"America's Flag Waves" By Judith ElyLast month the Centers for Disease Control and Prevention along with its director Dr. Thomas Frieden, coined the term “six winnable battles” as described on CDCs website: "CDC has coined the term Winnable Battles to describe public health priorities in an effort to describe public health priorities with large-scale impact on health and with known, effective strategies to intervene.”
The “six winnable battles"
CDC's six winning battles of 2010:
Smoking
AIDS
Nutrition
Obesity
Teen pregnancy
Auto injuries
However, Frieden's priority list was void of both Hepatitis C and Hepatitis B. Let’s see now, the CDC coined the term" six winnable battles" an impressive catch phrase. Wait, isn't Hepatitis C a winning battle and doesn't Hepatitis B have a vaccine?
Frieden has been criticized for his priority list and I agree that smoking already has strong initiatives in place; including secondhand smoke laws and higher cigarette taxes. It appears to be effective in New York City considering the smoking rate is less than half of the national rate, at about 8.5 percent.
I admit the six battles deemed winnable are in need of attention. The battle for HIV sure is, but smoking, please "Mr. CDC give up smoking for HCV"
CDC chief picks 6 'winnable battles' in health
HBV & HCV: America’s Hidden Epidemics
Hepatitis C : Medscape Sep 28, 2010
"According to the US Centers for Disease Control and Prevention (CDC), an estimated 1.8% of the US population is positive for HCV antibodies. Because 3 of 4 seropositive persons are also viremic, this corresponds to an estimated 2.7 million people with active HCV infection nationwide. Infection due to HCV accounts for 20% of all cases of acute hepatitis, an estimated 30,000 new acute infections, and 8000-10,000 deaths each year in the United States". .
Hepatitis C and Progression.
Hepatitis C is a serious disease that often results in long-term complications. There are two important causes to be concerned about. First, 80 percent of cases become chronic. Second, seldom do people become acutely ill, meaning it’s possible for them to carry the disease for years before being diagnosed. One common symptom that manifests later in the disease, fatigue may become increasingly severe. If cirrhosis has developed, other more serious symptoms may occur. Of those afflicted with chronic hepatitis C 20% will develop cirrhosis, some will unfortunately go on to develop liver cancer. It may take 10 to 40 years for serious liver damage to occur. Researchers have found some contributing factors that may increase the rate of progression. .
Factors In Fibrosis Progression HCV Advocate: Fibrosis occurs more rapidly in men than in women, and also in older people – particularly those over age 50. Progression does not seem to be linear; that is, the process appears to accelerate as more damage occurs. Immune system compromise, for example due to coinfection with HIV or use of immunosuppressive drugs after a liver transplant, also has been shown to accelerate fibrosis. Heavy alcohol consumption is strongly associated with worsening fibrosis and cirrhosis. Finally, studies indicate that steatosis (fattyliver) and insulin resistance are associated with more rapid and severe fibrosis.
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2010/Hepatitis C: eMedicine Gastroenterology
2010/Aging of Hepatitis C Virus (HCV)-Infected Persons in the United States: A Multiple Cohort Model of HCV Prevalence and Disease Progression
2006/Fibrosis progression in initially mild chronic hepatitis C: 36% with F1 Progress to F3 or cirrhosis
The quality of life in Hepatitis C infection can be affected by extrahepatic manifestation which affect other organs in the body other then the liver. .
Other conditions and HCV : Extrahepatic manifestation
This June an abstract from the Department of Infectious Diseases, Provincial Hospital, Kielce, Poland, was published which presented data on conditions outside the liver in people infected with Chronic Hepatitis C infection . The data included 340 patients who never treated HCV . These people were around the age of 42 , and were studied between 2000 and 2006. Patients were excluded if they had cirrhosis, HBV, HIV, autoimmune liver diseases or were alcohol abusers. Although the purpose was to "assess the prevalence and predictive factors of extrahepatic manifestation" the data showed out of 340 patients 210 showed extrahepatic manifestations.
(61.7%) presented at least 1 extrahepatic manifestation
mixed cryoglobulinemia (37.1%)
thrombocytopenia (27.6%)
thyroid autoimmunity (16.2%)
dermatological disorders (4.1%)
type 2 diabetes (4.1%)
Other EM such as the sicca syndrome, nephropathy, polyneuropathy and B-cell lymphoma were observed in single cases.
Adv Med Sci. 2010 Jun;55(1):67-73. Extrahepatic manifestations associated with chronic hepatitis C infections in Poland. Zarebska-Michaluk DA, Lebensztejn DM, Kryczka WM, Skiba E. Department of Infectious Diseases, Provincial Hospital, Kielce, Poland.
Abstract
PURPOSE: To assess the prevalence and predictive factors of extrahepatic manifestation (EM) in patients with chronic hepatitis C (CHC) infection in Poland.
MATERIAL AND METHODS: 340 consecutive patients (mean age: 42 years) with untreated CHC were studied between 2000 and 2006. The HCV infection was defined by positive serology and serum HCV RNA. The inflammation grade and fibrosis stage were assessed according to Ishak. Demographic, laboratory and liver biopsy data were collected. The patients with liver cirrhosis, concomitant HBV or HIV infection, autoimmune liver diseases and alcohol abusers were excluded from the analysis.
RESULTS: 210 patients with CHC (61.7%) presented at least 1 extrahepatic manifestation, including mixed cryoglobulinemia (37.1%), thrombocytopenia (27.6%), thyroid autoimmunity (16.2%), dermatological disorders (4.1%) and type 2 diabetes (4.1%). Other EM such as the sicca syndrome, nephropathy, polyneuropathy and B-cell lymphoma were observed in single cases. In multivariate analysis lower platelet count was found as a predictive factor of EM in patients with CHC.
CONCLUSIONS: The majority of patients with CHC, living in Poland, have EM, of which cryoglobulinemia, thrombocytopenia, thyroid autoimmunity, dermatological disorders and type 2 diabetes are most common. Through the multivariate analysis the lower platelet predicts extrahepatic manifestations associated with chronic hepatitis C. PMID: 20371429 [PubMed - indexed for MEDLINE]
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Treating Hepatitis C In 2010-2011.
Hepatitis C today is a whole new ballgame, a game that is being played well with a 75 percent win. This evidence has been put before us in the current clinical data resulting from trials on two in particular drugs. (more coming down the pipeline) The two big winners thus far are telaprevir and boceprevir and are heading for some face time with the coach (FDA). Telaprevir is looking at FDA approval within weeks.
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Current Treatment Success Rate
The cure rate today with FDA approved HCV therapy is fifty percent for genotype 1, genotypes 2, and 3 have the higher cure rates, at 81% and 74%...
Treatment Success Rate In The Near Future
This has been on the blog in the past, a re-cap for new readers:
In May, Vertex released results from the Phase III ADVANCE trial, which demonstrated that the telaprevir combination helped 75 percent of treatment-naïve patients chronically infected with genotype 1 HCV achieve an SVR..
In June the ILLUMINATE trial which enrolled 540 patients demonstrated that the majority of previously" untreated patients" with HCV who responded early to treatment with telaprevir achieved an SVR after 24 weeks instead of the current standard treatment duration of 48 weeks. Viral cure rates of 92% and 88% with 24 and 48-week regimens , respectively, in people who met certain response criteria. 72% of all 540 people treated with telaprevir in the study achieved a viral cure...
In Sept Vertex released results from the Phase III REALIZE trial, which showed that nearly two-thirds of patients with genotype 1 hepatitis C virus (HCV) who failed to respond to prior therapy were able to achieve a sustained viral response (SVR) following treatment with the company's experimental drug telaprevir used in combination with standard care.
Link: Quick Study; FAQ SVR Rates Treating With Telaprevir
As for boceprevir, the data is here HCV The Difficult To Treat: Re-Cap Telaprevir/Boceprevir
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Folks, we should be excited with the prospect of what is yet to unfold in the world of treating hepatitis c. We will be getting a little peek at which drugs are showing promise at the Boston meeting of the American Association for the Study of Liver Disease this week. I only wish we had the CDC behind both diseases; HCV and HBV.
Informational Links:
From People who make a difference:
Hepatitis C Support Project HCV Advocate:
http://www.hcvadvocate.org/
National AIDS Treatment Advocacy Project:
http://www.natap.org/
The California Hepatitis Alliance (CalHEP)
http://www.calhep.org/
Medical Advocates for Social Justice
http://www.medadvocates.org/
Hep C Connection:
http://www.hepc-connection.org/
Hepatitis C Association:
http://www.hepcassoc.org/
Hep C ALERT:
www.hepprograms.org/
STOPHepC
http://www.stophepc.org/
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