Wednesday, February 28, 2018

Journal, and patient blog updates - Beyond one virus: vaccination against hepatitis B after hepatitis C treatment.

Read the latest journal and viral hepatitis updates from patient bloggers who work hard to educate and inspire us all.

HCV Advocate
HCV Advocate has just published their Monthly Newsletter, check out the latest "March issue."

Judy Stone
Given the experience in Indiana, which saw a spike in STDs, Hepatitis C and HIV, Walensky expects the HIV/Hepatitis C to “go up in lock-step with those” other sexually transmitted diseases. Walensky raised interesting points regarding HIV medications as well, noting “In the past 2-3 years, the cost of first line antiretroviral ...

Gilead Sciences Canada, Inc. (Gilead Canada) today recognizes the Ontario Ministry of Health and Long-Term Care for its leadership in the expansion of access to therapies that treat chronic hepatitis C virus infection under the Ontario Drug Benefit (ODB) Program. Today, all eligible ODB recipients will have greater access to treatment, regardless of the severity of disease (fibrosis level), to achieve a cure and improve their quality of life. Patients with chronic hepatitis C will no longer have to wait for their disease to progress before starting treatment.

Specialty Pharmacy Times
A study published by Clinical Infectious Diseases suggests that screening all adults for HCV may be cost-effective and could also identify more patients with the infection than current recommendations.

In The Journals
Volume 18, No. 3, p246–247, March 2018
New treatments for hepatitis C virus (HCV) infection with direct-acting antivirals provide an extraordinary cure rate. A recent Article by Xavier Forns and colleagues1 shows an outstanding 99% sustained virological response among all viral genotypes.

Developing a universal influenza vaccine — a vaccine that can provide durable protection for all age groups against multiple influenza strains, including those that might cause a pandemic — is a priority for the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. Writing in the Journal of Infectious Diseases, NIAID officials detail the Institute’s new strategic plan for addressing the research areas essential to creating a safe and effective universal influenza vaccine. They describe the scientific goals that will be supported to advance influenza vaccine development. The strategic plan builds upon a workshop NIAID convened in June 2017 that gathered scientists from academia, industry and government who developed criteria for defining a universal influenza vaccine, identified knowledge gaps, and delineated research strategies for addressing those gaps.

Journal Of Hepatology
«The times they are a’changin’» – Positioning the European Association for the Study of the Liver in the changing landscape of hepatology
Bob Dylan’s words hold relevance for several forces currently acting upon hepatology and the European Association for the Study of the Liver (EASL). The arrival of direct-acting antivirals, which marked the definitive transformation of hepatitis C virus infection into a curable disease with a new focus on public health represents only one of the changes. Fuelled by demographic changes of an ageing population, by migration movements in and beyond Europe, as well as by lifestyle changes and the explosion of the metabolic syndrome, other areas are in rapid expansion. The most pronounced of which are related to non-alcoholic fatty liver disease (NAFLD), hepatitis B virus infection, alcoholic disease and hepatocellular carcinoma (HCC). Moreover, tremendous dynamics in science and drug development now offer treatment options for patients with rare diseases that are also increasing in prevalence. Major trends at the societal level also have an impact on EASL.

Foster GR, et al. Hepatol. 2018;doi:10.1002/hep.29852.
February 27, 2018
Zepatier demonstrated high efficacy among patients with hepatitis C genotype 3, regardless of treatment experience or baseline resistance-associated substitutions, according to recently published data.

Healio Gastroenterology
Ira M. Jacobson, MD
The field of hepatology has seen revolutionary changes occuring within hepatitis C therapy over the past few years. This extraordinary newfound ability to cure almost all patients with chronic HCV raises many questions about clinical outcomes.

“Herbal and dietary supplement-induced liver injury is an increasing healthcare problem,” Lucena said. “The present study is a comprehensive analysis of all HILI cases reported to the Spanish DILI Registry to date. This study provides relevant information about clinical features associated with HILI, and highlights the importance of identifying all medicinal products, prescription drugs as well as herbal and dietary supplement products, taken by patients who develop liver abnormalities.”

Of Interest @ Healio
By some estimates, there are between 50,000 and 200,000 apps intended to serve a medical need. These apps claim to manage symptoms of depression, improve care in patients with irritable bowel disease, manage diabetes as well as help patients with a myriad of other medical uses.

Read today's news or a nice summary of notable headlines published in the latest issue of "The Weekly Bull."

Hepatitis B
AGA Blog
Gastroenterology and Clinical Gastroenterology and Hepatology.
Dr. Kristine Novak
NVR3–778, a capsid assembly modulator, reduces serum levels of hepatitis B virus (HBV) DNA and HBV RNA in mice with humanized livers and stable HBV infection, researchers report in the February issue of Gastroenterology. The combination of NVR3–778 and interferon prevented viral replication and HBV RNA particle production to a greater extent than....

Hep B Blog
Hepatitis B Foundation
February 28, 2018
Welcome to “Journey to the Cure” This is a web series that chronicles the progress at the Hepatitis B Foundation and Baruch S. Blumberg Institute towards finding the cure for hepatitis B.

Hepatitis C
In a recent publication in Clinical Infectious Diseases, CHERISH trainee Dr. Shashi Kapadia, CHERISH staff member Philip Jeng, CHERISH director Dr. Bruce Schackman and CHERISH research affiliate Dr. Yuhua Bao characterize variation in DAA utilization among states and explore the association between changes in Medicaid treatment eligibility criteria and trends in DAA utilization.

Life Beyond Hep C
Connie M. Welch
Hep C Patient John, shares his conquering story from hepatitis C, end stage liver disease, liver cancer and liver transplant. Connie: John, Thank you for being with us this week and sharing your awesome story of how you’ve come through this battle with liver disease.

Hep Blogs
By Connie M. Welch 
February 28, 2018 
The guiding principle of the national transplant system has been; locals first. Most organs stay in the areas where they are donated, even if sicker patients are waiting in other parts of the country.

Hep - Forums 
Welcome to the Hep Forums, a round-the-clock discussion area for people who have Hepatitis B, C or a co-infection, their friends and family and others with questions about hepatitis and liver health. Check in frequently to read what others have to say, post your comments, and hopefully learn more about how you can reach your own health goals.
By Kimberly Morgan Bossley
February 27, 2018
Working has always been my “thing” you can say. I started very young and have never not had a job or career. During the Spring of 2005, I was running three individual companies. All...

By Daryl Luster
February 26, 2018
Yes I know, a sensational title. I apologize for the dramatic tone. The thing is that we are inclined to do this bracing thing in preparation for storms, difficult events, or things...

By Kimberly Morgan Bossley
February 23, 2018
Stop complaining about your situation and start doing things to change it. How many times have we all heard this through our journey in life? I know for myself growing up it... - Forums
Talk about it - privately
Have questions? Want to talk about Hep C? Connect with others privately in our forums!

Nature Blogs
Amy Maxmen
Several vaccines and drugs for preventing the spread of HIV are showing signs of success in clinical trials, three decades after scientists began the search. But some researchers fear that progress will stall without a coordinated strategy to ensure that the most promising therapies to prevent infection win support from policymakers and reach the people who need them.

The new edition of "HIV update is now online."
Untreated hepatitis C can cause serious liver disease, including fibrosis (a build-up of fibrous scar tissue, leading to a ‘stiff’ liver) and cirrhosis (serious scarring that blocks blood flow through the liver, kills liver cells and interferes with liver function). The more advanced the fibrosis and cirrhosis, the greater the risk of serious illness and death. Successful hepatitis C treatment can clear the virus from the body. But less is known about its long-term impact on fibrosis or cirrhosis.

Women and Viral Hepatitis
A systematic review and meta-analysis revealed that maternal viral load among mothers with hepatitis B was a significant risk factor for mother-to-child transmission, and was dose-dependent with HBV transmission incidence.

Rates of hepatitis C infections are on the rise among adults in the United States, and some of those adults are pregnant women.

Healthy You
Stanford Medicine 
February 26, 2018
There's a wide debate surrounding the use of antidepressants. Do they really work? If so, how well? And how do you know which one to select?

Harvard Health
Christopher Bullock, MD, Carolyn A. Bernstein, MD, FAHS
Getting regular exercise is one of the best actions you can take to improve or maintain your overall health. Fitting exercise into your life is not as difficult as it might seem, but it does require some planning.

Also @ Harvard Health - Diet and depression

Tuesday February 27 2018
A new UK study investigated levels of inappropriate antibiotic prescribing by GPs in England. This was defined as prescribing antibiotics where guidelines say they're of little to no benefit.

Thanks for stopping by.

Ontario Expands Patient Access to Chronic Hepatitis C Therapies On Public Drug Plan

Ontario Expands Patient Access to Chronic Hepatitis C Therapies On Public Drug Plan

  • Gilead applauds Ontario's Ministry of Health for expanding access to curative hepatitis C therapies to all diagnosed patients, regardless of severity of illness
  • Ontario's expanded access includes EPCLUSA®, a 12 week treatment for patients with chronic hepatitis C across all six genotypes
  • Gilead's new product, VOSEVI™ is now available under the Ontario Drug Benefit Program
  • The removal of the fibrosis level criterion for access furthers Canada's commitment to the World Health Organization's Global Hepatitis C elimination efforts
MISSISSAUGA, ON, Feb. 28, 2018 /CNW/ - Gilead Sciences Canada, Inc. (Gilead Canada) today recognizes the Ontario Ministry of Health and Long-Term Care for its leadership in the expansion of access to therapies that treat chronic hepatitis C virus infection under the Ontario Drug Benefit (ODB) Program. Today, all eligible ODB recipients will have greater access to treatment, regardless of the severity of disease (fibrosis level), to achieve a cure and improve their quality of life. Patients with chronic hepatitis C will no longer have to wait for their disease to progress before starting treatment.

"Expanded access is an important milestone to achieve Canada's commitment to eliminating hepatitis C by 2030," said Kennet Brysting, General Manager of Gilead Canada. "Increasing hepatitis C treatment rates among patients and high-risk populations will help to reduce the burden of illness, the risk of transmission and the significant associated costs to the healthcare system."

Today's announcement will allow more patients to access a broad selection of therapies, including all those developed by Gilead Canada – EPCLUSA (velpatasvir/sofosbuvir), VOSEVI (voxilaprevir/velpatasvir/sofosbuvir), HARVONI® (ledipasvir/sofosbuvir) and SOVALDI® (sofosbuvir). EPCLUSA is a publicly accessible treatment that can be used for patients with hepatitis C infection across all six genotypes, and VOSEVI is approved for use in patients who have failed on a previous direct-acting antiviral (DAA) treatment regimen.

"Canada has committed to eliminating hepatitis C by 2030, and to accomplish this goal we need to significantly increase treatment rates," said Dr. Morris Sherman, Chairperson, Canadian Liver Foundation and hepatologist at Toronto General Hospital. "Treatment regimens are getting shorter, simpler and more widely effective across genotypes meaning that treatment is now easier for both patients and physicians to manage.

"Currently, an estimated 44 per cent still remain undiagnosed, so increasing treatment rates also requires improving screening and diagnosis, which is why the Canadian Liver Foundation recommends that everyone in Canada born between 1945 and 1975 receive a one-time test for hepatitis C," added Dr. Sherman. "Treatment should be an option for everyone, regardless of disease severity, where they live in the province or their ability to pay. We're glad to see that the Ontario government is taking steps to make treatments accessible for more Ontarians with chronic hepatitis C."

For more information on the expanded access for hepatitis C therapies and VOSEVI listing:

Tuesday, February 27, 2018

Opioid abuse leads to heroin use, hepatitis C epidemic

Opioid abuse leads to heroin use, hepatitis C epidemic

Increasing rates of opioid use in the U.S. have public health consequences like heroin usage and the spread of hepatitis C, USC researchers say.

Heroin is worse than other drugs because people inject it much sooner, potentially resulting in increased risk of injection-related epidemics such as hepatitis C and HIV, a Keck School of Medicine of USC study shows.

As more people use opioids, many switch to heroin because it’s more potent and cheaper — a trend that complicates disease prevention as health officials crack down on opioids, said Ricky Bluthenthal, PhD, first author of the study and professor of preventive medicine at the Keck School.

Stigmatizing drug use is an ineffective way to address a public health outbreak, he added.

“The market is saturated with opiates. That cat is out of the bag,” Bluthenthal said. “At this point, we have to figure out what we’re going to do about opioid abuse because the opioid crisis is leading to downstream infectious disease epidemics such as acute hepatitis C.”

Published in the journal Drug and Alcohol Dependence on Feb. 15, the study surveyed 776 people in Los Angeles and San Francisco about their drug use. Researchers limited the investigation to heroin, methamphetamine or speed, powder cocaine and crack cocaine.

About 99 percent of participants who used heroin, regardless of demographics, eventually injected the drug — nearly three times the injection rate of people who used crack cocaine. The second most injected drug was meth or speed, with 85 percent of users reporting that they moved to injection.

Heroin had the shortest incubation period — about half a year — from initial drug use to drug injection. It took meth and speed users about twice that time and powder cocaine users nearly five times that length of time to begin injecting.

“Heroin is less expensive than opioids and more potent,” Bluthenthal said. “So transitioning to heroin is reasonable. Heroin is much more efficient when injected, and that’s why we see this trend.”

On the road to a solution

As the nation tries to clamp down on the opioid epidemic, it may inadvertently drive people to heroin more quickly, Bluthenthal said. The real solution, he noted, is to get people better treatment for their opioid addiction.

From 2002 to 2015, there was a six-fold increase in the number of overdose deaths involving heroin, according to the National Institute on Drug Abuse.

Hepatitis C linked to injection drug use has increased three-fold over a 10-year period, the study stated, citing research from the University of Cincinnati Medical Center.

“We want to interrupt people from escalating their drug use from legal prescription opioids to illicit heroin use,” Bluthenthal said.

Possible solutions include drug consumption rooms, supervised injection facilities, syringe exchange programs, overdose prevention education and naloxone distribution, Bluthenthal said. Naloxone is an antidote for opioid overdose.

“We’re always trailing the epidemic: We don’t know there is a problem until the bodies and infections start showing up,” Bluthenthal said. “We now know people are moving from opioids to heroin to injection. We missed the opportunity to change that progression, so we need to move more aggressively to reduce opioid abuse and to implement safer venues to consume drugs. The end result will benefit public health.”

Daniel Chu and Thomas Valente from the Keck School of Medicine, Alex Kral and Lynn Wenger from RTI International and Philippe Bourgois from the David Geffen School of Medicine at UCLA also contributed to this study.

The study was entirely supported by federal grants amounting to $1,656,797 from the National Institute on Drug Abuse (R01DA027689, R01 DA038965) and the National Cancer Institute (P30CA014089).

— Zen Vuong

February 26th, 2018|Announcements, Keck Net Intranet

Monday, February 26, 2018

Podcast: What happens when a pregnant woman has hepatitis C

Host: Amber Smith

What happens when a pregnant woman has hepatitis C
Rates of hepatitis C infections are on the rise among adults in the United States, and some of those adults are pregnant women. Helene Bernstein, MD, PhD, explains how the disease can easily be diagnosed through a blood test and treated with medication. (Click here for a paper she published on this topic.) She’s an associate professor of obstetrics and gynecology and of microbiology and immunology at Upstate.

Listen here:
Podcast: Play in new window | Download
Thursday, February 22nd, 2018
Upstate University Hospital

Hepatitis B - Role of Age and Race in the Risk of Hepatocellular Carcinoma in Veterans

February's issue of Clinical Gastroenterology and Hepatology

Article Summary @ GastroHep

"In a sample of male veterans with chronic hepatitis B virus infection, risk of hepatocellular carcinoma is highest among Asian Pacific Islanders, followed by whites and African Americans."

"Cirrhosis increased hepatocellular carcinoma risk."

"Among patients without cirrhosis, male patients who are older than 40 years and have increased levels of alanine aminotransferase might benefit from hepatocellular carcinoma surveillance, regardless of race."

Role of Age and Race in the Risk of Hepatocellular Carcinoma in Veterans With Hepatitis B Virus Infection
Sahil Mittal, Jennifer R. Kramer, Ronald Omino, Maneerat Chayanupatkul, Peter A. Richardson, Hashem B. El-Serag, Fasiha Kanwal

Full Text
View Full Article Online

Background & Aims
Hepatocellular (HCC) surveillance guidelines for patients with chronic hepatitis B virus (HBV) infection are based on race- and age-specific estimates of HCC risk, derived from studies conducted in areas in which HBV is endemic.

We conducted a retrospective cohort study using the national Veterans Administration data to identify patients with chronic HBV infection from 2001 through 2013. We examined the effect of race and age on HCC risk while adjusting for baseline clinical characteristics.

The study cohort had 8329 patients; 3498 patients (42.0%) were white, 3248 (39%) were African Americans, and 659 (7.9%) were Asian Pacific Islanders. The annual HCC incidence was highest in Asian Pacific Islanders (0.65%), followed by whites (0.57%) and African Americans (0.40%). After adjusting for clinical and viral factors, the risk of HCC was significantly higher in Asian Pacific Islanders compared with whites (adjusted hazard ratio [HR] = 2.04; 95% CI, 1.31–3.17). There was no difference in HCC risk between African Americans and whites (adjusted HR, 0.77; 95% CI, 0.58–1.02). HCC risk increased with age: adjusted HR was 1.97 (95% CI, 0.99–3.87) for 40–49 years; adjusted HR was 3.00 (95% CI, 1.55–5.81) for 50–59 years; and adjusted HR was 4.02 (95% CI, 2.03–7.94) for more than 60 years vs less than 40 years. Patients with cirrhosis had higher risk of HCC than patients without cirrhosis (adjusted HR = 3.69; 95% CI, 2.82–4.83). However, even among patients without cirrhosis, the annual incidence of HCC was more than 0.2% for all patients older than 40 years with high levels of alanine aminotransferase—regardless of race.

In a sample of male veterans with chronic HBV infection, risk of HCC is highest among Asian Pacific Islanders, followed by whites and African Americans. Cirrhosis increased HCC risk. Among patients without cirrhosis, male patients who are older than 40 years and have increased levels of alanine aminotransferase might benefit from HCC surveillance, regardless of race.

Continue reading:

Sunday, February 25, 2018

All About The Flu & A Closer Look At Tamiflu

Thanks for stopping by, listen to Dr. William Schaffner answer your questions about the flu over at NPR's morning show, followed with news and research about this year's severe flu season.

February 25, 2018
The Call-In: All About The Flu
NPR's Lulu Garcia-Navarro poses listener questions about the flu to Dr. William Schaffner, infectious disease specialist at Vanderbilt University, and takes a closer look at Tamiflu.

News, Research & You 

Living Healthy with Hepatitis C
Over-the-Counter Remedies and Hepatitis C
Excessive acetaminophen (Tylenol) is the leading cause of acute liver failure in the U.S. Because of this, many people avoid taking acetaminophen, sometimes following their doctor’s recommendations. The big problem with acetaminophen is that it is added to many medications, including remedies for colds, headaches, pain, sleep, sinus problems, cough and menstrual discomfort. People may not know that they are taking acetaminophen, let alone too much of it.

For the second week in a row, there was a drop in doctor visits for flu-like illness in the United States. And the latest drop was more pronounced than the one before, the U.S. Centers for Disease Control and Prevention reported Friday.

Latest FluView report: flu activity has declined, but remains high and will likely continue for several more weeks. All U.S. states but Hawaii and Oregon continue to report widespread flu activity.

Studies have shown that early treatment with a flu antiviral drug can shorten the duration of fever and illness symptoms, and can reduce the risk of serious flu complications.

February 20, 2018
Madeline K. Sofia, Meredith Rizzo

Japan's New Drug: One Pill May Stop The Flu in Just One Day
Bruce Y. Lee
One day, you may be able to stop flu viruses in your body in just one day with just one pill. Based on an announcement yesterday, that day may be someday very soon in May in Japan.

Press Release
Flu vaccines: ACIP brings back FluMist for the 2018-2019 flu season
February 22, 2018
AstraZeneca announced yesterday that the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) has voted in favor of a renewed recommendation for the use of FLUMIST® QUADRIVALENT (Influenza Vaccine Live, Intranasal) in the US for the 2018-2019 season.

Science Daily 
Immune history influences vaccine effectiveness, interacting with other potential problems arising from the manufacturing process
Date: February 20, 2018
Source: University of Chicago Medical Center Summary: Researchers show that poor immune responses, not egg adaptions, may explain the low effectiveness of the vaccine that year.

Date: February 15, 2018
Source: Ann & Robert H. Lurie Children's Hospital of Chicago Summary: With this year’s severe flu season, one statistic is especially chilling. Each year, around 50 percent of all children under 5 years old who die from the flu were previously healthy. Adults who die from the flu, on the other hand, typically had a medical condition that increased their risk of mortality. A new study offers new insights as to why healthy children are much more vulnerable. It also opens new opportunities for treatment.

CDC Reports That Flu Vaccine Has Been 36% Effective This Season
While a new report has found that the flu vaccine has been just 36% effective this year, a recent study suggests that history of exposure to flu may, in part, be to blame.

FEB 14, 2018 | EINAV KEET
Influenza A (H3N2) has caused most of the illnesses in this severe flu season, but influenza B is becoming increasingly responsible for more infections as the flu season continues to hit the United States.

The Atlantic
Sarah Zhang
Jan 13, 2018
A strong virus, a less-than-effective vaccine, and an IV bag shortage that goes back to Hurricane Maria.

In The Journals
Published in the January 2018 issue of Influenza and Other Respiratory Viruses
Estimates of influenza disease burden are broadly useful for public health, helping national and local authorities monitor epidemiologic trends, plan and allocate resources, and promote influenza vaccination. Historically, estimates of the burden of seasonal influenza in the United States, focused mainly on influenza-related mortality and hospitalization, were generated every few years.

Stay Healthy!

Friday, February 23, 2018

Podcast Series: Diagnosis and Treatment Of Hepatitis C

In case you missed it, interesting podcast. 

Diagnosis and Treatment Of Hepatitis C
February 22, 2018

Hepatitis C (HCV) is the most-deadly infectious disease in America.

  • More than 20,000 die every year because of HCV
  • Half of people infected do not know that they have the virus
  • HCV can remain undetected for decades

HCV is curable, even among past and current drug users. You can help turn the tide. Learn how to screen (hint: it's easy) and how screening can save lives.

Treatment is now simpler, more effective, and shorter than ever. And it should be offered to nearly everyone with HCV, regardless of the level of cirrhosis.

Tune in to START HCV Radio Hour to listen and learn as our expert faculty explore important topics, using patient stories in an engaging moderated DKBmed Talk, modeled after the famous and popular TED Talks.

  • Learn how to detect HCV infection with a simple blood test
  • Become familiar with revolutionary new treatment options that cure 99% of people who use them
  • Prevent the spread of HCV and the morbidity and mortality that can follow

The expert faculty includes Mark Sulkowski, MD, professor of medicine and medical director of the Viral Hepatitis Center at the Johns Hopkins University School of Medicine; Alain Litwin, MD, professor of medicine at Albert Einstein College of Medicine in New York; Kathleen Brady, MD, Distinguished University Professor at the Medical University of South Carolina and Director of the South Carolina Clinical and Translational Research Institute; and Raymond Chung, MD, director of hepatology and the Liver Center at Massachusetts General Hospital in Boston.