Saturday, September 2, 2017

Updates - Cochrane Rebuttal, Impact Of HCV Therapy On Fibrosis & OTC Pain Medications

September Newsletters & Blog Updates From Around The Web
Here is another look at must-read articles you might've missed over the last week.

Cochrane Rebuttal
As you may recall in July, a Cochrane Collaboration systematic review concluded achieving SVR (cure) for patients using hepatitis C direct-acting antivirals (DAAs) doesn't correlate with any long term benefits, a highly debated topic, check out each rebuttal, "here."

On Twitter
Sep 21, 2017
Tweeted by  Henry E. Chang: Recently, authors of Cochrane DAA review "changed" their conclusions but remain amazingly tone-deaf to what HCV community & experts are saying.

Click on image to enlarge

From the AGA Reading Room over at MedPage today, in this article: SVR Good Indicator of Hep C Treatment Benefit - just published; Experts blast Cochrane review suggesting inadequate evidence for effectiveness of direct-acting antivirals, read it here.

Recommended Reading
Treatment with DAAs reduces the risk of mortality in the first 18 months after the completion of treatment
Michael Carter
Published:10 August 2017
The study – published in Clinical Infectious Diseases – matched people who received therapy with all-DAA regimens with untreated controls. Mortality rates in the first 18 months after therapy were significantly lower among people who received DAAs. After controlling for other factors, treatment with DAAs was associated with a 57% reduction in the risk of death.

A recent Cochrane Collaboration systematic review concluded that, due to the lack of long-term follow-up studies, there was no evidence that DAAs prolonged life or reduced liver-related ill-health in people who achieved SVR to DAA treatment. The Cochrane review has been strongly criticised by European and United States associations of liver experts for ignoring the short-term nature of the studies of DAAS designed for registration and for ignoring previous evidence from the treatment of hepatitis C, which showed that achieving SVR to interferon-based treatment was associated with a reduction in the risk of death and liver disease......
Continue reading.....

In The Journals

Impact Of HCV Therapy On Fibrosis
In a prospective cohort study evidence suggest SVR (cure) using direct-acting antivirals (DAAs) is associated with regression of liver fibrosis, according to a study published in European Journal of Gastroenterology & Hepatology/Aug 29 2017; "Regression of liver fibrosis over a 24-wk period after completing direct-acting antiviral therapy in patients with HCV receiving care within the national hepatitis C elimination program in Georgia."

Achieving SVR using direct-acting antivirals (DAAs) is associated with regression in liver stiffness (LS), which could explain the clinical benefits associated with SVR. Our study also showed that irrespective of achieving SVR, liver damage will persist in a significant proportion of patients who had advanced fibrosis and cirrhosis at the time of HCV treatment initiation. Thus, early identification and treatment of patients with HCV infection can significantly prevent residual liver damage leading to the development of eventual hepatic complications.
LINK - Full text article
*PDF provided by Henry E. Chang via Twitter.

New Online

New England Journal Of Medicine
A Tale of Two Epidemics — HCV Treatment among Native Americans and Veterans
Brigg Reilley, M.P.H., and Jessica Leston, M.P.H.
PDF Download
Audio Interview
In light of ongoing debates about health care budgets and rising drug prices, a current public health crisis can provide useful insights. For patients who get their health care through two separate federal agencies, the hepatitis C virus (HCV) epidemic is unfolding in vastly different ways. In recent years, the Department of Veterans Affairs (VA) health care system has mounted a response to HCV that should be the envy of any health system, public or private. On the other hand, the Indian Health Service (IHS), an agency that serves American Indians and Alaska Natives, is struggling to meet the needs of its patients with HCV.
Continue reading....

New At Hepatitis C Online
Vosevi and Mavyret
Information on Gilead's newly FDA approved Vosevi and AbbVie's Mavyret is now available.

Australian recommendations for management of HCV have recently been updated.

Liver Health

Pharmacy Times
OTC Pain Medications: The Pros and Cons
AUGUST 30, 2017
Kathleen Kenny, PharmD, RPH
Two types of OTC pain medications are available. The first is acetaminophen (N-acetyl-p-aminophenol, or APAP), and the second is nonsteroidal anti-inflammatory drugs (NSAIDs), which include ibuprofen, naproxen, and aspirin.

Acetaminophen works by inhibiting the synthesis of prostaglandins, which help transmit pain signals and induce fever, thereby easing pain and lowering fever. Acetaminophen will not, however, reduce swelling and inflammation.5 Acetaminophen may be a good choice to treat headaches, arthritis pain, and fever.5 Certain patients should not take APAP, including those with liver disease, individuals taking blood thinners, people drinking three or more alcoholic beverages daily, and those with an allergy to APAP.6
Continue reading......

HCV Advocate
Acetaminophen and Your Liver
What does all this mean for people with chronic hepatitis B or C?
Doctors often recommend acetaminophen to relieve symptoms such as body aches and fever, which are common side effects of interferon therapy. For most people, acetaminophen is safe and effective. According to the FDA’s Dr. John Senior, “It’s very clear the average dose for the average person is very safe. But we are not all average people.” For many individuals, acetaminophen is still a good choice, especially considering that other over-the-counter pain relievers can cause problems of their own (such as stomach bleeding with aspirin and nonsteroidal anti-inflammatory drugs). Many HCV providers now recommend that their patients with HCV or other forms of liver disease take a somewhat lower dose than is generally recommended for people with healthy livers.
Continue reading.....

Of Interest
Harvard Heart Letter
Daily aspirin users 75 or older: Consider taking a stomach-protecting drug
Research we're watching

Roughly half of Americans ages 75 or older take a daily, low-dose aspirin to prevent a heart attack or stroke. New research suggests these people might benefit from taking a stomach-protecting drug to prevent a higher-than-expected risk of gastro-intestinal (GI) bleeding.

The study, published online June 13, 2017, by The Lancet, involved nearly 3,200 people who were prescribed aspirin because of a previous heart attack or stroke. Researchers followed them for up to 10 years to see how many were hospitalized for bleeding — a well-known side effect of aspirin use. Upper GI bleeding usually results from a stomach ulcer, which can cause anemia, heartburn, and abdominal pain.

The risk of serious GI bleeding was much higher among people ages 75 or older compared with people ages 65 or younger. But bleeding events were much less common in people taking prescription heartburn drugs called proton-pump inhibitors, such as omeprazole (Prilosec) and esomeprazole (Nexium). These drugs can reduce GI bleeding by as much as 90%, according to the study authors.

Blog Updates

HEP - Blog Updates
Hep is an award-winning print and online brand for people living with and affected by viral hepatitis. Offering unparalleled editorial excellence since 2010, Hep and Hep Magazine are the go-to source for educational and social support for people living with hepatitis.

Hepatitis C and Cirrhosis; Stages of Liver Damage
August 30, 2017 • By Connie M. Welch
Battle scars from hepatitis C. At times they can leave scars after going through a long journey with hepatitis C. No doubt each Hepatitis C patient transforms into a warrior on many fronts. Having hepatitis C is one of the leading causes for cirrhosis, cancer and liver transplants.

Sharing My Deepest Secrets
September 1, 2017 • By Carleen McGuffey
Like most people with Hepatitis-C I didn’t learn my status until decades after I had contracted the virus. By the time I was diagnosed I had changed my life so thoroughly that during the very few times I would even think about my wild years it would literally feel like I was considering a whole other person.

On Overdose Awareness Day, Let’s Choose Treatment Over Punishment
August 29, 2017 • By NVHR
People like Andrea Roberts, a 35-year-old mother of two children. Ms. Roberts had been incarcerated for about 6 weeks at LaPorte County Jail in Indiana, unable to afford bail, and had 2 weeks remaining until her release. Then, on July 15, 2017, a jail supervisor discovered her “unresponsive” in her cell. Within 30 minutes, after CPR was attempted, Ms. Roberts was pronounced dead.

To view a list of all bloggers please click here.

Médecins Sans Frontières/ Doctors Without Borders (MSF)
Médecins Sans Frontières(MSF) is an international, independent, medical humanitarian organisation. We offer assistance to people based on need, irrespective of race, religion, gender or political affiliation. Our actions are guided by medical ethics and the principles of neutrality and impartiality.

My name is Theresa Chan. I’m a family doctor and hospitalist from the United States. Working with MSF in the field has been a long-held dream. For most of 2017, I’ll be in Phnom Penh, Cambodia, where I’ll be working with a multi-national MSF staff to bring cutting-edge hepatitis C treatment to the people of Cambodia.

Fighting Hepatitis in Cambodia: Yellow as a Duck

'“This is the doctor,” said the son, pointing to me. The man in the bed made a weak attempt to greet me with his palms pressed together in the traditional Cambodian manner. “Hello,” I said, “may I listen to you?” He said yes. I listened to his faint breaths. He dozed off despite my prodding, the lids drawing like curtains over his yellow eyes.'

Cambodia: A Lot Happens On Our Days Off

Theresa is in Cambodia, where she's working at the Doctors without Borders / MSF hepatitis C clinic. She blogs about her tiniest patient so far, and why doctors are never entirely off duty...

At we empower patients and caregivers to take control of Hepatitis C by providing a platform to learn, educate, and connect with peers and healthcare professionals

Pain: The Invisible Symptom
September 1, 2017
Pain is one of the lesser known symptoms many living with hepatitis C or who have undergone treatment experience. Pain can range from muscles aches and joint pain to neuropathy.

Truth and Lies about Hepatitis C
By Karen Hoyt - September 1, 2017
There can be a lot of confusion when you are first diagnosed with the Hepatitis C Virus. It takes time to figure out what is the truth and what is a lie..

Tips for Choosing a Health Care Provider with Hep C
By Karen Hoyt
Do you have faith in your medical provider? Does it seem like they have your best interest at heart, or are you just a number to them? There are few relationships as...

View all blog updates, here.

Hepatitis B Foundation
The Hepatitis B Foundation is a national nonprofit organization dedicated to finding a cure for hepatitis B and helping to improve the lives of those affected worldwide through research, education and patient advocacy. Our monthly electronic newsletter, provides research updates, healthy liver tips, information on public health initiatives, and other HBF news.

Diagnosed with Hepatitis B? Preventing Transmission to Others Learning the HBV Basics, Transmission Part II
Part I discussed how hepatitis B is transmitted and may have helped you determine how you were infected with HBV.   In Part II we will discuss the people closest to you who may be susceptible to your infection.
Continue reading....

View all updates, here.

Creating a World Free of Hepatitis C
Welcome to my website and blog. My name is Lucinda Porter and I am a nurse committed to raising awareness about hepatitis C. I believe that we can create a world free of hepatitis C. We do this together, one step at a time.

New Healthcare Provider? Questions to Ask
Are you going to see a new healthcare provider? If so, you may have questions for her or him.

Acts More Powerful Than Hurricane Harvey
Recently, Hurricane Harvey flooded, buffeted, and devastated southeastern Texas and nearby coastal areas. Then Harvey moved eastward to cause more damage. The toll is enormous and continues to grow as those communities cope with Harvey’s wreckage. Many have donated money and time in response to these needs. However, there is more that you can do—be a blood, tissue and organ donor.

Just For Fun

MD Whistleblower
Michael Kirsch, M.D.
I am a full time practicing physician and writer. I write about the joys and challenges of medical practice including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When I'm not writing, I'm performing colonoscopies

Yikes! There's Food Stuck in My Throat! The Steakhouse Syndrome Explained
While I typically offer readers thoughts and commentary on the medical universe, or musings on politics, I am serving up some lighter fare today. Hopefully, unlike the patient highlighted below, you will be able to chew on, swallow and digest this post. If this blog had a category entitled, A Day in the Life of a Gastroenterologist, this piece would reside there.

View additional blog updates, here.

September Newsletters 
Whether you're looking for research, or easy-to-read articles on liver health, these newsletters reflect the most recent updates about viral hepatitis.

HCV Advocate
The HCV Advocate newsletter is a valuable resource designed to provide the hepatitis C community with monthly updates on events, clinical research, and education.

September Issue 
AbbVie’s Mavyret Approved.
Healthwise: Hepatitis C Is Threatening Our Youth
Under The Umbrella: Education in the HCV Treatment
Drug Pipeline


HCV Advocate Quick Links
Homepage - HCV Advocate
Homepage - HCV Medications Blog
News and Pipeline Blog - HCV Advocate
Homepage - Clinical Trials Reference Guide
Herbal Glossary
Homepage - HBV Advocate

Weekly Bull
HepCBC is a non-profit organization run by and for people infected and affected by hepatitis C. Our mission is to provide education, prevention and support to those living with HCV.

Latest Issue: Weekly Bull

The New York City Hepatitis C Task Force
The New York City Hepatitis C Task Force is a city-wide network of service providers and advocates concerned with hepatitis C and related issues. The groups come together to learn, share information and resources, network, and identify hepatitis C related needs in the community. Committees form to work on projects in order to meet needs identified by the community.

September Hep Free NYC Newsletter

HCV Action - UK
HCV Action brings together hepatitis C health professionals from across the patient pathway with the pharmaceutical industry and patient representatives to share expertise and good practice.

Public Health England has published its ninth annual Hepatitis C in the UK report, providing an update on the number of new hepatitis C infections and efforts to reduce mortality from HCV.

British Liver Trust
The British Liver Trust is the leading UK liver disease charity for adults – we provide information and support; increase awareness of how liver disease can be prevented and promote early diagnosis; fund and champion research and campaign for better services.

September Newsletter

News Updates
New research into end of life care for people with liver disease
Research published today has highlighted limitations in the care provided to people with advanced liver disease who are in the last year of life.

New study finds 86% of public support mandatory labelling on alcohol
As part of the Alcohol Health Alliance (AHA), the British Liver Trust has been …

Concerns over rise of substance misuse in “baby boomers”
A rise in alcohol and drug misuse among the over 50s (commonly known as “baby boomers”) is causing concern, warn experts. Researchers at South London …

The Hepatitis Foundation of New Zealand
The Hepatitis Foundation is a not-for-profit organisation which provides care for people living with hepatitis B. The Foundation provides a long-term follow-up programme for people living with chronic hepatitis B. This Programme provided Hepatitis B patients with ongoing monitoring and follow-up to help improve health outcomes.

Hepatitis symptom series: Depression and anxiety

Hep C Stories
James Story
I was diagnosed with hepatitis C in 2004. I had gone to my doctor because I was feeling a bit run down and he took some blood and put me on a vitamin supplement. At the time, I was working part time, studying full time and doing volunteer work. Being so busy, I had forgotten all about the blood test until I was contacted by the health department to inform me that I had been diagnosed hepatitis C positive and to get in touch with my doctor.

GI & Hepatology News
Over 17,000 gastroenterologists and hepatologists rely on GI & Hepatology News every month to cover the world of medicine with breaking news, on-site medical meeting coverage, and expert perspectives both in print and online. The official newspaper of the AGA Institute was launched in partnership with IMNG in January 2007.

View all newsletters, here.

Healthy You

In a study of sitting and walking ability that surveyed people ages 50 to 71 across 8 to 10 years, those who tended to sit the most and move the least had more than three times the risk of difficulty walking by the end of the study, when compared to their more active counterparts.

Some ended up unable to walk at all. The study appears in the current issue of The Journals of Gerontology: Medical Sciences.

Article here, listen below or here

Check back for updates, enjoy the rest of your weekend!

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