Friday, October 6, 2017

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

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

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

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

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

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

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

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

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

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

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

Of Interest
October Audio and Teleconference Transcript: Obesity and Cancer

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

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

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

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

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

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

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

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

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

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

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


Blog Updates
HEPATITISC.NET
You Don’t Gotta Go to Work 
By Rick Nash - October 5, 2017
When starting treatment, it’s an important question, how much can I work while on treatment? Of the six different treatments I’ve been on, I’ve worked part-time, full-time, some of the time, and...

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

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

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

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

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

Creating a World Free of Hepatitis C
Improving Your Memory
October 5, 2017
Lucinda Porter
In last week’s blog, I discussed age-related memory loss and cognitive decline. This week I provide some tools to help you slow down the process.

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

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

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

Newsletters
Weekly Bull
Read The Latest Issue: Weekly Bull

 Hepatitis B & C Public Policy Association
October 2017 – Newsletter

HCV Advocate
October Newsletter

National Viral Hepatitis Roundtable
September/October 2017 NVHR Newsletter

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

GI & Hepatology
October Newsletter

Support Forums



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

Hep Forum


Hep C Discussion Forum
Global Hepatitis C Support and Information

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

Helpful Links


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

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

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

Happy Friday!
Tina
Posted by at No comments:
File Under , , , , , ,

Thursday, October 5, 2017

Real-life results of sofosbuvir based therapy in chronic hepatitis C -naïve and -experienced patients in Egypt

Real-life results of sofosbuvir based therapy in chronic hepatitis C -naïve and -experienced patients in Egypt
Ahmed Nagaty, Ekram W. Abd El-Wahab Published: October 5, 2017

https://doi.org/10.1371/journal.pone.0184654

Full Text Article

Abstract
Background
More than ten million Egyptians are infected with HCV. Every one of them is going to infect about three to four persons every year. Treating those patients is a matter of national security. A dramatic improvement in hepatitis C virus (HCV) infection treatment was achieved in the last five years. A new era of direct-acting antivirals is now dawning in Egypt.

Objective(s)
We share in this report our clinical experience in treating chronic HCV Egyptian patients with Sofosbuvir based regimens to evaluate its safety and efficacy on real life practical ground.

Methods
A total of 205 chronic HCV patients (195 naive and 15 experienced) were enrolled in the study. Patient were treated with Sofosbuvir+Ribavirin 24 weeks as standard of care. Two interferon eligible patients were treated with PEG-INF+ Sofosbuvir+Ribavirin for 12 weeks. The primary efficacy endpoint was the proportion of patients with sustained virologic response at 24 weeks after cessation of therapy.

Results
The overall response rate was 97.1%. Sustained virological response rate did not differ among treatment-naive patients and patients with previous history of IFN-based therapy. Portal hypertension, prediabetes, and lack of early virologic response were predictors of non response. No clinically significant treatment-emergent adverse effects were noted. No treatment discontinuation was encountered.

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

Posted by at No comments:
File Under , , ,

October Audio and Teleconference Transcript: Obesity and Cancer

Recommended Reading
Editorial - Lancet
The US Centers for Disease Control and Prevention released a new report on cancer and obesity last week, highlighting that cancers associated with overweight and obesity, including thyroid, liver, kidney, and ovarian cancer, constitute 40% of cancers diagnosed in the USA, with over 630 000 diagnoses in 2014 alone.... 

 Obesity, hepatitis C epidemics drive ‘alarming’ increase in liver cancer incidence, mortality
HemOnc Today, October 10, 2017
A SEER analysis published this summer revealed staggering statistics about liver cancer in the United States. Incidence has increased steadily since the mid-1970s, and…

Vital Signs - October Teleconference Transcript: Obesity and Cancer

 Overweight and Obesity are Associated with Cancer




CDC Telebriefing: New Vital Signs Report – Why is the overall cancer rate declining, while cancer rates associated with overweight and obesity are on the rise?

 Tuesday, October 3, 2017

Listen here
Audio recording

Press Briefing Transcript
Please Note: This transcript is not edited and may contain errors.

OPERATOR: Good afternoon and thank you for standing by. As a reminder, today’s conference call is being recorded. If you have any objections, please disconnect at this time. Your lines have been placed in listen only mode until the Q&A session of today’s conference. At that time, you may press star followed by the number one to ask a question. I would now like to turn the conference over to your moderator, Kathy Harben. Thank you, you may begin.

KATHY HARBEN: Thank you, Michelle. Thank you, everyone, for joining us today for the release of a new CDC Vital Signs. We are joined today by CDC’s deputy director, Dr. Anne Schuchat, as well as, Dr. Lisa Richardson, who is director of CDC’s Division of Cancer Prevention and Control.

ANNE SCHUCHAT: Good afternoon, everyone, and thanks for joining us today. CDC provides for the common defense of the country against health threats. Each month in our vital signs report, we focus on a disease from the front lines and give you information to help stop it. Today’s report contains new information about national cancer trends and focuses in on trends in those cancers associated with obesity and overweight. Let’s start with the good news. We have made great strides in overall cancer since the 1990s. As a nation, we’re now better at preventing and treating some cancers. Improvements in early detection through screening have helped drive down cancer rates. Between 2005 and 2014, the incidence of cancers not associated with overweight or obesity decreased 13%. But today’s report shows in some types of cancers, we are going in the wrong direction. As we’ve highlighted before, we are seeing the effects of obesity and overweight on many chronic conditions. Today’s vital signs report highlights how the growing prevalence of obesity and overweight is affecting cancers as well. This may be surprising to many Americans, since awareness of some cancers being associated with obesity and overweight is not yet widespread. Research shows that being overweight or having obesity is associated with at least 13 types of cancer. Today’s report looked carefully at trends in the rates of specific cancers, comparing the ones that are associated with obesity and overweight with the ones that are not, and looking closely at colorectal cancer, which is associated with obesity but also has a very effective screening intervention that can address precancers. Our study shows that cancers not associated with obesity and overweight are going down. Colorectal cancer is going down, but the rates of most of the cancers associated with obesity or overweight has increased over the past decades. They’re up 7%. We’ve noticed these cancers are increasing particularly among middle-aged adults, people between the ages of 50 and 74. These are important results, and may be harbingers of even greater challenges in the years to come. Tackling obesity is difficult. Many of us struggle with our weight. We’ve heard for a long time that people who are obese or overweight are more likely to suffer from heart disease, strokes, and diabetes. But more than half of Americans are not aware that excess weight can increase the risk of many cancers. And unfortunately, two out of three Americans are either overweight or obese. It’s easier to prevent overweight and obesity than it is to reverse it and the science is still catching up on whether and how much losing weight can lower a person’s risk of some cancers. We do know that even modest weight loss can help when it comes to lowering the risk of other chronic diseases like diabetes and heart disease. The trends we’re reporting today are concerning. The first step to addressing a risk is to be aware of it. There are many good reasons to strive for healthy weight. Now you can add reducing your risk for cancer to the list. The obesity epidemic is a complex and major public health challenge that requires comprehensive efforts. People can eat healthy, be physically active, and get recommended cancer screening. I’m going to turn things over now to Dr. Lisa Richardson, who will share the detailed findings from the report.

LISA RICHARDSON: Thank you, Dr. Schuchat. For this Vital Signs report, we analyzed data from the United States Cancer Statistics database to calculate cancer rates associated with being overweight and having obesity in 2014 and trends from 2005 to 2014. We looked at the 13 types of cancer classified by the International Agency for Research on Cancer as having enough evidence to support being associated with excess body fat. These include cancers of the thyroid, gallbladder, upper stomach, liver, pancreas, kidneys, ovaries, uterus, colon and rectum, breast in post-menopausal women, myeloma, a cancer of blood cells, meningioma, cancer in the brain and spinal cord, and a type of cancer of the esophagus. In 2014, 13 cancers associated with overweight and obesity made up 40% of all cancers diagnosed. Around 55% of cancers in men and 24% of — sorry, in more men, and 24% of cancers in men were associated with overweight and obesity. The fact that endometrial, ovarian, and post-menopausal breast cancers accounted for 42% new cases in 2014 reflects the fact that these cancers occur among females. However, among cancers that affect both males and females, incidence rates were higher among males. For the time period studied, new cancer rates for all cancers associated with overweight and obesity are down, but the decrease varied widely by age group. Colorectal cancer had the second largest decrease in rate of new cases during the study period. Increased colorectal cancer screening, which prevents colon cancer, most likely accounts for this decline. It’s important to note, though, that when we took colorectal cancer out of the equation, we found cancers associated with overweight and obesity went up in all age groups except people age 75 or older. These findings are concerning and it will take the cooperation and coordination of many more organizations to help more people nationwide get to or maintain a healthy weight. On a federal level, CDC supports comprehensive cancer control programs in all 50 states, the District of Columbia, 8 tribes and 7 territories. Our programs focus on cancer prevention, education, screening, quality of cancer care, and survivorship. Our programs work with partners in the community that are already doing some of the following activities. Schools are providing healthy food options and quality physical education. Health care providers can screen for and educate patients about the dangers of overweight and obesity. Workplaces are encouraging physical activity and offering healthy food options in vending machines. Planners are building parks, gardens, and roads that are safe for all types of transportation to share including walking. Planners are being — sorry, encouraging families to be physically active is part of the equation as well. Maintaining a healthy weight and reducing overweight and obesity in adults and children can help reduce the risk and burden of cancer. We’re still learning how losing weight can decrease the risk of some cancers in people who weigh more than recommended. Losing weight also lowers the risk for high blood pressure, diabetes, heart disease, stroke, and other chronic conditions. The bottom line is it will take everyone working together to reduce cancer associated with overweight and obesity. Thank you. I will now turn it back to the moderator.

KATHY HARBEN: Thank you, Dr. Richardson. Michelle, we’re now ready for questions.

OPERATOR: Thank you. At this time if you would like to ask a question, you may press star one. To withdraw your question, you may press star two. Again, star one if you do have any questions. Jessica Glenza, from The Guardian, you may go ahead.

JESSICA GLENZA: Hello. Thank you so much for holding this call. My question is whether rates of obesity linked cancer now rival that of tobacco linked cancer since the CDC has said that tobacco-linked cancers account for 40% of overall cancer diagnoses in the United States.

ANNE SCHUCHAT: Thank you for that question. We could actually get you more information subsequently, but one thing I would like to clarify, when we say obesity associated cancers, some of those cancers are also actually associated with tobacco. It’s different to say something is associated with obesity and overweight than to say that that is the cause. We know that there are different levels of causation, and of course, tobacco has been pretty clearly shown to be the cause of several types of cancer. So, I think the specific numbers involved of adding up all the tobacco-associated cancers and whether those tally greater numbers than all of the current obesity-associated cancers is something that folks can do after the call. I do want to caution that our finding is looking at the 13 types of cancers that are considered associated to obesity and overweight, not that are necessarily all causally related to obesity and overweight. Next question.

OPERATOR: Thank you. Our next question comes from Laurie McGinley from The Washington Post. You may go ahead.

LAURIE MCGINLEY: Yes, thanks very much for taking my question. I’m interested in what you think the mechanisms are of the link here, whether it has to do with inflammation or if there is some explanation or if people don’t really know what the explanation is. And also, you mentioned that not losing weight, it’s not clear whether it would reduce the risk. Why would that be, that not losing weight would not necessarily reduce your risk? Thank you.

ANNE SCHUCHAT: Let me start — this is Dr. Schuchat, then I’ll let Dr. Richardson fill in more details. There are multiple mechanisms considered to be likely biological underpinnings for a link between overweight and obesity and cancer, including the endocrine changes that occur, as well as inflammatory mechanisms that can sometimes be turned on by some of those endocrinological changes that occur with overweight and obesity. In terms of the reversal, we know that it’s possible for some things. You know if you quit smoking for several years, your risk can reduce. The question is really whether the mechanisms that are turned on in the presence of overweight and obesity can be reversed, or whether the cancer process is already far enough along. That’s the high level answer. But let me let Dr. Richardson go into more details about the specific mechanisms.

LISA RICHARDSON: This is Dr. Richardson. Dr. Schuchat is exactly right. For some cancers, the endocrine mechanism, especially estrogen, is very prominent for blood cancer and endometrial cancer. As you stated, inflammation is extremely important in causing carcinogenesis or generating cancer in the first place. Regarding losing weight, the current evidence is the biomarkers, the inflammatory marker that we look for, are decreased when we lose weight about the evidence is still not there about whether it would reduce the risk for developing cancer completely. There is promising research that was published this year in the Journal of Clinical Oncology from the women’s health initiative looking at intention weight loss. In that study, women who lost weight of ten pounds or more did lower their risk of developing endometrial cancer. The evidence is early but promising.

ANNE SCHUCHAT: Thanks. Next question, please.

OPERATOR: Thank you. Mike Stobbe, from the Associated Press. You may go ahead.

MIKE STOBBE: Thank you for taking my call. Just a variation of the earliest one. Could you say in the clearest possible way, does obesity cause cancer, yes or no? Or what’s the most plainspoken statement you can make to answer that question?

ANNE SCHUCHAT: Obesity and overweight are associated with a higher risk of many types of cancers. Our report found an increase in a number of types of cancers associated with obesity and overweight at a period where the prevalence of obesity and overweight has increased substantially in the middle ages. So our report has indirect evidence that this greater evidence of obesity is starting potentially to show up in our cancer statistics. The evidence for a link between obesity and overweight and cancer is considered strong by the international association of research on cancer. And that consortium group has essentially identified 13 types of cancers that are associated with overweight and obesity. So it’s not exactly the same as what we say about tobacco and cancer. But the mounting evidence points to this association and the trends that we’re seeing are an indirect emphasis that there are important general changes going on. Next question?

MIKE STOBBE: Thank you.

ANNE SCHUCHAT: I’m sorry, did you have a follow-up, mike?

MIKE STOBBE: I was just wondering, are there other possible explanations for some of the trends that were noted in some of these cancers besides the fact that these categories of cancer are associated with obesity?

ANNE SCHUCHAT: Yes, and in particular, I think one of the simplest ones to think about is the trend in liver cancer. We saw an important increase in liver cancer between 2005 and 2014. But we know of a number of factors that are associated with liver cancer besides obesity and overweight. Of course, we’re talking a lot about Hepatitis C here as something that’s become quite a bit more common. So I think with liver cancer, there are a number of factors. Hepatitis C and Hepatitis B are both associated with liver cancer, as is fatty liver, which can result from alcohol problems and can also result from overweight and obesity. So I think that gives you an example of the complexity of each of these cancer statistics. I think the importance of today’s report is when we step back and we lump together all of the types of cancers that are associated with overweight and obesity, we saw a direction upwards. And when we looked at all of the other cancers except for colorectal cancer, we saw a direction downwards. That’s not a smoking gun. But that is a note of caution for us. And that’s one of the reasons that we’re trying to bring broader attention to awareness that at this point, obesity and overweight have been associated with a number of types of cancers. Most of us hadn’t heard of that, and that’s one of the things we’re trying to alert the public about. Next question.

OPERATOR: Thank you. Leigh Ann Winick from CBS News. You may go ahead.

LEIGH ANN WINICK: Thank you. I’m wondering and you mentioned in your introduction that about half of Americans are not aware of this association. What does that point to as far as a directive to primary care physicians and other public health officials? What might you be suggesting?

ANNE SCHUCHAT: You know, awareness is the beginning. And certainly we know that people hearing from their doctors or nurses take information differently than when they hear it from the general public or the media. So we do think it’s important for us to get the word out and for clinicians to get the word out with their patients about the potential health effects of overweight and obesity. We know that there’s lots of challenges with maintaining a healthy weight, but that it’s an important thing each of us can do. We know that there can be challenges with having enough physical activity in our daily schedules. But it’s an important thing to do. We do urge clinicians to talk with their patients about how to maintain a healthy weight. And if they are overweight or obese, what kinds of steps they might take to work on that. Next question.

OPERATOR: Thank you. Once again, as a reminder, you may press star one if you would like to ask a question. Our next question comes from Tom Corwin with Augusta Chronicles. You may go ahead.

TOM CORWIN: Thanks for taking my question. I see you have the 13 cancers listed here. One that’s not on the list is prostate cancer. I’m curious whether that was looked at in this report or not.

ANNE SCHUCHAT: Dr. Richardson can answer that one.

LISA RICHARDSON: No, prostate cancer was not reviewed in the most recent report, no. The report, it was not looked at.

TOM CORWIN: Okay. Thank you.

ANNE SCHUCHAT: Okay. Next question.

OPERATOR: Our next question comes from Rachel Bergman with the American Public Health Association. You may go ahead.

RACHEL BERGMAN: Yes, hi, thanks.

ANNE SCHUCHAT: It’s hard for us to hear you, could you try to speak closer to the microphone, please.

RACHEL BERGMAN: Is this any better?

ANNE SCHUCHAT: Just a little bit.

RACHEL BERGMAN: I apologize. I’ll try to speak up. You spoke a little bit about the disparate incidence between males and females with these cancers. Can you talk about other disparities you saw in other population groups?

ANNE SCHUCHAT: Right. Thank you. We did see that the increases were more pronounced in the middle-aged adults than in adults over 75 — or 75 and over. So that was — the trends were, you know, increasing in that middle-aged population. That was an important factor. You know, in terms of the direction that things were going rather than the individual risk. When we look at age in general, of course, cancer rates are higher in the oldest of age groups. But when we looked at the trend in the obesity and overweight associated cancers, we saw it was increasing in those younger age groups and not in the group that was 75 and over. There of course have been some racial and ethnic differences in the incidence of cancers in general, and there are as well in the incidence of obesity and overweight-related cancers, some geographic differences. But I think the important — most important of the differences that we found was that this age group of middle-aged adults, who probably are the cohort that has really experienced this increase in the prevalence of obesity and overweight in America, that that’s the group where obesity and overweight-related cancers, associated cancers, have been increasing, rather than in the oldest age group.

ANNE SCHUCHAT: Next question.

OPERATOR: Once again, if you do have any questions or comments, you may press star one. Again, that is star one if you would like to ask a question.

KATHY HARBEN: Michelle, this is Kathy Harben, the operator. If anyone else has questions, they’re welcome to call us at 404-639-3286. Or they can e-mail us at media@cdc.gov. I would like to thank Dr.’s Schuchat and Richardson for joining us today. We will post a transcript of this call later. And again, if you have other questions, please contact us by phone or e-mail. Thank you very much.

OPERATOR: And thank you. This concludes today’s conference call. You may go ahead and disconnect at this time.

Posted by at No comments:
File Under , , ,

Healio - Viekira Pak safe for patients with HCV, Child-Pugh A cirrhosis

New In Hepatology At Healio

October 5, 2017
Viekira Pak safe for patients with HCV, Child-Pugh A cirrhosis
Poordad F, et al. J Hepatol. 2017;doi:10.1016/j.jhep.2017.06.011.
Patients with hepatitis C and Child-Pugh A cirrhosis had similar rates of treatment-related adverse events and lower rates of hepatic decompensation after treatment with Viekira Pak compared with untreated patients, according to recently published data. However, those with a history of advanced cirrhosis were more likely to experience treatment-related adverse events.
Read More - https://www.healio.com/hepatology/hepatitis-c/news/online/%7Be4ff72dc-3ade-4e42-b1bb-83109f95e69f%7D/viekira-pak-safe-for-patients-with-hcv-child-pugh-a-cirrhosis

Study - Safety of the 2D/3D direct-acting antiviral regimen in HCV-induced Child-Pugh A cirrhosis – A pooled analysis
Published in The Journal of Hepatology
October 2017 Volume 67, Issue 4, Pages 700–707

Liver cancer remains a leading cause of cancer-related mortality worldwide
Primary liver cancer incidence increased by 75% between 1990 and 2015, and the disease remains one of the leading causes of cancer death in the world, according to a report from the Global Burden of Diseases Study 2015. Further, hepatitis B virus was the leading cause of new cases of liver cancer in 2015, the research showed.

In Case You Missed It
Oct 4, 2017
The AASLD and the Infectious Diseases Society of America have updated their guidelines and resources for the diagnosis and treatment of hepatitis C virus infection…

Despite treatment, severe steatosis predicts severe fibrosis in HBV
Severe steatosis correlated with severe fibrosis in patients with chronic hepatitis B, whether patients were on treatment or treatment-naive, according to recently…

Free registration may be required 
Posted by at No comments:
File Under , , ,

Hepatitis C - DAA failure and the clinical impact of retreatment in real-life patients treated in the advanced stage of liver disease

Incidence of DAA failure and the clinical impact of retreatment in real-life patients treated in the advanced stage of liver disease: Interim evaluations from the PITER network
Loreta A. Kondili , Giovanni Battista Gaeta, Maurizia Rossana Brunetto, Alfredo Di Leo, Andrea Iannone, Teresa Antonia Santantonio, Adele Giammario, Giovanni Raimondo, Roberto Filomia, Carmine Coppola, Daniela Caterina Amoruso, Pierluigi Blanc, Barbara Del Pin,  [ ... ], Edoardo Giovanni Giannini....

Published: October 4, 2017 https://doi.org/10.1371/journal.pone.0185728

View Full Text
Online
Download PDF

Abstract
Background
Few data are available on the virological and clinical outcomes of advanced liver disease patients retreated after first-line DAA failure.

Aim
To evaluate DAA failure incidence and the retreatment clinical impact in patients treated in the advanced liver disease stage.

Methods
Data on HCV genotype, liver disease severity, and first and second line DAA regimens were prospectively collected in consecutive patients who reached the 12-week post-treatment and retreatment evaluations from January 2015 to December 2016 in 23 of the PITER network centers.

Results
Among 3,830 patients with advanced fibrosis (F3) or cirrhosis, 139 (3.6%) failed to achieve SVR. Genotype 3, bilirubin levels >1.5mg/dl, platelet count <120,000/mm3 and the sofosbuvir+ribavirin regimen were independent predictors of failure by logistic regression analysis. The failure rate was 7.6% for patients treated with regimens that are no longer recommended or considered suboptimal (sofosbuvir+ribavirin or simeprevir+sofosbuvir±ribavirin), whereas 1.4% for regimens containing sofosbuvir combined with daclatasvir or ledipasvir or other DAAs. Of the patients who failed to achieve SVR, 72 (51.8%) were retreated with a second DAA regimen, specifically 38 (52.7%) with sofosbuvir+daclatasvir, 27 (37.5%) with sofosbuvir+ledipasvir, and 7 (9.7%) with other DAAs ±ribavirin. Among these, 69 (96%) patients achieved SVR12 and 3 (4%) failed. During a median time of 6 months (range: 5–14 months) between failure and the second DAA therapy, the Child-Pugh class worsened in 12 (16.7%) patients: from A to B in 10 patients (19.6%) and from B to C in 2 patients (10.5%), whereas it did not change in the remaining 60 patients. Following the retreatment SVR12 (median time of 6 months; range: 3–12 months), the Child-Pugh class improved in 17 (23.6%) patients: from B to A in 14 (19.4%) patients, from C to A in 1 patient (1.4%) and from C to B in 2 (2.9%) patients; it remained unchanged in 53 patients (73.6%) and worsened in 2 (2.8%) patients. Of patients who were retreated, 3 (4%) had undergone OLT before retreatment (all reached SVR12 following retreatment) and 2 (2.8%) underwent OLT after having achieved retreatment SVR12. Two (70%) of the 3 patients who failed to achieve SVR12 after retreatment, and 2 (2.8%) of the 69 patients who achieved retreatment SVR12 died from liver failure (Child-Pugh class deteriorated from B to C) or HCC complications.

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

View research article online - http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0185728
Posted by at No comments:
File Under ,

Despite Viability, ‘Increased-Risk’ Donor Organs a Tough Sell to Transplant Patients

Despite Viability, ‘Increased-Risk’ Donor Organs a Tough Sell to Transplant Patients
The opioid epidemic has created a tragic surge in donor organs. But despite their safety record, the organs that could save lives go unused.

Increasingly, transplant surgeons must initiate a tough conversation: explaining to patients what it means to accept an organ from a person who died from a drug overdose or engaged in other risky behaviors.

Organ donors who recently injected drugs, as well those who were incarcerated or had sex for drugs or money, are among a growing group of people classified as being at “increased risk” of an infectious disease such as hepatitis C or HIV.

But the label may not be doing patients any favors.

National organ transplant numbers show the United States Public Health Service’s increased risk of infection label (PHS-IR) is associated with hundreds of available organs going unused each year. Despite the very low risk of disease transmission, patients in need are saying no to these organs.

It’s a dilemma that’s becoming common for transplant patients as the nation’s opioid epidemic yields a tragic surge in organ donors. Surgeons also face a quandary in explaining how much risk an increased-risk label actually presents to their patients.

Better guidance is needed for surgeons and transplant team members who walk this fine line every day, says Daniel Kaul, M.D., director of the Transplant Infectious Disease Service at Michigan Medicine.

Untapped potential
One in 5 deceased organ donors in the U.S. is identified as increased risk.

For a study published in Transplantation, Kaul led an analysis of Organ Procurement and Transplantation Network (OPTN) data showing organs labeled as increased risk are 7 percent less likely to be used than organs without the label.

Increased-risk organs are viable and high-quality. They often come from young, otherwise healthy donors, but perceptions about their tainted past can lead to the organs being thrown out.

“Overall utilization was less despite the extraordinarily low risk of disease transmission,” says Kaul, a professor of internal medicine at the University of Michigan. “The organ may have gone to the next person on the transplant waiting list, but it might not have been used at all.”

Also troubling, utilization rates of PHS-IR organs varied dramatically by geography. Depending on the donation service area, transplantation of available adult kidneys from increased-risk donors ranged from 20 to 100 percent, the analysis found.

In other words, hospitals and organ procurement groups in some parts of the country use these organs as often as non-PHS-IR organs, while other service areas rarely use them.

“What that tells us is there may be a different understanding of true risk associated with this label — from one center to another and even within a center, from one organ specialty to another,” Kaul says.

A widening gap
All organs identified as increased risk were less likely to be used with the exception of livers, for which transplant rates were nearly identical.

A possible explanation? Patients with liver failure may be too sick to say no.

An available liver is offered to the sickest person on the waitlist in a nearby area. Those who turn it down may not survive until another offer, or they may get so close to dying that they are taken off the waitlist.

By comparison, a patient needing a kidney may continue dialysis and wait for another organ.

There’s also the chance that liver specialists are more comfortable discussing the risk of transmitting viral diseases such as hepatitis, Kaul says.

If the increased-risk label did not exist, an estimated 313 more transplants would be performed in the United States each year, according to the study.

Co-authored by Michael Volk, M.D., a former U-M physician now practicing in Loma Linda, California, and others, the study was published in a special issue of Transplantation that looked at reducing organ discard and maximizing organ availability.

As Kaul solemnly explains: “The tragedy of someone dying while waiting for an organ is a daily occurrence.”

Researchers analyzed criteria of donors from 2010 to 2013. The rate of nonutilization of increased-risk organs, the authors write, is likely now even higher because of a 2015 change to the PHS-IR criteria. Combined with the opioid epidemic, the change resulted in an increase in the proportion of organs with this label from 12 percent to 20 percent.

Favorable odds
For most patients with end-stage organ failure, the immediate risk of dying is greater than the risk of getting an organ with an infection.

After rigorous screening, the risk of HIV or hepatitis C transmission from organ donation is low, at less than 1 percent — much less, for example, than the lifetime chances of dying in a motor vehicle accident.

But with little guidance about magnitude of risk, the stigma surrounding drug addiction can lead someone to turn down an organ that could save his or her life.

As of early October, about 116,500 Americans are waiting for an organ transplant.

Donors’ blood is tested for common viruses before they are approved for transplantation. Nucleic acid testing detects viral genetic code harboring in the blood, but testing is not foolproof. If the donor caught an infection in the last week before death, there may not be enough RNA or DNA to be picked up.

Because of this slim risk — and for transparency’s sake — transplant centers are required to get informed consent from patients willing to accept organs labeled as increased risk.

The willingness of a patient to accept them can depend on what they understand about risk and benefit. At Michigan Medicine, teams plan talks about increased-risk organs well before they might be offered to a patient.

“Although it’s unlikely that the PHS designation will be eliminated, the transplant community could partially address the (utilization) problem through better patient and provider education,” Kaul says.

OPTN and United Network for Organ Sharing asked for public comment this year as the groups develop guidance and training programs to help transplant centers counsel patients about the kind of organ they could receive — and, just as crucial, to ensure fewer available organs go to waste.

Posted by at No comments:
File Under

Hepatitis C "Me-Too" Drugs: Innovation And Lower Cost

Hepatitis C "Me-Too" Drugs: Innovation And Lower Cost
By Josh Bloom — October 5, 2017

I have also written about the benefit of second- and third-generation drugs, which are dismissed as "me-too" drugs by know-nothing critics of the industry, such as Sidney Wolfe and Marcia Angell. Ignorant critics would have you believe that the fourth approved drug in a class is nothing more than a non-innovative cash cow for drug companies. They could hardly be more wrong.

It is now clear that patients benefit greatly when there are multiple choices of drugs for a particular ailment; not just medically, but also economically. There can be no better example of this than AbbVie's Mavyret, the newest weapon in the already-impressive arsenal against hepatitis C—a pernicious virus that has infected 3 million people in the US and 170 million worldwide.

Read More https://www.acsh.org/news/2017/10/05/hepatitis-c-me-too-drugs-innovation-and-lower-cost-11919
Posted by at No comments:
File Under

Wednesday, October 4, 2017

Overcoming Obstacles in HCV 2017: Experts discuss treating and testing updates

In Case You Missed It - Launched Last Month @ ViralEd.


Experts discuss HCV treating and testing updates in this straightforward and easy to understand program, available online at ViralEd.

Follow case-based modules featuring the following topics: 

Topics
Risk Factors and Prevention
Testing, Guidelines and Recommendations
Risks for Acute HCV
Pre-Treatment Management
Management of Chronic HCV
Post-Treatment Patient Management

Begin here.......
Posted by at No comments:
File Under ,
Subscribe to: Posts (Atom)