Thursday, August 25, 2011

Hepatitis News Ticker;Launch of HCV GenoSure and Insulin Resistance Affects SVR

Just In; HCV Resistance Testing - Launch of HCV GenoSure

Insulin Resistance Affects Sustained Response to Hepatitis C Treatment
Greater insulin resistance was association with poorer response to pegylated interferon plus ribavirin regardless of hepatitis C virus genotype, according to a meta-analysis described in the August 2011 issue of Alimentary Pharmacology and Therapeutics .

View Full Data ; Insulin resistance and sustained virological response in hepatitis C

"Alarming" Rate of Hepatitis C Re-infection among HIV+ Gay Men
One-third of HIV positive men who have sex with men who were treated for acute hepatitis C virus infection in Amsterdam became re-infected within 2 years, indicating a need for improved prevention efforts, according to a recent report.

Clinical Infectious Diseases
Why HIV infection rates are on the rise
By cross-referencing several databases and performing a molecular analysis of the virus, Prof. Zehava Grossman Tel Aviv University found that a large number of newly-diagnosed men with male sexual partners contracted HIV from infected partners already under treatment for the virus.

Evaluation of Three Rapid Screening Assays for Detection of Antibodies to Hepatitis C Virus - false positives for HIV+ persons
Persons identified as anti-HCV positive can be counseled to alter behaviors that may lead to transmission of virus and exposure to other infections, decrease alcohol intake, and avoid certain medications that could damage the liver

Illicit Drug Use on Spontaneous Hepatitis C Clearance
To the best of our knowledge, the current study is the first that has been conducted in such a large scale on HCV spontaneous clearance in Iran. In this study we were able to demonstrate that 38.5% of HCV infected subject might clear HCV infection spontaneously which is in agreement with many previous studies [8][10], [12][14], [37]. Also we found that both IDU and non-IDU are the main correlates of CHVC that significantly decrease the chance of SC among those patients who have acquired HCV infection. Over 50% of the total estimated 170 million HCV cases in the world occur among illicit drug users and over 75% of incident infections occur in this population [3]. It is known that, illicit drug use is the major correlate of HCV persistence [21], [23], [37]. Several hypotheses have been suggested to explain the underlying mechanisms of this finding which mainly include: inefficient immunological response [38] which is due to HIV in co-infected subjects [12], [14], [39] other co-infection or co-morbidities [40], [41], and finally repeated -infection [27]. As for IDU, frequent monitoring of HCV infection status among those who clear a primary infection demonstrated that re-infection of HCV following control of a primary infection is common.....

From PLoS ONE;

Study of HIV increase in Pakistan could benefit other research
Rates of HIV have increased in Pakistan's general population, as the virus has spread beyond at-risk groups to women and their children, according to an international team of researchers, including a University of Florida scientist.

Monoclonal Antibodies Recognizing the Non-Tandem Repeat Regions of the Human Mucin MUC4 in Pancreatic Cancer
Maneesh Jain, Ganesh Venkatraman, Nicolas Moniaux, Sukhwinder Kaur, Sushil Kumar, Subhankar Chakraborty, Grish C. Varshney, Surinder K. Batra Research Article, published 23 Aug 2011doi:10.1371/journal.pone.0023344Views: 126Citations: NoneBookmarks: None

Hepatitis C Virus Infection Suppresses the Interferon Response in the Liver of the Human Hepatocyte Chimeric Mouse
Masataka Tsuge, Yoshifumi Fujimoto, Nobuhiko Hiraga, Yizhou Zhang, Mayu Ohnishi, Tomohiko Kohno, Hiromi Abe, Daiki Miki, Michio Imamura, Shoichi Takahashi, Hidenori Ochi, C. Nelson Hayes, Fuyuki Miya, Tatsuhiko Tsunoda, Kazuaki Chayama Research Article, published 23 Aug 2011doi:10.1371/journal.pone.0023856 Article metrics data not available - please check back later.

Circulating MicroRNAs in Patients with Chronic Hepatitis C and Non-Alcoholic Fatty Liver Disease
Silvia Cermelli, Anna Ruggieri, Jorge A. Marrero, George N. Ioannou, Laura Beretta Research Article, published 23 Aug 2011doi:10.1371/journal.pone.0023937


Hep C victim battles treatment bill About 4,500 people in N.S. have disease
By JOHN McPHEE Health Reporter
Wed, Aug 24 - 7:46 AM
Like many people who battle a chronic disease, the woman on the phone says it’s sometimes difficult to pay for her medications.
She suffers from hepatitis C, which carries costs and other burdens beyond the price of treating the disease itself.

The Halifax woman, who did not want to be identified, was diagnosed in 1998. She was infected with hepatitis C many years before that, but like many people with the virus, she had no idea.
"It was stunning," she said in a recent interview. "You don’t have a whole lot of knowledge about it, except I saw some horrible things about it in the paper and that’s all I knew about it."
About 4,500 Nova Scotians have hepatitis C, which can cause cirrhosis of the liver and liver cancer. Its symptoms include fatigue, nausea and yellowing of the skin and eyes.
The woman has undergone three treatments, a combination of injections and pills, over a 48-week period, at a cost of about $2,000 per month.
"I had to go off work and go on disability, which immediately cuts your wages," she said. "At that point, I had my own medical plan. I paid just the deductible, which was very minimal, about $5 a prescription."

She lost that coverage after her former employer changed insurers. Over the years, she has paid for her treatment in various ways, such as through the Pharmacare provincial plan and "compassionate assistance" from the drug manufacturer.
At the moment, she’s on her former partner’s insurance plan, which has a 20 per cent deductible amounting to an out-of-pocket cost of $200 per month. It’s possible she’ll lose that coverage, which would mean going back to Pharmacare.
"Plus, there are all my other prescriptions that I have to get," she said. "My thyroid is out of whack and that is attributed to hep C, and I take blood pressure medication. That’s about $400 if you added it all up." ..........

Teva propofol plant closing followed jury award for hep C outbreak
Generics-maker Teva ($TEVA) ceased propofol production three weeks after a jury awarded $500 million to school principal Henry Chanin in May 2010. Chanin contracted hepatitis C during a procedure in which he was administered the anesthetic, acknowledged VP Craig Lea yesterday in a Las Vegas court. He was under examination by attorney Robert Eglet. According to a release issued by law concern Mainor Eglet, "public outcry" prompted the shutdown.
Teva faces almost 300 lawsuits from the hepatitis C outbreak, which appears to be traced to the Endoscopy Center. The defendants contend that misuse of the single-use propofol vials by medical providers caused the outbreak. A state grand jury indicted Dipak Desai, who ran the Endoscopy Center during the outbreak; he's been found incompetent to stand trial.
Read more

Scientists find weakness in deadly Ebola virus
CHICAGO (Reuters) - A protein that helps transport cholesterol inside cells may be a key to developing drugs to treat Ebola, a rare but lethal virus for which there are no known treatments, U.S. researchers said.
Science, 24 Aug 2011

Hepatitis B

Challenges to the effective delivery of health care to people with chronic hepatitis B in Australia
Jack Wallace A C, Stephen McNally A, Jacqui Richmond B, Behzad Hajarizadeh A and Marian Pitts A A Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin Street, Melbourne, Vic. 3000, Australia. B St. Vincent’s Hospital, 41 Victoria Parade, Fitzroy, Vic. 3065, Australia. C
Corresponding author. Email:

The complexity of the hepatitis B natural history and its prevalence in specific populations in Australia challenges the capacity of the health system to deliver health care effectively to affected people. This study explores the challenges in delivering health care to people with chronic hepatitis B (CHB) in Australia.

Methods: We conducted a grounded theory based qualitative study in which data were gathered from 70 in-depth interviews with government program officers, clinicians and health and community workers across Australia, and four focus group discussions with 40 health and community workers from the communities most at risk of CHB.

A systematic approach to screening populations at risk, including people born in countries with intermediate or high prevalence of CHB; consensus on clinical guidelines; development of a shared care framework for CHB involving general practitioners; and effective communication between patients and health professionals were identified as essential. Workforce development, particularly for primary health care professionals, and developing the knowledge and capacity of health professionals to communicate effectively with people with HBV were described as other major factors in reducing the barriers to CHB treatment in Australia.

To improve the clinical management of people with CHB in Australia, the health system needs to encourage the screening of people at risk, improve access to clinical services, and the knowledge and communication skills of primary health care and community health service providers. This study supported developing a shared care model and related infrastructures including training programs, referral pathways and clinical guidelines.

Screening immigrants for hepatitis B is cost effective
A selective hepatitis B screening program targeted at all immigrants in Canada is likely to be moderately cost-effective, reports the latest issue of Liver International.

The prevalence of chronic hepatitis B infection among the immigrants of North America ranges from 2 to 15%, among whom 40% develop advanced liver disease.

Screening for hepatitis B surface antigen is not recommended for immigrants.
Dr William Wong and colleagues from Canada estimated the health and economic effects of screening strategies for chronic hepatitis B among immigrants.

The research team used the Markov model to examine the cost-effectiveness of three screening strategies, including ‘No screening’, ‘Screen and Treat’, and ‘Screen, Treat and Vaccinate’ for 20–65 years old individuals who were born abroad but are currently living in Canada.
Model data were obtained from the published literature.

Screening all immigrants will prevent 59 Hep B virus-related deaths per 10,000 persons
Liver International

The team measured predicted hepatitis B virus (HBV)-related deaths, costs, quality-adjusted life-years, and incremental cost-effectiveness ratio.

The researchers showed that screening all immigrants will prevent 59 hepatitis B virus-related deaths per 10,000 persons screened over the lifetime of the cohort.
The team observed that screening was associated with an increase in quality-adjusted life expectancy and cost per person with an incremental cost-effectiveness ratio of $69,209/quality-adjusted life-years gained compared with ‘No screening’.

The ‘Screen, Treat and Vaccinate’ costs an additional $81, generates an additional 0.000022 quality-adjusted life-years per person, with an incremental cost-effectiveness ratio of $3,648,123/quality-adjusted life years compared with the ‘Screen and Treat’.
The team performed sensitivity analyses, which suggested that the ‘Screen and Treat’ is likely to be moderately cost-effective.
Dr Wong's team concludes, "We show that a selective hepatitis B screening program targeted at all immigrants in Canada is likely to be moderately cost-effective."
"Identification of silent chronic hepatitis B infection with the offer of treatment when appropriate can extend the lives of immigrants at reasonable cost."
Liver Int 2011: 31(8): 1179–119025 August 2011

Hepatitis A

Roma Ghetto in Southern Bulgarian City Struggling with Hepatitis A Outbreak
The Regional Health Inspection in Bulgaria's southern city of Plovdiv has registered a total of 144 cases of hepatitis in August.
According to the report, 34 of the 144 cases were located in the city's Roma ghetto, Stolipinovo.
The majority of patients were of Roma ethnic origin and children, the watchdog announced.
Most of the cases were of hepatitis A infection, but 10 of the probes raised suspicions of hepatitis B and C.

Liver Transplant

Liver transplant programs for overdose with suicidal intent
A study in September's issue of Liver Transplantation considers liver transplant programs in patients who overdosed with suicidal intent.

Liver transplantation programs encounter patients with fulminant hepatic failure resulting from suicide attempts involving acetaminophen or multidrug ingestion.
Dr Sourabh Aggarwal and colleagues from New York, USA report on a case study and evaluate programs that assist in decision making about transplantation.

Transplant programs have no guidelines to help decisions about transplant appropriateness
Liver Transplantation

The team noted that members of transplant teams often have different opinions about whether these patients should be offered transplantation.

The researchers observed that disagreements can delay the transfer of these patients to a transplant facility and negatively affect their management.
Currently, transplant programs have no guidelines to help them with their decisions about the appropriateness of liver transplantation for these patients.

Dr Aggarwal and colleagues comment, "We highlighted ethical principles that should help programs to make informed decisions about transplantation for these patients."
Liver Transplantation 2011: 17(9): 1111–1116
25 August 2011

Safety of prophylaxis withdrawal in patients liver-transplanted for HBV-related cirrhosis
The most recent issue of the Journal of Hepatology reports on the safety of complete and sustained prophylaxis withdrawal in patients liver-transplanted for Hepatitis B virus-related cirrhosis at low risk of Hepatitis B virus recurrence.

Hepatitis B virus reactivation after liver transplantation may be related to persistence of covalently closed circular (ccc) DNA.
Dr Ilaria Lenci and colleagues investigated the safety of HBV prophylaxis withdrawal in selected Hepatitis B virus transplanted patients.

The team assessed 30 patients transplanted 64–195 months earlier, Hepatitis B surface antigen-positive, Hepatitis B e antigen, and Hepatitis B virus-DNA negative at transplant, with undetectable intrahepatic total and ccc-DNA were enrolled.
All patients underwent anti-hepatitis B immunoglobulin withdrawal and continued lamivudine with monthly Hepatitis B surface antigen and HBV-DNA monitoring and sequential liver biopsies.

Those with confirmed intrahepatic total and ccc-DNA undetectability 24weeks after stopping anti-hepatitis B immunoglobulins, also underwent lamivudine withdrawal and were followed-up without prophylaxis.

The research team found that 25 patients did not exhibit signs of HBV recurrence after prophylaxis withdrawal.

5 patients became Hepatitis B surface antigen-positive
Journal of Hepatology

The team noted that 5 patients became Hepatitis B surface antigen-positive, 1 early after anti-hepatitis B immunoglobulin withdrawal, the other 4 after anti-hepatitis B immunoglobulins, and lamivudine withdrawal.

None of these patients experienced clinically relevant events.
In the first patient, anti-hepatitis B immunoglobulins were reinstituted with prompt Hepatitis B surface antigen negativization.

Of the other 4, 1 remained Hepatitis B surface antigen-positive with detectable Hepatitis B virus-DNA and mild ALT elevation and was successfully treated with tenofovir.
The research team observed that in the remaining 3, Hepatitis B surface antigen positivity was transient and followed by anti-antibodies against hepatitis B surface antigen, seroconversion, thus no antiviral treatment was needed.

Dr Lenci's team commented, "Patients with undetectable Hepatitis B virus viremia at transplant and no evidence of intrahepatic total and cccDNA may safely undergo cautious weaning of prophylaxis, showing low rate of Hepatitis B virus recurrence after a 2 year follow-up."
"Undetectability of intrahepatic ccc-DNA may help to identify patients at low-risk of recurrence, yet studies with longer follow-up are needed."
J Hepatol 2011: 55(3): 507-509
24 August 2011


Google Forfeits $500M Over Online Pharmacy Ads
Issuing a mea culpa, Google has agreed to forfeit $500 million for allowing online Canadian pharmacies to place ads through its AdWords program that targeted US consumers and, ultimately, caused medicines to be imported illegally, according to the US Department of Justice, which calls this one of the biggest forfeitures ever.

Ahead of the Bell: Achillion rates 'outperform'
Drug developer Achillion Pharmaceuticals Inc. is well-positioned to compete in the market for Hepatitis C virus treatments due to its portfolio of drugs under development, according to an analyst who started coverage of the company with an "outperform" rating.
Achillion, based in New Haven, Conn., does not have any products on the market. Its most advanced product is in mid-stage clinical testing. Most of its revenue comes from grants or collaborations.

Thomas J. Russo of Baird said in a Thursday morning research note the future of Hepatitis C treatments will involve combinations of different direct-acting antiviral classes of drugs. He added that Achillion "is well positioned with a portfolio of wholly owned protease inhibitors."
The analyst expects the market for treatments to grow from $2 billion to $3 billion toward $10 billion.

Hepatitis C is the primary cause of liver transplants in the U.S. and is expected to become a much larger public health problem as aging baby boomers succumb to the disease.
Hepatitis C is an infectious disease that is spread through the blood, including by sharing needles or having sex with an infected person. The disease could also be picked up from blood transfusions before 1992, when testing of the blood supply for the virus began.
Most people with hepatitis C don't even know they have the virus until after liver damage has occurred, which can cause abdominal pain, fatigue, itching and dark urine.
Copyright 2011 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Stem Cells

Limb regeneration mysteries revealed in Stanford study
[The researchers...] have shown that damage to a digit tip is repaired by specialized adult stem cells that spend their lives quietly nestled in each tissue type. Like master craftsmen, these cells spring into action at the first sign of damage, working independently yet side-by-side to regenerate bone, skin, tendon, vessels and nerves. But just as you wouldn’t ask a mason to wire your house, or an electrician to put on a new roof, the division of labor among these stem cells is strict. Each is responsible solely for its own tissue type.
In contrast, the blastema theory invokes a new pluripotent cell type formed out of urgency from previously specialized cells. This jack-of-all-trades cell discards its former profession and instead jumps in to indiscriminately regenerate all the tissue types of the limb.


Cancer patients like Jobs face risks from treatment
By Anna Yukhananov
WASHINGTON Thu Aug 25, 2011 2:03pm BST
WASHINGTON (Reuters) - Patients with the rare form of cancer suffered by Apple Inc's Steve Jobs face a tougher battle if the disease recurs, because of the methods used in fighting it.
Jobs said on Wednesday that he could no longer be chief executive of the company he co-founded. He had gone on medical leave in January for an undisclosed condition after years of fighting a rare type of pancreatic cancer and other health issues.

He gave no new details on his health in his latest announcement.
The type of pancreatic cancer is caused by an islet cell neuroendocrine tumor.
Jobs was reported to have undergone a liver transplant in 2009 to fight off the spread of the neuroendocrine tumor. The procedure is experimental and is fraught with complications.
Jobs has never publicly stated the reason for his liver transplant.
Dr. Simon Lo, director of pancreatic and biliary diseases at Cedars-Sinai Medical Center in Los Angeles said the most likely serious complication after Jobs' liver transplant would have been further spread of the cancer, which could have forced Jobs to leave his position permanently. Lo has not treated Jobs.

As many as 80 percent of patients who get liver transplants to treat this type of cancer live for at least five years, according to the University of California San Francisco.
Lo said a recent study showed about three-quarters of patients who got a liver transplant because of cancer saw their cancer return within two to five years. The cancer can return to the liver or spread to other organs in the body.

The immunosuppressant drugs necessary for a liver transplant also make it harder for the body to fight the return of the disease.
Jobs may be "confronting both the liver transplant related specific problems, as well as the cancer itself," Lo said. "Whenever you put patients on immunosuppressant medications, there's always a risk that it could take away natural resistance, so the cancer could grow faster."
Although this cancer is broadly lumped in with pancreatic cancer, neuroendocrine tumors have a different nature from most pancreatic tumors, which are highly lethal and which kill 95 percent of patients within five years.

Neuroendocrine tumors are more easily treated and less aggressive. According to the National Cancer Institute, there are only 200 to 1,000 new cases a year.
Jobs had a neuroendocrine tumor removed in 2004 and said afterward all the cancer was gone, and that he did not require chemotherapy or radiation treatment.
But he remained noticeably thin, even gaunt, and took time off in 2009 to deal with what he initially termed a hormone imbalance, again giving few details.
Islet-cell tumors can cause over-secretion of hormones, including insulin, into the bloodstream, wreaking havoc on digestion and leading to drastic weight loss. They are usually easily removed surgically, but recur in roughly half of patients, doctors say, possibly spreading to other organs.
(Editing by Michele Gershberg and Carol Bishopric)

Thinking of you today Mr. Jobs, my prayers go out to you and your family.

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