Friday, July 29, 2011

Friday News Digest;Hepatitis a risk to everyone

Hepatitis a risk to everyone

WASHINGTON — Nebraskan Evelyn McKnight offered a sobering point Thursday at a White House event on hepatitis.
Much of the afternoon's conversation dealt with "at-risk populations," such as IV drug users and people who had received blood transfusions many years ago.

"I brought forward that we talked a lot about at-risk population, but everybody in the room, everybody in the country, who accesses health care is an at-risk population," McKnight said. "That's how I contracted hepatitis C, was just accessing regular health care."
McKnight was one of 99 people infected with hepatitis C while receiving treatment at the Fremont Cancer Center.
State health officials linked the infections to reused syringes and other poor infection control practices at the clinic. The 2002 outbreak was the largest in U.S. history at the time.
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World Hepatitis Day
Sudbury - Around the globe, an estimated one in 12 people live with chronic hepatitis B or C.

Safe injection sites needed Canada-wide to fight hep B, C
By: The Canadian Press
Date: Thursday Jul. 28, 2011 8:04 AM PT
Canada needs safe-injection sites in every region to curb the spread of hepatitis B and C, says a health-care coalition that is calling for a more aggressive approach to combat the diseases.
The Canadian Coalition of Organizations Responding to Hepatitis B and C has issued a report card on Canada's performance and found that resources are inconsistent across the country.
Co-ordination appears particularly poor in Prince Edward Island, Nunavut and the Northwest Territories and prison inmates across the country are especially vulnerable, the group says in its report.

"Governments are essentially failing in terms of the prison population," the report says.
"There is no consistency from one institution to the next. Harm-reduction measures, resources and equipment must be available and accessible in all provincial and federal institutions."
The report notes that besides safe-injection sites, all regions also need methadone clinics and needle exchanges.

"All governments need to adopt a broader perspective on the determinants of health if they are to be able to address the harms associated with drug use and drug use policy," the report says.
It also suggested some prison policies actually hinder harm reduction.
Vancouver hosts North America's only safe-injection site, known as Insite, and the facility has been the subject of lengthy court wrangling after the Conservative government indicated its intention to have the facility closed. The case is currently before the Supreme Court of Canada.
Hepatitis B and C are infectious diseases of the liver. They can lead to serious liver damage, prompting the need for transplants, and can cause liver cancer.

While needle sharing has long been fingered as a vehicle for spreading hepatitis, as well as HIV, a study earlier this month from the University of Victoria concluded hepatitis may also be spread through shared crack pipes.

The report gave governments a grade of C- for ensuring every infant born in Canada is given a free vaccination against the diseases and the same grade was given to efforts to identify and offer vaccinations to those who didn't get it as an infant.

"It remains clear that too many people remain undiagnosed and untreated for (hepatitis C). Screening based on age, as well as risk, needs to be enforced," the report says.
Ultimately, the treatment for someone who has suffered the full effects of the diseases is a liver transplant, but the report says the numbers of transplants are too low.
The group recommends the federal government take a more active role in prompting organ donation.

The group also recommends the government add hepatitis B to the list of reportable diseases. Hepatitis C is currently on the list.

WHO renews push to cut hepatitis in babies in Asia
HONG KONG (Reuters) - Nine Asia Pacific countries will not meet a 2012 target to reduce hepatitis B infections among children, according to the World Health Organization which plans to intensify its fight against the disease.
Nine out of 10 remain chronically infected for the rest of their lives because their immune systems are undeveloped, which can lead to cirrhosis and then liver cancer later on.
But a WHO expert said the goal of reducing infection rates among children to below 2 percent by 2012 will not be met in Cambodia, Kiribati, Laos, Papua New Guinea, the Philippines, Samoa, Solomon Islands, Vanuatu and Vietnam.
"These nine countries don't look like they are going to make the 2 percent goal," said Karen Hennessey, technical officer for WHO's expanded program on hepatitis B immunization.
Hennessey, who spoke by telephone from Manila, said infection rates among children in these countries were around 8 percent before vaccination programs were introduced at different times starting from the 1980s.
While infection rates have fallen to about 3 to 4 percent, these programs have stalled because of the lack of technical expertise and training, or money, she said.
China is one of the exceptions with infection rates among its children down dramatically in the last five years to below 2 percent due to a successful vaccination program, Hennessey said. However, it still has a huge 10 percent pool of infected adults.
Hepatitis B, which is 50 to 100 times more infectious than HIV, is mostly passed from mother to child when the mother's infected blood comes into contact with open wounds on her newborn during delivery. But a vaccine given within the first 24 hours of birth can prevent infection.
To renew efforts to fight the virus, WHO wants to push a three-pronged approach, which includes getting more pregnant women to deliver in healthcare facilities so that their babies can be immunized soon after delivery.
"If it's very difficult to get women into hospitals, either because (their homes are) remote or very poor, the other possibility is to make sure there is a skilled attendant at every birth ... who are trained to give vaccine within 24 hours," Hennessy said.
The WHO will also help with providing training, she said.
"It is important to get that first dose within 24 hours. But it's not clear. Is it the first hour, first three hours? Who is responsible? Who writes it down? That is enough for people to not want to do it. There has to be training," she said.
About 2 billion people worldwide have been infected by this virus and 350 million of them live with chronic infection. About 600,000 people die each year from the virus, which is also passed through sexual contact and unclean needles. Apart from hepatitis B, other common forms of hepatitis are A, C and E.

Source: DGNews
Study: Viral Hepatitis Rates Forecast a Liver Health Crisis

NEW YORK -- July 27, 2011 -- To coincide with World Hepatitis Day, The Lancet has published an article online detailing the first global estimates of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection prevalence in injecting drug users (IDUs). Around 10 million IDUs are thought to have been exposed to HCV (range 6 to 15 million), or approximately 67% of the global IDU population, while 1.3 million have HBV infection (range 0.3 to 2.7 million), conclude the authors.

“The public-health response to blood-borne virus transmission in IDUs has mainly centred on HIV,” write the authors, who include Prof. Louisa Degenhardt, Centre For Population Health, Burnet Institute, Melbourne, Australia, and Paul Nelson, National Drug and Alcohol Research Centre, University of New South Wales (UNSW), Sydney, Australia. “Maintenance and strengthening of the response to HIV in IDUs remains crucial, but the significance of viral hepatitis needs to receive greater attention than it does at present.”

The costs of HIV drugs once made their use in resource-poor countries unlikely; but global efforts have ensured that access to these drugs has substantially improved for people living with HIV in developing countries. The authors say: “There are growing efforts to bring viral hepatitis treatments into the same (lower cost) access framework as HIV antiretrovirals.” These efforts are reflected in the Viral Hepatitis resolution passed by the 63rd World Health Assembly in 2010, which requested the WHO Director General “to collaborate with other organizations in the United Nations system, partners, international organizations and other relevant stakeholders in enhancing access to affordable treatments in developing countries.”
Access to treatments for viral hepatitis must also be enhanced in high-income countries, with recent estimates suggesting that only a fraction of those who could benefit are currently receiving antiviral therapy.

About 80% of individuals exposed to HCV develop chronic infection, and 3% to 11% of people with chronic HCV infection will develop liver cirrhosis within 20 years, with associated risks of liver failure and liver cancer.

HBV is transmitted through parenteral, sexual, and mother-to-child routes.
About 5% of adults exposed to HBV develop chronic HBV infection, compared with 90% of infants; this is why most of the 350 million chronically infected people worldwide were infected in childhood. It is also why universal infant vaccination against hepatitis B is so crucial to long-term control of this virus, which is the second most important known human carcinogen, after tobacco. Cirrhosis and death from liver cancer are important consequences of HBV infection, occurring in approximately one-quarter of those chronically infected.

In this study, infection was determined via presence of hepatitis C antibody (anti-HCV) and hepatitis B core antibody (anti-HBC) or surface antigen (HBsAg).

For hepatitis C infection, the authors located eligible reports with data for prevalence of anti-HCV in IDUs for 77 countries. Prevalence estimates suggested that 60% to 80% of IDUs had anti-HCV in 25 countries, including Spain (80%), Norway (76%), Germany (75%), France (74%), USA (73%), China (67%), Canada (64%); and more than 80% of IDUs did so in a further 12 countries, including Italy (81%), Portugal (83%), Pakistan (84%), Netherlands (86%), Thailand (90%), and Mexico (97%). The United Kingdom (50%), New Zealand (52%), and Australia (55%) all had lower prevalence. China (1.6 million), USA (1.5 million), and Russia (1.3 million) are thought to contain the largest IDU populations infected with HCV.

HBV infection among IDUs was estimated from eligible reports of HBsAg for 59 countries, with prevalence estimates of 5% to 10% in 21 countries and more than 10% in ten countries, including the USA at 12%. The United Kingdom had the highest rate in Western Europe at 9%. Worldwide, the highest rates were seen in Vietnam (20%), Estonia (19%), Saudi Arabia (18%), and Taiwan (17%). The authors estimate that globally 6.4 million IDUs have ever been infected with HBV (anti-HBC positive), with 1.2 million having active HBV infection (HBsAg positive).
The authors say: “Efforts to prevent, treat, and reduce harms related to liver disease in IDUs are essential -- especially in situations in which HIV has successfully been prevented or managed -- because the large numbers of IDUs infected with HCV and significant morbidity resulting from this infection mean that the health and economic costs of HCV transmitted by injected drug use might be as high as (or higher than) those of HIV. Nonetheless, HCV treatment is underused. … Part of the reason for this neglect is the high cost, which will remain a substantial barrier to increasing of treatment coverage in low-resource settings until costs are reduced.”

The authors stress that not only have prevention, treatment, and care been neglected in this field, but also, attention to high quality surveillance of viral hepatitis. They conclude: “We made the best efforts to identify the most representative studies of IDUs across countries, but there was considerable variation in the quality and recentness of the studies that these estimates are based upon. This reflects a similar lack of emphasis upon surveillance of viral hepatitis among people who inject drugs, as there has been upon prevention and treatment of these viruses. Until there are a more coordinated and sustained efforts to understand and respond to hepatitis, considerable uncertainty will remain in our estimates of the scale of the problem, and the best way to respond.”

The study was funded by the US National Institutes of Health, the World Health Organization’s HIV Department, and the National Drug and Alcohol Research Centre, UNSW.
SOURCE: The Lancet

Source: Int J Cancer
Liver cancer and non-hodgkin lymphoma in hepatitis C virus-infected patients: results from the danvir cohort study
Omland LH, Jepsen P, Krarup H, Christensen PB, Weis N, Nielsen L, Obel N, Sørensen HT, Stuver SO, on behalf of the DANVIR cohort study; International Journal of Cancer (Jul 2011)
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Hepatitis C virus (HCV)-infection can cause hepatocellular carcinoma (HCC) and most likely non-Hodgkin lymphoma (NHL). No studies have compared the risk of these cancers between patients with chronic and cleared HCV-infection. The aim of this study was to estimate the 10-year risk of HCC and NHL in HCV-infected patients and to compare the risk of these cancers between HCV-infected patients and the general population in Denmark and between patients with chronic and cleared HCV-infection.

Nationwide cohorts were used: 11,975 HCV-infected patients in the DANVIR cohort and 71,850 individuals from an age- and gender-matched general population cohort. Within DANVIR, 4,158 patients with chronic HCV-infection and 2,427 patients with cleared HCV-infection were studied.
The 10-year risks of HCC and NHL in HCV-infected patients were 1.0% (95% confidence interval (CI): 0.8 - 1.3%) and 0.1% (95% CI: 0.1 - 0.2%), respectively. Compared to the general population, HCV-infected patients had a 62.91 -fold increased risk of HCC (95% CI: 28.99 - 136.52), a 29.97 -fold increased risk of NHL during the first year of follow-up (95% CI: 6.08 - 147.84), and a 1.26-fold increased risk of NHL after the first year (95% CI: 0.36 - 4.41).

Chronic HCV-infection was associated with a 4.71-fold increased risk of HCC (95% CI: 1.67 - 13.32) compared to cleared HCV-infection; 5 and 0 events of NHL occurred in patients with chronic and cleared HCV-infection, respectively. HCC-risk is increased substantially in HCV-infected patients compared to the general population. Chronic as opposed to cleared HCV-infection increases the risk of HCC and perhaps NHL.

Source: J Hepatol
Comparison of 9 blood tests and transient elastography for liver fibrosis in chronic hepatitis C: the ANRS HCEP-23 study
Zarski JP, Sturm N, Guechot J, Paris A, Zafrani ES, Asselah T, Boisson RC, Bosson JL, Guyader D, Renversez JC, Bronowicki JP, Gelineau MC, Tran A, Trocme C, de Ledinghen V, Lasnier E, Poujol-Robert A, Ziegler F, Bourliere M, Voitot H, Larrey D, Rosenthal-Allieri MA, Hubert IF, Bailly F, Vaubourdolle M; Journal of Hepatology (Jul 2011)

Blood tests and transient elastography (Fibroscan™) have been developed as alternatives to liver biopsy. This ANRS HCEP-23 study compared the diagnostic accuracy of 9 blood tests and transient elastography (Fibroscan™) to assess liver fibrosis, versus liver biopsy, in untreated patients with chronic hepatitis C (CHC).
This was a multicenter prospective independent study in 19 French University hospitals of consecutive adult patients having simultaneous liver biopsy, biochemical blood tests (performed in a centralized laboratory) and Fibroscan™. Two experienced pathologists independently reviewed the liver biopsies (mean length = 25±8.4mm).
Performance was assessed using ROC curves corrected by Obuchowski's method.
Fibroscan™ was not interpretable in 113 (22%) patients. In the 382 patients having both blood tests and interpretable Fibroscan™, Fibroscan™ performed similarly to the best blood tests for the diagnosis of significant fibrosis and cirrhosis. Obuchowski's measure showed Fibrometer(®) (0.86), Fibrotest(®) (0.84), Hepascore(®) (0.84) and interpretable Fibroscan™ (0.84) to be the most accurate tests. The combination of Fibrotest(®), Fibrometer(®), or Hepascore(®) with Fibroscan™ or Apri increases the percentage of well classified patients from 70-73% to 80-83% for significant fibrosis, but for cirrhosis a combination offers no improvement. For the 436 patients having all the blood tests, AUROC's ranged from 0.82 (Fibrometer(®)) to 0.75 (Hyaluronate) for significant fibrosis, and from 0.89 (Fibrometer(®)) and Hepascore(®) to 0.83 (FIB-4) for cirrhosis.
Contrarily to blood tests, performance of Fibroscan™ was reduced due uninterpretable results. Fibrotest(®), interpretable Fibroscan™, Fibrometer(®), and Hepascore(®) perform best and similarly for diagnosis of significant fibrosis and cirrhosis.

Healthy You

Blueberries, A Cup A Day May Keep Cancer Away
Blueberries are among the nutrient-rich foods being studied by UAB Comprehensive Cancer Center investigators exploring the link between disease and nutrition.
Dieticians there say as little as a cup a day can help prevent cell damage linked to cancer.

Why are blueberries considered healthful?
They're full of antioxidants, flavonoids and other vitamins that help prevent cell damage. "Antioxidants protect cells by stabilizing free radicals and can prevent some of the damage they cause," says Laura Newton M.A.Ed., R.D., an associate professor in the Department of Nutrition Sciences at the University of Alabama at Birmingham.Free radicals, atoms that contain an odd number of electrons and are highly reactive, can cause cellular damage, one of the factors in the development of cancer; many believe a diet filled with fruits and vegetables may help reduce the risk. "Studies suggest that antioxidants may help prevent the free-radical damage associated with cancer," says Newton, a licensed dietician who often works with cancer patients.

Blueberries also are rich in vitamin C, which helps the immune system and can help the body to absorb iron. "Vitamin C also helps to keep blood vessels firm, offering protection from bruising," Newton says.Blueberry juice and other products may be nutritious but often contain less fiber than the whole fruit, and added sugar or corn syrup may decrease their nutritional value. Consuming fresh, raw blueberries provides the most benefits; the average serving size of raw blueberries is one cup, which contains about 80 calories.

Blueberry season is in full swing, and now is the perfect time to stock up on this delicious, nutritious fruit from farms located here in Alabama. "They can be frozen, so store some in the freezer to enjoy year round," says Newton. "To freeze blueberries, put them in a single layer on a cookie sheet. Freeze them and then transfer to an airtight bag or container and store. Rinse them with water prior to using."
Source: University of Alabama at Birmingham

Dr. Ashton answers viewer health questions
CBS News medical correspondent Dr. Jennifer Ashton answers viewer health questions on issues like high blood pressure, hydrating in the heat, lyme disease and food allergies.
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Diet Detective: Fiber One 90 Calorie Chocolate Peanut Butter Bar Deconstructed
By Charles Stuart Platkin
Published: Jul 27, 2011 at 10:10 AM PDT
This is the first in an ongoing series of columns that will be looking at the various products we consume on a regular basis and dissecting the ingredients. We'll start with Fiber One bars, which, I must say, are very tasty, but not exactly comparable to eating an apple.


Incivek storms hep C market with $75M
July 29, 2011 — 10:52am ET By

There's no doubt that the hepatitis C market was waiting for Incivek. In its first five weeks on the market, the Vertex Pharmaceuticals drug reaped nearly $75 million in sales. That's more than twice the $31 million analysts had been expecting. The question now is whether that pace can be sustained.

Incivek is one of two new game-changing drugs to hit the hepatitis C market. Both the Vertex drug and Merck's Victrelis are designed to be added to standard hepatitis C therapy, and they've proven to increase the cure rate and shorten the duration of the sometimes-painful treatment. But Incivek had been widely predicted to garner a bigger share of the market, thanks to data showing a 79% cure rate and to the possibility of even shorter treatment. Plus, Incivek is considered easier to use.

As Reuters notes, more than 3,000 patients had started on Incivek by mid-July, with a mix of people who had failed on older drugs and those who were new to hep C therapy. There's no way to tell how many of those scrips went to patients who had delayed treatment in anticipation of the new drug, but market-watchers had speculated that thousands were waiting on the sidelines for Incivek to make its debut.

"This is a really, really impressive revenue ramp," Sanford Bernstein analyst Geoffrey Porges told Reuters. "You run this trend forward and you get to $200 million in revenue in the third quarter." The strong sales helped offset the high cost of Incivek's launch, plus higher R&D expenses at the company, giving it a smaller-than-expected loss.
So far, Incivek scripts are outpacing Victrelis three to one. Merck didn't break out the drug's sales in its Q2 earnings announcement, so we have no way to compare dollar figures, at least not yet; executives will probably discuss it during today's conference call.
- read the Reuters news- get more from the Boston Globe

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