Showing posts with label transmission. Show all posts
Showing posts with label transmission. Show all posts

Tuesday, November 13, 2018

Hepatitis C is detectable in rectal and nasal fluid

Conference Coverage @ infohep
Hepatitis C is detectable in rectal and nasal fluid

Keith Alcorn Published: 12 November 2018

High levels of hepatitis C virus (HCV) can be found in the rectal and nasal fluids of people with high hepatitis C viral loads even when blood is not present, Austrian researchers reported on Sunday at the 2018 AASLD Liver Meeting.

The findings reinforce the plausibility of HCV transmission through sharing up rolled-up bank notes or other equipment for snorting drugs.

The findings were presented by Dr David Chromy of the Medical University of Vienna on behalf of the Vienna HIV & Liver Study Group.

Conference Updates: infohep news
Twitter - @infohep
Sign up for our AASLD Liver Meeting news bulletin.

Sunday, November 11, 2018

Tracking addiction: New treatments appear to be working

Tracking addiction: New treatments appear to be working
By Matt Bise
It has been almost a year since Gov. Henry McMaster called opioid and heroin addiction a statewide public health emergency. The declaration of a health emergency gives public health agencies and law enforcement new powers to act and respond on a much larger scale.

In October the Kennedy Center in Berkeley County started offering a new medical option for addicts who commit to counseling, and treatment for opioid or heroin addiction has shown that it can work when it’s accessible.

Meantime as new treatments make their way into rural communities, where the crisis takes root, another health concern is surfacing from the scourge — hepatitis C...

Hepatitis C Transmission
The great majority of HCV infections are found among people with a history of drug injection, including people who have been incarcerated. HCV is easily transmitted among drug injectors by sharing syringes or other injection paraphernalia (such as cookers, filters). Hepatitis C is easier to transmit through shared injection equipment than HIV, and HCV is usually the first blood borne virus IDUs acquire. As a result, as many as 50-90% of IDUs have been infected with HCV.

Tuesday, November 6, 2018

Over 2 Million Americans Have Hepatitis C; Affects nearly every generation

CDC Press Release
CDC Estimates Nearly 2.4 Million Americans Living with Hepatitis C
New data highlight urgent need to diagnose and cure more Americans, and to address rising infections due to U.S. opioid crisis.

Nearly 2.4 million Americans – 1 percent of the adult population – were living with hepatitis C from 2013 through 2016, according to new CDC estimates published today in the journal Hepatology.

** Link to full-text journal article provided below

Medications that cure hepatitis C offer the hope of eliminating the disease in the U.S., yet, today’s report suggests that millions are infected and have not benefited from these new treatment options. Expanded testing, treatment, and prevention services are urgently needed, especially in light of the surge in new infections linked to the opioid crisis.

Every American who has been cured of hepatitis C is living proof that ending this epidemic is possible,” said CDC Director Robert R. Redfield, M.D. “Hundreds of thousands of Americans have already been cured. In order to achieve our goal, we must commit to ensuring that everyone living with hepatitis C is tested and treated.”

To estimate total hepatitis C prevalence in the United States, researchers analyzed blood test results from the nationally representative National Health and Nutrition Examination Survey (NHANES) from 2013 through 2016. They also analyzed data from other studies of groups not surveyed in the NHANES, including active duty members of the military, and people who are incarcerated or homeless.

Opioid crisis puts new generations at risk of hepatitis C infections 
Adding to the burden of those already living with hepatitis C, separate CDC surveillance data indicate that the number of new infections each year in the United States is disturbingly high and on the rise. Acute hepatitis C cases reported to CDC more than tripled from 2010 to 2016, with most new hepatitis C infections due to increased injection drug use associated with the nation’s opioid crisis. Based on these data, CDC estimates that more than 41,000 Americans were newly infected with hepatitis C in 2016 alone.

Seeing an undiagnosable infection become a curable disease has been a public health highlight of the past 30 years. But the shadow of the opioid crisis puts our nation’s progress at risk,” said Jonathan Mermin, M.D., director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “Tackling hepatitis C requires diagnosing and curing people living with the virus and cutting off new infections at the source.”

Hepatitis C affects nearly every generation 
Hepatitis C now poses a serious health threat to three generations of Americans, all of whom need to be reached with prevention services, testing, and treatment:
Baby boomers (born between 1945 and 1965) account for a large portion of all chronic hepatitis C infections in the United States and currently have the highest rate of hepatitis C-related deaths. CDC recommends that all adults born between 1945 and 1965 get a one-time test for hepatitis C, but only a small fraction have done so. 

Adults under 40 have the highest rate of new infections, largely because of the opioid crisis.

Infants born to mothers with hepatitis C are a growing concern. The overall risk of an HCV-infected mother transmitting infection to her infant is approximately 4 percent to 7 percent per pregnancy. From 2011 through 2014, national laboratory data indicate that the rate of infants born to women living with hepatitis C increased by 68 percent. 

Eliminating hepatitis C requires substantial national commitment 
Even though new treatments can cure hepatitis C virus infections in as little as two to three months, far too many Americans have not been effectively treated. They may be unaware of their infection or they are unable to access medication because they lack healthcare coverage or have financial restrictions.

In addition to expanding testing and removing barriers to treatment, authors of the new report stress that intensified programs to prevent, track, and respond to new hepatitis C infections are also essential to reducing the number of infections. Prevention efforts to address new infections include support for comprehensive community-based prevention services. Such services focus on drug treatment and recovery and reducing transmission of viral hepatitis and HIV through hepatitis A and B vaccination, testing, linkage to care and treatment, and access to sterile syringes and injection equipment. 

“Until we as a nation remove the barriers to hepatitis C testing and treatment, it will continue to cost us dearly – both in terms of dollars and American lives,” said Dr. Mermin. “Every death from hepatitis C is a reminder of a promise not yet realized for far too many.” 

For more information from CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, visit

Read More From The CDC:
Hepatitis C Prevalence Estimates 2013-2016

In The Journal Hepatology
Full-Text Article
First published: 6 November 2018 - In Hepatology
Estimating Prevalence of Hepatitis C Virus Infection in the United States, 2013‐2016
Hepatitis C virus (HCV) infection is the most commonly reported bloodborne infection in the United States, causing substantial morbidity and mortality and costing billions of dollars annually. To update the estimated HCV prevalence among all adults aged ≥18 years in the United States, we analyzed 2013‐2016 data from the National Health and Nutrition Examination Survey (NHANES) to estimate the prevalence of HCV in the noninstitutionalized civilian population and used a combination of literature reviews and population size estimation approaches to estimate the HCV prevalence and population sizes for four additional populations: incarcerated people, unsheltered homeless people, active‐duty military personnel, and nursing home residents. We estimated that during 2013‐2016 1.7% (95% confidence interval [CI], 1.4‐2.0%) of all adults in the United States, approximately 4.1 (3.4‐4.9) million persons, were HCV antibody‐positive (indicating past or current infection) and that 1.0% (95% CI, 0.8‐1.1%) of all adults, approximately 2.4 (2.0‐2.8) million persons, were HCV RNA–positive (indicating current infection). This includes 3.7 million noninstitutionalized civilian adults in the United States with HCV antibodies and 2.1 million with HCV RNA and an estimated 0.38 million HCV antibody‐positive persons and 0.25 million HCV RNA–positive persons not part of the 2013‐2016 NHANES sampling frame. Conclusion: Over 2 million people in the United States had current HCV infection during 2013‐2016; compared to past estimates based on similar methodology, HCV antibody prevalence may have increased, while RNA prevalence may have decreased, likely reflecting the combination of the opioid crisis, curative treatment for HCV infection, and mortality among the HCV‐infected population; efforts on multiple fronts are needed to combat the evolving HCV epidemic, including increasing capacity for and access to HCV testing, linkage to care, and cure.
Continue to article:

Follow On Twitter
- This full-text research article was downloaded and shared today by @HenryEChang on Twitter.

In The Media
Over 2 Million Americans Have Hepatitis C; Opioids Help Drive Spread
By Amy Norton
HealthDay Reporter
TUESDAY, Nov. 6, 2018 (HealthDay News) -- More than 2 million Americans have hepatitis C -- and the opioid epidemic is a major contributor to the problem, according to a new government study.

The study, by the U.S. Centers for Disease Control and Prevention, does highlight progress against the potentially fatal liver disease. It also shows how much more work remains, CDC officials said.

Between 2013 and 2016, the agency estimated, nearly 2.4 million Americans had hepatitis C infections.

That's a small decline from previous years. And the CDC said that may indicate the effects of new therapies that have changed the face of hepatitis C treatment in the past several years.

Thursday, October 4, 2018

At-Risk Teens and Young Adults Overlooked During Opioid Crisis Too Few Tested for Hepatitis C, Research Suggests

SAN FRANCISCO – Teens and young adults who have injected drugs are at risk for contracting hepatitis C, but most aren’t tested and therefore don’t receive life-saving treatment, according to a national study being presented at IDWeek 2018. The study of more than 250,000 at-risk youth found only one-third of those with diagnosed opioid use disorder (OUD) were tested for hepatitis C.

Injection drug use increases the risk of contracting hepatitis C, but few teens and young adults are tested, according to a large national study presented at IDWeek.

The study of more than 250,000 youth determined only one-third of those with documented opioid use disorder were tested for hepatitis C.

Hepatitis C treatment was recently approved for teens, making it even more important that they get tested so they can be treated.

The Centers for Disease Control and Prevention seeks to eliminate HCV transmission among injection drug users. These data suggest that goal may not be attainable without substantial effort to improve testing rates.

This study is the first to look at opioid use and hepatitis C testing in at-risk youth. “We’re missing an opportunity to identify and treat young people who are at risk for this deadly infection,” said Rachel L. Epstein, MD, MA, lead author of the study and a post-graduate research fellow in the section of infectious diseases, Boston Medical Center. “Screening for OUD and other drug use, and then testing for hepatitis C in those at high risk, can help us do a better job of eliminating this serious infection, especially now that very effective hepatitis C medications are approved for teenagers.”

An infection of the liver, hepatitis C killed more than 18,000 Americans in 2016, making it the most common cause of death from a reportable infectious disease, according to the Centers for Disease Control and Prevention (CDC). It can be spread by sharing needles used to inject drugs. Health care providers may not test young people they suspect of misusing opioids because the drugs are available in pill form, which does not increase the risk of infection with hepatitis C. But studies show many youths who misuse prescription oral opioids eventually begin injecting them.

Results of the study suggest that current guidelines -- which only recommend testing those with known injected drug use or other specific risk factors – underestimate who is at risk for hepatitis C.

In 2017, the Food and Drug Administration (FDA) approved the first direct-acting hepatitis C medications for teens. These medications can cure a person with hepatitis C infection in two to three months. Without treatment, people may develop liver failure, liver cancer, or chronic liver disease (cirrhosis) many years after being infected.

For the study, researchers analyzed electronic medical records for 269,124 teens and young adults (13-21 years old) who visited one of 57 Federally Qualified Health Centers, which provide health care to diverse and underserved communities across 19 states, between 2012 and 2017. Of the 875 who had diagnosed OUD, 36 percent were tested for hepatitis C, and of those, 11 percent had been exposed to hepatitis C and 6.8 percent had evidence of chronic hepatitis C infection.

Overall, 6,812 (2.5 percent) who visited the health centers were tested for hepatitis C and of those, 122 (1.8 percent) tested positive for hepatitis C. Researchers found those most likely to be tested for hepatitis C were African American youth, those with any substance use disorder, and those 19-21 years old.

“The issue is complicated by the fact that not enough at-risk youth are screened for opioid or other drug use for a variety of reasons, including lack of time, comfort level between clinician and patient, and privacy and stigma concerns,” said Dr. Epstein. “And even when drug use is identified, there’s a belief that youth are less likely to test positive for hepatitis C, which isn’t necessarily the case as we show in our study. Clearly, this is an overlooked group that is at high risk.”

In addition to Dr. Epstein, co-authors of the study are: Jianing Wang, MSc, Kenneth Mayer, MD, Jon Puro, MPH, C. Robert Horsburgh, MD, Benjamin P. Linas, MD, MPH and Sabrina A. Assoumou, MD, MPH.

About IDWeek
IDWeek 2018TM is the annual meeting of the Infectious Diseases Society of America (IDSA), the Society for Healthcare Epidemiology of America (SHEA), the HIV Medicine Association (HIVMA) and the Pediatric Infectious Diseases Society (PIDS). With the theme “Advancing Science, Improving Care,” IDWeek features the latest science and bench-to-bedside approaches in prevention, diagnosis, treatment, and epidemiology of infectious diseases, including HIV, across the lifespan. IDWeek 2018 takes place Oct. 3-7 at the Moscone Center in San Francisco. For more information, visit

Monday, May 28, 2018

Canada launches call for proposals under its Harm Reduction Fund

Government of Canada launches call for proposals under its Harm Reduction Fund
Reducing the risk of HIV, hepatitis C and other blood-borne infections

OTTAWA, May 28, 2018 /CNW/ - Sexually transmitted and blood-borne infections, including HIV and hepatitis C, are largely preventable but remain a significant public health concern in Canada. The Government of Canada is taking action to reduce transmission of these diseases, including measures to prevent the spread of HIV and hepatitis C through the sharing of drug-use equipment, such as needles and pipes.

Through its Harm Reduction Fund, the Public Health Agency of Canada is investing $30 million over five years to support community initiatives to address the risk of infection among people who share drug-use equipment.

Today, the Honourable Ginette Petitpas Taylor, Minister of Health, launched an open call for proposals to support community projects that will reduce the rate of infections of HIV and hepatitis C among people who share injection and other drug-use equipment. Successful projects will implement evidence-based, time-limited interventions such as the development of educational resources for people who use drugs, peer outreach initiatives and training for health service providers.

The open call for proposals will allow applicants to apply for up to three years of funding for time-limited projects.

"The Harm Reduction Fund will help organizations implement response activities in communities where there are high rates of infections among people who share drug-use equipment, with the goal of reducing the rates of diseases, like HIV and hepatitis C, across our country."

The Honourable Ginette Petitpas Taylor, P.C., M.P.
Minister of Health

"Evidence shows that harm reduction is a vital part of a comprehensive, compassionate and collaborative public health approach to prevent the transmission of infectious diseases that result from the sharing of drug-use equipment. The Harm Reduction Fund will help Canadians who use drugs to adopt safer behaviours, and will reduce the rate of preventable diseases like HIV and hepatitis C."

Dr. Theresa Tam
Chief Public Health Officer of Canada

Quick Facts
Eligible activities under the Harm Reduction Fund include front-line prevention activities and capacity-building of individuals, providers and systems.
Additional calls for project proposals are planned for spring 2019 and 2020.
People who share drug-use equipment continue to be disproportionately represented among those acquiring HIV and hepatitis C infections in Canada.
In 2014, 10.5% of new HIV infections were among people who injected drugs.
68% of people who inject drugs and who were surveyed between 2010 and 2012 indicated that they had at one point been infected with hepatitis C.

Associated Links
Harm Reduction Fund
Canadian Drugs and Substances Strategy

SOURCE Public Health Agency of Canada

Friday, May 11, 2018

MMWR: Access to Syringe Services Programs — Kentucky, North Carolina, and West Virginia, 2013–2017

Centers for Disease Control and Prevention
Morbidity and Mortality Weekly Report (MMWR)
Weekly / May 11, 2018 / 67(18);529–532

Access to Syringe Services Programs — Kentucky, North Carolina, and West Virginia, 2013–2017
Danae Bixler, MD1; Greg Corby-Lee2; Scott Proescholdbell, MPH3; Tina Ramirez4; Michael E. Kilkenny, MD5; Matt LaRocco6; Robert Childs, MPH7; Michael R. Brumage, MD4; Angela D. Settle, DNP8; Eyasu H. Teshale, MD1; Alice Asher, PhD

The Appalachian region of the United States is experiencing a large increase in hepatitis C virus (HCV) infections related to injection drug use (IDU) (1). Syringe services programs (SSPs) providing sufficient access to safe injection equipment can reduce hepatitis C transmission by 56%; combined SSPs and medication-assisted treatment can reduce transmission by 74% (2). However, access to SSPs has been limited in the United States, especially in rural areas and southern and midwestern states (3). This report describes the expansion of SSPs in Kentucky, North Carolina, and West Virginia during 2013-August 1, 2017. State-level data on the number of SSPs, client visits, and services offered were collected by each state through surveys of SSPs and aggregated in a standard format for this report. In 2013, one SSP operated in a free clinic in West Virginia, and SSPs were illegal in Kentucky and North Carolina; by August 2017, SSPs had been legalized in Kentucky and North Carolina, and 53 SSPs operated in the three states. In many cases, SSPs provide integrated services to address hepatitis and human immunodeficiency virus (HIV) infection, overdose, addiction, unintended pregnancy, neonatal abstinence syndrome, and other complications of IDU. Prioritizing development of SSPs with sufficient capacity, particularly in states with counties vulnerable to epidemics of hepatitis and HIV infection related to IDU, can expand access to care for populations at risk.

During 2013–2017, the number of operational SSPs increased from one to approximately 50 in Kentucky, North Carolina, and West Virginia. Visits to SSPs by clients who inject drugs also increased. In Kentucky and North Carolina, this increase followed changes in laws permitting access to sterile injecting supplies; in West Virginia, SSPs were never prohibited under state law. In North Carolina, any group can start an SSP after notifying the state health department; Kentucky requires a lengthy approval process for local health departments before offering syringe services. This paper demonstrates that increasing access to SSPs is possible with community support using a variety of models if SSPs are not prohibited by law.

The increase in client visits to SSPs by persons who inject drugs represents an unprecedented opportunity to improve access to care for this highly stigmatized population. In addition to increased access to sterile needles, syringes, and injection paraphernalia (5), comprehensive syringe services programs should also improve access to medication-assisted treatment, counseling, and social support to address substance use disorder (6); naloxone and lay naloxone training to prevent fatal overdose (7); the full range of contraceptives, including long acting reversible contraceptives to prevent unintended opioid-exposed pregnancy; prenatal care and medication-assisted treatment to reduce harm from substance use disorder in pregnant women and their infants (8); vaccination; and HCV, HIV, and hepatitis B virus (HBV) screening and treatment (5). State and local health departments that are actively addressing the health effects of the opioid crisis might consider a formal evaluation process to improve service quality and access for persons who inject drugs, including those attending SSPs. Process evaluation indicators for SSPs should include number of clients, number of syringes distributed, number of syringes returned, availability of services in hours per week, summary statistics on HIV, HBV, and HCV testing, and number and type of services (e.g., patient-centered family planning services and naloxone) and referrals provided (e.g., medication assisted treatment, prenatal care, HIV, and hepatitis treatment) (9). Evaluation should also include health indicators such as rates of hepatitis, HIV, fatal and nonfatal overdose, unintended pregnancy and neonatal abstinence syndrome, and initiation and retention in drug treatment. CDC has published a framework to guide evaluation of public health programs (10), which might be useful for evaluating access to essential services at the community level for persons who inject drugs.

The findings in this report are subject to at least six limitations. First, data were self-reported from SSPs and are therefore subject to bias. Second, because some programs do not collect identifying information, the total numbers of clients served is estimated. Third, at the time of this analysis, North Carolina was in its first year of implementation, and limited data are available. Fourth, no data were obtained for SSPs operating underground (i.e., outside the legal framework). Fifth, growth of SSPs and service integration in these states is rapid, and the most recent data on SSPs should be sought through the state or local health department or harm reduction coalition. Finally, these data cannot be used to evaluate quality of service delivery and whether service delivery is adequate to meet the needs of the population.

SSPs can be implemented through a variety of models and by a variety of agencies and organizations including those in rural areas. Demand for syringe services is growing rapidly in these three states with underserved populations of persons who inject drugs, representing an opportunity to implement, evaluate, and improve access to evidence-based services known to reduce the considerable morbidity and mortality associated with injection drug use.

Full report -

Wednesday, May 9, 2018

Hepatitis Awareness Month - What is hepatitis C? What about hepatitis B or A?

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.

Hepatitis C Risk Factors
-IV drug use, sharing needles and syringes; Spike in HCV Linked to Opioid Injection Hits Young Adults Hardest
-Vertical transmission from mother to baby; HCV in Pregnant Women on Rise Increased risk of HCV infected infants.
-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.

Show Me The Guidelines

Current EASL Clinical Practice Guidelines
During The International Liver Congress 2018, The European Association for the Study of the Liver (EASL) released updated practice guidelines to help physicians, as well as patients manage and treat HCV. (Link) EASL Practice Guidelines - Hepatitis C 2018, Decompensated Cirrhosis, Hepatocellular Carcinoma, Alcoholic Liver Disease & Hepatitis E.

Current AASLD Clinical Practice Guidelines
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.......

Where To Get Tested - Hepatitis C and Hepatitis B

Find A HCV Specialist 
Find a Specialist In Your Area

Hepatitis B 
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: 

What Is Hepatitis B?
Facts and Figures
Acute vs. Chronic Infection
Commonly Asked Questions
The ABCs of Viral Hepatitis
Liver Cancer and Hepatitis B
Hepatitis Delta Coinfection
Hepatitis C Coinfection
HIV/AIDS Coinfection

AASLD 2018 hepatitis B guidance
Update on prevention, diagnosis, and treatment of chronic hepatitis B

ACIP Hepatitis B Vaccine Recommendations | CDC
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.

Immunization Action Coalition

Hepatitis A: Questions and Answers Information about the disease and vaccines
Read how hepatitis A is spread, the symptoms, how serious the virus is, when and who should get vaccinated.

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.
View the article here:

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.

Get Organized for Hepatitis Awareness Month 
By Lucinda K. Porter, RN
Raising hepatitis awareness is a great deal more fun if you participate with others. Here are some tips.
Hep C Daily Blog, Experts & Community

By Karen Hoyt · May 7, 2018
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.

All updates:

Hep B Blog
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.

May is Hepatitis Awareness Month
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!

Information On Hep B Blog:
Hepatitis B Diagnosis & Monitoring
Hepatitis B Prevention
Hepatitis B Treatment
Liver Cancer
Living with Hepatitis B

    Al D. Rodriguez Liver Foundation
    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…

    Viral Hepatitis - An Overview
    By Osmosis
    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.


    Friday, May 4, 2018

    HCV Infection in Teens on the Rise - Second-wave epidemic

    AGA Reading Room

    HCV Infection in Teens on the Rise
    Second-wave epidemic
    by Pippa Wysong
    Contributing Writer, MedPage Today
    The prevalence of HCV infection in children and adolescents has been reported to vary from 0.05% to 0.36% in the United States and Europe, to 1.8% to 5.8% in some developing countries -- and even that might be low.

    According to a review published in Hepatology Communications, the six genotypes seen in adults have been identified in children, with similar global geographic distribution as adults -- but that like adults, the younger cohort in the U.S. tend to have genotypes 1 through 3.

    The paper notes that while HCV infection in younger children tends to be from vertical transmission from HCV-infected mothers, in adolescents it is increasingly linked to intravenous drug abuse. In fact, one study from the Centers for Disease Control and Prevention shows a 364% increase in HCV infection among people ages 12 to 29 living in the Appalachian region of the U.S. between the years 2006 to 2012.
    Full article @ MedPage Today

    Friday, March 30, 2018

    Potential geographic "hotspots" for drug-injection related transmission of HIV and HCV and for initiation into injecting drug use in New York City, 2011-2015, with implications for the current opioid epidemic in the US

    Potential geographic "hotspots" for drug-injection related transmission of HIV and HCV and for initiation into injecting drug use in New York City, 2011-2015, with implications for the current opioid epidemic in the US
    D. C. Des Jarlais , H. L. F. Cooper, K. Arasteh, J. Feelemyer, C. McKnight, Z. Ross

    For HIV, the lack of potential hotspots is further validation of widespread effectiveness of efforts to reduce injecting-related HIV transmission. Injecting-related HIV transmission is likely to be a rare, random event. HCV prevention efforts should include focus on potential hotspots for transmission and on hotspots for initiation into injecting drug use. We consider application of methods for the current opioid epidemic in the US.
    Published: March 29, 2018

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    We identified potential geographic “hotspots” for drug-injecting transmission of HIV and hepatitis C virus (HCV) among persons who inject drugs (PWID) in New York City. The HIV epidemic among PWID is currently in an “end of the epidemic” stage, while HCV is in a continuing, high prevalence (> 50%) stage.

    We recruited 910 PWID entering Mount Sinai Beth Israel substance use treatment programs from 2011–2015. Structured interviews and HIV/ HCV testing were conducted. Residential ZIP codes were used as geographic units of analysis. Potential “hotspots” for HIV and HCV transmission were defined as 1) having relatively large numbers of PWID 2) having 2 or more HIV (or HCV) seropositive PWID reporting transmission risk—passing on used syringes to others, and 3) having 2 or more HIV (or HCV) seronegative PWID reporting acquisition risk—injecting with previously used needles/syringes. Hotspots for injecting drug use initiation were defined as ZIP codes with 5 or more persons who began injecting within the previous 6 years.

    Among PWID, 96% injected heroin, 81% male, 34% White, 15% African-American, 47% Latinx, mean age 40 (SD = 10), 7% HIV seropositive, 62% HCV seropositive. Participants resided in 234 ZIP codes. No ZIP codes were identified as potential hotspots due to small numbers of HIV seropositive PWID reporting transmission risk. Four ZIP codes were identified as potential hotspots for HCV transmission. 12 ZIP codes identified as hotspots for injecting drug use initiation.

    Tuesday, March 20, 2018

    Understanding and Addressing Hepatitis C Reinfection in the Oral Direct-Acting Antiviral Era

    What factors are associated with HCV reinfection and how can reinfection risk be minimized?
    Understanding and Addressing Hepatitis C Reinfection in the Oral Direct-Acting Antiviral Era
    O. Falade-Nwulia; M. S. Sulkowski; A. Merkow; C. Latkin; S. H. Mehta J Viral Hepat. 2018;25(3):220-227. Abstract and Introduction

    The availability of effective, simple, well-tolerated oral direct-acting antiviral (DAA) hepatitis C regimens has raised optimism for hepatitis C virus (HCV) elimination at the population level. HCV reinfection in key populations such as people who inject drugs (PWID) and HIV-infected men who have sex with men (MSM) however threatens the achievement of this goal from a patient, provider and population perspective. The goal of this review was to synthesize our current understanding of estimated rates and factors associated with HCV reinfection. This review also proposes interventions to aid understanding of and reduce hepatitis C reinfection among PWID and HIV-infected MSM in the oral direct-acting antiviral era.

    Full text available at: Medscape
    Free registration may be required

    Sunday, March 18, 2018

    Audio Story- Hepatitis C Is More Common In Vietnam Vets, But Nobody Is Sure Why

    From: American Homefront Project
    PRX » Station » North Country Public Radio
    By Sarah Harris • Mar 15, 2018
    Produced: Mar 13, 2018
    Sarah Harris reports on an effort to get Vietnam vets checked and treated for Hepatitis C.


    The reasons that Vietnam vets are more likely to have hepatitis C are disputed. Kaifetz blames a device called the "jet gun injector" that the military used to vaccinate service members during the Vietnam era. It generated a burst of air pressure to force the vaccine under the skin.

    "It was supposed to shoot the injection through your skin cells without piercing the skin with a needle," Kaifetz explained.

    Even though the gun wasn't supposed to break the skin, a lot of veterans say it made them bleed. The gun usually wasn't sterilized between each use.

    This story was produced by the American Homefront Project, a public media collaboration that reports on American military life and veterans. Funding comes from the Corporation for Public Broadcasting and the Bob Woodruff Foundation. 

    Saturday, March 10, 2018

    HCV in Pregnant Women on Rise Increased risk of HCV infected infants

    AGA Reading Room 03.08.2018
    HCV in Pregnant Women on Rise Increased risk of HCV infected infants
    by Pippa Wysong
    Contributing Writer, MedPage Today

    An estimated 1% to 2.5% of pregnant women in the United States are infected with hepatitis C virus (HCV), which translates to about 4,000 new cases yearly. This also comes packaged with about a 6% risk of mother-to-infant transmission.

    Worrisomely, the rates are increasing, with various studies adding to the discussion about screening for at-risk pregnant women and related to managing and treating them.

    According to Raymond Chung, MD, director of Hepatology and the Liver Center at Massachusetts General Hospital in Boston and a recent co-Chair of the American Association for the Study of Liver Diseases-Infectious Diseases Society of America HCV Guidance Panel, screening with an HCV antibody assay is recommended for pregnant women with known or suspected risk factors for HCV infection.

    "Confirmatory HCV RNA testing is recommended for women with a positive screening test," he told MedPage Today.

    Continue reading @ MedPage Today

    On This Blog

    Thursday, March 8, 2018

    Tenofovir fails to add extra hepatitis B protection for vaccinated newborns

    Tenofovir fails to add extra hepatitis B protection for vaccinated newborns
     Last Updated: 2018-03-07
    By Reuters Staff NEW YORK (Reuters Health)
    Adding tenofovir disoproxil fumarate (TDF) to an aggressive treatment strategy fails to give extra protection to newborns at risk for contracting hepatitis B virus (HBV) from their infected mothers, according to a study at 17 public hospitals in Thailand. The drug or placebo was given to 331 infected women from 28 weeks of gestation until two months postpartum. All newborns were also given both hepatitis B immune globulin and the first dose of hepatitis B vaccine at birth, with booster vaccine doses at 1, 2, 4 and 6 months.
    Continue reading:

    Wednesday, March 7, 2018
    Antiviral drug not beneficial for reducing mother-to-child transmission of hepatitis B when added to existing preventatives

    NIH-funded study observes no significant reduction of infection rates at age 6 months.

    Tenofovir disoproxil fumarate (TDF), an antiviral drug commonly prescribed to treat hepatitis B infection, does not significantly reduce mother-to-child transmission of hepatitis B virus when taken during pregnancy and after delivery, according to a phase III clinical trial in Thailand funded by the National Institutes of Health. The study tested TDF therapy in addition to the standard preventative regimen — administration of hepatitis B vaccine and protective antibodies at birth — to explore the drug’s potential effects on mother-to-child transmission rates. The results appear in the New England Journal of Medicine.

    “Limited evidence of the benefit of using antiviral drugs to prevent mother-to-child transmission of hepatitis B has led to conflicting practice recommendations around the world,” said Nahida Chakhtoura, M.D., a study team member and medical officer at NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). “Our study suggests that adding TDF to the current regimen seems to have little effect on infant infection rates when transmission rates are already low.”

    Hepatitis B (link is external) virus can cause serious, long-term health problems, such as liver disease and cancer, and can spread from mother-to-child during delivery. According to the latest estimates from the World Health Organization (WHO), approximately 257 million people in 2015 were living with the virus. Countries in Asia have a high burden of hepatitis B. There is no cure, and antiviral drugs used to treat the infection usually need to be taken for life.

    To prevent infection, WHO recommends that all newborns receive their first dose of hepatitis B vaccine within 24 hours of delivery. Infants born to hepatitis B-infected mothers are also given protective antibodies called hepatitis B immune globulin (HBIG). However, mother-to-child transmission can still occur in women with high levels of virus in their blood, as well as those with mutated versions of the virus.

    The current study was conducted at 17 hospitals of the Ministry of Public Health in Thailand. It screened more than 2,500 women for eligibility and enrolled 331 pregnant women with hepatitis B. The women received placebo (163) or TDF (168) at intervals from 28 weeks of pregnancy to two months after delivery. All infants received standard hepatitis B preventatives given in Thailand, which include HBIG at birth and five doses of the hepatitis B vaccine by age 6 months (which differs from the three doses given in the United States). A total of 294 infants (147 in each group) were followed through age 6 months.

    Three infants in the placebo group had hepatitis B infection at age 6 months, compared to zero infants in the TDF treatment group. Given the unexpectedly low transmission rate in the placebo group, the researchers concluded that the addition of TDF to current recommendations did not significantly reduce mother-to-child transmission of the virus.

    “We observed no treatment-related safety concerns for the mothers or infants and no significant differences in infant growth,” said the study’s lead author Gonzague Jourdain, M.D., Ph.D., of Thailand’s Chiang Mai University, the Harvard T.H. Chan School of Public Health and France’s IRD (Institut de recherche pour le développement). “These safety data also are relevant for pregnant women receiving TDF as part of HIV treatment or HIV pre-exposure prophylaxis.”

    According to the study authors, the clinical trial had enough participants to detect statistical differences if the transmission rate in the placebo group reached at least 12 percent, a rate observed in previous studies. Though the reasons are unknown, the researchers speculate that the lower transmission rate seen in the study may relate to the number of doses of hepatitis B vaccine given to infants in Thailand, lower rates of amniocentesis and Cesarean section deliveries in this study, or the lower prevalence of mutated viruses that result in higher vaccine efficacy in Thailand compared to other countries.

    Funding for the study was provided under a cooperative agreement between NICHD, the U.S. Centers for Disease Control and Prevention and the IRD. Study drugs were donated by Gilead Sciences, Inc.

    About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): NICHD conducts and supports research in the United States and throughout the world on fetal, infant and child development; maternal, child and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit NICHD’s website.

    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

    Jourdain G et al., Tenofovir versus placebo to prevent hepatitis B perinatal transmission. New England Journal of Medicine DOI: 10.1056/NEJMoa170813 (2018).

    Thursday, January 4, 2018

    MedPage Today - 2018: What's Next in Infectious Diseases?

    2018: What's Next in Infectious Diseases?
    Antibiotics, opioids, and the flu top expert predictions
    by Molly Walker, Staff Writer, MedPage Today
    January 04, 2018

    The field of infectious diseases is certainly not immune to the opioid epidemic. Myron Cohen, MD, of the University of North Carolina Chapel Hill, said that "infections and the opioid crisis" could be a major issue in the coming year

    ..... opioid epidemic will likely continue to drive new HIV and hepatitis C infections, which have the potential to affect pregnant women and newborn babies. Back in May, the CDC found that the rate of maternal HCV infection nearly doubled from 2009 to 2014....

    Friday, December 22, 2017

    Opioid crisis trims U.S. life expectancy, boosts hepatitis C: CDC

    CDC Reports - Mortality in the United States, 2016
    This report presents final 2016 U.S. mortality data on deaths and death rates by demographic and medical characteristics. These data provide information on mortality patterns among U.S. residents by variables such as sex, race and ethnicity, and cause of death. Life expectancy estimates, age-specific death rates, age-adjusted death rates by race and ethnicity and sex, 10 leading causes of death, and 10 leading causes of infant death were analyzed by comparing 2016 and 2015 final data

    In 2016, a total of 2,744,248 resident deaths were registered in the United States—31,618 more deaths than in 2015. From 2015 to 2016, the age-adjusted death rate for the total population decreased 0.6%, but life expectancy at birth decreased 0.1 year. Age-specific death rates between 2015 and 2016 increased for younger age groups and decreased for older age groups. The age-adjusted death rate decreased for non-Hispanic white females and increased for non-Hispanic black males.

    The 10 leading causes of death in 2016 remained the same as in 2015, although two causes exchanged ranks. Unintentional injuries, the fourth leading cause in 2015, became the third leading cause in 2016, while chronic lower respiratory diseases, the third leading cause in 2015, became the fourth leading cause in 2016. Age-adjusted death rates decreased for seven leading causes and increased for three. Life expectancy at birth decreased 0.1 year from 78.7 years in 2015 to 78.6 in 2016, largely because of increases in mortality from unintentional injuries, suicide, and Alzheimer’s disease, with unintentional injuries making the largest contribution. This is the second year in a row life expectancy has declined (1). Changes in death rates at younger ages have a larger impact on life expectancy than changes at older ages. The increases in death rates at the younger ages from 2015 to 2016 resulted in the decrease in life expectancy observed during that period.

    In 2016, a total of 23,161 deaths occurred in children under age 1 year, which was 294 fewer infant deaths than in 2015. The leading causes of infant death were the same in 2016 and 2015. The only significant change among the 10 leading causes of infant death was a 7.3% decrease in the IMR for maternal complications.

    Key findings
    Data from the National Vital Statistics System
    - Life expectancy for the U.S. population in 2016 was 78.6 years, a decrease of 0.1 year from 2015.
    - The age-adjusted death rate decreased by 0.6% from 733.1 deaths per 100,000 standard population in 2015 to 728.8 in 2016.
    - Age-specific death rates between 2015 and 2016 increased for younger age groups and decreased for older age groups.
    - The 10 leading causes of death in 2016 remained the same as in 2015, although unintentional injuries became the third leading cause, while chronic lower respiratory diseases became the fourth.
    - The infant mortality rate of 587.0 infant deaths per 100,000 live births in 2016 was not significantly different from the 2015 rate.
    - The 10 leading causes of infant death in 2016 remained the same as in 2015.
    This report updates statistics on deaths from drug overdoses in the United States and includes information on trends since 1999 as well as key findings for 2016.

    The rates of drug overdose deaths continued to increase. In 2016, the age-adjusted rate of drug overdose deaths (19.8 per 100,000) was more than three times the rate in 1999 (6.1). Rates increased for both males (from 8.2 in 1999 to 26.2 in 2016) and females (from 3.9 in 1999 to 13.4 in 2016). Rates also increased for all age groups studied. In 2016, among persons aged 15 and over, rates were highest for adults aged 25–34, 35–44, and 45–54, at about 35 per 100,000. From 2015 to 2016, drug overdose death rates increased 28% for persons aged 15–24, 29% for persons aged 25–34, 24% for persons aged 35–44, 15% for persons aged 45–54, 17% for persons aged 55–64, and 7% for persons aged 65 and over. In 2016, 22 states and the District of Columbia had age-adjusted drug overdose death rates that were statistically higher than the national rate; 5 states had rates that were comparable to the national rate; and 23 states had lower rates.

    The pattern of drugs involved in drug overdose deaths has changed in recent years. The rate of drug overdose deaths involving synthetic opioids other than methadone (drugs such as fentanyl, fentanyl analogs, and tramadol) doubled in a single year from 3.1 per 100,000 in 2015 to 6.2 in 2016. Rates of drug overdose deaths involving heroin increased from 4.1 in 2015 to 4.9 in 2016. Rates of drug overdose deaths involving natural and semisynthetic opioids increased from 3.9 in 2015 to 4.4 in 2016.

    Key findings 
    Data from the National Vital Statistics System, Mortality
    - In 2016, there were more than 63,600 drug overdose deaths in the United States.
    - The age-adjusted rate of drug overdose deaths in 2016 (19.8 per 100,000) was 21% higher than the rate in 2015 (16.3).
    - Among persons aged 15 and over, adults aged 25–34, 35–44, and 45–54 had the highest rates of drug overdose deaths in 2016 at around 35 per 100,000.
    - West Virginia (52.0 per 100,000), Ohio (39.1), New Hampshire (39.0), the District of Columbia (38.8), and Pennsylvania (37.9) had the highest observed age-adjusted drug overdose death rates in 2016.
    - The age-adjusted rate of drug overdose deaths involving synthetic opioids other than methadone (drugs such as fentanyl, fentanyl analogs, and tramadol) doubled between 2015 and 2016, from 3.1 to 6.2 per 100,000.
    Read More

    Opioid crisis trims U.S. life expectancy, boosts hepatitis C: CDC
    Julie Steenhuysen
    CHICAGO (Reuters) - The opioid crisis is rippling through the U.S. healthcare system, causing a spike in rates of hepatitis C related to increased opioid injections and reducing overall life expectancy among Americans, which has fallen for the second year in a row, U.S. health officials said on Thursday. Researchers used a national database that tracks substance abuse admissions to treatment facilities in all 50 U.S. states. They found a 133 percent increase in acute hepatitis C cases that coincided with a 93 percent increase in admissions for opioid injection between 2004 to 2014.

    By Nick Wing
    A new report shows back-to-back years of declining life expectancy, and the CDC says a third straight year appears to be on the way.
    The average American life expectancy ticked downward for the second straight year in 2016, on the back of surging drug overdose deaths, according to data released Thursday by the National Center for Health Statistics at the U.S. Centers for Disease Control and Prevention. And while the nation hasn’t experienced a back-to-back drop in life expectancy since the 1960s, the CDC says the opioid crisis is shaping up to extend this decline for a third consecutive year, a milestone that hasn’t been seen since the Spanish flu pandemic in 1918.

    Thursday, December 7, 2017

    December 2017 - Viral hepatitis newsletter and blog updates

    Welcome folks, check out recent journal and blog updates along with this months viral hepatitis newsletters.

    In The News
    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.”

    December 7, 2017 
    Robert Greenwald, Ryan Clary
    The American epidemic of opioid abuse is finally getting the attention it warrants. While policy solutions continue to be inadequate, the decision by President Trump to declare a national opioid emergency has helped to increase discussion about the problem and how the country can solve it. But the conversation also needs to address a dangerous – and largely ignored – interconnected public health crisis wreaking havoc among young American

    The problem is that more Americans than ever are injecting opioids and inadvertently infecting themselves with hepatitis C. Shared needles mean shared blood-borne infections – and that’s how the opioid crisis has created a new generation of hepatitis C patients. The number of reported hepatitis C infections nearly tripled from 2010 to 2015, with the virus is spreading at an unprecedented rate among young people under 30 – who are now, for the first time, the most at-risk population for contracting and transmitting hepatitis C.

    In the United States, an estimated 3.5 million people, and likely more, are currently living with hepatitis C. The virus kills nearly 20,000 Americans each year – more than HIV and all other infectious diseases combined.
    Read the article, here......

    December 2017
    By Tim Horn
    Arguments favoring universal health care (UHC) are easy. Achieving political consensus as to the best strategy to achieve this is considerably more vexing. This is particularly true in the U.S., where the Affordable Care Act (ACA) patchwork of legislation and regulations has faced a barrage of executive and legislative attacks since the beginning of the year. And although the ACA and expansion of Medicaid in 32 states represents the closest the U.S. has come to ensuring UHC for its citizenry, it continues to fall short for millions of Americans, meaning that it must be either repaired or replaced with an entirely new system that ensures equitable access to care.

    In the Fall 2017 issue of TAGline, we explore the political feasibility and sustainability of UHC in the U.S. UHC is, first and foremost, a human right. However, it will require robust advocacy to galvanize bipartisan support for guaranteed coverage and to rein in the high cost of health care and prescription drugs. But the potential merits are clear, notably in efforts to lower HIV incidence and end HIV/AIDS as an epidemic in the U.S. once and for all.
    Download PDF

    AASLD Symposium
    Released December 7, 2017
    Watch - Breaking News On HCV Regimens: An Interactive Case-based Symposium
    Hosted by Fred Poordad, MD; Robert S. Brown, Jr., MD, and MPH; Kris V. Kowdley, MD.

    Hepatitis A Outbreak in California
    December 6, 2017 | M. Kushel
    (DOI: 10.1056/NEJMp1714134)
    Most people affected by California’s hepatitis A outbreak are homeless, and infectious diseases are one of many health threats they face. To address the root cause of their health problems, we will need sustained efforts to fix the housing-affordability crisis.

    “Now that we have [nucleic acid testing (NAT)] available, that should be considered in labeling the donors rather than hepatitis C-positive or not,” Khurram Bari, MD, from the University of Cincinnati, told Healio Gastroenterology and Liver Disease. “NAT testing is a better indicator of hepatitis C positivity or negativity in donors ...

    December 6, 2017
    Treatment with Epclusa for 12 weeks resulted in high sustained virologic response rates among patients with hepatitis C genotypes 1 through 6, irrespective of baseline…

    National Health Care Spending In 2016: Spending And Enrollment Growth Slow After Initial Coverage Expansions
    Enrollment trends drove the slowdown in Medicaid and private health insurance spending growth in 2016, while slower per enrollee spending growth influenced Medicare spending. Furthermore, spending for retail prescription drugs slowed, partly as a result of lower spending for drugs used to treat hepatitis C, while slower use and intensity of services drove the slowdown in hospital care and physician and clinical services.

    by Eric Sagonowsky
    Dec 6, 2017 
    Drug pricing has been under a microscope in recent years as policymakers, market watchers and others look to determine what's sending costs upward. But a new report says retail spending on pharmaceuticals grew at a much slower rate last year than in recent history.

    Can hepatitis C be transmitted through oral sex?
    Last reviewed Wed 6 December 2017
    By Bethany Cadman
    Reviewed by Judith Marcin, MD
    Currently, there is no direct evidence to prove that hepatitis C is transmitted through oral sex alone. However, a person should still be cautious anytime blood is present because an infection can still occur. If either sexual partner has a break in their skin, there may be a risk of blood passing from one person to the other.

    In Case You Missed It
    Everyone with HIV and hepatitis C virus (HCV) coinfection should receive direct-acting antiviral therapy for hepatitis C and should receive the same treatment regimens for hepatitis C as people with HCV monoinfection, new European guidelines issued at the 16th European AIDS Conference recommend.

    Journal Updates
    December 7, 2017
    HCV kinetic and modeling analyses project shorter durations to cure under combined therapy with daclatasvir and asunaprevir in chronic HCV-infected patients
    High cure rates are achieved in HCV genotype-1b patients treated with daclatasvir and asunaprevir, DCV/ASV. Here we analyzed early HCV kinetics in genotype-1b infected Japanese subjects treated with DCV/ASV and retrospectively projected, using mathematical modeling, whether shorter treatment durations might be effective.

    Alimentary Pharmacology & Therapeutics
    Interferon-free therapy of chronic hepatitis C with direct-acting antivirals does not change the short-term risk for de novo hepatocellular carcinoma in patients with liver cirrhosis
    F. Mettke, B. Schlevogt, K. Deterding, A. Wranke, A. Smith, K. Port, M. P. Manns, A. Vogel, M. Cornberg, H. Wedemeyer
    First published: 4 December 2017
    Full publication history DOI: 10.1111/apt.14427
    AIM: To investigate the HCC incidence in cirrhotic HCV patients who cleared HCV with direct-acting antivirals vs untreated controls.

    On Twitter
    The following article was shared on Twitter by @HenryEChang

    In this study, we assessed quality of life in East Asian HCV patients who underwent treatment with an interferon-free regimen containing sofosbuvir+ribavirin, and found superior on-treatment quality of life scores of these patients during treatment and after achieving SVR.

    Clinical Care Options
    HBV Treatment at AASLD 2017: My Take on New Data
    Tram T. Tran, MD
    At AASLD 2017 in Washington, DC, the rapid advancement of research in HBV treatment was on full display. Exciting new data were presented on both current and investigational therapies. Here, I have highlighted some of the abstracts I found most interesting.
    *free registration required

    Blog Updates
    Living with Pain and Hep C in an “Opioid Crisis” Era
    By Daryl Luster - December 5, 2017
    Living with any pain, whether acute (shorter duration) or chronic (ongoing). In medical terms, these are two terms that are used outside of the strictest definition of their meaning. Having a broken...

    Hepatitis C – Buddy or Bozo?
    By Carleen Mcguffey - December 4, 2017
    I had been married to my husband, James, for 7 years before we had children, mostly due to the influence of the world around me, and also partly because of selfishness. I...

    The Holiday Season with Hepatitis C
    By Editorial Team - December 1, 2017
    Tis the season! The holidays can be a time of celebration, but the holidays can add an additional amount of stress for anyone managing hepatitis C and liver disease.

    Hepatitis B Foundation
    HIV/HBV Co-Infection
    December 6, 2017 World AIDS Day was last Friday, December 1st. It is a day dedicated to raising awareness about HIV and AIDS. However, it is also a great opportunity to discuss the possibility of coinfection with hepatitis B virus, HBV.

    The documentary film, produced by The Vaccine Makers Project, follows the unknown story of a man who “had more of an impact on [people’s] lives compared to Einstein.” The film tells the story of a courageous and gutsy scientist, Dr. Maurice R. Hilleman, and the elimination of diseases of children. With his unwavering determination, Dr. Hilleman invented the first-ever vaccine against a human cancer (the hepatitis B vaccine), developed the measles-mumps-rubella (MMR) combination vaccine, and prevented pandemic flu. During World War II he developed an urgently needed vaccine for Japanese B encephalitis in 30 days.

    Hepatitis B Updates
    ACP, CDC Issue Guidance on Hep B Screening, Treatment
    Vaccination, screening, and linkage to care can reduce the burden of chronic hepatitis B virus (HBV) infection. However, recommendations vary among organizations, and their implementation has been suboptimal. The American College of Physicians' High Value Care Task Force and the Centers for Disease Control and Prevention developed this article to present best practice statements for hepatitis B vaccination, screening, and linkage to care.

    HEP - Blog Updates
    December 7, 2017
    By Greg Jefferys
    A closer look at how HCV damages the body.

    December 6, 2017
    By Karen Hoyt
    Advanced liver disease can create problems with your dream time.

    By NVHR Staff
    NMDC policy fails to list another potential penalty for a major offense: denial of lifesaving treatment for the deadly hepatitis C virus.

    December 4, 2017
    By Lucinda K. Porter, RN
    Hepatitis C is curable, but it is not gone. Not by a long shot.

    Seasonal Flu
    HIV and ID Observations
    Paul E. Sax, MD
    Why, Even with Depressing Predictions About Flu Vaccine Effectiveness, We Should Still Recommend and Get It
    Each year, the print and broadcast media round up a bunch of experts on influenza and ask them to predict the severity of the upcoming flu season.

    Most of the time their responses are noncommittal — predicting how bad the flu season will be year to year is tricky business, akin to picking stocks, making 12-month weather forecasts in an almanac, or naming the winner of the World Series during spring training.

    Kevin MD
    Make a difference by being a vaccine insister
    William Schaffner, MD |
    December 5, 2017
    When a patient is diagnosed with a chronic disease, like diabetes or hypertension, physicians don’t merely suggest medications to lower blood sugar or blood pressure – they insist that patients take medications to protect their health. However, the recommendation to get an annual influenza (flu) shot to prevent flu is often not as emphatic. Research has shown that patients are much more likely to get a flu shot when it ...

    Seasonal Flu - In The News
    Flu season soars in the United States, especially in the South
    By Susan Scutti, CNN
    When we measure vaccine effectiveness, that's effectiveness against protecting against disease completely," said Schaffner, who was not involved in the CDC research, though he is a liaison representative of the Advisory Committee on Immunization Practices, which develops recommendations on the use of vaccines for the CDC."What's not measured is that, even if you get the flu in spite of the vaccine, your flu case is likely to be milder; you're less likely to have the complications of pneumonia, having to be hospitalized and dying," he said.

    Early flu cases could be harbinger of a bad season: B.C. expert
    By The Canadian Press, Vancouver Sun
    The influenza season in Canada is shaping up to be a potentially nasty one, with a mixed bag of viruses already circulating in much of the country, say infectious diseases experts.

    Dec 7, 2017
    According to the CDC, more than 6,000 people have tested positive for the flu so far this year, more than double the number of people infected at this time last year.

    Seasonal Flu - Journal Updates
    Infectious Disease Clinics - December 2017 Volume 31, Issue 4, Pages 757–766
    Influenza viruses cause significant morbidity and mortality in older adults. Prevention and treatment are critical for the reduction of morbidity and mortality in this population, but there are several challenges in the diagnosis, treatment, and prevention of influenza infection and its complications in older adults. This article will describe influenza, its epidemiology, clinical presentation, diagnostic modalities, treatment, and current prevention techniques. Despite the identification of influenza early in the last century, much is still not known about how to protect older adults from influenza infection and its complications. Current treatment and prevention strategies are imperfect, particularly in older frail adults.

    New England Journal Of Medicine
    Chasing Seasonal Influenza — The Need for a Universal Influenza Vaccine
    November 29, 2017
    (DOI: 10.1056/NEJMp1714916)
    As clinicians in the United States prepare for the start of another influenza season, experts have been watching the Southern Hemisphere winter for hints of what might be in store for us in the North. Reports from Australia have caused mounting concern, with record-high numbers of laboratory-confirmed influenza notifications and outbreaks and higher-than-average numbers of hospitalizations and deaths.1 The number of notifications reached 215,280 by mid-October, far exceeding the 59,022 cases reported during the 2009 H1N1 influenza pandemic, according to the Australian Government Department of Health. Influenza A (H3N2) viruses predominated, and the preliminary estimate of vaccine effectiveness against influenza A (H3N2) was only 10%. The implications for the Northern Hemisphere are not clear, but it is of note that the vaccine for this upcoming season has the same composition as that used in the Southern Hemisphere. As we prepare for a potentially severe influenza season, we must consider whether our current vaccines can be improved and whether longer-term, transformative vaccine approaches are needed to minimize influenza-related morbidity and mortality.


    Weekly Bull
    Read The Latest Issue: Weekly Bull

    HCV Advocate
    December Newsletter
    The Liver Meeting by Alan Franciscus:
    HCV screening rates among baby boomers
    A study on a marker that could lead to a condition called multiple myeloma
    Part B of the Co-Star study abut reinfections rates among people who inject drugs
    Identification of new subtypes and a new HCV genotype
    Adherence rates to treatment and the effect of being cured of hepatitis C
    Long-term follow-up on people with no or minimal fibrosis who were cured of hepatitis C – what is their disease progression and liver cancer rates?

    The Liver Meeting by Lucinda Porter:
    Curing hepatitis C (HCV) and reducing liver cancer
    Curing HCV and improvements in quality of life among people with hepatitis C
    Increase in liver cancer in patients without cirrhosis
    Fatty Liver and heart disease
    Men who have sex with men and acute HCV
    Mislabeling of herbs and dietary supplements
    Parkinson’s disease and hepatitis C medications
    HCV treatment and the risk of heart disease
    HCV positive livers transplanted to HCV negative recipients

    National Viral Hepatitis Roundtable
    NVHR Newsletter

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

    Improving Long-Term Quality of Life
    People who beat hepatitis C virus (HCV) see their health-related quality of life (HRQL) improve—and not just in the short term.

    Beating Hep C Improves Diabetic Outcomes
    People with type 2 diabetes and hepatitis C virus (HCV) who cure the virus tend to improve their blood sugar levels.

    Adapting Risky Behaviors Is Vital
    Among people with HCV, unhealthy behaviors such as smoking contribute as much to their higher risk of death as the virus itself.

    Hepatitis C May Hasten Menopause, Lower Fertility 
    Hepatitis C virus (HCV) may compromise women’s reproductive capacity. Earlier treatment of the virus may help mitigate such related risks.

    GI & Hepatology

    British Liver Trust
    All Newsletters

    British Liver Trust - In The News
    UK Liver Disease Burden: The Crisis We Can’t Afford
    A new report published today in the Lancet warns that the UK liver disease burden is continuing to rise, blighting the poorest groups and lowering economic productivity. Experts argue insufficient measures are being taken to control the main lifestyle risk factors driving this burden of largely preventable disease, namely alcohol consumption, obesity and viral hepatitis.

    December 6, 2017
    Andrew Joseph
    Before the development of the latest hepatitis C drugs, which are remarkably effective at curing the disease, the notion of eradication would have been implausible. That is no longer the case. But the virus is now being fueled by drug use, hitting patients who are the hardest to reach and have the least access to care and the pricey medications.

    NIH News in Health

    Until next time