Saturday, March 17, 2018

TGIF Rewind: HCV and HCC, Tips For Kidney Health & Treating HCV According to Genotype

Its Friday! Do you have any plans for this weekend? Thinking I may go play with the grandkids pup, she's so cute! In any event here are a few updates on the topic of viral hepatitis.

Starting over at Healio, the March issue of HCV NEXT is out, with a feature on HCV treatment for people who inject drugs, the associated stigma, and critical need for awareness. Bloggers from around the web have been busy as well, Karen Hoyt is your resource for everything HCV, read her new article about kidney disease, filled with helpful tips; from labs to nutrition. Greg Jefferys writes about treatment options for each HCV genotype, his article is easy to understand, a must read, available online at Hep Blogs. Finally, a link is provided below to the following journal updates; Fatty liver disease & HCV (in case you missed it), and two articles on treatment for patients with HCV and HCC.

In The Journals
World J Gastroenterol. Mar 21, 2018; 24(11): 1269-1277
Published online Mar 21, 2018. doi: 10.3748/wjg.v24.i11.1269
Fatty liver in hepatitis C patients post-sustained virological response with direct-acting antivirals
This is the first prospective study to assess the prevalence of fatty liver in hepatitis C patients who have achieved a sustained virological response with direct-acting antivirals. The study’s findings that fatty liver is present in 47.5% of these patients and that some steatotic patients have clinically significant fibrosis despite normal liver enzymes should raise awareness of the post-sustained virological response (SVR) prevalence of fatty liver and the importance of post-SVR assessment of steatosis and fibrosis and long-term follow up with these patients.
Full text

On Twitter
The following full-text articles were downloaded and shared by Henry E. Chang via twitter.
Emerging data are demonstrating lower sustained virologic response (SVR) rates in patients with HCC compared with patients without HCC. Conflicting studies have also suggested that rates of HCC recurrence in patients with a history of HCC can potentially be increased or decreased on DAA therapy. This review will provide a brief overview of these data and inform practitioners on important considerations to make when prescribing DAA therapy for patients with HCV and HCC

Persistence of hepatocellular carcinoma risk in hepatitis C patients with a response to IFN & cirrhosis regression 
The finding that HCC developed also in SVR patients with cirrhosis regression (F3)greatly attenuates the need for refining the management of SVR patients in relation to residual liver fibrosis. The fact that regressed patients developed HCC later than non regressors deserves attention.....

March Updates On This Blog
Stagnation of fibrosis regression is associated with a high risk for HCC after SVR
Side effects associated with different hepatitis C direct-acting antiviral drugs
Dos and Don’ts in the Management of Cirrhosis: A View from the 21st Century
Higher levels of vitamin D is associated with a lower risk of liver cancer
March 2018 - Recruiting hepatitis C clinical trials

The following articles appeared in the March print edition of HCV NEXT, provided online at Healio.
Moving Beyond the Low-Hanging Fruit in HCV Diagnosis and Treatment
HCV Next, March/April 2018
The trouble in engaging difficult to reach populations is, well, that they are difficult to reach. The low-hanging fruit of diagnosing and treating people who have…

Treating People Who Inject Drugs:
HCV Next, March/April 2018
As a population, people who inject drugs have the highest prevalence and incidence of hepatitis C infection. Despite this, people who inject drugs have historically had…

Blog Updates
I Help C - Your Best Friends Guide to Hep
Karen Hoyt March 10, 2018
If you are going to drown your Hepatitis C or cirrhosis sorrows – do it with water. Kidney disease is not as silent as liver disease, but it sure will sneak up on you if you’re not taking precautions. If you were holding your breath out of fear, you can let it out now. Your kidneys do NOT get damaged quite like the liver if you take care of your kidneys. This post celebrates with Wisdom for World Kidney Day.

Hep Blogs
Hepatitis C Treatment Options
By Greg Jefferys
An explanation of the various hepatitis C treatment options for each genotype. 

Check out a new patient friendly video launched by Hepatitis C activist Greg Jefferys, with a look at current therapies used to treat the hepatitis C virus across all HCV genotypes.

On March 8, 2018, NVHR participated HHS’s webinar, Hidden Casualties: National Partners’ Response to the Opioid Epidemic and Infectious Diseases. Below is a transcript of NVHR’s portion of the webinar.

Creating a World Free of Hepatitis C
Who’s in Charge, You or Stress?
Lucinda Porter March 15, 2018 All of us have stress. Life is an unpredictable string of events, and sometimes it feels like a circus juggling act. Lily Tomlin said, “Reality is the leading cause of stress for those in touch with it.”

Scratching That Itch
By Kimberly Morgan Bossley - March 15, 2018
Scratching that itch that seems to never go away. You know the one that interrupts your daily activities and your sleep. Itchy and irritated This has always been a big issue with...

Does Hepatitis C Go Away On Its Own?
By Carleen McGuffey - March 14, 2018
Hepatitis C can go away spontaneously in approximately 20% of cases, but the majority of the time, hep C becomes a chronic infection.1 Its a very hardy virus. If you have ever...

Hepatitis C and Opioid Addictions
By Karen Hoyt - March 13, 2018
If you are under 40 and diagnosed with Hepatitis C, you probably have more problems than you know what to do with. If you got HCV through a dirty needle, there is...
The real cause of the opioid epidemic: the government
Rudolph, MD March 13, 2018
The patient The patient is a forty-two-year-old male who works in the auto manufacturing arena. He takes one step to his left, he turns and lifts a seventy-five-pound piece of metal from a moving conveyor belt. He turns back and takes one step to his right to put the metal on his table. He tightens three screws, lifts the metal off the table to take one step to his right, turning, ...

Harvard Health Blog
Monique Tello, MD, MPH March 16, 2018
A recently published clinical guideline on vitamin and mineral supplements reinforces every other evidence-based guideline, research review, and consensus statement on this topic. The bottom line is that there is absolutely no substitute for a well-balanced diet, which is the ideal source of the vitamins and minerals we need.

Hep B Blog
What to do about hepatitis B when you’re pregnant?
March 14, 2018 Around the world, the most common mode of hepatitis B transmission is from mother to child. Unfortunately, pregnant mothers who have hepatitis B can transmit the virus to their newborn during the delivery process. 90% of these HBV infected babies will progress to chronic infection putting them at increased risk of serious liver disease or liver cancer later in life.
March 7, 2018
Discrimination is unethical, unnecessary and a violation of human rights. Hepatitis B is simply not transmitted through casual contact. The stigma that persists is based on ignorance and it impacts millions around the world daily.

BMJ Opinion
Richard Lehman’s journal reviews—12 March 2018
March 12, 2018
Fatty liver: the untapped market
Nearly a third of men in the richest countries have fatty livers: women and middle-income countries are racing to catch up. How about that for a market? An unlucky few of these will develop fibrosis and of these an unlucky few will die of liver failure or hepatocellular carcinoma. So you have your advertising copy sorted too. But by the same token any drug given to such a vast number of people will have to be very safe and will need some very lengthy hard-end point trials. And there is an excellent cheap candidate drug already—pioglitazone, which can reverse cirrhosis as well as steatosis. But never mind all that. Let’s read about a 116-patient phase 2 trial of an injectable experimental drug, lasting 12 weeks. In that time, a third of the participants experienced diarrhoea and three-quarters lost more than 5% of their liver fat. “Larger clinical trials of longer duration are now needed to fully assess the safety and efficacy of NGM282.” Might The Lancet not have found better use for its space in the meantime?

ACP Internist Blog
Scoping out the reasons for overuse of colonoscopy
Michael Kirsch, MD, FACP
In our practice we have an open endoscopy system, as do most gastroenterologists. This means that other physicians or patients themselves can schedule a procedure with us without seeing us in advance for a consultation. Of course, we are always pleased to see any of these patients for an office visit in advance, but many patients prefer the convenience of accomplishing the mission in one stop. This is reasonable for patients who truly need our technical skill more than our medical advice.

Enjoy the upcoming weekend. 

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