tests and liver-related abnormalities in pregnancy in a US-based population is not known. We sought to determine the prevalence of abnormal alanine aminotransferase (ALT) among pregnant Individuals who present to labor and delivery for evaluation and to evaluate prevalence of underlying diagnosed liver conditions. Prospective study evaluating liver tests in consecutive samples obtained on the labor and delivery unit. Patient characteristics were compared between those with and without abnormal ALT and those with and without abnormal ALT without a liver-related diagnosis made in clinical practice, using t tests for continuous measures and χ2 or Fisher's exact tests as appropriate for categorical measures. Logistic regression was utilized to identify factors associated with abnormal ALT in this subcohort to determine predictors of abnormal ALT in those without a known liver-related diagnosis. We collected 1024 laboratory specimens from 996 patients. Of these patients, 131 of 996 (13.2%) had elevated ALT ≥25 IU/L; 20 (2%) had ALT ≥50, 6 (0.6%) had ALT ≥125 and 3 (0.3%) had ALT ≥250. 61/131 (46.6%) of patients with ALT ≥25 IU/L had not had LTs checked during routine pregnancy care. 20 (15%) of individuals with abnormal LT had preeclampsia; 5 (4%) had cholestasis of pregnancy; 1 (0.8%) had hepatitis C; there were no other chronic liver diseases diagnosed. There were no significant demographic or clinical differences between those with and without ALT ≥25, whether liver disease diagnosis was made or not. We identified an over 10% prevalence of abnormal LTs in consecutive pregnant individuals who presented to L&D, most of whom did not have a liver-related condition diagnosed in clinical practice. Among those with liver-related diagnoses, PE and ICP were the most common among individuals with ALT≥25 IU/mL, with chronic liver disease rarely diagnosed. Further evaluation of the role of ALT testing as part of routine prenatal care is needed, particularly in establishing a baseline prevalence of liver test abnormalities in pregnancy and independent association with pregnancy outcomes.
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Affiliation(s)
- Tatyana Kushner
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
- * Correspondence: Tatyana Kushner, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1123, New York, NY 10029 (e-mail: )
| | - Claire Park
- Department of Obstetrics, Gynecology and Reproductive Science and the Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Dana Masand
- Department of Obstetrics, Gynecology and Reproductive Science and the Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Emma Rosenbluth
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Carin Carroll
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Marie Grace
- Department of Pathology and Laboratory Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Clara Rodriguez-Rivas
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hernis De La Cruz
- Department of Population Health Science and Policy, Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jessica Overbey
- Department of Population Health Science and Policy, Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rhoda Sperling
- Department of Obstetrics, Gynecology and Reproductive Science and the Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
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Lange M, Zaret D, Kushner T. Hepatitis Delta: Current Knowledge and Future Directions. Gastroenterol Hepatol (N Y) 2022; 18:508-520. [PMID: 36397990 PMCID: PMC9666792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Hepatitis delta virus (HDV) infection is caused by a unique circular RNA virus that relies on both the hepatitis B virus (HBV) antigen and human host polymerases for its transmission and replication. HDV infection can be acquired simultaneously with HBV as a coinfection or as a superinfection in patients already chronically infected with HBV. Chronic HDV is the most severe and progressive form of viral hepatitis-induced liver disease, accounting for significant morbidity and mortality worldwide. Despite the severity of disease and poor clinical outcomes, there are few therapeutic options for the treatment of HDV infection. This article discusses the epidemiology of HDV globally and in the United States, the diagnosis and clinical course of HDV infection, and the current and future therapeutic options for the management of HDV infection.
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Affiliation(s)
- Marcia Lange
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dina Zaret
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
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Kushner T. Clinical Research of Epidemiology in Pregnant Women. CLIN EXP OBSTET GYN 2022. [DOI: 10.31083/j.ceog4908175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Chen B, Wang Y, Lange M, Kushner T. Hepatitis C is associated with more adverse pregnancy outcomes than hepatitis B: A 7-year national inpatient sample study. Hepatol Commun 2022; 6:2465-2473. [PMID: 35748104 PMCID: PMC9426407 DOI: 10.1002/hep4.2002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/04/2022] [Accepted: 04/29/2022] [Indexed: 11/30/2022] Open
Abstract
Prior international studies have shown mixed results regarding the association of hepatitis B and hepatitis C with adverse pregnancy outcomes. We performed an updated evaluation of the prevalence of associated adverse pregnancy outcomes and evaluated trends over time of diagnosis of chronic hepatitis B (HBV) and chronic hepatitis C (HCV) in pregnant women in a national database. All pregnant women with HBV and HCV were identified from the National Inpatient Sample database 2012 to 2018. Multivariate logistic regression analyses were performed to compare pregnancy‐related complications, including rates of preeclampsia/eclampsia, gestational diabetes, intrauterine growth restriction, antepartum/intrapartum hemorrhage, preterm labor, and Cesarean section. We evaluated all‐cause in‐hospital mortality, length of stay, and total cost of hospitalizations. A total of 28.7 million pregnancy‐related hospitalizations that met our eligibility criteria were identified, including 51,200 with HBV and 131,695 with HCV. In comparison with the uninfected controls, the HBV group was significantly more likely to develop gestational diabetes (12.94% vs. 6.94%, p < 0.001). The HCV group was more likely to have preterm labor (9.63% vs. 6.27%, p < 0.001), intrauterine growth restriction (6.04% vs. 2.89%, p < 0.001), longer length of stay (3.4 days vs. 2.7 days, p < 0.001), and higher hospitalization cost (15,052 dollars vs. 14,258 dollars, p < 0.001). These findings should inform counseling of women who are found to have HBV or HCV during pregnancy regarding the risk of adverse pregnancy outcomes and support the need for an interdisciplinary approach to optimize maternal and neonatal outcomes.
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Affiliation(s)
- Bing Chen
- Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Yichen Wang
- Mercy Internal Medicine Service, Trinity Health of New England, Springfield, Massachusetts, USA
| | - Marcia Lange
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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25
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Kushner T, Huang V, Janssen R. Safety and immunogenicity of HepB-CpG in women with documented pregnancies post-vaccination: A retrospective chart review. Vaccine 2022; 40:2899-2903. [PMID: 35430105 DOI: 10.1016/j.vaccine.2022.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND There are currently no published data on the use of HepB-CpG (HEPLISAV-B®) during pregnancy or in women with documented pregnancies in the post-vaccination period. We aimed to evaluate data from the clinical development program of HepB-CpG in women who became pregnant during study participation and follow up. METHODS We identified all study participants in the HepB-CpG pivotal pre-licensure clinical trials that had documented pregnancies during study follow up. We measured immunogenicity among study participants in the HepB-CpG (Heplisav-B®) arm compared to the HepB-alum (Engerix-B®) arm of the studies by comparing seroprotection rates (SPRs; anti-HBs ≥ 10 mIU/mL) and geometric mean concentrations (GMCs) of anti-HBs, obtained with FDA approved anti-HBsAg antibody assays at prespecified time points up to 28 weeks of follow up. Pregnancy outcomes were ascertained by chart review of extracted medical records of study participants. RESULTS We identified 40 documented pregnancies in the HepB-CpG arm and 19 documented pregnancies in the HepB-alum arm. Among subjects with documentation of seroprotection rates, 97.2% (95% CI 85.5-99.9) were seroprotected in the HepB-CpG arm and 66.7% (95% CI 41.0-86.7) were seroprotected in the HepB-alum arm. In the HepB-CpG arm, thirty-six study participants from the pivotal trials had reported pregnancy outcomes, the majority, 21/36 (58%) had a healthy term delivery, with 3/36 (8%) with spontaneous abortions, 1/36 (3%) congenital anomaly, and 2/36 (6%) had preterm birth. In the HepB-alum arm, 10/17 (59%) had healthy term deliveries, with 2/17 (12%) had spontaneous abortions and 1/17 (6%) had congenital anomaly. CONCLUSIONS These limited data suggest that HepB-CpG is immunogenic in women who become pregnant after vaccination, and pregnancy outcomes appear to be similar to women who received HepB-alum prior to pregnancy. These results need to be further verified with larger prospective studies with HBV vaccine administration during pregnancy.
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Affiliation(s)
- Tatyana Kushner
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1123, New York, NY 10029, United States.
| | - Vivian Huang
- Dynavax Technologies Corporation, 2100 Powell Street, Emeryville, CA 94608, United States
| | - Robert Janssen
- Dynavax Technologies Corporation, 2100 Powell Street, Emeryville, CA 94608, United States
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Kushner T, Da BL, Chan A, Dieterich D, Sigel K, Saberi B. Liver Transplantation for Hepatitis D Virus in the United States: A UNOS Study on Outcomes in the MELD Era. Transplant Direct 2022; 8:e1253. [PMID: 34957333 PMCID: PMC8691494 DOI: 10.1097/txd.0000000000001253] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Without available curative therapies for delta hepatitis (hepatitis delta virus [HDV]), hepatic decompensation and hepatocellular carcinoma (HCC) among HDV patients often necessitates liver transplantation (LT). The objective of this study was to evaluate outcomes of LT among hepatitis B virus (HBV)/HDV patients in the United States. METHODS We performed the first US-based retrospective study of patients who underwent LT for HDV compared with HBV (monoinfection) in the years 2002-2019. We evaluated posttransplant survival and predictors of survival. RESULTS We identified a total of 152 HBV/HDV and 5435 HBV patients who underwent LT. HDV patients were younger at transplant (52 versus 55, P < 0.001), less commonly Asian (16% versus 36%, P < 0.001), more likely to be HCV Ab positive (42% versus 28%, P < 0.001), and less likely to be listed for LT with HCC (38% versus 51%, P = 0.001), more likely to have ascites (73% versus 64%, P = 0.019), had worse coagulopathy (mean INR 2.0 versus 1.82, P = 0.04), and were more likely to receive a HCV-positive donor organ (7% versus 3%, P = 0.001). Post-LT overall survival and graft survival were similar between HDV and HBV patients, including among patients with HCC. Older age, HCV coinfection, HCC, and higher model for end-stage liver disease at transplant were associated with higher posttransplant mortality. CONCLUSIONS HDV patients were sicker and more likely to be listed for LT for decompensated disease compared with HBV patients. Post-LT survival was similar between HDV and HBV patients, in contrast to prior international studies that suggested worse post-LT survival in HBV patients due to higher rates of HBV reactivation.
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Affiliation(s)
- Tatyana Kushner
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ben L. Da
- Department of Medicine, Division of Hepatology, Sandra Atlas Bass Center for Liver Diseases and Transplantation, Barbara and Zucker School of Medicine for Hofstra/Northwell Health, Manhasset, NY
| | - Aryana Chan
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Douglas Dieterich
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Keith Sigel
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Behnam Saberi
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
- Division of Gastroenterology/Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Kushner T, Fairchild A, Johnson FR, Sands BE, Mahadevan U, Subramanian S, Ananthakrishnan A, Ha C, Bewtra M. Women's Willingness to Accept Risks of Medication for Inflammatory Bowel Disease During Pregnancy. Patient 2021; 15:353-365. [PMID: 34750784 DOI: 10.1007/s40271-021-00561-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Women with inflammatory bowel disease (IBD) face difficult decisions regarding treatment during pregnancy: while the majority of IBD medications are safe, there is substantial societal pressure to avoid exposures during pregnancy. However, discontinuation of IBD medications risks a disease flare occurring during pregnancy. OBJECTIVE This study quantified women's knowledge about pregnancy and IBD and their willingness to accept the risks of adverse pregnancy outcomes to avoid disease activity or medication use during pregnancy. METHODS Women with IBD recruited from four centers completed an online discrete-choice experiment stated-preference study including eight choice tasks and the Crohn's and Colitis Pregnancy Knowledge questionnaire. Random-parameters logit was used to estimate preferences for both the respondent personally and what the respondent thought most women would prefer. We also tested for systematically different preferences among individuals with different demographic and personal characteristics, including IBD knowledge. The primary outcome was the maximum acceptable risk of premature birth, birth defects, or miscarriage that women with IBD were willing to accept to avoid (1) taking an IBD medication or (2) having a disease flare during pregnancy. RESULTS Among 230 respondents, women would accept, on average, up to a 4.9% chance of miscarriage to avoid a disease flare. On average, there were no statistically significant differences in women's preferences for continuing versus avoiding medication in the absence of a flare. However, prior understanding of IBD and pregnancy significantly affected preferences for IBD medication use during pregnancy: women with "poor knowledge" would accept up to a 6.4% chance of miscarriage to avoid IBD medication use during pregnancy, whereas women with "adequate knowledge" would accept up to a 5.1% chance of miscarriage in order to remain on their medication. Respondents' personal treatment preferences did not differ from their assessment of other women's preferences. CONCLUSIONS Women with IBD demonstrated a strong preference for avoiding disease activity during pregnancy. Knowledge regarding pregnancy and IBD was a strong modifier of preferences for continuation of IBD medications during pregnancy. These findings point to an important opportunity for intervention to improve disease control through education to increase medication adherence and alleviate unnecessary fears about IBD medication use during pregnancy.
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Affiliation(s)
- Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - F Reed Johnson
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Bruce E Sands
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Christina Ha
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Meenakshi Bewtra
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA, USA. .,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 724 Blockley Hall, 423 Guardian Dr, Philadelphia, PA, 19104, USA. .,Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.
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Chaillon A, Wynn A, Kushner T, Reau N, Martin NK. Cost-effectiveness of Antenatal Rescreening Among Pregnant Women for Hepatitis C in the United States. Clin Infect Dis 2021; 73:e3355-e3357. [PMID: 32282879 PMCID: PMC8563211 DOI: 10.1093/cid/ciaa362] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Indexed: 11/13/2022] Open
Abstract
To inform proposed changes in hepatitis C virus (HCV) screening guidelines in the United States, we assessed the cost-effectiveness of HCV antenatal rescreening for women without evidence of HCV during a prior pregnancy, using a previously published model. Universal HCV rescreening among pregnant women was cost-effective (incremental cost-effectiveness ratio, $6000 per quality-adjusted life-year) and should be recommended nationally.
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Affiliation(s)
- Antoine Chaillon
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, California, USA
| | - Adriane Wynn
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, California, USA
| | - Tatyana Kushner
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nancy Reau
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, California, USA
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
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Kushner T, Chappell CA. Letter to the Editor: Pregnant Women and their Providers Want Direct-Acting Antivirals, and We Are Missing the Mark. Hepatology 2021; 74:2311-2312. [PMID: 33959998 DOI: 10.1002/hep.31885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
| | - Catherina A Chappell
- Department of Obstetrics Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA
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Kushner T, Reau N. Had Anyone Considered the Donors? Fertility and Pregnancy Outcomes Among Female Living Donors. Liver Transpl 2021; 27:1235-1236. [PMID: 34118122 DOI: 10.1002/lt.26207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 06/11/2021] [Indexed: 01/13/2023]
Affiliation(s)
- Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nancy Reau
- Section of Hepatology, Hepatology Services, Rush University Medical Center, Chicago, IL
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Lieb W, Barclay-Korboi YM, Dike C, Khander A, Raymond S, Kushner T, Beddoe AM. Prevalence of Hepatitis B and C Among Healthcare Workers in a Tertiary Care Center in Monrovia Liberia. Ann Glob Health 2021; 87:74. [PMID: 34395197 PMCID: PMC8323532 DOI: 10.5334/aogh.3327] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Viral hepatitis is a leading cause of death worldwide, with a higher mortality rate than that from human immunodeficiency virus (HIV), tuberculosis (TB) or malaria. In order to meet the WHO's goal of eliminating hepatitis B and C by 2030, there is a dire need to establish baseline prevalence rates and increase public health awareness of this detrimental disease, especially in low and middle-income countries (LMICs) where establishing prevalence rates of hepatitis B (HBV) and hepatitis (HCV) continues to be a problem. Objective To establish baseline rates of hepatitis B and C among healthcare workers at the national medical center of Liberia. Methods Between October 2017 to 2018 we performed a prospective study to determine rates of hepatitis B and hepatitis C among healthcare workers at John F. Kennedy (JFK) Medical Center, the national medical center of Liberia. All healthcare workers were offered one-time point of care hepatitis B antigen (HBsAg) and hepatitis C antibody testing. Findings Two hundred forty-five participants were tested for hepatitis B and C. 15 participants (6.12%) tested positive for hepatitis B [95% CI, 3.47%, 9.90%]. Eleven of the fifteen (73.3%) participants received confirmatory hepatitis B profile testing, and eight (72%) of those were found to be chronic hepatitis B carriers. No participants tested positive for hepatitis C Ab. Conclusion Our finding of a greater than 5% prevalence rate, during first line testing, of chronic hepatitis B among health care workers, should help fuel efforts for national testing, vaccination, and treatment efforts in order to align with the WHO goals of elimination of hepatitis B and C by 2030.
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Affiliation(s)
- Whitney Lieb
- Division of Global Women’s Health, Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY US
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, US
| | | | - Christopher Dike
- Department of Internal Medicine, John F. Kennedy Medical Center, Monrovia, LR
| | - Amrin Khander
- Weill Cornell Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, New York, NY, US
| | - Samantha Raymond
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, US
| | - Tatyana Kushner
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, US
| | - Ann Marie Beddoe
- Division of Global Women’s Health, Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY US
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Kushner T, Park C, Masand D, Wagner B, Grace M, Rosenbluth E, Rodriguez-Rivas C, de la Cruz H, Overbey J, Sperling R. Corrigendum to: Hepatitis C Seroprevalence Among Consecutive Labor and Delivery Admissions in Two New York City Hospitals. Open Forum Infect Dis 2021; 8:ofab196. [PMID: 34195301 PMCID: PMC8239253 DOI: 10.1093/ofid/ofab196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
[This corrects the article DOI: 10.1093/ofid/ofaa514.].
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Affiliation(s)
- Tatyana Kushner
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Claire Park
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dana Masand
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brian Wagner
- Department of Obstetrics and Gynecology and Reproductive Science, Division of Maternal Fetal Medicine, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marie Grace
- Department of Pathology and Laboratory Medicine, Icahn School of Medicine at Mount Sinai
| | - Emma Rosenbluth
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Clara Rodriguez-Rivas
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hernis de la Cruz
- Department of Population Health Science and Policy, Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jessica Overbey
- Department of Population Health Science and Policy, Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rhoda Sperling
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Obstetrics, Gynecology and Reproductive Science and the Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Kushner T, Kaplowitz E, Mei R, Xu C, Acker A, Rosenbluth E, Oredein I, Sarkar M, Terrault N, Bansal M, Forde KA. Adherence to pregnancy hepatitis B care guidelines in women and infants in the United States and evaluation of two interventions to improve care: A multicentre hospital-based study. J Viral Hepat 2021; 28:582-591. [PMID: 33372359 DOI: 10.1111/jvh.13459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/12/2020] [Indexed: 12/15/2022]
Abstract
There has been an increase in hepatitis B (HBV) detection during pregnancy in the United States and an emphasis on measures to decrease mother-to-child transmission of HBV. We performed a multicentre retrospective study (2015-2018) evaluating care among all women with HBV during pregnancy. We determined rates and predictors of adherence to key maternal care measures including: (1) referral to HBV specialty care, (2) assessment of HBV DNA, and (3) initiation of antiviral therapy, and (4) rates of HBIG and HBV vaccine completion in infants. We evaluated two interventions to improve HBV care: (1) clinical decision support with best practice alert and (2) co-location of HBV care in obstetrics department. We identified 372 women with HBV during pregnancy. Patients had a median age of 33 (IQR 29, 36), were mostly of Asian (49%) or Black (36%) race, HBeAg-negative (83%) with HBV DNA ≤2000 IU/mL (65%) and maximum ALT ≤25 (66%). Regarding care measures, 62% were referred to an HBV specialist, 85% had HBV DNA checked during pregnancy and 68% with HBV DNA ≥200,000 were initiated on antiviral therapy. Co-located obstetric-liver diseases clinics appeared to improve adherence to maternal care measures. All infants received HBIG and the first HBV vaccine dose, 106 (81%) received the second, 94 (74%) received the 3rd dose, but fewer at the recommended time intervals. We identified clear gaps in adherence to HBV care measures for both mothers and infants. Co-location of HBV care in the obstetrics department shows promise in improving adherence to maternal care measures.
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Affiliation(s)
- Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elianna Kaplowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rena Mei
- Department of Medicine, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Chelsea Xu
- Division of Gastroenterology, University of California, San Francisco, CA, USA
| | - Alex Acker
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Emma Rosenbluth
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Monika Sarkar
- Division of Gastroenterology, University of California, San Francisco, CA, USA
| | - Norah Terrault
- Division of Gastrointestinal and Liver Diseases, Keck Medicine of University of Southern California, Los Angeles, CA, USA
| | - Meena Bansal
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kimberly A Forde
- Department of Gastroenterology and Hepatology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.,Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Kushner T, Reau N. Changing epidemiology, implications, and recommendations for hepatitis C in women of childbearing age and during pregnancy. J Hepatol 2021; 74:734-741. [PMID: 33248169 DOI: 10.1016/j.jhep.2020.11.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/10/2020] [Accepted: 11/19/2020] [Indexed: 02/08/2023]
Abstract
Despite the remarkable advances in HCV treatment brought about by the advent of direct-acting antivirals, HCV remains a global public health concern. One particular concern relates to the rising prevalence of HCV in women of childbearing age. Active HCV during pregnancy is associated with cholestasis of pregnancy as well as the risk of mother-to-child transmission. Guidelines are increasingly recommending universal screening during pregnancy, while the treatment of HCV during pregnancy is an area of ongoing research.
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Affiliation(s)
- Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Nancy Reau
- Hepatology Services, Rush University Medical Center, Chicago, IL, United States.
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Da BL, Kushner T, El Halabi M, Paka P, Khalid M, Uberoi A, Lee BT, Perumalswami PV, Rutledge SM, Schiano TD, Friedman SL, Saberi B. Liver Injury in Patients Hospitalized with Coronavirus Disease 2019 Correlates with Hyperinflammatory Response and Elevated Interleukin-6. Hepatol Commun 2021; 5:177-188. [PMID: 33230491 PMCID: PMC7675519 DOI: 10.1002/hep4.1631] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/22/2020] [Accepted: 10/11/2020] [Indexed: 02/06/2023] Open
Abstract
Liver injury is commonly seen in coronavirus disease 2019 (COVID-19); however, the mechanism behind liver injury, particularly in patients with severe and critical COVID-19, remains unclear, and the clinical course is poorly described. We conducted a single-center retrospective cohort study of consecutive patients hospitalized with severe and critical COVID-19 with or without liver injury and who underwent immunologic testing (interleukin [IL]-6, IL-8, tumor necrosis factor alpha [TNF-α], and IL-1β). Liver injury was defined as peak aminotransferases ≥3 times the upper limit of normal (40 U/L) or ≥120 U/L. Patients with liver injury were compared to those who had normal aminotransferases throughout the hospital course. We studied 176 patients: 109 with liver injury and 67 controls. Patients with liver injury were more likely to be men (71.6% vs. 37.3%, P < 0.001). Peak inflammatory markers and IL-6 were higher in the liver injury group: C-reactive protein (CRP), 247 vs. 168 mg/L, P < 0.001; lactate dehydrogenase (LDH), 706 vs. 421 U/L; ferritin, 2,973 vs. 751 ng/mL, P < 0.001; IL-6, 121.0 vs. 71.8 pg/mL, P < 0.001. There was no difference in the levels of IL-8, TNF-α, and IL-1β. The liver injury group had a longer length of stay in the hospital and more severe COVID-19 despite having less diabetes and chronic kidney disease. Conclusion: An exaggerated hyperinflammatory response (cytokine storm) characterized by significantly elevated CRP, LDH, ferritin, and IL-6 levels and increasing severity of COVID-19 appears to be associated with the occurrence of liver injury in patients with severe/critical COVID-19.
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Affiliation(s)
- Ben L Da
- Division of Liver DiseasesIcahn School of Medicine at Mount SinaiNew YorkNYUSA.,Sandra Atlas Bass Center for Liver Diseases & Transplantation, Division of Hepatology, Department of Internal MedicineDonald and Barabara Zucker School of Medicine for Hofstra/Northwell HealthManhasset, New YorkNYUSA
| | - Tatyana Kushner
- Division of Liver DiseasesIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Maan El Halabi
- Department of Internal MedicineMount Sinai Saint Luke's and Mount Sinai WestNew YorkNYUSA
| | - Pavan Paka
- Department of Internal MedicineMount Sinai Saint Luke's and Mount Sinai WestNew YorkNYUSA
| | - Mian Khalid
- Department of Internal MedicineIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Angad Uberoi
- Department of Internal MedicineMount Sinai Saint Luke's and Mount Sinai WestNew YorkNYUSA
| | - Brian T Lee
- Division of Liver DiseasesIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | | | - Stephanie M Rutledge
- Division of GastroenterologyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Thomas D Schiano
- Division of Liver DiseasesIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Scott L Friedman
- Division of Liver DiseasesIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Behnam Saberi
- Division of Liver DiseasesIcahn School of Medicine at Mount SinaiNew YorkNYUSA.,Division of Gastroenterology and HepatologyBeth Israel Deaconess Medical Center, Harvard Medical SchoolBostonMAUSA
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Hussain FN, Rosenbluth E, Feldman KM, Schneider E, Schmidt-Beauchat E, Rodriguez-Rivas C, Brustman L, Kushner T. 560 Postpartum transient elastography in patients with metabolic disorders of pregnancy. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Da BL, Ezaz G, Kushner T, Crismale J, Kakked G, Gurakar A, Dieterich D, Schiano TD, Saberi B. Donor Characteristics and Regional Differences in the Utilization of HCV-Positive Donors in Liver Transplantation. JAMA Netw Open 2020; 3:e2027551. [PMID: 33275155 PMCID: PMC7718602 DOI: 10.1001/jamanetworkopen.2020.27551] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Increased utilization of hepatitis C virus (HCV)-positive liver allografts for liver transplant (LT) has been endorsed as one of several ways to combat national organ shortages. However, HCV-positive donors remain poorly characterized, and Organ Procurement and Transplantation Network regional differences in the utilization of HCV-positive liver allografts are unclear. OBJECTIVE To characterize HCV-positive donors and the allografts that come from them. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, the Scientific Registry of Transplant Recipients database was queried for all donors who underwent HCV testing from June 2015 to December 2018. Clinical and allograft characteristics were evaluated, and utilization across the United States was studied. Patients with positive or negative results for HCV antibody (Ab) and HCV nucleic acid amplification testing (NAT) were included in this study. Donors utilized for living donor transplant and pediatric (age <18 years) recipients were excluded. MAIN OUTCOMES AND MEASURES The primary comparison was between donors who were HCV Ab positive and those who were HCV Ab negative. Regional variations in the utilization of HCV-positive and HCV-negative donors were analyzed. RESULTS Of 24 500 donors utilized for LT, 1887 (7.7%) were HCV Ab positive; 64.4% of HCV Ab-positive donors were HCV NAT positive. HCV Ab-positive donors were younger (median [interquartile range] age, 35 [29-46] years vs 40 [27-54] years) and had fewer comorbidities, such as diabetes (8.3% vs 12.0%) and hypertension (25.9% vs 35.2%), compared with HCV Ab-negative donors. These findings were even more pronounced in HCV Ab-positive /NAT-positive compared with HCV Ab-positive/NAT-negative donors. Organ Procurement and Transplantation Network regions 2, 3, 10, and 11 had the highest absolute utilization of HCV Ab-positive donors, accounting for 64.4% of all HCV Ab-positive donors used in the United States. Region 1 had the highest relative utilization of HCV Ab-positive donors (18.7%). The use of HCV Ab-positive donors in some regions was associated with the rate of drug overdose, but this was not always the case. Similar utilization results were found with HCV NAT-positive donors. CONCLUSIONS AND RELEVANCE In this cross-sectional study, HCV-positive donors were younger and healthier than utilized HCV-negative donors. Significant differences exist in the utilization of HCV-positive donors across the 11 Organ Procurement and Transplantation Network regions, which is not entirely explained by organ demand or by higher availability of HCV-positive livers as per the distribution of the opioid epidemic. Initiatives to increase the use of HCV-positive donors, particularly in regions of high organ demand, should be implemented.
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Affiliation(s)
- Ben L. Da
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
- Sandra Atlas Bass Center for Liver Diseases & Transplantation, Division of Hepatology, Department of Internal Medicine, Donald and Barbara Zucker School of Medicine for Hofstra/Northwell Health, Manhasset, New York
| | - Ghideon Ezaz
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - James Crismale
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gaurav Kakked
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ahmet Gurakar
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Douglas Dieterich
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Thomas D. Schiano
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Behnam Saberi
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Kushner T, Park C, Masand D, Wagner B, Grace M, Rosenbluth E, Rodriquez-Rivas C, de la Cruz H, Overbey J, Sperling R. Hepatitis C Seroprevalence Among Consecutive Labor and Delivery Admissions in Two New York City Hospitals. Open Forum Infect Dis 2020; 7:ofaa514. [PMID: 33241070 PMCID: PMC7676505 DOI: 10.1093/ofid/ofaa514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/19/2020] [Indexed: 12/13/2022] Open
Abstract
Background Rates of hepatitis C virus (HCV) among women of childbearing age have increased as a result of the opioid epidemic, especially in the nonurban white population. Recently updated US Preventative Services Task Force and Centers for Disease Control and Prevention guidance have recommended universal HCV screening during pregnancy, but obstetrics societies have not yet endorsed this recommendation. We evaluated the seroprevalence of HCV among pregnant women in an inner-city population, compared rates with other sexually transmitted infections (STIs) screened for during pregnancy, and evaluated factors associated with HCV positivity. Methods We performed a prospective seroprevalence study of consecutive labor and delivery admissions (both antepartum complications and delivery admissions) by testing serum samples for HCV antibody over 9 months at 2 major hospital settings in New York City. Results Fifty-six of 7373 (0.75%; 95% confidence interval [CI], 0.57–0.98) patients screened positive for HCV, with 28 of 4013 (0.70%; 95% CI, 0.46%–1.01%) and 28 of 3413 (0.82%; 95% CI, 0.55%–1.18%) at each hospital. Forty-one percent of HCV-positive patients had any reported HCV risk factors. Hepatitis C virus-positive patients were less likely to have private insurance and more likely to have a history of cannabis, cocaine, and injection drug use (P < .001). The HCV rates were higher among antepartum admissions compared with delivery admissions and higher than that of hepatitis B virus (0.65%; 95% CI, 0.48–0.86), human immunodeficiency virus (0.27%; 95% CI, 0.16–0.42), and syphilis (0.16%; 95% CI, 0.08–0.28). Conclusions We found a higher than expected HCV seroprevalence among pregnant women and higher than most other STIs routinely screened for in pregnancy. Most patients had no risk factors. These findings support universal screening for hepatitis C during pregnancy.
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Affiliation(s)
- Tatyana Kushner
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Claire Park
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dana Masand
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brian Wagner
- Department of Obstetrics and Gynecology and Reproductive Science, Division of Maternal Fetal Medicine, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marie Grace
- Department of Pathology and Laboratory Medicine, Icahn School of Medicine at Mount Sinai
| | - Emma Rosenbluth
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Clara Rodriquez-Rivas
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hernis de la Cruz
- Department of Population Health Science and Policy, Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jessica Overbey
- Department of Population Health Science and Policy, Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rhoda Sperling
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Obstetrics, Gynecology and Reproductive Science and the Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Tressler SR, Kushner T, Bhandari R. Factors Associated With Hepatitis B Exposure Among People Who Report Using Methamphetamine: National Health and Nutrition Examination Survey 2009-2016. J Infect Dis 2020; 221:243-250. [PMID: 31504660 DOI: 10.1093/infdis/jiz445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 08/29/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND With the nation's focus on the opioid crisis, methamphetamine has made a comeback, potentially increasing risk for hepatitis B. We examined factors associated with hepatitis B virus (HBV) exposure among people who reported ever using methamphetamine in a nationally representative survey. METHODS We used the National Health and Nutrition Examination Survey to examine factors associated with HBV exposure among participants who reported ever using methamphetamine using bivariate and multivariable logistic regression. RESULTS Overall, 847 participants met the study inclusion criteria. In multivariable logistic regression, female sex (adjusted odds ratio, 3.83; 95% confidence interval, 1.65-8.90), living below the poverty threshold (3.17; 1.39-7.21), injection drug use (4.89; 1.95-12.26), active hepatitis C virus infection (3.39; 1.10-12.26), and identifying as men who have sex with men (28.21; 5.19-153.38) were significantly associated with HBV exposure. CONCLUSIONS The odds of HBV exposure for female participants who reported using methamphetamine were 4 times than that for male participants. Poverty, injection drug use, and hepatitis C virus infection were also associated. As methamphetamine use increases, it is critical to identify those at risk of acquiring HBV infections in order to target testing and vaccination.
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Affiliation(s)
- Stacy R Tressler
- Department of Epidemiology, West Virginia University, Morgantown, West Virginia, USA
| | - Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ruchi Bhandari
- Department of Epidemiology, West Virginia University, Morgantown, West Virginia, USA
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40
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Kushner T, Sperling R. Liver Disease and Pregnancy. Obstet Gynecol 2020. [DOI: 10.1002/9781119450047.ch14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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41
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Kushner T, Chen Z, Tressler S, Kaufman H, Feinberg J, Terrault NA. Trends in Hepatitis B Infection and Immunity Among Women of Childbearing Age in the United States. Clin Infect Dis 2020; 71:586-592. [PMID: 31504302 PMCID: PMC7384310 DOI: 10.1093/cid/ciz841] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/22/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The current opioid injection drug use epidemic has been associated with an increase in hepatitis C virus infections among women of childbearing age in the United States, but changes in hepatitis B virus (HBV) infections have not been studied. METHODS A retrospective analysis of HBV statuses among women of childbearing age nationally and by state was conducted, utilizing the Quest Diagnostics database. Rates of HBV in women born before and after the implementation of universal HBV vaccination recommendations were determined. RESULTS We identified 8 871 965 women tested for HBV from 2011-2017. Nationally, the annual rate of acute HBV infections was stable, but rates increased in Kentucky, Alabama, and Indiana (P < .03). The national prevalence of new, chronic HBV diagnoses decreased significantly, from 0.83% in 2011 to 0.19% in 2017 (P < .0001), but increased in Mississippi, Kentucky, and West Virginia (P ≤ .05). A declining prevalence of HBV seroprotection was evident over time, especially within the birth-dose cohort (which dropped from 48.5% to 38.5%; P < .0001). CONCLUSIONS National rates of newly diagnosed acute and chronic HBV infections declined or were stable overall, but increased significantly in specific Appalachian states. The HBV vaccine is effective in decreasing infections, but seroprotection wanes over time. These trends in new infections may be related to increased injection drug use and highlight potential gaps in HBV vaccine protection.
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Affiliation(s)
- Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zhen Chen
- Quest Diagnostics, Secaucus, New Jersey, USA
| | - Stacy Tressler
- Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, West Virginia, USA
| | | | - Judith Feinberg
- Departments of Behavioral Medicine & Psychiatry, Neuroscience and Medicine, Division of Infectious Diseases, West Virginia University, Morgantown, USA
| | - Norah A Terrault
- Division of Gastroenterology/Hepatology, University of Southern California, Los Angeles, USA
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42
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Kushner T, Cafardi J. Chronic Liver Disease and COVID-19: Alcohol Use Disorder/Alcohol-Associated Liver Disease, Nonalcoholic Fatty Liver Disease/Nonalcoholic Steatohepatitis, Autoimmune Liver Disease, and Compensated Cirrhosis. Clin Liver Dis (Hoboken) 2020; 15:195-199. [PMID: 32537135 PMCID: PMC7280613 DOI: 10.1002/cld.974] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/09/2020] [Accepted: 05/09/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Tatyana Kushner
- Division of Liver DiseasesIcahn School of Medicine at Mount SinaiNew YorkNY
| | - John Cafardi
- Division of Infectious DiseasesThe Christ HospitalCincinnatiOH
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43
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Puigvehí M, Hashim D, Haber PK, Dinani A, Schiano TD, Asgharpour A, Kushner T, Kakked G, Tabrizian P, Schwartz M, Gurakar A, Dieterich D, Boffetta P, Friedman SL, Llovet JM, Saberi B. Liver transplant for hepatocellular carcinoma in the United States: Evolving trends over the last three decades. Am J Transplant 2020; 20:220-230. [PMID: 31437349 PMCID: PMC6940543 DOI: 10.1111/ajt.15576] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 07/15/2019] [Accepted: 08/09/2019] [Indexed: 01/25/2023]
Abstract
Hepatitis C virus infection has been the most common etiology in HCC-related liver transplantation (LT). Since 2014, direct-acting antivirals (DAAs) have dramatically improved HCV cure. We aimed to study the changing pattern of etiologies and impact in outcome in HCC-related LT according to HCV treatment-era through retrospective analysis of the Scientific Registry of Transplant Recipients (SRTR) database (1987-2017). A total of 27 855 HCC-related liver transplants were performed (median age 59 years, 77% male). In the DAA era (2014-2017) there has been a 14.6% decrease in LT for HCV-related HCC; however, HCV remains the most common etiology in 50% of cases. In the same era, there has been a 50% increase in LT for NAFLD-related HCC. Overall survival was significantly worse for HCV-related HCC compared to NAFLD-related HCC during pre-DAA era (2002-2013; P = .031), but these differences disappeared in the DAA era. In addition, HCV patients had a significant improvement in survival when comparing the DAA era with IFN era (P < .001). Independent predictors of survival were significantly different in the pre-DAA era (HCV, AFP, diabetes) than in the DAA era (tumor size). HCV-related HCC continues to be the main indication for LT in the DAA era, but patients' survival has significantly improved and is comparable to that of NAFLD-related HCC.
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Affiliation(s)
- Marc Puigvehí
- Liver Cancer Program, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dana Hashim
- Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, New York
| | - Philipp K. Haber
- Liver Cancer Program, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Amreen Dinani
- Icahn School of Medicine at Mount Sinai, Division of Liver Diseases, New York, New York
| | - Thomas D. Schiano
- Icahn School of Medicine at Mount Sinai, Recanati / Miller Transplantation Institute, New York, New York
| | - Amon Asgharpour
- Icahn School of Medicine at Mount Sinai, Division of Liver Diseases, New York, New York
| | - Tatyana Kushner
- Icahn School of Medicine at Mount Sinai, Division of Liver Diseases, New York, New York
| | - Gaurav Kakked
- Icahn School of Medicine at Mount Sinai, Division of Liver Diseases, New York, New York
| | - Parissa Tabrizian
- Icahn School of Medicine at Mount Sinai, Recanati / Miller Transplantation Institute, New York, New York
| | - Myron Schwartz
- Icahn School of Medicine at Mount Sinai, Recanati / Miller Transplantation Institute, New York, New York
| | - Ahmet Gurakar
- Johns Hopkins University School of Medicine, Division of Gastroenterology and Hepatology-Transplant Hepatology, Baltimore, Maryland
| | - Douglas Dieterich
- Icahn School of Medicine at Mount Sinai, Division of Liver Diseases, New York, New York
| | - Paolo Boffetta
- Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, New York
| | - Scott L. Friedman
- Icahn School of Medicine at Mount Sinai, Division of Liver Diseases, New York, New York
| | - Josep M. Llovet
- Liver Cancer Program, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York,Liver Cancer Translational Lab, Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Hospital Clinic de Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Catalonia, Spain,Institució Catalana de Recerca i Estudis Avançats, Barcelona, Catalonia, Spain
| | - Behnam Saberi
- Icahn School of Medicine at Mount Sinai, Division of Liver Diseases, New York, New York
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Affiliation(s)
| | - John Cafardi
- Department of Infectious Disease, Christ Hospital, Cincinnati, OH
| | - Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nancy Reau
- Section of Hepatology, Rush University Medical Center, Chicago, IL
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45
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Hong J, Kushner T, Dieterich D, Garry D, Marcos LA, Beneri C, Sperling R, Patel P. Reducing mother-to-child transmission of HCV: Is it attainable with a multidisciplinary approach? J Hepatol 2019; 71:229-230. [PMID: 31029380 DOI: 10.1016/j.jhep.2019.01.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 01/29/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Julie Hong
- Stony Brook School of Medicine, Stony Brook University Hospital, USA
| | | | | | - David Garry
- Stony Brook School of Medicine, Stony Brook University Hospital, USA
| | - Luis A Marcos
- Stony Brook School of Medicine, Stony Brook University Hospital, USA
| | - Christy Beneri
- Stony Brook School of Medicine, Stony Brook University Hospital, USA
| | | | - Pruthvi Patel
- Icahn School of Medicine, Mount Sinai Hospital, USA.
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Kushner T, Tholey D, Dodge J, Saberi B, Schiano T, Terrault N. Outcomes of liver transplantation for acute fatty liver disease of pregnancy. Am J Transplant 2019; 19:2101-2107. [PMID: 31017355 DOI: 10.1111/ajt.15401] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/19/2019] [Accepted: 04/08/2019] [Indexed: 01/25/2023]
Abstract
Acute fatty liver of pregnancy (AFLP) often resolves after pregnancy delivery but can progress to acute liver failure necessitating liver transplantation. We performed a retrospective review of the national Scientific Registry of Transplant Recipients (SRTR) data to identify all women in the United States undergoing liver transplantation (LT) for acute liver failure (ALF) from AFLP from 1991 to 2015, and compared to outcomes in women of childbearing age undergoing transplant for ALF from acetaminophen and ALF from other etiologies. Women with AFLP were likely to be on life support at time of LT and had high rates of renal dysfunction (median Cr 2.1, IQR 1.2-2.3), and hyperbilirubinemia (median bilirubin 17.1, IQR 11.0, 19.9). Although their early and late LT survival outcomes were comparable to the other indications for LT, cumulative 5-year graft survival was numerically lower among AFLP patients (54%, 95% CI, 27-76) compared to APAP (70%, 95% CI, 63-77) and "Other ALF" (76%, 95% CI, 72-80) groups. In conclusion, although AFLP is a rare indication for LT, AFLP patients were as sick or sicker than other women of childbearing age undergoing LT for ALF. Worsened graft survival may be related to higher rates of rejection in the AFLP group.
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Affiliation(s)
| | | | - Jennifer Dodge
- University of California San Francisco, San Francisco, California
| | - Behnam Saberi
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Thomas Schiano
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Norah Terrault
- University of California San Francisco, San Francisco, California
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Abstract
Purpose of review The purpose of this review is to discuss the reasons for HCV testing during pregnancy and to review what is known about antiviral treatment during pregnancy. Recent findings Hepatitis C virus affects over 3 million persons in the United States and is one of the leading infectious causes of death. While HCV is most commonly transmitted via parenteral exposures, thus affecting people who inject drugs, it is also transmitted from mother-to-child. Due to an expanding opioid crisis, an increasing number of women of childbearing age are now infected, resulting in transmission to infants. Risk-based screening has never been proven effective and thus universal screening of pregnant women for HCV infection has been recommended. Summary Obstetricians may play a key role in the U.S. by implementing universal testing for HCV in pregnant women, thereby enhancing the health of mothers and identifying children at risk.
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Affiliation(s)
- Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1123, New York, NY, 10029
| | - Catherine A Chappell
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA 15206
| | - Arthur Y Kim
- Division of Infectious Diseases, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street Cox 6, Boston, MA 02114
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48
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Affiliation(s)
- Monina Pascua
- The Oregon Clinic Gastroenterology, Tualatin, Oregon.
| | - Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
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Kushner T, Sperling RS, Dieterich D. Family Counseling for Hepatitis B and Hepatitis C. Clin Liver Dis (Hoboken) 2019; 13:93-97. [PMID: 31061700 PMCID: PMC6491030 DOI: 10.1002/cld.754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 08/11/2018] [Indexed: 02/04/2023] Open
Affiliation(s)
- Tatyana Kushner
- Division of Liver DiseasesIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Rhoda S. Sperling
- Department of Obstetrics, Gynecology and Reproductive ScienceIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Douglas Dieterich
- Division of Liver DiseasesIcahn School of Medicine at Mount SinaiNew YorkNY
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50
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Hershman M, Mei R, Kushner T. Implications of Nonalcoholic Fatty Liver Disease on Pregnancy and Maternal and Child Outcomes. Gastroenterol Hepatol (N Y) 2019; 15:221-228. [PMID: 31435201 PMCID: PMC6696596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
With an estimated 10% prevalence of nonalcoholic fatty liver disease (NAFLD) among women of childbearing age, it is important to understand the implications of this disease on pregnancy. This article explores the relationship between NAFLD and gestational diabetes mellitus, the implications of maternal NAFLD on both the pregnancy and the infant, and the effects of breastfeeding on maternal and offspring health. Prospective studies and sensitive diagnostic techniques for the evaluation of NAFLD during pregnancy are limited; however, emerging evidence suggests that appropriate counseling and monitoring of patients with, or at risk of developing, NAFLD during pregnancy may have significant benefits on maternal and child health.
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Affiliation(s)
- Melissa Hershman
- Dr Hershman is a fellow in the Division of Gastroenterology at Mount Sinai Beth Israel, Mount Sinai St. Luke's, and Mount Sinai West in New York, New York. Ms Mei is a medical student at the Icahn School of Medicine at Mount Sinai in New York, New York. Dr Kushner is an assistant professor of medicine in the Division of Liver Diseases at the Icahn School of Medicine at Mount Sinai
| | - Rena Mei
- Dr Hershman is a fellow in the Division of Gastroenterology at Mount Sinai Beth Israel, Mount Sinai St. Luke's, and Mount Sinai West in New York, New York. Ms Mei is a medical student at the Icahn School of Medicine at Mount Sinai in New York, New York. Dr Kushner is an assistant professor of medicine in the Division of Liver Diseases at the Icahn School of Medicine at Mount Sinai
| | - Tatyana Kushner
- Dr Hershman is a fellow in the Division of Gastroenterology at Mount Sinai Beth Israel, Mount Sinai St. Luke's, and Mount Sinai West in New York, New York. Ms Mei is a medical student at the Icahn School of Medicine at Mount Sinai in New York, New York. Dr Kushner is an assistant professor of medicine in the Division of Liver Diseases at the Icahn School of Medicine at Mount Sinai
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