Sunday, March 18, 2018

Audio Story- Hepatitis C Is More Common In Vietnam Vets, But Nobody Is Sure Why

From: American Homefront Project
PRX » Station » North Country Public Radio
By Sarah Harris • Mar 15, 2018
Produced: Mar 13, 2018
Sarah Harris reports on an effort to get Vietnam vets checked and treated for Hepatitis C.


The reasons that Vietnam vets are more likely to have hepatitis C are disputed. Kaifetz blames a device called the "jet gun injector" that the military used to vaccinate service members during the Vietnam era. It generated a burst of air pressure to force the vaccine under the skin.

"It was supposed to shoot the injection through your skin cells without piercing the skin with a needle," Kaifetz explained.

Even though the gun wasn't supposed to break the skin, a lot of veterans say it made them bleed. The gun usually wasn't sterilized between each use.

This story was produced by the American Homefront Project, a public media collaboration that reports on American military life and veterans. Funding comes from the Corporation for Public Broadcasting and the Bob Woodruff Foundation. 

Fibroblast growth factor analog shows promise in non-alcoholic steatohepatitis

Through a randomized, double-blind, placebo-controlled phase II clinical trial, researchers at University of California San Diego School of Medicine report that small doses of NGM282, a non-tumorigenic variant of an endocrine gastrointestinal hormone, can significantly and rapidly decrease liver fat content in patients with non-alcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH)

Reuters Health
NEW YORK (Reuters Health) - An engineered analog of FGF-19, a hormone that regulates bile-acid synthesis and glucose homoeostasis, rapidly curbs liver fat in patients with non-alcoholic steatohepatitis, but has frequent side effects, according to an industry-funded trial.

Dr. Michael Charlton of the Center for Liver Diseases at the University of Chicago, who wrote an accompanying editorial, told Reuters Health that the study "dramatically demonstrates the capacity for FGF-19 agonists to rapidly delipidate the liver with associated signals for improved inflammation and fibrosis."

Dr. Charlton added, "The results are, however, preliminary, with frequent side effects limiting tolerability at the doses used and some rebounding of inflammatory markers at the conclusion of this short study."

UC San Diego News Center
By Gabrielle Johnston, MPH
In clinical trial, treatment significantly reduced liver fat in NAFLD and NASH patients, offering possible new treatment for conditions that currently lack medical remedies

Through a randomized, double-blind, placebo-controlled phase II clinical trial, researchers at University of California San Diego School of Medicine report that small doses of NGM282, a non-tumorigenic variant of an endocrine gastrointestinal hormone, can significantly and rapidly decrease liver fat content in patients with non-alcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH). The findings, they say, represent an important proof-of-concept for the compound as there are currently no Food and Drug Administration-approved treatments for NAFLD and NASH.

The study is published in the March 5 online issue of The Lancet.

"Patients with NAFLD and NASH have had limited treatment options for years. What the results of our phase II study show is a promising future where NGM282 may be able to provide relief to these patients," said senior author Rohit Loomba, MD, director of the UC San Diego NAFLD Research Center and director of hepatology at UC San Diego School of Medicine.

NAFLD includes a spectrum of chronic hepatic (liver) diseases, with NASH being the most aggressive type. The cause of both NAFLD and NASH remains a mystery, but certain health conditions, including obesity and type 2 diabetes, can be predisposing factors. It is estimated that tens of millions of people globally are living with NAFLD and NASH. Weight loss and a healthier diet are the current standards of care.

The study involved 166 patients, ages 18 to 75, at 18 different hospitals, gastroenterology or liver clinics in the United States and Australia. Participants had confirmed NAFLD or NASH biopsies and a liver fat content of at least 8 percent. Participants were randomly assigned by a web-based computer system on a 1:1:1 model to receive 3 milligrams (mg) or 6 mg of NGM282 or a placebo injection once per day. They were then monitored biweekly over a three-month period.

Loomba explained that both the 3 mg and 6 mg doses of NGM282 produced rapid and sustained change of liver fat content. "The most promising outcome of this study was the absolute change in liver fat that we were able to measure using advanced magnetic resonance imaging (MRI) methods previously developed and validated in pilot studies conducted at the UC San Diego NAFLD Research Center. Looking from baseline to week 12, we consider participants who had a liver fat reduction of at least either a 5 percent absolute reduction or greater than 30 percent relative reduction from baseline to be clinically significant."

To measure reduction in liver fat, researchers used hepatic MRIs with proton density fat fraction. This type of imaging is extremely sensitive to changes in liver composition compared with traditional assessments of tissue samples under a microscope.

NMG282 is a non-tumorigenic variant of fibroblast growth factor 19, an endocrine gastrointestinal hormone that regulates stomach acid and is responsible for glucose and lipid metabolism in the body. It is suspected that NMG282 is able to improve liver steatosis as well as inflammation and fibrosis commonly associated with NAFLD and NASH. Study participants generally tolerated NMG282 with reported side effects including pain at the injection site, diarrhea, abdominal pain and nausea. No life-threating events or patient deaths occurred during the study. The authors said additional and longer trials are needed to fully understand the efficacy and effectiveness of NGM282.

"Moving forward, we are continuing the development of this compound for the treatment of NASH related fibrosis," said Loomba. "In this, we hope to further examine the efficacy of this hormone in improving liver histology based end-points in patients with biopsy-proven NASH with fibrosis."


Saturday, March 17, 2018

WHO calls for better monitoring of viral hepatitis and liver cancer

New Surveillance protocol
Protocol for surveillance of the fraction of cirrhosis and hepatocellular carcinoma attributable to viral hepatitis in clinical centres of excellence
Need for national mortality estimates
The “mortality envelope” from cirrhosis and hepatocellular carcinoma is attributed to HBV and HCV on the basis of evidence from published studies that reported the proportion of patients with these sequelae who had HBV and HCV infection (which is referred to as “the attributable fraction”). At the national level, however, most countries lack a systematic process to generate national estimates of mortality from viral hepatitis. Thus, countries need to institutionalize methods that have been used in an ad-hoc manner in the past for published studies and turn these into a routine surveillance system. To generate national estimates of hepatitis-related mortality, it is necessary (i) to estimate mortality from chronic liver disease (including cirrhosis and hepatocellular carcinoma), and (ii) to estimate the fraction of these conditions that are attributable to various hepatitis viruses. For the first step, national mortality data are usually available. Alternatively, in countries where the quality of data from vital registration systems is not optimal, estimates regarding mortality from cirrhosis and hepatocellular carcinoma are available from WHO or the GBD. However, for the second step, most countries lack a system to estimate which proportion of the sequelae is attributable to the various hepatitis viruses and which due to other causes (e.g. alcohol, metabolic syndrome), and consolidate data from various sources in order to estimate mortality.

WHO Press Release
WHO calls for better monitoring of viral hepatitis and liver cancer
18 March 2018, New Delhi – WHO is sharing a new surveillance protocol to improve understanding of the link between viral hepatitis and its 2 main consequences: cirrhosis and hepatocellular carcinoma (a key type of liver cancer).

Viral hepatitis B and C infections lead to an estimated 1.34 million deaths every year. Most of these deaths are caused by untreated chronic hepatitis infections resulting in cirrhosis and liver cancer. In fact, chronic hepatitis B and C infections are thought to be responsible for about 2 thirds of all cases of liver cancer globally.

However, existing national monitoring systems do not collect death reports with sufficient detail to measure the exact gravity of this important cause of mortality. In national statistics systems, cirrhosis and hepatocellular carcinoma/liver cancer are provided as the causes of death without attribution to the original cause – viral hepatitis.

WHO shared the new protocol today at the Congress of the Asian Pacific Association for the Study of the Liver. It will be implemented at a network of clinics ("centres of excellence") where hepatologists, gastroenterologists and other health-care providers treating cirrhosis and hepatocellular carcinoma patients can start documenting mortality causes and other data more accurately. Their improved documentation will contribute to obtaining more accurate data on the scope of the problem at regional and global levels.

Better understanding of the linkages between viral hepatitis and liver cancer will be key to improving global and national policies and strategies to reduce deaths caused by both diseases.

In 2016, the World Health Assembly endorsed a resolution calling for the elimination of viral hepatitis as a public health threat by 2030. Elimination is defined as a 90% reduction in new cases and a 65% reduction in mortality. By unveiling the link between viral hepatitis and its deadly consequences, the new protocol will help assemble more accurate data to guide progress towards the elimination goal.

Hep C Compounds Alcoholism’s Effect on Brain Volume

JAMA Psychiatry Published March 14, 2018
Full Text Article: The Role of Aging, Drug Dependence, and Hepatitis C Comorbidity in Alcoholism Cortical Compromise
This combined cross-sectional/longitudinal study evaluated magnetic resonance imaging data collected during 14 years in 199 control and 222 alcohol-dependent participants. Findings revealed frontally distributed cortical volume deficits in individuals with alcohol dependence, accelerated age-dependent decline, and compounded deficits with drug dependence or hepatitis C virus infection comorbidity.

These findings raise concern for heightened risk of accelerated cortical aging with alcohol dependence even when alcohol misuse develops later in life.

In The Media
Hep C Compounds Alcoholism’s Effect on Brain Volume
Last Updated: March 16, 2018.
Media Source - DoctorsLounge

FRIDAY, March 16, 2018 (HealthDay News) -- Alcohol dependence has deleterious effects on frontal cortical volumes that are compounded by hepatitis C virus (HCV) infection and drug dependence, according to a study published online March 14 in JAMA Psychiatry.

Edith V. Sullivan, Ph.D., from the Stanford University School of Medicine in California, and colleagues examined cortical volume deficits using 826 structural magnetic resonance images from 222 individuals with alcohol dependence and 199 age-matched control participants. Longitudinal data were available for 116 participants with alcoholism and 96 controls.

The researchers found that participants with alcohol dependence had volume deficits in frontal, temporal, parietal, cingulate, and insular cortices; the deficits were prominent in fontal subregions and were not dependent on sex. In the frontal cortex and precentral and superior gyri, accelerated aging occurred; this could not be attributed to the amount of alcohol consumed, which was greater in younger- versus older-onset participants with alcoholism. Smaller frontal volumes were seen for alcohol plus cocaine and alcohol plus opiate groups versus drug-dependence-free alcoholism groups. Greater deficits were seen in those with versus those without HCV infection in frontal, precentral, superior, and orbital volumes; in uninfected participants with alcoholism, total frontal, insular, parietal, temporal, and precentral volume deficits persisted compared with control participants with known HCV status.

"We speculate that age-alcohol interactions notable in frontal cortex put older adults at heightened risk for age-associated neurocompromise even if alcohol misuse is initiated later in life," the authors write.

Abstract/Full Text

Cost-effectiveness analysis of Zepatier treating HCV genotype 1 in stage 4-5 chronic kidney disease patients in France

Cost-effectiveness analysis of elbasvir-grazoprevir regimen for treating hepatitis C virus genotype 1 infection in stage 4-5 chronic kidney disease patients in France
Franck Maunoury , Aurore Clément, Chizoba Nwankwo , Laurie Levy-Bachelot, Armand Abergel, Vincent Di Martino, Eric Thervet, Isabelle Durand-Zaleski

Published: March 15, 2018

Full Text

To assess the cost-effectiveness of the elbasvir/grazoprevir (EBR/GZR) regimen in patients with genotype 1 chronic hepatitis C virus (HCV) infection with severe and end-stage renal disease compared to no treatment.

This study uses a health economic model to estimate the cost-effectiveness of treating previously untreated and treatment experienced chronic hepatitis C patients who have severe and end stage renal disease with the elbasvir-grazoprevir regimen versus no treatment in the French context. The lifetime homogeneous markovian model comprises of forty combined health states including hepatitis C virus and chronic kidney disease. The model parameters were from a multicentre randomized controlled trial, ANRS CO22 HEPATHER French cohort and literature. 1000 Monte Carlo simulations of patient health states for each treatment strategy are used for probabilistic sensitivity analysis and 95% confidence intervals calculations. The results were expressed in cost per quality-adjusted life year (QALY) gained.

The mean age of patients in the HEPATHER French cohort was 59.6 years and 56% of them were men. 22.3% of patients had a F0 fibrosis stage (no fibrosis), 24.1% a F1 stage (portal fibrosis without septa), 7.1% a F2 stage (portal fibrosis with few septa), 21.4% a F3 stage (numerous septa without fibrosis) and 25% a F4 fibrosis stage (compensated cirrhosis). Among these HCV genotype 1 patients, 30% had severe renal impairment stage 4, 33% had a severe renal insufficiency stage 5 and 37% had terminal severe renal impairment stage 5 treated by dialysis.

Fixed-dose combination of direct-acting antiviral agents elbasvir and grazoprevir compared to no-treatment.

EBR/GZR increased the number of life years (6.3 years) compared to no treatment (5.1 years) on a lifetime horizon. The total number of QALYs was higher for the new treatment because of better utility on health conditions (6.2 versus 3.7 QALYs). The incremental cost-utility ratio (ICUR) was of €15,212 per QALY gained for the base case analysis.

This cost-utility model is an innovative approach that simultaneously looks at the disease evolution of chronic hepatitis C and chronic kidney disease. EBR/GZR without interferon and ribavirin, produced the greatest benefit in terms of life expectancy and quality-adjusted life years (QALY) in treatment-naïve or experienced patients with chronic hepatitis C genotype 1 and stage 4–5 chronic kidney disease including dialysis patients. Based on shape of the acceptability curve, EBR/GZR can be considered cost-effective at a willingness to pay of €20,000 /QALY for patients with renal insufficiency with severe and end-stage renal disease compared to no treatment.

Progression of diabetes, heart disease, and stroke multimorbidity in middle-aged women: A 20-year cohort study

Research Article

Progression of diabetes, heart disease, and stroke multimorbidity in middle-aged women: A 20-year cohort study

Xiaolin Xu , Gita D. Mishra, Annette J. Dobson, Mark Jones Published: March 13, 2018

Full Text
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The prevalence of diabetes, heart disease, and stroke multimorbidity (co-occurrence of two or three of these conditions) has increased rapidly. Little is known about how the three conditions progress from one to another sequentially through the life course. We aimed to delineate this progression in middle-aged women and to determine the roles of common risk factors in the accumulation of diabetes, heart disease, and stroke multimorbidity.

Methods and findings
We used data from 13,714 women aged 45–50 years without a history of any of the three conditions. They were participants in the Australian Longitudinal Study on Women's Health (ALSWH), enrolled in 1996, and surveyed approximately every 3 years to 2016. We characterized the longitudinal progression of the three conditions and multimorbidity. We estimated the accumulation of multimorbidity over 20 years of follow-up and investigated their association with both baseline and time-varying predictors (sociodemographic factors, lifestyle factors, and other chronic conditions).
Over 20 years, 2,511 (18.3%) of the women progressed to at least one condition, of whom 1,420 (56.6%) had diabetes, 1,277 (50.9%) had heart disease, and 308 (12.3%) had stroke; 423 (16.8%) had two or three of these conditions. Over a 3-year period, the age-adjusted odds of two or more conditions was approximately twice that of developing one new condition compared to women who did not develop any new conditions. For example, the odds for developing one new condition between Surveys 7 and 8 were 2.29 (95% confidence interval [CI], 1.93–2.72), whereas the odds for developing two or more conditions was 6.51 (95% CI, 3.95–10.75). The onset of stroke was more strongly associated with the progression to the other conditions (i.e., 23.4% [95% CI, 16.3%–32.2%] of women after first onset of stroke progressed to other conditions, whereas the percentages for diabetes and heart disease were 9.9% [95% CI, 7.9%–12.4%] and 11.4% [95% CI, 9.1%–14.4%], respectively). Being separated, divorced, or widowed; being born outside Australia; having difficulty managing on their available income; being overweight or obese; having hypertension; being physically inactive; being a current smoker; and having prior chronic conditions (i.e., mental disorders, asthma, cancer, osteoporosis, and arthritis) were significantly associated with increased odds of accumulation of diabetes, heart disease, and stroke multimorbidity. The main limitations of this study were the use of self-reported data and the low number of events.

Stroke was associated with increased risk of progression to diabetes or heart disease. Social inequality, obesity, hypertension, physical inactivity, smoking, or having other chronic conditions were also significantly associated with increased odds of accumulating multimorbidity. Our findings highlight the importance of awareness of the role of diabetes, heart disease, and stroke multimorbidity among middle-aged women for clinicians and health-promotion agencies.

Author summary
Why was this study done?
  • In an aging population, it is common for women to experience two or more of diabetes, heart disease, and stroke.
  • Few published studies have investigated how women progress from a “healthy” state to having one of diabetes, heart disease, and stroke and then to multimorbidity.
  • No prospective evidence is available on the roles of time-varying common risk factors (i.e., high blood pressure or obesity) in the accumulation of multimorbidity from diabetes, heart disease, and stroke—information that may be important for health promotion and risk modification.
What did the researchers do and find?
  • In this national prospective cohort study, 13,714 middle-aged Australian women (45–50 years old) were recruited in 1996 and have been followed for 2 decades. We collected data on their health conditions, including diabetes, heart disease, and stroke, as well as potential risk factors every 3 years until 2016.
  • From early to late middle age, many more women developed a single condition than multimorbidity. However, the odds ratio for accumulation of multimorbidity (i.e., from none or one to two or three, or from two to three of diabetes, heart disease, or stroke) was much higher than the odds of developing only one new condition, compared to women who did not develop any new condition over 3 years.
  • Nearly one-quarter of women who were initially diagnosed with stroke subsequently progressed to other conditions, a much higher percentage than those who were initially diagnosed with diabetes (9.9%) or heart disease (11.4%).
  • Women who were obese, had hypertension, were physically inactive, were smokers, or had other chronic conditions had higher odds of accumulating diabetes, heart disease, and stroke multimorbidity over the following 3-year period than women without these characteristics.
What do these findings mean?
  • To our knowledge, this is the first study to delineate the accumulation of diabetes, heart disease, and stroke multimorbidity and investigate its association with both baseline and time-varying predictors in a prospective cohort study.
  • These findings suggest that health promotion, interventions for modifying lifestyle factors (obesity, high blood pressure, physical inactivity, and smoking), and treatment of other chronic conditions would be potentially beneficial for preventing the accumulation of diabetes, heart disease, and stroke multimorbidity.
  • For women who have had a stroke, health promotion, intervention, and treatment would be particularly important, as they appear most likely to progress to other conditions
Continue to full text article:

March HCV Newsletters & America’s Opioid Crisis: Overdoses Still Increasing

March HCV Newsletters & Updates: America’s opioid crisis is still increasing

Today the CDC reported emergency department visits for opioid overdoses rose 30% across the US.

- Particularly hard hit were Midwestern states, with a 70% increase in opioid overdoses. 
- Opioid overdoses increased for both sexes and all age groups. 
- People who have had an opioid overdose are more likely to have another.  
- Repeat opioid overdoses can be avoided through treatment referrals provided during emergency department visits.  
- Timely and coordinated response efforts can also better prevent more opioid overdoses in the community. 
- Learn more about preventing opioid overdoses and what to do if an overdose occurs in order to save a life. 

For more information, visit

In The Media
America’s opioid crisis has become an “epidemic of epidemics”
By Ella Nilsen Mar 6, 2018
Opioid and heroin use is causing a dramatic spike in new hepatitis C infections, as well as dangerous bacterial infections that, if left untreated, can cause strokes and require multiple open-heart surgeries. Doctors and public health officials also fear America is on the brink of more HIV outbreaks, driven by intravenous drug use.

Jump In Overdoses Shows Opioid Epidemic Has Worsened
Rob Stein
In just one year, overdoses from opioids jumped by about 30 percent, according to the a report released Tuesday by the Centers for Disease Control and Prevention.

"Overall as a nation, we are still failing to adequately respond to the opioid addiction epidemic," says Dr. Andrew Kolodny, co-director of opioid policy research at Brandeis University. "It is concerning that 20 years into this epidemic, it is still getting worse. The number of Americans experiencing opioid overdoses is still increasing."

Check out this months newsletters & blog updates with information and support for people living with or treating viral hepatitis.

Read today's news or a nice summary of notable headlines published in the latest issue of The Weekly Bull.

HCV Advocate
HealthWise – Is Hepatitis C Treatment Safe?
By Lucinda Porter, RN – My first article for the HCV Advocate appeared 20 years ago. Hepatitis C virus infection (HCV) wasn’t curable yet. HCV is now easily curable and one would think the problem is solved, but it isn’t. Numerous obstacles stand in the way of eliminating this disease. A large percentage of the population is still undiagnosed because of inadequate HCV screening. Access to health care is uneven, particularly for those who need it the most.”

Review and Editorial Comments by Alan Franciscus Executive Director of the Hepatitis C Support Project, Editor-in-Chief of the HCV Advocate Website

List Of Articles
1- Direct-Acting Antiviral Sustained Virologic Response: Impact on Mortality in Patients without Advanced Liver Disease—L.I. Backus, et. al.

2- Increasing Prevalence of Hepatitis C among Hospitalized Children Is Associated with an Increase in Substance Abuse—A S Barritt, et. al.

3- Population-level outcomes and cost-effectiveness of expanding the recommendation for age-based hepatitis C testing in the United States—J. A. Barocas, et. al.

4- Glecaprevir/Pibrentasvir for Hepatitis C Virus Genotype 3 Patients with Cirrhosis and/or Prior Treatment Experience: A Partially Randomized Phase 3 Clinical Trial—D. Wyles, et. al.
National Viral Hepatitis Roundtable
NVHR Newsletter
NVHR Welcomes Two Federal Actions to Help Prevent and Treat Hepatitis B
The New York City Hepatitis C Task Force
British Liver Trust
HEPVOICE - World Hepatitis Alliance
GI & Hepatology
From the AGA Journals
Sofosbuvir/ledipasvir looks good in HBV coinfected patients
Hep Magazine
Advocacy in Action
Best of You
Is U.S. Lagging in Hepatitis Efforts?
As Injection Drug Use Rises, So Does Hep C
An Early Cure Protects the Liver?
Cured of Hep C, at Risk of Fatty Liver

Blog Updates
Hep Blogs
Factors That May Increase Your Risk of Death from Hepatitis C
March 5, 2018
By Lucinda K. Porter, RN
Barely a week goes by in which I don’t read about the increased risk of death from hepatitis C. People living with this virus are at risk of dying prematurely from all the major causes of mortality, such as cancer, heart disease, and stroke. However, it appears that certain behaviors may hasten death when you have hepatitis C.
By Kimberly Morgan Bossley - March 5, 2018
I had a very unsettling experience a few years back that really got me to thinking about how knowledgeable are most physicians about hep C. Finding a the Right Doctor for You...

5 Things That Make Stress Worse 
By Karen Hoyt - March 2, 2018
Stress can make you miserable. Everything sets you on edge. The noise someone makes when they eat. The bank teller wanting copies of whatever when you’re rushed. Your neighbor mowing his lawn...

Effects of Chronic Illness on Our Moods 
By Daryl Luster - March 1, 2018
Sounds like depression by another name, but is it necessarily as simple as that? I am not suggesting that depression is simple or should ever be dismissed as “nothing” as some might...
Blogs - Healio
BLOG: A word of caution to insulin pump users to ‘spring forward’
It’s happening again — the daylight saving time spring ritual. This year the daylight saving time change will...
BMC Blog
Raquel Peck 1 Mar 2018
On Zero Discrimination Day (March 1st), the World Hepatitis Alliance (WHA) is encouraging the hepatitis community to challenge misconceptions and speak out about the devastating impact of stigma and discrimination across the globe.

Xu Zhang 5 Mar 2018
Pain, an unpleasant feeling and physical and psychological burden for patients, has drawn the attention of dedicated scientists trying to tackle the problem from… 
Oxford University

Romance and reality: clinical science in liver transplant for alcoholism
By Thomas P. Beresford 4 Mar 2018
The alcoholic with liver disease has a liver from birth that is genetically vulnerable in some way to the ravages of drink. Only about 15% of heavy drinkers develop alcoholic liver disease. The other 85% of heavy drinkers will never need a transplanted liver. Should the 15% die because of their genetic vulnerability to alcoholism—a treatable condition in which large numbers recover every year?
The internet is an amazing source of information and misinformation. How do you know if what you are reading is accurate?

Healthy You

Medical News Today
Last updated Fri 2 March 2018
By Tim Newman Reviewed by Elaine K. Luo, MD
This MNT Knowledge Center article will cover the main roles of the liver, how the liver regenerates, what happens when the liver does not function correctly, and how to keep the liver healthy.
The Atlantic
Evolution doomed us to have vital organs fail. For years, experts failed us, too.
Harvard Health Blog
In November 2017 the American Heart Association and the American College of Cardiology changed the definition for high blood pressure. One day your blood pressure of 130/80 was normal — the next day you had stage 1 hypertension, and suddenly you found yourself in a higher risk category formerly reserved for people with blood pressure of 140/90. While you probably don’t feel like celebrating the change, it may actually be a good thing.

Conference on Retroviruses and Opportunistic Infections CROI 2018
News, slidesets, interviews, and webinars

Thanks for stopping by.

TGIF Rewind: HCV and HCC, Tips For Kidney Health & Treating HCV According to Genotype

Its Friday! Do you have any plans for this weekend? Thinking I may go play with the grandkids pup, she's so cute! In any event here are a few updates on the topic of viral hepatitis.

Starting over at Healio, the March issue of HCV NEXT is out, with a feature on HCV treatment for people who inject drugs, the associated stigma, and critical need for awareness. Bloggers from around the web have been busy as well, Karen Hoyt is your resource for everything HCV, read her new article about kidney disease, filled with helpful tips; from labs to nutrition. Greg Jefferys writes about treatment options for each HCV genotype, his article is easy to understand, a must read, available online at Hep Blogs. Finally, a link is provided below to the following journal updates; Fatty liver disease & HCV (in case you missed it), and two articles on treatment for patients with HCV and HCC.

In The Journals
World J Gastroenterol. Mar 21, 2018; 24(11): 1269-1277
Published online Mar 21, 2018. doi: 10.3748/wjg.v24.i11.1269
Fatty liver in hepatitis C patients post-sustained virological response with direct-acting antivirals
This is the first prospective study to assess the prevalence of fatty liver in hepatitis C patients who have achieved a sustained virological response with direct-acting antivirals. The study’s findings that fatty liver is present in 47.5% of these patients and that some steatotic patients have clinically significant fibrosis despite normal liver enzymes should raise awareness of the post-sustained virological response (SVR) prevalence of fatty liver and the importance of post-SVR assessment of steatosis and fibrosis and long-term follow up with these patients.
Full text

On Twitter
The following full-text articles were downloaded and shared by Henry E. Chang via twitter.
Emerging data are demonstrating lower sustained virologic response (SVR) rates in patients with HCC compared with patients without HCC. Conflicting studies have also suggested that rates of HCC recurrence in patients with a history of HCC can potentially be increased or decreased on DAA therapy. This review will provide a brief overview of these data and inform practitioners on important considerations to make when prescribing DAA therapy for patients with HCV and HCC

Persistence of hepatocellular carcinoma risk in hepatitis C patients with a response to IFN & cirrhosis regression 
The finding that HCC developed also in SVR patients with cirrhosis regression (F3)greatly attenuates the need for refining the management of SVR patients in relation to residual liver fibrosis. The fact that regressed patients developed HCC later than non regressors deserves attention.....

March Updates On This Blog
Stagnation of fibrosis regression is associated with a high risk for HCC after SVR
Side effects associated with different hepatitis C direct-acting antiviral drugs
Dos and Don’ts in the Management of Cirrhosis: A View from the 21st Century
Higher levels of vitamin D is associated with a lower risk of liver cancer
March 2018 - Recruiting hepatitis C clinical trials

The following articles appeared in the March print edition of HCV NEXT, provided online at Healio.
Moving Beyond the Low-Hanging Fruit in HCV Diagnosis and Treatment
HCV Next, March/April 2018
The trouble in engaging difficult to reach populations is, well, that they are difficult to reach. The low-hanging fruit of diagnosing and treating people who have…

Treating People Who Inject Drugs:
HCV Next, March/April 2018
As a population, people who inject drugs have the highest prevalence and incidence of hepatitis C infection. Despite this, people who inject drugs have historically had…

Blog Updates
I Help C - Your Best Friends Guide to Hep
Karen Hoyt March 10, 2018
If you are going to drown your Hepatitis C or cirrhosis sorrows – do it with water. Kidney disease is not as silent as liver disease, but it sure will sneak up on you if you’re not taking precautions. If you were holding your breath out of fear, you can let it out now. Your kidneys do NOT get damaged quite like the liver if you take care of your kidneys. This post celebrates with Wisdom for World Kidney Day.

Hep Blogs
Hepatitis C Treatment Options
By Greg Jefferys
An explanation of the various hepatitis C treatment options for each genotype. 

Check out a new patient friendly video launched by Hepatitis C activist Greg Jefferys, with a look at current therapies used to treat the hepatitis C virus across all HCV genotypes.

On March 8, 2018, NVHR participated HHS’s webinar, Hidden Casualties: National Partners’ Response to the Opioid Epidemic and Infectious Diseases. Below is a transcript of NVHR’s portion of the webinar.

Creating a World Free of Hepatitis C
Who’s in Charge, You or Stress?
Lucinda Porter March 15, 2018 All of us have stress. Life is an unpredictable string of events, and sometimes it feels like a circus juggling act. Lily Tomlin said, “Reality is the leading cause of stress for those in touch with it.”

Scratching That Itch
By Kimberly Morgan Bossley - March 15, 2018
Scratching that itch that seems to never go away. You know the one that interrupts your daily activities and your sleep. Itchy and irritated This has always been a big issue with...

Does Hepatitis C Go Away On Its Own?
By Carleen McGuffey - March 14, 2018
Hepatitis C can go away spontaneously in approximately 20% of cases, but the majority of the time, hep C becomes a chronic infection.1 Its a very hardy virus. If you have ever...

Hepatitis C and Opioid Addictions
By Karen Hoyt - March 13, 2018
If you are under 40 and diagnosed with Hepatitis C, you probably have more problems than you know what to do with. If you got HCV through a dirty needle, there is...
The real cause of the opioid epidemic: the government
Rudolph, MD March 13, 2018
The patient The patient is a forty-two-year-old male who works in the auto manufacturing arena. He takes one step to his left, he turns and lifts a seventy-five-pound piece of metal from a moving conveyor belt. He turns back and takes one step to his right to put the metal on his table. He tightens three screws, lifts the metal off the table to take one step to his right, turning, ...

Harvard Health Blog
Monique Tello, MD, MPH March 16, 2018
A recently published clinical guideline on vitamin and mineral supplements reinforces every other evidence-based guideline, research review, and consensus statement on this topic. The bottom line is that there is absolutely no substitute for a well-balanced diet, which is the ideal source of the vitamins and minerals we need.

Hep B Blog
What to do about hepatitis B when you’re pregnant?
March 14, 2018 Around the world, the most common mode of hepatitis B transmission is from mother to child. Unfortunately, pregnant mothers who have hepatitis B can transmit the virus to their newborn during the delivery process. 90% of these HBV infected babies will progress to chronic infection putting them at increased risk of serious liver disease or liver cancer later in life.
March 7, 2018
Discrimination is unethical, unnecessary and a violation of human rights. Hepatitis B is simply not transmitted through casual contact. The stigma that persists is based on ignorance and it impacts millions around the world daily.

BMJ Opinion
Richard Lehman’s journal reviews—12 March 2018
March 12, 2018
Fatty liver: the untapped market
Nearly a third of men in the richest countries have fatty livers: women and middle-income countries are racing to catch up. How about that for a market? An unlucky few of these will develop fibrosis and of these an unlucky few will die of liver failure or hepatocellular carcinoma. So you have your advertising copy sorted too. But by the same token any drug given to such a vast number of people will have to be very safe and will need some very lengthy hard-end point trials. And there is an excellent cheap candidate drug already—pioglitazone, which can reverse cirrhosis as well as steatosis. But never mind all that. Let’s read about a 116-patient phase 2 trial of an injectable experimental drug, lasting 12 weeks. In that time, a third of the participants experienced diarrhoea and three-quarters lost more than 5% of their liver fat. “Larger clinical trials of longer duration are now needed to fully assess the safety and efficacy of NGM282.” Might The Lancet not have found better use for its space in the meantime?

ACP Internist Blog
Scoping out the reasons for overuse of colonoscopy
Michael Kirsch, MD, FACP
In our practice we have an open endoscopy system, as do most gastroenterologists. This means that other physicians or patients themselves can schedule a procedure with us without seeing us in advance for a consultation. Of course, we are always pleased to see any of these patients for an office visit in advance, but many patients prefer the convenience of accomplishing the mission in one stop. This is reasonable for patients who truly need our technical skill more than our medical advice.

Enjoy the upcoming weekend. 

CDC: US binge drinking responsible for over half of 88,000 alcohol-attributable deaths per year

CDC: US binge drinking responsible for over half of 88,000 alcohol-attributable deaths per year

Binge drinking can result in dangerous driving, risky sexual behavior, and violent behavior. Over time, binge drinking also increases the risk of serious health problems such as cancer, heart disease, and liver failure. Annually, binge drinking is responsible for more than half of the 88,000 alcohol-attributable deaths and three-quarters of the $249 billion in economic costs associated with excessive drinking in the United States.

During binges, U.S. adults have 17 billion drinks a year

More than half of those drinks are by adults ages 35 years and older
U.S. adults consumed more than 17 billion binge drinks in 2015, or about 470 binge drinks per binge drinker, according to a first-of-its-kind study released by the Centers for Disease Control and Prevention (CDC). The study appears in the American Journal of Preventive Medicine.

CDC researchers found that 1 in 6, or 37 million, adults binge drink about once a week, consuming an average of seven drinks per binge. Binge drinking is defined as consuming five or more drinks for men, or four or more drinks for women, in about two hours.

“This study shows that binge drinkers are consuming a huge number of drinks per year, greatly increasing their chances of harming themselves and others,” said study co-author Robert Brewer, M.D., M.S.P.H., lead researcher in CDC’s alcohol program. “The findings also show the importance of taking a comprehensive approach to prevent binge drinking, focusing on reducing both the number of times people binge drink and the amount they drink when they binge.”

For this report, CDC scientists analyzed data on self-reported binge drinking during the past 30 days from CDC’s 2015 Behavioral Risk Factor Surveillance System (BRFSS). Total annual binge drinks was calculated by multiplying the estimated total number of binge drinking episodes among binge drinkers by the average largest number of drinks consumed per episode, and was assessed by age, sex, education, race/ethnicity, household income, and state.

Binge drinking varied by age, sex, and social factors

New insights on binge drinking reported in the study include:
-While the prevalence of binge drinking was more common among young adults ages 18-34 years, more than half of the binge drinks consumed each year were by adults ages 35 years and older. 
-About 4 in 5 total binge drinks were consumed by men.
-Binge drinkers with lower household incomes (less than $25,000 a year) and lower educational levels (less than high school) consumed substantially more binge drinks per year than those with higher incomes and educational levels.
-Binge drinkers consumed the most alcohol in Arkansas, Mississippi, Kentucky, and Hawaii, and the least in Washington, DC; New Jersey, New York, and Washington State.

Binge drinking can result in dangerous driving, risky sexual behavior, and violent behavior. Over time, binge drinking also increases the risk of serious health problems such as cancer, heart disease, and liver failure. Annually, binge drinking is responsible for more than half of the 88,000 alcohol-attributable deaths and three-quarters of the $249 billion in economic costs associated with excessive drinking in the United States.

How to reduce binge drinking
Widespread use of effective community prevention strategies, such as limiting the number of alcohol outlets in a geographic area, limiting days and hours of sale, and legal liability for outlets that illegally serve underage or intoxicated patrons, could help reduce total binge drinks and related harms. The U.S. Preventive Services Task Force also recommends alcohol screening and brief intervention by health care providers as part of routine clinical care.

The U.S. Dietary Guidelines for Americans recommends that if alcohol is consumed, it should be consumed in moderation — up to one drink per day for women and up to two drinks per day for men — and only by adults of legal drinking age.

For more information on excessive alcohol use:

Thursday, March 15, 2018

HCV infection, older age, and cirrhosis correlate with an increased risk of gallstones

Hepatitis C Virus Infection Increases Risk of Gallstone Disease in Elderly Chinese Patients with Chronic Liver Disease

In conclusion, we found that the risk of gallstone development in Chinese CLD patients was significantly associated with the occurrence of liver cirrhosis, older age, and HCV infection. Furthermore, patients infected with HCV formed more gallstones than did patients infected with HBV.

Scientific Reports volume 8, Article number: 4636 (2018)
Received: 12 January 2018 Accepted: 28 February 2018 Published online: 15 March 2018

We investigated possible links between the etiology of liver disease and gallstone risk in Chinese patients with chronic liver disease (CLD). We compared the outcomes of 267 Chinese CLD patients with gallstones and those of a control group of 1,015 CLD patients without gallstones. Logistic regression analyses adjusting for demographic features and other gallstone risk factors revealed that liver cirrhosis increased the risk of gallstone development twofold [adjusted odds ratio (AOR); 95% confidence interval (95% CI): 2.343 (1.710–3.211)]. HCV infection increased gallstone risk 1–2-fold [AOR; 95% CI: 1.582 (1.066–2.347)] higher than did HBV infection. Multivariate analyses of the risk of developing gallstones in patients with liver cirrhosis after an HCV or HBV infection yielded an estimated AOR (95% CI) of 1.601 (1.063–2.413) in patients with an HCV infection. In elderly patients with CLD (≥60 years of age), gallstone risk also increased significantly after an HCV infection [AOR (95% CI): 2.394 (1.066–5.375)]. HCV infection, older age, and liver cirrhosis significantly correlate with an increased risk of gallstone development in Chinese patients with CLD. HCV infection further increases this risk in both patients with liver cirrhosis and in elderly CLD patients (≥60 years of age).

Continue to full-text article......

Wednesday, March 14, 2018

Stagnation of fibrosis regression is associated with a high risk for HCC after SVR

Also see:
The above Full-Text article downloaded and shared by @HenryEChang via Twitter.

Stagnation of histopathological improvement is a predictor of hepatocellular carcinoma development after hepatitis C virus eradication
Hiroyuki Motoyama, Akihiro Tamori , Shoji Kubo, Sawako Uchida-Kobayashi, Shigekazu Takemura, Shogo Tanaka, Satoko Ohfuji, Yuga Teranishi, Ritsuzo Kozuka, Etsushi Kawamura, Atsushi Hagihara, Hiroyasu Morikawa, Masaru Enomoto, Yoshiki Murakami, Norifumi Kawada

Published: March 13, 2018

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Hepatocellular carcinoma (HCC) develops in some patients who achieve sustained virological response (SVR) against hepatitis C virus (HCV) infection via anti-HCV therapy. To examine the pathogenesis of HCC development after HCV eradication, histopathological changes and clinical markers were evaluated in SVR patients.

Of 654 SVR patients treated with interferon (IFN)-based therapies, 34 patients who had undergone liver biopsy before initiating IFN therapy and after SVR achievement were enrolled: 11 patients with HCC and 23 patients without HCC (male/female, 9/2 and 8/15, respectively: age, 58 ± 5 and 54 ± 11 years, respectively). We compared the clinical and histopathological factors between the two groups. Immunohistochemistry for Cytoglobin (CYGB) and α smooth muscle actin (α-SMA) was also performed.

At baseline, prior to initiating the IFN-based therapy, there were significant differences between the SVR-non-HCC and SVR-HCC groups in the male gender, HBc antibody positivity, prothrombin activity, and histological inflammatory grade. Histopathological evaluation, using the new Inuyama classification system, revealed an improvement in the inflammatory grade, from 2.1 ± 0.6 to 1.0 ± 0.6 (p < 0.0001), whereas the fibrosis stage remained unchanged, from 2.3 ± 0.9 to 2.0 ± 1.2 (p = 0.2749), during the 97 ± 72-month observation period in the SVR-HCC group. Both the grade and stage scores were significantly improved in the SVR-non-HCC group. The area of collagen deposition, evaluated using Sirius red staining, showed a marked decrease, from 18.6 ± 7.6% to 7.7 ± 4.6%, in the SVR-non-HCC group, with no change in the SVR-HCC group. CYGB- and α-SMA-positive hepatic stellate cells (HSCs), indicative of the HSC activated phenotype, remained in the fibrotic tissue of livers among patients in the SVR-HCC group.

Stagnation of fibrosis regression is associated with a high risk for HCC after SVR. HSC activation may inhibit improvement in fibrosis after SVR and potentially contribute to hepatocarcinogenesis.