Friday, February 1, 2013

TGIF-HCV Rewind:Liver Cancer, Interferon Free Regimens and Noninvasive Methods To Diagnose Liver Fibrosis

Hello folks,

Welcome to HCV rewind, a weekly digest of news, research and a look at today's headlines. Grab a cup of jamoke, sit back and catch up on what you missed.

Liver Cancer

A Few Facts;

The World Health Organization has predicted that by 2020 liver cancer will surpass lung as the No. 1 cancer worldwide.

At present, it is estimated that about 170 million people, roughly 3% of the world population, are chronically infected with HCV.

Source - Medscape : Out of 100 people that contract the infection, 75–85 people will develop chronic infection, 60–70 people will develop chronic liver disease, five to 20 people will develop cirrhosis over the course of their chronic infection and one to five people will die of complications including hepatocellular carcinoma (HCC).

A study is published in the December issue of Liver Transplantation reported; HCV is the most common blood-borne infection and cause of liver disease requiring transplantation in the U.S., chronically infecting more than one percent of Americans. Previous studies show that among patients living with chronic HCV, 10% to 20% will develop cirrhosis and up to 5% will progress to liver cancer (hepatocellular carcinoma; HCC). Further evidence implicates HCV as the primary risk factor for developing HCC in up to 47% of cases of patients with HCC.

Journal Update

Over at Clinical Liver Disease, an issue devoted to Hepatocellular Carcinoma headed up by Jorge A. Marrero, MD, MS, and a team of leading experts in the field hepatology address current issues in HCC. Topics include; natural history, staging, risk factors, and new treatment options. Visitors are able to view videos, full data, and download files in either HTML or PDF formats.
Click here to view this issue of CLD.

Failure - HEAT Study

Celsion announced yesterday their Phase III HEAT Study of ThermoDox® in combination with radio frequency ablation (RFA) for hepatocellular carcinoma (HCC) or primary liver cancer failed to meet the company's goal.
(Reuters) - Celsion Corp shares plunged by more than 80 percent after a late-stage study of the company's experimental liver cancer treatment ThermoDox failed to meet the main goal of increasing patients' survival without worsening their cancer.
In the HEAT Study, ThermoDox® is administered intravenously in combination with RFA. ThermoDox® is a proprietary heat-activated liposomal encapsulation of doxorubicin, an approved and frequently used oncology drug for the treatment of a wide range of cancers.
Read more here...


Scientists Discover Process That Turns Normal Liver Cells to Cancer Cells

A team of scientists from the Cancer Science Institute of Singapore (CSI) at the National University of Singapore (NUS) has identified a genetic process in which normal liver cells transform into cancerous ones.
Continue reading....

Statins May Lower Death Risk in Liver Cancer

SAN FRANCISCO -- Statin use seemed to reduce the risk of death in patients with hepatocellular cancer, researchers reported here.
Continue reading @ MedPage Today

Noninvasive Methods To Diagnose Liver Fibrosis

Noninvasive Estimation of Fibrosis Progression Overtime Using the FIB-4 Index in Chronic Hepatitis C

Discussion Only
Full Text Available @ Medscape

Recently, noninvasive markers of liver fibrosis have been used as a predictive factor of liver-related outcome such as mortality[22–24] or HCC development[24–26] in patients with chronic liver disease. There have been few studies that investigated the association between changes of noninvasive markers and liver-related outcome.[27–29] However, it is still unclear whether there is a relation between the time-course changes in the value of noninvasive markers and progression of liver fibrosis.

The aim of the study was to evaluate the utility of the real-time assessment of the FIB-4 index for the prediction of time-course progression in liver fibrosis. We have shown that the FIB-4 index reduced along the regression of the fibrosis stage, while the FIB-4 index increased along the progression of the fibrosis stage. These results indicate that the measurement of the time-course changes in the FIB-4 index may be useful for the noninvasive and real-time estimation of the progression in liver fibrosis overtime.

Although the gold standard for diagnosis of liver fibrosis is liver biopsy, there are a variety of problems including invasiveness and sampling errors.[6] Diagnostic methods of liver fibrosis by measurement of elasticity of the liver by ultrasonography[10–14] have been developed, but these modalities are not widely available.

The FIB-4 index has an advantage among these noninvasive liver fibrosis diagnostic methods. Firstly, it is quite easily calculated. The parameters required for calculation are only age, AST, ALT and platelet counts, which are measured at the routine examination of patients with liver disease.

Therefore, additional blood collection is unnecessary, and the index can be calculated at no cost. Secondly, because of its simple calculation, it is possible to evaluate the clinical conditions in a real-time manner. Repeated measurements of the FIB-4 index make it possible to predict deterioration in liver fibrosis continuously over time. Because no special equipment or system is necessary, and objective data on the clinical conditions are provided in a real-time manner, the FIB-4 index is simple and convenient compared with other noninvasive liver fibrosis diagnostic methods.

It is widely known that a decrease in platelet counts is useful for the prediction of the progression of fibrosis stage.[30] We have reported that elevated AST or ALT is also associated with the progression of liver fibrosis.[31] However, the results of this study showed that a change in the FIB-4 index over time was a more useful factor for the prediction of the progression of fibrosis stage than AST, ALT and changes in platelet counts.

Liver biopsy is still an important examination as the gold standard for diagnosis of liver fibrosis, but time-course changes cannot be readily observed by repeated biopsies because of its invasiveness. On the other hand, it is possible to estimate the progression of liver fibrosis by repeated measurement of the FIB-4 index. Therefore, two examinations should be combined: liver biopsy may be utilized to determine the baseline of fibrosis stage, and the serial measurement of the FIB-4 index may be utilized to predict changes of fibrosis stages overtime in a real-time manner.

In conclusion, we believe that measurement of the time-course changes in the FIB-4 index is useful for the noninvasive and real-time estimation of the progression in liver fibrosis.
Continue reading @ Medscape

Retreatment of Hepatitis C - Monotherapy

Update Cochrane Review

This review addressed the ability of interferon monotherapy to favorably alter the clinical course of chronic hepatitis C when it is used to retreat patients who failed at least one previous course of therapy

Chronic hepatitis C: Interferon may be harmful in re-treatment

People with hepatitis C and chronic liver disease who relapsed or failed to respond to initial treatment are unlikely to improve on interferon retreatment. In fact, they may face an increased risk of dying sooner, and are likely to experience a variety of adverse effects, according to an updated systematic review published in The Cochrane Library.

Hepatitis C affects around 170 million people worldwide. In some cases, infection leads to chronic liver disease, liver failure or liver cancer, eventually resulting in death. Treatment is based on antiviral drugs.

Interferon monotherapy, meaning using interferon alone, is not the first choice of therapy for most clinicians, but it is used in some patients when other drugs cannot be used. Despite costing thousands of dollars to treat one patient for a year, there is currently little evidence that it works. Treatment is considered to have been successful if the virus cannot be detected in a patient's blood six months after treatment. This outcome is known as sustained viral response (SVR). However, it has never been confirmed that SVR leads to an improvement in the patient's disease state or their chances of survival.

The authors of the review analysed data from seven trials involving a total of 1,976 patients with chronic hepatitis C liver disease who were being retreated with interferon monotherapy having previously been treated unsuccessfully. When they included all trials in their analysis, the risk of death was no higher for interferon than for placebo or no treatment. However, the researchers also performed a further analysis, leaving out studies that had a high risk of bias and gave less reliable estimates of effect. For example, one of these trials was not blinded, was stopped before the planned number of patients had been enrolled, and did not have all of those who had been enrolled counted in the final analysis. This left the two largest trials, together incorporating 1,676 patients. Focusing only on these trials, the risk of death was significantly higher at 9.4% for interferon retreatment compared to 6.7% for placebo or no treatment.

"It was troubling to see that in those trials providing the most reliable estimates of treatment effects, interferon seemed to increase the risk of death," said lead researcher Ronald Koretz of Granada Hills in California, US. "Based on these results, interferon monotherapy cannot be recommended for chronic hepatitis C patients who have already failed one course of treatment and are being retreated. Furthermore, patients who are receiving interferon as part of a combination therapy should be informed about this potential adverse effect."

Interferon treatment did seem to reduce levels of hepatitis C virus in the blood compared to controls, resulting in what would be considered successful treatment or SVR. However, since this response was not associated with an improvement in disease or risk of death, the review suggests that SVR may be inadequate as an indicator of a successful treatment outcome. "Sustained viral response did not suggest that a patient who was destined to develop symptoms or death from hepatitis C was cured, at least in this setting. This tells us that as a treatment outcome it is not universally reliable and needs to be validated before it can be viewed as the goal of any therapy in other clinical scenarios," said Koretz.

Patients in the treatment group were also more likely to suffer adverse effects. Although the drug did appear to reduce the incidence of nonfatal internal bleeding, the researchers conclude that it is so expensive that it may be hard to justify based on this one small benefit.

Listen to the podcast here, continue to updated material @ Cochrane, additional summary is available at Medscape.

Pegasys Or PegIntron ?

*pegylated interferon alfa-2a (Pegasys) and alfa-2b (PegIntron)

Pegylated interferon alfa-2a, 2b similarly effective for chronic HCV genotype 1

Coppola N. BMC Infect Dis. 2012;doi:10.1186/1471-2334-12-357.

January 29, 2013

Standard doses of pegylated interferon alfa-2a and alfa-2b, administered with ribavirin, were similarly effective in patients with chronic hepatitis C genotype 1 in a recent study.

Researchers performed meta-analysis of seven studies evaluating the efficacy of peginterferon-alfa-2a (Peg-IFN a-2a) and 2b (Peg-IFN a-2b) in 3,026 patients with chronic hepatitis C genotype 1. Five prospective randomized trials and one prospective and one retrospective nonrandomized trial were included. All participants were treatment-naive and anti-HIV-negative.

Study quality was measured according to the Chalmers and Jadad scales. Scores on the Chalmers scale ranged from 0.2 to 0.6 (mean of 0.43) overall, from 0.11 to 0.58 (mean 0.36) for the protocol, and from 0.23 to 0.67 (mean 0.53) for data analysis and presentation. On the six-point (0-5) Jadad scale, two studies scored 0, two scored 1 and three scored 3.

Rapid virological response (RVR) was evaluated in four studies in 2,729 patients, and occurred at similar rates among patients taking alfa-2a and 2b (RR=1.05; 95% CI, 0.87-1.27). Sustained virological response (SVR) rates, measured in 2,646 patients across six studies, also were similar for the treatments (RR=1.08; 95% CI, 0.99-1.18).

Early complete virological response (EVR) and end-of-treatment response (ETR) were assessed in five studies each, in 2,766 and 2,460 patients, respectively. EVR and ETR were more common among alfa-2a recipients (RR=1.12, 1.03-1.22 for EVR; RR=1.22, 1.14-1.31 for ETR).
Sensitivity analysis excluding nonrandomized and poor-quality studies did not significantly impact results.

“The data show that there is no difference between the two treatments in the achievement of RVR and SVR; the higher rates of EVR and ETR in the patients treated with Peg-IFN a-2a are clearly of lesser clinical impact,” the researchers wrote. “The datum on SVR may be considered the most important result from this meta-analysis. … Peg-IFN a-2a and Peg-IFN a-2b, both in combination with ribavirin … can be used indifferently for patients with genotype 1 chronic hepatitis C who are anti-HIV-negative and naïve to antiviral treatment.”

Peginterferon/ribavirin effective for children, adolescents with chronic HCV

Druyts E. Clin Infect Dis. 2012;doi:10.1093/cid/cis1031.
February 1, 2013

Treatment of chronic hepatitis C with pegylated interferon and ribavirin is effective and relatively safe for children and adolescents, according to recent results.

Researchers performed a systematic review and meta-analysis of eight trials assessing the use of pegylated interferon (PEG-IFN) alfa-2a or 2b with ribavirin (RBV) in patients aged 3 to 18 years with chronic HCV. Complete early virologic response (EVR) was defined as undetectable HCV RNA after 12 weeks of treatment, and sustained virologic response (SVR) was defined as undetectable RNA after 24 weeks of post-treatment follow-up.

Across all cohorts, EVR occurred in 70% of patients and SVR occurred in 58%, with higher response rates among participants with genotypes 2 (87% of cases) or 3 (89%) than those with genotypes 1 (61%) or 4 (52%). Relapse occurred in 7% of cases.

Lack of response in 15% of participants resulted in discontinuation of treatment, while 4% required discontinuation because of adverse events and 4% discontinued as a result of virologic breakthrough. Common adverse events included leukopenia (52%), neutropenia (32%), erythema at the injection site (27%), alopecia (13%) and anemia (11%).

Investigators noted that, across five studies with evaluable data, some growth inhibition was observed during treatment, and it returned to normal upon treatment cessation. In one randomized controlled trial, some participants who had experienced growth inhibition had not returned to baseline height-for-age after 2 years of follow-up.

Edward J. Mills, PhDEdward J. Mills
“In the rare instance where a child is identified to be progressing toward advanced liver disease from HCV … our work demonstrates that PEG-IFN and RBV can be used relatively safely and with a reasonable hope of cure,” researcher Edward J. Mills, PhD, department of clinical epidemiology and biostatistics at McMaster University in Hamilton, Canada, told He also noted that combination direct-acting antiviral regimens may provide better therapeutic options in the future. “[IFN-based] medications do cause multiple side effects and adverse events, which is not ideal in any population; in particular, a population of children.”

Disclosure: See the study for a full list of relevant disclosures.
Source - Healio

Hepatitis C -Frequency of Thyroid Dysfunctions during Interferon Alpha Treatment

Thyroid dysfunction is the commonest endocrinopathy associated with HCV infection due to interferon-based treatment. This comprehensive and systematic review presents the available evidence for newly developed thyroid antibodies and dysfunctions during interferon treatment (both single and combination) in HCV patients.
Continue reading....

Boceprevir and Telaprevir

Boceprevir and Telaprevir Improve Hepatitis C Treatment, Literature Reviews Find
Triple therapy with a direct-acting antiviral drug was more effective than pegylated interferon and ribavirin alone for people with chronic hepatitis C, but there is not yet enough data to determine many differences between boceprevir and telaprevir , or to see effects on long-term clinical outcomes, according to 2 recent medical literature ...
Continue reading....

Interferon Free Regimens

Is The HCV Pipeline Heading in the Right Direction? - Commentary
24 January 2013
Andrew Aronsohn, Andrew J. Muir, Donald Jensen
Will All Patients Be Able to Be Treated Without Interferon?

Interferon-free HCV therapy will represent a breakthrough in HCV treatment. Trials to date are encouraging, but have begun to reveal important interactions between drug, host, and virus that need to be better understood before interferon-free therapy becomes a mainstay of treatment. Previously unidentified host and viral characteristics may create a requirement for interferon-based therapy for some, raising the possibility that all oral regimens may not be appropriate for all patients. In addition, the cost of newly developed interferon-free regimens may be prohibitive, especially in many resource-limited regions of the world. Enthusiasm over the possibility of an "all-oral" cure for HCV must be balanced with realization that cost of therapy will create a disparity among those who can receive interferon-free therapy and those who do not have access. HCV will carry an extensive global burden of disease, even in an interferon-free era, if efforts are not made to diminish this disparity....
Read More.....
Hepatitis C progress in pipeline

New drugs to treat virus expected be available in 2014-15

January 30, 2013
For more on this rapidly changing landscape, we turned to Dr. Donald M. Jensen, director of the Center for Liver Diseases at University of Chicago Medicine and a noted hepatitis C researcher, with more than 100 peer-reviewed articles .
Q: Tell me about the new drugs and what they mean for patients.

A: In May 2011, two new drugs were approved — telaprevir and boceprevir — and were added to the backbone of interferon, which has been around since the early 1990s, and ribavirin (since 1998), and have always been the standard of care. The old therapy had a lot of side effects — such as aches, severe fatigue and depression. Even then, the cure rate was only about 40 percent.
Q: Did the new drugs eliminate the nasty side effects?
A: No. Sometimes, it aggravated them ... with anemia and a skin rash. It wasn't pleasant, but the success rate jumped to 70 percent, which was nothing to scoff at. But now there are even better drugs in the pipeline, such as Sofosbuvir, Daclatasvir, Simeprevir, Faldaprevir, ABT450, Danoprevir, Apeline, which should be available in the 2014-15 time frame. The treatment is shorter — 12 to 24 weeks vs. 24 to 48 weeks — and has fewer side effects and even better success rates (90 to100 percent cure rates). Many patients with mild cases are deciding to wait.

Read more.........

Interferon free regimens for the “difficult to treat”: are we there?

Journal of Hepatology

This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

In this editorial response rates using interferon free combinations and standard therapy in difficult to treat patients are discussed.

Within the next few years, we will certainly witness more progress. When choosing a combination of antiviral agents, we will need to take into consideration a certain number of variables: potency, genetic barrier to resistance, range of activity (pangenotypic or not), potential drug-drug interactions. Importantly, safety and simplicity of the regimen will also be very relevant. Up to now, most of the oral compounds appear to be safe and well tolerated by most patients, but until large phase 3 studies are finished, safety needs to be closely monitored. Most of our current knowledge on interferon-free regimes is based on phase 2 trials including small numbers of patients. Added to which, we still have very little information on the safety and efficacy of these regimens in difficult to treat subjects, particularly in null responders with advanced fibrosis or cirrhosis, or in special populations such as transplant patients with hepatitis C recurrence....

Download PDF, or view the editorial here on the blog.

Clinical Trials

New Interferon-free Development Program
Alan Franciscus
Editor-in-Chief, HCV Advocate
January 28 2013 - Medivir announced a collaboration between Medivir/Janssen and Idenix for the clinical development of multiple HCV inhibitors with and without ribavirin—all the studies will be interferon-free.
Continue reading....

Press Release...
Simeprevir, TMC647055 and IDX719 Phase II all-oral combination Hepatitis C studies to be initiated shortly

More @ NATAP includes four articles:
Phase II all-oral combination studies of Simeprevir (TMC435), TMC647055 (non nuc polymerase inhibitor) and IDX719 (NS5A) for the treatment of Hepatitis C

HCV Awareness

The U.S. Centers for Disease Control recently issued its recommendation that all adults born between 1945 and 1965 should have a one-time hepatitis C test. The Canadian Liver Foundation (CLF has extended the recommendation for testing beyond the boomer generation to those born between 1945 and 1975, taking into account immigration from countries where hepatitis C is more common.

National Hepatitis C Survey Prompts Call for All Canadian Boomers to Get Tested

TORONTO, Jan. 29, 2013 /CNW/ - Current realities of chronic hepatitis C in Canada and results of a new national survey of physicians and Canadians on awareness of the liver disease, have prompted the Canadian Liver Foundation (CLF) to urge general practitioners (GPs) to immediately begin recommending a one-time blood test for all adults born between 1945 and 1975.

"We know that risk-based testing has not been effective in identifying all infected adults, and most physicians surveyed agree they do not screen enough patients for hepatitis C," said Dr. Morris Sherman, Chairman of the CLF and hepatologist at Toronto General Hospital. "Given that today's treatments can cure a majority of those infected, it's time to be proactive at identifying chronic hepatitis C in the age group with the highest prevalence. The hepatitis C antibody test is inexpensive and is covered by all provincial health care plans."

According to the survey, conducted by Ipsos Reid, 83 per cent of GPs agree that patients would benefit from more routine screening. GPs also admit to having a limited understanding of the disease and its treatment. Only 35 per cent feel they know a lot about symptoms and nearly four in 10 (38 per cent) feel they know nothing at all or not much about available treatments. More than half (57 per cent) are unaware that hepatitis C can be cured.

Focus on Boomers
While anyone can be exposed to hepatitis C, Canadian data show that chronic hepatitis C is most pervasive among those born between 1945 and 1975.1 Baby boomers are up to five times more likely to be infected by hepatitis C than other adults.2 Yet Canadian boomers are less likely than younger generations to have been tested, according to the survey. Additionally, boomers claim to be the most knowledgeable generation about hepatitis C, but scores from the survey show they know the least.
"Hepatitis C is a silent disease, meaning often symptoms don't appear for many years until the liver is severely damaged," said Dr. Marc Bilodeau, hepatologist and Associate Professor of Medicine at Université de Montréal. "The large number of people infected, the asymptomatic nature of the disease and the serious consequences associated with it justify broader testing. The good news is nearly all Canadians would accept being tested if suggested by their doctor."

The CLF extended the recommendation for testing beyond the boomer generation, taking into account immigration from countries where hepatitis C is more widespread and common.
While nine in 10 Canadians believe that someone can have hepatitis C and not know it, this is not leading to testing. In fact, while over 300,000 Canadians are living with chronic hepatitis C and an estimated 71,000 Canadians are living with HIV,3 more are being tested for HIV/AIDS (32 per cent) than hepatitis C (23 per cent) according to the survey.

Survey Design and Methodology

The results of the survey, completed in September 2012, are based on 1,000 online interviews conducted nationally with adults over the age of 18 and 300 online interviews with GPs. The sample was generated by Ipsos Reid's Canadian Online Panel to reflect the Census data for Canadian adults and the national distribution of Canadian GPs.4

With the given sample size, the poll is accurate within +/- 3.5 percentage points for all Canadians and +/- 6.5 percentage points for all GPs, 19 times out of 20 had the entire adult population and all GPs been polled.5

The survey was conducted by Ipsos Reid on behalf of the Canadian Liver Foundation. The Canadian Liver Foundation acknowledges Merck Canada for its support of the Canadian Liver Foundation's campaign to raise awareness of hepatitis C as a serious liver disease and promote liver health.

About Hepatitis
Hepatitis C is a serious and potentially fatal liver disease. More than 300,000 people in Canada are living with chronic hepatitis C but many are unaware of it.6 It can take decades after individuals are infected for symptoms to appear.7 Undiagnosed and untreated chronic hepatitis C can lead to cirrhosis, liver cancer, liver failure or the need for a liver transplant.8

People can contract hepatitis C through any blood-to-blood contact including injection drug use (even a single episode), blood transfusions prior to 1990, participation in medical procedures or immunization in countries where hepatitis C is common, sharing personal care items (razors/nail clippers), and tattoos and piercings with improperly sterilized equipment.9

The CLF is encouraging GPs to learn more about screening and testing for hepatitis C. Tools to help physicians screen, diagnose and treat hepatitis C are available at Canadians looking for more information on hepatitis C can also visit the CLF website at

Silent killer may lurk in baby boomers' blood

He picked up hepatitis C sometime in his 62 years, possibly after a motorcycle accident that led to a blood transfusion as far back as the 1960s. If that was the source, it didn't turn up until almost a half-century later, in 2011.

That discovery led to a costly drug treatment with miserable side effects, but Hays looks back now as a man who is happy, cured and in disbelief
Read more.........


Spread of hepatitis C pinpointed
Scientists say they have, for the first time, worked out the pattern of spread of hepatitis C, showing early diagnosis is key to preventing epidemics.

A study in injecting drug users in Greece indicated that each infected person spread the disease to 20 others - 10 of these in the first two years.

The researchers said their results would help tackle the disease's spread.

Globally up to 180 million people live with the virus, most are unaware that they have it.

Those infected do not develop symptoms for up to 20 years and spread it to others without realising.

Study leader Dr Gkikas Magiorkinis, from Oxford University, said when people were infected with something such as flu it was very easy to work out where it had come from, because people knew they were infected within days.

But with hepatitis C, no-one has been able to pin down how the virus spreads, because cases occur months or years apart.

Genetic signature

To overcome this problem, the researchers looked at four hepatitis C epidemics in Greece, using data from 943 patients collected between 1995 and 2000.

But to provide more detail on how it spreads, they also included genetic information on the virus taken from 100 samples.

Plugging the details into a computer model, they calculated that injecting drug users were "super-spreaders", each transmitting the virus to 20 other people.

Most importantly they discovered that most of the transmissions occurred in the first couple of years, they report in PLoS Computational Biology.

The researchers said that people were more infectious at in the early days of catching hepatitis C because they had higher levels of virus.

The evidence they have produced suggests programmes targeting the diagnosis and treatment of hepatitis C in high-risk groups as early as possible would prevent many new infections and associated health care costs many years down the line.

About 20% of those infected will develop cancer or liver scarring after 20 years of infection, at which point the only treatment is liver transplantation, which costs about £100,000 ($160,000).

Dr Magiorkinis, who did the work in collaboration with the University of Athens and Imperial College London, said the model had helped build a "solid argument" to improve early diagnosis and antiviral treatment in drug users.

"Working out how many people are likely to be infected by each super-spreader of Hepatitis C, as well as how soon they will be infected, has been a puzzle for over 20 years," he said.

"Our research has resolved this issue and paves the way for a modelling study to show what kind of public health interventions could really make a difference."

He added the approach could be useful in other infections such as HIV.

Related - Drug Users Are 'Super-Spreaders' of Hepatitis C, Study Finds

 In Case You Missed It

Hepatitis Connect Presents An Interview With Alan Franciscus

There is a very good argument to be made that Alan Franciscus is the most significant trailblazer in his work for the hepatitis C awareness and advocacy movement in the United States. In 1997, Alan founded the Hepatitis C Support Project (HCSP) to help support and advocate for people affected by hepatitis C, hepatitis B, and HIV and hepatitis coinfections. HCSP has generated several essential support services and informational resources that have become an invaluable part of the current HCV landscape in America.
Continue reading...

Hepatitis C infection and presence of advanced fibrosis:Wait or treat? Why wait? There is no time to lose, is there?

All too frequent we physicians ignore “primum non nocere” (first do not harm), and believe all too frequently treatment is always the answer. Once we have treatments available, we frequently believe that the worst which can happen is the failure of treatment, ignoring that side effects might be more than a mere nuisance. Even a supposedly safe treatment such as lamivudine was demonstrated to be lethal in very special individuals with certain viral resistance mutations, when lamivudine was not stopped in time. In contrast to lamivudine and other oral antivirals for hepatitis B, which extremely rarely cause adverse events and seem to have a safety profile similar to placebo the current therapy of hepatitis C is both less safe and not effective in everyone.
Read more here...

Healthy You

Mindfulness-Based Meditation May Help Reduce Inflammation

Mindfulness meditation techniques designed to reduce emotional reactivity also reduce poststress inflammatory responses and might be useful in chronic inflammatory conditions such as rheumatoid arthritis, psoriasis, inflammatory bowel disease, and asthma, according to a study by Melissa A. Rosenkranz, PhD, and colleagues at the University of Wisconsin-Madison.
Read more @ Medscape

Infectious flu particles reach as far as 6 feet

Bischoff W. J Infect Dis. 2013;doi:10.1093/infdis/jis773.
Patients in the hospital with influenza could potentially spread influenza virus particles as far as 6 feet by air, researchers from Wake Forest University have found, potentially exposing health care workers to small infectious particles.The CDC [and others] have expressed lack of knowledge and the urgent need for research in influenza virus transmission routes,” the researchers wrote in the Journal of Infectious Diseases. “CDC and WHO state that influenza virus transmission primarily occurs by large-particle respiratory droplets traveling within a short distance of the source and that such particles are blocked during encounters between patients and health care professionals.”
The researchers evaluated 94 patients with influenza-like illness who were admitted to the ED or inpatient care. The patients provided nasopharyngeal swab specimens, and the researchers evaluated air samples at distances of 1 foot, 3 feet and 6 feet from the patient’s head.

Sixty-one patients tested positive for influenza, and 26 of these patients released influenza virus into the room air. At all sample locations, the airborne 50% human infectious dose of influenza virus was surpassed. Health care workers were mainly exposed to small influenza virus particles, and the concentrations decreased as they went farther from the patient.

The release of influenza virus into the air was associated with higher nasopharyngeal viral load. Among patients with a higher viral load, coughing and sneezing were associated with increased influenza virus release. Five of the virus emitters released 32 times more influenza virus into the air, and these patients had more severe illness.

“We found that patients produced mostly small influenza virus-carrying particles during routine, non-aerosol-generating care activities,” the researchers wrote. “Health care professionals could be exposed to infectious doses of influenza virus at a distance of 6 feet from patients, with small particles potentially exceeding the suggested exposure zones. This raises concerns regarding the adequacy of protection afforded to health care professionals by the current recommendations during routine care.”

In an accompanying editorial, Caroline Breese Hall, MD, of the University of Rochester School of Medicine and Dentistry in New York, wrote that it is important to better understand influenza transmission, especially because global travel presents the risk for a worldwide influenza outbreak.
“A tenable conclusion from these findings is that infection control procedures should be commensurate with the concern generated by the clinical observations of the intensity and severity of the community outbreak,” she wrote.

Disclosure: The researchers report no relevant financial disclosures. Breese Hall has consulted for GlaxoSmithKline and MedImmune.
Read more @ Healio


February 2013 HCV Advocate
In This Issue:

HCV in Water, Containers and Filters
Alan Franciscus, Editor-in-Chief

HCV Snapshots
Lucinda K. Porter, RN

HealthWise: - The Happy Hepper
Lucinda K. Porter, RN

Liver Cancer in People with Hepatitis C: Part 1—Benefits of Antiviral Therapy
Liz Highleyman

New Phase III Interferon-Free Studies
Alan Franciscus, Editor-in-Chief

Personal Experiences

New @ Hepatitis C News

This week, we’ve been taking a closer look at I Help C, a moving and personal blog and resource from Karen Hoyt.
Read more.........

New @ Life Beyond Hepatitis C

Hep C Triple Therapy Experience from Hep C Warrior K: Part 3

Today we continue our interview with Hep C Warrior K and her Hep C Triple Therapy Experience

Connie: What has your blood work been like while on treatment?

Hep C Warrior K: I’ve been showing “Undetected” (virus count) since week 4. My white and red blood counts are getting better but not normal yet. I’ve had some changes with my thyroid and changed my thyroid medication.

Connie: How long is the course of your treatment with receiving Non-Detected virus count?

Hep C Warrior K: I started treatment August 19th 2012 and will finish February 2, 2013. The course of my treatment will be 6 months.
Read More......

New @ Lucinda Porter.Com

Twenty-Five Years of Living with Hepatitis C

On this date, twenty-five years ago, I received a life-saving blood transfusion, along with an unintended extra ingredient—hepatitis C. For twenty-five years, hepatitis C has been replicating in my liver every day. The miracle is that I am as healthy as I am.

New @  Hep B Blog

Preventable Loss of an Older Brother From Hepatitis B Related Liver Cancer

A frantic call from my sister-in-law shattered what would have otherwise been an enjoyable Labor Day weekend in 2010. She anxiously told me that my brother, Dan, would be undergoing an emergency procedure on his liver.
Read more.....

Off The Cuff

Supramap, a recently developed Web application, tracks the global movement of epidemics, offering a visual record of the evolution and spread of deadly diseases around the world.


  1. Wow - you are a Hep C Goddess (or is it Bloggess?)

  2. HAAA I watched your TED Talk on hepatitis C awareness and screening with my four year old grandson, incredible. My lttle guy thought you were pretty - I told him you're a really big movie star.