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Hepatitis C Infection: Recent Advances in Treatment
Dr. Sanjeeva T Reddy Speaks about Hepatitis C Infection and Recent Advances in Treatment in International CME, held on December 29, 2011, at 2PM at Taj Deccan Hotel, Hyderabad
Hepatitis C Infection: Recent Advances... by teluguone
HCV Screen Based on Birth Cohort Proves Cost-Effective
By Kristina Fiore, Staff Writer, MedPage Today
Published: January 02, 2012
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.
Screening patients for hepatitis C virus (HCV) based on their age rather than their risk is cost-effective, this study suggests.
"[It] appears to be a reasonable strategy to identify asymptomatic cases of HCV," they wrote.
The CDC currently recommends screening patients who may be at risk of HCV, such as injection-drug users or those with elevated alanine aminotransferase levels.
But no more than 50% of patients who are chronically infected with the virus are aware of their status. That may be a result of difficulty implementing risk-based screening methods or the awkwardness of discussing behavioral risks, the researchers said.
Expanding screening recommendations to cover patients born between 1945 and 1965 -- those in whom prevalence of HCV is highest -- may be a complement or alternative to risk-based screening, they wrote, although its impact on healthcare costs has been unknown.
So to estimate the cost-effectiveness of birth cohort screening, Rein and colleagues used data from the National Health and Nutrition Examination Survey (NHANES) 2001-2006 on patients who had at least one or more annual visits to a primary care doctor.
They found that, compared with current practices, birth cohort screening identified an estimated 808,580 additional cases of chronic HCV infection at a cost of $2,874 per case identified.
If birth cohort screening was followed by standard treatment with pegylated interferon and ribavirin, screening increased QALYs by 348,800 and costs by $5.5 billion, for an incremental cost-effectiveness ratio (ICER) of $15,700 per QALY gained.
They added that treatment would prevent 82,300 deaths.
If screening were followed by standard-of-care pegylated interferon plus ribavirin in addition to a direct-acting antiviral, a newer class of HCV drugs, QALYs would be increased by 532,200 and costs by $19 billion, amounting to an ICER of $35,700 per QALY saved.
This treatment strategy would prevent 121,000 deaths, the researchers estimated.
They wrote that although there's no accepted standard for determining what level of cost-effectiveness justifies implementing of a new screening strategy, HCV birth-cohort screening appears to rank on par with colorectal cancer screening, hypertension screening, influenza vaccination of adults ages 50 and up, and vision screening and pneumococcal vaccination of patients ages 65 and up.
They warned that the study had several limitations, including relying on the assumption that patients without insurance weren't offered treatment. Also, cost-effectiveness estimates of direct-acting antivirals plus standard treatment were speculative because actual data on their clinical implementation haven't yet been reported.
They also cautioned that disease progress was capped at 20 years, which may be an underestimate, and the study may lack generalizability because NHANES data don't include information on institutionalized or homeless patients, who may be at risk of HCV.
Mechanism explains how virus survives in the liver and how a new antiviral works
MicroRNAs are involved in regulating the expression of genes in cells, usually by blocking the production of key proteins or by destabilizing the messenger RNAs that encode the cell's proteins as it grows and divides. Normally they act by downregulating gene expression. The research team found that the binding of a prominent microRNA in liver cells, called miR-122, to the viral RNA results in its stabilization, promoting efficient replication of the virus genome in the liver and supporting the virus' lifecycle.
"First, it has evolved a unique relationship with a key regulator, since miR-122 represents about half of all microRNAs present in the liver. Second, the virus has usurped a process that usually downregulates gene expression to upregulate the stability of its RNA and expression of viral proteins needed for its lifecycle. It's a classic example of how viruses subvert normally beneficial functions of the cell to their own nefarious purposes."
Hepatitis C is a continuing public health problem, which is difficult to measure because symptoms occur months to years after infection. The Centers for Disease Control and Prevention estimates as many as 4 million people in the United States may be persistently infected with hepatitis C virus, and most do not know they are infected. More than a third of those who are long-term carriers may develop chronic liver disease or liver cancer, a deadly form of cancer that is becoming increasingly common due to the spread of this virus.
Podcast
Podcast-Vincent, Alan, and Rich review ten compelling virology stories of 2011.
Ten virology stories of 2011:
- XMRV, CFS, and prostate cancer
- Influenza H5N1, ferrets, and the NSABB
- The Panic Virus
- Polio eradication
- Viral oncotherapy
- Hepatitis C virus
- Zinc finger nuclease and HIV therapy
- Bacteria help viruses
- Human papillomaviruses
- Combating dengue with Wolbachia
Hall Of Shame
An American university scientist was arrested on 27 December, accused of supplying stem cells for use in unapproved therapies.
Click here to continue reading.
Off The Cuff
Most Shocking Moments in Celebrity Health
2011 Year in Review: 27 Most Shocking Moments in Celebrity Health
By: Michele R. Berman, MD
Charlie Sheen Will Make Your Face Melt Off
Michael Douglas Beats Throat Cancer
Bret Michaels Survives Heart Surgery
Barbara Walters Opens Her Heart to the World
Serena Williams Undergoes Treatment for Pulmonary Embolism
Matthew Morrison’s Sweet Potato Abs
Keenan Cahill is Dynamite!
Missy Elliot with Graves
Harry Potter was an Alcoholic?!
R. Kelly Has a Bump N’ Grind Removed (from his throat)
Angelina Jolie Eats Bugs
Kim Kardashian Gets a Nasty Rash
I’ll take “Kick Ass Game Show Hosts For $100, Alex”
Dianna Agron Gets a Broken Nose
Sean Kingston looks at Beautiful Girls, Crashes Jet Ski & Nearly Dies, Twice!
Steven Tyler Slips in the Tub
Tanorexics Everywhere! [Snookie, George Hamilton, Rebecca Minkoff]
Bono’s Heart Skips a Beat
Venus Williams Leaves US Open
Don’t Chew Anything Around Kelly Ripa
John Mayer Silenced
Demi Lovato Does What Few Actresses Do
Wanda Sykes says Breast Cancer is No Laughing Matter
Did Alternative Medicine Kill Steve Jobs?
Adele Can’t Sing
Gabby Giffords learns to speak again
They’re letting Khloe Kardashian Have a Baby?!
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