HCV Weekend Reading- Liver Health, Coffee and Genotype 3

Welcome to this edition of weekend reading, today the topic is hepatitis C and liver health. No surprise here.

On this warm August day, information is just a click away. Maybe an article on fatty liver, nutrition, or the benefit of drinking coffee may tickle your fancy. Who says that? Tickle your fancy?

In any event, catch up on what you missed, or come back at your leisure to further investigate any article of interest.

Lucinda K. Porter, RN

After I was diagnosed with HCV, I found myself online researching hepatitis C, ways to improve my overall health and treatment options. My search often lead me to Lucinda K. Porter, RN., a well known author and HCV advocate. Lucinda has written two books, countless articles for HCV Advocate, and graces our community with weekly articles, found here, on her incredible blog.

Lucinda is to the HCV community - what a Coast Guard-approved life jacket - is to a non-swimmer. By arming our community with lifesaving knowledge, she has saved us from drowning in a deep pool of misguided information.

I admire Lucinda, not only for her beauty; I think she resembles Gwyneth Paltrow, and apparently her granddaughter has inherited her good looks, but for her devotion to the families, and people living with this serious life altering disease.

HCV Genotype 3 - Cirrhosis and Cancer

Let us begin with an article written by our lovely Lucinda, found in the August issue of HCV Advocate's newsletter. Lucinda writes about the increased risk of cirrhosis and cancer in persons with hepatitis C, and genotype 3, reported recently in the journal Hepatology. Other topics in the article include information on noninvasive tests for liver fibrosis. Please click here to review the article, a good read - to be sure.

Fatty Liver and Hepatitis C

In other research, HCV genotype 3 has been associated with a higher risk of fatty liver disease, all genotypes can trigger the condition, but people with genotype 3 have a higher risk at 60% - 80% for developing moderate or severe steatosis. Steatosis is extremely common in people with chronic hepatitis C, close to 40% of people with hepatitis C have steatosis, compared to about 14% to 31% of the general population.  For more information check out this full text article published in BioMed Research International, April 2013 issue, found here.

Diet and Hepatitis C

We know there isn't really a diet for people living with HCV, (outside cirrhosis) however, a 2013 study published in Nutrition found that HCV patients who participated in a diet and exercise program lowered their grade of steatosis and, remarkably, their fibrosis score.

The Mediterranean Diet and Liver Health

When I was much younger, dieting was easy, as I grew older that wasn't the case. Today, I follow the Mediterranean way of eating. Check this out, researchers from St. Vincent's Hospital, in Melbourne, compared the Mediterranean Diet to the National Heart Foundation Diet and found people who followed the Mediterranean Diet reduced liver fat, inflammation and significantly improved insulin sensitivity. Food for thought for people living with hepatitis C, pun was accidentally intended.

"Weight loss is difficult to achieve and maintain; however this has previously been the only accepted therapeutic strategy for NAFLD," said Dr. Ryan, "We have now demonstrated that adherence to the Mediterranean Diet can reduce liver fat, and improve insulin sensitivity, without weight loss, thus reducing the risk of development of liver disease and Type 2 Diabetes Mellitus."

The study was presented at AASLD 2011.

Mediterranean Diet, Hepatocellular Carcinoma and Viral Hepatitis
This is exciting, could the diet help against liver cancer? What about people with viral hepatitis? According to a study found in the Journal of Hepatology, November 2013, it may;

A closer adherence to the Mediterranean diet appears to be protective against HCC (liver cancer). Our results also point to potential benefits from adhering to a Mediterranean dietary pattern for patients chronically infected with hepatitis viruses.

Read the full article over at NATAP, abstract here.

Coffee - Drink Up
Following a healthy diet can be difficult, but for most people drinking coffee has become part of our daily ritual. Fortunately, that morning cup of stimulation may have beneficial effects on liver disease, hepatitis C, fatty liver, even improved SVR rates after peg-interferon combination therapy.

Side Note
Although, interferon is most certainly not our drug of choice. Like you, I am elated that some people have and will benefit from treating with Sovaldi - without interferon. Soon additional new interferon sparing agents to treat HCV will be available at a pharmacy near you.

Coffee and Liver Cirrhosis
Back to coffee, findings in the November 2009 issue of Hepatology suggest consuming two or more cups of coffee each day reduces the risk of death from liver cirrhosis by 66%, specifically cirrhosis caused by non-viral hepatitis.

In summary, in a prospective study of individuals with hepatitis C and bridging fibrosis or cirrhosis at baseline, we found a significant inverse association between regular coffee intake and liver disease progression.

Continue reading...

In case you missed it, this commentary, published in the April 2013 issue of Gastroenterology looks promising;

Excerpt; Is It Time to Write a Prescription for Coffee? Coffee and Liver Disease

Based on the available data from predominantly observational trials, there seems to be a clinical benefit of coffee consumption for those patients at risk of developing hepatic fibrosis either from NAFLD or viral hepatitis. Rates of liver cancer and the development of metabolic syndrome may also be improved with daily moderate filtered coffee intake. CGA and caffeine are the best candidates for beneficial effects on hepatic fibrosis, and cafestol and kahweol may reduce rates of HCC. It is unclear whether any of these benefits are significant enough to “treat” patients with chronic liver disease and further study is required with standard doses of each of these purported therapies in appropriately powered, multicenter, randomized, controlled trials with both biochemical and hepatic histology as endpoints. In the interim, moderate daily unsweetened coffee ingestion is a reasonable adjunct to therapy for NAFLD patients that often includes lifestyle modification with diet and exercise.

So What About Those Liver Enzymes and Coffee

Alanine Aminotransferase (ALT) and Aspartate aminotransferase (AST)

Keeping with 2013, Published online in PLOS ONE, a peer-reviewed, open-access, online publication, a study concluded; Patients with Hepatitis C-related liver disease, who have a higher consumption of coffee, have a lower rate of disease progression than those drinking less coffee. 

Here is an excerpt from the article; Effect of Caffeine-Containing Beverage Consumption on Serum Alanine Aminotransferase Levels in Patients with Chronic Hepatitis C Virus Infection: A Hospital-Based Cohort Study

Coffee is one of the most commonly consumed beverages in the world. Its health benefits including improved overall survival have been demonstrated in a variety of disease states. To examine the association of coffee consumption with liver disease, a systematic review of studies on the effects of coffee on liver associated laboratory tests, viral hepatitis, nonalcoholic fatty liver disease (NAFLD), cirrhosis and hepatocellular carcinoma (HCC) was performed. Coffee consumption was associated with improved serum gamma glutamyltransferase, aspartate aminotransferase (ALT) and alanine aminotransferase (AST) values in a dose dependent manner in individuals at risk for liver disease. In chronic liver disease patients who consume coffee, a decreased risk of progression to cirrhosis, a lowered mortality rate in cirrhosis patients, and a lowered rate of HCC development were observed. In chronic hepatitis C patients, coffee was associated with improved virologic responses to antiviral therapy. Moreover, coffee consumption was inversely related to the severity of steatohepatitis in patients with non-alcoholic fatty liver disease. Therefore, in patients with chronic liver disease, daily coffee consumption should be encouraged.

Full article....

From Medscape Gastroenterology published April 14, 2014

Can Coffee Treat Liver Disease?

Daily consumption of coffee appears to have an effect on developing fibrosis in some liver diseases, especially alcoholic liver disease and NAFLD. In addition to improving liver tests, such as GGT and ALT, coffee appears to inhibit the development of fibrosis in chronic hepatic inflammatory disorders. Whereas reduction of fibrosis and a potential effect on the outcome of patients with chronic HCV infection has been demonstrated, a similar benefit for the HBV-infected patient is not as clear. Additional studies of the effect of coffee on cirrhosis of HBV infection are needed.

Furthermore, coffee appears to reduce the risk for HCC in patients who are at risk for the disease. Once again, the evidence for any effect of coffee on HBV-related liver cancer needs additional study.

Whether the effect of coffee on liver disease is related to caffeine or some other agent in coffee is not clear. However, many studies have failed to show a significant effect of other caffeine-containing drinks, such as green or black tea, on reducing fibrosis or inhibiting the development of HCC. 

Although we have treatments for many forms of chronic liver disease, alcoholics who continue to consume ethanol-containing beverages and patients with NAFLD who are unable to control their associated causal factors might benefit from drinking 2 or more cups of regular coffee daily. Whether this should be a boiled or filtered coffee preparation is probably up to the wishes of the patient. However, this recommendation for coffee is obviously an unapproved indication, and reaching a stronger conclusion will require many more studies. A careful conversation with patients at risk is needed before giving this advice.

Continue to Medscape to read full article...

Once again, several studies has shown coffee has may help to prevent liver inflammation, which is often related to hepatitis C, cirrhosis, and liver cancer. In this August 2013 systematic review , published online in the April 2014 issue of Liver International, (download PDF here, HTML here) researchers investigated several studies assessing the effect of coffee on liver disease.

Excerpt from Healio; Studies indicate protective effects of coffee for liver disease.

Review of six studies assessing coffee’s impact on cirrhosis indicated a reduced risk for progression among patients with chronic liver disease. Cirrhotic patients who consumed coffee also were found to be at lower risk for death in two case-control studies, with a greater benefit among patients who reported drinking three or more cups daily.

Several studies of patients with chronic hepatitis C indicated improved outcomes among coffee drinkers, with associations observed between coffee and reduced fibrosis severity and disease progression, plus improved response to antiviral therapy.  

“While the aforementioned studies … suggest that coffee is useful as an alternative medicine in the treatment of the most common types of liver disease, blinded, randomized controlled trials must be performed,” the researchers wrote, adding that the primary use of observational and cross-sectional studies, the lack of demographic information, standardization of coffee cup size and data on consumption at multiple time points were study limitations.

The complete easy to read study summary can be found online, here. 

This brings us to our final 2014 study; Intake of Coffee and Caffeine are Associated with Decreased Risk of Hepatitis C-related Hepatic Fibrosis presented at Digestive Disease Week in Chicago, provided by NATAP, which reported that drinking coffee may offer a protective effect against advanced hepatic fibrosis in persons with hepatitis C.

In closing, we end up where we began, with Lucinda and HCV Advocate. Provided below are some articles of interest for anyone newly diagnosed, considering therapy, undergoing therapy or living with HCV, brought to you by Lucinda and Alan Franciscus, and the great staff at HCV Advocate.

Newly Diagnosed
New Medications and Who Will Pay For Them, by Jacques Chambers, CLU
Use of FibroScan® in clinical practice, by Maurizio Bonacini, MD

HCV Drug Pipeline

The Latest Hepatitis C Treatment Recommendations: Who Decides Your Future? by Lucinda K. Porter

HCV Treatment Side Effects: Photosensitivity, by Alan Franciscus

Current drugs to treat hepatitis C

You can find Lucinda on Facebook and Twitter, search for clinical trials, or read the latest news on HCV Advocate's website or blog. Connect with HCV Advocate on Facebook and Twitter.  In addition, NATAP can be found on Twitter as well, for current research on new drugs to treat HCV visit their website.

Enjoy this wonderful weekend! Until next time.

Always Tina