Wednesday, September 28, 2011

Wednesday Hepatitis C News Ticker

HCV Daily News

LAS VEGAS -- Late last week, state medical experts determined Dr. Depak Desai, the man at the center of the 2007 hepatitis C outbreak, was competent to stand trial.
Desai spent the last six months being evaluated by psychiatrists, psychologists and physicians at a state mental hospital, and those experts believe Desai is faking it....

By: David LaHoda September 28th, 2011
The physician at a Las Vegas clinic associated a hepatitis outbreak is competent to stand trial. District Attorney David Roger confirmed that Nevada state medical experts have found Dr. Dipak Desai is competent to stand trial on criminal patient neglect charges for the hepatitis C outbreak at his Endoscopy Center of Southern Nevada in 2008, according to the Las Vegas Review-Journal, September 22. Last march, court-appointed medical experts from Las Vegas had found Desai incompetent to stand trial because of the effects of two strokes, reports the Journal. The charges in the case concern seven of Desai’s patients who allegedly were infected with the hepatitis C virus at Desai’s endoscopy clinics.

MVA-B Spanish HIV vaccine shows 90 percent immune response in humans
Phase I clinical trials developed by Spanish Superior Scientific Research Council (CSIC) together with Gregorio Marañón Hospital in Madrid and Clínic Hospital in Barcelona, reveals MVA-B preventive vaccine's immune efficiency against Human's immunodeficiency virus (HIV). 90% of the volunteers who went through the tests developed an immunological response against the virus and 85% has kept this response for at least one year. Safety and efficiency of this treatment have been described in articles for Vaccine and Journal of Virology science magazines.
The success of this vaccine, CSIC's patent, is based on the capability of human's immune system to learn how to react over time against virus particles and infected cells. "MVA-B vaccine has proven to be as powerful as any other vaccine currently being studied, or even more", says Mariano Esteban, head researcher from CSIC's National Biotech Centre.
In 2008, MVA-B already showed very high efficiency in mice as well as macaque monkeys against Simian's immunodeficiency virus (SIV). Due to it's high immunological response in humans, Phase I clinic trials will be conducted with HIV infected volunteers, to test its efficiency as a therapeutic vaccine.

Weapon's origins
Back in 1999, Esteban's research team began to work in the development and preclinical studies of MVA-B, which name comes from its composition, based in Modified Ankara Vaccinia virus. MVA-B is an attenuated virus, which has already been used in the past to eradicate smallpox, and also as a model in the research of many other vaccines. The "B" stands for the HIV subtype it is meant to work against, the most common in Europe.

Development of MVA-B is based in the insertion of four HIV genes (Gag, Pol, Nef & Env) in Vaccina's genetic sequence. A healthy immunitary system is able to react against MVA.
On the other hand, the inserted HIV genes in its DNA are not able to self-replicate, which guarantees the safety of the clinical trial.
30 healthy volunteers participated in this clinical trial. 24 of them were treated with MVA-B, while the other 6 were treated with a placebo, following a double-blind testing method. 3 doses of the vaccine were given via intramuscular route in weeks 0, 4 and 16. The effects were studied in peripheral blood until the trial ended on week 48.

Combat battalion
Inoculating the vaccine in a healthy volunteer is intended to train it's immune system to detect and learn how to combat those virus components. According to Esteban " it is like showing a picture of the HIV so that it is able to recognise it if it sees it again in the future".
Lymphocytes T and B are the main cells in this experiment, the soldiers in charge of detecting the foreign substances in the body and sending the right coordinates to destroy them.
"Our body is full of lymphocytes, each of them programmed to fight against a different pathogen" says Esteban. For that reason "Training is needed when it involves a pathogen, like the HIV one, which cannot be naturally defeated".

Lymphocytes B are responsible for the humoral immune response, producing antibodies which attack the HIV particles before they penetrate and infect the cell, anchoring themselves to the external structure and blocking it. 48th week blood tests reveal 72,7% of the treated volunteers hold specific antibodies against HIV.

On the other side, lymphocytes T control cell's immune response, in charge of detecting and destroying HIV infected cells. In order to verify their defence response to the vaccine, production of interferon gamma immunitary protein was measured.
Tests performed on the 48th week, 32 weeks after the last inoculation of the vaccine, show the production of lymphocytes T CD4+ and CD8+ of the vaccinated group is 38,5% and 69,2%, respectively, while it stays at 0% in the control group.

Action in several fronts
Besides interferon gamma, other immune proteins (cytokines and chemokines) are produced by the body when the presence of a pathogen is detected. Each of these proteins tends to attack a different enemy front. When T lymphocytes' defence action is able to generate several of these proteins it is called a polyfunctional action. CSIC's researcher adds "The importance of polyfunctionality has to do with the capability of pathogens to develop resistance to the immune systems attacks. The higher the polyfunctionality, the lower the resistance".
The defence spectrum of T lymphocytes in vaccinated subjects was measured based on the production of 3 other immunitary proteins. Tests indicate the vaccine generates up to 15 types of lymphocyte T CD4+ and CD8+ populations. 25% of CD4+ type and 45% of CD8+ type are able to produce two or more different proteins, proving their polyfunctionality.

War veterans
For a vaccine to become really effective, besides its immune system's defence capability, generating a long lasting response against future attacks is the key. For this purpose, the body needs to be able to keep a basic level of memory T lymphocytes. These lymphocytes, generated after a first pathogen attack, are veteran soldiers, which can circulate the body for years, prepared to respond to a new enemy's incursion.
48th week blood tests ran on vaccinated subjects show over 50% of CD4+ and CD8+ lymphocytes were memory T lymphocytes in the 85% of the patients who kept an immune response at this point of the trials.

In Esteban's opinión "MVA-B immune profile meets, initially, the requirements for a promising HIV vaccine". MVA-B is not capable of removing the virus from the body as once a cell is infected, virus' genetic data is integrated and replicated with the cell. However, the immune response induced by the vaccine could keep the virus under control, "if the virus enters the body and tries to develop in a cell, the immune system is ready to inactivate the virus and destroy the infected cell".

According to CSIC's researcher: "If this genetic cocktail passes Phase II and Phase III future clinic trials, and makes it into production, in the future HIV could be compared to herpes virus nowadays". Virus would not cause a disease anymore and would become a minor chronic infection, which would only show its effects in a low defence scenario, with a much lower contagious profile.

From Aids Beacon
Alcohol Abuse And Sexual Orientation Affect The Use Of Substance Abuse Treatment In People With HIV
Results of a recent study indicate that individuals with HIV who have alcohol dependence problems or who identify themselves as bisexual, gay, or lesbian are less likely to seek treatment for substance abuse problems.
However, individuals co-infected with hepatitis C and individuals who reported past physical or sexual abuse were more likely to seek substance abuse treatment....

From Natap
ICAAC: Responder-relapser (RR) patients might obtain benefit in liver fibrosis, after anti-HCV chemotherapy, in comparison to non-responders (NR) or non-treated (control) HIV- HCV coinfected patients
This study was aimed to investigate the possible benefit of unsuccessful anti-HCV therapy on LF estimated by non-invasive procedures, TE and BLFI (APRI, Fib-4 and Forns indexes) and by changes in liver stiffness staging (LSS) in 3 years of follow-up.

ICAAC: Longitudinal assessment of liver fibrosis (LF) by non-invasive methods in HIV- HCV coinfected patients, after HCV chemotherapy
Anti-HCV treatment may modify liver fibrosis (LF) progression in HCV/HIV-coinfected patients, which can be measured noninvasively by elastometry (TE) and biochemical indices (BLFI).

IL-17 in liver injury: an inflammatory issue?
Full story: Immunology and Cell Biology
Correspondence: Ian N Crispe, Seattle Biomedical Research Institute, 307 North Westlake Avenue, Seattle, WA 98109, USA.


Living donor liver transplantation improves survival over deceased donor transplants
Patients with liver cancer and low MELD scores may not find similar benefit
New research shows liver transplantation candidates without hepatocellular carcinoma (HCC) derive a greater survival benefit from a living donor liver transplant (LDLT) than waiting for a deceased donor liver transplant (DDLT). The study now available in the October issue of Hepatology, a journal published by Wiley-Blackwell on behalf of the American Association for the Study of Liver Diseases, reports that survival benefit from LDLT remains significant across the range of model for end-stage liver disease (MELD) scores, but this benefit was not apparent for low MELD candidates with HCC.

Liver diseases such as hepatitis B and C, nonalcoholic fatty liver disease, and HCC can range in severity from mild to life-threatening liver failure. In end-stage liver disease, when patient life is at risk, transplantation is the recommended option. According to the Organ Procurement and Transplant Network (OPTN), as of September 2011 more than 16,000 Americans are on the waiting list to receive a liver. Between January and June 2011 OPTN reported 3108 liver transplants were performed in the U.S., with roughly 96% being DDLTs and 4% LDLTs.
Previous studies found receipt of LDLT to be associated with improved survival compared with waiting for DDLT, however it remains unclear whether this advantage persists in candidates with low MELD scores (less than 15). "In order to better inform liver transplant candidates of survival outcomes, our study investigated the mortality risk of undergoing transplantation using livers from living donors versus waiting to receive a deceased donor organ," explains lead author Carl Berg, M.D., with the University of Virginia Health System.

For the present study, data on liver transplant candidates and potential donors were supplied by transplant centers involved in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study. A total of 868 adult liver transplant candidates were included in the study and were followed for a mean of 4.6 years. Living donors of the study candidates were evaluated between February 2002 and August 2009—the period following MELD-based liver allocation. DDLT recipients transplanted at study centers were obtained for comparison during the same time period.

Mortality for LDLT recipients was compared to mortality of candidates remaining on the waiting list or who received DDLT, with categories of MELD score lower or greater than 15, and HCC diagnosis. Researchers reported that of the potential LDLT recipients, 453 had MELD scores lower than 15 and 415 were greater than 15. Transplantation was performed on 712 candidates (406 LDLT; 306 DDLT), 83 died without transplant, and 73 remained without transplant at the final follow-up.

"We found that survival was significantly higher for candidates without HCC who underwent LDLT, rather than waiting for DDLT," concluded Dr. Berg. Results showed that LDLT recipients had a 56% lower mortality rate, and among candidates without HCC the mortality benefit was seen in both patients groups—those with MELD scores above and below 15. However, researchers did not observe a similar survival benefit for candidates with HCC who had MELD scores lower than 15.

"Dr. Berg and colleagues have provided very valuable new insights that will help answer the important question of optimal time to transplant. However, this study group was comprised of candidates who were deemed appropriate for LDLT and was not a randomized trial," said Julie Heimbach, M.D., an Associate Professor of Surgery with the Mayo Clinic College of Medicine in Minnesota, in her editorial also published in this month's issue of Hepatology. "Future studies validating quality of life outcomes following LDLT compared to prolonged wait listing or DDLT would assist physicians in advising patients and families in timing of and donor options for liver transplantation."


Blood sugar control beyond standard target doesn't improve cognitive decline for diabetics
Intensive treatment provides no benefit over standard when it comes to memory
WINSTON-SALEM, N.C. – Sept. 27, 2011 – Intensive control of blood sugar levels beyond standard targets provides no additional protection against cognitive decline in older people with diabetes than standard treatment, according to a national study coordinated by researchers at Wake Forest Baptist Medical Center.

The first results of the Action to Control Cardiovascular Risk in Diabetes-Memory in Diabetes (ACCORD-MIND) study appear online today in The Lancet Neurology.
"We know that people with type 2 diabetes have a much higher risk of dementia and memory loss than people without diabetes," said Jeff D. Williamson, M.D., chief of the Department of Geriatrics and Gerontology and principal investigator of the study's coordinating center at Wake Forest Baptist. "What we didn't know was, if you intensively control blood sugar levels in people who have had a history of trouble controlling them, does the added cost and effort to control blood sugar result in a slowed rate of memory loss? After conducting this study, there remains no evidence that it does.

"We also learned, however, that the intensive blood sugar control does preserve brain volume," added Williamson, director of the Roena Kulynych Center for Memory and Cognition Research at Wake Forest Baptist. "What that means for the long term preservation of cognitive function of these patients, we're still trying to figure out."

The ACCORD-MIND trial is a national study sponsored by the National Heart Lung and Blood Institute – part of the National Institutes of Health – designed to examine the effects of different glucose-lowering strategies on the risk for cardiovascular disease.
Wake Forest Baptist was asked to lead the ACCORD-MIND study because of its international reputation in both gerontology and in the conduct of very large clinical trials in the elderly, Williamson explained. A growing area of research focus at the medical center lies in the relationship between chronic diseases, such as diabetes and obesity, and memory loss.
To determine whether intensive blood glucose control would improve cognitive outcomes, the research team recruited nearly 3,000 people with long-standing type 2 diabetes and a high risk for heart disease for the study. Each was assigned either to an "intensive" program to maintain their hemoglobin A1c lower than standard targets at below 6 percent, or to a "standard" program to maintain the levels between 7 and 7.9 percent. Hemoglobin A1c is a marker for control of blood glucose levels. The patients ranged in age from 55 to 80 years old.
All of the participants underwent cognitive testing and more than 600 people also received magnetic resonance imaging (MRI) scans to measure any change in brain volume during the study.

The initial study plan was to measure the participants' cognitive ability (through cognitive tests) and brain volume (through MRI) after 40 months, but an increased risk of dying in the intensive strategy group led the researchers to switch all the participants to the standard glucose-lowering strategy at a median treatment time of 39 months.
Cognitive test scores revealed no difference between the groups. People in the intensive treatment group had larger total brain volume. However, this result, when weighed against the lack of cognitive benefit, the increased risks of cardiovascular problems and increased mortality in the intensive treatment group, did not support use of the more intensive therapy, the researchers concluded.

"While these findings do not support the use of intensive therapy to reduce the possible effects of diabetes on the brains of older people, it remains important for older adults with type 2 diabetes to continue well-established regimens to keep their blood glucose levels under control," said lead author Lenore J. Launer, Ph.D., of the National Institute on Aging (NIA). "Cognitive health is of particular concern in type 2 diabetes. We will continue to investigate how managing blood sugar levels might be employed to protect people with diabetes from increased risk of cognitive decline as they age."

Wake Forest Baptist researcher Michael E. Miller, Ph.D., who served as the lead statistician for the trial, added that, while the study's findings do not support the use of intensive blood glucose control therapy beyond standard targets to preserve cognition, there are other things people with diabetes may be able to do to gain benefit.

"It is important to note that the average person in this study had type 2 diabetes for more than 8 years and had demonstrated difficulty in controlling their blood sugar," Williamson said. "Today, many people like this with diabetes spend lots of money, time and energy worrying about and trying to drive their blood sugar levels down lower than recommended goals, but we've already shown that using lots of medication to do this does not help prevent heart attacks. This result on memory gives added guidance to those people and some relief from that pressure to take more and more medication. Now, they will be able to focus their attention and money on other things to improve their overall health, such as diet, exercise and behavioral interventions that may work to preserve memory and reduce heart disease."
Co-authors on the study are: Jingzhong Ding, Ph.D., Laura C. Lovato, M.S., James Lovato, M.S., Laura Coker, Ph.D., and Joseph Maldjian, M.D., all of Wake Forest Baptist; Ron M. Lazar, Ph.D., of Columbia University College of Physicians and Surgeons; Ann M. Murray, M.D., of Hennepin County Medical Center and Chronic Disease Research Group; Karen R. Horowitz, M.D., of Case Western Reserve University School of Medicine; Santica Marcovina, Ph.D., of Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington; Hertzel C. Gerstein, M.D., of McMaster University and Hamilton Health Sciences; Mark Sullivan, M.D., of the University of Washington; Karen L. Margolis, M.D. and Patrick O'Connor, M.D., of the Health Partners Research Foundation; Edward W. Lipkin, M.D., of the University of Washington Medical Center; Joy Hirsh, M.D., of Columbia University; Jeffrey L. Sunshine, M.D., of Case Western Reserve University; Charles Truwit, M.D., of Hennepin County Medical Center and Hennepin Faculty Associates Facility; and Christos Davatzikos, Ph.D. and R. Nick Bryan, M.D., of the University of Pennsylvania Health System.
For a pre-embargo copy of the study, please contact The Lancet Neurology. ARTICLE: "Effects of intensive glucose lowering on brain structure and function in people with type 2 diabetes (MIND): a randomised open-label substudy of the ACCORD trial," by Lenore J. Launer, et al., Lancet Neurology. Published online September 27, 2011.

Media Relations Contacts: Jessica Guenzel,, (336) 716-3487; or Bonnie Davis,, (336) 716-4977.

Wake Forest Baptist Medical Center ( is a fully integrated academic medical center located in Winston-Salem, N.C. Wake Forest School of Medicine directs the education and research components, with the medical school ranked among the nation's best and recognized as a leading research center in regenerative medicine, cancer, the neurosciences, aging, addiction and public health sciences. Piedmont Triad Research Park, a division of Wake Forest Baptist, fosters biotechnology innovation in an urban park community. Wake Forest Baptist Health, the clinical enterprise, includes a flagship tertiary care hospital for adults, Brenner Children's Hospital, a network of affiliated community-based hospitals, physician practices and outpatient services. The institution's clinical programs and the medical school are consistently recognized as among the best in the country by U.S.News & World Report.

China: Where a blood test determines everything
BEIJING—For at least 10 per cent of China’s population, the future can hinge on a blood test.
While China is home to an estimated one-third of the world’s hepatitis B carriers, it’s also a place where those with the virus are routinely rejected by employers and schools, spurned by friends and romantic partners. And while discrimination isn’t going away, the nation’s hepatitis sufferers have new means, some legal and some deceitful, to battle bias.
In recent years, a plethora of websites has emerged where China’s hepatitis carriers can hire “gunmen” to take blood tests on their behalf. Hired guns can be paid to take just about any test in China these days and blood screening is no exception. For between $125 to $300 U.S., gunmen with no viral infections show up at pre-employment health exams and, essentially, give job candidates with hepatitis equal footing...


The barrage of prescription meds being peddled by websites is spurring the FDA to go after bogus operators who are apparently located in Ukraine, Panama, New York or who-knows-where. Of course, whether the warning letters issued last week to two such operators will ever be received is unclear - there is so much confusion about locations that the missives were addressed to e-mail addresses...

From Pharma Times
Fury over Australian "Coke and fries" prescription deal
Strong criticism has greeted a deal agreed by the Pharmacy Guild of Australia to promote dietary supplements with prescription drugs..

For Your Reading Pleasure

Grand Rounds
Grand Rounds is a weekly summary of the best health blog posts on the Internet. Each week a different blogger takes turns hosting Grand Rounds, and summarizing the best submissions for the week.

This Weeks Host Is ZDoggMD
In the midst of this galactic chaos, Starfleet Command has asked us to host the 8th anniversary edition of medical bloggers’ Grand Rounds. So the great medical bloggers from around the galaxy have kindly contributed their bits and bytes, included below with my own two cents thrown in. Thanks to longtime Borg plastic surgeon Dr. Ramona Bates for hosting the last Grand Rounds; the next will be hosted by those crazy Klingons over at The Healthcare Economist on October 11th, so make sure to boldly go where no…awwww, never mind.

And Now: Grand Rounds Vol. 8 No. 1

A few submissions from this weeks grand rounds below, to read more click here

Funny Medical Stuff:
And speaking of ER nurses, the AWESOME blog Madness: Tales of an Emergency Room nurse presents a case of “one in a million shot, doc. One in a million shot.” Scary stuff.

My evil counterpart in the emergency room, Dr. Rob Orman of ERCast, presents a great podcast wherein whiny docs rant about stuff that pisses them off. Gold, people.

Unfunny Medical Stuff:
Colorado Health Insurance Insider actually sent me this article in response to my request for submissions with the theme “Funny Medical Stuff.” This is riotously hilarious…if you are a Colorado health insurance insider.

iReveal: Medical Lessons discusses Steve Jobs’ medical privacy.

Check out the amusing videos here @ZDoggMD

Worth A Look

What the Doc Didn't Tell Me
What didn't the doc tell me? Plenty! Due to cirrhosis caused by hepatitis C, I had a liver transplant and my world was forever changed. Doctors explained the risks and said it would be tough, but their warnings didn't begin to adequately prepare us for what laid ahead. This blog describes my experiences and what I've learned, including the things my docs didn't tell me. I created it to be a place for learning, complaining and celebrating while traveling our difficult journeys.

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