Hepatitis C News: Was pulmonary toxicity induced by interferon therapy?

From Medscape;

Simultaneous Occurrence of Pleural Effusion and Interstitial Pneumonitis After Treatment With Pegylated Interferon for Hepatitis C Virus Infection
This patient with chronic hepatitis C presented with a rare simultaneous occurrence of pleural effusion and interstitial pneumonitis.

Was pulmonary toxicity induced by interferon therapy?

Southern Medical Journal, March 2011

Abstract and Introduction
Case Report
Discussion
Conclusion

Discussion Only/Click here for Full Data

Although pulmonary complications of interferon (IFN) are rare, the growing number of patients receiving such therapy will undoubtedly lead to an increasing number of patients with pulmonary manifestations, of which IP and sarcoidosis are the most common, while pleural effusion is rare. There are only three cases described to date in the English literature, including our case. The clinical data of the three cases are shown in the Table.

The present case is the second case in which the patient developed pleural effusion and IP during pegylated interferon-α and ribavirin therapy for HCV infection. In this patient's case, it seems highly likely that pegylated interferon-α was responsible for the onset of pulmonary toxicity. All other possible infectious or systemic causes were ruled out; ribavirin had been interrupted at week 12, and the absence of any previous pulmonary history and specificity of the results of the various investigations carried out in the context of the pleural effusion and IP showed a relationship between the pegylated interferon treatment and the onset of complications. We used the causal criteria from the World Health Organization to show the probability of adverse drug reaction.[8]

The cornerstone of management of IFN-induced pulmonary toxicity is to stop the drug immediately.[1] There was convincing evidence that steroids induce an increase of hepatitis C virus replication; whether steroids should be included in the treatment modality remains controversial.[9] Treatment with steroids was not considered initially, since pleural effusion in the other two cases[5,6] and IP in some patients recovered after discontinuation of (pegylated) IFN/ribavirin,[1] the severity of pulmonary injury was of moderate degree, and there was premature cessation of ribavirin, which is correlated with a higher risk of virus relapse. However, methylprednisolone was used due to progressive dyspnea and cough with severe pulmonary injury and subsequent hypoxemia. Steroid therapy caused a dramatic improvement of symptoms and imaging, which suggested that pulmonary toxicity is related to the immunomodulatory reactions of IFN.

HCV Advocate Newsletter, March 2011

In This Issue:
HCV Protease Inhibitor—TMC435: Phase 3 Studies
Alan Franciscus, Editor-in-Chief

Hepatitis C in Egypt
Alan Franciscus, Editor-in-Chief

HCV Snapshots
Lucinda K. Porter, RN

Liver Transplantation: An Overview
Liz Highleyman

HealthWise: The Power Is in Our Hands
Lucinda K. Porter, RNHCV Advocate

Eblast HCV Advocate;
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Three died in one week after organs from same donor
Adrian Lowe March 3, 2011
World's largest online family history resource.+6 billion records
THREE women died within one week of each other after they received diseased organs in transplant procedures at the Austin and Royal Melbourne hospitals, an inquest has heard.

From GastroHep.com

Predictors of readmission with advanced liver disease
The latest issue of Clinical Gastroenterology & Hepatology investigates the incidence and predictors of 30-day readmission among patients hospitalized for advanced liver disease.
The rate of readmission to the hospital 30 days after discharge (30-day readmission rate) is used as a quality measure for hospitalized patients.
However, it has not been studied adequately for patients with advanced liver disease.
Dr Kenneth Berman and colleagues investigated the incidence and factors that predict this rate and its relationship with mortality at 90 days.
The researchers analyzed data from patients with advanced liver disease who were hospitalized to an inpatient hepatology service at 2 large academic medical centers in 2008.
Patients with elective admission and recipients of liver transplants were not included.
The 30-day readmission rate was 20%
Clinical Gastroenterology & Hepatology
During the study period, there were 447 patients and a total of 554 eligible admissions.
Multivariate analyses were performed to identify variables associated with 30-day readmission, and to examine its relationship with mortality at 90 days.
The researchers found that the 30-day readmission rate was 20%.
After the team adjusted for multiple covariates, readmission within 30 days was associated independently with model for end-stage liver disease scores at discharge, the presence of diabetes, and male sex.
After adjusting for age, sex, and model for end-stage liver disease score at discharge, the 90-day mortality rate was significantly higher among patients who were readmitted to the hospital within 30 days than those who were not.
Dr Berman's team concludes, "Patients with advanced liver disease frequently are readmitted to the hospital within 30 days after discharge."
"These patients have a higher 90-day mortality rate than those who are not readmitted in 30 days."
"These data might be used to develop strategies to reduce early readmission of hospitalized patients with cirrhosis."
Clin Gastroenterol Hepatol 2011: 9(3): 254-5903 March 2011

Hepatitis B

Hep B virus in the United States
This month's Annals of Internal Medicine investigates the rates of infection, exposure, and immunity in a nationally representative survey.
Up-to-date estimates of the prevalence of hepatitis B virus (HBV) infection, exposure, and immunity are necessary to assess the effectiveness of ongoing programs aimed at preventing HBV transmission.
Dr George Ioannou from Washington, USA determined the prevalence and associations of chronic hepatitis B virus infection, past exposure, and immunity in the United States from 1999 to 2008.
The research team performed a nationally representative, cross-sectional household survey in a civilian, noninstitutionalized population in the USA.
The researchers evaluated 39,787 participants in the National Health and Nutrition Examination Survey aged 2 years or older.
5% had been exposed to hepatitis B virus
Annals of Internal Medicine
Chronic hepatitis B virus infection was defined by presence of serum HBV surface antigen and past exposure by serum antibody to hepatitis B core antigen among persons aged 6 years or older.
Infant immunity was defined by presence of serum antibody to hepatitis B surface antigen among children aged 2 years.
Among persons aged 6 years or older, 0.3% had chronic Hepatitis B virus infection, and 5% had been exposed to hepatitis B virus.
The researchers noted that these estimates are lower than estimates of hepatitis B virus infection, and exposure in the United States reported from 1988 to 1994.
Infection and past exposure were very uncommon among persons aged 6 to 19 years.
The research team found that children aged 2 years have high rates of immunity.
Adults, including those at high risk for infection, have much lower rates of immunity.
The researchers reported that incarcerated and homeless persons were not sampled.
The team observed that categorization of race or ethnicity did not identify high-risk groups, such as persons of Asian and Pacific Islander descent.
Dr Ioannou's team concludes, "A cohort of children and adolescents is growing up in the United States with high rates of immunity against hepatitis B virus and very low rates of infection."
"Vaccination of high-risk adults should continue to be emphasized."
Ann Int Med 2011: 154(5): 319-32803 March 2011

Kinetics of Hep B surface antigen differ with peginterferon vs entecavir treatment
A study in March's issue of the Journal of Hepatology investigates the kinetics of hepatitis B surface antigen treatment with peginterferon and entecavir.
Dr Jurriën Reijnders and colleagues investigated serum hepatitis B surface antigen levels in patients with chronic hepatitis B virus infection during peginterferon and entecavir monotherapy.
Hepatitis B surface antigen was quantified at baseline and during antiviral therapy in hepatitis B e antigen-positive patients treated with entecavir or peginterferon and in hepatitis B surface antigen-negative patients treated with entecavir or peginterferon.
Within the hepatitis B surface antigen-positive population, patients treated with peginterferon tended to have a steeper hepatitis B surface antigen decline than entecavir-treated patients.
In Hep B surface antigen-negative patients, entecavir did not reduce antigen levels
Journal of Hepatology
The hepatitis B surface antigen decline was larger in those patients who became hepatitis B surface antigen negative, irrespective of the treatment regimen.
The researchers observed that a decline in hepatitis B surface antigen was confined to entecavir-treated patients with elevated baseline alanine aminotransferase levels, whereas hepatitis B surface antigen decline was not associated with baseline ALT in patients treated with peginterferon.
The research team found that within the hepatitis B surface antigen-negative population, peginterferon induced a significant hepatitis B surface antigen decline, while hepatitis B surface antigen did not decrease in entecavir-treated patients.
Both in hepatitis B surface antigen-positive and hepatitis B surface antigen-negative patients, the decline in serum hepatitis B virus DNA was larger in patients who received entecavir as compared to patients treated with peginterferon.
Dr Reijnders' team concludes, "In hepatitis B surface antigen-positive patients, the decline in serum hepatitis B surface antigen is mainly confined to patients who clear hepatitis B surface antigen, by either peginterferon or entecavir treatment."
"In hepatitis B surface antigen-negative patients, peginterferon therapy resulted in a significant reduction in hepatitis B surface antigen levels, whereas these did not decrease in entecavir-treated patients.
http://www.gastrohep.com/news/news.asp?id=107892

HIV

6-month drug regimen cuts HIV risk for breastfeeding infants, NIH study finds
Giving breastfeeding infants of HIV-infected mothers a daily dose of the antiretroviral drug nevirapine for six months halved the risk of HIV transmission to the infants at age 6 months compared with giving infants the drug daily for six weeks, according to preliminary clinical trial data presented today at the 18th Conference on Retroviruses and Opportunistic Infections (CROI) in Boston. NIH/National Institute of Allergy and Infectious Diseases

From HIV and Hepatitis

ARIEL: 24-week Safety and Eefficacy of darunavir/ritonavir in Treatment-experienced Pediatric Patients Aged 3 to less then 6>

Pharmacokinetic Parameters of Once-Daily TMC278 Following Administration of Efavirenz in Healthy Volunteers

Lipid profiles of TMC278 and Efavirenz in Ttreatment-naïve, HIV-1-infected Patients: Pooled Week 48 Data from the Randomized, Double-blind, Phase III ECHO and THRIVE Trials

Neurologic and Psychiatric Safety Profile of TMC278 Compared with Eefavirenz in Treatment-naïve, HIV-1-infected Patients: Pooled Analysis from the Randomized, Double-blind, Phase III ECHO and THRIVE Trials at 48 Weeks

Change in Vitamin D Levels Smaller and Risk of Development of Severe Vitamin D Deficiency Lower Among HIV-1-Infected, Treatment-naïve Adults Receiving TMC278 Compared with Efavirenz: 48-week Results from the Phase III ECHO Trial

Chronic Illness

Survey shows patients with rare diseases and their caregivers are avid Internet users
By Lia Steakley
An earlier report by the Pew Internet & American Life Project found searching for health information is the third-most-popular activity on the web. Now new research from the nonprofit shows that when it comes to using the Internet to seek health information and support, one community outpaces all the rest: patients with rare diseases and their caregivers.

Healthy You

From Harvard World Health News

Fatigue Kills
Tom Avril(The Philadelphia Inquirer, February 28, 2011)
"Fatigue is an epidemic in this country, and experts say it is both underrecognized and dangerous -- accounting for more than 20 percent of transportation accidents, by some estimates. And while scientists can tell if a person is too tired to function well, there is no good way to evaluate anyone who can't stop what they're doing to take a test, such as pilots, truck drivers, surgeons, or astronauts. So researchers…are looking for clues."

Toxic or Not?
Karen Weintraub (The Boston Globe, February 28, 2011)
"It’s nearly impossible to prove scientifically that certain diseases are caused by household chemicals…known as endocrine disruptors…The question is how much exposure is too much…Exposures are cumulative…The trouble is no one knows how much each exposure matters. And no one knows how the chemicals might interact with each other, compounding their impact on the body. No one knows in part because chemical companies aren’t required to find out."

My Unhealthy Diet? It Got Me This Far
Henry Alford(The New York Times, February 28, 2011)
"It’s a common belief that life as we know it ends in old age. Gone are the little [culinary] joys that make existence worthwhile…all subsumed under a banner reading, 'Doctor’s Orders.' For older people, the irony of eating is that your metabolism slows down, so you need less food, but your body needs just as many nutrients, if not more. Declining health and the voices of authority only dampen the proceedings further…One trope that comes up often in conversations with older gourmands is that eating what they want is, at their age, a right or privilege."

Many Americans Have Poor Health Literacy
Sandra G. Boodman
(The Washington Post in collaboration with Kaiser Health News,
February 28, 2011)
"Regardless of their literacy skills, patients are expected to manage multiple chronic diseases, to comply with drug regimens that have grown increasingly complicated and to operate sophisticated medical devices…health literacy is the focus of unprecedented attention from government officials, hospitals and insurers who regard it as inextricably linked to implementing the health-care overhaul law and controlling medical costs."

Off The Cuff

From Parmalot

Which Drugmaker Fails Most FDA Inspections?

By Ed Silverman // March 2nd, 2011 //

Some of the biggest drugmakers do not have a good track record when it comes time for FDA inspectors to visit their plants. Overall, the FDA found violations at 54 percent of plants inspected last year, up 20 percent from a decade low in 2007, according to data obtained from the agency by Bloomberg News

And Yet Another Johnson & Johnson Recall…

By Ed Silverman // March 2nd, 2011 // 7:02 pm

The sutures are marketed under various brand names - Ethilon, Ethibond, Mersilene and Mersilk - and are used to close surgical incisions and wounds. Some of the products in the 140 lots that were recalled may not have been sealed properly, posing a risk that they could become infected, according to the notice, which you can read here. J&J tells the Associated Press that the problem was caused by “modifications of manufacturing equipment” that have since been corrected. We await a comment concerning any patients who may have been harmed.

UPDATE: A J&J Ethicon spokeswoman wrote us to say there were no adverse events reported.

Six Biggest Gripes of Employed Doctors
Medscape BuVictoria Rentel, a family physician in Columbus, Ohio, joined a hospital-owned group several years ago. At first, nearly everything went fine. There were a few glitches: she'd occasionally order tests or consults at competing facilities, either for patient convenience or because of health plan coverage. When the hospital's administrators found out, they told her it was a violation of her contract; but that didn't stop her because she knew the hospital never enforced this provision.siness of Medicine, March 2, 2011

.