This blog is all about current FDA approved drugs to treat the hepatitis C virus (HCV) with a focus on treating HCV according to genotype, using information extracted from peer-reviewed journals, liver meetings/conferences, and interactive learning activities.
Risk Of Developing Liver Cancer After HCV Treatment
Authorities in Ohio have officially declared a statewide hepatitis A outbreak following the confirmation of 79 hepatitis A cases this year, which is already almost double the number of confirmed cases the entire previous year. Montgomery County has the most cases in the state with 17 confirmed cases, followed by Lawrence with 12 cases, and Lucas with 10. Continue reading..
Links
CDC Hepatitis A Questions and Answers for the Public
I think I have been exposed to hepatitis A. What should I do?
If you have any questions about potential exposure to hepatitis A, call your health professional or your local or state health department. If you were recently exposed to hepatitis A virus and have not been vaccinated against hepatitis A, you might benefit from an injection of either immune globulin or hepatitis A vaccine. However, the vaccine or immune globulin are only effective if given within the first 2 weeks after exposure. A health professional can decide what is best based on your age and overall health.
Read the complete article @ Gastroenterology Download PDF View Online
Severe morbidity can result from viral hepatitis co-infection, particularly in persons with existing chronic liver disease. Vaccination is the most effective way of preventing infection with the hepatitis A virus (HAV) and hepatitis B virus (HBV). Persons with chronic liver disease are currently recommended by the Advisory Committee on Immunization Practices to receive the HAV and HVB vaccines if they have not previously been vaccinated. Recently, the Advisory Committee on Immunization Practices approved language clarifying that all patients with hepatitis C virus (HCV) infection are recommended for HBV vaccination1 and that persons with HBV and HCV infections should also be specifically considered for vaccination against HAV.2, 3
Recent large outbreaks of HAV related to foodborne4, 5 and ongoing person-to-person exposures have resulted in substantial rates of morbidity and mortality5, 6, 7; these events underscored the relatively low prevalence of immunity against HAV infection among the US-born adult population.8 Poor HAV vaccine coverage among adults, combined with decreased childhood exposures to HAV since childhood vaccination initiation in 1996, have resulted in a low population immunity as measured by the prevalence of antibody to HAV (anti-HAV). Among adults age ≥18 years with chronic liver conditions participating in the 2014 and 2015 National Health Interview Survey, for example, only 19.4% reported having received 1 dose and 11.5% received 2 doses of HAV vaccine. Even among those with ≥10 provider visits, only 13.8% had received two doses of HAV vaccine, indicating missed opportunities for vaccination.9
The 1999 through 2012 National Health and Nutrition Examination Survey (NHANES) revealed that the overall anti-HAV prevalence among adults aged ≥20 years was about 25%.8 In the United States, immunity to HAV is greatest among the cohort of young people born after the 1996 recommendation for pediatric vaccination of children residing in areas of high transmission or incidence, particularly the cohort of children subject to the 2006 recommendation for universal pediatric HAV vaccination. Data from NHANES 2007 through 2012 showed 60% anti-HAV positivity among those aged 2 to 11 years in contrast with 16% to 18% among those aged 30 to 49. In earlier NHANES data from 1999 through 2006, only 21.4% of children aged 2 to 11 years had tested anti-HAV positive.8 Data from the National Immunization Survey—Child for 2012 through 2016 revealed that 82% of children 19 to 35 months had received ≥1 dose of vaccine in 2012, increasing incrementally each year to 86% in 2016.10 The increasing vaccine coverage and decreasing acute infection among children has resulted in reduced exposure to HAV for adults and consequently lower immunity among adults. This is exacerbated by poor vaccine coverage among adults, causing decreasing population immunity.
Recent data from the Chronic Hepatitis Cohort Study (CHeCS) at 4 large integrated US health care systems11 indicates that vaccination rates are far below desired public health goals. Among 3846 living chronic HBV-diagnosed and 15,471 HCV-diagnosed patients, results were available from total anti-HAV testing performed as part of routine clinical care and vaccination records from the electronic health record at any time in the patient’s past medical history through 2015. Updated vaccination records through 2016 were available for patients from 2 sites representing 35% of the cohorts. More than one-half of the HBV cohort patients had testing for anti-HAV and 60% were positive indicating immunity through either vaccination or past infection (Table 1). A similar proportion of HCV-infected patients had anti-HAV testing and 39% were positive. Among patients ever tested for anti-HAV in both HBV and HCV cohorts, significantly higher anti-HAV positivity was found among specific racial and ethnic groups. Higher numbers of patients of Asian/Pacific Islander and Hispanic race/ethnicity (70.3% and 56.3%, respectively) were immune to HAV compared with non-Hispanic black or white patients (37.7% and 38.4%, respectively; both P < .001). These differences could reflect exposure in early life among persons born in countries endemic for both HAV and HBV.
Featured on the blog today in honor of Hepatitis Awareness Month, is a look at three common viruses that cause hepatitis, brought to you by Centers of Disease Control and Prevention (CDC), health experts, advocates, and patient bloggers, who work hard to spread information and awareness about viral hepatitis.
Hepatitis C
Lets start with the hepatitis C virus (HCV), a virus that once caused serious damage to my liver, putting me at risk for liver-related complications. The good news is after testing; it all starts with getting tested for HCV, I went on to successfully treat the virus. The bad news is close to 50% of people who have HCV have not yet been diagnosed. Why not take this opportunity to learn more about viral hepatitis, or better yet, have a long frank discussion with "yourself" about getting tested.
Young Or Not So Young - The Risk
Today we have two different groups of people that are at risk for hepatitis C, young people who have injected drugs and well, older people. We know that the hepatitis C epidemic peaked between 1940 and 1965 due in part because of hospital transmissions caused by the practice of reusing needles. So if you are at risk for HCV, rather you are young or part of the baby boomer generation; people born between 1945 and 1965, I hope you consider getting tested for HCV.
-You were born from 1945 through 1965
-Extensive surgical procedures
-Needlestick injuries in health care settings
- Recipients of donated blood, blood products, and organs (once a common means of transmission but now rare in the United States since blood screening became available in 1992)
-People who received a blood product for clotting problems made before 1987
-Hemodialysis patients or persons who spent many years on dialysis for kidney failure
-Other possible risk behaviors: tattoos, body piercing, living and medical care in a developing country, folk medicine, intranasal cocaine
-Sexual transmission, rare; the risk of sexual transmission to an individual is probably less than 3% when a person is in a stable monogamous relationship - Unless you also have human immunodeficiency virus (HIV).
-Sharing personal care items, such as razors or toothbrushes, that may have come in contact with the blood of an infected person
-Unknown--up to 5% of patients have no identifiable risk factors
May 19th is Hepatitis Testing Day!
Are You At Risk For Viral Hepatitis?
Find out if you should get tested or vaccinated by taking a quick, online Hepatitis Risk Assessment, developed by the CDC and get a personalized report.
Hepatitis C - A Few Facts
Of every 100 people infected with hepatitis C, 75 to 85 will develop chronic disease and 10-20 will go on to develop cirrhosis over a period of 20-30 years. Early on HCV doesn't always have noticeable symptoms but overtime and with certain co-factors the virus can lead to serious liver problems, including cirrhosis (scarring of the liver) or liver cancer. Almost 80 percent of cases of hepatocellular carcinoma (HCC) are due to underlying chronic hepatitis B and C infection, and 80 to 90 percent of people with HCC have liver cirrhosis. According to the recent EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma;Vaccination against hepatitis B reduces the risk of HCC and is recommended for all new-borns and high-risk groups. In patients with chronic hepatitis, antiviral therapies leading to maintained HBV suppression in chronic hepatitis B and sustained viral response in hepatitis C are recommended, since they have been shown to prevent progression to cirrhosis and HCC development.
The American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) with the International Antiviral Society developed a living document with ever evolving guidelines to treat HCV. The guidelines break down treatment according to liver damage and HCV genotype, updated when new HCV drugs are approved, or new real world data is established.
Help - Where Do I Begin?
Talk To Someone Help‑4‑Hep is a non-profit, peer-to-peer helpline where counselors work with patients to meet the challenges of hepatitis C head-on. Callers talk one-to-one with a real person, typically someone who's had hepatitis C touch their own life. And they talk about the specifics of their particular situation. The phone call, support and information are all provided free of charge. Let us help you cut through the clutter and confusion. Call toll-free: 877‑Help‑4‑Hep (877‑435‑7443).
Begin here.......
More than 2 million Americans are chronically infected with hepatitis B virus (HBV), to learn more about HBV visit The Hepatitis B Foundation, for patients it's the best site for easy to understand information, here are a few links to get you started:
You may have questions about the hepatitis A virus (HAV) after reading about HAV outbreaks across the US; Michigan, California, Indiana, Kentucky and Utah. The outbreak began in California in 2017, this year Michigan, Utah, and Kentucky have reported outbreaks with a high number of cases. Here is a Public Service Announcement from San Diego County Health & Human Services Agency on HAV prevention.
I think I have been exposed to hepatitis A. What should I do?
If you have any questions about potential exposure to hepatitis A, call your health professional or your local or state health department. If you were recently exposed to hepatitis A virus and have not been vaccinated against hepatitis A, you might benefit from an injection of either immune globulin or hepatitis A vaccine. However, the vaccine or immune globulin are only effective if given within the first 2 weeks after exposure. A health professional can decide what is best based on your age and overall health.
What is postexposure prophylaxis (PEP)?
Postexposure prophylaxis (PEP) refers to trying to prevent or treat a disease after an exposure. For hepatitis A, postexposure prophylaxis is an injection of either immune globulin or hepatitis A vaccine. However, the vaccine or immune globulin are only effective in preventing hepatitis A if given within the first 2 weeks after exposure. Begin here.......
Blog Updates: The ABCs Of Viral Hepatitis
Swedish Medical Center
What is hepatitis C, and how does it differ from hepatitis A or B?
By 2030, the World Health Organization wants to have hepatitis C eliminated from the planet. A key to reaching that goal is to create awareness of the disease among baby boomers, who suffer from it in larger numbers compared to the rest of the population, as well as those with increased lifestyle risks. But what is hepatitis C, and what can be done to reduce its numbers? Kris Kowdley, MD, director of the Liver Care Network and Organ Care Research at Swedish Medical Center in Seattle, WA, discusses hepatitis C in detail.
HEP Blogs Go-to online source for educational and social support for people living with hepatitis. The website is devoted to combating the stigma and isolation surrounding hepatitis.
What are the Different Types of Hepatitis?
May 9, 2018 • By Connie M. Welch
Viral hepatitis is a liver infection that causes inflammation and damage. There are 5 viruses that cause viral hepatitis, Hepatitis A, B, C, D, and E. Hepatitis A and E viruses can cause acute infections (infections that last less than 6 months). Hepatitis B, C, and D viruses can cause acute and chronic (lasting longer than 6 months and typically ongoing) liver infections.
So, you are hanging out with the same crowd that you always have. They’re like your family. In many ways, they are closer to you than your own family.
The Fallout Guide for Hep C: Support Network
By Rick Nash · May 2, 2018
I am lucky after my transplant, I carry that reminder on my stomach. Because when someone hears you have a condition, they may not initially understand the reality of how that affects you. This is part two of a six-part series, view part one here.
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.
Hepatitis Awareness Month is dedicated to increasing awareness of hepatitis in the United States and to encourage high risk populations to get tested. If you’re not sure how you can get involved in the hepatitis B community this month, here are some ways you can!
The Al D. Rodriguez Liver Foundation is a 501(c)(3) non-profit organization that provides resources, education and information related to screening, the prevention of and treatment for the Hepatitis Virus and Liver Cancer.
A New York Post article about an unsafe “pizza joint manager” — who was reported to have sparked hepatitis C scare — made a few rounds on the panicked social media circuit earlier this year.
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, and peer-reviewed journals. A quick free registration may be required.
Hepatitis Awareness Month: 10 recent reports on viral hepatitis
May 8, 2018
The Centers for Disease Control and Prevention have designated May as Hepatitis Awareness Month to raise public awareness of viral hepatitis including the most common strains: hepatitis A, hepatitis B and hepatitis C. Additionally, the CDC designated May 19th as Hepatitis Testing Day. The following recent reports, many from recent meetings including the International Liver Congress 2018, include new research data on hepatitis prevalence and outbreaks, transmission risks and treatment outcomes...
May 9, 2018
Physicians should consider administering hepatitis A vaccines to their patients with hepatitis B and those with hepatitis C, according to a…
What is the hepatitis virus? Well, the hepatitis virus invades liver cells and causes inflammation in the liver tissue. There are five known hepatitis viruses—hepatitis A, hepatitis B, hepatitis C, hepatitis D, and hepatitis E, all of which have slightly different presentations, symptoms and severity.
Do you want to know your status? If you fall under any of the above mentioned risk groups please consider getting tested.
Source Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America.
Abstract BACKGROUND AND GOALS: Hepatitis A (HAV) and hepatitis B (HBV) vaccination in patients with chronic liver disease is an accepted standard of care. We determined HAV and HBV vaccination rates in a tertiary care referral hepatology clinic and the impact of electronic health record (EHR)-based reminders on adherence to vaccination guidelines.
METHODS: We reviewed the records of 705 patients with chronic liver disease referred to our liver clinic in 2008 with at least two follow-up visits during the subsequent year. Demographics, referral source, etiology, and hepatitis serology were recorded. We determined whether eligible patients were offered vaccination and whether patients received vaccination. Barriers to vaccination were determined by a follow-up telephone interview.
RESULTS: HAV and HBV serologic testing prior to referral and at the liver clinic were performed in 14.5% and 17.7%; and 76.7% and 74% patients, respectively. Hepatologists recommended vaccination for HAV in 63% and for HBV in 59.7% of eligible patients. Patient demographics or disease etiology did not influence recommendation rates. Significant variability was observed in vaccination recommendation amongst individual providers (30-98.6%), which did not correlate with the number of patients seen by each physician. Vaccination recommendation rates were not different for Medicare patients with hepatitis C infection for whom a vaccination reminder was automatically generated by the EHR. Most patients who failed to get vaccination after recommendation offered no specific reason for noncompliance; insurance was a barrier in a minority.
CONCLUSIONS: Hepatitis vaccination rates were suboptimal even in an academic, sub-speciality setting, with wide-variability in provider adherence to vaccination guidelines.
Introduction Hepatitis A and hepatitis B are amongst the most common infectious diseases worldwide [1], [2]. Superinfection with hepatitis A virus (HAV) or hepatitis B virus (HBV) in patients with underlying chronic liver disease is associated with a higher risk of morbidity and mortality [3], [4], [5]. Both HAV and HBV infections are preventable by highly effective and safe vaccines [6], [7], [8], [9]. Experts have recommended screening for susceptibility to HAV and HBV infection and vaccination against them for all patients with chronic liver disease [10], [11]. The CDC and several professional societies have also recommended vaccination against HAV and HBV for susceptible patients with chronic liver disease. In 2008, Centers for Medicare and Medicaid Services (CMS) proposed HAV and HBV vaccination for eligible patients with chronic hepatitis C infection (HCV) as a quality measure [12], [13], [14], [15].
Prior studies have demonstrated shortcomings in adherence to vaccination guidelines in specific subgroups of patients with chronic liver disease in the United States and around the world. In a study of patients with chronic hepatitis C infection in a Veterans Administration Healthy System in California, an adherence rate of 71% for HAV and 70% for HBV and 62% for both vaccination was found [16]. Similarly, in a large cohort of HCV patients from the Department of Veterans Affairs quality measure of HAV and HBV vaccination or documentation of immunity were met in just 57% and 45.5% patients, respectively [17]. A study of patients with autoimmune hepatitis from Germany found vaccination rates of just 11% for HBV and 13% for HAV [18].
Given the increased focus on preventive care and advent of pay for performance models of health care delivery, it likely that adherence to vaccination guideline will be emphasized as a quality measure. Low adherence to vaccination guidelines in primary care settings has been documented [19]. However, limited data are available on whether specialists that care for chronic liver disease patients perform better on these quality measures than community physicians [19]. Furthermore, it is also unknown whether adoption of electronic health records (EHR) and introduction of CMS-mandated quality measures reporting has affected physician practice patterns in terms of adhering to hepatitis vaccination guidelines.
Therefore, the objectives of this study were: (1) To evaluate adherence to hepatitis vaccination guidelines in patients with chronic liver disease at a tertiary care hepatology clinic, (2) to identify barriers to vaccinations in patients with chronic liver disease, and (3) to determine physician variability in adherence to vaccination guidelines......
Routine HAV vaccination in patients with HCV may not be cost-effective or beneficial to patients, according to recent study results.
In a meta-analysis of 10 studies, researchers evaluated the mortality risk from HAV superinfection among 22,371 patients with HCV who were vaccinated against HAV. Incorporated data included the type of study, data collection methods, diagnostic criteria, study length, the number of patients involved and the number of deaths attributed to HAV.
Investigators established a pooled OR of 7.23 (95% CI, 1.24-42.12) for mortality risk from HAV superinfection, which was equated with 1.4 deaths for every one million susceptible patients with HCV annually. Heterogeneity between studies was determined (I2=56%, P=.03), and this analysis excluded three studies reporting zero deaths. A subsequent analysis that incorporated all 10 studies and used a random effects model and continuity correction resulted in an OR of 6.88 (95% CI, 1.32-36.01).
Publication bias toward increased mortality risk was observed, with studies submitted as original articles reporting a higher mortality risk (OR=38.75; 95% CI, 7.33-204.84) while those published as correspondence suggested rates similar to the population risk (OR=0.86; 95% CI, 0.15-4.90).
Assuming an incidence rate of five cases of HAV superinfection for every 100,000 patients with HCV, researchers calculated the number needed to vaccinate (NNV) patients with HCV against HAV was 23,565 to prevent one case. The NNV to prevent one death annually was calculated at 814,849, with an estimated cost of $162 million for the vaccine, or $80.1 million per death prevented. Both calculations assumed a 94.3% efficacy rate and 90% uptake for the vaccine.
“These data challenge the use of routine HAV vaccination in HCV-infected persons and its incorporation into clinical practice guidelines,” the researchers wrote. “These findings highlight several key issues in the development of both guidelines and quality measures. Firstly, the assessment of the evidence and the benefit of interventions need occur in light of relevant prevalence data. Secondly, changes in prevalence need to be considered when guidelines or quality measures are revised or reassessed. Physicians otherwise run the risk of exposing many patients to interventions that are ultimately of no benefit to them.”
