Friday, March 18, 2011

Hepatitis In The News;March 18

New drug combo for hepatitis C shows promise
Researchers at St. Louis University have been testing a new drug that could increase the cure rate for hepatitis C by half or more.
If the Food and Drug Administration approves the new drug combination this summer as researchers predict, the medical community will be able to cure about 75 percent of known hepatitis C cases, said Dr. Bruce R. Bacon, principal investigator of the "HCV Respond-2" study.
Bacon announced his findings at a recent conference of hepatology researchers.
Bacon explained that the current FDA-approved treatment for hepatitis C combines a weekly injection called peginterferon and daily pills called ribavirin. The combination cures about half of the cases of hepatitis C.
But hepatitis C comes in several varieties ranging from easily curable with standard treatment, to stubborn to not curable. Also, some people can appear cured, then the disease returns after treatment is stopped.
Bacon, known for helping several entertainers overcome hepatitis C, has been wrestling the virus for more than a decade............

All Hands Together to Fund Hepatitis C Infected Patients

Submitted by Annabel Tautou on Fri, 03/18/2011 - 07:59

Recently a survey was conducted in Sudbury-Manitoulin and it was found that nearly 2000 residents there suffer from Hepatitis C. The provincial rate for Hepatitis C was discovered as 0.87%. This virus generally spreads through blood exposure to an infected source. Two of the most-common ways of receiving it were detected through receiving tainted blood products or by shared injection drug needles.
The most risky part of this disease is that it does not become evident in about half of all infected people for years.
However, the side-effects of hepatitis C infection include fatigue, fever, nausea-vomiting, loss of appetite and joint pain.
In order to address the high rate of Hepatitis C in districts of Sudbury and Manitoulin, the provincial government there has decided to provide additional funding.
In addition to $644,364 to the Access AIDS Network of Sudbury/Manitoulin, Sudbury MPP Rick Bartolucci also announced $4,800 for the Sudbury Action Centre for Youth as a contribution to help the sufferers of hepatitis C.
He also told the press conference on Thursday at Access AIDS Network's headquarters on Elm Street "Today, we celebrate green, but today's announcement, it's all about red and yellow (the colours of the AIDS and Hepatitis C ribbons). It's not simply funding the AIDS Network ... It is ensuring the support programs for people are in place. It's ensuring that when they contact this place, there is a resource people can turn to. We want to reinforce the message for people who are infected: you are not alone”.

Hepatitis C transmission still high among injection drug users

Efforts to control blood-borne infections have dramatically reduced HIV incidence among injection drug users (IDUs), but declines in hepatitis C virus (HCV) infection have been less substantial, prompting health officials to call for better prevention and treatment strategies.
Incidence of HIV infection decreased from 5.5 cases per 100 person-years in a cohort of injection drug users recruited from 1988 to 1989 to zero cases per 100 person-years in a cohort recruited between 2005 and 2008.
In contrast, HCV infections declined from 22 cases per 100 person-years in the 1988 to 1989 cohort, to 17.2 per 100 person-years in a cohort recruited in 1994 and 1995. A slight increase to 17.9 cases was reported in another group recruited in 1998, before infections rates declined to 7.8 cases per 100 person-years from 2005 to 2008 (P=0.07).
The disparity in HIV and HCV reduction rates may be due to the fact that HCV is 10-times more transmissible than HIV, according to study researcher Shruti H. Mehta, MD, of the Johns Hopkins Bloomberg School of Public Health, in Baltimore, and colleagues.
Because HCV can be acquired after just one instance of needle-sharing, hazard reduction interventions such as needle exchange and substance abuse treatment programs that have been effective at reducing HIV, may have less of an impact. CDC estimates indicate that approximately one-third of IUDs share needles.
“Efforts need to be intensified on both the prevention and treatment fronts to reduce the reservoir of HCV-infected IDUs,” the researchers wrote in the March 1 issue of the Journal of Infectious Diseases.
To get a better understanding of HCV incidence in IDUs, they analyzed data from four cohorts of IDUs during a 20-year period (1988-1989, n=2,946; 1994-1995, n=391; 1998, n=244; 2005-2008, n=875).
The researchers found that compared with the 1988-1989 cohort, HCV incidence significantly declined among patients younger than 39 years in each subsequent cohort (adjusted prevalence ration=0.73; 95% CI: 0.65-0.81).
However, the same decreases were not observed in patients older than 39 years — among that age group HCV infection rates only declined in the most recent cohort (adjusted prevalence ratio=0.87; 95% CI: 0.77 to 0.99).
“For many persons, the interval between initiation and injection simply remains too brief for prevention strategies to be successful,” the researchers wrote.
They emphasized the importance of targeting prevention efforts towards very young IDUs and drug users who have not yet begun injecting. The other strategy for reducing the HCV reservoir is treatment, the efficacy of HCV treatment regimens is often limited among certain subpopulations including blacks with genotype-1 HCV and those with HIV coinfection, the researchers noted.
“With new, more efficacious therapeutics on the horizon, it is critical that strategies to improve uptake and completion of HCV infection treatment of IDUs be implemented,” they wrote.
Jason Grebely, PhD, and Gregory J. Dore, MBBS, PhD, of the University of New South Wales in Sydney, Australia, offered several suggestions for improving treatment and prevention.
“The development and implmentation of national harm-reduction strategies including broader coverage, enhanced early access and intesnifcation and combination of interventions are probably all needed,” they wrote.
Grebely and Dore also emphasized the importance of conducting randomized clinical trials to evaluate new HCV interventions to ensure that they are successful.

Report: States Fail to Discipline Rogue Doctors

Linda Shrieves (Orlando Sentinel, March 15, 2011)"For the past two decades, state medical boards responsible for disciplining doctors have failed to punish more than half of those whose hospitals revoked or restricted their privileges…The report...was based on data from the National Practitioner Data Bank from 1990 to 2009…The National Practitioner Data Bank…was designed to stop the movement of 'problem practitioners' from one hospital or one state to another. Licensing boards are required to report all actions that revoke, suspend or restrict a license for reasons related to the practitioner's professional competence or conduct…Patient advocates say the report is troubling."

Emotions high after Dr. Kaplan patient takes HIV test

Las Vegas, NV (KTNV) - Patients of local doctor turned up by the dozens at a prostate cancer support group Thursday night. some aren't even sick, but they're afraid they will be after their doctor, Michael Kaplan, was accused of reusing medical instruments.
"When they said between December 2010 and March 2011, I immediately just kind of, just sat there, in total shock for a little while," Kaplan's patient, C. Regi Rodgers says......

Donor gave kidney, plus HIV, to recipient

HIV transmission via live organ donation can still happen. To be more specific: It has now happened for the first time since 1989. A person suffering from kidney failure -- who had no known history of sexually transmitted infections, injection drug use or high-risk sexual activity -- was given a kidney, and HIV, in 2009.The New York City case marks the first known HIV transmission of this type in the U.S. since 1985, when laboratory screening for HIV became available. An account in this week's Morbidity and Mortality Weekly Report from the CDC has the details....The transplant team knew the donor, a male, had previously been treated for syphilis and that he'd had sex with men, but laboratory tests 79 days before transplant had found no evidence of the human immuno-deficiency virus, hepatitis B or hepatitis C. The operation commenced....

Doctor at center of hepatitis C scare taken into custody

Dipak Desai, the man who was at the center of the hepatitis C scare that swirled through Southern Nevada in 2007 and 2008, was taken into state custody Thursday morning.
Desai made a brief appearance in Clark County District Judge Jackie Glass's courtroom with his attorneys, was placed into handcuffs and led off to eventually be taken to a state mental evaluation facility in Northern Nevada...

Patient Unhappy Despite Doctor's Surrender
Desai Being Moved To State Mental Hospital
POSTED: 8:04 am PDT March 17, 2011

LAS VEGAS -- The doctor at the center of a 2007 hepatitis outbreak in southern Nevada surrendered to authorities on Thursday so he could be transferred to a state hospital.
Dr. Dipak Desai has avoided trial on racketeering charges by claiming to have suffered a mental breakdown, although many former patients believe the doctor faked his illness.
"Our office is happy he is where he belongs, which is in custody where we want him to be," chief deputy district attorney Michael Staudaher said.
A judge ruled in February that Desai be transferred to the Lake’s Crossing facility in Reno for further evaluation......

Minnesota nurse may have infected patients
MINNEAPOLIS (Reuters) - A nurse is suspected of inadvertently tainting intravenous painkillers at St. Cloud Hospital while seeking drugs, spreading bacterial infections to 23 patients since October, the hospital said on Wednesday.
The nurse has been suspended and St. Cloud Hospital has launched an investigation with state health officials into the infections possibly caused when drugs were diverted from IV bags for personal use, said the hospital, in the city of the same name 70 miles northwest of Minneapolis.
A criminal investigation is under way and the hospital and state health department are trying to determine if other patients were infected, it said. The 23 known infected patients had hospital stays in one unit from October to early March.
"We take this matter very seriously," St. Cloud Hospital President Craig Broman said in a statement. "Our highest priority is to provide safe, quality patient care."
St. Cloud Hospital said it launched the investigation in February after staff members noticed "increased incidence of organisms that do not normally infect people."
The hospital has not identified the nurse or the drugs alleged to have been diverted from patients. It described the investigation as preliminary.
There was no evidence that blood-borne pathogens such as Hepatitis B, Hepatitis C or HIV were transmitted to the patients who suffered from bacterial infections, it said.
The hospital tested all patient-controlled IV bags containing painkillers for bacteria as well as multiple supplies and environmental resources in its investigation, it said. The hospital said it also evaluated employees and hospital practices for distributing narcotics.
© 2004 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing, linking or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon....

Drug company recalls pills over dangerous labelling mix-up

A pharmaceutical company has launched a voluntary recall of a drug which may have been mislabelled — with possible "life-threatening" consequences for patients with high blood pressure, says Health Canada.
Following a complaint by a pharmacist regarding a prescription product containing the wrong medication, Mylan Pharmaceuticals is recalling one lot of Mylan-Minocycline 50 mg capsules and Mylan-Amlodipine 5 mg tablets, both sold in bottles of 100.
The risk, says Health Canada, is that patients sensitive to tetracyclines or minocycline may be taking minocycline in error, due to mislabelled bottles.
"In addition, a patient who requires MYLAN-AMLODIPINE for their high blood pressure or angina will not get the medication needed to help them treat these conditions," said a Health Canada statement.
Mylan-Amlodipine is used to treat high blood pressure and chest pains. Mylan-Minocycline is used to treat certain types of skin infections, urinary tract infections, gallbladder infections, and respiratory tract infections such as bronchitis, pneumonia, and sinusitis.
According to Mylan Pharmaceuticals, the company was contacted in mid-March by a pharmacist who reported that she had ordered four 100-count bottles of Mylan-Minocycline and received one bottle labelled as Mylan-Amlodipine which actually contained Mylan-Minocycline tablets.
The company says its quality investigation, which is ongoing, revealed a labelling error in which the labels for the Mylan-Amlodipine 5 mg tablets were mixed in with labels for the Mylan-Minocycline 50 mg capsules.
The company is advising pharmacists and wholesalers to return all quantities of lot number 1037180 to Mylan Pharmaceuticals.
Health Canada urges consumers to contact their doctors of pharmacists with any questions, and to contact Health Canada to report any adverse reactions possibly linked to the drugs.
Mylan Pharmaceuticals can be contacted at 1-800-575-1379.

Hepatitis C Abstract

IL28B genetic variation and treatment response in patients with hepatitis C virus genotype 3 infection

Polymorphisms near the IL28B gene, which code for interferon (IFN)-λ3, predict response to pegylated interferon- (PEG-IFN) and ribavirin treatment in hepatitis C virus (HCV) genotype 1 infected patients. Follow-up studies of the effect of IL28B gene in HCV non–genotype 1 infected patients have almost always used predominantly HCV genotype 2–infected or mixed genotype 2/3–infected cohorts with results partly conflicting with HCV genotype 1. We performed a retrospective analysis of 281 patients infected with HCV genotype 3 for association of response to therapy with IL28B polymorphisms. We found that the HCV genotype 1 responder genotypes at rs12979860 and rs8099917 did not associate with sustained virological response to PEG-IFN/ribavirin therapy. However, the responder genotypes of both SNPs showed association with rapid viral response measured at 4 weeks (rs12979860, P = 3 × 10−5; rs8099917, P = 3 × 10−4). In multivariate analysis, age (less then 40 years), baseline viral load ( less then 4 × 105 IU/mL) and the responder genotypes of SNPs rs12979860 or rs8099917 remained significant independent predictors of rapid viral response to therapy. Furthermore, we show that IL28B polymorphisms are associated with relapse in patients who achieve rapid viral response to PEG-IFN/ribavirin therapy. The responder genotypes also showed association with markers of stage and activity of liver disease, namely high aspartate aminotransferase platelet ratio index (APRI, rs12979860, P = 0.018; rs8099917, not significant) and high alanine aminotransferase (ALT, rs12979860, P = 0.002; rs8099917, P = 0.001), in addition to a high baseline viral load (rs12979860, P = 1.4 × 10−5; rs8099917, P = 7.3 × 10−6). Conclusion: Polymorphisms near the IL28B gene show association with rapid viral response but not sustained viral response to PEG-IFN/ribavirin therapy in HCV genotype 3-infected patients. (HEPATOLOGY 2011;)

Genetic variation in IL28B with respect to vertical transmission of hepatitis C virus and spontaneous clearance in HCV infected children

The vertical transmission of Hepatitis C Virus (HCV-VT) is a major route of HCV infection in children, but the risk factors remain incompletely understood. This study analyses the role of IL28B in HCV-VT and in the spontaneous clearance of HCV among infected infants. Between 1991 and 2009, 145 mothers were recruited to this study: 100 were HCV-RNA+ve/HIV-ve, with 128 children, and 33 were HCV-RNA-ve/HCV antibody+ve, with 43 children. The infants were tested for HCV-RNA at birth and at regular intervals until the age of 6 years. IL28B (single nucleotide polymorphism rs12979860) was determined in the mothers and children. HCV-VT was assumed when children presented HCV-RNA+ve in two subsequent blood samples. HCV-VT infected infants were categorized as: (A) transient viremia with posterior HCV-RNA-ve and without serum-conversion; (B) persistent infection with serum-conversion. Of the 31 mothers with CC polymorphism, 19(61%) were HCV-RNA+ve whereas among the 68 mothers with non-CC polymorphism, 56(82%) were HCV-RNA+ve. 26 of 128(20%) infants born to the HCV-RNA+ve mothers acquired HCV infection, but only 9(7%) were chronically infected. The rate of HCV-VT was higher among the mothers with higher HCV viremia. No HCV-VT was detected in the HCV-RNA-ve women. Neither the mothers' nor the children's IL-28 status was associated with an increased risk of HCV-VT. The factors influencing viral clearance among the infected children were genotype non-1 and genotype CC of the IL28B. In logistic regression, child CC polymorphism was the only predictor of HCV-clearance in HCV genotype-1.

High maternal viral load is the only predictive factor of HCV-VT. IL28B plays no role in HCV-VT, but IL28B CC child polymorphism is associated independently with the spontaneous clearance of HCV genotype-1 among infected children. (HEPATOLOGY 2011.)

Hepatitis B

Diabetes mellitus influences response to Hep B vaccine in dialysis patients

The latest issue of the Alimentary Pharmacology & Therapeutics investigates the impact of diabetes mellitus on the immunological response to hepatitis B virus vaccine in dialysis patients.
Patients on maintenance dialysis typically show a suboptimal immune response to hepatitis B virus vaccine compared with the non-uraemic population.
A variety of inherited or acquired factors have been implicated in this diminished response.
It is well known that patients with diabetes mellitus have a compromised immune system, and diabetic nephropathy is an important cause of chronic kidney disease.
However, the impact of diabetes mellitus on the immune response to HBV vaccine in patients receiving long-term dialysis remains unclear.
There was decrease in response rates among diabetic patients
Alimentary Pharmacology & Therapeutics
Dr Fabrizi and colleagues evaluated the influence of diabetes mellitus on the immune response to Hepatitis B vaccine in dialysis population by performing a systematic review of the literature with a meta-analysis of clinical studies.
The research team used the random effects model of DerSimonian and Laird with heterogeneity and sensitivity analyses.
The end-point of interest was the rate of patients showing seroprotective antibody against hepatitis B surface antigen at completion of vaccine schedule in the diabetic vs the nondiabetic dialysis individuals.
The researchers identified 12 studies involving 1002 unique patients on long-term dialysis.
The research team found that the aggregation of study results showed a significant decrease in response rates among the diabetic vs the nondiabetic patients.
Stratified analysis in various subgroups of interest did not meaningfully change our results.
Dr Fabrizi's team concludes, "Our meta-analysis showed a clear association between diabetes mellitus and impaired response to hepatitis B virus vaccine in individuals on long-term dialysis."
"Such a relationship is biologically plausible."
"Vaccination schedules with adapted vaccine doses and frequent serum testing for loss of immunity against hepatitis B virus should be considered in patients on maintenance dialysis with diabetes mellitus."
Aliment Pharmacol Ther 2011: 33(7): 815–21

Hepatitis B: Top 10 Treatment Centers
Thursday, 17 Mar 2011 02:45 PM

Here are the top treatment centers for Hepatitis B, a liver disorder:
1. The Johns Hopkins Hospital, Baltimore, Maryland: It is not only one of the best hospitals in the U.S., but also ranks among the best hepatitis B treatment centers in the country. The hospital combines medical technologies such as epidemiology, host immune response, viral pathogenesis, and viral evolution studies to gain insight into the treatment and prevention of hepatitis B.
2. The Mayo Clinic, Rochester, Minnesota: This hepatitis B treatment center plays a pivotal role in spreading awareness among the public and vaccinating people. With high-tech facilities and proficient medical personnel, Mayo Clinic is certainly one of the best picks for patients combating this disease.
3. The Massachusetts General Hospital, Boston, Massachusetts: A member of the extensive hepatitis B research network, the viral hepatitis department here is one of the best when it comes to treating the disease. This hepatitis B treatment center has phlebotomy, diagnostic labs, and radiographic facilities on site. The microbial and histopathological evaluations of the hepatitis B treatment center are world-class. The clinical trials done at the treatment center are highly competent.
4. The Cleveland Clinic, Cleveland, Ohio: This treatment center places importance on educating the public on hepatitis B. With some of the best doctors and specialists in the country on board, the treatment center has some of the best practices for the treatment of hepatitis B.
5. The UCLA Medical Center, Los Angeles, California: The medical center is known for its liver programs and advanced treatment methods. The center also has a remarkable pediatric center for hepatic complications. Their "Asian Liver Program" is one of the best known hepatitis programs in the country.
6. The New York-Presbyterian University Hospital of Columbia: The hospital has remarkable statistics on curing patients with hepatitis B. The Center for Liver Disease and Transplantation at the center is one of the best of its kind in the U.S.
7. The University of California, San Francisco Medical Center: The center does not charge a fee for testing and charges a nominal fee for vaccination. It has done work in treating patients with hepatitis B disease. The treatment center has also been doing commendable work in spreading public awareness about the disease. The San Francisco Hepatitis B Collaborative, established in 2004, is one such example of the initiative.
8. The Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania: This hospital is one of the best hepatitis B treatment centers in the country according to The U.S. News and World Report. This center, with its dedicated team of doctors, has treated numerous patients with hepatitis B. It has adopted a thorough vaccination strategy.
9. The Duke University Medical Center, Durham, North Carolina: The medical center is a part of the "Hepatitis B Research Network," which brings together leading clinics with excellent hepatitis departments to combat the disease globally.
10. The University of Washington Medical Center, Seattle, Washington: The medical center in Washington has high-tech treatment methods and is part of the "Hepatitis B Research Network," one of the biggest such initiatives in the world
17 March 2011
The Fantastic Voyage Continues - World First Localized Delivery Of An Anti-Cancer Drug By Remote-Controlled Microcarriers
17 March 2011

Soon, drug delivery that precisely targets cancerous cells without exposing the healthy surrounding tissue to the medication's toxic effects will no longer be an oncologist's dream but a medical reality, thanks to the work...

Healthy You

What Is Vitamin B1? What Is Thiamine?
Written by Christian NordqvistVitamin B1, also known as Thiamine or Thiamin, is a water-soluble vitamin of the B complex. Water-soluble means it can dissolve in water. We need vitamin B1 so that our body can use carbohydrates as energy - it is essential for glucose metabolism....

Vitamin A Plays Key Role in the Human Body, Study Suggests
In a recently published study mapping the structure and function of the so-called "orphan" nuclear receptor TR4, investigators suggest that vitamin A may play a more direct role than was previously ...

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