Friday, July 20, 2012

TGIF-HCV Weekly Rewind- Video- US attorney: Former technician at Exeter Hospital Arrested

Hello folks,
Welcome to HCV rewind, a weekly digest of news, research and a look at today's headlines.

In The News

Tech in hepatitis C case says he 'fabricated' life
HOLLY RAMER, Associated Press
Updated 05:44 a.m., Friday, July 20, 2012

CONCORD, N.H. (AP) — A traveling hospital technician accused of infecting 30 people with hepatitis C with tainted needles in New Hampshire told investigators he "lied to a lot of people" and "fabricated" his life, but denied taking or selling drugs.
David Kwiatkowski, a former technician at Exeter Hospital, was arrested Thursday morning at a Massachusetts hospital where he was receiving treatment. Once he is well enough to be released, he will be transferred to New Hampshire to face federal drug charges, said U.S. Attorney John Kacavas, who called Kwiatkowski, 33, a "serial infector" who worked in at least half a dozen states.

Continue reading....

Published on Jul 19, 2012 by


In a review at Medscape complicated questions about chronic hepatitis C are answered in a summary using basic terms. Topics include; the long-term outcomes of IFN or PEG-IFN and their combinations with RBV in terms of durability of SVR, regression of liver fibrosis and cirrhosis, mortality and morbidity, and improving survival and quality of life.
View Full Text @ Medscape
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Exciting news this week from researchers at the University of Florida (UF) which claim that newly created “nanorobots” (in cell culture and mice) all but eradicated the hepatitis C virus.

The Holy Grail of nanotherapy is an agent so exquisitely selective that it enters only diseased cells, targets only the specified disease process within those cells and leaves healthy cells unharmed.
The new virus-destroyer, called a nanozyme, has a backbone of tiny gold particles and a surface with two main biological components. The first biological portion is a type of protein called an enzyme that can destroy the genetic recipe-carrier, called mRNA, for making the disease-related protein in question. The other component is a large molecule called a DNA oligonucleotide that recognizes the genetic material of the target to be destroyed and instructs its neighbor, the enzyme, to carry out the deed. By itself, the enzyme does not selectively attack hepatitis C, but the combo does the trick.

Continue reading...

Hepatitis C may increase deaths from both liver-related and other diseases
In a long-term study of people infected with the hepatitis C virus (HCV), researchers found increased deaths from both liver-related and non-liver related diseases in patients with active infections who had not cleared their infection.

New At - NATAP

Chronic Hepatitis C Virus Infection Increases Mortality From Hepatic and Extrahepatic Diseases: A Community-Based Long-Term Prospective Study - (R.E.V.E.A.L.)-HCV study
A note from the Executive Director of NATAP
Jules: this study found if a person had HCV with detectable viral load which almost everyone does, risk for death due to liver related disease increased a lot, risk for extrahepatic disease (kidney, cancers, heart disease, circulatory diseases increased.

THIS notion is something that clinicians often in the past never told their patients, patients were told 'you can delay therapy, in fact maybe you don't ever have to be treated. But its clear, always has been to me & to some others that there is a real risk for developing extrahepatic diseases & this study found this increases risk for death!!!!
Very important, the message is to get cured.

New At - GastroHep News

Challenges of bacterial infections in end-stage liver disease
A study in the latest issue of Gut reports on current challenges and future directions of bacterial infections in end-stage liver disease.

Bacterial infections continue to be a leading cause of mortality and acute-on-chronic liver failure in end-stage liver disease.

The consequences of infection include prolonged hospitalization, acute kidney injury, death, de-listing from liver transplant and susceptibility to further infections.
The diagnosis of infections in cirrhosis is fraught due to the background of a partial systemic inflammatory response syndrome state and negative cultures in 30-50% of patients.
Furthermore, the lack of multi-center studies limits the generalizability of currently available results.

With sepsis, mortality increases to more than 50%
Dr Jasmohan Bajaj and colleagues from Virginia, USA investigate effective strategies for the prevention, diagnosis, and management of infections in end-stage liver disease form a large unmet need.
The modulation of infections by the underlying immune state, gut barrier function and super-imposed medications such as beta-blockers, proton pump inhibitors and antibiotics is required.

The team report that a rational approach to the diagnosis and prevention of acute kidney injury associated with infection, withjudicious use of crystalloids and albumin, is also needed.
The research team notes that changes in bacteriology including emergence of multi-resistant organisms and Clostridium difficile have also recently changed the approach for prophylaxis and therapy of infections.

The team recommend that a systematic approach to study the epidemiology, bacteriology, resistance patterns, and procedure and medication utilisation specific to end-stage liver disease is needed to improve outcomes.

Bacterial infections in patients with end-stage liver disease affect candidacy for liver transplantation. Up to one-third of all hospitalised patients with cirrhosis are infected.

With sepsis, mortality increases to more than 50% and is associated with significant costs.
The team identified a recent systematic review that demonstrates a 4-fold increased risk of death in infected cirrhotic patients compared with their non-infected counterparts.

Dr Bajaj's team comments, "Intensive care unit mortality of patients with cirrhosis has remained unchanged over 50 years, unlike disease states such as cardiac failure where mortality has decreased."
"In this review, we therefore considered the prevention, diagnosis and management of infections assoiated with liver disease."
Source - GastroHep News
Gut 2012; 61: 1219-1225
20 July 2012

Supplements and Herbs

Vitamin B12 supplements may help treat hepatitis
Safe and inexpensive option for boosting response rate to antiviral drugs [Vitamin B12 supplementation improves the rate of sustained viral response in patients chronically infected with hepatitis C virus

Related @ MedPage Today -
Vitamin B12 Boosts Response to Hep C Therapy (CME/CE)
7/18/2012 MedPage Today Gastroenterology
(MedPage Today) -- Adding vitamin B12 to standard of care treatment for hepatitis C virus (HCV) infection significantly increased rates of sustained viral response, an open-label pilot study found.

Video - Milk Thistle No Help in Tough Hepatitis C Cases
Silymarin, a milk thistle extract, probably will not be of much help to patients with chronic hepatitis C virus (HCV) who have already failed interferon therapy, researchers found.

Obesity Plus Low Vitamin D Equals Greater Risk of Insulin Resistance
PHILADELPHIA -- July 17, 2012 -- The combination of obesity and vitamin D deficiency may put people at even greater risk of insulin resistance than either factor alone, according to a study published online ahead of the print issue of the journal Diabetes Care.

"Vitamin D insufficiency and obesity are individual risk factors for insulin resistance and diabetes," said lead author Shaum Kabadi, Drexel University School of Public Health, Philadelphia, Pennsylvania. "Our results suggest that the combination of these 2 factors increases the odds of insulin resistance to an even greater degree than would have been expected based on their individual contributions."

In the study, obese individuals who had healthy levels of vitamin D had insulin resistance almost 20 times more often than the overall study population. But in obese individuals whose serum vitamin D was low, insulin resistance was much higher -- about 32 times more common than the average.

"It's not clear whether obesity itself causes a low vitamin D level or if it's the other way around," said senior author Longjian Liu, MD, Drexel University School of Public Health.

For the study, the researchers analysed data on serum vitamin D levels and indicators of insulin resistance and diabetes from 5,806 respondents to a major national health survey, the National Health and Nutrition Examination Survey (NHANES). This was the first study of the association between vitamin D and diabetes risk for obese patients using a large, nationally representative sample of adults.

The survey reported data from individuals at a single point in time and was therefore unable to determine whether there is a cause-and-effect relationship among vitamin D, obesity and insulin resistance.

Further studies could indicate whether vitamin D supplements are effective at reducing the risk of insulin resistance and diabetes in obese individuals. If so, the authors noted that it would be an inexpensive and practical prevention strategy compared with the difficulty involved in healthy weight loss.

Dr. Liu said that vitamin D supplements may be useful for people who are overweight or obese to help control diabetes, but he cautioned against too much vitamin D due to side effects such as weakness and fatigue. In addition, vitamin D deficiency is just one of many known risk factors associated with insulin resistance and diabetes.

"Therefore, to control diabetes, we need to have comprehensive prevention strategies," said Dr. Liu. "For example, physical activity may be the most cost-effective way to control weight and subsequently to control conditions including diabetes and heart disease."
SOURCE: Drexel University

Vitamin D May Protect Lung Function in Smokers
Vitamin D deficiency is associated with worse lung function and more rapid decline in lung function over time in smokers, suggesting that vitamin D may have a protective effect against the effects of smoking on lung function, according to a new study from researchers in Boston.

Interferon - Treating Depression

Escitalopram for the Prevention of Peginterferon-α2a–Associated Depression in Hepatitis C Virus
Patients with chronic hepatitis C virus, or HCV, are commonly treated with pegylated interferon-a combined with antiviral agents. Up to 70 percent of HCV patients treated with interferon-a will experience mild to moderate depressive symptoms, and up to 40 percent have major depression. Preventing depression in these patients is imperative because it can derail treatment adherence and effectiveness, and suicide attempts also become a major concern. Researchers sought to determine if prophylactic escitalopram treatment can decrease the incidence or severity of depression associated with interferon-a treatment. The researchers randomly assigned 181 HCV-infected patients with no history of psychiatric disorders to either escitalopram 10 mg/d (n=90) or placebo (n=91) starting two weeks before and continuing for 24 to 48 weeks during antiviral therapy. They found that preemptive treatment with escitalopram is effective in reducing the incidence and severity of depressive symptoms in this patient population. According to the authors, this research has implications for other patients, as interferon-a has current or future indications in gastroenterology, dermatology, and oncology, as well.

Related @ MedPage Today -
Meds Stop HCV Tx Blues (CME/CE)
7/19/2012 MedPage Today Gastroenterology
(MedPage Today) -- Prophylactic antidepressant treatment of patients with hepatitis C virus (HCV) undergoing antiviral therapy cut the incidence of depression almost in half, a randomized study found.

The Role Of Liver Biopsy

National patterns and predictors of liver biopsy use for management of hepatitis C
Liver biopsy rates in the VA system have variability that seems unrelated to clinical need. New antiviral therapies and non-invasive assessment techniques may create additional uncertainty for the role of liver biopsy, perhaps explaining its decline in recent years. The availability of more effective antiviral therapies may also affect biopsy rates in the future.

Liver Cancer

Bristol-Myers Squibb reported yesterday that the Phase 3 trial of its drug, brivanib, versus sorafenib , as a first-line treatment in patients with liver cancer didn't meet its primary overall survival objective.
 “The treatment options for patients with advanced hepatocellular carcinoma are limited, and we are disappointed that the primary endpoint was not met,” said Brian Daniels, M.D., senior vice president, Global Development and Medical Affairs, Bristol-Myers Squibb. “Bristol-Myers Squibb remains committed to developing medicines for the treatment of diseases with serious unmet medical need, including diseases of the liver such as hepatitis C, hepatitis B, and liver cancer.”
Continue reading....

Vitamin E may lower liver cancer risk
High consumption of vitamin E either from diet or vitamin supplements may lower the risk of liver cancer, according to a study published July 17 in the Journal of the National Cancer Institute.
Continue reading here....

HCV Awareness

Video - The HIV and Viral Hepatitis Epidemic
Dr. John Ward, Director of CDC's Division of Viral Hepatitis, brings to the table the similarities 
between the Hepatitis B and Hepatitis C epidemics and the HIV epidemic in the United States.
Johnson urges Congress’ support for testing in battle against ‘silent killer’

World Hepatitis Day Focused On Awareness, Testing And Treatment
July 19, 2012|Donna Sciacca, American Liver Foundation, Connecticut Division, Statewide
The American Liver Foundation joins the World Hepatitis Alliance on July 28 as part of World Hepatitis Day to raise awareness of the serious implications of hepatitis B and C. The theme of the day, "Know It, Confront It and Get Tested" speaks to the need to increase knowledge of hepatitis, to remove the stigma of the disease, and take down barriers from seeking treatment. It is estimated there are 12 million people in the world with hepatitis.

Hepatitis C is often called the silent killer as there may be no symptoms for 20-30 years after the person is infected. The disease is transmitted when infected blood enters the body. The most common ways of infection are sharing needles with IV drug use or having received infected blood in a blood transfusion prior to 1992....Continue reading.........

Conquering Hepatitis C

WASHINGTON, D.C. – U.S. Congressman Hank Johnson this week sent a letter to the 434 House colleagues, urging their support for the bipartisan H.R. 3381,

the Viral Hepatitis Testing Act of 2011.
Saying he wanted to encourage support in educating the public and testing for the debilitating disease, Johnson shared his personal story of conquering Hepatitis C.

He urged others to step out of the shadows, saying he hoped his story would give them confidence to do so: .
(Johnson comes on at about 38:19 on the timeline).

The Act requires the Secretary of Health and Human Services (HHS) to expand awareness and testing campaigns for the hepatitis B (HBV) and hepatitis C (HCV) virus and the Centers for Disease Control and Prevention (CDC) to revise the guidelines it uses to screen for HCV.
“I am asking that we work together to raise awareness about HCV so that others at risk can get tested and treated,” said Rep. Johnson in the letter. “By supporting H.R. 3381, the Viral Hepatitis Testing Act of 2011, we can save lives and help others avoid the needless suffering and debilitating medical costs associated with treating this disease.”

H.R. 3381 is sponsored by Reps. Bill Cassidy (R-LA) and Mike Honda (D-CA).
In 2009, Rep. Johnson disclosed that he had suffered from hepatitis C since 1998.
After completing successful treatments, Johnson is free of the disease. The letter comes ahead of World Hepatitis Day, recognized every year on July 28. -To read the letter, click here
Continue reading.............

Hepatitis C and B

Assessing Long-Term Treatment Efficacy in Chronic Hepatitis B and C: Between Evidence and Common Sense
All in all, even if no randomized controlled trial will ever demonstrate that an SVR improves liver related survival in HCV patients without cirrhosis, indirect evidence suggests this to be the case, supporting SVR as an excellent marker of efficacy in this subgroup of HCV patients....

In the face of remission or inactivation of cirrhosis spontaneously occurring in HBV carriers, there are recent reports of histological regression of HBV related cirrhosis following successful anti-HBV treatment....


HIV scientists release road map for cure: "Today's the first step"
(AP) WASHINGTON - For years it seemed hopeless. Now the hunt for a cure for AIDS is back on.
International AIDS specialists on Thursday released what they call a road map for research toward a cure for HIV - a strategy for global teams of scientists to explore a number of intriguing leads that just might, years from now, pan out.

As HIV/AIDS turns 30, doctors see glimmer of cure
HIV Cure? Doctors Say Stem Cells Cured Man of AIDS Virus
UN report highlights better access to AIDS medication in developing countries

"Today's the first step," said French Nobel laureate Francoise Barre-Sinoussi, co-discoverer of the HIV virus who also co-chaired development of the strategy.

"No one thinks it's going to be easy," added strategy co-chair Dr. Steven Deeks of the University of California, San Francisco. "Some don't think it's possible."

The announcement came just before the International AIDS Conference begins on Sunday, when more than 20,000 scientists, activists and policymakers gather in the nation's capital with a far different focus: how to dramatically cut the spread of the AIDS virus, what they call "turning the tide" of the epidemic, using some powerful tools already in hand.
Continue reading....

Treating HCV Improves Insulin Resistance in HIV Coinfection
In patients with hepatitis C virus (HCV) and the human immunodeficiency virus (HIV), pegylated interferon and ribavirin therapy for the hepatitis produce significant metabolic improvements as well.
The effect lasts only while treatment continues, however, leaving just a modest persistent improvement in insulin resistance, researchers reported online May 4th in Clinical Infectious Diseases.

Stem Cells

Stem cell research aids understanding of of how cancer develops in the liver, pancreas and oesophagus
An international team of researchers led by renowned stem cell scientist Professor Martin Pera has discovered a novel marker that plays an important role in our understanding of how cancer develops in the liver, pancreas and oesophagus.

New Book- HCV Treatment

Hepatitis C No Longer a Lifelong Illness
Leading hepatologist and hepatitis C expert Gregory Everson, M.D. provides state-of-the-science information in Curing Hepatitis C -- a new book that outlines the latest treatment protocols that offer the outcome of complete cure from this disease.

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