Tuesday, July 10, 2018

N.J. Expands hepatitis C treatments for all Medicaid enrollees

N.J. Expands Vital Hepatitis C Treatments for Medicaid Enrollees 

TRENTON – The New Jersey Department of Human Services announced expanded hepatitis C treatments for all Medicaid enrollees in the state, a policy facilitated by increased funding in the fiscal year 2019 budget.

The improvement comes amid ongoing concern about increased infections due to the opioid epidemic and a growing focus on identifying and treating hepatitis C infection among Baby Boomers.

New Jersey Human Services Commissioner Carole Johnson said that under the new policy, New Jersey Medicaid will cover hepatitis C curative drug treatment once someone is diagnosed with the virus. Previously, individuals in New Jersey were required to wait until their liver had already been damaged before accessing this treatment.

Hepatitis C management simplification from test to cure: a framework for primary care physicians

Clinical Therapeutics
Available online 5 July 2018
In Press, Corrected Proof

Hepatitis C Management Simplification From Test to Cure: A Framework for Primary Care Providers 
Shashi N. Kapadia, MD, MS; and Kristen M. Marks, MD, MS
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Weill Cornell Medicine, Division of Infectious Diseases, New York, New York
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Weill Cornell Medicine, Division of Infectious Diseases, New York, New York
Shashi N. Kapadia, MD, MS; and Kristen M. Marks, MD, MS

Abstract
This article proposes a strategy for primary care providers to begin treating patients with hepatitis C virus (HCV). We are motivated by the need to expand HCV treatment and by developments that have simplified treatment for most patients. This article presents 5 steps to achieving quality HCV treatment in the primary care setting: (1) accurate diagnosis via reflex testing; (2) risk stratification and identifying comorbidities via pretreatment evaluation; (3) simple, once-daily, pan-genotypic HCV treatment regimens; (4) minimized on-treatment monitoring: and (5) posttreatment monitoring and high-quality care for comorbidities such as cirrhosis and injection drug use. We provide indications for referral to specialists: notably children, patients with genotype 3 and cirrhosis, advanced liver or kidney disease, previous treatment failures, drug interactions with recommended regimens, and hepatitis B co-infection. Finally, potential barriers for providers are discussed, as well as further research findings and policy interventions that can promote HCV treatment in the primary care setting. We believe that a substantial portion of patients with HCV can be treated safely and effectively by nonspecialists and that the engagement of primary care providers is critical to efforts to end the HCV epidemic.

Continue to full text article: https://jumpshare.com/v/F4SHY4XQZ4lZQSJeAnhA

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Full-text article shared by Henry E. Chang.

Monday, July 9, 2018

Targeting non-alcoholic fatty liver disease

In Case You Missed It
In the July Issue of the patient-friendly HCV Advocate newsletter, Lucinda Porter, RN., writes a must read article about: Avoiding Fatty Liver.

Targeting non-alcoholic fatty liver disease
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One of the lines of research of the UPV/EHU's Lipids & Liver group, which focusses on the mechanisms involved in the development and progression of non-alcoholic fatty liver disease, is achieving significant advances in a range of aspects; these include the identification of proteins that alter the metabolic pathways in the development and progression of liver disease, and even cancer, and the seeking of targets to enable the disease to be reversed.

According to the latest figures, non-alcoholic fatty liver disease affects 30% of the general population, and this percentage rises to between 70% and 80% in certain risk groups, such as obese patients, patients with diabetes, etc., due to the fact that the latter is linked to metabolic diseases. The disease begins with a simple build-up of fat or lipid in the liver which in principle may be benign but which in some patients may progress and lead to hepatitis, steatohepatitis, because of its inflammation, and this is a risk factor for developing hepatic cirrhosis and even liver cancer. Right now, there is no specific treatment for this disease, and owing to the current high prevalence of obesity and diabetes, it is forecast that within a few years liver cancer cases caused by this fat storage could soar, as could the number of transplants caused by non-alcoholic steatohepatitis.

The Lipids & Liver research group in the department of Physiology at the UPV/EHU’s Faculty of Medicine and Nursing is working to find out what mechanisms are involved in the development and progression of liver diseases, and mainly the mechanisms related to alterations linked to lipid (fat) metabolism. Specifically, one of the group’s lines of research, which focusses on the study of non-alcoholic fatty liver disease, is involved in research that aims to “find out why the disease develops in some patients and not others; to find evolution markers that can provide us with a prognosis as to which patients are going to develop the disease; and to find not only hepatic markers (that can be obtained through biopsy) but also serum markers, which by means of simple blood tests can say which phase the patient is in”, explained Dr Patricia Aspichueta, head of the line of research.
The liver is the metabolic centre of the whole body

Basically, the members of the research group are focusing on the study of lipid metabolism in the liver, in other words, on the chemical reactions in which they are formed or consumed. To do this, they work with animal models in which a gene has been silenced and to which different diets and treatments designed to induce the disease are given, and once a target in the animal model has been confirmed or identified, they proceed to validate it in human samples. What is more, they also work with in vitro or cell models, “because there it is easier to find out in which cell the metabolism has been damaged, modified or altered, we can play around with different drugs, different inducers, and it is easier to silence specific metabolic pathways, etc.”, explained Aspichueta.

The members of the group are studying different molecules or targets involved in various liver disease processes. Aspichueta specifies some of the pathways that they have open in the research group: “Firstly, we want to identify the proteins that alter the metabolic pathways and which supply the liver with more lipid. We want to find out why this lipid store forms, and why the store causes the disease to progress to phases such as cancer, even. It is important to know which players are involved in these processes to be able to silence them and see if the disease is reversed.” They are also exploring the involvement of lipids in liver regeneration, “a hugely important perspective with respect to patients who have had a portion of their liver removed, because the liver is the only organ that regains its normal size”. In another of the studies they are exploring “how the liver controls adipose tissue, and how by modulating liver function we can get animals to lose weight”.

Aspichueta confirms that they have found “an important therapeutic target that modulates the metabolism and the progression of the disease”. They have induced the development of liver cancer associated with obesity in animal models in which this protein has been silenced and “we have seen that the animals do not develop the disease at all: neither liver cancer nor the fat store. It’s amazing,“ said the doctor. Now “we are working on human samples of non-alcoholic fatty liver disease to validate the involvement of these proteins in human pathology”. The researchers are aiming to find targets that control several metabolic pathways at the same time, “because the metabolic alteration does not take place in a single pathway, rather a decompensation takes place, the metabolism becomes unbalanced and various pathways are affected,” she concluded. The liver is the metabolic centre, and if we control the liver we can control many disorders associated with this liver disease”.
Additional information

The Lipids & Liver research group has been recognised as a Consolidated Group by the Department of Education of the Basque Government since 2007. Its research work relating to the Physiopathology of Lipid Metabolism comes within the strategic Health and Life Quality line of the Spanish Ministry of the Economy and Competiveness and of the Basque Government, in the sphere of the Euskampus biomedicine and healthy Ageing and life quality.

The group works in close collaboration with various research groups at the UPV/EHU as well as external ones with which they have had numerous publications in various scientific journals. The group is part of the Biocruces Institute for Health in which it broadens its research to the disorder in humans. It also collaborates with CIC bioGUNE, the University of Santiago de Compostela, other groups in Madrid, the Hospital of Valdecilla (Santander), as well as with the University of South Carolina and Yale University. It also works with an American pharmaceutical company in the quest for treatment targets.

Promising new HIV vaccine candidate trialled in humans

Monday 9 July 2018 5:37PM (view full episode)

Researchers have been trying for decades to find a vaccine for HIV. Several candidates have made it through initial rounds of clinical trials, only to prove ineffective at generating an immune response in humans. But a new vaccine candidate is the fifth ever to make it through to the so-called 'phase 2b' trial stage.

Listen @ Health Radio, hosted by Dr Norman Swan with guest Dr Dan Barouch, professor of Medicine at Beth Israel Deaconess and Harvard Medical School in Boston.

The Health Report is a valued information source for professionals and students in the medical and health professions, as well as attracting a sizeable audience of general listeners seeking jargon-free, easy-to-understand information and analysis on health and medical matters.

Friday, July 6, 2018

Cabozantinib Ups Survival in Advanced Liver Cancer - Results Phase 3 Trial

News > Medscape Medical News > Oncology News
Cabozantinib Ups Survival in Advanced Liver Cancer
Roxanne Nelson, BSN, RN
July 05, 2018

The targeted agent cabozantinib (Cabometyx, Exelixis) could be a new treatment option for previously treated patients with advanced hepatocellular carcinoma (HCC), suggest results from a phase 3 trial.

As compared with placebo, treatment with cabozantinib resulted in longer overall survival and progression-free survival.

Median overall survival was 2.2 months longer for patients who received cabozantinib, and treatment was associated with a 56% reduction in the risk for progression or death.

The results were initially presented at the Gastrointestinal Cancers Symposium (GICS) 2018 and were reported by Medscape Medical News at that time. They have now been published in the New England Journal of Medicine. 

Free registration may be required

Monday, July 2, 2018

Coffee Drinkers Are More Likely To Live Longer. Decaf May Do The Trick, Too

NPR
Coffee Drinkers Are More Likely To Live Longer. Decaf May Do The Trick, Too 
July 2, 2018

Coffee is far from a vice.

There's now lots of evidence pointing to its health benefits, including a possible longevity boost for those of us with a daily coffee habit.

The latest findings come from a study published Monday in JAMA Internal Medicine that included about a half-million people in England, Scotland and Wales. Participants ranged in age from 38 to 73.

$20 blood test could help diagnose thousands of patients with hepatitis B in need of treatment

$20 blood test could help diagnose hepatitis B patients across Africa
Imperial College London
A simple $20 blood test could help diagnose thousands of patients with hepatitis B in need of treatment in some of Africa's poorest regions.

Researchers have developed an accurate diagnostic score that consists of inexpensive blood tests to identify patients who require immediate treatment against the deadly hepatitis B virus - which can lead to liver damage or cancer (1).

The score consists of two simple blood tests: one measuring presence of antigens, proteins produced by the virus, and another for enzymes produced by the liver in response, to accurately assess patients for treatment.

The score was found to be as accurate as existing methods for identifying the patients in need of immediate treatment but at a fraction of the cost, $20 compared to $100-500 for current tests.

It is also far more accessible than existing methods - such as liver biopsy or HBV DNA, a much more complicated blood sample analysis - which requires resources and laboratories that are not always accessible in sub-Saharan Africa.

Researchers from Imperial College London and Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, collaborating with the Pasteur Institute in Paris and other African and European institutions, used data from hundreds of hepatitis B patients in The Gambia who were part of the PROLIFICA (Prevention of Liver Fibrosis and Cancer in Africa) study.

Clinical data from more than 800 hepatitis B patients, who had been tested through the PROLIFICA programme, were used to develop this new score.

The tests were then validated with data from African patients in Senegal, Burkina Faso, Germany, France and the UK. The results are published in the Journal of Hepatology.

The new diagnostic test, called TREAT-B, was found to accurately identify HBV positive patients who require treatment in 85% of cases (called sensitivity), and could accurately identify those who do not need treatment in 77% of cases (called the specificity).

The scientists say that further research is needed but if the test is successful in larger studies it could be used widely to identify patients in need of hepatitis B treatment and refer thousands of people for life-saving treatment. The test could also be developed further to be implemented as a finger-prick test, similar to those used to detect HIV, to get quicker results.

The researchers also discovered that the diagnosis method worked at all stages of the disease - meaning that people in the early stages of liver disease without symptoms could also be screened and identified.

Imperial's Dr Maud Lemoine, co-author of the study, said: "These results show that this simple and inexpensive test could be an accurate way to diagnoses patients in need of hepatitis B treatment in countries with limited resources.

"This could potentially help diagnose and subsequently treat thousands of people across Africa."

Co-author, Yusuke Shimakawa from the Pasteur Institute said: "Once these results are validated by further studies, they could be potentially integrated into the WHO guidelines and local guidelines - and implemented in daily practice.

"There is great potential to diagnose more people and improve access to treatment.

Viral hepatitis is a major global health problem and in 2013 an estimated 1.45 million people died from the virus. It is the seventh leading cause of death worldwide and about half of deaths are attributable to the hepatitis B virus infection.

The hepatitis B virus infects around 250 million people worldwide, and is transmitted through blood and bodily fluids. In Africa, it is commonly transferred from mother to baby during birth or between children. However the virus causes no immediate symptoms, and can remain undetected in the body for decades until triggering severe complications such as liver damage (cirrhosis) and cancer.

The region most affected by hepatitis B is Sub-Saharan Africa, where around 80 million people are infected. 

http://www.imperial.ac.uk/news/187009/new-test-could-diagnose-hepatitis-patients/

Sunday, July 1, 2018

Cost-effective universal screening for hepatitis C in France

Cost-effective universal screening for hepatitis C in France
It is currently recommended in Europe that screening for hepatitis C virus (HCV) should target people at high risk of infection. In France, public health data suggest that in 2014 approximately 75 000 people aged 18 to 80 were infected by HCV, but were unaware of their status. In at least one in ten cases, these people are at an advanced stage of the disease when diagnosed. Today's treatments of HCV infection are both highly effective and well tolerated, and cure the infection in a few weeks in over 95% of cases. In Professor Yazdan Yazdanpanah's Inserm research team, Sylvie Deuffic-Burban has developed a mathematical model that assesses the efficacy and cost-effectiveness of different screening strategies, including universal screening.

This study applied data from a 2004 InVS seroprevalence survey to 18- to 80-year-olds in France, excluding people with diagnosed chronic HCV infection. The researchers developed their analytical model using a combination of these seroprevalence data and findings from studies of the characteristics of people infected (age, sex, stage of the disease at diagnosis, alcohol intake, etc.), the natural progression of the disease, the efficacy of treatments, the quality of life of the patients treated, and the cost of treatment of infection. The screening strategies assessed targeted the following groups: the at-risk population only, all men aged between 18 and 59, all people aged between 40 and 59, all people aged between 40 and 80, and everyone aged between 18 and 80, ie, universal screening.

The modeling results show that universal screening is associated with better life expectancy adjusted for quality of life than other strategies. Universal screening is cost-effective if the patients tested for HCV infection are treated rapidly after diagnosis. Sylvie Deuffic-Burban points out that "Screening, on an individual basis, enables rapid treatment, which avoids the development of serious complications. In time, collective screening helps eliminate hepatitis C from a population that has been screened without restrictions." The results of this ANRS-funded study therefore argue in favor of universal screening for HCV in France, followed by immediate treatment of those diagnosed with HCV infection. Sylvie Deuffic-Burban concludes that "Although our model is unable to test the idea, the epidemiological similarities of HCV, HIV, and HBV suggest that universal and combined screening for these three viruses could be of particular interest."

Sources: Research Article
Assessing the cost-effectiveness of hepatitis C screening strategies in France
Sylvie Deuffic-Burban, Alexandre Huneau, Adeline Verleene, Cécile Brouard, Josiane Pillonel, Yann Le Strat, Sabrina Cossais, Françoise Roudot-Thoraval, Valérie Canva, Philippe Mathurin, Daniel Dhumeaux, Yazdan Yazdanpanah
DOI: https://doi.org/10.1016/j.jhep.2018.05.027
Publication stage: In Press Corrected Proof
Published online: July 1, 2018

Article Source