This blog is all about current FDA approved drugs to treat the hepatitis C virus (HCV) with a focus on treating HCV according to genotype, using information extracted from peer-reviewed journals, liver meetings/conferences, and interactive learning activities.
Risk Of Developing Liver Cancer After HCV Treatment
Watch experts discuss important HCV related topics in this easy to access webinar series presented by HepCure.
June 26, 2018 Transplant & HCV
On Tuesday, June 26th, Dr. Thomas Schiano of Mount Sinai Medical Center presented on: “Transplant & HCV”
Watch, here….
Download Slides, here.....
June 19, 2018
Nonalcoholic Fatty Liver Disease and Hepatitis C
On June 19th Dr. Amon Asgharpour of the Icahn School of Medicine at Mount Sinai. Dr. Asgharpour presented “Nonalcoholic Fatty Liver Disease and Hepatitis C.”
Liver stiffness and liver fat (steatosis) in people with chronic hepatitis C virus (HCV) infection both improve significantly after treatment with direct-acting antivirals (DAAs) resulting in sustained virological response (SVR), investigators from Japan report in Alimentary Pharmacology and Therapeutics. Both measures of liver health were assessed six months after SVR. Improvement was associated with a reduction in ALT levels and an increase in platelet count.
In the July Issue of the patient-friendly HCV Advocate newsletter, Lucinda Porter, RN., writes a must read article about: Avoiding Fatty Liver.
June 2018
Hepatitis C and Alcohol
On Tuesday, June 5th, Peter Hauser, MD, Director of the National VA Telemental Health Hub Long Beach presented on: “Hepatitis C and Alcohol”.
May 2018 - HCV Treatment “Ace the Case”
Program presented last month led by Dr. Douglas Dieterich of the Icahn School of Medicine at Mount Sinai. This webinar is patient based, with question and answer participation.
Topics
Late relapse in people with HCC
Reinfection
Chemo On HCV
Treating Patients with HCV & Depression & More....
Watch, here.....
HCV in the Elderly Patient
On May 29th, Dr. Roxana Bodin of Westchester Medical Center Health presented on: “HCV in the Elderly Patient”
HepCure Patient App
The patient app is a free resource for patients with hepatitis C, which allows them to track medication adherence, symptoms, and gain access to resources. It is available to download for free on iOS (App Store) and Android (Google Play) operating systems. While the app can be used by patients independently from the dashboard, it can also be linked with the provider dashboard. Providers can push lab data to patients and track treatment adherence and symptom data input by patients in real time.
Learn more here...…
Study May Lessen Controversy Over DAAs’ Relationship to Liver Cancer
Washington—Eradication of chronic infection with the hepatitis C virus with the new class of antiviral agents is associated with a 71% reduction in the risk for de novo liver cancer, according to a large retrospective cohort study involving the Veterans Affairs health care system.
The findings should provide some assurance for patients taking direct-acting antivirals (DAAs), according to lead study author George Ioannou, BMBCh, MS, the director of hepatology at Veterans Affairs Puget Sound Health Care System, in Seattle.
This page offers an index of links to current data investigating the possible risk of developing liver cancer (hepatocellular carcinoma, or HCC) during and after direct-acting antiviral therapy in patients with hepatitis C.
HCV clearance by direct antiviral therapy and occurrence/recurrence of hepatocellular carcinoma: still an issue?
Francesco Paolo Russo, Martina Tessari, Angela Imondi, Erica Nicola Lynch, Fabio Farinati
Received: 4 May 2018 | First Decision: 15 May 2018 | Revised: 10 Jun 2018 | Accepted: 16 Jun 2018 | Published: 27 Jun 2018
In conclusion, the risk reduction in hepatic decompensation as well as in HCC incidence in patients achieving SVR is the only proven evidence. The reports about the increased risk of HCC occurrence/recurrence in DAA treated patients are afflicted by selection and methodologic biases, that weaken the impact of these studies. We strongly believe that is mandatory to treat HCV-infected patients with DAAs but also to maintain an active surveillance for liver cancer as the guidelines suggest; the previously presented data must be considered with caution.
New regimens with direct-acting antivirals (DAAs) agents have changed both efficacy and safety of hepatitis C virus (HCV)-treatment, as almost all patients can be treated and cured at any stage of liver disease. The rates of sustained virological response to currently available combinations exceed 95% in real-life practice. However, conflicting results have been produced on the occurrence/recurrence of hepatocellular carcinoma (HCC) in patients with HCV-associated cirrhosis treated with DAAs. In this review we analyse the data available in the literature in order to elucidate the impact of DAAs on the risk of HCC occurrence in patients without previous history of tumor, and of recurrence after successful treatment of the tumor. Data on “de novo” HCC incidence were quite homogeneous, suggesting that the treatment with DAAs does not modify the risk of HCC developing during the first 6-12 months after HCV eradication. On the contrary, HCC recurrence rates after DAAs were extremely variable across different studies, reflecting a large heterogeneity in this clinical setting. The possibility that treatment with DAAs may favour tumour growth and spread in individual patients with active HCC foci is supported by some observations but remains unproven.
World J Gastroenterol. Jun 28, 2018; 24(24): 2555-2566 Published online Jun 28, 2018. doi: 10.3748/wjg.v24.i24.2555 Hepatitis C virus infection in children in the era of direct-acting antiviral
Malgorzata Pawlowska, Malgorzata Sobolewska-Pilarczyk, Krzysztof Domagalski
Core tip: There are more than 11 million hepatitis C virus (HCV)-infected children worldwide. Most new HCV-infected cases have occurred through vertical transmission. Currently, a new era of highly effective direct-acting antiviral agents for the treatment of HCV infection has begun for pediatric patients. The first results of clinical trials with interferon-free therapy are very promising. ESPGHAN developed a position paper for the management of chronic HCV infection in children. Non-invasive methods to measure hepatic fibrosis enable the identification of patients with significant liver fibrosis. This article summarizes the current data on epidemiology, new therapies and non-invasive methods in pediatric patients with HCV infection.
MONDAY, June 25, 2018 -- For older patients with hepatitis C virus (HCV), direct-acting antiviral (DAA) therapy is effective, according to a study published online May 25 in the Journal of the American Geriatrics Society.
Chiara Mazzarelli, M.D., from King's College Hospital in London, and colleagues conducted a retrospective review involving individuals aged 65 years and older treated with DAA therapy for HCV. Participants were divided into two cohorts: 88 aged 65 to 74 years and 25 aged 75 years and older.
June 2018 · Liver international: official journal of the International Association for the Study of the Liver 06/2018; · DOI:10.1111/liv.13918
Review
Should we cure HCV in patients with hepatocellular carcinoma while treating cancer?
Giuseppe Cabibbo, Ciro Celsa, Calogero Cammà, Antonio Craxì
Direct acting antivirals (DAAs) stabilize or improve liver function in the majority of patients with HCV cirrhosis. Hepatic decompensation is the main driver of death of patients with early, successfully treated HCC superimposed to cirrhosis. Treatment with DAAs could improve the prognosis of these subjects, independently from the subsequent course of HCC, if the efficacy in obtaining viral clearance is as high as in patients without a history of HCC, and if the risk of HCC recurrence is unaffected. When dealing with HCC patients, DAAs can be indicated in two different settings: a) subjects in which HCC has been already successfully treated (“cured” HCC), or b) subjects whose HCC is still untreated or untreatable (“active” HCC). While there are abundant data on “cured” HCC, evidence supporting treatment decisions in patients with “active” HCC is at best scarce and controversial, since these patients as well as patients with HCC listed for liver transplantation (LT) are usually excluded from treatment.
Authorities in Ohio have officially declared a statewide hepatitis A outbreak following the confirmation of 79 hepatitis A cases this year, which is already almost double the number of confirmed cases the entire previous year. Montgomery County has the most cases in the state with 17 confirmed cases, followed by Lawrence with 12 cases, and Lucas with 10. Continue reading..
Links
CDC Hepatitis A Questions and Answers for the Public
I think I have been exposed to hepatitis A. What should I do?
If you have any questions about potential exposure to hepatitis A, call your health professional or your local or state health department. If you were recently exposed to hepatitis A virus and have not been vaccinated against hepatitis A, you might benefit from an injection of either immune globulin or hepatitis A vaccine. However, the vaccine or immune globulin are only effective if given within the first 2 weeks after exposure. A health professional can decide what is best based on your age and overall health.
The National Comprehensive Cancer Network (NCCN), a not-for-profit alliance of 25 of the world's leading cancer centers devoted to patient care, research, and education, is dedicated to improving the quality, effectiveness, and efficiency of cancer care so that patients can live better lives. The intent of the NCCN Guidelines is to assist in the decision-making process of individuals involved in cancer care-including physicians, nurses, pharmacists, payers, patients, and their families-with the ultimate goal of advancing patient care in the fight against cancer.
The National Comprehensive Cancer Network (NCCN) has released a new guideline for liver, gallbladder, and bile duct cancers to assist patients in understanding their treatment decisions.
The new edition of the NCCN Guidelines for Patients reformats the evidence-based treatment recommendations from the NCCN Clinical Practice Guidelines and creates a patient-friendly version.
These step-by-step guides to the latest advances in cancer care, feature:
Questions to ask your doctors
Patient-friendly illustrations
Glossaries of terms and acronyms
"An essential element of patient empowerment is accessible, actionable, high-quality information," said Donna R Cryer, JD, President & CEO, Global Liver Institute, in a press release (June 19, 2018). The Institute provided sponsorship for the new guidelines for patients. "The Global Liver Institute is proud to work with NCCN to provide this information to support liver and bile duct cancer patients and their families in the hope that together we can make the cancer journey easier and more successful."
Incidence and deaths related to liver cancer are increasing globally, which correlates with rising rates of hepatitis B and hepatitis C infections, the latter of which is often a precursor to liver cancer. Additionally, metabolic disorders are associated with an increased risk of liver cancer. There are many treatment options for patients with hepatobiliary cancer to consider, including liver transplantation, surgery, radiation, ablation or embolization, and drug therapy.
"When people are diagnosed with liver cancer, they hope their doctor will be able to present them with a definitive best course of action, but there are often multiple treatments from which to choose,” explained Al B Benson III, MD, Robert H Lurie Comprehensive Cancer Center, Northwestern University. Dr Benson is the chair of the NCCN guidelines panel for hepatobiliary cancers. “The best choice for any given individual has to take into account their disease status, symptoms, lab results, and, of course, personal preferences.”
SOF/VEL and Resistance-associated Substitutions in HCV GT3
Alimentary Pharmacology & Therapeutics, June 21, 2018
J. von Felden; J. Vermehren; P. Ingiliz; S. Mauss; T. Lutz; K. G. Simon; H. W. Busch; A. Baumgarten; K. Schewe; D. Hueppe; C. Boesecke; J. K. Rockstroh; M. Daeumer; N. Luebke; J. Timm; J. Schulze zur Wiesch; C. Sarrazin; S. Christensen
Does the presence of resistance-associated substitutions impact the efficacy of therapy with sofosbuvir/velpatasvir with or without ribavirin in patients with HCV genotype 3?
Medscape - Full Text
Abstract and Introduction
Abstract
Background Twelve weeks of the pangenotypic direct–acting antiviral (DAA) combination sofosbuvir/velpatasvir (SOF/VEL) was highly efficient in patients with hepatitis C virus (HCV) genotype 3 (GT3) infection in the ASTRAL–3 approval study. However, presence of resistance–associated substitutions (RASs) in the HCV nonstructural protein 5A (NS5A) was associated with lower treatment response.
Aim To assess the efficacy and safety of SOF/VEL ± ribavirin (RBV) and the impact of NS5A RASs and RBV use on treatment outcome in HCV GT3 infection in a real–world setting.
Cost of illness of hepatocellular carcinoma in Japan: A time trend and future projections
Kunichika Matsumoto,
Yinghui Wu,
Takefumi Kitazawa,
Shigeru Fujita,
Kanako Seto,
Tomonori Hasegawa
HCC using the cost of illness (COI) of HCC has been decreasing since 1996. Treatment of patients infected with hepatitis C virus using newly introduced technologies has high therapeutic effectiveness, and will affect the future prevalence of HCC. These policies and technologies may accelerate the downward tendency of COI, and the relative economic burden of HCC is likely to continue to decrease.
Abstract
Background
Hepatocellular carcinoma (HCC) is the fifth leading cause of death in Japan. The aim of this study was to calculate the social burden of HCC using the cost of illness (COI) method, and to identify the key factors driving changes in the economic burden of HCC.
Methods
Utilizing government-based statistical nationwide data, the cost of illness (COI) method was used to estimate the COI for 1996, 1999, 2002, 2005, 2008, and 2014 to make predictions for 2017, 2020, 2023, 2026, and 2029. The COI comprised direct and indirect costs (morbidity and mortality costs) of HCC.
Results
From 1996 to 2014, COI trended downward. In 2014, COI (579.2 billion JPY) was 0.71 times greater than that in 1996 (816.2 billion JPY). Mortality costs accounted for more than 70% of total COI and were a major contributing factor to the decrease in COI. It was predicted that COI would continue a downward trend until 2029, and that the rate of decline would be similar.
Conclusions
COI of HCC has been decreasing since 1996. Treatment of patients infected with hepatitis C virus using newly introduced technologies has high therapeutic effectiveness, and will affect the future prevalence of HCC. These policies and technologies may accelerate the downward tendency of COI, and the relative economic burden of HCC is likely to continue to decrease. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199188
7 in 10 people with liver disease in the UK don’t even know they have it
Although over 60,000 adults in the UK have cirrhosis (scarring) of the liver, nearly 75% percent don't know it, according to research published in the Lancet. For many, the first indication is following admission to Accident and Emergency when the disease is advanced and chance of survival is very low. This week, 18th to 24th June, is Love Your Liver week, and the British Liver Trust has launched a new version of an online screening tool so that people can find out if they are at risk.
Although over 60,000 adults in the UK have cirrhosis (scarring) of the liver, nearly 75% percent don't know it, according to research published in the Lancet. For many, the first indication is following admission to Accident and Emergency when the disease is advanced and chance of survival is very low. This week, 18th to 24th June, is Love Your Liver week, and the British Liver Trust has launched a new version of an online screening tool so that people can find out if they are at risk.
Liver disease is one of the leading causes of premature death in England and is responsible for more than 1 in 10 deaths of people in their 40s.
Professor Nick Sheron, a liver expert from the University of Southampton involved in the research, said: "Liver disease develops silently with no signs or symptoms and is the second leading cause of years or working life lost. If current trends continue it become the leading cause of premature mortality in the UK. Yet, most people with fatal advanced liver disease only become aware that they have a liver problem when they are admitted as an emergency. We MUST diagnose these people much earlier."
Liver problems develop silently with no obvious symptoms in the early stages yet the disease is largely preventable through lifestyle changes. The Love Your Liver awareness campaign, promoted by the British Liver Trust, aims to reach the one in five people in the UK who may have the early stages of liver disease, but are unaware of it.
More than 90% of liver disease is due to three main risk factors: obesity, alcohol and viral hepatitis.
Judi Rhys, Chief Executive, British Liver Trust said, “Helping people understand how to reduce their risk of liver damage is vital to address the increase in deaths from liver disease. Although the liver is remarkably resilient, if left too late damage is often irreversible. I would urge everyone to take our online screener on our website to see if they are at risk.”
The British Liver Trust’s Love Your Liver campaign focuses on three simple steps to Love Your Liver back to health:
- Drink within recommended limits and have three consecutive alcohol-free days every week
- Cut down on sugar, carbohydrates and fat and take more exercise
- Know the risk factors for viral hepatitis and get tested or vaccinated if at risk
Finding out your risk of liver disease only takes a few minutes. It could be the most important thing you do today. Take the British Liver Trust’s screener here
Liver disease is one of the leading causes of premature death in England and is responsible for more than 1 in 10 deaths of people in their 40s.
Professor Nick Sheron, a liver expert from the University of Southampton involved in the research, said: "Liver disease develops silently with no signs or symptoms and is the second leading cause of years or working life lost. If current trends continue it become the leading cause of premature mortality in the UK. Yet, most people with fatal advanced liver disease only become aware that they have a liver problem when they are admitted as an emergency. We MUST diagnose these people much earlier."
Liver problems develop silently with no obvious symptoms in the early stages yet the disease is largely preventable through lifestyle changes. The Love Your Liver awareness campaign, promoted by the British Liver Trust, aims to reach the one in five people in the UK who may have the early stages of liver disease, but are unaware of it.
More than 90% of liver disease is due to three main risk factors: obesity, alcohol and viral hepatitis.
Judi Rhys, Chief Executive, British Liver Trust said, “Helping people understand how to reduce their risk of liver damage is vital to address the increase in deaths from liver disease. Although the liver is remarkably resilient, if left too late damage is often irreversible. I would urge everyone to take our online screener on our website to see if they are at risk.”
Finding out your risk of liver disease only takes a few minutes. It could be the most important thing you do today. Take the British Liver Trust’s screener here
Methadone and buprenorphine reduce risk of death after opioid overdose NIH research confirms effective treatments for opioid use disorder are underutilized.
A National Institutes of Health-funded study found that treatment of opioid use disorder with either methadone or buprenorphine following a nonfatal opioid overdose is associated with significant reductions in opioid related mortality. The research, published today (link is external) in the Annals of Internal Medicine, was co-funded by the National Institute on Drug Abuse (NIDA) and the National Center for Advancing Translational Sciences, both parts of NIH.
Study authors analyzed data from 17,568 adults in Massachusetts who survived an opioid overdose between 2012 and 2014. Compared to those not receiving medication assisted treatment, opioid overdose deaths decreased by 59 percent for those receiving methadone and 38 percent for those receiving buprenorphine over the 12 month follow-up period. The authors were unable to draw conclusions about the impact of naltrexone due to small sample size, noting that further work is needed with larger samples. Buprenorphine, methadone, and naltrexone are three FDA-approved medications used to treat opioid use disorder (OUD).
The study, the first to look at the association between using medication to treat OUD and mortality among patients experiencing a nonfatal opioid overdose, confirms previous research on the role methadone and buprenorphine can play to effectively treat OUD and prevent future deaths from overdose.
Despite compelling evidence that medication assisted treatment can help many people recover from opioid addiction, these proven medications remain greatly underutilized. The study also found that in the first year following an overdose, less than one third of patients were provided any medication for OUD, including methadone (11 percent); buprenorphine (17 percent); and naltrexone (6 percent), with 5 percent receiving more than one medication.
In an editorial commenting on the study, Dr. Nora Volkow, director of NIDA, said, “A great part of the tragedy of this opioid crisis is that, unlike in previous such crises America has seen, we now possess effective treatment strategies that could address it and save many lives, yet tens of thousands of people die each year because they have not received these treatments. Ending the crisis will require changing policies to make these medications more accessible and educating primary care and emergency providers, among others, that opioid addiction is a medical illness that must be treated aggressively with the effective tools that are available.” The editorial was co-authored by NIDA scientist Dr. Eric Wargo.
Another alarming study finding was that despite having had an opioid overdose, 34 percent of people who experienced an overdose were subsequently prescribed one or more prescriptions for opioid painkillers over the next 12 months, and 26 percent were prescribed benzodiazepines.
“Nonfatal opioid overdose is a missed opportunity to engage individuals at high risk of death,” said Marc Larochelle, M.D., the study’s lead investigator at Boston Medical Center’s Grayken Center for Addiction and Boston University School of Medicine. “We need to better understand barriers to treatment access and implement policy and practice reforms to improve both engagement and retention in effective treatment.”
The authors conclude that a nonfatal opioid overdose treated in the emergency department is a critical time to identify people with OUD, and an opportunity to offer patients access to treatment inventions, providing linkage to care following their discharge, and making improvements in treatment retention.
PLoS ONE 13(6): e0198336. Hepatitis C virus notification rates in Australia are highest in socioeconomically disadvantaged areas
Samuel W. Hainsworth, Paul M. Dietze,David P. Wilson, Brett Sutton, Margaret E. Hellard, Nick Scott
High-coverage treatment scale-up is required if Australia is to eliminate HCV as a public health threat, and this scale-up is necessary now if we are to achieve the WHO elimination targets by 2030. While this is only a preliminary analysis of the HCV burden, the findings provide important information for service prioritisation and planning, highlighting that the per capita burden of HCV is greatest in socioeconomically disadvantaged areas and the unmet demand for HCV services is greatest in geographic areas outside major cities. Our results suggest that strategies for HCV prevention and treatment in Australia would benefit from considering these factors. Any future research which has access to testing and treatment data could provide greater insight for the development of needs-based service planning. Despite this, the data used in our analysis are routinely available demographic and health service data, meaning that our analysis can serve as a useful framework for the ongoing monitoring of Australia’s efforts to eliminate HCV. Additionally, a similar framework for service planning could be employed in other countries wanting to scale up HCV testing and treatment in an effort to achieve HCV elimination.
Abstract
Background
Poor access to health services is a significant barrier to achieving the World Health Organization’s hepatitis C virus (HCV) elimination targets. We demonstrate how geospatial analysis can be performed with commonly available data to identify areas with the greatest unmet demand for HCV services.
Methods
We performed an Australia-wide cross-sectional analysis of 2015 HCV notification rates using local government areas (LGAs) as our unit of analysis. A zero-inflated negative binomial regression was used to determine associations between notification rates and socioeconomic/demographic factors, health service and geographic remoteness area (RA) classification variables. Additionally, component scores were extracted from a principal component analysis (PCA) of the healthcare service variables to provide rankings of relative service coverage and unmet demand across Australia.
Results
Among LGAs with non-zero notifications, higher rates were associated with areas that had increased socioeconomic disadvantage, more needle and syringe services (incidence rate ratio [IRR] 1.022; 95%CI 1.001, 1.044) and more alcohol and other drug services (IRR 1.019; 1.005, 1.034). The distribution of PCA component scores indicated that per-capita healthcare service coverage was lower in areas outside of major Australian cities. Areas outside of major cities also contained 94% of LGAs in the lowest two socioeconomic quintiles, as well as 35% of HCV notifications despite only representing 29% of the population.
Conclusions
As countries aim for HCV elimination, routinely collected data can be used to identify geographical areas for priority service delivery. In Australia, the unmet demand for HCV treatment services is greatest in socioeconomically disadvantaged and non-metropolitan areas.
With DAA therapy as the new standard of care, the HCV cascade of care (CoC) has transformed, still plagued by challenges in linkage to care yet substantially improved with regards to treatment outcomes. Interventions to emphasize screening, linkage to care, and access to treatment may address some of these challenges. Though DAA agents remain expensive for all groups, efforts to enhance and improve access across payer groups should be pursued. Integration of pharmacy services demonstrated high rates of medication access compared to previous studies, even in those with Medicaid. With new medications and modern tools, HCV treatment can be well-tolerated, effective, and result in high rates of completion.
Barriers remain in the hepatitis C virus (HCV) cascade of care (CoC), limiting the overall impact of direct acting antivirals. This study examines movement between the stages of the HCV CoC and identifies reasons why patients and specific patient populations fail to advance through care in a real world population. We performed a single-center, ambispective cohort study of patients receiving care in an outpatient infectious diseases clinic between October 2015 and September 2016. Patients were followed from treatment referral through sustained virologic response. Univariate and multivariate analyses were performed to identify factors related to completion of each step of the CoC. Of 187 patients meeting inclusion criteria, 120 (64%) completed an evaluation for HCV treatment, 119 (64%) were prescribed treatment, 114 (61%) were approved for treatment, 113 (60%) initiated treatment, 107 (57%) completed treatment, and 100 (53%) achieved a sustained virologic response. In univariate and multivariate analyses, patients with Medicaid insurance were less likely to complete an evaluation and were less likely to be approved for treatment. Treatment completion and SVR rates are much improved from historical CoC reports. However, linkage to care following referral continues to be a formidable challenge for the HCV CoC in the DAA era. Ongoing efforts should focus on linkage to care to capitalize on DAA treatment advances and improving access for patients with Medicaid insurance.
What Is NAFLD?
Non-alcoholic fatty liver disease (NAFLD) is the build up of extra fat in liver cells that is not caused by alcohol. It is normal for the liver to contain some fat. However, if more than 5% – 10% percent of the liver’s weight is fat, then it is called a fatty liver (steatosis), learn more, here
While the burden of liver disease from HCV decreases - lowering the number of patients waiting or undergoing liver transplant - the waitlist for nonalcoholic steatohepatitis (NASH) has increased. In addition, NASH is the Fastest Growing Cause of Hepatocellular Carcinoma in Liver Transplant Candidates.
Research Articles:
The Effects of Physical Exercise on Fatty Liver Disease
For people with HCV (without fatty liver disease) research shows weight reduction leads to a decrease in steatosis and liver enzymes, and also to an improvement in fibrosis, despite persistence of the virus. Previous research also indicates HCV patients who participated in a diet and exercise program lowered their grade of steatosis and remarkably their fibrosis score, according to a study published in Nutrition 2013. Whether you have fatty liver disease, HCV or both read; The Effects of Physical Exercise on Fatty Liver Disease, published in Gene Expression 2018, to learn more about the effects of exercise on NAFLD and NASH.
"NAFLD is most prominently linked to chronic kidney disease, mellitus type 2 and cardiovascular disease, as well as a number of other severe chronic diseases. These findings demonstrate that NAFLD ranks amongst the most serious public health problems of our time."
Also noted in the article, prevalence of Nonalcoholic Steatohepatitis (NASH) in people who are obese and have type 2 diabetes may be as high as 40%, whereas it is less than 5% in people without type 2 diabetes.
NAFLD is the most common form of liver disease in Western countries.[4] Men are affected more than women.[5] Persons with a "high body mass index in late adolescence" are at risk for advanced liver disease and hepatocellular carcinoma (HCC)..
The term "NAFLD" describes both hepatic steatosis with hepatocyte fat accumulation in a liver lacking inflammation, whereas NASH is associated with fat accumulation, hepatic inflammation, and hepatocyte injury with or without fibrosis or cirrhosis..
Not every patient with NAFLD is obese. Seven percent of lean patients have NAFLD,[18] especially in the presence of metabolic syndrome.[19] Lean patients with fatty liver also are observed among those with polycystic ovary syndrome.[20] Compared with lean patients, obese patients with NAFLD are more likely to have greater fibrosis and a worse clinical prognosis.[21] Nonobese patients with NAFLD have a lower prevalence of hypertension, diabetes mellitus, metabolic syndrome, and steatohepatitis than obese patients[22] but remain at risk for development of advanced liver disease[23] and associated metabolic abnormalities and cardiovascular disease.[22]
Continue reading @ Medscape Free registration may be required.
2017
The International Liver Congress 2017 NASH: It's Fibrosis, Not Fat, that Matters
Analysis sheds new light on what drives disease progression
AMSTERDAM -- It isn't fat but rather fibrosis that drives disease progression in people with advanced non-alcoholic steatohepatitis (NASH), a researcher said here Continue reading....
Free registration may be required.
2017
HCV & Steatosis
Given the development of steatosis is well-known in people with HCV, the following articles may be of interest to you, lets start with an article published in Clinical Liver Disease 2017; Metabolic Manifestations of Hepatitis C Virus
Out of excessive consumption, steatosis should be classified into 2 types according to hepatitis C virus (HCV) genotypes: metabolic steatosis, which is associated with features of metabolic syndrome and insulin resistance in patients infected with nongenotype 3, and viral steatosis, which is correlated with viral load and hyperlipemia in patients infected with genotype 3.
Treatment for hepatitis C genotype 3 infection can be completed in 8 weeks in people without cirrhosis, three real-world studies presented at the conference confirmed.
2018
Fatty liver is very common in hepatitis C virus (HCV) patients post-SVR
According to data published March 21, 2018 in the online journal World J Gastroenterology, evidence of steatosis was reported to be found in close to half of patients who achieve a sustained virologic response after treating with direct-acting antivirals.
Core tip: 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.
"NASH is currently the second leading cause for LT waitlist registration/liver transplantation overall, and in females, the leading cause. Given the rate of increase, NASH will likely rise to become the leading indication for LT in males as well" according to a June 2018 study published in The American Journal of Gastroenterology. Videos
7 sequences about NASH
On June 12, 2018, the 1st International NASH Day was launched by The NASH Education Program, along with their seven part educational program to help patients understand this serious liver disease. Listen to expert interviews, learn about symptoms, non-invasive tests used to measure liver inflammation and fibrosis, and hear from patients struggling with the disease.
NASH What Is It?
The video is the first part of a WEBTV of 7 sequences about NASH
Published June 12, 2018
Speakers: Pr Stephen Harrison, Pr Sven Francque
In this first TV show you will understand – thanks to a worldwide overview – how little-known NASH is and why this situation has to be changed. Liver experts will go over non-alcoholic steatohepatitis (NASH) details, its mechanisms, consequences, symptoms and stigmas. These will also be highlighted by a patient testimony at the end of the video footage. Part One
SUBTITLES ARE AVAILABLE IN 6 LANGUAGES, using settings of the video (Gear Icon at the bottom right of the video): English - Spanish - French - Italian - German - Portugese
In this first TV show you will understand – thanks to a worldwide overview – how little-known NASH is and why this situation has to be changed. Liver experts will go over non-alcoholic steatohepatitis (NASH) details, its mechanisms, consequences, symptoms and stigmas. These will also be highlighted by a patient testimony at the end of the video footage.
In this second TV show, you will understand how widespread NASH is, with prevalence figures and future projections exposed. During the interviews, livers experts will bring up information on NASH frequency, genetic predispositions, how children are now subject to this preventable disease, and which populations are most commonly affected.
In this third TV show, you will discover that NASH is much more than just a liver disease and that it is related to metabolic disorders – such as diabetes and obesity – and closely linked to modern lifestyles: unhealthy diets and lack of physicial activity. The diverse speaker panel will explain why some people are more at risk than others and how much exercise can help, if sufficient and sustained. Lastly, the video will follow patients associations in their mobilizations against NASH.
In this fourth TV show, you will discover how much of challenge NASH diagnosis is – mainly because NASH is a silent disease (no symptoms) which makes it difficult to diagnose – and how current procedures can be a bottleneck in the patient journey. Liver experts will explain the current invasive and non-invasive diagnostic techniques used when NASH is suspected, as well as latest research in novel diagnostic tools and what the future holds in terms of diagnosis.
In this fifth TV show, you will learn more about the consequences of non-alcoholic steatohepatitis in the liver, but also in the rest of the body, with associated conditions. A French sports journalist will share his testimony as a NASH patient that overcame a liver transplant and a kidney as the last resort to survive, and a representative from The Liver Forum will explain how experts work to research the best patient clinical management solutions. In the end, you will know more about the consequences on health, the consequences on the economy, stigmas, lessons learned and the dire need for awareness.
In this sixth video, you will discover how much of a challenge patient management is, and especially, how to answer this burning question: “how can we care for patients in the absence of treatment?” – Today, on top of the lifestyle change (weight loss and exercise) ongoing research on therapeutic solutions paves the way for a better patient care. Moreover, you’ll discover how physicians are all working hand in hand to cover all the aspects of this multi-faceted disease. Finally, you will have the opportunity to hear the American Liver Foundation’s CEO’s perspectives on NASH.
In this seventh video, you will learn more about the next key challenges in the field of NASH, and about the crucial need for awareness and for public policy. Experts will give some forecast about NASH, ongoing research and the shed light on future management solutions You will get insights on the economic burden of NASH and the need for all stakeholders to be involved in NASH awareness. To conclude these seven sequences, there will be a special focus on how street art can help increase awareness and what we can hope for in the future.
Elsewhere
Non-alcoholic fatty liver disease: risks, prevention, and more
June 11, 2018
Lauren Phinney
Doctor Rohit Loomba appeared on KUSI News in San Diego to discuss Non-alcoholic fatty liver disease and how to prevent it.
The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases A recent publication from the American Association for the Study of Liver Diseases (AASLD) provides guidance for the evaluation and management of patients with NAFLD.
This guidance provides a data‐supported approach to the diagnostic, therapeutic, and preventive aspects of nonalcoholic fatty liver disease (NAFLD) care. A “Guidance” document is different from a “Guideline.” Guidelines are developed by a multidisciplinary panel of experts and rate the quality (level) of the evidence and the strength of each recommendation using the Grading of Recommendations, Assessment Development, and Evaluation system. A guidance document is developed by a panel of experts in the topic, and guidance statements, not recommendations, are put forward to help clinicians understand and implement the most recent evidence.
New data on the world’s hepatitis C epidemic, presented at this week’s Global Hepatitis Summit in Toronto, Canada (14-17 June) shows that only 12 countries in the world are on track to meet the WHO elimination targets that 194 countries globally signed up to in 2016. The data is presented by Dr Homie Razavi and his team from the Polaris Observatory, Center for Disease Analysis Foundation (CDAF), Lafayette, CO, USA.
Since the last global update in 2017, Italy, Spain, Switzerland, the UK and Mongolia have all been added to the list, thanks to the number of patients they treated in 2017, plus the lifting of treatment restrictions to include all patients with hepatitis C regardless of their degree of liver damage. These countries join the others already on track to eliminate by 2030: Australia, Egypt, France, Georgia, Iceland, Japan and the Netherlands. In all cases, these countries are treating at least 7% of their infected population each year, and have opened treatment up to all those infected.
Liver Cancer a Big Threat to U.S., Other Developed Nations
FRIDAY, June 15, 2018 (HealthDay News) -- Liver cancer cases in several developed countries have doubled in the past 25 years, due to the continuing obesity epidemic and a spike in hepatitis infections, new research suggests.
Even worse, the sharp rise in liver cancer cases is starting to swamp the limited number of liver specialists in those nations, the researchers added.
In the four countries -- the United States, the United Kingdom, Australia and Canada -- liver cancer is the only major cancer for which death rates are rising.
The findings were to be presented Friday at the Global Hepatitis Summit, in Toronto. Research presented at meetings is considered preliminary until published in a peer-reviewed journal.
Directly-acting antivirals (DAA) have changed the chronic hepatitis C virus (HCV) infection therapeutic scenario allowing virus eradication in more than 95% of patients, independently from the genotype, with 12 to 24-week treatment regimens. We describe a 51-year-old Pakistani man with a chronic HCV-genotype 3 (GT3a) infection with moderate liver fibrosis, who achieved sustained virological response (SVR) 24 after a tripled dose of Daclatasvir (DCV) taken erroneously associated to Sofosbuvir (SOF). The patient had a concomitant intestinal TB infection whose treatment had been delayed in order to firstly eradicate HCV to reduce the liver toxicity of anti-mycobacterial drugs. Thanks to the cultural mediator support, we explained to the patient the correct posology of each drug to take during the day consisting of 12 week SOF (400 mg daily) plus DCV (60 mg daily) regimen. He returned 13 days after for a programmed visit and we were surprised to learn that he had taken 3 pills of DCV (180 mg/daily) instead of one, thus ending DCV assumption after only 9 days while SOF was taken correctly. He complained no symptoms. We immediately performed blood test that showed alteration of lactate dehydrogenase, creatine phosphokinase, and creatin kinase MB activity. At day 15 we stopped SOF closely monitoring the patient. Blood test alterations returned normal after one week of treatment suspension, HCV viremia remained suppressed after 4, 12 and 24 weeks proving HCV eradication. If confirmed, these data could suggest that higher doses of DCV, if tolerated, might be employed in short-time HCV-GT3 treatment.
Blacks and Hispanics less likely to get surveillance, early diagnosis, and curative treatment
by Diana Swift, Contributing Writer June 14, 2018
A large retrospective study of hepatocellular (HCC) patients in Texas found racial and ethnic differences in outcomes, with blacks and Hispanics less likely than whites to get early diagnosis and curative treatment, and blacks less likely to survive.
"Our findings have important implications for health policy and highlight the need for further study on racial-ethnic disparities in HCC, including identification of additional actionable intervention," wrote Amit Singal, MD, MS, of the University of Texas (UT) Southwestern Medical Center's Simmons Cancer in Dallas, and colleagues in Clinical Gastroenterology and Hepatology
Continue reading:
Toronto doctors safely transplant lungs from hepatitis C-infected donors by Sheryl Ubelacker, The Canadian Press
Last Updated Jun 14, 2018 at 8:24 am EDT
Toronto doctors have successfully transplanted lungs from deceased donors with hepatitis C into patients in need of the lifesaving organs, followed by treatment to prevent them from becoming infected with the potentially liver-destroying virus.
Since October, surgeons at Toronto General Hospital have performed the transplants in 11 patients as part of a pilot study to evaluate the safety of using lungs from hepatitis C-infected donors — a previously untenable idea.
That’s because antiviral drugs can now cure the disease in 98 per cent of people infected with hepatitis C, which affects an estimated 250,000 Canadians, about 40 to 70 per cent of them unaware they harbour the blood-borne virus.
“With the opioid crisis and persistent high rates of intravenous drug use, we have a great number of potential lung donors who are hepatitis C-positive, many of whom didn’t even know they were sick when they were alive,” said Dr. Marcelo Cypel, a thoracic surgeon at TGH and principal investigator of the study.
Canadian team reports success in transplanting hepatitis C organs
WASHINGTON: A long-running shortage in donor organs has pushed doctors to find ways to use those with hepatitis C, an infection that is increasingly common in the United States due to the opioid crisis, and which can be cured with medicine.
Some US hospitals, particularly in Boston, have already transplanted infected donor organs into people without hepatitis C. These patients are swiftly treated with drugs to eliminate the virus.
In Toronto, Canada, another team of doctors on Thursday announced early results from a trial using a different technique, involving 10 people who received lung transplants from donors with hepatitis C.
The reduction in new hepatitis C virus (HCV) infections that has taken place in Scotland since 2008 is most likely due to increased provision of needle and syringe programmes and opioid substitution therapy, rather than a reduction in the number of people with hepatitis C as a result of increased treatment of HCV infection, a modelling study published in the journal Addiction reports.
KEYWORDS
Veterans
Direct-acting antiviral
SVR
Hepatitis C
Population health
Innovation
System redesign
KEY POINTS
Since January 2014 the Department of Veterans Affairs (VA) has made significant progress
in the treatment of veterans with hepatitis C virus (HCV) and, as of December 2017, more
than 100,000 veterans have been treated.
Special regional multidisciplinary Hepatitis C Innovation Teams were created that used
lean process improvement and system redesign, resulting in innovative hepatitis C practice models that help to address gaps in care.
The VA has expanded access and treatment capacity for HCV-infected veterans through
the use of nonphysician providers (clinical pharmacists, nurse practitioners, and physician
assistants), video telehealth, and electronic technologies.
The VA continues to use population health management tools to effectively manage and
track the treatment and care of veterans with HCV.
Abstract
The Department of Veterans Affairs (VA) has made significant progress in treating hepatitis C virus, experiencing more than a 75% reduction in veterans remaining to be treated since the availability of oral direct-acting antivirals. Hepatitis C Innovation Teams use lean process improvement and system redesign, resulting in practice models that address gaps in care. The key to success is creative improvements in veteran access to providers, including expanded use of nonphysician providers, video telehealth, and electronic technologies. Population health management tools monitor and identify trends in care, helping the VA tailor care and address barriers.
•A short-duration, pangenotypic cure for HCV infection may help treat more patients.
•Glecaprevir plus pibrentasvir (G/P) therapy for 8 weeks had an overall cure rate of 98%.
•The efficacy of 12-week G/P therapy (99%) was not significantly higher than that of 8-week G/P therapy (p = 0.2).
•Treatment responses were high irrespective of any baseline patient or viral trait.
•G/P demonstrated a favourable safety profile regardless of treatment duration.
Background & Aims
Glecaprevir plus pibrentasvir (G/P) is a pangenotypic, once-daily, ribavirin-free direct-acting antiviral (DAA) treatment for hepatitis C virus (HCV) infection. In nine phase II or III clinical trials, G/P therapy achieved rates of sustained virologic response 12 weeks after treatment (SVR12) of 93–100% across all six major HCV genotypes (GTs). An integrated efficacy analysis of 8- and 12-week G/P therapy in patients without cirrhosis with HCV GT 1–6 infection was performed.
Methods
Data were pooled from nine phase II and III trials including patients with chronic HCV GT 1–6 infection without cirrhosis who received G/P (300 mg/120 mg) for either 8 or 12 weeks. Patients were treatment naïve or treatment experienced with peginterferon, ribavirin, and/or sofosbuvir; all patients infected with HCV GT 3 were treatment naïve. Efficacy was evaluated as the SVR12 rate.
Results
The analysis included 2,041 patients without cirrhosis. In the intent-to-treat population, 943/965 patients (98%) achieved SVR12 when treated for eight weeks, and 1,060/1,076 patients (99%) achieved SVR12 when treated for 12 weeks; the difference in rates was not significant (p = 0.2). A subgroup analysis demonstrated SVR12 rates > 95% across baseline factors traditionally associated with lower efficacy. G/P was well tolerated, with one DAA-related serious adverse event (<0.1%); grade 3 laboratory abnormalities were rare.
Conclusions
G/P therapy for eight weeks in patients with chronic HCV GT 1–6 infection without cirrhosis achieved an overall SVR12 rate of 98% irrespective of baseline patient or viral characteristics; four additional weeks of treatment did not significantly increase the SVR12 rate, demonstrating that the optimal treatment duration in this population is eight weeks.
Lay summary
In this integrated analysis of nine clinical trials, patients with chronic HCV genotype 1–6 infection without cirrhosis were treated for either 8 or 12 weeks with the direct-acting antiviral regimen glecaprevir/pibrentasvir (G/P). The cure rate was 98% and 99% following 8 and 12 weeks of treatment, respectively; the difference in rates was not significant (p = 0.2), nor was there a significant difference in the cure rates across the two treatment durations on the basis of baseline patient or viral characteristics. These results, along with a favourable safety profile, indicate that G/P is a highly efficacious and well-tolerated pangenotypic eight-week therapy for most patients with chronic HCV infection.
•Fatty liver disease is a growing cause of cirrhosis and liver cancer globally.
•Disease burden is expected to increase with the epidemics of obesity and diabetes.
•Modeling shows slow growth in total cases and greater increase in advanced cases.
•Mortality and advanced liver disease will more than double during 2016-2030.
Abstract
Background
Nonalcoholic fatty liver disease (NAFLD) with resulting nonalcoholic steatohepatitis (NASH) are increasingly a cause of cirrhosis and hepatocellular carcinoma (HCC) globally. This burden is expected to increase as epidemics of obesity, diabetes and metabolic syndrome continue to grow. The goal of this analysis was to use a Markov model to forecast NAFLD disease burden using currently available data.
Methods
A model was used to estimate NAFLD and NASH disease progression in 8 countries based on data for adult prevalence of obesity and type 2 diabetes mellitus (DM). Published estimates and expert consensus were used to build and validate the model projections.
Results
If obesity and DM level off in the future, we project a modest growth in total NAFLD cases (0-30%), between 2016-2030, with the highest growth in China as result of urbanization and the lowest growth in Japan as result of a shrinking population. However, at the same time, NASH prevalence will increase 15-56%, while liver mortality and advanced liver disease will more than double as result of an aging/increasing population.
Conclusions
NAFLD and NASH represent a large and growing public health problem and efforts to understand this epidemic and to mitigate the disease burden are needed. If obesity and DM continue to increase at current and historical rates, both NAFLD and NASH prevalence are expected to increase. Since both are reversible, public health campaigns to increase awareness and diagnosis, and to promote diet and exercise can help manage the growth in future disease burden.
Lay summary
Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) can lead to advanced liver disease, and are occurring in increasing numbers in tandem with epidemics of obesity and diabetes. A mathematical model was built to understand how the disease burden associated with NAFLD and NASH will change over time. Results suggest increasing numbers of cases of advanced liver disease and liver-related mortality in the coming years.
Welcome, check out the following patient bloggers who share tips and inspiring stories on the topic of viral hepatitis.
HepCBC
Read a nice summary of notable headlines published in the latest issue of The Weekly Bull. Hep Tray Tables Up, Hepatitis C on a Plane
Some unexpected turbulence from stigma and ignorance on a flight from an advocacy conference.
Every so often, I’ll read an article or study about hepatitis C, and feel shaken to my core. “Long-Term Liver Disease, Treatment, and Mortality Outcomes Among 17,000 Persons Diagnosed with Chronic Hepatitis C Virus Infection” by Anne Moorman and colleagues is a core shaker.
Numerous articles and videos circulated on social media and reputable websites, stating that light to moderate alcohol intake offers cardio-vascular health benefits. But does this apply to everyone? Studies show that it might not be the case for people with liver disease.
When Adult Kids Disrespect You
When we’re dealing with chronic, ongoing health problems, it can mess up the way our family relates to one another. We don’t use it as an excuse. We use wise parenting skills.
Help us raise awareness for World Hepatitis Day (July 28th, 2018) by telling the world why it is important to get tested for hepatitis B! Create an awareness message about hepatitis B by answering the prompt below.The Hepatitis B Foundation will compile video entries for a larger video that will be released on World Hepatitis Day, July 28, 2018.
Much of the stress on your liver can be avoided with a proper regimen of healthy eating and exercise. Here are some more helpful tips that will help you get active, and keep your liver in tiptop shape!
After a battery of blood tests and a CT scan, doctors determined she had an enlarged liver due to a build-up of fat. Once she was referred to a liver specialist, further tests and a biopsy revealed that she had non-alcoholic steatohepatitis or NASH, the most severe form of NAFLD.
A new shingles vaccine is available and recommended for adults over age 50, regardless of whether they’ve had the older shingles vaccine in the past.
Vegetable of the month: Avocado
Avocados are one of the few fruits that contain healthy unsaturated fats. These fats help lower undesirable LDL cholesterol when eaten in place of saturated fat.
Your digestive tract, also called the gut, contains trillions of bacteria. Many of those bacteria play a number of useful roles in the body, including metabolizing nutrients from food. While much of the bacteria in the gut are valuable, some are not. There have been studies done about how an imbalance between good and bad gut bacteria could contribute to certain medical disorders.
