Showing posts with label Rebuttal over Cochrane Review of DAAs. Show all posts
Showing posts with label Rebuttal over Cochrane Review of DAAs. Show all posts

Thursday, May 17, 2018

Experts Respond To Latest BMJ Article: Do direct acting antivirals cure chronic hepatitis C?

A 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. A day later BMJ talk medicine aired this disturbing podcast with Jakobsen; New antivirals for Hepatitis C - what does the evidence prove? 

Experts Respond To Latest BMJ Article: Do direct acting antivirals cure chronic hepatitis C?
May 16, 2018
Experts weigh in with the following response: 

View BMJ Response:

Dear Editor
Viral hepatitis experts are convinced of the benefits of antiviral therapy for hepatitis C.

We were dismayed that the Editors of the BMJ presented the widely discredited Cochrane review of Hepatitis C virus (HCV) therapy as mainstream opinion (1,2). It is not. This Cochrane review contained significant methodological flaws and lacked clinical insight or knowledge of the natural history of HCV. The opinion of informed hepatologists, infectious disease, and public health physicians, as well as the World Health Organisation (WHO), the National Institute for Clinical Excellence (NICE), and all international liver associations, is that directly acting antiviral (DAA) oral therapy for hepatitis C represents a breakthrough development that prevents end stage liver disease and death (3,4). This opinion is based on the dramatic benefits following widespread use of these drugs. Independent surveillance data from the Public Health England hepatitis C annual report (5) show that deaths from hepatitis C related end stage liver disease and hepatocellular carcinoma were increasing, more than doubled, between 2005 and 2014, but have fallen since 2014 with the introduction of HCV treatment with these drugs. PHE data indicates that registrations for liver transplant and transplants undertaken, where post hepatitis C cirrhosis is given as the indication for transplant, had remained relatively stable between 2008 and 2014, but have fallen since 2014 (5). Similar changes have been seen in every country where these drugs have been introduced. There is no credible explanation for the fall in hepatitis C liver disease morbidity and mortality associated with the introduction of effective anti-virals other than the use of these drugs.

Independent experts agreed that the most appropriate end-point in therapy trials for hepatitis C was sustained virological response (SVR). This was chosen, by independent regulators as the trial end-point. It was selected because in almost every infectious disease where there is a link between the pathogen and disease, clearance of the infection is beneficial and there is evidence that SVR with interferon-based therapies reduces mortality. The reasonable assumption that viral clearance with DAAs would reduce liver-related complications has been confirmed by long term follow up studies: the English Early Access Programme (EAP) shows a fall in deaths in patients who achieved SVR (6), and emerging data from large patient cohorts confirm this. There remains a risk of hepatocellular carcinoma in patients who developed cirrhosis prior to viral clearance, but evidence from studies of patients with advanced liver disease suggests that this risk is reduced. The legitimate debate about the value of an inflammatory milieu in patients with liver cancer and the role of viral clearance in this scenario does not obviate the clear mortality benefits from therapy and can not be used to imply that physicians are concerned about therapy in patients without cancer.

Hepatitis C is an infectious virus – the obvious extrapolation that effective therapy prevents transmission has now been confirmed. Dr Jakobsen and colleagues ignore the anxiety suffered by patients who are frightened of infecting their loved ones. Quite apart from the personal benefits of DAA therapy to patients who are already infected and their immediate contacts, reducing the overall burden of infection will reduce the risk of transmission to the rest of the population. DAA treatment of hepatitis C represents a rare opportunity to eliminate hepatitis C as a major public health concern and this opportunity is clearly recognised by WHO in its Global Strategy for Viral Hepatitis.

To suggest to patients that they should continue to suffer and not access safe and highly effective curative treatments that have been used in hundreds of thousands of patients without incident is inhumane.

The clinical utility of a drug is not inversely proportional to its price and NICE’s assessment of hepatitis C antivirals is that they are cost effective. We are not aware of any data questioning the NICE review. Since this review NHSE have negotiated a reduction in the price of these lifesaving drugs and the NHS is now in a position to plan an affordable hepatitis C elimination programme. This will focus on those populations most affected – often vulnerable members of society, such as people who inject drugs and the homeless. Many patients with hepatitis C do not attend primary care physicians to discuss the risks and benefits of therapy – they attend needle exchange, drug and alcohol, and homeless health services where they need to be identified (at considerable expense), engaged and offered antiviral therapy that may save their life. This gives them an opportunity to re-engage with society and move on with their lives. The overwhelming majority of clinicians are confident that there is very convincing evidence of benefit from DAA therapy and are planning to move antiviral services to all patients to amplify the remarkable benefits already demonstrated.

Dr Jakobsen is factually correct that only a large, placebo controlled trial over several decades with death as an end-point will prove beyond all doubt that SVR improves mortality. If the BMJ believes this to be an ethical approach it should have the courage to say so, and should then make the case for patients to live with the clinical, psychosocial and public health consequences of being infected and suffer symptoms until death to prove a scientific point. In the opinion of clinical experts the current data prove, beyond reasonable doubt, that achieving an SVR stops people transmitting and dying from hepatitis C. In the early HIV era a handful of idiosyncratic scientists refused to accept the association between HIV and AIDS and recommended that effective antiretroviral therapy be withheld. Sadly some governments, notably South Africa, followed this ill-informed advice and many vulnerable South Africans died as a direct consequence. It would be unfortunate if Dr Jakobsen’s views led to a similar tragedy in HCV. We hope that the BMJ will make clear that his personal opinion is not shared by reputable clinicians and policy makers. Patients should be encouraged to be tested and then treated for hepatitis C safe in the knowledge that they will join the millions of treated patients who will be protected from liver fibrosis and premature death.

Graham R Foster NHSE ODN Clinical Lead
Kosh Agarwal, Transplant hepatologist, HCV CRG member
Matthew Cramp Chair BASL
John Dillon Chair Scottish HCV Clinical Leads
Ahmed Elsharkawy Chair BVHG
Charles Gore CEO The Hepatitis C Trust
William Irving Chair NSGVH
Sema Mendal PHE HCV Lead
Peter Moss Chair HCV CRG
Chloe Orkin Chair BHIVA
Stephen Ryder Chairman HCV Coalition

1 Jakobsen JC, Nielsen EE, Koretz RL, Gluud C. Do direct acting antivirals cure chronic hepatitis C? BMJ. 2018 May 10;361:k1382

2 Jakobsen JC, Nielsen EE, Feinberg J, etal . Direct-acting antivirals for chronic hepatitis C. Cochrane Database Syst Rev 2017. 10.1002/14651858.CD012143.pub3.

3 Powderly WG, Naggie S, Kim AY, Vargas HE, Chung RT, Lok AS.IDSA/AASLD Response to Cochrane Review on Direct-Acting Antivirals for Hepatitis C
Clin Infect Dis. 2017 Nov 13;65(11):1773-1775.

4 European Association for the Study of the Liver. Electronic address: Response to the Cochrane systematic review on DAA-based treatment of chronic hepatitis C. J Hepatol. 2017 Oct;67(4):663-664

5 Public Health England, Hepatitis C in England 2018 report

6 Cheung MCM, Walker AJ, Hudson BE, Verma S, McLauchlan J, Mutimer DJ, Brown A, Gelson WTH, MacDonald DC, Agarwal K, Foster GR, Irving WL; HCV Research UK. Outcomes after successful direct-acting antiviral therapy for patients with chronic hepatitis C and decompensated cirrhosis. J Hepatol. 2016 Oct;65(4):741-747

Competing interests: Professor Foster has previously received funding from companies that market antivirals for hepatitis C but no longer does so. PHE staff have no competing interests. Other authors have received speaker and consultancy fees from companies that market oral antiviral agents for hepatitis C. Peter Moss and Charles Gore, no personal competing interests. 

On This Blog: View each expert rebuttal and ongoing controversy 

Saturday, May 12, 2018

Controversy over Cochrane Review on HCV Direct-acting antivirals

Controversy over Cochrane Review on HCV Direct-acting antivirals 
A review by the Cochrane Collaboration published June 6, 2017/updated September 8 2017, cast doubt on the effectiveness of new hepatitis C treatments. Follow the links to each expert rebuttal, research article, commentary and ongoing controversy.

Feb 12, 2019
Lancet Study: Direct-acting antivirals reduce risk of premature mortality and liver cancer for people with chronic hepatitis C 
These findings firmly counter those of a Cochrane review of direct-acting antiviral treatment trials that could neither confirm nor reject if direct-acting antivirals had an effect on long-term HCV-related morbidity and mortality. They also provide the best evidence to date to support guidance documents that recommend direct-acting antiviral treatment for all patients with chronic HCV infection.

Jan 6, 2019
Has Cochrane lost its way?
Cochrane’s critics contend this growth is not necessarily something to be celebrated. “In healthcare, more does not mean better,” argues former Cochrane board member David Hammerstein. “The core business of Cochrane is its systematic reviews, yet in the past decade Cochrane has dragged its heels in response to insistent concerns that they are largely synthesised information from industry sponsored studies.

May 12, 2018, BMJ published; Do direct acting antivirals cure chronic hepatitis C ? by Cochrane author Janus Christian Jakobsen. BMJ talk medicine also aired this disturbing podcast with Jakobsen; New antivirals for Hepatitis C - what does the evidence prove? On May 16, 2018 the experts weighed in, read the response: Experts Respond To Latest BMJ Article: Do direct acting antivirals cure chronic hepatitis C?

 April 29, 2018 - Cochrane Review Flawed For Discounting SVR As A Marker Of Viral Cure & Endpoint For Measuring Treatment Impact.

March 3, 2018 - Cochrane Review Of HCV Drugs - The Controversy Continues

On Twitter, Henry E. Chang has kept the HCV community updated since 2017, pointing out each expert response to the Cochrane review.

On This Blog:
Rebuttal over Cochrane Review of DAAs

Nov 15, 2017
The Cochrane Review Conclusion for Hepatitis C DAA Therapies Is Wrong
Welcome, Autumn is just a day away, as the season changes so did one systematic review, one that was highly debated by researchers, clinicians, and HCV advocates this summer.  This past June/2017 a Cochrane Review concluded that achieving SVR (cure) for patients using hepatitis C direct-acting antivirals (DAAs) doesn't correlate with any long term benefits. Soon a Guardian article was in widespread circulation across social networks, with this glaring headline; Hepatitis ‘wonder drug’ may be clinically ineffective, say experts. Patients were confused, experts disappointed, and the HCV community was blindsided.

Follow Henry E. Chang
on Twitter
The Controversy Is Archived On Twitter
While advocates and clinicians were in the process of writing a rebuttal, Henry E. Chang put together a nice collection of tweets during the controversy: "Reactions from Hepatitis C Community on a Recent Cochrane Review of DAAs." Thank you for continuing to make the conversation easy to follow, especially for patients.

New On Twitter - Cochrane Update
Updated Nov 15, 2017
The Cochrane Review Conclusion for Hepatitis C DAA Therapies Is Wrong

*Article shared by Henry E. Chang‏ today on Twitter.

Oct 19, 2017
Another update from Mr. Chang: "Benefits of Direct-Acting Antivirals for Hepatitis C," published in Annals of Internal Medicine.
In light of the World Health Organization and National Academies of Sciences, Engineering, and Medicine goals to eliminate HCV by 2030 (9), we believe the Cochrane review does a grave disservice to these efforts and to patients living with chronic HCV infection
September 20, 2017
Yesterday on Twitter we were updated, again thanks to Henry E. Chang.
Recently, authors of Cochrane DAA review "changed" their conclusions but remain amazingly tone-deaf to what HCV community & experts are saying.
View the tweet here, and changed conclusions with links below.

Full Text
A message from Mr. Chang with the full-text Cochrane review articles (pub 2) and (pub 3).

Changed Conclusions - September 18, 2017
Version 3
Direct-acting antivirals for chronic hepatitis C
Janus C Jakobsen, Emil Eik Nielsen, Joshua Feinberg, Kiran Kumar Katakam, Kristina Fobian, Goran Hauser, Goran Poropat, Snezana Djurisic, Karl Heinz Weiss, Milica Bjelakovic, Goran Bjelakovic, Sarah Louise Klingenberg, Jian Ping Liu, Dimitrinka Nikolova, Ronald L Koretz, Christian Gluud

First published:
Editorial Group: Cochrane Hepato-Biliary Group
DOI: 10.1002/14651858.CD012143.pub3  View/save citation
Cited by (CrossRef): 0 articles Last updated
Authors' conclusions
The evidence for our main outcomes of interest come from short-term trials, and we are unable to determine the effect of long-term treatment with DAAs. The rates of hepatitis C morbidity and mortality observed in the trials are relatively low and we are uncertain as to how DAAs affect this outcome. Overall, there is very low quality evidence that DAAs on the market or under development do not influence serious adverse events. There is insufficient evidence to judge if DAAs have beneficial or harmful effects on other clinical outcomes for chronic HCV. Simeprevir may have beneficial effects on risk of serious adverse event. In all remaining analyses, we could neither confirm nor reject that DAAs had any clinical effects. DAAs may reduce the number of people with detectable virus in their blood, but we do not have sufficient evidence from randomised trials that enables us to understand how SVR affects long-term clinical outcomes. SVR is still an outcome that needs proper validation in randomised clinical trials.

Initial Conclusions - June 6, 2017
Version 2
Janus C Jakobsen, Emil Eik Nielsen, Joshua Feinberg, Kiran Kumar Katakam, Kristina Fobian, Goran Hauser, Goran Poropat, Snezana Djurisic, Karl Heinz Weiss, Milica Bjelakovic, Goran Bjelakovic, Sarah Louise Klingenberg, Jian Ping Liu, Dimitrinka Nikolova, Ronald L Koretz, Christian Gluud

First published:
Editorial Group: Cochrane Hepato-Biliary Group
DOI: 10.1002/14651858.CD012143.pub2

Authors' conclusions

Overall, DAAs on the market or under development do not seem to have any effects on risk of serious adverse events. Simeprevir may have beneficial effects on risk of serious adverse event. In all remaining analyses, we could neither confirm nor reject that DAAs had any clinical effects. DAAs seemed to reduce the risk of no sustained virological response. The clinical relevance of the effects of DAAs on no sustained virological response is questionable, as it is a non-validated surrogate outcome. All trials and outcome results were at high risk of bias, so our results presumably overestimate benefit and underestimate harm. The quality of the evidence was very low.

Janus C Jakobsen, Emil Eik Nielsen, Joshua Feinberg, Kristina Fobian, Kiran Kumar Katakam, Goran Hauser, Goran Poropat, Snezana Djurisic, Karl Heinz Weiss, Milica Bjelakovic, Goran Bjelakovic, Sarah Louise Klingenberg, Jian Ping Liu, Dimitrinka Nikolova, Ronald L Koretz, Christian Gluud
Article first published online: 5 Apr 2016 | DOI: 10.1002/14651858.CD012143

The Experts Weigh In: Rebuttals
The European Association for the Study of the Liver (EASL) published a response to the Cochrane Systematic Review, as did the Lancet in this June editorial, and in the July issue of the Lancet; What is the impact of treatment for hepatitis C virus infection? The American Association for the Study of Liver Diseases (AASLD) and Infectious Diseases Society of America (IDSA) put out this statement. In Australia a joint Position Statement was released by Australian Health Organisations urging medical professionals and patients not to be influenced by the report. Here is an Australian podcast as well; The Cochrane Collaboration assessment of hepatitis C drug trials comes under review from our resident hep C expert Carla Treloar. In addition Hepatitis C Trust responded with concern over media coverage, citing a Guardian article. Finally, under letters the Guardian published; Hepatitis C antiviral drugs are effective, with this subtitle, "The Cochrane analysis casting doubt on this life-saving therapy is flawed and may deter patients from seeking it, say clinicians and scientists."

Moving on, Lucinda K. Porter explained Cochrane’s findings in an easy to read article: Horrendous Hepatitis Headlines. Published over at ACGBLOG at the end of June, experts wrote; The Cochrane Review Conclusion for Hepatitis C DAA Therapies is Wrong.  MedPage Today's article was all about a show of support from the medical community and advocates; Hep C Experts Condemn Cochrane Review Dissing Direct Antivirals. Commentary was offered over at HIV and ID Observations; Mystifying Cochrane Library Review on HCV Therapy Elicits Strong Response from IDSA and at Healio; IDSA, AASLD critical of Cochrane review of HCV drugs, as well. 

Recommended Reading
Justin Chan • Neliswa Gogela • Hui Zheng • Sara Lammert • Tokunbo Ajayi • Zachary Fricker • Arthur Y. Kim • Gregory K. Robbins • Raymond T. Chung
Treatment of chronic HCV with modern DAA therapy was associated with a significant improvement in LSM by VCTE measurement, suggesting possible early improvement in liver fibrosis along with resolution of inflammation over the first year after treatment completion....
Link Tweeted By @HenryEChang

Treatment with DAAs reduces the risk of mortality in the first 18 months after the completion of treatment
Michael Carter
Published:10 August 2017
The study – published in Clinical Infectious Diseases – matched people who received therapy with all-DAA regimens with untreated controls. Mortality rates in the first 18 months after therapy were significantly lower among people who received DAAs. After controlling for other factors, treatment with DAAs was associated with a 57% reduction in the risk of death....

May 1, 2018 |
Reduced Risk for Hepatocellular Carcinoma After Successful Anti-HCV Therapy in Patients with Cirrhosis 
Atif Zaman, MD, MPH reviewing Calvaruso V et al. Gastroenterology 2018 Apr 12
There is now ample evidence to support this treatment benefit...

Photo of Mr. Chang gently borrowed from his twitter feed, thinking he sort of looks like a superhero. Well, he is and does to me!

Sunday, April 29, 2018

Cochrane Review Flawed For Discounting SVR As A Marker Of Viral Cure & Endpoint For Measuring Treatment Impact.

One Step Forward, Two Steps Back
Is it just me, or does it seem like each emerging milestone we make on the war against hepatitis C is eventually somewhat derailed? Either in the media, or worse yet, by failed and highly disputed research. Let me explain, over the years it went something like this; awareness (test all baby boomers, not everyone agreed), stigma (still working on it), cost (great drugs, too expensive), access & coverage (restrictions, you're not sick enough), and finally we cure the virus (Cochrane Review, cure, no proof of benefit).

Cochrane Review - Controversial Paper On HCV Therapy
Patients, advocates, and experts agree stigma and discrimination remains a barrier to testing and treatment, however, the benefit of curing hepatitis C with astounding cure rates is not all that controversial. Reason enough for experts to get caught up in a 2017 systematic review published by the Cochrane Collaboration on the benefit of achieving a cure using hepatitis C direct-acting antivirals (DAAs). The review concluded patients who were cured with DAA-based regimens did not reduce their risk for HCV-related morbidity or all-cause mortality. Within days, an outcry emerged from experts urging patients not to be influenced by the misleading and harmful conclusion, or be confused by any media coverage that followed.

*In case you missed the backstory, click here to review each expert rebuttal.

Cochrane Research Flawed 
Published April 10, 2018, online in Critical Public Health, patients can further explore the most recent rebuttal; Evidence-making controversies: the case of hepatitis C treatment and the promise of viral elimination.

*Thank you Henry E Chang, for downloading and sharing the full-text report on Twitter.

Here is an excerpt to get you started:
The EASL claims the Cochrane research has a ‘flawed methodological approach’, and that this is linked to its lack of hepatology expertise, including an ‘ignorance of the natural history of hepatitis C’. This ‘ignorance’ centres on the truth most troubled by the Cochrane review; that it ‘fails to accept that DAA treatment to attain an SVR is a pivotal outcome of treatment’, and that it ‘does not accept the likelihood that an SVR will reduce the risks of long-term outcomes of hepatitis C’. All the published responses we analysed (see above) present as ‘unanimous’ in characterising the Cochrane review as flawed for its discounting of SVR as a marker of viral cure and as an appropriate endpoint for measuring treatment impact.
Begin here.....

EASL's 2018 International Liver Congress - The Evidence Is In
Although this months "infohep bulletin" is not an official rebuttal over the failed Cochrane group's review, it does offer us an overview of EASL's 2018 International Liver Congress, and highlighted two studies at the meeting that "provided clear evidence that curing hepatitis C infection results in a reduction in the risk of dying from a liver-related cause."

Begin here....

Until next time,

Saturday, April 28, 2018

April "infohep bulletin" - Overview of EASL's 2018 International Liver Congress

Patients looking for an overview of EASL's 2018 International Liver Congress can find it in this month's "infohep bulletin"

Effectiveness of hepatitis C treatment
Direct-acting antiviral (DAA) treatment for hepatitis C is highly effective in curing hepatitis C infection but the long-term objective of treatment is to prevent liver disease and death. The long-term effects of curing hepatitis C virus (HCV) infection with DAAs was called into question by a Cochrane Collaboration systematic review in 2017. The review concluded that there was not yet sufficient evidence to show that curing HCV infection reduced illness and death. This conclusion was strongly questioned by liver experts.

At The International Liver Congress in Paris, a large prospective study carried out in Italy provided clear evidence that curing hepatitis C infection results in a reduction in the risk of dying from a liver-related cause. People with Child-Pugh A cirrhosis (compensated cirrhosis) were 15 times more likely to die of a liver-related cause if they did not achieve a sustained virologic response to DAA treatment, the study found. They were also at higher risk of dying from cardiovascular disease.

A study which followed everyone treated for hepatitis C in Scotland found that liver decompensation due to cirrhosis in people previously diagnosed with chronic hepatitis C declined by 29% between 2013 and 2016. During the same period 94% of people treated for hepatitis C in Scotland achieved a sustained virologic response.

Similarly, a Europe-wide study of liver transplants found that while the number of transplants carried out in Europe remained stable between 2007 and 2017, the proportion that were carried out as a consequence of hepatitis C fell from 23% to 11%. The decline in HCV-related transplants became evident after 2014 and was especially evident in people with HCV-related decompensated cirrhosis. The survival of liver transplant recipients with HCV also improved.

April Bulletin
This edition of the infohep bulletin covers news from the annual meeting of the European Association for the Study of the Liver (EASL), The International Liver Congress. The meeting took place in Paris from 11 to 15 April 2018. 

Wednesday, March 21, 2018

Rebuttal Cochrane Review: Is there sufficient evidence to repeal three decades of clinical research on chronic hepatitis C?

A new rebuttal over the flawed Cochrane review on DAAs downloaded and shared via Twitter by Henry E. Chang‏

Is there sufficient evidence to repeal three decades of clinical research on chronic hepatitis

The Cochrane Collaboration has published a systematic review about the treatment chronic hepatitis C (CHC) with direct-acting antivirals (DAAs) concluding that there is no evidence either to confirm or to reject the premise that DAAs have any clinical effects and they also state that sustained virological response is an unreliable surrogate marker to assess clinical efficacy. Here we discuss the implication of the Cochrane Collaboration review at the light of the current knowledge of CHC clinical management and propose a framework for the future research.
Continue to article:

Rebuttal over Cochrane Review on DAAs 
A systematic review published by the Cochrane Collaboration suggested achieving SVR (cure) for patients using hepatitis C direct-acting antivirals (DAAs) doesn't correlate with any long term benefits. View each rebuttal and all ongoing media coverage, here.

Saturday, March 3, 2018

Cochrane Review Of HCV Drugs - The Controversy Continues

The Backstory
In the summer of 2017 a Cochrane Review concluded that achieving SVR (cure) for patients using hepatitis C direct-acting antivirals (DAAs) doesn't correlate with any long term benefits; reduce risks for HCV-related morbidity or all-cause mortality. Later that year, as we entered into November, Cochrane group’s conclusions changed, somewhat. Check out a quick overview, here.

Twitter & Mr. Chang
Henry E. Chang provided this blog with the above mentioned links, and kept the HCV community updated throughout the ongoing controversy by documenting each rebuttal on twitter, here is nice collection of his tweets: "Reactions from Hepatitis C Community on a Recent Cochrane Review of DAAs."

The Controversy Continues
On Twitter today an update from @HenryEChang

Authors of Cochrane HCV DAA review respond to AmJGastro Red Section commentary with their uncompromising worship for "well-designed & - executed RCTs to assess the utility of DAA treatment"→

The Front Lines Of The Hepatitis C Crises
Patients, advocates, and physicians who have been on the front lines of the hepatitis C crises (for decades) understand first hand the damage Cochrane group’s irresponsible conclusions caused individuals living with HCV.

The Damage Is Done
Soon after the Cochrane Review was published, patients were hit with this horrendous headline in the media; "Hepatitis ‘wonder drug’ may be clinically ineffective, say experts." Leaving innocent patients confused and frightened, we'll never know how many people decided to forgo testing or treatment that summer, we can only surmise.

The New Era Of Hepatitis C Drugs

Today we have effective drugs to cure HCV, across all six HCV genotypes, including direct-acting antiviral therapy for people with severe liver damage, such as compensated cirrhosis, or kidney disease. HCV eradication is associated with the reversal of fibrosis, improvement of fibrosis and quality of life, as well as overall reduction of liver cancer, liver failure, risk of liver transplant, and liver-related mortality, including extrahepatic manifestations of HCV in patients who achieve SVR.

Do you think those Cochrane people, authors, men or women, even know the damage they have caused?

I do, and I am not alone.

Stay aware, stay healthy

Wednesday, January 31, 2018

Top 5 stories about HCV: Long-term effects of DAAs, AASLD critical of Cochrane review of HCV drugs & more

Top 5 stories about HCV
January 30, 2018

Report raises questions about long-term effects of DAAs for HCV
The changing HCV treatment cascade
Sharing injection paraphernalia does not lead to HCV transmission
Women injecting drugs at higher risk for HCV than men
IDSA, AASLD critical of Cochrane review of HCV drugs

Wednesday, November 15, 2017

Blog Updates Around The Web: Does an SVR to Therapy for HCV-associated Cirrhosis Reduce Portal Pressure?

Viral Hepatitis Updates
With Thanksgiving just around the corner, and Christmas on the way, it's a busy time of the year, hopefully you'll save some time online with this quick summary of blog and journal updates. 
AGA Journals BLOG
Dr. Kristine Novak is the science editor for Gastroenterology and Clinical Gastroenterology and Hepatology. She has worked as an editor at biomedical research journals and as a science writer for 15 years, covering advances in gastroenterology, hepatology, cancer, immunology, biotechnology, molecular genetics, and clinical trials. She has a PhD in cell biology and an interest in all areas of medical research.

Does an SVR to Therapy for HCV-associated Cirrhosis Reduce Portal Pressure?
A sustained virologic response (SVR) to all-oral therapy in patients with hepatitis C virus (HCV)-associated cirrhosis significantly reduces the hepatic venous pressure gradient (HVPG), researchers report in the November issue of Gastroenterology. Nevertheless, almost 80% of patients maintain significant portal hypertension and have a continued risk of decompensation.
Continue reading...
Clinical Care Options CCO
Mission Statement - To optimize clinicians’ competence with the goal of improving patient care through the development of educational solutions that address the explosion of new medical information and the overwhelming task of its assimilation by clinicians, with easy-to-use, innovative, interactive educational and decision support models that can be used at the point of care and provide the latest evidence-based information whenever, wherever, and however it is needed.

Hepatology Meeting Shed Light on the Clinical Benefits of HCV DAAs
Jordan J. Feld, MD, MPH - 11/14/2017 Clinical Thought 
For the first time in several years, we did not see the presentation of dramatic data from phase III trials of emerging investigational HCV therapies at the American Association for the Study of Liver Diseases (AASLD) meeting. What we learned is that we likely now have the full complement of direct-acting antivirals (DAAs) and—unfortunately—that some relatively promising regimens that were in clinical development are unlikely to come to clinical use.

What did emerge at the meeting were several studies that provided critical evidence that treatment with DAAs leads to important clinical benefits for patients with HCV infection. Although these types of studies can feel like something of a foregone conclusion, they are actually critical for payers, policymakers, and clinicians to be confident that contemporary HCV therapies are associated with the intended benefits.

*Free registration required
On Twitter
The Cochrane Review Conclusion for Hepatitis C DAA Therapies Is Wrong

*Article shared by Henry E. Chang‏ today on Twitter.

Full Text Articles
I highly suggest you follow Henry E. Chang on Twitter if you are interested in reading full text articles about the treatment and management of hepatitis C.

On The Blog
HepCBC is a non-profit organization run by and for people infected and affected by hepatitis C. Our mission is to provide education, prevention and support to those living with HCV.

Read today's news or check out the latest issue of: Weekly Bull
The CATIE Blog is a unique opportunity for individuals to express a wide latitude of opinion on a range of issues. The views expressed in the blog are solely those of the authors and do not necessarily reflect the policies or opinions of CATIE nor the views of its funders

Eliminating viral hepatitis is possible: Four lessons from the World Hepatitis Summit
By Melisa Dickie
As deaths from many communicable diseases continue to decline globally, deaths caused by viral hepatitis have now surpassed all other chronic infectious diseases, including HIV/AIDS, malaria and tuberculosis. Yet it is one of the few global health threats with easy solutions. Highly effective vaccines exist for hepatitis A and B. We now have a cure for hepatitis C. With these tools at our disposal, why aren’t we seeing an impact on the epidemic?
Continue reading....
National Viral Hepatitis Roundtable
The National Viral Hepatitis Roundtable is a broad coalition working to fight, and ultimately end, the hepatitis B and hepatitis C epidemics. We seek an aggressive response from policymakers, public health officials, medical and health care providers, the media, and the general public through our advocacy, education, and technical assistance.

Why We Need a Movement for Racial Justice and Health Equity in Order to Eliminate Hepatitis B and Hepatitis C
by the National Viral Hepatitis Roundtable’s Steering Committee
Recently, some people have questioned why the National Viral Hepatitis Roundtable’s staff and members of its Steering Committee have made statements in words and action standing up for racial justice. We hope this statement provides additional context for why speaking out about the need for racial justice and health equity is critical to the hepatitis B and hepatitis C response.

NVHR Welcomes New Hepatitis B Vaccine
NVHR today welcomed the U.S. Food and Drug Administration’s (FDA) approval of HEPLISAV-B for prevention of hepatitis B virus infection in adults ages 18 and older.
Médecins Sans Frontières/ Doctors Without Borders (MSF)
Médecins Sans Frontières (MSF) is an international, independent, medical humanitarian organisation. We offer assistance to people based on need, irrespective of race, religion, gender or political affiliation. Our actions are guided by medical ethics and the principles of neutrality and impartiality.

Fighting Hepatitis in Cambodia: Medical Week

"The best part of Medical Week was the opportunity to meet MSF colleagues from all over the world, most of whom had more experience than I have and who had lots of advice for me, such as..."
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POZ is an award-winning print and online brand for people living with and affected by HIV/AIDS. Offering unparalleled editorial excellence since 1994, POZ magazine and are identified by our readers as their most trusted sources of information about the disease.

Finding Folks Who Have HIV or Hep C in an Opioid-Ravaged Region
West Virginia has been hit hard by the opioid epidemic, so it is important to identify people living with HIV and hepatitis C virus (HCV), which can be spread by injection drug use. A four-year $1.375 million grant aims to do exactly that. Funding goes to the West Virginia University (WVU) School of Medicine’s Department of Emergency Medicine and arrives from Frontlines of Communities in the United States (FOCUS), an initiative of pharma giant Gilead Sciences.
Continue reading....
At 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.

Elimination: What Does It Look Like?
By Daryl Luster—November 14, 2017
Elimination. There’s a kind of ominous ring this word, but this is what we hear a lot in the world of viral hepatitis, including HBV and HCV. The meaning here is meant to describe a global effort to eliminate hep C as a health threat. With estimates of worldwide infection ranging wildly, suffice to say it is well over 100 million people now living with hep C. Some peg it at around 150-170 million, and no matter which is accurate it is a huge number.
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. Our commitment includes funding focused research, promoting disease awareness, supporting immunization and treatment initiatives, and serving as the primary source of information for patients and their families, the medical and scientific community, and the general public.

Diagnosing Hepatitis Delta in the U.S.
November 15, 2017 hepbtalk
Hepatitis D, or hepatitis delta, is the most severe form of viral hepatitis known to humans. The hepatitis D virus infects the liver and is dependent on the hepatitis B virus to reproduce. This means that people who are already infected with hepatitis B are at risk of contracting hepatitis D as well.
MD Magazine
MD Magazine is a comprehensive clinical news and information portal that provides physicians with up-to-date specialty and disease-specific resources designed to help them provide better care to patients.

Aspirin Could Reduce HBV Patients' Liver Cancer Risk
Patients with chronic hepatitis B virus (HBV) who take an aspirin a day may reduce their risk of hepatocellular carcinoma (HCC), the most common form of adult liver cancer, a new study suggests.
Medscape is the leading online global destination for physicians and healthcare professionals worldwide, offering the latest medical news and expert perspectives; essential point-of-care drug and disease information; and relevant professional education and CME.

Preventing Perinatal Transmission of Hepatitis B
November 14, 2017
 Dr William Balistreri surveys the latest guidelines and studies aiming to improve maternal and neonatal outcomes.
Kaiser Family Foundation
Kaiser Health News (KHN) is a nonprofit news service committed to in-depth coverage of health care policy and politics. And we report on how the health care system — hospitals, doctors, nurses, insurers, governments, consumers — works.

Vaccine Shortage Complicates Efforts To Quell Hepatitis A Outbreaks
By Stephanie O'Neill
San Diego County, battling a deadly outbreak of hepatitis A, is postponing an outreach campaign to provide the second of two inoculations against the contagious liver disease until a national shortage of the vaccine is resolved, the county’s chief public health officer said. “Our goal is to get that vaccine in as many arms as possible for that first dose,” said Dr. Wilma Wooten, who is leading the fight against an epidemic that has ravaged unsanitary homeless encampments in San Diego County for the past year, sickening 544 people and killing 20 of them as of Nov. 6.
Continue reading.......
Harvard Health Blog
Harvard Health Publishing is the media and publishing division of the Harvard Medical School of Harvard University, under the direction of Dr. Gregory Curfman, Editor in Chief. 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.

Seasonal Influenza
What’s new with the flu shot?
Posted November 13, 2017, 10:30 am
Dominic Wu, MD, Contributing Editor
Should you get the influenza (flu) vaccine this year? The short, quick answer (barring any medical reasons you shouldn’t, such as severe allergies), is yes! But recent research raises another important question: When should you get the shot?
Healio features the industry’s best news reporting, dynamic multimedia, question-and-answer columns, CME and other educational activities in a variety of formats, quick reference content, blogs, peer-reviewed journals and a full line of popular book titles.

Welcome to the New World Order A Competitive HCV Drug Marketplace
November/December print edition of HCV NEXT, available online at Healio.
Monthly Prescribing Reference (MPR) is a multispecialty drug information resource for healthcare professionals offering concise prescribing information, point-of-care tools, as well as news and features on hot topics in pharmacotherapy.

Labeling for Several HCV Drugs Updated With New Drug Interactions
Specifically, the prescribing information for Viekira Pak (ombitasvir, paritaprevir, ritonavir, with dasabuvir; AbbVie), Viekira XR (dasabuvir, ombitasvir, paritaprevir, ritonavir; AbbVie), Technivie (ombitasvir, paritaprevir, ritonavir; AbbVie), Sovaldi (sofosbuvir; Gilead), Harvoni (ledipasvir, sofosbuvir; Gilead), Epclusa (sofosbuvir, velpatasvir; Gilead), Vosevi (sofosbuvir, velpatasvir, voxilaprevir; Gilead), Olysio (simeprevir; Janssen), Daklinza (daclatasvir; Bristol-Myers Squibb), and Zepatier (elbasvir, grazoprevir; Merck) has been updated to include information pertaining to changes in International Normalized Ratio (INR) values in patients receiving warfarin. Fluctuations in INR values may occur in patients receiving warfarin concomitant with HCV treatment.
Read more..... 

Journal Updates
The world’s first multidisciplinary Open Access journal, PLOS ONE accepts scientifically rigorous research, regardless of novelty. PLOS ONE’s broad scope provides a platform to publish primary research, including interdisciplinary and replication studies as well as negative results. The journal’s publication criteria are based on high ethical standards and the rigor of the methodology and conclusions reported.

Evolution of acute hepatitis C virus infection in a large European city: Trends and new patterns
The aims of this study were to describe the evolution of acute hepatitis C virus (HCV) infections since 2004 and to determine its associated factors. Acute HCV infections diagnosed in Barcelona from 2004 to 2015 were included. Incidence ratios (IR) were then estimated for sex and age groups. Cases were grouped between 2004–2005, 2006–2011 and 2012–2015, and their incidence rate ratios (IRR) were calculated. In addition, risk factors for acute HCV infection were identified using multinomial logistic regression for complete, available and multiple imputed data. 204 new HCV cases were identified. Two peaks of higher IR of acute HCV infection in 2005 and 2013 were observed. Men and those aged 35–54 had higher IR. IRR for men was 2.9 times greater than in women (95% confidence intervals (CI): 1.8 ‒ 4.7). Factors related to the period 2012–2015 (versus 2006–2011) were: a) sexual risk factor for transmission versus nosocomial (relative-risk ratio (RRR): 13.0; 95% CI: 2.3 ‒ 72.1), b) higher educated versus lower (RRR: 5.4; 95% CI: 1.6 ‒ 18.7), and c) HIV co-infected versus not HIV-infected (RRR: 53.1; 95% CI: 5.7 ‒ 492.6). This is one of the few studies showing IR and RRRs of acute HCV infections and the first focused on a large city in Spain. Sexual risk for transmission between men, higher educational level and HIV co-infection are important factors for understanding current HCV epidemic. There has been a partial shift in the pattern of the risk factor for transmission from nosocomial to sexual.
Continue to full text article........

Sex difference in the interaction of alcohol intake, hepatitis B virus, and hepatitis C virus on the risk of cirrhosis.
Stroffolini T, et al. PLoS One. 2017
BACKGROUND: The joint effect of the interaction of alcohol intake, hepatitis B virus (HBV) and hepatitis C virus (HCV) on the risk of cirrhosis is still unexplored because a large sample size is required for this investigation.

OBJECTIVE: Evaluation of interaction of HBV, HCV and alcohol abuse on the risk of cirrhosis.
DESIGN: We analysed 12,262 consecutive patients with chronic liver disease of various aetiologies referring to 95 Italian liver units in 2001 or 2014. To evaluate the interaction between alcohol abuse, HBV infection, and HCV infection, patients unexposed to either factors were used as reference category. Adjustment for BMI and age was done by multiple logistic regression analysis.
RESULTS: Females were older than males (p<0.01) and less frequently showed HBV and alcoholic aetiology (p<0.01). In both sexes, an overtime increasing age and an increasing proportion of subjects with liver cirrhosis was observed, reflecting a better survival (0.01). An additive interaction is observed in females: the O.R. generated by the simultaneous presence of HBV, HCV, and alcohol (5.09; 95% C.I. 1.06-24.56) exceeds the sum (4.14) of the O.R. generated by a single exposure (O.R. = 0.72 for HBsAg positivity, OR = 1.34 for anti-HCV positivity, and O.R. = 2.08 for alcohol intake). No interaction is observed in male sex.
CONCLUSIONS: The observed gender difference suggests that the simultaneous presence of HBV/HCV coinfection and risky alcohol intake enhances the mechanism of liver damage to a greater extent in females than in males.
The Lancet
The Lancet began as an independent, international weekly general medical journal founded in 1823 by Thomas Wakley. Since its first issue (October 5, 1823), the journal has strived to make science widely available so that medicine can serve, and transform society, and positively impact the lives of people.

Eliminating viral hepatitis: time to match visions with action

Of Interest
AMI Podcast - November 13, 2017 episode
2017 World Hepatitis Summit

Hepatitis C in Canada

Dr. Jordan Feld from the Toronto Centre for Liver Disease discuss what it will take for hepatitis C to be cured in Canada.

Of all infectious disease in Canada the one disease that causes most years of life lost is hepatitis C. 
Listen here......

Friday, October 6, 2017

TGIF - HCV Headlines & Newsletters - Reuters Updated Article On The Cochrane Review of HCV Direct-acting Antivirals

HCV Headlines, Blog and Newsletter Updates 
Welcome to Friday! Check out today's news, along with recent journal and blog updates. Plus this months great index of October newsletters.

In The News
The Cochrane Review of HCV direct-acting antivirals is in the news again, yesterday an "updated article" from Reuters, noted the change in the authors conclusions, pointed out last month via Twitter by "Henry E. Chang."

An excerpt from the updated article; Do direct-acting antivirals curb the long-term effects of chronic HCV infection?
As reported in the Cochrane Database of Systematic Reviews, online September 18, the team stated they "could not reliably determine the effect of DAAs on the market or under development on (the) primary outcome of hepatitis C-related morbidity or all-cause mortality."
Full-text Cochrane Review with updated conclusions
Again thanks to Mr. Chang, "click here," to read the full-text Cochrane Review with updated conclusions. In addition, check out the backstory or follow the links to each rebuttal, written by HCV experts and devoted advocates.
Begin here...

Today's News
Is Birth Cohort Screening Effective for Identifying HCV Cases?
Yes; in three randomized trials, birth cohort screening was three to eight times more effective than risk-based screening...

California Works to Contain Deadly Hepatitis A Outbreaks - Medscape
"In our outbreak, 45% of the cases are illicit drug users, and nearly one in four had chronic hepatitis B or C yet had not been previously immunized," said Dr ...

Hundreds Hospitalized in San Diego as Hepatitis A Outbreak Spreads
Drug users, the homeless most affected; county has launched vaccination effort..

Denver VA nurse accused of swapping fentanyl syringes
DENVER – A former nurse at the Denver VA has been charged with stealing fentanyl. Investigators say it happened in 2016 and on several occasions Lisa Marie Jones allegedly removed fentanyl from a vial and replaced it with another substance.

How HCV Drug Makers Hit a Wall
There’s reason to believe the well for hepatitis C (HCV) treatments has dried up.

Liver Cancer Remains a Major Public Health Burden Globally
FRIDAY, Oct. 6, 2017 (HealthDay News) -- Causes of primary liver cancer differ widely among populations globally, but most cases can be prevented, according to a study published online Oct. 5 in JAMA Oncology.

Treating Hepatocellular Carcinoma: A Fight Against the Odds
Jasenka Piljac Žegarac, PhD
In an interview with Infectious Disease Advisor, Richard Burkhart, MD, assistant professor of surgery at Johns Hopkins Hospital, Baltimore, Maryland, and Amulya A. Nageswara Rao, associate professor of pediatrics and director of the Pediatric Brain Tumor Clinic at Mayo Clinic, Rochester, Minnesota, discussed the challenges associated with treating HCC.

Of Interest
October Audio and Teleconference Transcript: Obesity and Cancer

Seasonal Flu
Influenza Vaccine Good Match for Circulating Strains
Antigenic and genetic characterization of circulating influenza strains detected to date show few surprises, suggesting the 2017 to 2018 vaccine will offer good protection against this year's viruses.

Read all past and current Seasonal Flu Vaccine articles posted on this blog.

Journal Updates
Real-life results of sofosbuvir based therapy in chronic hepatitis C -naïve and -experienced patients in Egypt
In the real-life setting, Sofosbuvir based regimens for 24 weeks has established an efficacious and well tolerated treatment in naïve and experienced patients with chronic HCV genotype 4 infection; although shorter treatment durations may be possible. However, patient follow up should extent to at least 6 months post-treatment and verifying viral load on yearly basis is warranted to track any late relapse...

Incidence of DAA failure and the clinical impact of retreatment in real-life patients treated in the advanced stage of liver disease: Interim evaluations from the PITER network
Failure rate following the first DAA regimen in patients with advanced disease is similar to or lower than that reported in clinical trials, although the majority of patients were treated with suboptimal regimens. Interim findings showed that worsening of liver function after failure, in terms of Child Pugh class deterioration, was improved by successful retreatment in about one third of retreated patients within a short follow-up period; however, in some advanced liver disease patients, clinical outcomes (Child Pugh class, HCC development, liver failure and death) were independent of viral eradication...

Restrictions for reimbursement of interferon-free direct-acting antiviral drugs for HCV infection in Europe
All-oral direct-acting antiviral drugs (DAAs) for hepatitis C virus, which have response rates of 95% or more, represent a major clinical advance. However, the high list price of DAAs has led many governments to restrict their reimbursement. We reviewed the availability of, and national criteria for, interferon-free DAA reimbursement among countries in the European Union and European Economic Area, and Switzerland. Reimbursement documentation was reviewed between Nov 18, 2016, and Aug 1, 2017. Primary outcomes were fibrosis stage, drug or alcohol use, prescriber type, and HIV co-infection restrictions. Among the 35 European countries and jurisdictions included, the most commonly reimbursed DAA was ombitasvir, paritaprevir, and ritonavir, with dasabuvir, and with or without ribavirin (33 [94%] countries and jurisdictions). 16 (46%) countries and jurisdictions required patients to have fibrosis at stage F2 or higher, 29 (83%) had no listed restrictions based on drug or alcohol use, 33 (94%) required a specialist prescriber, and 34 (97%) had no additional restrictions for people co-infected with HIV and hepatitis C virus. These findings have implications for meeting WHO targets, with evidence of some countries not following the 2016 hepatitis C virus treatment guidelines by the European Association for the Study of Liver.

On Twitter
The following articles were shared on Twitter, by @HenryEChang

High sustained virological response rates using imported generic direct acting antiviral treatment for hepatitis C
This analysis assessed the efficacy of generic imported DAAs.

Treatment of HCV with 8 weeks of LDV/SOF: Highly effective in a predominately black male patient population
Reducing the duration of hepatitis C therapy may cut costs and improve adherence, but recent studies suggest that black men have lower cure rates than other patients when treatment durations are shortened. Here, we report high efficacy in a real world cohort of predominantly black male patients with hepatitis C.

Curing HCV infection: Best practices from the U.S. Department of Veterans Affairs
The widespread availability of curative oral DAA medications has made HCV epidemiologic control seem achievable. The VA is steadily approaching this goal and remains committed to diagnosing and treating all veterans with HCV infection who are willing and able to be treated.

Role of Age and Race in the Risk of HepatocellularCarcinoma in Veterans With HepatitisB Virus Infection
We conducted a retrospective cohort study using the national Veterans Administration data to identify patients with chronic HBV infection from 2001 through 2013. We examined the effect of race and age on HCC risk while adjusting for baseline clinical characteristics.

The cost of successful antiviral therapy in hepatitis C patients: a comparison of iFn-free versus iFn-based regimens at an individual patient level in Australia
We performed a retrospective chart review of 30 HCV-infected patients successfully treated with IFN-based therapy between 2013 and 2015. We also generated a model for a virtual group of 100 genotype 1 (GT1) and 100 genotype 3 (GT3) patients treated with IFN-free therapy derived from national guidelines and clinical trial data.

Blog Updates
By Rick Nash - October 5, 2017
When starting treatment, it’s an important question, how much can I work while on treatment? Of the six different treatments I’ve been on, I’ve worked part-time, full-time, some of the time, and...

The Dark Side of Stigma with Hepatitis C (Part 2) 
By Karen Hoyt - October 4, 2017
Click here to read Part 1 of The Dark Side of Stigma with Hepatitis C. Most of us have experienced stigma from having hep C. It’s easy to recognize the judgment that...

Staying Connected 
By Daryl Luster - October 3, 2017
Back in the day, when people were said to have connections it had nothing to do with the internet or the modern world of connectivity, where we are almost all involved in...

In Case You Missed It
The Physical and Emotional Toll of Hep C: Results from the Hepatitis C In America Survey

Hepatitis B Foundation
Who is Ted Slavin?
“Who is Ted Slavin? Why haven’t I heard about him before?” crept into my mind as I was reading The Immortal Life of Henrietta Lacks. Rebecca Skloot wrote a short snippet about Ted Slavin, detailing the story of a hemophiliac who sold his antibodies and aided Dr. Baruch Blumberg in the discovery of the link between the hepatitis B virus and liver cancer, which eventually led to the first hepatitis B vaccine..

Save The Date - October 12, 2017
On Thursday, Oct. 12, representatives from Hepatitis B Foundation, CDC’s Division of Viral Hepatitis, and NASTAD (the National Alliance of State and Territorial Aids Directors) will co-host a twitter chat at 2 p.m. EST using the hashtag #liverchat.

Creating a World Free of Hepatitis C
Improving Your Memory
October 5, 2017
Lucinda Porter

HEP - Blog Updates
Hepatitis C Treatment: Taking Care Physically
By Connie M. Welch        
Tips for how to take care of your health when living with hepatitis C..

HIV and ID Observations
With Several Wrong Predictions Behind Me, Here’s One I Got Right
Oct 1, 2017
Paul E. Sax, MD
However, when I wrote this summer that we might be at the end of HCV drug development, it turned out to be pretty spot-on. Since then, two companies have ended their HCV drug development programs, one in early September, then another last week. You can read more about the business reasons here, but the simple medical reason is that it would be an enormous challenge to improve on what we have now — which is good news for our patients, provided remaining access issues can be resolved...

MD Whistleblower
Does Secretary Tom Price Deserve Forgiveness?
Oct 1, 2017
Michael Kirsch, M.D.
What is the explanation for Tom Price, a physician and current Secretary of Health and Human Services, taking private charter flights costing taxpayers hundreds of thousands of dollars?

Weekly Bull
Read The Latest Issue: Weekly Bull

Hepatitis B & C Public Policy Association
October 2017 – Newsletter

HCV Advocate
October Newsletter

National Viral Hepatitis Roundtable
September/October 2017 NVHR Newsletter

The New York City Hepatitis C Task Force
Hep Free NYC Newsletters

GI & Hepatology
October Newsletter

Support Forums

Our goal is to be friendly, supportive, and most of all, informative about all aspects of transplantation. If we don't have an immediate answer to a question, we will search the Internet for information for you.

Hep Forum

Hep C Discussion Forum
Global Hepatitis C Support and Information

This message board will allow you to keep in touch with other patients, or caregivers, exchange ideas, as well as give and receive support. 

Helpful Links

Video Updates - Medscape
The Power to Protect: Vaccination Guidelines for Adults With Chronic Diseases
October 2017
CDC reviews the latest vaccine recommendations for adults, including patients with chronic medical conditions.

2017-2018 Influenza Vaccination Recommendations        
October 2017
The latest CDC influenza vaccination recommendations outline which vaccine products should--and which should not--be used to protect against flu this season.

Should You Recommend Coffee Drinking to Your Patients?
October 2017                         
(Video) Recent studies suggest that coffee drinking may be good for you, but more data replicating these studies are needed. Should you recommend coffee consumption to patients?
Free registration may be required to view videos

Happy Friday!