Swiss Hepatitis Strategy: Is HCV elimination possible by 2030?

Progress toward implementing the Swiss Hepatitis Strategy: Is HCV elimination possible by 2030?

Beat Müllhaupt, Philip Bruggmann, Florian Bihl, Sarah Blach, Daniel Lavanchy, Homie Razavi, Sarah Robbins Scott, David Semela, Francesco Negro

Published: December 31, 2018
https://doi.org/10.1371/journal.pone.0209374 

Full-Text

View online

Download PDF

Abstract
Catalyzed by the concerns over the growing public health and economic burden of Hepatitis C virus (HCV) in Switzerland, a diverse group of experts and patient representatives came together in 2014 to develop the Swiss Hepatitis Strategy, setting targets for the elimination of viral hepatitis in Switzerland by 2030. Previous studies have reported the estimated number of chronic HCV infections and forecasted burden of disease given different intervention strategies. However, given new prevalence data by the Swiss Federal Office of Public Health, which decreased total infections by about half, an updated analysis is warranted. We aimed to provide an updated viremic prevalence estimate for Switzerland and evaluate the impact on forecasted liver related morbidity and mortality of an ‘inaction’ scenario and intervention scenarios to achieve the Global Health Sector Strategy for Viral Hepatitis and Swiss Hepatitis Strategy goals by 2030. A Markov disease-progression model was used to calculate the present and future burden of HCV infection by disease stage according to these different strategies. In 2017, there were an estimated 36,800 (95% UI: 26,900–39,200) viremic infections in Switzerland. Given the current standard of care, total viremic infections are expected to decline by 45%, while cases of decompensated cirrhosis, hepatocellular carcinoma, and liver-related deaths will decrease by 20%. If treatment and diagnosis efforts were to cease in 2018, late stage HCV-related morbidity and mortality would increase by 90–100% by 2030. Increasing treatment and diagnosis to achieve the Global Health Sector Strategy or Swiss Hepatitis Strategy goals by 2030, will reduce the number of chronic infections to less than 13,000 and 4,000, respectively. Although the HCV epidemic is declining in Switzerland, efforts to expand diagnosis and treatment are needed to achieve elimination by 2030.

Continue reading:
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0209374

The $35 billion race to cure a silent killer that affects 30 million Americans

Modern Medicine 

Sun, December 30, 2018 7:39 AM 

In the U.S. 30 million Americans suffer from a form of fatty liver disease that turns into a form of liver cirrhosis that leads to death unless a patient can receive a liver transplant. Now drug companies are spending billions to help find a cure.

The $35 billion race to cure a silent killer that affects 30 million Americans

Lori Ioannou

The race is on in the pharmaceutical industry to develop drugs to treat a form of fatty liver disease called nonalcoholic steatohepatitis, also known as NASH.

Industry experts estimate the global market for these new drugs is $35 billion.

The U.S. is spending $5 billion annually in health-care costs related to the disease, which include chemotherapy, transplants, tests and hospitalizations, reports the Center for Disease Analysis.

The National Institutes of Health estimates as many as 12 percent of U.S. adults have this disease, or 30 million people.

Read More: https://www.cnbc.com/2018/12/21/the-35-billion-race-for-a-cure-for-a-liver-disease-that-affects-millions.html

Merry Christmas 

Patients at New Jersey surgery center possibly exposed to HIV, hepatitis

More than 3,000 patients at New Jersey surgery center possibly exposed to HIV, hepatitis
The patients may have been exposed to blood-borne illnesses due to "lapses in infection control in sterilization," according to the surgery center.
By Kalhan Rosenblatt

An ambulatory surgery center in New Jersey may have exposed thousands of patients to HIV and hepatitis due to "lapses in infection control" and sterilization, the state's department of health said Monday.

More than 3,700 patients who had procedures at HealthPlus Surgery Center in Saddle Brook, New Jersey, may have been exposed to blood-borne illnesses such as HIV, hepatitis B, and hepatitis C, according to a statement from the center.

Read More: 

https://www.nbcnews.com/news/us-news/more-3-000-patients-new-jersey-surgery-center-possibly-exposed-n951791

Symposium - New HCV Clinical Advances

In Case You Missed It

Webcast
Hepatitis Elimination
Sit back and watch a live symposium from the November 2018 Liver Meeting featuring table discussions with leading physicians discussing viral hepatitis, launched by Chronic Liver Disease Foundation (CLDF) on December 13, 2018. 

LINK
View Program
Webcast may take a moment to load

Topics

1. Welcome and Introduction
Jordan Feld, MD, MPH

2. Breaking News: New HCV Clinical Advances
Jordan Feld, MD, MPH

3. What Will it Take to Achieve Global Hepatitis Elimination by 2030: Lessons from Country Experiences
Nick Walsh, MD, PhD

4. Enhancing Access to HCV Testing and Treatment in Prisons: Lessons from the Australian Model
Alex Thompson, MBBS (Hons), PhD, FRACP

5. Recruiting and Training PCPs in Rural California-One County at a Time
Norah Terrault, MD, MPH

6. The Role of Civil Society in Hepatitis Elimination: WHA Campaign from the Primary Care & Patient Advocate Perspective
Su Wang, MD, MPH, FACP

7. Panel Discussion and Q&A

HCV Next Is Saying Goodbye

I was overcome with great sadness this morning after reading HCV Next, a monthly publication available online at Healio, has published their last issue.

Thank You Healio

Thank you to all those amazing people who made HCV NEXT possible each month. I am so grateful for every outstanding interview, expert analysis, news article and in-depth editorial that was published over the last five years. Please know each issue made a difference in the lives of hepatitis C patients struggling to reach the finish line. 

Your publication will be missed!

Read the November/December Issue. 

Healio HCV News

Please continue to keep up on your HCV news via our other news outlets: Healio Gastroenterology and Liver Disease, Infectious Disease News and, launching soon, Healio Primary Care. 

Hepatitis C -  Barriers To Eradication

Despite all of the advances in hepatitis C treatment, it remains a “silent epidemic” with more than 70 million people infected worldwide. In this months issue of HCV Next, Michael S. Saag, MD., writes about HCV eradication and the huge barriers standing in the way; Passing the Torch from Implementation to Eradication. 

Are You At Risk?
Today, two different groups of people are at risk for hepatitis C; baby boomers, that is people born between 1945 and 1965 and young people - or - people who inject drugs. Although, HCV screening strategies for baby boomers have improved, the same is not true for people who use drugs, as reported by the good people at Imagine Hope recently over at NPR;

"Health care facilities that serve people who use drugs are well-positioned to initiate screening, studies show that often doesn't happen."

CEO of the American Liver Foundation added;

"It's a disease that can be cured the moment we identify somebody," says Tom Nealon, "Not testing is incomprehensible when you look at what hepatitis C does to their bodies and their livers."

Read the article: Why Aren't More Users Of Opioids Or Meth Screened For Hepatitis C?

NEW @ JAMA

During 2013 to 2016, what proportion of adults were living with hepatitis C virus (HCV) infection in each US state?

December 21, 2018
Regions with long-standing HCV epidemics, and those with newly emergent ones partly driven by the opioid crisis, face substantial HCV prevalence.

Prevalence of Hepatitis C Virus Infection in US States and the District of Columbia, 2013 to 2016

Prevalence of HCV infection varies widely in the United States. Highest rates are frequently in states deeply affected by the opioid crisis or with a history of increased levels of injection drug use and chronic HCV infection, particularly in the West. Progress toward hepatitis C elimination is theoretically possible with the right investments in prevention, diagnosis, and cure. The urgency for action and the resources necessary will vary by jurisdiction.

In The News
Dec 21, 2018
JAMA In The News: Hepatitis C Cases Cluster in States Hit Hard by Opioids

FRIDAY, Dec. 21, 2018 (HealthDay News) -- More than half of Americans with hepatitis C are living in just nine U.S. states -- five of those in a region hit hard by the opioid epidemic, a new study shows.

Dec 19, 2018
Medscape: Hep C and Drug Abuse Often Go Hand in Hand, but Screening Lags
Recent studies have shown that health care facilities often fail to screen people who use drugs. Not testing these patients for hepatitis C is an enormous missed opportunity, public health experts agree.

Young People with Hepatitis C Face Cirrhosis at Younger Age 

Dec 16, 2018
One-third (32%) of people who contract hepatitis C virus (HCV) as a child will go on to develop cirrhosis at a median of 33 years post-infection, according to new research.

Until next time.

Tina

‘Alarming’: Projected Burden of Liver Cancer in the US

Of Interest
Controlling the Global Burden of Liver Cancer
By Meg Barbor, MPH
December 25, 2018

According to Dr. Mohamed, target populations for hepatocellular carcinoma surveillance should include all patients with cirrhosis, regardless of etiology; patients with chronic HBV, particularly Asian men older than age 40 and women older than age 50; individuals with a family history of hepatocellular carcinoma; African and North American black individuals older than age 20 with HBV; and patients with noncirrhotic HCV and bridging fibrosis.
Read more: http://www.ascopost.com/issues/december-25-2018/controlling-the-global-burden-of-liver-cancer/

‘Alarming’: Projected Burden of Liver Cancer in the US 

Roxanne Nelson, RN, BSN 

December 21, 2018

Source 

Medscape

Follow On Twitter
@Medscape

The incidence of hepatocellular carcinoma in the US has been rapidly rising, but experts are cautiously optimistic that the trend can be reversed.

Over the past two decades, the incidence of hepatocellular carcinoma (HCC) has been steadily rising and is now a leading cause of cancer-related death in the United States. However, HCC disproportionally affects all US racial/ethnic minority populations, with blacks, Hispanics, and Asians experiencing higher age-specific incidence rates than non-Hispanic whites, according to an editorial in Journal of the National Cancer Institute (JNCI).

While incidence rates for HCC among most racial/ ethnic groups have steadily increased overall, the rates for blacks and Hispanics are projected to be the highest by 2030.

That said, even though the "projected burden of HCC in the United States is alarming, this future is not inevitable," write authors Amit G. Singal, MD and Caitlin C. Murphy, PhD, both of the University of Texas Southwestern Medical Center in Dallas.

They point to two studies recently published in the JNCI, which reviewed the racial/ethnic differences in incidence and projected future HCC burden. These two papers "paint a roadmap to reduce the increasing incidence and disparities in HCC in the United States," the editorialists comment.

Read the full article: https://www.medscape.com/viewarticle/906912

Real-world effectiveness and safety of Harvoni with/without ribavirin hepatitis C virus genotype 1

Real-world effectiveness and safety of sofosbuvir and ledipasvir with or without ribavirin for patients with hepatitis C virus genotype 1 infection in Taiwan 
Chen-Hua Liu, Chun-Jen Liu, Tung-Hung Su, Hung-Chih Yang, Chun-Ming Hong, Tai-Chung Tseng, Pei-Jer Chen, Ding-Shinn Chen, Jia-Horng Kao

Published: December 21, 2018 https://doi.org/10.1371/journal.pone.0209299

Full-Text Article
Download PDF

Abstract
Background
The real-world data for the effectiveness and safety of sofosbuvir/ledipasvir (SOF/LDV) with or without ribavirin (RBV) in patients with hepatitis C virus genotype 1 (HCV-1) infection remain limited in Taiwan.

Methods
A total of 273 chronic HCV-1 patients receiving 8, 12, or 24 weeks of SOF/LDV with or without RBV were enrolled. The sustained virologic response rate at week 12 off-therapy (SVR12) by evaluable population (EP) and per-protocol population (PP) were assessed for effectiveness. The treatment discontinuation rate due to adverse events (AEs) and serious AE rate were assessed for safety. Baseline patient characteristics and on-treatment HCV viral kinetics associated with SVR12 were analyzed.

Results
The SVR12 rates by EP and PP analyses were 96.7% (95% confidence interval [CI]: 93.9%-98.3%) and 97.5% (95% CI: 94.8%-98.8%), respectively. The rates of treatment discontinuation due to AE and serious AE were 0.4% and 4.4%, respectively. Seven patients with true virologic failure were relapsers. In 2 patients who were lost-to follow-up, one expired at treatment week 3 due to pneumonia which was considered not related to treatment, and one declined follow-up at off-therapy week 4. The SVR12 rates were comparable in terms of baseline patient characteristics and viral decline at week 4 of treatment.

Conclusions

SOF/LDV with or without RBV for 8–24 weeks is well tolerated and achieves a high SVR12 rate in patients with HCV-1 infection in Taiwan.

View Online: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0209299

Hepatitis C - Impact of treatment with direct-acting antivirals on anxiety and depression

Impact of treatment with direct-acting antivirals on anxiety and depression in chronic hepatitis C 
Marta Gallach , Mercedes Vergara, Joao Pedro da Costa, Mireia Miquel, Meritxell Casas, Jordi Sanchez-Delgado, Blai Dalmau, Núria Rudi, Isabel Parra, Teresa Monllor, Meritxell Sanchez-Lloansí, Angelina Dosal, Oliver Valero, Xavier Calvet
Published: December 19, 2018 https://doi.org/10.1371/journal.pone.0208112

Full-Text Article
Download PDF
View Online

Abstract
Background and aim
Treatment of hepatitis C with direct-acting antiviral agents (DAA) has few side effects. Although pivotal studies suggested that DAA were safe in patients with psychiatric diseases who could not be treated with previous antiviral therapies, their effects on anxiety and depression have not yet been analysed in clinical practice. The aim of our study was to analyse anxiety and depression in the setting of DAA treatment in a clinical practice series.

Methods
All patients starting DAA treatment between November 1, 2014 and October 31, 2015 were eligible. Patients completed the Hospital Anxiety and Depression scale at different times during treatment. The results were plotted on line graphs and evaluated using a linear regression model with repeated measures.

Results
One hundred and forty-five patients were included (11% with major psychiatric disorders; 32% on psychiatric treatment). Sustained virologic response (SVR) was achieved in 97.3% of cases. Anxiety and depression measures did not differ between time points. No differences between patients on psychiatric treatment or with advanced fibrosis or cirrhosis were found at any time point analysed.

Conclusion
DAA treatment had no impact on anxiety or depression during or after chronic hepatitis C infection treatment, even in high-risk patients with major psychiatric disorders.
Read More: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0208112

HCV patients treated with DAA undergo a marked reduction of insulin resistance

Improvement of insulin sensitivity in diabetic and non diabetic patients with chronic hepatitis C treated with direct antiviral agents 
Alessandro Gualerzi, Mattia Bellan , Carlo Smirne, Margherita Tran Minh, Cristina Rigamonti, Michela Emma Burlone, Ramona Bonometti, Sara Bianco, Azzurra Re, Serena Favretto, Giorgio Bellomo, Rosalba Minisini, Gian Piero Carnevale Schianca, Mario Pirisi
Published: December 20, 2018 https://doi.org/10.1371/journal.pone.0209216 

Full-Text Article

Download PDF

View Online

Abstract

Background
The increased incidence of type 2 diabetes mellitus among hepatitis C virus (HCV) infected patients is likely due to viral-induced insulin resistance (IR). Indeed, control of diabetes in these patients benefits of successful antiviral treatment; whether the same applies to subtler alterations of glucose metabolism is unknown. We aimed to fill this gap.

Methods
The study population included 82 HCV-RNA positive patients (48 males, median age 66 years, 73 with advanced fibrosis, 41 HCV-1b), attending the liver clinic of an academic hospital to receive direct antivirals. None was previously known to be diabetic. All underwent a standard oral glucose tolerance test (OGTT) before antiviral treatment and right after its conclusion.

Results
At baseline, the majority of patients had evidence of abnormal glucose metabolism (N. = 45, 55%; impaired fasting glucose 10%, impaired glucose tolerance16%, both the above 12%, 17% diabetes), while only 37 (45%) were normally glucose tolerant (NGT). At the end of treatment, HCV-RNA quantification was below the detection threshold (HCV-RNA <12 UI/ml), for all patients enrolled. A significant decrease in glucose and insulin plasma concentrations was observed, leading to a significant reduction in Homeostasis Model Assessment (HOMA)-IR (from 3.42 [2.66–5.38] to 2.80 [1.78–3.95];p<0.001) and a corresponding increase in insulin sensitivity (ISI Belfiore from 0.49 [0.26–0.75] to 0.64 [0.42–0.91];p<0.001), despite a significant reduction in insulin secretion (EFP Stumvoll from 1363 [959–1730] to 1264 [976–1588];p = 0.027). Importantly, HOMA-IR reduction occurred also in the subgroup of NGT patients (p = 0.017). The number of NGT patients increased to 53, 65% (p = 0.013) paralleled by a reduced number of those satisfying criteria for prediabetic conditions (31 (38%) vs. 17 (21%); p = 0.025).

Conclusions

Glucose metabolism parameters of HCV infected patients improve early after antiviral treatment, with benefits that are not limited to diabetics. These findings confirm how deep and widespread is the impairment of insulin pathways exerted by HCV infection.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0209216

December Newsletters: Curing Hep C May Dial Back Liver Damage

Hi folks, over the next few weeks I'll be taking a holiday break to spend time with the family. Can't wait to start my Christmas shopping, trick out my tree, and bake some millennial sugar cookies. Using Pillsbury ready to make slice-and-bake cookies, add sprinkles after baking. Bad Nana!

In any event, here's your list of December newsletters with blog updates from across the web.

News & Review 

Catch up on what you missed this week by reading one of two HCV week in review publications:

The Weekly Bull is published by the Canadian non-profit organization HepCBC, the second publication by Caring Ambassadors Program, is filled with news as well, in addition to a monthly review of relevant HCV research published on PubMed.

News Update
Jan 1, 2019
CDC: Could be a tough flu season based on early viruses, hospitalizations
By Anne-Gerard Flynn

The country could be in for another challenging flu season. There are already 11 pediatric deaths associated with the flu and hospitals rates among very young children are high, according to the Centers for Disease Control and Prevention.

Dec 19, 2018

NPR - Even in a setting with an identified risk factor in opioid-use disorder, too few youths are being screened for hepatitis C
As the number of people who inject drugs and share needles has soared, the rate of infection with Hep C has climbed too. Yet many drug treatment patients aren't tested for the liver-damaging virus.

Dec 17, 2018

Great news for New Zealanders pangenotypic regimen Maviret unrestricted access from Feb 2019 with $0 co-payment - PHARMAC funding decision gives Kiwis with hepatitis C access to a potential cure

December Newsletters

The aim of infohep.org is to develop a high-quality online resource to increase awareness of viral hepatitis, its treatment, and the needs of people living with viral hepatitis in Europe. 

The December edition of the infohep bulletin is now online: 

http://www.infohep.org/page/3409947

Highlights
Global trends in non-alcoholic fatty liver disease
NAFLD can occur in lean people too
Hepatitis C and the US opioid epidemic
Resistance testing for hepatitis C
Rwanda aims for hepatitis C elimination

Egypt hepatitis C elimination

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

Winter Issue 2018

Highlights

Curing Hep C May Dial Back Liver Damage

Hep C Testing Slowly Rising Among Baby Boomers

People Who Inject Drugs Succeed With Hep C Treatment
and more....

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

In this month's newsletter coverage of the Liver Meeting continues; read easy to understand commentary on HCV-related topics that matter most to patients. In next month's issue notable research on liver cancer presented at the meeting will be featured as well.

December Newsletter

On This Blog
After The Liver Meeting Summary: Viral Hepatitis & Fatty Liver Disease
For patients - An index of links provide an overview of the meeting with a focus on HCV; read expert analysis of key data, interviews with leading researchers and clinicians, or listen to live presentations, view slidesets and capsule summaries. Sit back and watch daily clips or a live symposium, finally review a webinar with all the notable Liver Meeting updates. 

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

The World Hepatitis Alliance goal is to achieve a world free from viral hepatitis, World Hepatitis Alliance provides global leadership in awareness-raising, advocacy and in efforts to find the missing millions.
News & Headlines 

Click here to read our latest newsletter.

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

work on projects in order to meet needs identified by the community.
December Newsletter: Reminder: NYC Hep C Task Force Meeting. December 5 (3-5 PM) @ 132 West 32nd St.
NYC Hep C Task Force
All - Hep Free NYC Newsletters

Hepatitis NSW provides information, support, referral and advocacy for people affected by viral hepatitis in NSW. We also provide workforce development and education services both to prevent the transmission of viral hepatitis and to improve services for those affected by it.
News Updates

GI & Hepatology News covers the world of liver disease with breaking news, on-site medical meeting coverage, and expert perspectives both in print and online. 
View all updates here....

Hepatitis Victoria is the peak not-for-profit community organisation working across the state for people affected by or at risk of viral hepatitis.
View the Latest Newsletter, or relax and listen to a short podcasts interviewing health experts and practioners on topics related to viral hepatitis - have a listen!

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

The Hepatitis C Trust is run by patients with the goal of eliminating HCV in the United Kingdom. The Trust’s mission is to reverse the rapidly increasing death toll caused by hepatitis C in the UK until no-one dies from this preventable and treatable disease and, ultimately, it is all but eradicated in this country.

View all newsletters

The National Viral Hepatitis Roundtable (NVHR) is national coalition working together to eliminate hepatitis B and C in the United States.

NVHR 2018 Year in Review
View all NVHR newsletters

Check out the latest National Institutes of Health Newsletter.
December Newsletter

Plan Your Plate - Shifting to a Healthy Eating Style

Blog Updates

I Help C

Karen Hoyt is devoted to offering support and accurate information to people coping with the effects of hepatitis C.
Latest blog entry: Holiday and Health Problems
Find Karen on Facebook
YouTube Page

Lucinda K. Porter
Lucinda Porter is a nurse, speaker, advocate and patient devoted to increasing awareness about hepatitis C.
View all new blog updates, here....

Hep 
Hep is an award-winning print and online brand for people living with and affected by viral hepatitis.

Latest blog updates: 

Hepatitis: Bad News, Good News 

By Lucinda K. Porter, RN

10 Steps to Living One Day at a Time 

By Connie M. Welch 

Hepatitis C Cure 
By Greg Jefferys
View all blog updates, here...

AGA Blog
Gastroenterology and Clinical Gastroenterology and Hepatology

Latest blog entry by Dr. Kristine Novak: What Are the Effects of Virologic Response to Treatment on Outcomes of Patients With Chronic HBV Infection and Decompensated Cirrhosis?

View all blog updates, here...

Life Beyond Hepatitis C

Life Beyond Hep C is where faith, medical resources and patient support meet, helping Hep C patients and their families navigate through the entire journey of Hep C.
Latest blog entry: 5 Common Questions and Answers about Hepatitis C Treatment
View all updates, here...

Canadian Liver Foundation
We strive to improve prevention and the quality of life of those living with liver disease by advocating for better screening, access to treatment, and patient care.
Latest blog entry: Tips for a struggling caregiver

View all updates, here...

Hepatitis B Foundation

The Hepatitis B Foundation is a national nonprofit organization dedicated to finding a cure and improving the quality of life for those affected by hepatitis B worldwide.
Latest blog entry: My partner has been diagnosed with hepatitis B. Can transmission be prevented by vaccination?
 Ask An Expert: Managing Hepatitis Delta During Pregnancy
View all updates, here....

ADRLF (Al D. Rodriguez Liver Foundation)
Al D. Rodriguez Liver Foundation is a non-profit organization that provides resources, education and information related to screening, the prevention of and treatment for the Hepatitis Virus and Liver Cancer.

Alzheimer’s and Liver Health: What’s the Connection?

View all updates, here....

HepatitisC.net

At HepatitisC.net we empower patients and caregivers to take control of Hepatitis C by providing a platform to learn, educate, and connect with peers and healthcare professionals.
Part 1: Doctors and Dragons: The Adventure Continues - By Rick Nash

Here We Go Again: Dealing with Chronic Illnesses - By Daryl Luster 

View all updates, here....

KevinMD 

Kevin Pho is a practicing physician and most known for his blog KevinMD. Thousands of authors contribute to his blog: primary care doctors, surgeons, specialist physicians, nurses, medical students, policy experts. And of course, patients, who need the medical profession to hear their voices.
View latest blog entry, here... 

Harvard Health Blog
The goal of our publications is to bring people around the world the most current health information that is authoritative, trustworthy, and accessible, drawing on the expertise of the 10,000+ faculty physicians at Harvard Medical School.
Latest blog entry: Alcohol use disorder: When is drinking a problem?
Benefits of a healthy diet — with or without weight loss
Safe and effective use of insulin requires proper storage

University of Michigan - Lab Blog
Providing physicians with virtual access to specialists can be lifesaving to liver disease patients.
View all updates: Lab Blog

In Case You Missed It
Webcast
Dec 13, 2018
New HCV Clinical Advances
Sit back and watch a live symposium from the November 2018 Liver Meeting featuring table discussions with leading physicians discussing viral hepatitis, launched by Chronic Liver Disease Foundation (CLDF) on December 13, 2018.

December 21, 2018
NEW @ JAMA
During 2013 to 2016, what proportion of adults were living with hepatitis C virus (HCV) infection in each US state?
Regions with long-standing HCV epidemics, and those with newly emergent ones partly driven by the opioid crisis, face substantial HCV prevalence.
Prevalence of Hepatitis C Virus Infection in US States and the District of Columbia, 2013 to 2016
Prevalence of HCV infection varies widely in the United States. Highest rates are frequently in states deeply affected by the opioid crisis or with a history of increased levels of injection drug use and chronic HCV infection, particularly in the West. Progress toward hepatitis C elimination is theoretically possible with the right investments in prevention, diagnosis, and cure. The urgency for action and the resources necessary will vary by jurisdiction.

JAMA In The News: Hepatitis C Cases Cluster in States Hit Hard by Opioids

FRIDAY, Dec. 21, 2018 (HealthDay News) -- More than half of Americans with hepatitis C are living in just nine U.S. states -- five of those in a region hit hard by the opioid epidemic, a new study shows.

JAMA Patient Page

This JAMA Patient Page describes recent advancements in hepatitis C treatment.

December 4, 2018
Treating Hepatitis C

From a medical point of view, almost all patients with hepatitis C should be treated.

See you soon!
Tina

Progress and difficulties in the elimination of HCV infection: A population-based cohort study in Spain

Progress in the elimination of hepatitis C virus infection: A population-based cohort study in Spain 

Regina Juanbeltz, Alejandra Pérez-García, Aitziber Aguinaga, Iván Martínez-Baz, Itziar Casado, Cristina Burgui, Silvia Goñi-Esarte, Jesús Repáraz, José Manuel Zozaya, Ramón San Miguel, Carmen Ezpeleta, Jesús Castilla

Published: December 4, 2018
https://doi.org/10.1371/journal.pone.0208554 

Full-text article available online: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0208554

Abstract 

Background
The World Health Organization set targets to eliminate hepatitis C virus (HCV) infection through detection and treatment of all cases by 2030. This study aimed to describe the progress and difficulties in the elimination of HCV infection in Navarra, Spain.

Methods
Using electronic healthcare databases, we performed a population-based prospective cohort study to describe changes in the prevalence of diagnosed active HCV infection at the beginning of 2015 and the end of 2017, the rate of new diagnoses and the rate of post-treatment viral clearance (PTVC) during this period.

Results
At the beginning of 2015 there were 1503 patients diagnosed with positive HCV-RNA, 2.4 per 1000 inhabitants, and at the end of 2017 the prevalence had decreased by 47%. In the study period, 333 (18 per 100,000 person-years) new positive HCV-RNA cases were detected, but only 76 (23%; 4.2 per 100,000 person-years) did not have anti-HCV antibodies previously detected. Prevalent cases and new diagnoses of active infection were more frequent in men, people born in 1950–1979, HIV-infected patients and in those with lower income levels. Among patients with HCV-RNA, 984 achieved PTVC (22.7 per 100 person-years). PTVC was less frequent in patients born before 1940, in immigrants and in patients with lower income levels.

Conclusions
The prevalence of diagnosed active HCV infection has dropped by almost half over three years, because the number of patients with PTVC was much higher than the number of new diagnoses. Interventions specifically targeted at population groups with less favourable trends may be necessary.

On This Blog
Efforts to Eliminate Hepatitis C

More Raw Beef Recalled After Nationwide Salmonella Outbreak

NPR

More Raw Beef Recalled After Nationwide Salmonella Outbreak 

Amy Held
More than 2,500 tons of raw beef are being added to a recall in connection with a salmonella outbreak that federal officials say has sickened hundreds of people across 25 states. 

The Arizona-based JBS Tolleson processing plant initially recalled about 3,500 tons of potentially contaminated beef in October. JBS, the top global meatpacker that owns the plant, still maintains the move ensured all of the affected product had already been removed from store shelves

https://www.npr.org/2018/12/05/673702290/more-raw-beef-recalled-after-nationwide-salmonella-outbreak?utm_source=dlvr.it&utm_medium=twitter

New Test Could Detect All Types of Cancer in Just Minutes

This New Test Could Detect All Types of Cancer in Just Minutes

ABU SINA, LAURA G CARRASCOSA & MATT TRAU, THE CONVERSATION
5 DEC 2018

Researchers have developed a test that could be used to diagnose all cancers. It is based on a unique DNA signature that appears to be common across cancer types.

The test has yet to be conducted on humans, and clinical trials are needed before we know for sure if it can be used in the clinic.

Each cancer type, whether it be breast or bowel cancer, has different genetic and other features. A test that detects one cancer may not work on another.

Researchers have long been looking for a commonality among cancers to develop a diagnostic tool that could apply across all types.

Our research, published in the journal Nature Communications, has found that cancer DNA forms a unique structure when placed in water. The structure is the same in DNA from samples of breast, prostate and bowel cancers, as well as lymphoma.

We used this discovery to develop a test that can identify the cancerous DNA in less than ten minutes.

How our test works

Current detection of cancer requires a tissue biopsy – a surgical procedure to collect tissue from the patient's tumour. Researchers have been looking for a less invasive diagnostic test that can detect cancers at an earlier stage.

One possibility, still in development, is a liquid biopsy, testing for circulating cancer DNA in the blood.

Our test also uses circulating cancer DNA but involves a different detection method.

Nearly every cell in a person's body has the same DNA, but studies have found that cancer's progression causes this DNA to undergo considerable reprogramming.

This change is particularly evident in the distribution pattern of a tiny molecule called a methyl group, which decorates the DNA.

A normal cell DNA's distinct methyl pattern is crucial to regulating its machinery and maintaining its functions. It is also responsible for turning genes on and off. Altering this pattern is one of the ways cancer cells regulate their own proliferation.

This methyl patterning has been studied before. However, its effect in a solution (such as water) has never been explored.

Using transmission electron microscopy (a high-resolution microscope), we saw that cancerous DNA fragments folded into three-dimensional structures in water. These were different to what we saw with normal tissue DNA in the water.

In the lab, gold particles are commonly used to help detect biological molecules (such as DNA). This is because gold can affect molecular behaviour in a way that causes visible colour changes.

We discovered that cancerous DNA has a strong affinity towards gold, which means it strongly binds to the gold particles.

This finding directed us to develop a test that can detect cancerous DNA in blood and tissue. This requires a tiny amount of purified DNA to be mixed with some drops of gold particle solution.

By simply observing the colour change, it is possible to identify the cancerous DNA with the naked eye within five minutes.

The test also works for electrochemical detection – when the DNA is attached onto flat gold electrodes.

Since cancer DNA has higher affinity to gold, it provides a higher relative electrochemical current signal in comparison to normal DNA. This electrochemical method is highly sensitive and could also eventually be used as a diagnostic tool.
Why this matters

For this test to work properly the DNA must be pure. So far we have tested more than 200 tissue and blood samples, with 90 percent accuracy. Accuracy is important to ensure there are fewer false positives – wrongly detecting cancer when there is none.

The types of cancers we tested included breast, prostate, bowel and lymphoma. We have not yet tested other cancers, but because the methylation pattern is similar across all cancers it is likely the DNA will respond in the same way.

It is a promising start, though further analysis with more samples is needed to prove its clinical use.

The next step is to do a large clinical study to understand how early a cancer can be detected based on this novel DNA signature. We are assessing the possibility to detect different cancer types from different body fluids from early to later stages of cancer.

We are also considering whether the test could help monitor treatment responses based on the abundance of DNA signatures in body fluid during treatment.

Abu Sina, Research Fellow, The University of Queensland; Laura G. Carrascosa, Postdoctoral Research Fellow, The University of Queensland, and Matt Trau, Professor, The University of Queensland.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Appeal lodged against decision to uphold Gilead’s patent on hepatitis C drug

Video - The story of sofosbuvir illustrates how research and development for new prescription drugs really works: When Big Pharma plays for keeps, who wins and who loses?

Appeal lodged against decision to uphold Gilead’s patent on hepatitis C drug

Press Release
5 December 2018

Paris – Six organisations, including Médecins Sans Frontières (MSF), have just appealed the European Patent Office’s September decision to uphold US pharmaceutical corporation Gilead Science’s patent on the key hepatitis C drug sofosbuvir.

The appeal – filed by Médecins du Monde (MdM), MSF, AIDES (France), Access to Medicines Ireland, Praksis (Greece) and Salud por Derecho (Spain) – states that the European Patent Office (EPO) should revoke Gilead’s patent because it does not meet the requirements to be a patentable invention from a legal or scientific perspective.

The appeal comes exactly five years after sofosbuvir was first approved for use, in the US, where Gilead launched the drug at US$1,000 per pill, or $84,000 for a 12-week treatment course.

The corporation has made more than $58 billion from sales of the drug and its combinations in the last five years.

In March 2017, civil society organisations from 17 European countries filed a challenge against Gilead’s patent on the base compound of sofosbuvir, stating that Gilead’s patent claims were not legitimate, primarily because they lack inventiveness. 

Out-of-control drug prices 

Gilead’s monopoly on sofosbuvir in Europe has allowed the corporation to charge excessive prices for the drug.

In some European countries, Gilead charges as much as €43,000 for a 12-week treatment course, when generic versions of the same course can be purchased for less than €75 outside Europe.

"What is the point of medical innovation if people and health systems cannot afford the products coming out of it? Gaëlle Krikorian, head of policy at MSF’s Access Campaign"

These exorbitant prices have forced health systems to ration sofosbuvir, leaving thousands of people in Europe with hepatitis C without treatment.

Despite compelling arguments presented by the organisations opposing the patent, on 14 September 2018 the European Patent Office (EPO) decided to uphold Gilead’s patent, thereby making it impossible to produce or sell affordable generic versions of the drug in Europe.

“The EPO is being too lenient with pharmaceutical corporations, giving them a free pass,” said Olivier Maguet of MdM’s drug pricing campaign. “There needs to be much greater scrutiny in Europe when it comes to determining whether pharmaceutical corporations deserve patents or not; otherwise, unmerited monopolies will continue to result in out-of-control drug prices.”

The appeal aims to put an end to pharmaceutical corporations’ abuse of medicines patenting systems to increase their own profits – including in countries outside Europe, where patent offices often follow the EPO’s decisions when they decide whether to grant a patent to a pharmaceutical corporation or not.

As some new patented drugs – such as those to treat cancer – come to market with price tags reaching €400,000 per person, there is an urgent need to reform patent systems so that people have access to the medicines they need to stay alive and healthy.

“Unmerited patents in Europe are giving pharmaceutical corporations the monopoly power that allows them to charge exorbitant prices for many lifesaving drugs,” said Gaëlle Krikorian, head of policy at MSF’s Access Campaign.

The excessive prices Gilead is charging for sofosbuvir have kept this breakthrough medicine away from millions of people with hepatitis C in Europe and around the world. What is the point of medical innovation if people and health systems cannot afford the products coming out of it?”
https://www.msf.org/appeal-lodged-against-decision-uphold-gileads-patent-hepatitis-c-drug

On This Blog
The controversy over expensive new drugs for hepatitis C
Link to a collection of current articles regarding the effectiveness and safety of generic hepatitis C medicines, as well as addressing the high cost, insurance restrictions; private insurers/Medicaid and availability of generic versions/India, Egypt and other lower-income countries or through online "buyers clubs"

China's National Medical Products Administration Approves Harvoni®

China’s National Medical Products Administration Approves Harvoni® (Ledipasvir/Sofosbuvir) for Treatment of Chronic Hepatitis C Virus Genotype 1-6

--Harvoni Offers Highly Effective, Short-Duration, Pan-Genotypic Treatment for Chinese Patients with HCV Infection--

--Harvoni Achieved Cure Rate (SVR12) of 100 Percent in Clinical Trial of Chinese Patients with Genotype 1--

FOSTER CITY, Calif.--(BUSINESS WIRE)--Dec. 4, 2018-- Gilead Sciences, Inc. (NASDAQ: GILD) announced today that the National Medical Products Administration (NMPA) has approved Harvoni® (ledipasvir 90 mg/sofosbuvir 400 mg) in China for the treatment of chronic hepatitis C virus (HCV) genotype 1-6 infection in adults and adolescents aged 12 to 18 years.

Hepatitis C is a significant public health challenge. Nearly 10 million people in China are estimated to have chronic HCV, with approximately 58 percent having HCV genotype 1 infection.

“The multicenter clinical trials in China have shown that the once-daily single tablet treatment regimen of Harvoni achieved a 100% SVR12 (defined as undetectable HCV RNA 12 weeks after completing therapy) rate in treatment patients with genotype 1 HCV infection,” said Professor Lai Wei, Peking University People’s Hospital and Institute of Hepatology, Beijing.

“Gilead has continued to develop and deliver new treatments for HCV to help enable people with HCV the potential to be cured,” said John McHutchison, AO, MD, Chief Scientific Officer, Head of Research and Development, Gilead Sciences. “We are pleased to offer an important new treatment option that can help patients achieve HCV cure and further support efforts to stem the epidemic in China.”

The approval of Harvoni in China is supported by an open-label, Phase 3b study, which was conducted at 18 study centers in mainland China between May 2016 and July 2017. The study evaluated 12 weeks of treatment with Harvoni in 206 genotype 1 HCV patients, including treatment-naïve and treatment-experienced patients without cirrhosis or with compensated cirrhosis.

https://www.gilead.com/news/press-releases/2018/12/chinas-national-medical-products-administration-approves-harvoni-ledipasvirsofosbuvir-for-treatment-of-chronic-hepatitis-c-virus-genotype-16 

Millions flock to free tests as Egypt seeks to eradicate hepatitis C

Millions flock to free tests as Egypt seeks to eradicate hepatitis C
Mahmoud Mourad, Lena Masri
MIT NAMA (Reuters) - When Houaida Mabrouk heard about a government campaign that offers free hepatitis C screenings, she hesitated, afraid of testing positive. But after many from her community started visiting health clinics to get checked, she changed her mind.

“I thought, ‘I should go too’,” Mabrouk said, speaking at a clinic in the Mit Nama village near Cairo before learning she did not have the virus.

Egypt, which has the highest rate of hepatitis C in the world, is carrying out an unprecedented campaign to detect and treat the disease in a bid to eliminate it by 2022. It aims to test the entire adult population — about 50 million people.

Read more:
https://www.reuters.com/article/us-health-egypt-hepatitis-c/millions-flock-to-free-tests-as-egypt-seeks-to-eradicate-hepatitis-c-idUSKBN1O21IO

After The Liver Meeting 2018 Summary: Viral Hepatitis & Fatty Liver Disease

The Liver Meeting® 2018
San Francisco, CA.
November 9-13, 2018

Page updated: December 13, 2018

After The Liver Meeting
Hi folks, today we have a nice summary of the Liver Meeting, highlighting significant research on both viral hepatitis and fatty liver disease. Follow each post-meeting link provided below and start reviewing expert analysis of key data presented at the meeting, listen to audio live from the meeting, or view slidesets, and capsule summaries.

HCV Advocate December Newsletter
December 1, 2018
In this month's HCV Advocate Newsletter coverage of the Liver Meeting continues; read easy to understand commentary on HCV-related topics that matter most to patients. In next month's issue notable research on liver cancer presented at the meeting will be featured.

Start here: 

http://hcvadvocate.org/news/NewsUpdates_pdf/Advocate_2018/advocate1218.pdf

The Liver Meeting® Content Now Available On Demand
Open Access: The Best of The Liver Meeting®. This product, bundled as downloadable slide sets, contains highlights from the meeting and investigates nine topics with key findings, data and analyses.

View the summary slide decks by topic.
Alcoholic Liver Disease
Basic and Translational Research
Cholestatic and Autoimmune Liver Diseases
Liver and Biliary Cancer
NAFLD/NASH
Pediatric Liver Diseases
Portal Hypertension/Cirrhosis
Liver Transplant
Viral Hepatitis

Webinar
Dec 4, 2018
“Liver Meeting 2018 Updates” presented by Tatyana Kushner, MD, MSCE from Mount Sinai Medical Center, available now over at HepCure.

Webcast
Dec 13, 2018
Chronic Liver Disease Foundation

Hepatitis Elimination 

Symposium live from the meeting featuring table discussions with leading physicians discussing viral hepatitis, launched in December by CLDF. The primary goal of this CME symposium is to better understand how to effectively identify, manage, and treat patients with viral hepatitis in order to achieve viral eradication by 2030.

Updates

Healio
Website Healio - Twitter @HealioHep

December 4, 2018

Liver transplantation highlights from The Liver Meeting 2018

This year at The Liver Meeting, data presented on liver transplantation focused on comorbid complications, such as alcohol misuse and obesity, and their correlated…

ID Practitioner

December 4, 2018
Hepatitis C debrief: Therapy has matured, access issues remain
The Liver Meeting 2018: Hepatitis B novel therapies debrief – key abstracts

Modern Medicine 
December 4, 2018
HCV Expert Interview with Jordan Feld, MD, MPH
In this interview, Jordan Feld, MD, MPH, discusses key highlights from studies presented at The Liver Meeting 2018, held recently in San Francisco by the American Association for the Study of Liver Diseases (AASLD).

Hep
Website: Hep 
December 3, 2018

The Liver Meeting 2018 Roundup

By Benjamin Ryan 

A review of the major findings presented at the Annual Meeting of the American Association for the Study of Liver Diseases in San Francisco

infohep

November 30, 2018
Website infohep Twitter - @infohep
This month’s infohep bulletin focuses on news from The Liver Meeting 2018, organised by the American Association for the Study of Liver Diseases (AASLD), which took place in San Francisco, USA, from 9 to 13 November 2018.

Link: Conference bulletin

Medscape
November 29, 2018
Website Medscape Twitter @Medscape
Viral Hepatitis: Five Highlights From the Liver Meeting
Dr William Balistreri reports on the most important viral hepatitis news from this year's Liver Meeting.

Clinical Care Options
Nov 27, 2018
Website Clinical Care Options - Twitter @CCO_Hepatitis 
Hot Topics in NASH

Audio: NAFLD/NASH Studies Influencing My Practice Following San Francisco 2018
Viral Hepatitis
Audio: Key Viral Hepatitis Studies Influencing My Practice Following San Francisco 2018
Slides: Clinical Impact of New Viral Hepatitis Data From San Francisco 2018
CCO Coverage: https://www.clinicaloptions.com/hepatitis/conference-coverage/san-francisco-2018

Healio

Nov 28, 2018
Website Healio - Twitter @HealioHep

Healio presents highlights of Fatty Liver and NASH data presented this year at The Liver Meeting.

Fatty liver highlights from The Liver Meeting 2018

Hep B Foundation
Nov 27, 2018
After the Liver Meeting, Dr. Tim Block, the @HepBFoundation's co-founder & President, answered some of the most asked questions about the path to a hepatitis B cure. This is a two-part series. Read the first Q & A here: http://ow.ly/UEAT50jOb61 

Video
Quick Review: Each Day Of The Meeting
Practice Point is once again launching daily clinical clips reviewing hot topics in HCV, presented each day at the meeting. Although the activity is intended for physicians and health care professionals, anyone, especially patients can benefit from each 5-minute review as well:
Independent Conference Coverage from the 2018 Annual Meeting of the American Association for the Study of Liver Disease (AASLD)*

In this video series, Dr. Saab will present ‘what you need to know in 5‐minutes’ regarding today's presentations from AASLD 2018 in San Francisco, CA
Free "registration" is required, once accomplished:
ACCESS ACTIVITY
Answer 3 question pre-test, and click Access Activity.

Twitter - @Practice_Point

Navigate This Blog - Stay Updated

Easy to navigate index; link to meeting coverage, updates during and after the meeting, with a focus on viral hepatitis, nonalcoholic steatohepatitis/NASH, liver cancer and liver transplantation. 

Check back for updates

Enjoy the weekend!

Tina