HCV New Drugs: 1/1/11

Monday, January 31, 2011

Liver Cancer Symptoms/Risk Factors

How Liver Cancer Develops

A healthy liver is made up of cells. Normally, these cells maintain specialized functions as they grow and divide. Eventually these cells become old and die. The body replaces them with new, healthy cells. A balance maintained between cell birth and cell death. Cells that are part of a bigger structure--like the liver--can communicate and influence each other.

In patients with cirrhosis, healthy liver tissue is replaced by scar tissue. Cirrhosis is most often due to inflammation within the liver. This scar tissue disrupts the normal organization and function of the liver. Cirrhosis, in some individuals, can be a cause of liver cancer

Liver cancer develops when the organized control of cell growth and death is disrupted. Either new cells form when the body does not need them or old cells do not die when they should. Cancer cells are damaged. Uncontrolled cancer cells can invade and damage surrounding tissue and form "masses" or "tumors".

Liver tumors can be benign or malignant. Benign tumors are masses of tissue but they are not cancer. They are usually not harmful and do not spread to other parts of the body. Malignant tumors are considered cancers. Malignant tumors of liver tissue localized in the liver, or metastatic to other organs, can be life threatening

More commonly, cancers may metastasize, or spread, to the liver from other organs. Secondary liver cancers may develop in tissues distant from the liver. Cancer cells from the breast, lung, colon and pancreas can reach be carried to the liver by the blood or lymph systems. Some cancers will "invade" the liver by direct extension from adjacent organs (gallbladder, stomach).

Symptoms

Many patients with HCC have no symptoms in the early stages.

Some, with more advanced tumors, have symptoms such as:

Pain in the upper right portion of the abdomen.

Worsening liver function, as noted by increasing jaundice (yellowing of the whites of the eyes and skin and/ or increasing abdominal fluid (ascites).

Abdominal pain is the most common symptom of HCC and usually signifies a very large tumor or widespread involvement of the liver. Additionally, unexplained weight loss or unexplained fevers are warning signs of HCC in patients with cirrhosis. These symptoms are less common in individuals with HCC in the U.S. because these patients are usually diagnosed at an earlier stage. However, whenever the overall health of a patient with cirrhosis deteriorates, every effort should be made to look for HCC.

On physical examination, an enlarged, sometimes tender, liver is the most common sign. HCCs are very vascular (containing many blood vessels) tumors. Thus, increased amounts of blood feed into the hepatic artery (artery to the liver) and cause turbulent blood flow in the artery. The turbulence results in a distinct sound in the liver (hepatic bruit) that can be heard with a stethoscope in about one quarter to one half of patients with HCC.

A very common sign of HCC in a patient with compensated cirrhosis (no complications of liver disease) is the sudden onset of a complication. For example, the sudden appearance of ascites (abdominal fluid and swelling), jaundice (yellow color of the skin), or muscle wasting without causative (precipitating) factors (e.g., alcohol consumption) suggests the possibility of HCC. What's more, the cancer can invade and block the portal vein (a large vein that brings blood to the liver from the intestine and spleen). When this happens, the blood will travel paths of less resistance, such as through esophageal veins. This causes increased pressure in these veins, which results in dilated (widened) veins called esophageal varices. The patient then is at risk for hemorrhage from the rupture of the varices into the gastrointestinal tract. Rarely, the cancer itself can rupture and bleed into the abdominal cavity, resulting in bloody ascites.

In advanced HCC, the tumor can spread locally to neighboring tissues or, through the blood vessels, to elsewhere in the body (distant metastasis). Locally, HCC can invade the veins that drain the liver (hepatic veins). The tumor can then block these veins, which results in congestion of the liver. The congestion occurs because the blocked veins cannot drain the blood out of the liver. (Normally, the blood in the hepatic veins leaving the liver flows through the inferior vena cava, which is the largest vein that drains into the heart.) In African patients, the tumor frequently blocks the inferior vena cava. Blockage of either the hepatic veins or the inferior vena cava results in a very swollen liver and massive formation of ascites. In some patients, as previously mentioned, the tumor can invade the portal vein and lead to the rupture of esophageal varices.

Regarding the distant metastases, HCC frequently spreads to the lungs, presumably by way of the blood stream. Usually, patients do not have symptoms from the lung metastases, which are diagnosed by radiologic (x-ray) studies. Rarely, in very advanced cases, HCC can spread to the bone or brain.

HCC Risk Factors & High Risk Populations
What are the risk factors for HCC?

Hepatitis B Infection

It is well established that Hepatitis B infection can cause HCC. The vast majority of HCC that is associated with hepatitis B virus (HBV) occurs in patients who have had hepatitis B infection for most of their lives, also called chronic Hepatitis B. In patients with chronic HBV and HCC, the genetic material of HBV is frequently found to be part of the genetic material of the cancer cells. The HBV genetic material enters the normal liver cells and disrupts their function, causing these normal cells to turn into cancerous cells. Because of this genetic mutation caused by HBV, a patient who has the HBV infection may develop HCC with or without liver cirrhosis (scarring of the liver).

Hepatitis C Infection

The development of HCC is also associated with chronic Hepatitis C virus (HCV). The majority of patients who develop HCC as a result of HCV will have liver cirrhosis. The average time to develop HCC after initial exposure to HCV is about 28 years, and usually about 8-10 years after the development of liver cirrhosis. The way in which HCV causes HCC is not well understood, unlike with the HBV infection. HCV can cause cirrhosis, and cirrhosis can be a cause of HCC. It is possible to develop HCC if an individual has HCV but no cirrhosis. It is thought that the core protein of the virus may impede the natural process of cell death or interfere with the function of normal tumor suppressor genes within the body.

In patients with HCV, risk factors for the development of HCC include the presence of cirrhosis, older age, male gender, elevated baseline alpha feto-protein levels (a blood test used in determining liver cancer), alcohol use, and co-infection with HBV.

2017-2016 Research and News

Liver Cancer After Treatment For Hepatitis C
November 23, 2016
A collection of 2016 articles retrieved online from press releases, conferences (The Liver Meeting® 2016 and the International Liver Congress 2016) and peer-reviewed journals featuring long-term risk for liver cancer in those who were cured of Hepatitis C.

December 2016

The following article appeared in the December print edition of HCV NEXT, published online at Healio; Screening for HCC in the Post-SVR12 Setting

Gastroenterology & Hepatology
December 2016
Interview
The Possible Association Between DAA Treatment for HCV Infection and HCC Recurrence
Download the PDF

G&H How common is the coexistence of hepatocellular carcinoma and hepatitis C virus infection in a patient?
RB Among patients with hepatitis C virus (HCV) infection and cirrhosis, the risk of hepatocellular carcinoma (HCC) is estimated to be 1% to 3% per year. Thus, in any given year, the risk is relatively low, but over a decade, the risk is considerable. More importantly, with the rise in the number of baby boomers who have had HCV infection for more than 2 decades, we are seeing an increasing prevalence of HCC. Although the rate of new cases of HCV infection is falling, the prevalence of HCV infection with cirrhosis is still rising, as is the number of patients who have HCV infection and HCC.
Continue reading...

Alcohol

Cirrhosis caused by chronic alcohol consumption is the most common association of HCC in the developed world. Actually, we now understand that many of these cases are also infected with chronic HCV. The usual setting is an individual with alcoholic cirrhosis who has stopped drinking for ten years, and then develops HCC. It is somewhat unusual for an actively drinking alcoholic to develop HCC. What happens is that when the drinking is stopped, the liver cells try to heal by regenerating (reproducing). It is during this active regeneration that a cancer-producing genetic change (mutation) can occur, which explains the occurrence of HCC after the drinking has been stopped.

Patients who are actively drinking are more likely to die from non-cancer related complications of alcoholic liver disease (e.g., liver failure). Indeed, patients with alcoholic cirrhosis who die of HCC are about 10 years older than patients who die of non-cancer causes. Finally, as noted above, alcohol adds to the risk of developing HCC in patients with chronic HCV or HBV infections.

Aflatoxin B1

Aflatoxin B1 is the most potent liver cancer-forming chemical known. It is a product of a mold called Aspergillus flavus, which is found in food that has been stored in a hot and humid environment. This mold is found in such foods as peanuts, rice, soybeans, corn, and wheat. Aflatoxin B1 has been implicated in the development of HCC in Southern China and Sub-Saharan Africa. It is thought to cause cancer by producing changes (mutations) in the p53 gene. These mutations work by interfering with the gene's important tumor suppressing (inhibiting) functions.

Drugs, medications, and chemicals

There are no medications that cause HCC, but female hormones (estrogens) and protein-building (anabolic) steroids are associated with the development of hepatic adenomas. These are benign liver tumors that may have the potential to become malignant (cancerous). Thus, in some individuals, hepatic adenoma can evolve into cancer.

Certain chemicals are associated with other types of cancers found in the liver. For example, thorotrast, a previously used contrast agent for imaging, caused a cancer of the blood vessels in the liver called hepatic angiosarcoma. Also, vinyl chloride, a compound used in the plastics industry, can cause hepatic angiosarcomas that appear many years after the exposure.

Hemochromatosis

HCC will develop in up to 30% of patients with hereditary hemochromatosis (a disorder that causes the body to accumulate excessive amounts of iron). Patients at the greatest risk are those who develop cirrhosis with their hemochromatosis. Unfortunately, once cirrhosis is established, effective removal of excess iron (the treatment for hemochromatosis) will not reduce the risk of developing HCC.

Cirrhosis

Individuals with most types of cirrhosis of the liver are at an increased risk of developing HCC. In addition to the conditions described above (hepatitis B, hepatitis C, alcohol, and hemochromatosis), alpha 1 anti-trypsin deficiency, a hereditary condition that can cause emphysema and cirrhosis, may lead to HCC. Liver cancer is also strongly associated with hereditary tyrosinemia, a childhood biochemical abnormality that results in early cirrhosis.

Certain causes of cirrhosis are less frequently associated with HCC than are other causes. For example, HCC is rarely seen with the cirrhosis in Wilson's disease (abnormal copper metabolism) or primary sclerosing cholangitis (chronic scarring and narrowing of the bile ducts). It used to be thought that HCC is rarely found in primary biliary cirrhosis (PBC) as well. Recent studies, however, show that the frequency of HCC in PBC is comparable to that in other forms of cirrhosis.

High Risk Populations for HCC

Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world. The frequency of HCC is greater in certain geographic areas than others. For example, the incidence in Southeast Asia and sub-Saharan Africa is much higher than in North America and Western Europe. However, recent data suggests that the frequency of HCC in the United States is overall rising, primarily due to the increase in the amount of patients with viral hepatitis, one of the risk factors for HCC.

http://www.usclivercancer.org/hccsymptoms.html

Hepatocellular Carcinoma/update

Oncology - Hepatocellular Carcinoma

Authors: Ghassan K. Abou-Alfa, MD, Eileen O'Reilly, MD

Table of Contents

Introduction

Managing hepatocellular carcinoma (HCC) is a daunting and challenging task due to the ever-changing epidemiology, the complexities contributed by the underlying cirrhosis, and the evolving therapeutic algorithms. Integral to conquering this challenge is demystifying these complexities through a better understanding of the basics of this disease. This chapter provides an overview of the epidemiology, staging, and multidisciplinary management of the disease.
The incidence of HCC is governed by the epidemiology of the risk factors that contribute to the development of the disease. Globally, chronic hepatitis B virus (HBV) infection is the most prevalent risk factor for the development of HCC due to its endemic presence in the heavily populated regions such as Southeast Asia and Sub-Saharan Africa.[Parkin 2005] In the United States, HBV-related HCC predominantly occurs in cosmopolitan areas with high numbers of immigrants from endemic countries. In addition, the incidence of HCC is increasing at an alarming rate, according to a 1999 report by El-Serag and colleagues.[El-Serag 1999] From the data presented, one can deduce that a 3-fold increase in the age-adjusted rates for HCC, up to 7 cases per 100,000 people, is possibly correlated to the increasing incidence of hepatitis C virus (HCV) that was readily discernable in the last 3 decades. Moving forward, the reduction of the incidence of HCV, which has currently plateaued,[Daniels 2009] would ultimately contribute to a reduced incidence of HCC due to HCV. This could be accomplished through preventive and educational strategies. However, a liver injury and repair model characterized by HCV-damaged liver cells developing dysplasia and ultimately HCC, is estimated to occur over 10-30 years. Therefore, it will take that long to appreciate the impact of HCV reduction on the incidence of HCC.[El-Serag 1999]

Contrary to the anticipated reduction of the HCV risk factor for HCC, a continued rise in the incidence of HCC is expected secondary to the increased prevalence of nonalcoholic steatohepatitis (NASH). NASH occurs mainly in morbidly obese individuals with body mass indexes ≥ 35. The morbidly obese population has an increased relative risk of death from HCC, which is 4.52 times higher among men and 1.68 times higher among women when compared with men and women with body mass indexes within the normal range of 19-25.[Calle 1999] NASH has also been associated with patients with diabetes, another group of individuals who have been reported to have an increased risk of developing HCC.[El-Serag 2001] Alcohol-induced cirrhosis is a major contributor to the development of HCC in the United States and is responsible for almost one third of cases.[Morgan 2004] These 4 risk factors—HBV, HCV, NASH, and alcohol-induced cirrhosis—make up the majority of HCC cases in a typical practice in the United States. Other risk factors that contribute to HCC include a wide array of metabolic disorders, the most common of which is hemochromatosis.[Fracanzani 2001] Of all environmental factors, the one established as a causative risk for HCC is aflatoxins.[Jackson 1999]

.
Clinical Presentation
Surgical Resection, Adjuvant Therapy, and Treatment of Locally Advanced HCC
Curative Treatments
Adjuvant Therapy for Hepatocellular Carcinoma
Therapy for Locally Advanced Disease
Systemic Therapy
Chemotherapy
Molecular Targets in Hepatocellular Carcinoma
Epidermal Growth Factor Receptor Inhibitors
Inhibitors of the Proangiogenic Pathway
Combination Therapy
Conclusion
Tables and Figures
References

BOY GEORGE is aiming to raise money for victims of hepatitis C

British singer BOY GEORGE is aiming to raise money for victims of hepatitis C by selling specially-created celebrity portraits at auction.

The former Culture Club frontman was moved to help raise awareness of the disease after he discovered three-quarters of sufferers are unaware they have contracted the illness.
He has arranged for several British stars to pose as their favourite celebrity for a photoshoot, and will exhibit the prints in London before auctioning them off in March (11) in aid of The Hepatitis C Trust.

Actress Sadie Frost was snapped as Madonna, TV star Mathew Horne took on the guise of Adam Ant, and singer Paloma Faith posed as Boy George himself for the series of photos.
The Karma Chameleon hitmaker tells U.K. TV show This Morning, "I have just done this exhibition for the hep trust, which is a charity. Apparently 75 per cent of people that have it don't know they have it."

http://www.contactmusic.com/news.nsf/story/boy-georges-charity-shoot-with-stars_1197475

St.Jude; Using studies as a sales tool to get business

Jude Whistleblower: ‘This Wasn’t Patient Care’
By Ed Silverman // January 28th, 2011 // 9:52 am

Last week, St. Jude Medical agreed to pay $16 million to resolve allegations the device maker used post-marketing studies and a data registry to pay kickbacks to induce docs to implant pacemakers and defibrillators (read the settlement).

The allegations were contained in a qui tam, or whistleblower lawsuit filed by Chuck Donigian, who worked for St. Jude as a technical service specialist between 2004 and 2007. His job was to provide support to the sales force by helping to market the devices, visiting cath labs and operating rooms, and assisting with paperwork for enrolling patients. But he didn’t like what he saw – St. Jude staff would sometimes fill out paperwork for follow-up visits instead of docs, sign forms on behalf of physicians, patients were enrolled improperly and scientific posters were allegedly ghostwritten. Then there were bottles of wine and sporting tickets given some docs. In all, St. Jude allegedly handed out millions of dollars around the country to bolster use of its devices. For his trouble, Donigian will receive $2.6 million, plus interest, but before paying his attorneys and taxes. We spoke with him about his experience…

Pharmalot: What behavior prompted you to blow the whistle on your employer?

Donigian: When I started realizing they were using studies as a sales tool to get business. At first, I was kind of excited to get involved with clinical work. But when the patients weren’t meeting criteria for inclusion in the trials, I started raising questions. But they told me to enroll anybody and everybody or the physicians weren’t going to implant the devices. That’s when I started realizing we weren’t doing science.

Pharmalot: What happened then?
Donigian: At first, I brought it up with my team members and was told by manager that it was my job to do this. So I later called the corporate hotline and spoke with an attorney, who said he wouldn’t speak with me unless I told him who I was. He said I was protected. And then he went on to tell me we’re not supposed to do the paperwork. He proceeded to contact my boss to let him know I was raising hey…And so during my review in April 2006, I sat down with my regional manager and he brought up all my conversations with corporate, the attorneys. He wrote in my review that I was insubordinate and questioning what was happening. I was constructively discharged. I received threats.

Read more »

Hepatitis; List Of Clinical Trials Updated Jan 31 2011

Monday Hepatitis C News Updates Jan 31

New mouse model paves the way for the development of hep C vaccines

Posted: 2011-01-28 20:17
Researchers have created a new animal model for hepatitis C infection that could facilitate the development of new treatments for the disease.
Currently, the main therapeutic strategy for treating hepatitis C virus (HCV) infections involves the administration of a cytokine to modulate the immune system. However, this approach is difficult for patients to tolerate, often leading to excessive fatigue, nausea and anemia, among other ailments. New antiviral medications are on the horizon, but even these are not expected to help around 30% of people infected.
One critical roadblock to developing better treatment options is a lack of suitable mouse models. At present, researchers searching for new HCV therapies rely on chimpanzees, which are susceptible to HCV infection. This sensitivity could be because these primates also have cell surface proteins similar to those found in humans that are thought to facilitate viral infection.
Now, Charles Rice, a virologist at Rockefeller University in New York, and his colleagues have engineered mice susceptible to HCV infection by introducing two human protein receptors that facilitate virus entry into the liver. In a series of unpublished experiments presented on Monday at the New York Academy of Sciences, the Rockefeller team showed that vaccinated mice had lower rates of HCV infection compared to non-vaccinated controls. According to study lead author Alexander Ploss, another Rockefeller virologist, these mice can now be used to develop HCV vaccines and to search for new drugs to prevent re-infection in people who receive liver transplants as a result of HCV-triggered disease.
This study follows the introduction of another humanized mouse model — published online earlier this month from a team that included Rice and Ploss— that recapitulates liver disease characteristic of people suffering from chronic HCV infection.
For more on the quest to develop mouse models of HCV infection, check out our 'community corner' discussion on the topic.
Image: GrahamColm, Wikimedia

Two Supplements May Strengthen Hep C Antiviral Treatment
Although many have heard of the supplements SAMe and betaine, their potential benefits to those on Hepatitis C treatment are not yet widely known.
by Nicole Cutler, L.Ac.

For the estimated four to five million American adults with chronic Hepatitis C, attempts to conquer the virus can be challenging. This illness' current antiviral treatment, pegylated interferon and ribavirin, is only about 50 percent effective in those infected with the most common strain of Hepatitis C in North America. Thus, investigators are constantly seeking ways to boost the success of these medicines. Building on previous knowledge about S-adenosyl-L-methionine (SAMe) and betaine, researchers from Switzerland have found two potential, seemingly non-toxic contenders for supporting Hepatitis C antiviral therapy.

Those unable to rid themselves of all Hepatitis C genetic material are burdened by the prospect of chronic liver disease progressing, a process that could eventually lead to liver cirrhosis, liver failure or liver cancer. Until better treatment options actualize, people in this situation typically seek experimental, innovative or alternative solutions to preserve their health. There are several ways health professionals attempt to help those who are not responsive to Hepatitis C treatment, such as:
· Developing more potent drugs that have a higher success rate for eliminating the Hepatitis C virus.· Guiding infected individuals toward herbal supplements and lifestyle choices that strengthen liver cells to better protect them from the virus.
· Adding certain substances to pegylated interferon and ribavirin that enhance their success rate.
While true progress against Hepatitis C is likely to involve all three of these approaches, the research from Switzerland focuses on the latter - enhancing pegylated interferon and ribavirin.
About the ResearchA research team from Basel, Switzerland identified viral interference with interferon signal transduction as an important factor explaining the mediocre success of Hepatitis C treatment. Because prior experiments with SAMe and betaine have shown these substances can increase interferon signal strength, the researchers investigated if adding SAMe and betaine to Hepatitis C treatment would increase its efficacy.

As published in a November 2010 edition of the journal PLoS ONE, the researchers tested this concept in Hepatitis C patients who had previously failed antiviral therapy. For their trial, the participants were treated with pegylated interferon, ribavirin, SAMe and betaine.
Compared with their first attempt at antiviral treatment consisting of just pegylated interferon and ribavirin, study participants fared better in their second therapy attempt that included SAMe and betaine. This improvement was measured by a higher percentage of participants achieving an early virological response - undetectable viral load 12 weeks after starting treatment.

The researchers concluded that adding SAMe and betaine to pegylated interferon/ribavirin therapy improves early virological response in chronic Hepatitis C. Based on the fact that the inability to detect Hepatitis C genetic material after 12 weeks increases the chances of treatment success, some clinicians are recognizing the potential therapeutic application of SAMe and betaine.

About SAMe and BetaineBoth considered to be natural substances, SAMe and betaine are nutrients known as methyl donors. Other methyl donors include folic acid and vitamins B6 and B12. These substances carry and donate methyl molecules in the body to help make chemical processes work. Donation of methyl molecules is involved in proper liver function and cellular reproduction.

SAMe is a synthetic form of a compound formed naturally in the body from the essential amino acid methionine and adenosine triphosphate (ATP), the energy-producing compound found in all cells in the body. Besides studies supporting SAMe's use for relieving the pain of osteoarthritis and helping depression, trials examining this supplement also suggest that it may help to normalize liver enzyme levels.

Betaine can be obtained in the diet from beets, broccoli, grains, shellfish and spinach. Besides studies supporting betaine's use for heart disease and homocystinuria, there is also evidence that betaine may help protect against fatty deposits in the liver.

The research from Switzerland on these two supplements is encouraging, but there is far more evidence needed to accept SAMe and betaine as worthy and valuable additions to Hepatitis C treatment medications. Although not yet open to participant recruitment, one related follow-up study is being conducted at the University of Nebraska. This pilot study will examine betaine's addition to Hepatitis C antiviral therapy in those who have either not responded to previous treatment or who have relapsed. More information on this study can be found at http://www.clinicaltrials.gov/

As the quest to help people conquer the Hepatitis C virus intensifies, expect to see more research into substances that aid pegylated interferon/ribavirin efficacy. SAMe and betaine are two such contenders, and the Hepatitis C community will be keeping a close eye on future developments involving these nutrients..
Read More..

Study finds little decline in hepatitis C infections among injection drug users
Research suggests improvements in prevention and treatment efforts needed
[EMBARGOED FOR JAN. 31, 2011]

A recent 20-year study of injection drug users (IDUs) in Baltimore found a significant decline in new cases of HIV infection but only a slight decline in new cases of hepatitis C virus (HCV) infection. The findings suggest that efforts to curb blood-borne transmission of these viral infections have had success but must be expanded against the highly transmissible HCV. Researchers from Johns Hopkins School of Public Health and other centers, led by Shruti H. Mehta, PhD, MPH, report the findings in the March 1 issue of The Journal of Infectious Diseases, now available online. (Please see below for a link to the embargoed study online.)

Previous data had suggested that HIV incidence among IDUs has declined. This trend is often attributed in part to harm reduction measures, including needle exchange programs and substance abuse treatment. However, these measures have not been as successful in lowering the rates of HCV incidence and prevalence. For example, HCV infection is nearly 10 times more transmissible by sharing needles than is HIV infection. Sharing a needle even once can be enough to transmit HCV.

The investigators found that new cases of HIV infection declined dramatically across four different time periods during the past 20 years, from 5.5 per 100 person-years (PY) in 1988-'89, to two per 100 PY in 1994-'95, and to zero cases in 1998 and 2005-'08. While researchers also observed reductions in new cases of HCV infection, these were not nearly as substantial: from 22 per 100 PY in 1988-'89, to 17.2 per 100 PY in 1994-'95, to 17.9 in 1998, and to 7.8 per 100 PY in 2005-'08. Overall, cases appeared to decline only among younger IDUs, who had started injecting drugs recently.

According to researchers, these data suggest that "current prevention efforts delay but do not prevent HCV at the population level and will need to be further intensified to reduce risk of HCV infection to the level of HIV." Efforts on both the prevention and the treatment fronts to reduce the reservoir of HCV-infected IDUs will have to be expanded, the investigators concluded.
In an accompanying editorial, Jason Grebeley, PhD, and Gregory J. Dore, MB BS, MPH, PhD, of the University of New South Wales in Australia, agreed that higher prevalence of HCV infection and greater transmission risk following an injection with a contaminated syringe as compared to HIV have hampered harm reduction measures. They also noted that current implementation of harm reduction measures in most settings is inadequate. Rates of equipment sharing remain high, and access to opioid substitution therapy and other drug treatment programs is limited.
The editorial authors also pointed out the impact that an HCV vaccine could have on new cases of HCV infection. Though a highly efficacious vaccine has not yet been discovered, efforts to do so are crucial. They suggested that even though the window for preventing HCV may be small, improvements in HCV prevention are feasible.
###
Fast Facts:
1) Among the community of injection drug users (IDUs) in Baltimore, HIV incidence declined dramatically over 20 years, while new cases of hepatitis C virus (HCV) infection declined only slightly.

2) HIV incidence decreased from 5.5 per 100 person-years (PY) in 1988-'89, to two per 100 PY in 1994-'95, and to zero in 1998 and 2005-'08. The declines in HCV infection were not nearly as substantial: from 22 per 100 PY in 1988-'89, to 17.2 per 100 PY in 1994-'95, to 17.9 in 1998, and to 7.8 per 100 PY in 2005-'08.

3) Prevention and treatment efforts must be expanded to reduce the number of HCV infections among IDUs.

NOTE: The study and the accompanying editorial are available online. They are embargoed until 12:01 a.m. EST on Monday, Jan. 31, 2011:
"Changes in Blood-borne Infection Risk Among Injection Drug Users" http://www.oxfordjournals.org/our_journals/jid/jiq112.pdf
"Prevention of Hepatitis C Virus in Injecting Drug Users: A Narrow Window of Opportunity" http://www.oxfordjournals.org/our_journals/jid/jiq111.pdf
Founded in 1904, The Journal of Infectious Diseases is the premier publication in the Western Hemisphere for original research on the pathogenesis, diagnosis, and treatment of infectious diseases; on the microbes that cause them; and on disorders of host immune mechanisms. Articles in JID include research results from microbiology, immunology, epidemiology, and related disciplines. JID is published under the auspices of the Infectious Diseases Society of America (IDSA). Based in Arlington, Va., IDSA is a professional society representing more than 9,000 physicians and scientists who specialize in infectious diseases. For more information, visit
http://www.idsociety.org/.

Elastography for Hepatic Fibrosis Severity in Chronic Hepatitis B or CMaria-Vasiliki

Papageorgioua, George V. Papatheodoridisa, Spilios Manolakopoulosa, Emmanuel Tsochatzisa, Hariklia Kranidiotia, Georgia Kafirib, Athanasios I. Archimandritisaa2nd Department of Internal Medicine, Medical School of Athens University, andbDepartment of Pathology, ‘Hippokration’ General Hospital of Athens, Athens, Greece

Abstract

Aims: To assess the value of transient elastography for predicting significant fibrosis or cirrhosis in chronic hepatitis B or C (CHB or CHC) patients.

Methods: 75 patients (CHB: 45, CHC: 32) were included. All underwent elastography and liver biopsy concurrently. Biopsies were evaluated using Ishak’s classification. Fibrosis was mild, moderate or severe/cirrhosis when scores were 0–1 (n = 30), 2–3 (n = 20), 4–6 (n = 25), respectively.

Results: Median liver stiffness values were higher in patients with severe fibrosis or cirrhosis than in those with moderate or mild fibrosis (14.8 vs. 6.4 vs. 5.3 kPa, p < 0.001). The diagnostic accuracy of elastography for severe fibrosis and cirrhosis was excellent [area under the receiver operating characteristic (AUROC) curve 0.938 vs. 0.948], but it was not optimal for mild fibrosis (AUROC 0.78). Values of 7.5, 9.0 and 12 kPa had a sensitivity and specificity for severe fibrosis/cirrhosis of 96, 84 and 60%, and 76, 90 and 94%, respectively.

The median stiffness value in cirrhotic patients (score 5–6) was 16.6 kPa (7.7–48). No differences in accuracy of elastography between CHB or CHC patients were found. Cutoff was 12.5 kPa for cirrhosis; 10/75 patients (13%) were misclassified. Conclusion: Transient elastography has an excellent diagnostic accuracy for severe fibrosis and cirrhosis in CHB and CHC, but the cutoffs need further evaluation. Copyright © 2011 S. Karger AG, Basel

Also See; Liver Biopsy and Noninvasive Tests For Fibrosis

Trapero-Marugán M, Mendoza J, Chaparro M, González-Moreno L, Moreno-Monteagudo JA, Borque MJ, Moreno-Otero R

Long-term outcome of chronic hepatitis C patients with sustained virological response to peginterferon plus ribavirin.

[JOURNAL ARTICLE]World J Gastroenterol 2011 Jan 28; 17(4):493-498.

AIM: To assess the clinical, biochemical and virological long-term outcome in chronic hepatitis C (CHC) patients with a sustained virological response (SVR) after peginterferon (PEG-IFN) plus ribavirin combination therapy.

METHODS: One hundred and fifty three patients with a SVR after treatment with PEG-IFN plus ribavirin were included in a 5-year follow-up study in a single Spanish center, based on standard clinical practice. Clinical anamnesis, biochemical analysis, hepatitis C virus RNA and alpha-fetoprotein measurement, ultrasonography and transient elastography were performed annually.

RESULTS: The mean follow-up period of the 153 patients was 76 ± 13 mo after they obtained a SVR. Five patients (3.26%) presented with cirrhosis before treatment and 116 (75.8%) had genotype 1. No patient showed evidence of hepatic decompensation. One patient (0.65%) developed a hepatocellular carcinoma at month 30 after achieving SVR. There were no virological relapses during this follow-up period. Persistently elevated alanine aminotransferase was found in only one patient (0.65%). At the end of the 5-year follow-up, the mean value of transient elastography was 7 ± 4.3 kPa (F1). There were no deaths and no other tumors.

CONCLUSION: The long-term outcome of 153 CHC patients with SVR to PEG-IFN plus ribavirin was good. No evidence of a virological relapse was seen. One patient (0.65%) developed a hepatocellular carcinoma.
More from this journal
World journal of gastroenterology : WJG [World J Gastroenterol]

Aoki YH, Ohkoshi S, Yamagiwa S, Yano M, Takahashi H, Waguri N, Igarashi K, Sugitani SI, Takahashi T, Ishikawa T, Kamimura T, Wakabayashi H, Watanabe T, Matsuda Y, Nomoto M, Aoyagi Y

Characterization of elevated alanine aminotransferase levels during pegylated-interferon α-2b plus ribavirin treatment for chronic hepatitis C.

Abnormal ALT values during treatment were observed in 23.0% of patients

[JOURNAL ARTICLE]Hepatol Res 2011 Feb; 41(2):118-125.

Aim: Elevation of alanine aminotransferase (ALT) levels during pegylated-interferon (peg-IFN) plus ribavirin therapy in patients with chronic hepatitis C [CHC] is a problem that cannot be disregarded. The aim of this study is to assess the frequency and to characterize clinical parameters of this phenomenon.

Methods: Two hundred and thirty-five (235) CHC patients with genotype 1b receiving peg-IFN α-2b plus ribavirin therapy were analyzed. Clinical parameters that may be associated with abnormal ALT values during treatment and therapy outcomes were evaluated statistically. One hundred and sixteen (116) patients treated with peg-IFN α-2a plus ribavirin were also included for partial analysis.

Results: Abnormal ALT values during treatment were observed in 23.0% of patients. It was observed in 14.5% of those with sustained virological response (SVR) and 17.8% of those with relapse, in whom viral clearance was observed during therapy. Multivariate logistic regression analysis revealed that pretreatment ALT values, therapy outcome, and body mass index (BMI) were significant factors related to abnormal ALT values during treatment. Abnormal ALT values during treatment became normal in SVR patients at 6 months after the completion of treatment, but not in NR (non-response) patients.

Mean ALT values were significantly higher at some time points during treatment in patients treated with α-2a when compared to those treated with α-2b.

Conclusion: Abnormal ALT values during peg-IFN plus ribavirin treatment are observed relatively frequently, even in patients without detectable HCV RNA. Direct or indirect involvement of drugs is considered as one possible cause.
More from this journal
Hepatology research : the official journal of the Japan Society of Hepatology [Hepatol Res]

HIV

HIV Causes Rapid Aging In Key Infection-Fighting Cells, Research Suggests
29 January 2011In the early years of the AIDS epidemic, being infected with the virus that causes the disease was considered a virtual death sentence. But with the development of antiretroviral therapy, many with HIV are now living much longer...
read article

HIV/AIDS Awareness
(NAPSI)—Black Americans continue to be disproportionately affected by HIV/AIDS, according to the U.S. Centers for Disease Control and Prevention (CDC). In fact, in their lifetime, one in 16 black men and one in 32 black women will be infected with HIV. This National Black HIV/AIDS Awareness Day, as the nation approaches the 30th year of the HIV epidemic, we are faced with the stark reminder that HIV prevalence in blacks is almost eight times that of whites.
“These alarming statistics remind us that all communities—particularly communities of color—need new biomedical tools, including a vaccine to prevent further spread of the virus,” says S. Wakefield, director of external relations at the HIV Vaccine Trials Network. “It is also essential that we identify culturally appropriate approaches to engage all individuals in using proven HIV prevention tools and in the search for new ones. This is critical as we continue to search for ways to overcome the health inequities currently impacting black communities. A commitment to engaging those most affected is the only way we can truly make a significant difference in HIV research.”

CDC data show that more people are living with HIV in the United States than ever before, and while there is no cure for HIV/AIDS, advances in treatment can help the majority of those who are infected live longer, fuller lives. But treatment is costly and remains out of reach for many people in the United States. The best hope in the fight against AIDS is to find a preventive HIV vaccine, and recent studies are bringing us closer than ever before to that discovery.
Scientists are gaining new insights into how vaccines, microbicides and other HIV prevention strategies may work. These studies would not have been possible without the support and participation of volunteers of all races and ethnicities, including African Americans. However, more volunteers are still needed to find a safe and effective vaccine that prevents HIV infection for everyone.
Because community involvement and education are essential to the success of HIV vaccine research, initiatives are under way across the country to help people understand why HIV vaccine research is relevant to them and how they can support these efforts.
About HIV Vaccine Research
• HIV/AIDS is the third-leading cause of death for black men and women aged 35 to 44.
• Historically, vaccines have been the most powerful weapon against infectious diseases such as polio, measles and hepatitis B.
• The HIV vaccine candidates being studied in humans do not contain the actual HIV virus, so they cannot cause anyone to become infected with HIV.
To learn more about HIV vaccine research in the United States,
visit http://www.bethegenera/ tion.nih.gov.

Access To Medicines: Johnson & Johnson/Tibotec AIDS Drug Licenses Exclude Too Many Patients
31 January 2011Licenses just agreed between three generic manufacturers and pharmaceutical company Tibotec, owned by Johnson & Johnson, will keep a promising new AIDS medicine out of the hands of many patients across the developing world...
[read article]

Tibotec Signs Multiple Agreements With Generic Manufacturers To Provide Access To New HIV Treatment
30 January 2011Tibotec Pharmaceuticals announced that it has granted multiple non-exclusive licenses to generic manufacturers including Hetero Drugs Limited, Matrix Laboratories Limited (a Mylan company) of India and Aspen Pharmacare of...
[read article]

HIV Causes Rapid Aging In Key Infection-Fighting Cells, Research Suggests
29 January 2011In the early years of the AIDS epidemic, being infected with the virus that causes the disease was considered a virtual death sentence. But with the development of antiretroviral therapy, many with HIV are now living much longer...
[read article]

Liver Cancer

Microsulis Medical Limited Receives Health Canada Approval of the Accu2i Percutaneous Microwave Tissue Ablation Device
Microsulis Medical Limited, the leading company in microwave technology for medical devices, today announced that it has received approval from Health Canada for the Acculis Accu2i percutaneous microwave tissue ablation (pMTA) system for the coagulation of soft tissue during surgical procedures. The system has already been in use in Europe and the United States treating liver and lung tumors via a small 1.8 mm needle puncture of the skin. This groundbreaking treatment allows physicians to apply precise microwave energy to remove unwanted tissue masses whilst avoiding the risks associated with longer, more invasive surgical interventions.

The Accu2i pMTA system is now cleared in Europe, the United States, and Canada and it delivers 2.45 GHz of power to ablate tumors of the liver and lung. The design consists of a 1.8 mm diameter closed water cooled needle that allows physicians to ablate up to five centimeter lesions in minutes. The system is unique in that it uses specialized patented microwave antenna designs that achieve the very high levels of microwave energy deposition into tissue needed to quickly and effectively coagulate unwanted areas of soft tissue.

“The Health Canada approval builds on the momentum we experienced in 2010 with the CE mark and FDA clearance of the Accu2i pMTA system,” said Stuart McIntyre, CEO of Microsulis Medical Limited. “We are pleased to have received this approval from Health Canada for the pMTA system so physicians can begin to offer this game changing treatment options for patients in Canada with liver or lung tumors.”
For more information about the Acculis Accu2i pMTA system, visit http://www.acculis.com/.
Read more: http://www.financialpost.com/

Provectus Pharmaceuticals, Inc. (OTC-BB: PVCT),
a development-stage oncology and dermatology biopharmaceutical company, has completed patient accrual and treatment of all subjects in its Phase 1 clinical trial of PV-10 for liver cancer.

Dr. Craig Dees, PhD, CEO of Provectus said, “Preliminary results for PV-10 as a treatment for liver cancer are very encouraging as they show the treatment was generally well-tolerated, with substantial evidence of efficacy. We believe PV-10’s ability to selectively target and destroy cancer cells without harming surrounding healthy tissue make it a potentially attractive therapy for cancers of the liver, which can be very serious and difficult to treat if they cannot be fully removed through surgery.”The Phase 1 study of PV-10 for liver cancer involved six subjects with cancer metastatic to the liver or with recurrent liver cancer. The primary objective of the open-label study is to determine the safety and tolerability of a single intralesional injection of PV-10 in patients with cancer of the liver.

Additional objectives include assessing the distribution and retention of PV-10 in the injected lesion, tumor response and viability, and plasma pharmacokinetics of PV-10 following intralesional injection. In each of two dose cohorts there were three subjects. Dose escalation occurred following assessment of safety and tolerability in the first cohort. Dr. Paul Goldfarb, M.D., of Sharp Memorial Hospital in San Diego, is the Principal Investigator for the study.Malignant lesions in the liver arising from primary hepatocellular carcinoma (HCC) or metastases from a wide range of cancers represent an ongoing treatment challenge for oncologists. HCC is one of the most common malignancies worldwide, and its incidence is rapidly increasing in the United States.

The liver is a common site of metastases from solid tumors, particularly those arising in the gastrointestinal tract. Other tumors, such as lung and breast cancer and melanoma, also readily spread to the liver.

New book urges use of antidepressants to treat, prevent cancer
"Killing Cancer" by Dr. Julian Lieb reviews medical research in an effort to demonstrate that antidepressants have anticancer properties
BURLINGTON, Vt. (MMD Newswire) January 31, 2011 -- In "Killing Cancer", Dr. Julian Lieb cites clinical and laboratory studies with hopes of illuminating the anticancer properties of antidepressants.

"Antidepressants kill cancer cells, inhibit their proliferation, protect nonmalignant cells from damage by ionizing radiation and chemotherapy toxicity, restore sensitivity to multidrug resistant cells and target the mitochondria of cancer cells while sparing those of healthy ones," explains Lieb. Lieb believes antidepressants are capable of arresting cancer even in advanced stages and occasionally eradicating it.

"Killing Cancer" presents a list of 60 published reports which reveal that antidepressants are potentially effective for the treatment of malignancies, including those that often resist treatment, such as cancer of the lungs, kidneys and liver; malignant gliomas of the brain; and inflammatory breast cancer. Lieb points out that the use of relatively inexpensive antidepressants could make cancer treatment available to low-income and disadvantaged segments of the population as well.

"Great advances seldom emanate from ivory tower medical schools or government health agencies," Lieb says. "They are often made by outsiders that draw together observations whose relationship to each other had never been suspected."
"Killing Cancer" is available for sale online at Amazon.com and other channels.
About the AuthorDr. Julian Lieb is a former Yale School of Medicine psychiatry professor and director of the Dana Psychiatric Clinic at Yale-New Haven Hospital. The author or co-author of 48 published articles and 11 books, Lieb is a recognized expert on the immunostimulating and antimicrobial properties of lithium and antidepressants and the anticancer properties of antidepressants. He has worked closely with pioneers in prostaglandin research, and has been invited to address international cancer conferences in Greece, Germany and India.
MEDIA CONTACT:Dr. Julian Lieb E-mail: julian@doctorlieb.com Phone: (802) 658-4909
Source

Transplants

Digital image analysis of liver collagen predicts clinical outcome of recurrent hepatitis C Virus 1 year after liver transplantation†

Pinelopi Manousou1,Amar P. Dhillon2,†, Graziela Isgro1, Vincenza Calvaruso1,3,
T.V. Luong2, Emmanuel Tsochatzis1, E. Xirouchakis1, G. Kalambokis1, Timothy J. Cross1,
N. Rolando1,James O'Beirne1, David Patch1, . Thornburn1, drew K. Burroughs1,*,‡
Article first published online: 28 JAN 2011
DOI: 10.1002/lt.22209

Abstract

Clinical outcomes of recurrent hepatitis C virus after liver transplantation are difficult to predict. We evaluated collagen proportionate area (CPA), a quantitative histological index, at 1 year with respect to the first episode of clinical decompensation.

Patients with biopsies at 1 year after liver transplantation were evaluated by Ishak stage/grade, and biopsy samples stained with Sirius red for digital image analysis were evaluated for CPA. Cox regression was used to evaluate variables associated with first appearance of clinical decompensation. Receiver operating characteristic (ROC) curves were also used. A total of 135 patients with median follow-up of 76 months were evaluated.

At 1 year, median CPA was 4.6% (0.2%-36%) and Ishak stage was 0-2 in 101 patients, 3-4 in 23 patients, and 5-6 in 11 patients. Decompensation occurred in 26 (19.3%) at a median of 61 months (15-138).

Univariately, CPA, tacrolimus monotherapy, and Ishak stage/grade at 1 year were associated with decompensation; upon multivariate analysis, only CPA was associated with decompensation (P = 0.010; Exp(B) = 1.169; 95%CI, 1.037-1.317).

Area under the ROC curve was 0.97 (95%CI, 0.94-0.99). A cutoff value of 6% of CPA had 82% sensitivity and 95% specificity for decompensation. In the 89 patients with hepatic venous pressure gradient (HVPG) measurement, similar results were obtained.

When both cutoffs of CPA more then 6% and HVPG ≥ 6 mm Hg were used, all patients decompensated. Thus, CPA at 1-year biopsy after liver transplantation was highly predictive of clinical outcome in patients infected with hepatitis C virus who underwent transplantation, better than Ishak stage or HVPG. Liver Transpl 17:178–188, 2011. © 2011 AASLD.
Source

HIV, Hepatocellular Carcinoma And Liver Transplantation
Main Category: HIV / AIDSAlso
Included In: Liver Disease / Hepatitis;
Transplants / Organ Donations; Cancer / Oncology

French researchers determined that infection with human immunodeficiency virus (HIV) impaired results of transplant surgery for liver cancer, with more HIV infected patients dropping off the transplantation wait list.

The team found that overall survival and recurrence-free survival was not impacted following liver transplantation in patients with controlled HIV disease. Details of this single center study - the largest to date - are published in the February issue of Hepatology, a peer-reviewed journal of the American Association for the Study of Liver Diseases (AASLD). More than 40 million individuals are infected with HIV; of these roughly two to four million and four to five million are also carriers of chronic hepatitis B virus (HBV) and hepatitis C virus (HCV), respectively. With the introduction of highly active antiretroviral therapy (HAART) in 1996 the survival of patients with HIV infection has improved dramatically and now end-stage liver disease has become the principal cause of death among HIV- positive patients co-infected HBV or HCV. Prior studies have shown that 25% of liver-related mortality in HIV-positive patients is attributable to hepatocellular carcinoma (HCC), or liver cancer.

"Liver transplantation is the optimum treatment for HCC and can also be considered for controlled HIV-positive patients with liver cancer," said René Adam, MD, PhD, from Hospital Paul Brousse in France and lead author of the current study. "Our study showed that HIV infection impaired the results of liver transplantation on an intent-to-treat basis but exerted no significant impact on overall survival and recurrence-free survival following transplantation." The research team analyzed data from 21 HIV-infected and 65 HIV-negative patients with HCC who were listed for liver transplantation between 2003 and 2008. All HIV-positive patients were treated with HAART and had not experience any AIDS event or opportunistic infections prior to being place on the wait list. Researchers observed a trend towards a higher drop-out among HIV-positive wait listed patients (23%) compared to patients without HIV (10%).

Patients with HIV who dropped out had significantly higher alpha-fetoprotein (AFP) levels at the time of listing than those who received a transplant - 98 μg/L versus 12 μg/L, respectively. A similar difference in AFP levels was not found in HIV-negative patients -18 μg/L in those who dropped out versus 13 μg/L for those who underwent liver transplantation. Only one HIV-positive patient who did not have increased AFP levels while on the wait list dropped out due to progression from controlled HIV to AIDS. Medical evidence indicates a major predictive factor for HCC recurrence post-transplantation is an increase in patient's AFP level of more than 15 μg/L per month while on the waiting list. "Our study confirmed the importance of this preoperative factor (AFP levels), as all HIV-positive patients who dropped out displayed a rise in AFP levels," Dr. Adam concluded.

"There is clearly a critical need for more effective neoadjuvant therapy in HIV-positive patients with HCC, however there are no objective arguments to contraindicate liver transplantation in this group if strict criteria are used for selection and patients are closely monitored until surgery." Article: "Liver transplantation for Hepatocellular Carcinoma: The Impact of HIV Infection." Eric Vibert, Jean-Charles Duclos-Vallée, Maria-Rosa Guigna, Emir Hoti, Chady Salloum, Catherine Guettier, Denis Castaing, Didier Samuel, René Adam. Hepatology; Published Online: January 3, 2010 (DOI: 10.1002/hep.24062); Print Issue Date:
February 2011. Source: Dawn PetersWiley-Blackwel

Healthy You

Winning The Battle With Fibromyalgia
After 27 years of service, decorated U.S. Army Brigadier General Becky Halstead (Retired), the first female West Point graduate in U.S. history to command at the strategic level in Iraq and Afghanistan, decided to retire after being diagnosed with fibromyalgia - a medically unexplained syndrome affecting the muscles and connective tissues. Currently, the disease affects as many as 12 million Americans and has been reported two times as prevalent in deployed veterans (Annals of Internal Medicine, June 7, 2005, Vol. 142 No.11).
"Agonizing pain, debilitating fatigue, joint stiffness and sleep deprivation-you name it and I felt it," says Halstead. "There I was in Iraq, responsible for over 20,000 military men and women, and I privately struggled to physically keep myself going."

Initially, Halstead was prescribed every drug imaginable, though the pills only masked the pain and resulted in a spiral of reactions affecting her psychological and physical health. It wasn't until a close friend suggested chiropractic that she was able to find relief and return to a normal, nearly pain-free life. She discovered that the comprehensive treatment of chiropractic care improves joint motion, reducing and in some cases eliminating the pains and symptoms associated with fibromyalgia - such as fatigue, sleep deprivation and depression.
"Chiropractic treatment helped improve my whole outlook on dealing with this chronic ailment," she says. "The spinal adjustments along with the postural and nutritional advice I received helped to treat the fibromyalgia and allowed me to have many days with minimal pain -- and most days without any medications. The care of a doctor of chiropractic was life changing for me."

Today, Halstead is a spokesperson for the Foundation for Chiropractic Progress, a not-for-profit organization dedicated to raising public awareness of the benefits associated with chiropractic care. Brig. General Halstead has made it her personal mission to educate others suffering with fibromyalgia - and to consider consulting with doctor of chiropractic, as she did.
"Chiropractic care is a viable option that can positively impact overall wellness and health," she concludes.
Source: Foundation for Chiropractic Progress http://www.medicalnewstoday.com/

Daily Electronic Assessments Help Fibromyalgia Patients Cope
28 January 2011Hand-held PDA devices for recording daily symptoms are helping fibromyalgia patients and their doctors better understand links between pain, emotional distress and fatigue in this complex pain disorder, according to research...
[read article]

UNMC Study Links Chronic Hives, Vitamin D Deficiency
A University of Nebraska Medical Center research study has determined that patients with chronic hives may benefit by supplementing their diet with vitamin D. The study also suggests that health providers consider screening their patients with chronic hives for vitamin D deficiencies. Jill Poole, M.D., assistant professor in the UNMC Department of Internal Medicine, was the principal investigator on the study recently published in the Journal of Allergy and Clinical Immunology. "Chronic hives can be quite frustrating for patients as treatment options are limited.

They can make you feel miserable," said Dr. Poole, an allergist. "Vitamin D may be one part of the answer to this troublesome disease. Given the health benefits, there's no harm in taking vitamin D if you don't overdo it. It's easy, inexpensive and can be taken daily at 1,000 to 2,000 international units (IUs)." Chronic hives typically occur at least three times a week and last longer than six weeks. They appear as red, itchy welts and can lead to difficulty in breathing. In the small study, researchers compared 25 patients with chronic hives to 25 patients with nasal allergies. Researchers found patients with hives had significantly reduced levels of vitamin D, with nearly half of them considered to be vitamin D deficient. Dr. Poole said more studies are warranted to determine if vitamin D supplementation could improve health outcomes in patients with mild to severe hives.

Vitamin D deficiencies also are associated with osteoporosis, autoimmune diseases, cancer, cardiovascular disease, hypertension and even death. In a type of eczema, vitamin D has been found to help relieve symptoms. Through world-class research and patient care, UNMC generates breakthroughs that make life better for people throughout Nebraska and beyond. Its education programs train more health professionals than any other institution in the state. Source: University of Nebraska Medical Center

Lightly Steamed Broccoli Has Powerful Anticancer Enzyme Myrosinase
30 January 2011Broccoli can significantly reduce your risk of developing cancers if you don't destroy the enzyme myrosinase - you can only do this effectively by steaming the vegetable lightly...
[read article]

In Memory

Breaking News: Charles Nolan dies aged 53
Sadly, American designer, Charles Nolan, passed away on Sunday in his Manhatten apartment, at the tender age of 53.Vogue UK reports the designer’s life was unfortunately taken by liver cancer- leaving his partner, Andrew Tobias and large family behind.
Throughout his extensive career, Nolan designed for labels such as Anne Klein, Ellen Tracy, Blassport, Tahari, Christian Dior and Bill Haire- bringing a touch of preppy sportswear chic to the American fashion scene.
He later established his own eponymous label in 2003- followed shortly by an exclusive collection for Saks Fifth Avenue in 2004- WWD reports he was one of the first overseas designer’s to include a wide varying range in his prices, as well as introducing gifts, home goods and furniture to his list of talents.
His multitude of artistic skills will surely be missed in, and out of, the fashion world- our condolences go out to his friends and family.

New On The Blog;
Treating Hepatitis C In 2011; The Bible Of Links
Its time to roll out the "Bible of Links" for all those people who may be getting ready to contemplate treatment. If all goes well the two new HCV drugs, telaprevir and boceprevir should be ready for market by the end of this year. This blog has made an attempt to breakdown the data in order for you to ready yourself for that first treatment consultation.

New At HCV Advocate
http://www.hcvadvocate.org/ and http://www.hbvadvocate.org/:
Hear Gene’s Story about his struggles with hepatitis C and his need for a liver transplant.
Check out our drug pipeline which has been updated to include the latest information.
Many of our fact sheets have also been revised or updated.
Last but not least—find out the results from the survey about the top news stories of 2010 for HBV and HCV.

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Risk Of Developing Liver Cancer After HCV Treatment