Time - Herbal Supplements May Be Dangerous When You Take Certain Prescription Drugs

Herbal Supplements May Be Dangerous When You Take Certain Prescription Drugs

By Amanda MacMillan
January 24, 2018 

A number of common herbal supplements, including green tea and Ginkgo biloba, can interact with prescription medications, according to a new research review published in the British Journal of Clinical Pharmacology. These interactions can make drugs less effective—and may even be dangerous or deadly. 

The new review analyzed 49 case reports of adverse drug reactions, along with two observational studies. Most people in the analysis were being treated for heart disease, cancer or kidney transplants, and were taking warfarin, statins, chemotherapy drugs or immunosuppressants. Some also had depression, anxiety or neurological disorders, and were being treated with antidepressant, antipsychotic or anticonvulsant medications.

Continue reading: http://time.com/5116664/are-herbal-supplements-safe/

HSE urged to step-up on hep C

News Features

HSE urged to step-up on hep C 
Catherine Reillyl | 25 Jan 2018 |

Resources are required to support increased testing and treatment of hepatitis C in the community as significant numbers of patients are not presenting for hospital-based care, heard a recent seminar in Dublin organized by the Hepatitis C Partnership. Catherine Reilly reports.

Since 2015, DAAs have been accorded an annual budget of €30 million under the HSE National Hepatitis C Treatment Programme (NHCTP). But clinicians and community stakeholders are fervently calling for better-resourced outreach and support, as well as testing and care in community settings. They strongly believe there are significant numbers of unidentified progressive cases among the populations primarily affected by hepatitis C, ie, former and current injecting drug-users, which are hard-to-reach groups.

Continue reading: http://www.medicalindependent.ie/101158/hse_urged_to_step_up_on_hep_c

Use of direct-acting antiviral agents in hepatitis C virus-infected liver transplant candidates

Minireviews World J Gastroenterol. Jan 21, 2018; 24(3): 315-322
Published online Jan 21, 2018. doi: 10.3748/wjg.v24.i3.315

Use of direct-acting antiviral agents in hepatitis C virus-infected liver transplant candidates

Chiranjeevi Gadiparthi, George Cholankeril, Brandon J Perumpail, Eric R Yoo, Sanjaya K Satapathy, Satheesh Nair, Aijaz Ahmed

Published online: January 21, 2018

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Abstract
Since the advent of direct acting antiviral (DAA) agents, chronic hepatitis C virus (HCV) treatment has evolved at a rapid pace. In contrast to prior regimen involving ribavirin and pegylated interferon, these newer agents are highly effective, well-tolerated, have shorter course of therapy and safer essentially in all HCV patients including those with advanced liver disease and following liver transplantation. Clinicians caring for HCV-infected patients on the liver transplant (LT) waitlist are often faced with a dilemma whether to treat HCV infection before or after liver transplantation. Sustained virological response (SVR) rates following HCV treatment may improve hepatic function sufficiently enough to negate the need for LT in certain patients. On the other hand, the decrease in MELD without improvement in quality of life in certain patients may lead to delay or dropout from potentially curative LT surgery list. In this context, our review focuses on the approach to and optimal timing of DAA-based treatment of HCV infection in LT candidates in the peri-transplant period.

Core tip: Optimal timing of antiviral therapy for hepatitis C virus (HCV) infection in liver transplant candidates using second generation direct-acting antivirals is debated. Available evidence lacks conviction if the viral eradication is beneficial in all HCV patients before liver transplantation. We aim to review the current literature to better delineate the appropriate timing of HCV treatment in the era of direct-acting antiviral agents.

Continue reading article: https://www.wjgnet.com/1007-9327/full/v24/i3/315.htm

Treating Insulin Resistance in Hepatitis C-Infected Patients With Diabetes

Treating Insulin Resistance in Hepatitis C-Infected Patients With Diabetes
Elizabeth Kukielka, PharmD
Publish Date: Wednesday, January 24, 2018

Both insulin resistance (IR) and type 2 diabetes mellitus (T2DM) are more prevalent in patients with chronic hepatitis C virus (HCV) infection compared with the general population. 

As this is one of the first studies to demonstrate the benefit of treating HCV-positive patients who also have IR with both standard HCV therapy and metformin to achieve SVR, more studies are needed to confirm the results and help determine a standard regimen for patients with HCV and IR, researchers noted.

Continue reading: https://www.specialtypharmacytimes.com/news/treating-insulin-resistance-in-hepatitis-c-infected-patients-with-diabetes

Full Text

Comparison of metformin and pioglitazone in achieving sustained virological response in chronic hepatitis C patients with insulin resistance: A quasi-experimental study

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Shared by Henry E. Chang on Twitter
HCV eradication by DAA improves glucose tolerance & reduces post-load insulin resistance in nondiabetic patients with genotype 1

Hepatitis B Virus Infection and Hepatitis C Virus Treatment in a Large Cohort of Hepatitis C–Infected Patients in the United States

Article in Press
Hepatitis B Virus Infection and Hepatitis C Virus Treatment in a Large Cohort of Hepatitis C–Infected Patients in the United States
Anne C. Moorman, Jian Xing ia Loralee B. Rupp, Stuart C. Gordon Philip R. Spradling Joseph A. Boscarino Mark A. Schmidt Yihe G. Daida Kaiser Eyasu H. Teshale, Scott D. Holmberg

The rare emergence of hepatitis B virus (HBV) reactivation among hepatitis C virus (HCV)-infected patients receiving direct-acting antiviral (DAA) therapy raises questions about how many HCV-infected patients have active, past, or latent/occult HBV co-infection, and their DAA treatment experience1–3 We sought to characterize these factors, including possible post-DAA reactivation, among HCV patients in the Chronic Hepatitis Cohort Study (CHeCS), a “dynamic” observational study conducted at 4 large integrated U.S.

Full Text Online: http://www.gastrojournal.org/article/S0016-5085(17)36689-1/fulltext
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Population-based estimate of hepatitis C virus prevalence in Ontario, Canada

PLoS One. 2018

Population-based estimate of hepatitis C virus prevalence in Ontario, Canada

Shelly Bolotin , Jordan J. Feld, Gary Garber, William W. L. Wong, Fiona M. Guerra, Tony Mazzulli Published: January 23, 2018

https://doi.org/10.1371/journal.pone.0191184

Abstract
Background
Hepatitis C virus (HCV) is the most burdensome infectious illness in Canada. Current screening strategies miss a significant proportion of cases, leaving many undiagnosed. Elevated HCV prevalence in those born between 1945 and 1965 has prompted calls for birth-cohort screening in this group. However, Canada lacks population-level data to support this recommendation. We performed a serosurvey to obtain population-based HCV prevalence estimates in Ontario residents born between 1945–1974, to generate evidence for birth-cohort screening recommendations.

Methods
We tested anonymized residual sera in five-year age-sex bands from Ontario for anti-HCV antibody. We performed descriptive epidemiological analysis and used a logistic regression model to determine HCV risk-factors.

Results
Of 10,006 sera analyzed, 155 (1.55%, 95% confidence interval (CI) 1.32, 1.81) were positive for HCV antibody. Individuals born between 1950–1964 had a significantly higher combined prevalence of 1.92% (95% CI 1.56, 2.34) compared to 1.14% (95% CI 0.69, 1.77) (p = 0.04) for those born between 1970–1974. For males, comprising 107/155 (69.03%) of positive samples, the highest prevalence was 3.00% (95% CI 1.95, 4.39) for the 1960–1964 birth-cohort. For females, the highest prevalence was 1.56% (95% CI 0.83, 2.65) for those born between 1955–1959. Male sex was significantly associated with positive HCV serostatus.

Interpretation
HCV prevalence in Ontario is highest among those in this birth cohort, and higher than previous estimates. The prevalence estimates presented in our study provide important data to underpin birth-cohort screening recommendations.

Full Text: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0191184

Combating Frailty's Fatal Impact in Liver Disease

COMMENTARY

Advice for Combating Frailty's Fatal Impact in Liver Disease
Rowen K. Zetterman, MD
January 22, 2018

Dr Rowen Zetterman on the various ways in which frailty imperils outcomes in liver disease, and the most useful strategies for addressing them.

Medscape
Experts And Viewpoints, January 2018 

Diagnosing Frailty in Patients With Cirrhosis 
Frailty also increases the risk for morbidity and mortality in patients with chronic liver disease.[6,7] Sarcopenia (loss of muscle mass) and frailty may not directly correlate with the clinical severity of liver disease, and must be carefully sought to establish the diagnosis.[6]

Using observation alone to diagnose frailty in patients with end-stage liver disease is inadequate, because frailty may not be recognized by clinicians until late in the course of disease or simply be overlooked in well-groomed patients, some women, and those with obesity. Using body mass index as an indicator of malnutrition and frailty can be deceptive, because it fails to consider the functional issues of frailty. Multiple clinical measures of frailty have been published using a combination of findings, such as unintentional weight loss, reduced walking or gait speed, muscle weakness, and evidence of reduced physical activity.[1,2,7,8]

Continue reading: https://www.medscape.com/viewarticle/891271

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Co-managing HIV, Hepatitis C, and Opioid Abuse

COMMENTARY
Co-managing HIV, Hepatitis C, and Opioid Abuse
Naveed Saleh, MD, MS
January 23, 2018

Infection and Opioids
Effective antiretroviral treatments for HIV and hepatitis C exist and are widely available. In fact, treatment for hepatitis C is curative, which hardly seemed imaginable only a few short years ago. But despite there being effective treatments for these diseases, barriers exist that make their treatment difficult. Chief among these barriers is intravenous use of opioids.

The stark reality is that people with hepatitis C or HIV, or both diseases, are much more likely to die of drug overdose than of chronic illness itself. Furthermore, according to the Centers for Disease Control and Prevention, in 2014 death from drug overdose was more common than death caused by motor vehicle accidents or firearms. Of note, 80% of people who inject drugs and are HIV-positive also have hepatitis C.

At IDWeek 2017, managing infectious disease in opioid users was an important topic of coverage. In a lecture titled "Co-management of Opioid Treatment, HIV, and Hepatitis C Treatment," Brianna Norton, DO, MPH, an assistant professor of infectious disease and internal medicine at the Albert Einstein College of Medicine, discussed evidence-based approaches to treating opioid use disorder in patients with HIV and hepatitis C.

Continue reading: https://www.medscape.com/viewarticle/891282?src=rsshttp://www.medscape.com/viewarticle/891282?src=rss

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