Among those coinfected with HIV, a cure for hepatitis C virus (HCV) is linked with improvements in liver stiffness, even if they have cirrhosis, aidsmap reports. Publishing their findings in the journal AIDS, researchers studied 98 HIV/HCV-coinfected individuals who had taken at least one dose of hep C therapy.
Fifty-three members of the cohort (54 percent) achieved a sustained virologic response 12 weeks after completing therapy (SVR12, considered a cure).
The median follow-up time for the entire study group was 45 months.
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Monday, August 24, 2015
Thursday, August 20, 2015
Op-Ed How to pay the bill for hepatitis C
"California...is helping to lead the way out of the hepatitis C conundrum with a sensible policy: Treat everyone who needs it, but not until treatment is necessary."
How long should you wait to treat a possibly fatal but curable disease?
That's a question with major implications for millions of patients and for insurers and government programs that have to pay for the treatment.
In the last year this question has focused on hepatitis C, a viral infection of the liver that, left untreated, can lead to cirrhosis, cancer, liver failure and death. Hepatitis C is the leading cause for liver transplants in the United States.
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Snapshots Alan Franciscus, Editor-in-Chief
Article: Hepatitis C in children in times of change—RD Baker et al.
Source: Curr Opin Pediatr. 2015 Jul 18. [Epub ahead of print]
Source: Curr Opin Pediatr. 2015 Jul 18. [Epub ahead of print]
Results and Conclusions
The main focus of the abstract was when to initiate treatment and when it is safe to wait for approval of the new highly effective direct-acting antiviral therapies to treat hepatitis C (HCV).
The main focus of the abstract was when to initiate treatment and when it is safe to wait for approval of the new highly effective direct-acting antiviral therapies to treat hepatitis C (HCV).
Pegylated interferon and ribavirin is the current standard of care to treat children with hepatitis C. There are pediatric clinical trials of sofosbuvir/ledipasvir, ribavirin, and Vieikira Pak, with and without ribavirin. Approval of these drugs is expected in the near future.
The authors make a good case for their recommendations:
- Wait: Children generally have a slow disease progression so in most cases it is safe to wait for the interferon- and ribavirin-free medications to be approved.
- Treat: In the case of children who do have serious disease progression treatment now is warranted. Genotype information should be factored into the treatment decision process since genotype 2 and 3 cure rates are higher and treatment durations are shorter with pegylated interferon and ribavirin combination therapy.
The Bottom Line
All children with HCV should be monitored on a regular basis. Any treatment decisions for children should be evaluated on a case-by-case basis.
All children with HCV should be monitored on a regular basis. Any treatment decisions for children should be evaluated on a case-by-case basis.
Editorial Comment
The general consensus is to wait (if possible) until the interferon- and ribavirin- free therapies are available. However, there is a small percentage of children with HCV who progress on to serious liver disease very quickly—this is why it is so important to identify and monitor children on a regular basis.
The general consensus is to wait (if possible) until the interferon- and ribavirin- free therapies are available. However, there is a small percentage of children with HCV who progress on to serious liver disease very quickly—this is why it is so important to identify and monitor children on a regular basis.
It will be very interesting once the new therapies are approved to treat children with HCV. Will insurance companies be as restrictive as they are with adults? Hopefully not! But if they are it just might be enough to raise the level of public ire to demand that they cover the medications for everyone. It might also be enough that the public finally demand that the prices come down so that everyone affected by hepatitis C can afford the medications.
Coming soon: An Overview of HCV in Children
Article: Prevalence of Cirrhosis in Hepatitis C Patients in the Chronic Hepatitis Cohort Study (CHeCS): A Retrospective and Prospective Observational Study—S C Gordon et. al
Source: Am J Gastroenterol. 2015 Jul 28. doi: 10.1038/ajg.2015.203. [Epub ahead of print]
Source: Am J Gastroenterol. 2015 Jul 28. doi: 10.1038/ajg.2015.203. [Epub ahead of print]
Results and Conclusions
In the Chronic Hepatitis Cohort Study (CHeCS) there were 9,783 patients, 2,788 (28.5%) were cirrhotic by at least one method. Biopsy identified cirrhosis in only 661 (7%). Other parameters, such as the International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) were not assigned to the biopsy proven cirrhosis results.
In the Chronic Hepatitis Cohort Study (CHeCS) there were 9,783 patients, 2,788 (28.5%) were cirrhotic by at least one method. Biopsy identified cirrhosis in only 661 (7%). Other parameters, such as the International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) were not assigned to the biopsy proven cirrhosis results.
The Bottom Line
The authors noted that the since the ICD-9 codes may not be the best codes to indicate the prevalence of cirrhosis and that there may be a ‘fourfold’ higher prevalence of cirrhosis in studies previously reported.
The authors noted that the since the ICD-9 codes may not be the best codes to indicate the prevalence of cirrhosis and that there may be a ‘fourfold’ higher prevalence of cirrhosis in studies previously reported.
Editorial Comment
This is an important study. We need to understand the true prevalence of cirrhosis in this country. It will help to push for better funding and making sure that people are treated sooner rather than waiting until people become sick.
This is an important study. We need to understand the true prevalence of cirrhosis in this country. It will help to push for better funding and making sure that people are treated sooner rather than waiting until people become sick.
Article: Chronic Hepatitis C Virus Infection Is Associated with Subclinical Coronary Atherosclerosis in the Multicenter AIDS Cohort Study (MACS): a Cross-Sectional Study—RA McKibben
Source: J Infect Dis. 2015 Jul 27. pii: jiv396. [Epub ahead of print]
Source: J Infect Dis. 2015 Jul 27. pii: jiv396. [Epub ahead of print]
Results and Conclusions
Eighty-seven men with chronic hepatitis C were evaluated for the risk of cardiovascular disease (CVD).
Eighty-seven men with chronic hepatitis C were evaluated for the risk of cardiovascular disease (CVD).
Note: the study also looked at HIV and HIV/HCV coinfected men but did not find an association.
The men were assessed for coronary plaque using non-contrast coronary CT and CT angiography and evaluated the associations of CHC with measures of plaque (substances that lead to hardening of the veins/arteries), prevalence, extent, and stenosis (narrowing of the veins). It was found that all types of plaques were significantly higher in men with chronic hepatitis C.
Bottom Line
This is not the first study that has shown that there are cardiovascular problems associated with hepatitis C. But it is important to remember that this is a small study. It also needs to be replicated in a larger patient population and in women with HCV.
Editorial Comment:
As we come to understand more and more about hepatitis C it becomes clear how much damage hepatitis C causes to many organs outside of the liver. Everyone with hepatitis C needs to be monitored on a regular basis. In this case men and women need to be monitored for cardiovascular disease. This is another reason why people with hepatitis C should be treated before these types of health issues are allowed to begin.
http://hcvadvocate.org/news/newsLetter/2015/advocate0815_mid.html#4
Wednesday, August 19, 2015
Local Health Officials Worried Over Spike in Hepatitis C Cases
"The Green Bay area is following a national trend."
Health officials fear a public health concern they predicted a few years ago is now happening.
When heroin use began surging locally, they warned a jump in Hepatitis C cases would follow.
Now, that’s exactly what’s happening.
Expression of a single gene lets scientists easily grow hepatitis C virus in the lab
"What prevents non-mutated HCV from replicating in laboratory-grown cell lines?"
In a study published in Nature on August 12, scientists led by The Rockefeller University’s Charles M. Rice, Maurice R. and Corinne P. Greenberg Professor in Virology and head of the Laboratory of Virology and Infectious Disease, report that when they overexpressed a particular gene in human liver cancer cell lines, the virus could easily replicate. This discovery allows study of naturally occurring forms of hepatitis C virus (HCV) in the lab.
“Being able to easily culture HCV in the lab has many important implications for basic science research,” says Rice. “There is still much we don’t understand about how the virus operates, and how it interacts with liver cells and the immune system.”
Scientists have long attempted to understand what makes HCV tick, and in 1999 a group of German scientists succeeded in coaxing modified forms of the virus to replicate in cells in the laboratory. However, it was soon discovered that these forms of the virus were able to replicate because they had acquired certain “adaptive” mutations.
Read more...
In a study published in Nature on August 12, scientists led by The Rockefeller University’s Charles M. Rice, Maurice R. and Corinne P. Greenberg Professor in Virology and head of the Laboratory of Virology and Infectious Disease, report that when they overexpressed a particular gene in human liver cancer cell lines, the virus could easily replicate. This discovery allows study of naturally occurring forms of hepatitis C virus (HCV) in the lab.
“Being able to easily culture HCV in the lab has many important implications for basic science research,” says Rice. “There is still much we don’t understand about how the virus operates, and how it interacts with liver cells and the immune system.”
Scientists have long attempted to understand what makes HCV tick, and in 1999 a group of German scientists succeeded in coaxing modified forms of the virus to replicate in cells in the laboratory. However, it was soon discovered that these forms of the virus were able to replicate because they had acquired certain “adaptive” mutations.
Read more...
The Five: HCV Myth Busters —Alan Franciscus, Editor-in-Chief
Ever since I’ve been working in hepatitis C there have been many, many myths about hepatitis C. Thankfully, some of the myths have disappeared, but unfortunately, many still linger. I have included the most common myths I still hear, but these are by no means all of the myths circulating out there!
1. Myth: Hepatitis C is a death sentence!
Fact: When someone is newly diagnosed with hepatitis C, one of the first questions he or she asks themselves is this question. Yes, too many people die from hepatitis C but it is not necessarily hepatitis C that is killing people—the lack of diagnosis, medical care and treatment are responsible for all the deaths. No one should die from hepatitis C! If everyone with hepatitis C was diagnosed early on, received regular monitoring and was treated with HCV medications we would not see these many deaths that we see. But of course, that is not reality so people are needlessly dying.
Fact: When someone is newly diagnosed with hepatitis C, one of the first questions he or she asks themselves is this question. Yes, too many people die from hepatitis C but it is not necessarily hepatitis C that is killing people—the lack of diagnosis, medical care and treatment are responsible for all the deaths. No one should die from hepatitis C! If everyone with hepatitis C was diagnosed early on, received regular monitoring and was treated with HCV medications we would not see these many deaths that we see. But of course, that is not reality so people are needlessly dying.
2. Myth: Genotype 1 is the ‘worst’ genotype!
Fact: Wrong! As it turns out genotype 3 turns out to be the genotype that has the lower treatment response, and that seems to increase the chances of developing fatty liver. While the direct link between genotype 3 and fatty liver is not completely understood, it is known that when people with genotype 3 are cured the fatty liver is reduced and sometimes completely resolved. It is well-known that fatty liver increases the rate of HCV disease progression that can lead to cirrhosis. People with genotype 3 also have faster rates of disease progression.
Fact: Wrong! As it turns out genotype 3 turns out to be the genotype that has the lower treatment response, and that seems to increase the chances of developing fatty liver. While the direct link between genotype 3 and fatty liver is not completely understood, it is known that when people with genotype 3 are cured the fatty liver is reduced and sometimes completely resolved. It is well-known that fatty liver increases the rate of HCV disease progression that can lead to cirrhosis. People with genotype 3 also have faster rates of disease progression.
There may also be a link between genotype 3, insulin resistance and viral load, but more studies are needed.
People with genotype 3 and cirrhosis have a much lower response rate with the two currently approved HCV medications—Sovaldi plus ribavirin and Daklinza plus Sovaldi. More HCV medications are under development to meet this unmet medical need.
3. Myth: HCV has no symptoms!
Fact: Come on! Anyone who is living with hepatitis C can tell you that there are many symptoms from hepatitis C. They may come on so gradually that some people with hepatitis C may not even notice that the symptoms are from hepatitis C. When cured, however, the symptoms for the most part fade away. The most common symptoms are fatigue. The type of fatigue can be mild, moderate or severe. It is difficult to measure some of the symptoms and that is the reason that they are many times dismissed. There are many other symptoms such as muscle and joint pain, brain fog, skin problems, insomnia, and of course there can be some very severe symptoms and problems associated with hepatitis C.
Fact: Come on! Anyone who is living with hepatitis C can tell you that there are many symptoms from hepatitis C. They may come on so gradually that some people with hepatitis C may not even notice that the symptoms are from hepatitis C. When cured, however, the symptoms for the most part fade away. The most common symptoms are fatigue. The type of fatigue can be mild, moderate or severe. It is difficult to measure some of the symptoms and that is the reason that they are many times dismissed. There are many other symptoms such as muscle and joint pain, brain fog, skin problems, insomnia, and of course there can be some very severe symptoms and problems associated with hepatitis C.
4. Myth: There is a hepatitis C vaccine!
Fact: BIG FALSE! This myth is because people get hepatitis A, B, C confused and lump them all together. There is a vaccine to protect against hepatitis A and hepatitis B. But, don’t we wish there was a vaccine for hepatitis C? There are also other confusing myths out there like: “Isn’t that the one you get from eating bad food?”; “Isn’t hepatitis C that one when hepatitis A gets worse, turns into hepatitis B, gets even worse and turns into hepatitis C—all of these are myths.
Fact: BIG FALSE! This myth is because people get hepatitis A, B, C confused and lump them all together. There is a vaccine to protect against hepatitis A and hepatitis B. But, don’t we wish there was a vaccine for hepatitis C? There are also other confusing myths out there like: “Isn’t that the one you get from eating bad food?”; “Isn’t hepatitis C that one when hepatitis A gets worse, turns into hepatitis B, gets even worse and turns into hepatitis C—all of these are myths.
Note: It is important to remember, however, that people with hepatitis C should be vaccinated against hepatitis A and hepatitis B if they are not immune. You don’t want to get another hepatitis virus on top of hepatitis C.
5. Myth: Hepatitis C is a sexually transmitted disease!
Fact: Hepatitis C is not classified as a sexually transmitted disease. It can be transmitted sexually, but it is uncommon among people who are in a stable long-term monogamous relationship. In people who are not in a stable long-term monogamous relationship the risk of sexual transmission is higher. If you fall within this group safer sex practices should be followed.
http://hcvadvocate.org/news/newsLetter/2015/advocate0815_mid.html#3
Tuesday, August 18, 2015
Liver damage in hepatitis C patients significantly underestimated, says Henry Ford study
DETROIT - The number of hepatitis C patients suffering from advanced liver damage may be grossly underestimated and underdiagnosed, according to a study led by researchers at Henry Ford Health System and the U.S. Centers for Disease Control and Prevention.
The findings were the result of a study of nearly 10,000 patients suffering from hepatitis C, and could have a significant effect on patient care and healthcare policy regarding the chronic disease.
"Knowledge of the prevalence of liver damage will help decision making regarding screening for the effects of hepatitis C, when to start anti-viral therapy, and the need for follow-up counseling," says Stuart Gordon, M.D., lead researcher and Director of Hepatology at Henry Ford Hospital.
Read more...
The findings were the result of a study of nearly 10,000 patients suffering from hepatitis C, and could have a significant effect on patient care and healthcare policy regarding the chronic disease.
"Knowledge of the prevalence of liver damage will help decision making regarding screening for the effects of hepatitis C, when to start anti-viral therapy, and the need for follow-up counseling," says Stuart Gordon, M.D., lead researcher and Director of Hepatology at Henry Ford Hospital.
Read more...
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