Showing posts with label HCV-Education. Show all posts
Showing posts with label HCV-Education. Show all posts

Wednesday, June 13, 2018

Liver Cancer After Treatment For Hepatitis C


Page updated: June 2018

Liver Cancer After Treatment For Hepatitis C
Research demonstrates that while SVR markedly reduced liver-related complications and liver cancer, some long-term risk for liver cancer remained in those who were cured of Hepatitis C. But after direct-acting antiviral therapy does the risk of developing liver cancer increase?

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.

June 2018
June 15 2018
Alimentary Pharmacology & Therapeutics
Direct-acting Antiviral Treatment for Hepatitis C Virus Infection and Risk of Incident Liver Cancer
Does DAA-based HCV treatment reduce the risk of incident liver cancer compared to untreated HCV or interferon-based treatment?

May 2018
May 12, 2018
Nature reviews gastroenterology & hepatology
HCV therapy and risk of liver cancer recurrence: who to treat?
Article shared and download by Henry E. Chang on Twitter

May 4, 2018
This large real-life study proves that the efficacy of DAA in cirrhotic patients is not impaired by successfully treated HCC.

April 2018
April 21, 2018
Editorial
Hepatocellular carcinoma as a consequence of hepatitis C direct-acting anti-virals-the great urban myth of hepatology
Aliment Pharmacol Ther. 2018 May;47(10):1418-1419. doi: 10.1111/apt.14634.

April 17, 2018
Does interferon-free therapy for hepatitis C after curative treatment for hepatocellular carcinoma lead to unexpected recurrences of HCC?
PLOS ONE | https://doi.org/10.1371/journal.pone.0194704

April 11, 2018
New At Healio: 8 reports on liver cancer outcomes with HCV, DAA therapy

April 5, 2018
Hepatitis C - Interferon-free therapy did not increase the risk of liver cancer
LAY SUMMARY: We examined the risk of liver cancer among 857 patients with cirrhosis in Scotland who received hepatitis C antiviral therapy and achieved a cure. We compared the risk of first-time liver cancer in patients treated with the newest interferon-free regimens, to patients treated with interferon. After accounting for the different characteristics of these two treatment groups, we found no evidence that interferon-free therapy is associated with a higher risk of liver cancer.

Mar 19, 2018
Patients with hepatitis C who are successfully treated with direct-acting antiviral agents experience a dramatic reduction in their risk for liver cancer, new data show. However, the decrease is much lower for those diagnosed with cirrhosis before starting a DAA.

Mar 13, 2018
Persistence of hepatocellular carcinoma risk in hepatitis C patients with a response to IFN & cirrhosis

Stagnation of fibrosis regression is associated with a high risk for HCC after SVR

Mar 3, 2018

Feb 12, 2018
Hepatocellular carcinoma - Updated and evidence-based review
Alejandro Forner, MD, MD Alejandro Forner
Published: 04 January 2018
DOI: http://dx.doi.org/10.1016/S0140-6736(18)30010-2

Full Text
Hepatocellular carcinoma appears frequently in patients with cirrhosis. Surveillance by biannual ultrasound is recommended for such patients because it allows diagnosis at an early stage, when effective therapies are feasible. The best candidates for resection are patients with a solitary tumour and preserved liver function. Liver transplantation benefits patients who are not good candidates for surgical resection, and the best candidates are those within Milan criteria (solitary tumour ≤5 cm or up to three nodules ≤3 cm). Image-guided ablation is the most frequently used therapeutic strategy, but its efficacy is limited by the size of the tumour and its localisation. Chemoembolisation has survival benefit in asymptomatic patients with multifocal disease without vascular invasion or extrahepatic spread. Finally, sorafenib, lenvatinib, which is non-inferior to sorafenib, and regorafenib increase survival and are the standard treatments in advanced hepatocellular carcinoma. This Seminar summarises the scientific evidence that supports the current recommendations for clinical practice, and discusses the areas in which more research is needed....

Future perspectives
In the past 10 years, treatment of hepatocellular carcinoma has evolved considerably. Nowadays, patients with hepatocellular carcinoma can benefit from effective options that improve their survival whatever the evolutionary stage of disease at diagnosis. However, improvement can still be made in several areas. Prevention of the acquisition of the risk factors for development of hepatocellular carcinoma is the best strategy for decreasing mortality. The high efficacy of direct acting antivirals in elimination of chronic hepatitis C virus infection is expected to have an impact on the incidence of hepatocellular carcinoma, but further information about disease evolution in the patients after viral cure needs to be collected.......

Article Downloaded & shared by @HenryEChang via Twitter.
View Article: https://jumpshare.com/v/La5WS4Mn8Uwpi927nbeU

December 2017
Healio - December 8, 2017
Liver cancer incidence after HCV therapy linked to risk factors, not treatment
Li DK, et al. Hepatol. 2017;doi:10.1002/hep.29707. 
Direct-acting antiviral treatment for hepatitis C did not correlate with an increased risk for hepatocellular carcinoma in a large cohort study of both treated and untreated patients with or without cirrhosis. Those with incident HCC after DAA treatment had higher risk factors at baseline. “There was no increased risk for HCC as a result of having received DAA therapy whatsoever,” Raymond T. Chung, PhD, director of Hepatology and Liver Center at Massachusetts General Hospital, told Healio Gastroenterology and Liver Disease. “The risk was related to their preexisting likelihood of developing HCC. The fact that HCC developed post-DAA, we think, is more likely to be an accident of timing than the idea that it's related to receipt of DAA — these persons were at risk for HCC whether they received DAAs or not.”

Innes H, et al. J Hepatol. 2017;doi:10.1016/j.jhep.2017.10.033.
Recently published data suggest that higher hepatocellular carcinoma incidence after sustained virologic response with interferon-free hepatitis C treatment correlates to patient baseline risk factors, such as age, Child-Turcotte Pugh score and prior treatment, rather than IFN-free therapy.

HCV Clearance Lowers Liver Cancer Risk by 70% no Matter Drug of Choice
Reaching sustained virologic response with direct-acting antivirals reduced the occurrence of hepatocellular carcinoma by 71%, but all treatments that cleared the virus saw a similar reduction in risk, according to a presenter at The Liver Meeting 2017.


November 2017
HCV Advocate – Direct-Acting Antiviral Treatment & Decrease a Incidence of Liver Cancer
The studies on this blog looked at treatment with DAAs to find out if curing hepatitis C (HCV) with DAAs improved HCV disease progression and reduced the risk of liver cancer.

October 2017
Oct 23, 2017
The Liver Meeting® 2017 - Vets with HCV Might Settle Cancer Controversy
In the largest cohort analyzed to date -- some 62,000 patients in the VA system -- there is no evidence that therapy with newer agents that act directly against the virus (DAAs) increases the risk of hepatocellular carcinoma (HCC), according to George Ioannou, BMBCh, of the Veterans Affairs Puget Sound Health Care System in Seattle.

Oct 20, 2017
The Liver Meeting® - Direct‐Acting Antiviral Therapy Cuts Liver Cancer Risk By 71%
The study’s findings showed that DAA‐induced sustained virological response is associated with a 71 percent reduction in patients’ liver cancer risk, and showed treatment with DAAs is not associated with increased liver cancer risk compared to treatment with interferon.

Oct 16, 2017
Short-term risk of hepatocellular carcinoma after hepatitis C virus eradication following direct-acting anti-viral treatment
In conclusion, our data showed no evidence of an increased risk of de novo HCC or recurrence by patients treated with interferon-free SOF-based regimens. However, cirrhosis was strongly associated with the short-term development of HCC after HCV eradication. Moreover, our findings underscore the fact that the serum EOT-AFP level is a useful marker for predicting de novo HCC for cirrhotic patients and that close HCC surveillance should be required for patients with a past history of HCC, especially for patients treated with noncurative procedures. Going forward, further studies will be required to elucidate the risk of HCC development over the long-term.....

Oct 3, 2017
HCV Treatment Not Associated with Liver Cancer, New Evidence Suggests
Kenneth Bender
An assessment of over 62,000 patients treated for hepatitis C (HCV) revealed no evidence to support the suggestion that direct acting antiviral (DAA) agents promote recurrence of hepatocellular carcinoma (HCC), and found instead that successful treatment with or without DAAs is associated with reduced risk of HCC.

September 2017
Sep 18, 2017
Coverage OncLive - 2017 International Liver Cancer Association Annual Conference
Study Shows DAAs Are Not Associated With Increased HCC Recurrence Risk
Angelica Welch
Published Online: Monday, Sep 18, 2017
Direct acting antivirals (DAA) are a novel and completely oral hepatitis C therapy that is associated with a high response rate. DAAs are used in most patients being treated for hepatitis C, including those with decompensated cirrhosis.

Sep 12, 2017
Full Text Article Provided by NATAP
"Most HCV-infected patients in the United States will undergo DAA-based antiviral treatment in the next few years and the vast majority of them will achieve SVR. Our results suggest that DAA-induced SVR is associated with a 71% reduction in HCC risk (AHR 0.29, 95% CI 0.23-0.37) compared to treatment failure. The reduction in HCC risk associated with SVR was similar irrespective of whether SVR was achieved by DAA-ONLY, DAA+IFN or IFN-ONLY regimens. This suggests that eradication of HCV reduces HCC risk independently of how it is achieved. In contrast to prior reports that suggested an increased HCC risk in patients treated with DAAs[[3], [7]], we found that receipt of DAA-ONLY antiviral treatment was not associated with increased risk of HCC when compared to receipt of IFN-ONLY antiviral treatment.....We found no evidence that treatment with DAAs was associated with increased risk of HCC compared to treatment with IFN.

Sept 5, 2017
Risk for hepatocellular carcinoma after HCV antiviral therapy with DAAs: case closed?
Several studies of patients treated with interferon -based therapy nicely documented that the risk for hepatocellular carcinoma (HCC) was markedly lower in patients who achieved SVR compared to those without SVR. 5-7 As a result, it was naturally assumed that with higher cure rates with DAAs, cancer rates would start to decline. It was therefore surprising and unsettling in 2016 to see a series of reports of unexpectedly high rates of ‘early’ HCC recurrence after ‘curative’ therapy as well as higher than expected rates of de novo HCC in patients who achieved SVR with DAAs.
PDF Full Text Article - Provided by @HenryEChang via Twitter

August 2017
Aug 15, 2017
How Do Direct-Acting Antivirals for HCV Affect HCC Risk?
The latest data on the controversial hepatitis C-hepatocellular carcinoma treatment link are examined.

Aug 10, 2017
The risks of hepatocellular carcinoma development after HCV eradication are similar between patients treated with peg-interferon plus ribavirin and direct-acting antiviral therapy
The risk of hepatocellular carcinoma (HCC) development is reduced following viral elimination by interferon therapy in chronic hepatitis C patients. However, the risk in patients treated with interferon-free direct-acting antivirals (DAAs) is unknown. We evaluated chronic hepatitis C patients who achieved viral eradication by pegylated-interferon plus ribavirin (PEG-IFN/RBV, n = 244) or daclatasvir plus asunaprevir (DCV/ASV, n = 154) therapy...

Aug 4, 2017
Liver cancer, mortality risks decrease with SVR after direct-acting antivirals
Patients who achieved sustained virologic response after direct-acting antiviral treatment also had significantly lower all-cause mortality and lower incident rates of…

July 2017
July 26, 2017
Medscape
With Hepatitis C Virus on the Run, Meet the New Challenge: Hepatocellular Carcinoma
Significant advances in the clinical practice of hepatology were addressed during this year's Digestive Disease Week. This review focuses on the concerns related to the apparent increase in the incidence of hepatocellular carcinoma (HCC).

July 16
Hepatitis C virus eradication with direct antiviral agents and liver cancer recurrence: Is the best the enemy of the good? Antiviral therapy has long been perceived as an adjuvant treatment modality worth to be offered to patients with chronic hepatitis C virus (HCV) infection after successful removal of a hepatocellular carcinoma (HCC), an approach dating more than two decades since interferon was first employed to treat non-A, non-B hepatitis.

July 10
DAAs do not affect HCC risk, SVR reduces risk
July 10, 2017
Recently published data showed a link between sustained virologic response and a reduced risk for hepatocellular carcinoma among patients treated with direct-acting…

July 3
Sustained response to direct-acting HCV antivirals tied to lower HCC risk
July 3, 2017
by Marilynn Larkin
NEW YORK (Reuters Health) - A sustained virologic response to direct-acting antiviral treatment of hepatitis C (HCV) is associated with a “considerable” reduction in the risk of hepatocellular carcinoma (HCC), researchers say. Dr. Fasiha Kanwal of Baylor College of Medicine in Houston, Texas and colleagues analyzed data on 22,500 HCV patients (mean age 62) from 129 Veterans Health Administration hospitals who filled more than one prescription of sofosbuvir, simeprevir, ledipasvir, a combination of paritaprevir/ritonavir or ombitasvir and dasabuvir, and daclatasvir in 2015.

June 2017
June 26, 2017
Challenges in Treatment of Hepatitis C among Patients with Hepatocellular Carcinoma

June 3, 2017
Medscape Coverage from the International Liver Congress (ILC) 2017
Navigating the Hep C Treatment and Cancer Risk Minefield

May 2017
May 26
Hepatocellular carcinoma and direct- acting antivirals: A never ending story?
Vincenza Calvaruso* andAntonio Craxì Version of Record online: 24 MAY 2017 DOI: 10.1111/liv.13421
Liver International
Volume 37, Issue 6, pages 812–814, June 2017

Key Points
• The benefit of SVR is higher in patients without clinically significant portal hypertension
• HCC occurrence in patients with compensated cirrhosis is comparable to historical controls of patients who achieved SVR after interferon-based therapy.
• Patients who achieve SVR with DAAs had a lower risk of developing liver cancer than those patients whose HCV infection was not cured.
• Data available on patients with previous HCC do not show an increased risk of HCC recurrence and report a comparable rate of reappearance of cancer among DAA-treated and untreated patients.

Full Text

Link Provided By
Henry E. Chang via Twitter

May 26
Summary Of  Available Data:
New Hep C Treatment Not Linked to Liver Cancer
Contrary to some earlier research, most recent studies see no association between response to DAAs and HCC

Do HCV DAAs Increase HCC Recurrence Risk or Not?
Does the administration of direct-acting antiviral (DAA) therapy increase a patient’s risk of hepatocellular carcinoma (HCC) recurrence?

Direct-acting-antivirals (DAA) can cure patients of the life-threating hepatitis C virus (HCV) infection, with cure rates exceeding 95%. However, questions have been raised about the long-term consequences of curing patients with DAAs, including a potential link between DAA treatment and the development of hepatocellular carcinoma (HCC).

Improved survival of patients with hepatocellular carcinoma and compensated HCV-related cirrhosis who attained SVR
Few studies examined the outcome of patients with HCV-related cirrhosis who developed hepatocellular carcinoma (HCC). The relative weight as determinant of death for cancer versus endstage-liver-disease (ESLD) and the benefit of HCV eradication remain undefined. This multicenter, retrospective analysis evaluates overall survival (OS), rate of decompensation and tumor recurrence in compensated HCC patients treated with IFN according to HCV status since HCC diagnosis.

Of Interest
HCC in presence of HCV decreases cure rate in DAA treatment
Patients with hepatocellular carcinoma and hepatitis C were less likely to achieve sustained virologic response while receiving direct-acting antiviral therapy compared with patients without HCC, according to results of a retrospective study.

International Liver Congress
April 21,2017
Direct-acting antivirals for hepatitis C not linked to higher liver cancer risk in most studies
People with hepatitis C who take treatment with direct-acting antivirals (DAAs) do not appear to have a higher risk of developing liver cancer compared to those treated with interferon, and the seemingly higher rates seen in some studies are attributable to risk factors such as older age and more advanced liver disease, according to a set of studies presented on Thursday at the International Liver Congress in Amsterdam. The congress is the annual meeting of the European Association for the Study of the Liver (EASL).

April 20, 2017
#ILC 2017: Is direct-acting antiviral therapy for Hepatitis C associated with an increased risk of liver cancer? The debate continues
Eight studies being presented at The International Liver Congress™ 2017 demonstrate contrasting evidence on the potential link between direct-acting antiviral treatment for Hepatitis C and liver cancer

Commentary on this study
Hepatitis C Patients At No Elevated Risk of Developing HCC Following DAA Compared To Interferon
Patients were at no elevated risk of developing hepatocellular carcinoma (HCC) after achieving sustained virologic response (SVR) following treatment with direct-acting antiviral therapy (DAA) for hepatitis C compared to interferon therapy, according to results of a meta-analysis reported at the 2017 International Liver Congress (ILC).

Timing of DAA therapy and HCC response may impact recurrence rate
April 20, 2017
AMSTERDAM — Unexpectedly high hepatocellular carcinoma recurrence rates were reported among patients who achieved sustained virologic response after receiving direct-acting antiviral therapy, according to data presented at the International Liver Congress.
“This update further supports our findings about an unexpected high recurrence rate associated in time with DAA, but also exposes a more aggressive pattern of recurrence and faster tumor evolution,” Maria Reig, MD, of the Barcelona Clinic Liver Cancer Group, Liver Unit, Hospital Clinic Barcelona, at the University of Barcelona, said in her presentation.

Liver International
April 20, 2017
Download PDF - Full Text
Direct-acting antiviral therapy decreases hepatocellular carcinoma recurrence rate in cirrhotic patients with chronic hepatitis C
Arrival of direct-acting antiviral (DAA) agents against hepatitis C virus (HCV) with high-sustained virological response (SVR) rates and very few side effects has drastically changed the management of HCV infection. The impact of DAA exposure on hepatocellular carcinoma (HCC) recurrence after a first remission in patients with advanced fibrosis remains to be clarified

Editorial - Healio
April 20, 2017
HCC After DAAs Requires More Study, but no Cause for Withheld Treatment
HCV Next, April 2017
As we continue to see the success of direct-acting antiviral therapy in treating hepatitis C virus, we must be aware of any potential complications from the underlying liver disease after successful treatment, especially hepatocellular carcinoma.

March 15, 2017
Full Text - Download PDF
Hepatitis C-related hepatocellular carcinoma in the era of new generation antivirals
Abstract
Hepatitis C virus infection is a major cause of hepatocellular carcinoma worldwide. Interferon has been the major antiviral treatment, yielding viral clearance in approximately half of patients. New direct-acting antivirals substantially improved the cure rate to above 90%. However, access to therapies remains limited due to the high costs and under-diagnosis of infection in specific subpopulations, e.g., baby boomers, inmates, and injection drug users, and therefore, hepatocellular carcinoma incidence is predicted to increase in the next decades even in high-resource countries. Moreover, cancer risk persists even after 10 years of viral cure, and thus a clinical strategy for its monitoring is urgently needed. Several risk-predictive host factors, e.g., advanced liver fibrosis, older age, accompanying metabolic diseases such as diabetes, persisting hepatic inflammation, and elevated alpha-fetoprotein, as well as viral factors, e.g., core protein variants and genotype 3, have been reported. Indeed, a molecular signature in the liver has been associated with cancer risk even after viral cure. Direct-acting antivirals may affect cancer development and recurrence, which needs to be determined in further investigation.
Download PDF

Feb 27, 2017
People with HIV and hepatitis C virus (HCV) co-infection who are successfully treated for hepatitis C using interferon-free direct-acting antiviral (DAA) therapy do not appear to have an increased likelihood of developing hepatocellular carcinoma (HCC), according to a study presented at the Conference on Retroviruses and Opportunistic Infections (CROI 2017) this month in Seattle.

Accepted Manuscript
Gastroenterology Accepted Date: 23 January 2017
Genome-wide Association Study Identifies TLL1 Variant Associated With Development of Hepatocellular Carcinoma After Eradication of Hepatitis C Virus Infection

Media Coverage of this Article
Feb 22, 2017
Genetic variant linked to risk of liver cancer after hep C eradication
NEW YORK (Reuters Health) – A single nucleotide polymorphism (SNP) in the tolloid-like 1 (TLL1) gene is associated with the development of hepatocellular carcinoma (HCC) after eradication of hepatitis C virus (HCV) infection, researchers from Japan report.
“When we constructed different models for predicting HCC in patients with mild as opposed to advanced hepatic fibrosis by combining this TLL1 variant with other distinct risk factors, these proposed models including TLL1 variant could be useful for predicting the occurrence of HCC after achieving sustained virological response (SVR) in the clinical practice,” Dr. Yasuhito Tanaka from Nagoya City University Graduate School of Medical Sciences told Reuters Health by email.
Continue reading...

Feb 8, 2017
High Rates of Hepatocellular Carcinoma After Hepatitis C Treatment
NEW YORK (Reuters Health) - Patients treated with direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV)-related cirrhosis appear to have high rates of hepatocellular carcinoma (HCC).

"If these findings are confirmed from other centers, studies are suggested to examine mechanisms of these findings," Dr. Ashwani Singal from University of Alabama at Birmingham told Reuters Health by email.

Some studies have shown unexpectedly high HCC recurrence rates after DAA therapy, whereas others have shown no such association.

Dr. Singal and colleagues examined the occurrence of de novo HCC in their retrospective study of 66 patients with HCV-related cirrhosis who received DAA between 2015 and 2016.

Typically, patients with HCV cirrhosis have an HCC incidence of 3%-5% per year, the researchers say.

But six of these patients (9.1%) developed HCC during or within six months after treatment, and two additional patients (3%) developed indeterminate liver lesions, according to their letter online February 1st in Gastroenterology.

They note that another study showed a reduced risk of HCC occurrence among DAA-treated patients who achieved sustained viral responses (SVR) versus those not achieving SVR, so they suggest prospective multicenter studies to confirm these findings.

"Be aware of this potential issue and consider more intensive HCC surveillance of HCV cirrhotics during and after HCV therapy," Dr. Singal concluded.

Dr. Gaetano Serviddio from University of Foggia, Italy, who has reported on the outcomes of DAA therapy, told Reuters Health by email, "DAAs have completely changed the prognosis of chronic hepatitis C patients who have a unique possibility to be cured definitively. To discover that such drugs have some tumor risks is particularly terrible. In any case, the number of events is small, and the data are not enough to support the hypothesis that the risk is directly related to the drugs."

"DAAs are safe and powerful drugs; millions of lives will be saved with such drugs," he said. "Studies should be supported to completely define patients at risk of HCC recurrence."
SOURCE: http://bit.ly/2lmDbXa
Gastroenterol 2017.

January 2017
In Press, Corrected Proof
Digestive and Liver Disease
Available online 21 January 2017
HCV clearance by direct antiviral therapy and occurrence/recurrence of hepatocellular carcinoma: A “true-or-false game”
Three years ago, the new direct antiviral therapies (DAAs) were approved for HCV treatment and the scenario completely changed. The share of patients in whom eradication is obtained raised to over 90% [7], the limits in the stage of the disease that can be treated disappeared, but solid data on the long-term outcome of cirrhotics treated with these new drugs are lacking.

A totally unexpected, intriguing and somehow hard-to-believe report of an increased incidence of HCC with rapid recurrence after HCV eradication with DAAs was first presented at the 2016 EASL meeting and then published in the Journal of Hepatology.....
Continue to full text article...

2016
AASLD 2016 and International Liver Congress 2016
Two studies presented at The Liver Meeting® 2016, and research presented in April at the International Liver Congress 2016.

Patients With HCV Who Treated With Interferon-based Therapy  
We begin with a study presented at AASLD 2016; The impact of sustained virological response to HCV infection on long term risk of hepatocellular carcinoma: the BC Hepatitis Testers Cohort, that suggested patients achieving SVR were still at risk for hepatocellular carcinoma, more specifically older patients and those with cirrhosis, commentary on the study is available over at Healio; SVR post–interferon-based therapy reduces, not eliminates risk for HCC, below is a summary of the study followed by slides @ NATAP 

Liver cancer risk reduced in patients cured of HCV
A large study found that the risk of hepatocellular carcinoma was reduced by 80% in people cured of HCV compared to those who were not cured.

This was a study of the entire population of people treated for HCV in British Columbia province, Canada, between 1990 and 2013. The study identified 8147 people treated with interferon-based regimens, 57% of whom were cured. Treated individuals were followed for a median of 5.6 years.

The liver cancer incidence was highest among those with cirrhosis who did not achieve a SVR (21 cases per 1000 patient-years of follow-up). In comparison, the liver cancer incidence was 6.4 per 1000 patient-years in those with cirrhosis who achieved SVR, 7.2 in those without cirrhosis who did not achieve SVR12 and 1.1 per 1000 patient-years in those without cirrhosis who achieved SVR12.

In a multivariable analysis liver cancer was associated with cirrhosis, age over 50 years, genotype three infection versus genotype one, alcohol consumption and being male in those who were not cured. In those who were cured of hepatitis C, only cirrhosis, age over 50 and being male were associated with an increased risk of liver cancer.

The researchers concluded that although curing HCV greatly reduces the risk of developing liver cancer, it does not eliminate the risk entirely. Older people and those with cirrhosis are at higher risk than others, underlining the importance of early diagnosis and treatment.

Reference
The impact of sustained virological response to HCV infection on long term risk of hepatocellular carcinoma: the BC Hepatitis Testers Cohort. Janjua NZ et al. The 67th Meeting of the American Association for the Study of Liver Diseases, Boston 2016. Abstract 175
Summary Source - https://www.basl.org.uk/

Review Slides

Patients With HCV Who Treated With Oral DAAs
In a prospective study presented at the 2016 AASLD; Incidence and pattern of "de novo" hepatocellular carcinoma in HCV patients treated with oral DAAs, reported that treatment with direct-acting antiviral therapy did not increase the risk of developing hepatocellular carcinoma in patients with HCV, but patients with advanced liver disease should continue to be monitored for liver cancer after treatment, here is the AASLD press release, followed by slides @ NATAP.

AASLD Press Release;
AASLD 2016 - Is There an Increased Risk of Cancer After Taking Direct-Acting Antiviral Medication?
BOSTON, Nov. 11, 2016
A new study presented this week at The Liver Meeting® — held by the American Association for the Study of Liver Diseases — found patients with hepatitis C who take direct-acting antiviral medication are at no higher risk for developing liver cancer than those who do not take the medication. However, they might be at an increased for more aggressive, infiltrative patterns of cancer, should they develop it.

"Data on clinical outcomes in cirrhotic patients with hepatitis C treated with direct-acting antiviral agents (DAAs) are still scanty and somehow controversial, and this is particularly true for development of a liver cancer, one of the most frequent and deadly complications of the disease," says Alfredo Alberti; professor of gastroenterology at University of Padova in Padova, Italy, and lead investigator in the study.

Recent studies have suggested the possibility of increased risk of developing liver cancer (hepatocellular carcinoma, or HCC) during and after DAA treatment in patients with hepatitis C (HCV). Dr. Alberti's team recently looked at the incidence of new cases of liver cancer among 3,075 HCV patients with advanced liver disease who were treated with DAAs. Almost 70 percent of the patients studied were men, and nearly 86 percent had cirrhosis (scarring of the liver). HCV genotypes one through four were all represented in the study, and patients with a past history of liver cancer were excluded.

All participants were treated with oral DAA therapy and monitored monthly. At the time of Dr. Alberti's team's analysis, patients had an average follow up of nearly 305 days from the time they started DAA therapy. During this period, the researchers found 41 patients had developed liver cancer, and the overall incidence (per 100 patient years) was 1.64.

Dr. Alberti's team further noted an incidence rate of 0.23 in patients without cirrhosis and of 1.93 in those with cirrhosis (1.93 for men and 1.94 for women). Incidence rates varied among HCV genotypes as well, with HCV-1 at the low end (1.70) and HCV-3 at the high end (2.44). Finally, cirrhotic patients with a Child-Pugh score of 'A' had an incidence rate of 1.64 and those with more advanced disease and a score of 'B' had a rate of 2.92.

"These rate incidences were not significantly different from those observed in historical control cohorts of similar patients from the same geographic area, not receiving antiviral therapy, indicating that the risk of developing HCC is not increased by oral DAAs, being closely dependent on stage of disease as in untreated cases," says Dr. Alberti.

Liver cancer was diagnosed four weeks after starting DAA therapy in three patients, at week eight in three patients, week 12 in six patients, between week 12 and 24 in thirteen patients, and after treatment ended in sixteen patients. Fifty percent of patients who developed liver cancer developed a single nodular cancer with a typical vascular pattern, while 50 percent had a more aggressive pattern. Finally, 28 out of the 41 patients who developed cancer were successfully cured of HCV (reaching a sustained virological response at 12 weeks), while the remaining 13 relapsed.

In different analyses of the data, Dr. Alberti's team found elevated liver enzymes and low platelet count to be associated with liver cancer risk, while gender, age, HCV genotype and DAA regimen were not. The best baseline predictor of liver cancer risk was APRI scores (which calculate scarring in the liver). The researchers find the risk of developing liver cancer increased linearly by 10 percent at each one-point increase in APRI value.

"The results of this study, while confirming that DAAs treatment doesn't increase the overall risk of HCC, indicate that there is no pharmacological prevention of HCC even with successful antiviral therapy, at least during the first six to 12 months after initiation of treatment when microscopic and therefore initially invisible HCC foci might even be boosted in their growth as consequence of the profound immunological and molecular changes in the liver microenvironment following abrupt cessation of HCV replication," explains Dr. Alberti. "Therefore, it is mandatory that patients treated with DAAs with advanced liver disease should continue to be monitored for HCC."

This release contains updated data. Dr. Alberti will present these findings at AASLD's press conference in Room 313 at John B. Hynes Veterans Memorial Convention Center in Boston on Saturday, November 12 at 4pm. The study entitled "Incidence and pattern of "de novo" hepatocellular carcinoma in HCV patients treated with oral DAAs" will be presented by Antonietta Romano, MD in Ballroom A on Sunday, November 13 at 10am. The corresponding abstract (number 19) can be found in the journal, Hepatology – Special Issue: The 67th Annual Meeting of the American Association for the Study of Liver Diseases: The Liver Meeting 2016.

View the slides @ NATAP Reported by Jules Levin
"Incidence and pattern of "de novo" hepatocellular carcinoma in HCV patients treated with oral DAAs"
Another look at both studies;  Incidence and pattern of `de novo` hepatocellular carcinoma in HCV patients treated with oral DAAs and The impact of sustained virological response to HCV infection on long term risk of hepatocellular carcinoma: the BC Hepatitis Testers Cohort.

Liver cancer risk reduced after hepatitis C treatment, but vigilance needed for aggressive cancers in months after treatment
Keith Alcorn
People who are cured of hepatitis C after a course of direct-acting antiviral treatment do not have a higher risk of developing liver cancer (hepatocellular carcinoma), and probably have a reduced risk, studies from Italy and Canada presented at The Liver Meeting this week in Boston have shown. However, Italian researchers also found that those people who did develop liver cancer during or shortly after antiviral treatment were more likely to develop an aggressive form of liver cancer, perhaps because of changes in immune surveillance in the liver as a result of treatment.

Patients With HCV And History Of Liver Cancer Who Treated With New Antivirals
As a reference point two studies presented in April at the International Liver Congress 2016 found; patients with a history of hepatocellular carcinoma have the highest risk of developing a tumor after direct-acting antiviral therapy, but new diagnoses were also reported. ​​Read the report; Liver Cancer Found in Hepatitis C Patients on New Antivirals provided below, or over at Medscape.

Liver Cancer Found in Hepatitis C Patients on New Antivirals
Kate Johnson
April 15, 2016
BARCELONA, Spain — In a surprising number of patients with hepatitis C and cirrhosis, hepatocellular carcinoma develops within weeks of starting treatment with direct-acting antivirals, new research suggests.

"I do not think that direct-acting antivirals are directly responsible," said lead investigator Stefano Brillanti, MD, from the University of Bologna, Italy.

"The hypothesis is that immune surveillance may be reduced too rapidly," he told Medscape Medical News. "You have an immediate drop in viremia, but also attenuation of inflammation. I think inflammation is a bad thing in terms of hepatitis progression, but it may be a good thing in terms of controlling cancer."

The study by Dr Brillanti's team, presented here at the International Liver Congress 2016, suggests that patients with hepatitis C should be closely monitored after treatment with direct-acting antivirals. Two days earlier, a study conducted by a team from the University of Barcelona in Spain suggested the same thing (J Hepatol. Published online April 12, 2016).

Both studies indicate that patients with a history of hepatocellular carcinoma have the highest risk of developing a tumor after direct-acting antiviral therapy, but new diagnoses were also reported.

The EMA has extended the scope of its review of the six direct-acting antivirals approved for use in the European Union for the treatment of chronic hepatitis  C infection to include the risk for early liver cancer recurrence, the agency reported.

Tumor Risk
"Patients with previous hepatocellular carcinoma are, of course, at risk of recurrence anyway," Dr Brillanti said. "A 30% rate over 3 years from initial surgery or ablation is normal. What was surprising to us was that we were observing 4 cm lesions after 12 weeks."

The retrospective cohort study involved 344 consecutive patients with hepatitis C and cirrhosis who were treated with one or two direct-acting antivirals and followed for 24 weeks after therapy. Median age was 63 years.
In this cohort, 237 patients were infected with hepatitis C genotype 1, 191 had received previous antiviral treatment, and 59 had been successfully treated for hepatocellular carcinoma.

Contrast-enhanced ultrasonography and CT scans or MRIs were performed at baseline to exclude active hepatocellular carcinoma, and then again 12 and 24 weeks after treatment.
During the follow-up period, 26 of the 344 patients (7.6%) were diagnosed with hepatocellular carcinoma. This included 17 of the 59 patients previously treated for hepatocellular carcinoma, and nine of the 285 patients (3.2%) with no history of carcinoma.

There was no association between recurrence and hepatitis C genotype, direct-acting antiviral regimen, or treatment response for patients who did not develop hepatocellular carcinoma or for those who did. The sustained viral response rate at 12 weeks was 89% in the two groups.
For patients with a history of hepatocellular carcinoma, those who developed a recurrence were significantly younger than those who did not (56 vs 73 years), were more frequently treatment-experienced (88.2% vs 61.9%), and had more advanced liver fibrosis at baseline.

More patients who developed hepatocellular carcinoma during the follow-up period, regardless of history, had advanced cirrhosis than those who did not, indicated by a Child-Pugh class B score (26.9% vs 10.1%; P =.02). They also had more liver stiffness, indicated by a measure above 21.3 Kpa (61.5% vs 31.8%; P = .005), and fewer platelets at baseline (102.3 vs 124.4 × 1000/mm³; P = .02).

Second Study
In the Spanish study, all 58 hepatitis C patients had a history of hepatocellular carcinoma (with complete radiologic response), and all but three were cirrhotic at the start of direct-acting antiviral therapy. After a median follow-up of 5.7 months, the rate of tumor recurrence was 27.6%, with a median time to recurrence of 3.5 months. The sustained viral response rate at 12 weeks was 97.5%.

In their publication, the Spanish authors note that these findings "raise a concern about the benefits" of direct-acting antiviral therapy in the subgroup of hepatitis C patients with a history of hepatocellular carcinoma. Although the therapies "offer a major hope for current and future patients, we may face a drawback that may change these predictions in specific groups of patients," they point out.

Dr Brillanti said he is less concerned. "Clones of the hepatocellular carcinoma were present before the therapy," he pointed out, suggesting that direct-acting antivirals simply accelerated their inevitable progression. Either way, he said, an increased risk for hepatocellular carcinoma should not deter clinicians or patients from pursuing treatment with direct-acting antivirals when it is needed.

"This is a different cancer than elsewhere in oncology — it is a cancer within an advanced chronic disease — so the prognosis, the life expectancy, is related not only to the liver cancer but also to the liver disease and liver function," he explained. "If you don't treat these patients and ameliorate their liver function, and if hepatocellular carcinoma occurs, you have no chance of curing them. But if you ameliorate liver function and they develop hepatocellular carcinoma, you can cure it better because their improved liver function will allow an ablation."

This finding is "quite striking and unexpected, but we have to be cautious," said Laurent Castera, MD, PhD, from Hôpital Beaujon in Clichy, France, who is vice-secretary of the European Association for the Study of the Liver, and was not involved with the research.

"It is potentially worrying, but these are retrospective studies, with possible referral bias, and no long-term follow-up," he told Medscape Medical News.

Dr Brillanti reports receiving research grants from Gilead Sciences and being on the advisory board for Janssen and Gilead Sciences. Dr Castera reports serving on the speaker's bureau for Echosens.
International Liver Congress (ILC) 2016: Abstract LBP506. Presented April 14, 2016.
Source - Medscape

Feb 2017
Of Interest - In The News
Risk of liver cancer low in patients with cirrhosis, study finds
01 Feb 2017
The results of a study by researchers at The University of Nottingham suggest that the risk of liver cancer in patients with cirrhosis may be much lower than previously thought.

Liver cancer – or hepatocellular carcinoma (HCC) – is one of the most serious complications of cirrhosis, or scarring of the liver, caused by long-term liver damage.

However, an analysis of health records, published in the academic journal Alimentary Pharmacology and Therapeutics, found that the 10-year incidence of HCC in UK patients with cirrhosis is actually only four per cent, or lower.

Joe West, Professor of Epidemiology in the University’s School of Medicine, led the study and believes that the results could better inform doctors on how best to focus resources for the benefit of patients with liver damage.

He said: “This very low incidence of HCC occurrence in people with cirrhosis caused by alcohol or of unknown origin suggests that surveillance for HCC among these groups is likely to benefit patients little.

“As surveillance incurs substantial cost, it is therefore unlikely to represent value for money for the NHS. There may well be other ways of spending this money that would benefit patients far more.”

Cirrhosis is caused by long-term damage to the liver, which leads to a build-up of scar tissue which replaces healthy tissue and eventually can result in liver failure.

The researchers identified more than 3,000 patients with cirrhosis of the liver using the UK’s General Practice Research Database between 1987 and 2006 and then cross-referenced this information with diagnoses of HCC on linked national cancer registries.

The study found that only 1.2 per cent of patients with alcoholic cirrhosis and 1.1 per cent of patients with cirrhosis of unknown cause will develop HCC within a decade. The highest 10-year incidence of HCC was among those with cirrhosis due to chronic viral hepatitis (four per cent).
http://www.nottingham.ac.uk/news/pressreleases/2017/january/risk-of-liver-cancer-low-in-patients-with-cirrhosis-study-finds.aspx

March 2017
Antiviral medication successful for treating HCV in hepatocellular carcinoma

Hepatocellular Carcinoma Decreases the Chance of Successful Hepatitis C Virus Therapy with Direct-Acting Antivirals
The new medications for hepatitis C have excellent cure rates. However, our study shows that in patients with both liver cancer and hepatitis C, they do not achieve these cure rates. Patients with liver cancer are almost 6 times more likely to fail hepatitis C treatment than patients without liver cancer

AGA Institute Clinical Practice Update: Care of Patients Who Have Achieved a Sustained Virologic Response (SVR) Following Antiviral Therapy for Chronic Hepatitis C Infection
Ira M. Jacobson M.D., Joseph K. Lim, M.D., and Michael W. Fried, M.D.
ACCEPTED MANUSCRIPT
DOI: http://dx.doi.org/10.1053/j.gastro.2017.03.018

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Abstract
Chronic hepatitis C virus (HCV) infection is well-recognized as a common blood borne infection with global public health impact, affecting 3 to 5 million persons in the U.S. and over 170 million persons worldwide. Chronic HCV infection is associated with significant morbidity and mortality due to complications of liver cirrhosis and hepatocellular carcinoma (HCC). Current therapies with all-oral directly acting antiviral agents (DAAs) are associated with high rates of sustained virologic response (SVR), generally exceeding 90%. SVR is associated with a reduced risk of liver cirrhosis, hepatic decompensation, need for liver transplantation, and both liver-related and all-cause mortality. However, a subset of patients who achieve SVR will remain at long-term risk for progression to cirrhosis, liver failure, HCC, and liver-related mortality. Limited evidence is available to guide clinicians on which post-SVR patients should be monitored versus discharged, how to monitor and with which tests, how frequently should monitoring occur, and for how long. In this clinical practice update, available evidence and expert opinion are used to generate best practice recommendations on the care of patients with chronic HCV who have achieved SVR.

Index
Assessment of HCV RNA after SVR12 has been attained
With the initiation of trials of DAA regimens, initially in combination with interferon and later without it, the attainment of SVR 12 weeks after completion of treatment replaced SVR24 as the primary endpoint, defined as undetectable HCV RNA on a highly sensitive PCR assay (lower limit of detection <12 IU/mL). This transition was based upon the rarity of relapse after follow up week 12, and it helped move the field ahead by shortening the intervals between successive trials in development programs (22). It has become apparent that late relapse beyond this time point is no more common, and perhaps less so, than it was after interferon-based therapy
Ongoing surveillance for hepatocellular carcinoma after SVR Is HCC risk after SVR exclusive to patients with advanced fibrosis and cirrhosis?
Can HCC surveillance ever be discontinued?
How should screening for, and management of, varices be affected by SVR?
Should patients be routinely monitored for regression of advanced fibrosis or
cirrhosis?
Recurrent HCC After SVR
Reinfection
Lifestyle Measures
Conclusions
Continue reading...

Tuesday, June 12, 2018

Blogger Updates: Opioid & hepatitis C epidemic


Thanks for stopping by, we begin with an article published today on Harvard Law, about the opioid & hepatitis C epidemic:

Harvard Law 
Hepatitis C Virus Infection: Another Consequence of the Opioid Epidemic
HCV is matching the grim statistics of marching hand-in-hand with the opioid epidemic and we must make sure treatment is available to everyone.

There were 42,000 deaths from suspected opioid overdose in 2016, more than in any previous year to date. These deaths illuminate the direct impact of the epidemic, but this is only the tip of the iceberg. Hepatitis C is another epidemic that goes increasingly hand-in-hand with the opioid crisis, and is likely to take a long-term toll on American lives as well.

Read the article here: Harvard Law 

In The News
Reuters Health News
June 12, 2018
Sofosbuvir-velpatasvir-voxilaprevir effective in previously treated chronic hepatitis C

Blog Updates
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
Understanding Hepatitis C Genotypes
Hepatitis C genotypes are like different races, or breeds, of the virus. Here is the long and the short of it...

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. 

Liver disease such as viral hepatitis and other liver conditions can cause damage to the liver which can range from mild to severe. 

Longtime hepatitis C activist and advocate, Orlando Chavez died from a massive brain hemorrhage on June 3, 2018 in Oakland, CA. 

View all updates: Hep

HepatitisC.net
There are many lab tests done to help diagnosis liver disease. Understanding and tracking liver lab tests can help 

This is the sixth and final installment of a six-part series called The Fallout Guide for Hep C. Six emotional 

Kim’s article I Have Hep C, I Am Not Hep C. 

View all blog updates: HepatitisC.net 

Lucinda K. Porter 
Now I am turning 65. Hepatitis C is gone, and I’ve been thinking about goals. 

View all updates: Lucinda K. Porter 

ADRLF (Al D. Rodriguez Liver Foundation)
Alcohol’s Heart Benefits May Not Apply to People With Liver Disease
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.

View all updates: ADRLF

Life Beyond Hepatitis C
Hep C Treatment Mile Markers
I discovered a very helpful way to get through Hep C Treatment with weekly achievable goals called Mile Markers. 

View all updates: Life Beyond Hepatitis C 

I Help C
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.

View all updates: I Help C

Other Updates
Hepatitis B Foundation
World Hepatitis Day 2018: Why is Hepatitis B testing Important?
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.

View all updates: Hepatitis B Foundation 

Canadian Liver Foundation
Keeping your liver lively!
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!

When NASH becomes a family affair
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.

View all updates: Canadian Liver Foundation

Harvard Medical School
Six common depression types
Ongoing mood, cognitive changes may require professional help

Harvard Health
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.

View all updates here: Harvard Health Blog 

Mayo Clinic
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.

View all updates: Mayo Clinic

University of Michigan
Video Conferencing Helps PCPs Improve Liver Disease Care, Survival Rates
Providing physicians with virtual access to specialists can be lifesaving to liver disease patients. A new study finds that it boosts survival rates by 54 percent. 

View all updates: Lab Blog

See you soon,
Tina

Photo Credit: https://www.pexels.com/

NIH launches HerbList, app with information about safety and effectiveness of herbal products


NIH launches HerbList, a mobile app on herbal products

To help consumers navigate information about popular herbs and herbal supplements, the National Institutes of Health’s National Center for Complementary and Integrative Health has launched HerbList™ – an app for research-based information about the safety and effectiveness of herbal products. Developed by NCCIH and launched through the National Library of Medicine’s app pages, HerbList is available on the Apple App Store (link is external) and Google Play Store (link is external).

HerbList helps consumers, patients, healthcare providers, and other users to quickly access information about the science of popular herbs and herbal supplements including kava, acai, ginkgo, turmeric, and more than 50 others marketed for health purposes.

Users can access information on potential safety problems, side effects, and herb-drug interactions with additional links to resources for more information. They can also mark favorite herbs for quick recall and offline accessibility.

HerbList provides only scientific, research-driven information to provide consumers and health care practitioners with unbiased information to make informed decisions about supplement use.

"Providing an app for users is part of NCCIH's effort to inform consumers and health care providers within the complementary and integrative health space," said David Shurtleff, Ph.D., acting director of NCCIH. "People are considering herbs and herbal supplements for various reasons, and it is important that they are aware of what the research says about safety and effectiveness."

The app was built using NCCIH's Herbs at a Glance webpage; a series of brief fact sheets that provide basic information about specific herbs or botanicals—common names, what the science says, potential side effects and cautions, and resources for more information.

HerbList is available to download for your iPhone or iPad from the Apple App Store (link is external) or to your Android device via Google Play (link is external).

About the National Center for Complementary and Integrative Health (NCCIH): NCCIH’s mission is to define, through rigorous scientific investigation, the usefulness and safety of complementary and integrative health approaches and their roles in improving health and health care. For additional information, call NCCIH’s Clearinghouse toll free at 1-888-644-6226. Follow us on Twitter (link is external), Facebook (link is external), and YouTube.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

On This Blog
Hepatitis C and Dietary Supplements

Monday, June 4, 2018

DDW 2018 - Is an HCV cure rate of 100 percent realistic?

DDW News | Jun 4, 2018 | 2018, AASLD, DDW Daily News, Monday Issue 2018, Watch Videos

David E. Bernstein, MD, FAASLD, discusses the possibility of an HCV cure rate of 100%

Is an HCV cure rate of 100 percent realistic?
David E. Bernstein, MD, FAASLD, wants to break down the barriers preventing access to curative therapies for hepatitis C virus (HCV). Although antiviral therapy has led to a cure rate of more than 90 percent of HCV cases, Dr. Bernstein thinks more can be done to increase the cure rate.

In this DDW Daily News video exclusive, he discusses several obstacles preventing patients’ access to curative therapies, including cost concerns, public policy issues and insurance variations that have led to different state rules and regulations. Dr. Bernstein also addresses the benefits of HCV therapy and whether it’s possible to eradicate HCV and achieve 100 percent cure rate.

“It’s the only viral disease that we can actually cure, but from a public policy standpoint a significant portion of our population does not have access to these life-changing and curative therapies for unclear reasons,” says Dr. Bernstein, director of the Sandra Atlas Bass Center for Liver Diseases at the Zucker School of Medicine at Hofstra/Northwell, East Garden City, NY.
Video:
http://blog.ddw.org/is-an-hcv-cure-rate-of-100-percent-realistic/

Links
Digestive Disease Week® (DDW) 2018 June 2-5, 2018
Website - Digestive Disease Week® (DDW)
DDW Blog
DDW Daily News
On Twitter - #DDW18

June Newsletters - Hepatitis C in Colorado & Liver Congress 2018 Coverage

June Hepatitis Newsletters
Welcome, we start with a few June publications, followed by events you may have missed last month. Next, sift through the June index of newsletters, and finish off with a list of well written blogs with extremely useful information on the topic of viral hepatitis.

June Updates
A Guide to Understanding Hepatitis C (HCV)
HCV Advocate: We have completely updated and given our most popular publication and a new look. To download, click here

Despite the availability of new DAA regimens and changes in restrictions of these therapies, absolute denials of DAA regimens by insurers have remained high and increased over time, regardless of insurance type.

Updated Guidelines - Hepatitis C testing recommended for Canadians born between 1945 and 1975
More than 250,000 Canadians are believed to be infected with hepatitis C, but 40 to 70 per cent are unaware they harbour the blood-borne virus. The Canadian Association for the Study of the Liver, a national group of health-care providers and researchers, published its guidelines on testing and treating hepatitis C in Monday’s edition of the Canadian Medical Association Journal.

When to Initiate HCV Therapy and Overview Of New Drugs
Sit back, grab your favorite beverage and review; Making a Decision on When to Initiate HCV Therapy, updated a few days ago, published by Hepatitis C Online.

What You Missed In May
Screening for Hepatitis C Climbs in Colorado

Each year, more Coloradans are contracting hepatitis C, the infectious liver disease spread by contact with infected blood. The state’s hep C death rate is heading higher as well. An analysis by the Colorado Health Institute of newly available information from the state’s All Payer Claims Database (APCD) reveals the rate of Coloradans getting screened for the hepatitis C virus nearly tripled between 2011 and 2016.

Key Takeaways:
The rate of screening for hepatitis C among Coloradans nearly tripled between 2011 and 2016, a Colorado Health Institute analysis of newly available data shows.

Baby boomers between ages 55 and 64 saw the largest increase in screening rates during that time; millennials between 25 and 34, had the highest screening rate each year.

Medical advances, federal and state policy changes and fallout from the opioid epidemic have contributed to the rise in screening.  
Download the report.

Full of Life: The Stories of People Affected by Hepatitis C
The Institute’s Hepatitis Policy Project has released a new report that features the stories of people affected by hepatitis C. The report was authored by Sonia Canzater and Jeffrey S. Crowley. “Full of Life: The Stories of People Affected by Hepatitis C,” underscores the impact of hepatitis C and the potential for improving the lives of those with the disease.

Real people make up the HCV epidemic, and their experiences and the full lives they lead offer motivation and resolve to work to eliminate HCV as a public health threat. But, as this report will show, the reality of what is happening to respond to HCV in the United States (US) falls short of the possibility of what we could make happen to save lives and strengthen communities, read it here....
This project is supported by a grant from Gilead Sciences.

AASLD online HCV guide update includes key at-risk populations

May 31, 2018
The American Association for the Study of Liver Diseases and the Infectious Diseases Society of America recently updated their hepatitis guideline website, HCVguidelines.org, to include several new testing and management recommendations for pregnant women, men who have sex with men, people who inject drugs and incarcerated individuals. Kristen M. Marks, MD, assistant professor of medicine at Weill Cornell Medical College in New York and HCV Guidance co-chair, discussed the new updates with HCV Next, read it here...

New Hepatitis C Virus Guidelines and Lyme Disease Prevention



Perspective - New England Journal Of Medicine 
The FDA and the Next Wave of Drug Abuse — Proactive Pharmacovigilance
In response to the opioid crisis, the Food and Drug Administration (FDA) has taken action on multiple fronts. We have approved better measures for treating opioid use disorder and preventing deaths from overdose, have launched efforts to inform more appropriate prescribing as a way to limit clinical exposure to opioids, have taken actions to reduce the excess opioids available for abuse, and are working to facilitate development of new therapeutics that can effectively and safely help patients suffering from pain. Going forward, the FDA needs to remain vigilant to recognize shifting trends in the addiction landscape. Taking a systematic approach to monitoring such trends should allow us to intervene promptly and appropriately and protect the public from associated risks, read the article here...…

Surrey develops hepatitis C model that could help improve treatment
The University of Surrey has created a new mathematical model that details how the hepatitis C (HCV) infection develops and behaves more accurately than previous models, read the press release, here.....

New strategy to cure chronic hepatitis B infection
Scientists from Karolinska Institutet and Hannover Medical School have published two studies that provide insights into how the immune system responds and helps to clear a hepatitis B infection after treatment interruption. The findings offer a framework for future tailored treatment strategies and are published in The Journal of Infectious Diseases and Journal of Hepatology, read it here....

Conditions Related To HCV
Listen - Hepatitis C: It’s About More than Liver Disease
The National Viral Hepatitis Roundtable is pleased to present a webinar to discuss the health effects of hepatitis C virus (HCV) infection that occur outside the liver. Learn more about how conditions such as kidney disease, depression, certain types of cancer, and diabetes are related to HCV infection. The webinar will feature clinician and patient perspectives to facilitate discussion about the importance of recognizing these conditions as part of HCV management and the implications for early HCV treatment.
This webinar is now archived. Click here for the slides. Click here for the recording. (Click the link and then enter the requested information to view the webinar).

Fatigue & Achieving SVR

Do fatigue and quality of life improve after hepatitis C is cured?
Patient-reported outcomes such as fatigue, vitality and mental health improve substantially in the two years following hepatitis C cure for people with cirrhosis, but people with cirrhosis are less likely than others to experience rapid resolution of severe fatigue after successful hepatitis C treatment, according to two studies from the Center for Outcomes Research in Liver Diseases reported last month at the 2018 International Liver Congress in Paris, read it here...

Fibrosis
Can anti-viral therapy reduce liver fibrosis and steatosis in patients with chronic hepatitis C virus?
In this study, changes in liver stiffness and steatosis as determined by MRI in patients with chronic HCV genotype 1 or 2 infection who received direct-acting anti-viral therapy and achieved SVR is investigated, read the article here....

Screening & Treating HCV
HCV From Screening to Cure
The following video presentation; "HCV From Screening to Cure: A Closer Look at Changing At-Risk Populations and an Evolving Treatment Landscape" with Ira M. Jacobson, MD., and provided by Medical Learning Institute, Inc. and PVI, PeerView Institute for Medical Education, will discuss screening strategies, stigma, patient-related barriers to treatment, hepatitis C testing for identifying current infection, and tests used to stage fibrosis. Also discussed is treatment for HCV patients with cirrhosis, as well as treatment adherence, duration, treatment according to HCV genotype, ending with "How Much Care Do The Cured Need?" Watch the video, here....

Supervised injection sites are coming closer to reality in several cities in the United States.
U.S. Cities Consider Supervised Injection Sites
Safe injection facilities can reduce overdoses, disease transmission, and public drug use.

Prospective Study: No psychiatric side effects with new IFN-free treatment for HCV 
Treatment of Hepatitis C virus (HCV) infection has evolved from interferon (IFN)-based treatments to direct-acting antivirals (DAAs). Patients with HCV have an elevated psychiatric morbidity (including substance abuse) and patients with such comorbidity have often been excluded from treatment with IFN. To date, little is known about psychiatric adverse effects of DAA-based regimens. We therefore aimed to study the psychiatric side effects of new IFN-free treatment for HCV (including depressive symptoms and sleep) in real world patients also including those with a history of psychiatric diagnosis, substance abuse or drug dependence, read the article here....

The Truth about Hepatitis C Treatment long term Side Effects
Karen Hoyt is devoted to offering support and accurate information to people coping with the effects of liver disease through a series of informative videos, topics include ascites, hepatic encephalopathy and other liver-related complications.
Here is the latest video: The Truth about Hepatitis C Treatment long term Side Effects.

AASLD Special Collection: Treating Liver Disease in 2018
Topics include: Hepatitis C virus reactivation in patients receiving cancer treatment, drug‐drug interactions in hepatitis C virus treatment and more. Start here...…

Fatty Liver
Journal of Gastroenterology and Hepatology
Special Issue: Burden of Nonalcoholic Fatty Liver Disease in Australia.
In this review, we present available data on the prevalence of NAFLD in Australia, its associated health burden in terms of hepatic and extrahepatic complications, common presentations, and evidence‐based therapeutic options. We also outline a research agenda highlighting gaps in knowledge that are needed to improve diagnosis and management of people with NAFLD specific to the Australian context. Full-text available here.....  

Behind The Headlines
Most multivitamins and supplements are a 'waste of money' 
The review found that taking the most widely used supplements – multivitamins, vitamin D, vitamin C and calcium – had no significant effect on the risk of heart-related illnesses. And some supplements, such as vitamin B3 (niacin) may do more harm than good, read it here.... 

HIV
A new edition of our 'Antiretroviral drugs chart' is now available online. This one-page reference guide lists all the anti-HIV drugs licensed for use in the European Union, with information on formulation, dosing, key side-effects and food restrictions, read it here ….

The Controversy 
Do direct acting antivirals cure chronic hepatitis C?
A controversial review by the Cochrane Collaboration published June 6, 2017/updated September 8 2017, cast doubt on the effectiveness of new hepatitis C treatments, on May 12, 2018, BMJ published; Do direct acting antivirals cure chronic hepatitis C ? by Cochrane author Janus Christian Jakobsen. BMJ talk medicine also aired a follow-up podcast with Jakobsen; New antivirals for Hepatitis C - what does the evidence prove? On May 16, 2018 experts weighed in on the program, read what they had say: Experts Respond To Latest BMJ Article: Do direct acting antivirals cure chronic hepatitis C?

June Newsletters
HCV Advocate
The HCV Advocate newsletter is a valuable resource designed to provide the hepatitis C community with monthly updates on events, clinical research, and education.
Newsletter
June Issue
We are continuing our conference coverage of the International Liver Congress 2018 and we have the following posters and presentations:
More of Lucinda’s Highlights from the 2018 International Liver Congress:
STUDY Abstract: THU-099 Lowering the upper limit of serum alanine aminotransferase levels may detect significant liver disease in the elderly – H. Schmilovitz-Weiss, et al.
STUDY Abstract: THU-100 Hepatitis C patients with HIV co-infection demonstrate unique liver-related complications and health behaviors compared to HCV mono-infected patients – M. Lu, et al.
STUDY Abstract: THU-399 Incidence and prevalence of extrahepatic manifestations of HCV – H. El-Serag, et al.
STUDY Abstract: THU-418 Lymphomas incidence in HIV/HCV coinfected versus HIV monoinfected patients over twenty-one years of follow up (1993–2014) – A.M. de Cea, et al.
STUDY Abstract: FRI-368 Long-term immunological and clinical impact of HCV eradication with directacting antivirals in patients with HCV-associated cryoglobulinemia vasculitis – M. Bonacci, et. al.
STUDY Abstract: THU-412 Among 1945–1965 birth cohort patients with at least one additional hepatitis C virus risk factor, one in eight were positive for HCV antibody: an underserved safety-net population experience – G. Hirode, et. al.
STUDY Abstract: THU-429 Strong increase of acute HCV infections in HIV-negative men having sex with men – L. Cotte, et. al.

More of Alan’s Highlights from the 2018 International Liver Congress:
STUDY Abstract: GS-018 Long-term follow-up of patients with chronic HCV infection and compensated or decompensated cirrhosis following treatment with sofosbuvir-based regimens – A. Mangia, et. al.
STUDY Abstract: LBO-008 A phase 3b, open-label, randomized, pragmatic study of glecaprevir/ pibrentasvir +/− ribavirin (RBV) for HCV genotype 1 subjects who previously failed an NS5A inhibitor + sofosbuvir (SOF) therapy – A. Lok, et. al.
STUDY Abstract: THU-121 Track, Trace & Treat: Results from a retrieval strategy to identify lost to follow-up chronic hepatitis c patients – I. Munsterman, et. al.
STUDY Abstract: LBP-0231 The percentage of patients with HCV infection in need of a liver transplant is rapidly declining while their survival after transplantation is improving: a study based on European Liver Transplant Registry – G. Perricone, et al.
STUDY Abstract: FRI-028 Liver transplant waitlist mortality, transplantation rates and post-liver transplant outcomes in Hispanics – P.J. Thuluvath, et al.
STUDY ABSTRACT: FRI-374 The impact of sustained virologic response on severe fatigue in patients with chronic hepatitis C: the role of HCV viremia and co-morbidities – Z. Younossi, et. al.
STUDY Abstract: THU-075 hepatitis C screening within the National Elimination Program in the country of Georgia – A. Gamkrelidze, et. al. 

BRIEFLY…
STUDY Abstract: THU-075 hepatitis C screening within the National Elimination Program in the country of Georgia – A. Gamkrelidze, et. al.
STUDY Abstract: THU-104 The first result from the general population hepatitis screening in Mongolia: 38% of 40– 65-year-olds screened and anti-HCV prevalence of 15.6% among 40– 65-year-olds – B. Dashtseren, et. al.
STUDY Abstract: PS-090 Direct-acting antiviral treatment in sub-Saharan Africa: A prospective trial of ledipasvir/ sofosbuvir for chronic hepatitis C infection in Rwanda (The SHARED Study) – N. Gupta, et. al.

Hepatitis Materials Available:

We have a limited supply of free materials available. They are pre-packaged in the following quantities:
A Box of 1,500 Palm cards
A box of 1,000 Palm cards, 500 Baby Boomer postcards, & 500 website cards.

Please email us at Rosanne1956@hotmail.com if you have a need for materials to distribute.

Pack Health
Don’t forget to check out Pack Health: a free resource to help patients navigate their HCV treatment journey from applying for treatment to cure.
Enter your contact info
Use promo code: HCV2017
Get 3 months of membership free! As easy as 1-2-3!

Questions? Call us at 885-255-2362 8am-5pm | Monday-Friday 
• Get a personal Health Advisor to coach you on your journey 
• Develop a personalized plan – you set the goals, we’ll help you get there 
• Find answers and accountability to get the results you want 
• Use the tools and guides we send you to track your progress.
View all newsletters here....

Hep - Your Guide to Hepatitis
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.

June - Hep Summer Issue 2018
Alive and Kicking
A photographer helps his mom get cured of hep C after reading Hep magazine.

Mother and Child Reunion 
Connie Dewbre’s son convinced her to get cured of HCV again after visiting our Hep magazine website.
Read the news
Check out the talented people who blog at Hep.

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

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

HCV Action
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.
View recent newsletters

Healio: International Liver Congress 2018
HCV Next is a monthly publication offering patients the latest research, news and commentary on liver disease and viral hepatitis, published online at Healio.
Read a nice summary of the liver meeting in the May/June issue.

World Hepatitis Alliance
We run global campaigns, convene high-level policy events, build capacity and pioneer global movements, ensuring people living with viral hepatitis guide every aspect of our work.
Read all updates
Newsletters - World Hepatitis Alliance (WHA) presents hepVoice, a monthly magazine with updates on the latest projects, news from WHA members and key developments in the field of hepatitis.

GI & Hepatology News
Over 17,000 gastroenterologists and hepatologists rely on GI & Hepatology News every month to cover the world of medicine with breaking news, on-site medical meeting coverage, and expert perspectives both in print and online.
View all updates here....

Weekly Bull

HepCBC is a Canadian non-profit organization offering awareness with basic information about HCV and a weekly digest of news.
Read the highly successful Weekly Bull.

Pacific Hepatitis C Network (PHCN)

Welcome to the Pacific Hepatitis C Network (PHCN)‘s Hepatitis C News in Review Newsletter. This is where we review all of the major current issues and events around hepatitis C and hep C treatments. It is an email that includes links to our recent blog posts—including links to blog posts about Public Health Agency of Canada funding.
View all updates
Newsletter Sign Up

CATIE
CATIE strengthens Canada’s response to HIV and hepatitis C by bridging research and practice. We connect healthcare and community-based service providers with the latest science, and promote good practices for prevention and treatment programs.
Sign up for CATIE Email Newsletters
Updates - News

CanHepC - Canadian Network on Hepatitis C
CanHepC is a collaborative research network funded by the Canadian Institutes of Health Research (CIHR) and the Public Health Agency of Canada (PHAC) dedicated to translational research linking over 100 researchers, trainees, knowledge-users (community members, community-based organizations, policy and decision makers) in the field of Hepatitis C (HCV) from across Canada as well as international partners.
View all newsletters here.....

Hepatitis Victoria
Hepatitis Victoria is the peak not-for-profit community organisation working across the state for people affected by or at risk of viral hepatitis.
GOOD LIVER MAGAZINE is our quarterly newsletter, providing in-depth articles, interviews and reports, as well as detailing upcoming events, support groups, liver clinics, and other items likely to be of interest to our members. HepChat is our monthly electronic newsletter sharing news and information about hepatitis and the projects and activities we're working on, subscribe to HepChat. We also produced short podcasts interviewing health experts and practioners on topics related to viral hepatitis - come have a listen!

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

Hepatitis B Foundation
Hepatitis B Foundation is a national nonprofit dedicated to finding a cure and improving the quality of life for people affected by hepatitis B worldwide.
All newsletters, sign up
Blog & News

Hepatitis A - Voice of San Diego
Voice of San Diego is an award-winning nonprofit news organization based in San Diego, California.
The Hep A Fallout Continues: On this week’s San Diego Explained, Voice of San Diego’s Jesse Marx and NBC 7’s Monica Dean take a look back at San Diego’s response to last year’s hepatitis A outbreak, listen here.

National Institutes of Health
A monthly newsletter from the National Institutes of Health, part of the U.S. Department of Health and Human Services
June Newsletter
View all newsletters: https://newsinhealth.nih.gov/

Blogs
The Best Of The Best
HCV Advocate - Hepatitis C Blog - Daily Updates
HepatitisC.net - Updated with about 5 posts per week
Lucinda K. Porter - Updated about once a week
Hep - Updated with 5 or more posts per week
ADRLF (Al D. Rodriguez Liver Foundation) - Updated monthly
Hepatitis NSW Updated about twice or more per month
Life Beyond Hepatitis C - Updated with about 3 posts per week
I Help C - Updated about twice or more per month
CATIE Blog - Updated about twice or more per month
Canadian Liver Foundation - Updated about twice or more per month
AGA Journals - Updated once a week
Hepatitis B Foundation - Updated once a week or more.
HIV and ID Observations - Updated once a week
The Hepatitis C Mentor and Support Group - (News) Updated once a week or more

Wellness
Live Fit Liver Fit Get Fit (American Liver Foundation) - Monthly updates
Harvard Health Blog - Updated with about 3 posts per week
ACP Internist and American College of Physicians - Weekly & monthly updates
Healio Med Blog- Monthly updates

Conference 
Digestive Disease Week® (DDW) 2018
June 2-5, 2018
Website - Digestive Disease Week® (DDW)
DDW Blog
DDW Daily News
Topics at DDW:
AASLD’s annual Hepatology Update: The Year in Review session will feature recent advances in hepatitis C, hepatitis B, nonalcoholic fatty liver disease, and liver transplantation. Other sessions include Functional GI and Motility Disorders; Irritable Bowel Syndrome, Functional Dyspepsia.

Updates
On This Blog

Meeting Coverage
Healio 
Healio staff will report live on breaking news presented at the meeting and capture video interviews with experts to gain their perspectives on important presentations. 
Free registration may be required

Thanks for stopping by!
Tina