Podcast Series: Diagnosis and Treatment Of Hepatitis C

In case you missed it, interesting podcast. 

Diagnosis and Treatment Of Hepatitis C
February 22, 2018

Hepatitis C (HCV) is the most-deadly infectious disease in America.

• More than 20,000 die every year because of HCV
• Half of people infected do not know that they have the virus
• HCV can remain undetected for decades

HCV is curable, even among past and current drug users. You can help turn the tide. Learn how to screen (hint: it's easy) and how screening can save lives.

Treatment is now simpler, more effective, and shorter than ever. And it should be offered to nearly everyone with HCV, regardless of the level of cirrhosis.

Tune in to START HCV Radio Hour to listen and learn as our expert faculty explore important topics, using patient stories in an engaging moderated DKBmed Talk, modeled after the famous and popular TED Talks.

• Learn how to detect HCV infection with a simple blood test
• Become familiar with revolutionary new treatment options that cure 99% of people who use them
• Prevent the spread of HCV and the morbidity and mortality that can follow

The expert faculty includes Mark Sulkowski, MD, professor of medicine and medical director of the Viral Hepatitis Center at the Johns Hopkins University School of Medicine; Alain Litwin, MD, professor of medicine at Albert Einstein College of Medicine in New York; Kathleen Brady, MD, Distinguished University Professor at the Medical University of South Carolina and Director of the South Carolina Clinical and Translational Research Institute; and Raymond Chung, MD, director of hepatology and the Liver Center at Massachusetts General Hospital in Boston.

Start HCV: Part 1

Start HCV: Part 2

Begin here.......

HBV Infection: When to Treat vs When to Monitor?

Latest content at Clinical Care Options 

HBV Infection: When to Treat vs When to Monitor?
Tram T. Tran, MD - 2/21/2018

Would you treat or monitor a patient with low HBV DNA levels and high ALT? Here’s my take.

One of the most complex issues in managing patients infected with HBV is determining when to treat vs when to monitor the infection. For example, what would you recommend for an HBeAg-positive middle-aged woman with HBV DNA < 20,000 IU/mL, ALT ≥ 2 x ULN, but no cirrhosis?

Like many patients with HBV infection, she may be asymptomatic, be reluctant to take long-term medications that do not immediately affect how she feels, have concerns about adverse events, or be at risk for nonadherence.

Continue reading: HBV Infection: When to Treat vs When to Monitor?

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Health News Review: Pulling back the curtain on ‘The Doctors’ and ‘The Dr. Oz Show:’ What our analysis revealed

Pulling back the curtain on ‘The Doctors’ and ‘The Dr. Oz Show:’ What our analysis revealed
Ranit Mishori, MD

Earlier this month, Mehmet Oz, MD celebrated his 1,500th “Dr. Oz” show. Oprah Winfrey, Gayle King and Martha Stewart made appearances, proffering congratulations and discussing everything from mercury in fish to the #metoo movement.

I felt less jubilant: In the decade that The Dr. Oz Show has been on the air, it hasn’t been unusual for me to encounter patients who ask about topics, treatments and suggestions mentioned on the program and another popular medical show, “The Doctors.” The advice my patients tell me they’ve heard on these shows often does not square with what I know about the medical evidence.

While I may know that TV shows should be considered entertainment, my patients may not. After all, in our culture, a white coat and a “Dr.” title is a powerful symbol for a trustworthy person of knowledge.

Read full article: https://www.healthnewsreview.org/2018/02/pulling-back-the-curtain-on-the-doctors-and-the-dr-oz-show-what-our-analysis-reveals/

The characteristics of residents with unawareness of hepatitis C virus infection in community

The characteristics of residents with unawareness of hepatitis C virus infection in community
Pin-Nan Cheng ,Yen-Cheng Chiu,Hung-Chih Chiu, Shih-Chieh Chien

Published: February 22, 2018

https://doi.org/10.1371/journal.pone.0193251

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Abstract
Background
Control of hepatitis C virus infection (HCV) is an increasingly important issue. Enhancing screening coverage is necessary to discover more HCV infected subjects in community. However, a substantial population is unaware of HCV infection that needs more attention.

Aim
The aims of this study were to evaluate the status of HCV infected residents in remote villages, to compare characteristics between already known and unaware HCV infection subjects, and to analyze the disease insights.

Patients and methods
Screening intervention for liver diseases was conducted in remote villages of Tainan City of southern Taiwan from August 2014 to July 2016. Items of screening examinations included questionnaire, blood sampling for liver tests and viral hepatitis markers (hepatitis B surface antigen and anti-HCV antibody), abdominal sonography survey, and liver stiffness measurement by transient elastography. Quantitation of HCV RNA was measured for residents with positive anti-HCV antibody.

Results
A total of 194 (13.5%) out of 1439 participants showed positive for anti-HCV antibody. HCV viremia was detected in 119 (61.3%) residents. Previously unaware HCV infection by questionnaire record was present in 68 (35.1%) of ant-HCV positive residents. By multivariate logistic analysis, unaware HCV infected residents exhibited significantly mild liver fibrosis (OR 0.876, 95% CI 0.782~0.981, p = 0.022), more prevalent of heart diseases (OR 6.082, 95% CI 1.963~18.839, p = 0.002), and less cluster of family history of liver diseases (OR 0.291, 95% CI 0.113~0.750, p = 0.011) when comparing with already known HCV infected residents. Among the 126 already know HCV infected residents, only 59 (46.8%) received antiviral treatment or regular follow-up. No concept or no willing to receive medical care was observed in 44 (34.9%) residents.

Conclusion
In HCV endemic villages of Taiwan, residents with unaware HCV infection comprised about one third of HCV infected residents and exhibited obscure characteristics to identify. Less than half of already known HCV infected residents received adequate medical care. To eliminate HCV infection, vigorous efforts on enhancing screening coverage, educating update knowledge of liver diseases, and linking to medical care are urgently needed.

Read full article: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0193251

Young men's drinking tied to later liver disease risk

Young men's drinking tied to later liver disease risk
Last Updated: 2018-02-22
By Lisa Rapaport (Reuters Health)

Men who drink alcohol in late adolescence are more likely to develop severe liver disease decades later than young people who don't drink at all, a Swedish study suggests.

Researchers examined data on alcohol consumption for 43,296 men entering military service in 1969 and 1970 when they were 18 to 20 years old.

After an average follow-up of almost 38 years, a total of 383 men were diagnosed with severe liver disease, including 208 who died.

Each daily gram of alcohol men typically consumed in their youth was associated with a 2% increase in the risk of severe liver disease, even after researchers accounted for other independent risk factors for liver damage like obesity, smoking and cardiovascular disease.

Continue reading: http://www.chronicliverdisease.org/reuters/article.cfm?article=20180222Other1195795296

Hepatitis C: The Bane of Baby Boomers, Though Treatable

Pharmacy Times

Hepatitis C: The Bane of Baby Boomers, Though Treatable

FEBRUARY 21, 2018
Jeannette Y. Wick, RPh, MBA, FASCP

More than 3 million Americans have chronic hepatitis C virus (HCV), and physicians diagnose about 17,000 new cases annually. HCV is a silent disease, and most infected individuals are unaware that they are infected until they develop liver damage, cirrhosis, or liver cancer. Consequently, 12,000 Americans die from HCV complications each year.1,2,3 And people born between 1945 and 1965 are 5 times more likely to have hepatitis C than others.4 Although treatments have been available for many years, the consistent ability to cure HCV is recent.

Choosing the Treatment Regimen
Treatment goals include a persistent absence of HCV ribonucleic acid in serum 6 months or more after completing antiviral treatment, and preventing progression to serious complications.

Since 2013, oral regimens combining direct-acting antivirals from different classes (Table 1) have effectiveness exceeding 90%. These therapies have shorter durations and fewer adverse effects than older options.

Continue reading.... 

Study finds racial differences in cure rates for Hepatitis C

Study finds racial differences in cure rates for Hepatitis C

In a large ethnically diverse group of patients seen at a community-based Veterans Affairs practice, cure rates for chronic hepatitis C were lower for African American individuals relative to White individuals, even when patients were receiving optimal therapies. The findings are published in Pharmacology Research & Perspectives.

The investigators noted that although the results demonstrate the importance of racial/ethnic differences in chronic hepatitis C, the true causes of these differences remain unclear and should be further explored in prospective studies where drug levels and patient genetics are taken into account.

Source: http://newsroom.wiley.com/press-release/wiley-research-headlines/study-finds-racial-differences-cure-rates-hepatitis-c

New AASLD Guidelines for Hepatocellular Carcinoma: The Big Questions Tackled

COMMENTARY
New AASLD Guidelines for Hepatocellular Carcinoma: The Big Questions Tackled

David A. Johnson, MD
February 21, 2018

View video and read the complete article at Medscape

Hello. I'm Dr David Johnson, professor of medicine and chief of gastroenterology at Eastern Virginia Medical School in Norfolk, Virginia.

When we see patients with cirrhosis in the clinic, we are concerned about screening for hepatocellular carcinoma (HCC). I'm not a transplant hepatologist, but I deal with these patients all the time, as you do.

HCC is an incredibly common disease. It's the fifth most common tumor in the world and the second leading cause of cancer-related death.[1] In the United States, there are an estimated 39,000 new cases per year and over 27,000 related deaths[2,3]; the incidence is likely to rise at least until 2030.[4] This problem is not going away.

Why is that? It's about cirrhosis. The majority of HCCs, 85%-95%, occur in patients with cirrhosis[5,6]—the exception to the rule being hepatitis B, where patients do not need to be cirrhotic. The incidence of HCC in patients with cirrhosis that I quote to my patients is 2%-4% per year.[7] Thus, it is recommended that we screen these patients because early screening may lead to earlier diagnosis and appropriate interventions.

Continue reading online: https://www.medscape.com/viewarticle/892790

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