Hepatitis C in Japan

Be sure to check out this new fact sheet in our "Hepatitis C Around the World" series:

Hepatitis C in Japan

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Snapshots —Alan Franciscus, Editor-in-Chief

Article:  Improvement of health-related quality of life and work productivity in chronic hepatitis C patients with early and advanced fibrosis treated with ledipasvir and sofosbuvir—ZM Younossi
  Source: J Hepatol.2015 Mar 17. pii: S0168-8278(15)00192-0. doi: 10.1016/j.jhep.2015.03.014. [Epub ahead of print]

The main goal of HCV treatment is viral eradication or being cured of hepatitis C. However, there are equally important reasons and objectives besides being cured—better overall mental and physical functioning and being able to increase work productivity (and being able to increase income). 

The aim of the current study was to examine what being cured of hepatitis C with sofosbuvir plus ledipasvir with or without ribavirin means with respect to improving health-related quality of life—mainly physical functioning and work productivity.  There were 1,005 patients in the current study that were drawn for the ION-1,2,3 clinical trials.  The patient’s fibrosis stage was determined pretreatment based on the Metavir fibrosis staging system:

• F0: 94 patients (pts);
• F1: 311 pts;
• F2: 301 pts ;
• F3: 197 pts;
• F4:102 pts

Four questionnaires [Chronic Liver Disease Questionnaire-HCV (CLDQ-HCV), Short Form-36 (SF-36), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Work Productivity and Activity Index: Specific Health Problem (WPAI:SHP)] were administered at baseline, during, and after treatment.

The Bottom Line:  It is not surprising that patients with the most advanced fibrosis (F4) had the most impairment in health-related quality of life with respect to physical functioning compared to those who were stage F0. 

This continued during and post-treatment.  After being cured there was a significant improvement from baseline in most areas of health-related quality of life regardless of the level of fibrosis stage. 

After analysis, not surprisingly, advanced fibrosis was associated with impairment of health-related quality of life and work productivity. However, it was noted that health-related quality of life and work productivity after being cured was not related to the stage of fibrosis.

Editorial Comment: This is an important study because it proved that curing people of hepatitis C improved physical well-being and work productivity.  I am eager to see more of these types of studies because we all need more information about every aspect of being cured of hepatitis C—this helps people living with hepatitis C to make the treatment decision and it will further justify the expense and need to treat people with hepatitis C.

Abstract: Chronic hepatitis C virus infection and lymphoproliferative disorders: Mixed cryoglobulinemia syndrome, monoclonal gammopathy of undetermined significance, and B-cell non-Hodgkin lymphoma—GP Caviglia
  Source: J Gastroenterol Hepatol.2015 Apr;30(4):742-7. doi: 10.1111/jgh.12837.

The researchers reviewed a study of 1,313 HCV patients who had enrolled in previous studies from January 2006 and December 2013.  There was a total of 121 people with HCV and lymphoproliferative disorders (LPDs) and 130 without LPDs.  The two groups were evenly divided between age and gender.  In the groups with LPDs—25 had mixed cryoglobulinemia (MCS)*; 55 had monoclonal gammopathy of undetermined significance (MGUS)**; 41 had B-cell non-Hodgkin Lymphoma (B-HNL)***.  The patients with LPDs did not differ in age, severity of disease, HCV genotype, and response HCV therapy. 

The Bottom Line:  After analyzing the data, it was found that there was an association between MGUS and B-NHL and cirrhosis, but there was no association between MCS and cirrhosis. 

Editorial Comment:  It is interesting that there was a correlation between MGUS and cirrhosis.  However, both conditions typically take many years before serious disease progression occurs.  In regards to MCS it can occur earlier in the course of HCV infection.  Still, it is important that people living with hepatitis C understand this information and talk with their medical providers to be tested for these conditions and for medical providers to make sure they are tested.  If someone infected with hepatitis C does have these serious conditions they may be more likely to qualify for treatment.  It would be, however, best medical and patient practice to nip these and HCV in the bud by treating and curing hepatitis early before any disease or associated condition has a chance to occur. 

*Mixed cryoglobulinemia (MCS) is one of the most common disorders associated with hepatitis C.  Cryoglobulinemia (cryo for short) is a blood disorder caused by abnormal proteins in the blood called cryoglobulins that precipitate or clump together when blood is chilled and then dissolve when warmed.  Cryo can lead to many other disorders. 

**Monoclonal gammopathy of undetermined significance (MGUS) are abnormal proteins in the blood.   They can be associated with another disease (such as hepatitis C).  They rarely cause disease, but in some people with certain conditions, such as hepatitis C, MGUS’s can progress to other diseases. 

***B-cell non-Hodgkin Lymphomas (B-HNL) are cancers of the lymphoid tissues.  The cancers are typically uncommon and usually occur after many years of infection with hepatitis C. 

More detailed information can be found on our fact sheet page.

http://hcvadvocate.org/news/newsLetter/2015/advocate0415_mid.html#1

Warning: Pegasys plus Ribavirin Pediatric Use

Pegasys (peginterferon alfa-2a)

Detailed View: Safety Labeling Changes Approved By FDA Center for Drug Evaluation and Research (CDER)
March 2015

WARNINGS AND PRECAUTIONS

Impact on Growth in Pediatric Patients

• During combination therapy for up to 48 weeks with PEGASYS plus ribavirin growth inhibition was observed in pediatric subjects 5 to 17 years of age. Decreases in weight for age z-score and height for age z-score up to 48 weeks of therapy compared with baseline were observed. At 2 years post-treatment, 16% of pediatric subjects were more than 15 percentiles below their baseline weight curve and 11% were more than 15 percentiles below their baseline height curve.
• The available longer term data on subjects who were followed up to 6 years post-treatment is too limited to determine the risk of reduced adult height in some patients [see Clinical Trials Experience (6.1)].

Read more...

Caffeinated drinks associated with decreased risk of liver scarring

Modest daily consumption of caffeinated drinks is associated with less advanced liver scarring in people with hepatitis C, according to a recent study by Baylor College of Medicine researchers that appears online in the journal Clinical Gastroenterology and Hepatology.

Dr. Hashem El-Serag, chief of gastroenterology and hepatology at Baylor and at the Michael E. DeBakey Veterans Affairs Medical Center and lead author of the study, said the results showed that the risk of liver scarring in hepatitis C patients was decreased when individuals regularly consumed caffeinated coffee, and to a lesser extent tea and soda.

“We found that participants who drank caffeinated coffee daily had the best results,” he said. “This is most likely do to the fact that one coffee drink has more caffeine than tea or sodas.”

Read more....

See Also: The Five: Coffee

UK: Ten year drive to wipe out hepatitis C in Bradford

CASES of hepatitis C could be eradicated in Bradford by 2025, according to leading liver expert Dr Sulleman Moreea.

The consultant hepatologist at Bradford Royal Infirmary said the dream of wiping out the virus that could be affecting up to 4,000 people in the city really is "an achievable goal".

There are about 1,200 patients who have been referred to the hospital with Hepatitis C but the total number of people with it in Bradford is estimated to be between 3,000 to 4,000, according to Dr Moreea.

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Maine sets a record for drug needle exchanges

The total hit 564,847 last year, up 238 percent since 2010, as heroin use surged and clinics like Portland's worked to prevent cases of HIV and hepatitis C.

State law has allowed needle exchanges in Maine since 1997, but the program only became active in 2002. There are four state-certified needle exchange programs, operating at six sites: Portland, Lewiston, Augusta, Bangor, Ellsworth and Machias.

All of Maine’s programs operate without federal or state funding. Federal funding for needle exchange has been banned since 1988 (except for a period from 2009 to 2012) and states often don’t provide funding either, so the programs run mainly on private grants or donations.

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Weekly Special Topic: HCV Diagnostic Tools

 

HCV Diagnostic Tools

We have updated and condensed our HCSP Fact Sheet Series "HCV Diagnostic Tools" into one fact sheet: 

An Overview of HCV Diagnostic Tests 

Check it out!