Monday, April 21, 2014

HCV Next - A Conversation with Douglas T. Dieterich, MD

The following articles appeared in the March/April 2014 print edition of  HCV Next at Healio.

Introducing our Chief Medical Editors

In this issue, you will read an in-depth cover story with expert opinion on the controversial costs of care surrounding implementation of the new approved direct-acting antiviral therapies. The feature article explores the debate between risk-based and universal HCV screening recommendations for baby boomers. HCV Next Editorial Board member Catherine T. Frenette, MD, and colleagues present an interesting Case Challenge about a patient with unique adverse events after receiving interferon therapy; Douglas T. Dieterich, MD, answers 5 questions about his life in and out of the office; and three HCV Next Editorial Board members provide their take on the most interesting news from CROI 2014.

5 Questions
A Conversation with Douglas T. Dieterich, MD
In this issue, HCV Next asks five questions of Douglas T. Dieterich, MD, professor of medicine in the division of liver diseases and director of continuing medical education at Icahn School of Medicine at Mount Sinai in New York. He maintains a triple appointment in the divisions of liver disease, gastroenterology and infectious diseases.

Case Challenges
An Interesting Case of Inclusion Body Myositis after 48-Week Treatment Course

Andrea Scherschel, MSN, FNP; William B. Minteer, BS; Catherine T. Frenette, MD
A 64-year-old male presents to the gastroenterology/hepatology clinic with chief complaints that included increased shortness of breath since stopping his interferon therapy, progressive lower-extremity weakness and dysphagia.

Cover Stories
DAA is $1,000 a pill; SVR is priceless 
The Price of a Cure
The new generation of direct-acting antiviral agents for the treatment of hepatitis C virus promise a potential cure for an estimated 3 million infected Americans, but also promise to come with a high price.

The therapies are making headlines in both the health care community and the mainstream media, largely for three reasons: the drugs’ unprecedented efficacy, attractive adverse event profiles and cost. Although recently approved drugs such as sofosbuvir (Sovaldi, Gilead Sciences) and simeprevir (Olysio, Janssen Therapeutics) have been hailed as groundbreaking therapies with high sustained virologic response rates, the costs are under scrutiny.

A Collaboration for Improved Care

Ira M. Jacobson, MD; Michael S. Saag, MD
Hepatitis C is a multi-faceted disease, with coinfections and rare comorbidities seen in patients that have necessitated a more collaborative approach to care. As each progressive stage of disease often requires the expertise of a different specialist, increased communication and the sharing of knowledge between gastroenterologists, hepatologists, and infectious disease specialists is the optimal approach to comprehensive HCV care. 

Calling All Baby Boomers: HCV Screening Slowly Takes Hold

“A one-time blood test for hepatitis C should be on every baby boomer’s medical checklist,” CDC director Thomas R. Frieden, MD, MPH, stated in a recent press release. “The new recommendations can protect the health of an entire generation of Americans and save thousands of lives.”

Simeprevir: A New NS3/4A Protease Inhibitor

Leah Molloy, PharmD
Several novel direct-acting antivirals are currently under development in the rapidly evolving field of hepatitis C virus treatment. The newest protease inhibitor, simeprevir, was approved for the treatment of HCV genotype 1 infection in November and appears to offer a significantly improved tolerability profile over 
the existing protease inhibitors boceprevir and telaprevir.

Patient Profile
Current Concepts on the Patient with HCV and Cryoglobulinemia

Sandeep T. Samuel, MD; Andrew H. Talal, MD, MPH; Anthony D. Martinez, MD
Among HCV-infected patients, 75% develop chronicity, which can lead to cirrhosis and hepatocellular carcinoma. The binding and replication of HCV in extra-hepatic sites, particularly lymphoid tissues and subsequent immune system modulation, is fundamental to the extra-hepatic manifestations of HCV infection such as mixed cryoglobulinemia, porphyria cutanea tarda, sicca syndrome, lichen planus and idiopathic thrombocytopenic purpura. 

The Take Home
The Take Home: CROI 2014
Meeting highlights and analysis from the Conference on Retroviruses and Opportunistic Infections.

Trend Watch
Sleep Disturbances Common for Patients with HCV

Chronic fatigue associated with hepatitis C virus is associated with poor sleep quality and increased nocturnal activity, leading researchers to suggest that there may be an alteration of sleep architecture behind fatigue in HCV-associated encephalopathy.

2.7 Million US Residents Have Chronic HCV Infection

Investigators for a new study estimated that approximately 2.7 million US residents have chronic hepatitis C virus, which is about 500,000 fewer than in a similar analysis between 1999 and 2002.

Researchers Identify HCV Surface Protein, Raise Hope for Vaccine

Scientists at Rutgers University and Emory University have identified the structure of a hepatitis C virus surface protein, a finding that could potentially further the development of a vaccine.

Liver Disease Persists in HIV/HCV Coinfection Despite Antiretroviral Therapy

Patients coinfected with HIV and hepatitis C virus have higher rates of liver compensation compared with patients with hepatitis C virus monoinfection, despite the use of antiretroviral therapy, according to recent study results.

Vantage Point 
Antiviral Therapy for HCV in Liver Transplant Candidates
Steven A. Gonzalez, MD, MS
The emergence of direct-acting antiviral therapy has transformed the management of chronic hepatitis C virus infection. The availability of telaprevir and boceprevir in 2012, followed recently by simeprevir (Olysio, Janssen Therapeutics) and sofosbuvir (Sovaldi, Gilead), has provided clinicians with more highly effective and well-tolerated treatment options. An important subgroup of patients who have historically experienced the greatest challenges in HCV therapy are those with cirrhosis awaiting liver transplantation. Although these individuals may have the most to gain by achieving viral eradication, they have also been faced with lower efficacy, poor tolerance and safety concerns while undergoing therapy.

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