Finding strengths—and weaknesses—in hepatitis C's armor

Using a specially selected library of different hepatitis C viruses, a team of researchers led by Johns Hopkins scientists has identified tiny differences in the pathogens' outer shell proteins that underpin their resistance to antibodies. The findings, reported in the January 2015 issue of the Journal of Clinical Investigation, suggest a reason why some patients' immune systems can't fend off hepatitis C infections, and they reveal distinct challenges for those trying to craft a successful vaccine to prevent them. Due to concerns about the rising costs of newly available hepatitis C drugs, researchers are looking to a vaccine as a more viable and less costly option.

The systems of some people who become infected with the liver-ravaging hepatitis C virus launch a robust immune attack, producing antibodies that attach to a broad array of the germs with different genetic makeups. About one-third of these individuals successfully clear the pathogen from their bodies. However, says Justin Bailey, M.D., Ph.D., assistant professor of medicine in the Division of Infectious Diseases in the Johns Hopkins University School of Medicine, no single antibody has been found that can neutralize all strains of hepatitis C virus.

To better understand how hepatitis C viruses avoid even the most broadly neutralizing antibodies, Bailey; Stuart C. Ray, M.D., professor of medicine in the Division of Infectious Diseases in the Johns Hopkins University School of Medicine; and colleagues tested the power of 18 antibodies known to broadly attack the virus against a library of 19 viral strains that make up about 94 percent of the genetic variability of hepatitis C viruses in the most common genetic group, called genotype 1.

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Snapshots—Lucinda K. Porter, RN

Article: Systematic Review: Patient-Reported Outcomes in Chronic Hepatitis C - The Impact of Liver Disease and New Treatment Regimens - Z. Younossi and L. Henry
  Source: Alimentary Pharmacology and Therapeutics January 23, 2015

How do we measure successful hepatitis C (HCV) treatment? Is it strictly by clinical trial data showing how safe and effective a treatment is? Alternatively, is it by patients’ experiences, outcomes, and overall quality of life? This ambitious study examined patients’ experiences of living with hepatitis C and its treatment. 

They found that current data support the fact that HCV patients suffer substantially. This burden was much worse during interferon/ribavirin treatment and worse yet if that treatment used telaprevir or boceprevir. The newer interferon-free treatments showed that patients reported improvements in quality of life and productivity; and even bigger improvements with ribavirin-free regimens. Patients who reported easier treatment were more likely to complete therapy and respond to it.

This study also looked at fibrosis stage, finding significant fatigue and impairment among those with early stage liver disease. Patients with early fibrosis reported significant benefits, similar to the gains achieved by those with advanced fibrosis.

 

The Bottom Line: Using fibrosis stage to limit the cost of HCV treatment does not take in to account the other costs of HCV, such as its effect on work productivity, quality of life, etc.

 

Editorial Comment: This study validates what patients have been reporting for decades—that having hepatitis C is hard, and that the newer treatments offer hope for improved quality of life. Denying access to treatment violates human rights.

Article: Seven Years of Chronic Hepatitis C Virus Infection in an HIV-Infected Man without Detectable Antibodies – Joost Vanhommerig, et al.
  Source: AIDS 2015, Vol 29 No 3

After an HCV exposure, about half of those exposed will form antibodies in 5 to 10 weeks.

It averages 10 to 13 weeks for HCV antibodies to be detectable in HCV/HIV-coinfected men who have sex with men (MSM). There have been reports of some HIV-infected individuals for whom HCV antibodies didn’t show up for more than 3 years. In this case study, an HIV-positive man had positive HCV viral load results for 7 years but never had a positive HCV-antibody test result. 

The Bottom Line: These researchers recommend HCV viral load testing rather than relying solely on antibody testing for HIV-infected MSM.

 

Editorial Comment: I am both fascinated and irritated when there are rare exceptions in medical science, but they do exist. 

Article: Hepatitis C Virus Infection: A Risk Factor for Parkinson’s Disease – Wendy Wu, et al.
  Source: Journal of Viral Hepatitis January 21, 2015

Recent evidence indicates that HCV may invade the central nervous system.  In rat studies, researchers observed that HCV and Parkinson’s disease both overexpress inflammatory biomarkers. Analyzing data from 62,276 subjects, researchers found similarities between HCV and Parkinson’s.

 

The Bottom Line: This study demonstrated an association between HCV infection and Parkinson’s and confirms the observation of dopaminergic toxicity of HCV similar to that found in rats.

 

Editorial Comment: As horrifying as these results are, perhaps this research will shed light on the nature of “brain fog,” which is experienced by so many HCV patients. 

Article: Hepatitis A hospitalizations in the United States, 2002-2011 – Melissa Collier, et al.
  Source: Hepatology February 2015

This study reviewed hospitalization rates for hepatitis A from 2002-2011. The number of hepatitis A-related hospitalizations hasdeclined significantly, but patients who are hospitalized for hepatitis A are older and more likely to have liver diseases and other comorbid medical conditions.

 

The Bottom Line: Immunization could prevent hepatitis A infection and ensuing hospitalizations.

 
Editorial Comment: Hepatitis A vaccination is recommended for hepatitis C patients.

http://hcvadvocate.org/news/newsLetter/2015/advocate0315.html#4