Tuesday, September 5, 2017

Burden of HCV-induced cirrhosis expected to shift from men to women

Burden of HCV-induced cirrhosis expected to shift from men to women
Prevalence of hepatitis C virus (HCV) complications among women grew at a rate similar to that of men, while mortality among men was nearly double that of women, according to a study conducted through the Veterans Affairs office.

The retrospective cohort study analyzed 264,409 HCV-infected veterans, 7,162 of whom were women, between January 2000 and December 2013.
Continue reading....

Hepatitis C virus-related complications are increasing in women veterans: A national cohort study
Authors J. R. Kramer, H. B. El-Serag, T. J. Taylor, D. L. White, S. M. Asch, S. M. Frayne, Y. Cao, D. L. Smith, F. Kanwal First published: 16 August 2017

2017 Aug 16. doi: 10.1111/jvh.12728. [Epub ahead of print]

There are gender-specific variations in the epidemiology and clinical course of hepatitis C virus (HCV) infection. However, few long-term longitudinal studies have examined trends in the incidence and prevalence of serious liver complications among women compared with men with HCV infection.

We used the Veterans Administration Corporate Data Warehouse to identify all veterans with positive HCV viraemia from January 2000 to December 2013. We calculated gender-specific annual incidence and prevalence rates of cirrhosis, decompensated cirrhosis and hepatocellular cancer (HCC) adjusting for age, diabetes, HIV and alcohol use. We also calculated the average annual per cent change (AAPC) for each outcome by gender using piecewise linear regression in the Joinpoint software.

We identified 264 409 HCV-infected veterans during 2000-2013, of whom 7162 (2.7%) were women. There were statistically significant increases over time in the incidence rates of cirrhosis, decompensated cirrhosis and HCC for both men and women. The annual-adjusted incidence rates of cirrhosis, decompensated cirrhosis and HCC were higher in men than women for all study years. However, these complications increased at a similar rate in both groups. Specifically, the AAPC for cirrhosis was 13.1 and 15.2, while it was 15.6 and 16.9 for decompensated cirrhosis and 21.0 and 25.3 for HCC in men and women, respectively (all test of parallelism not significant). The results were similar in the prevalence analyses, although AAPCs were slightly smaller for each outcome.

In conclusion, we found an ongoing upward trend in the incidence and prevalence of HCV complications in this cohort of HCV-infected women. This increase in cirrhosis complications in women with active HCV infection is similar to those in men. With cure from HCV now becoming a reality, most of the projected burden of HCV is potentially preventable. However, benefits of HCV treatment will need to extend to all patients in order to stem the rising tide of HCV complications.

Effect of DAA therapy on type 2 diabetes patients with HCV genotype 4 infection.

Diabetes Metab J. 2017 Aug;41(4):316-321. doi: 10.4093/dmj.2017.41.4.316.

Factors Associated with Improved Glycemic Control by Direct-Acting Antiviral Agent Treatment in Egyptian Type 2 Diabetes Mellitus Patients with Chronic Hepatitis C Genotype 4.
Dawood AA1, Nooh MZ2, Elgamal AA3.

Full Text Article

The association of chronic hepatitis C virus (HCV) infection with type 2 diabetes mellitus (T2DM) was first reported in 1994. Little is known about the effect of direct-acting antiviral agents (DAAs) on glycemic control in T2DM patients. The aim of the present study was to evaluate the factors associated with improved glycemic control (IGC) by DAA treatment in Egyptian T2DM patients with chronic HCV genotype 4 infection.

This study included 460 T2DM patients with chronic HCV genotype 4 infection. Four hundred patients received DAAs and 60 patients did not receive DAAs. Patients with sustained virological response after 3 months of DAAs (378 patients) were allocated into two groups: first group included 292 patients (77.2%) with IGC and second group included 86 patients (22.8%) with non-improved glycemic control (NIGC).

In IGC group, 78 patients (26.7%) needed to decrease the dose of antidiabetic treatment. There were no significant differences between IGC and NIGC groups as regards age, sex, and body mass index. The percentage of patients with positive family history of T2DM, those with Child B class and duration of T2DM were significantly higher in NIGC group compared to IGC.

Diabetic patients receiving DAAs should be closely monitored for reduction of antidiabetic drugs especially insulin and sulfonylurea to avoid hypoglycemic events. Improvement of glycemic control with DAAs is more in patients without family history of T2DM, short duration of diabetes mellitus, and mild liver disease.

Risk for hepatocellular carcinoma after HCV antiviral therapy with DAAs: case closed?

Risk for hepatocellular carcinoma after HCV antiviral therapy with DAAs: case closed?
Raoel Maan, Jordan J. Feld

(2017), doi: 10.1053/j.gastro.2017.08.052

PDF Full Text Article
Provided by @HenryEChang via Twitter 

Several studies of patients treated with interferon -based therapy nicely documented that the risk for hepatocellular carcinoma (HCC) was markedly lower in patients who achieved SVR compared to those without SVR. 5-7 As a result, it was naturally assumed that with higher cure rates with DAAs, cancer rates would start to decline. It was therefore surprising and unsettling in 2016 to see a series of reports of unexpectedly high rates of ‘early’ HCC recurrence after ‘curative’ therapy as well as higher than expected rates of de novo HCC in patients who achieved SVR with DAAs. 8-10 Purported mechanisms focused on a loss of immune control due to clearance of HCV-specific T cells from the liver . 11 These disturbing reports created quite a stir in the HCV community. However data from three distinct prospective French cohorts found no increase in HCC recurrence among those with SVR com pared with untreated individuals and more importantly, found decreased incidence of de novo HCC in patients with cirrhosis who achieved SVR. 12 At this year’s International Liver Congress, multiple groups reported on HCC occurrence and recurrence after DAA-based therapy, with no clear consensus. The studies were generally small and of varying quality, leaving clinicians uncertain of how to advise their patients. In short: the HCV community needed larger cohort studies. In the current issue, Kanwal et al. have provided just that and have likely closed the case on the HCC-occurrence issue post-SVR

Full Text Articles
I highly suggest you follow Henry E. Chang on Twitter if you are interested in reading full text articles about the treatment and management of hepatitis C.

Monday, September 4, 2017

Baby Boomers - What About HCV, Vaccinations, Liver Health & All That Jazz 

Baby Boomers - What About HCV, Vaccinations, Liver Health & All That Jazz
Whether you're a baby boomer, new to hepatitis C, thinking about getting tested or just looking to close a few knowledge gaps, thanks for stopping by.

With the flu season on its way, the focus today is on vaccinations for adults with HCV, risk associated with the use of acetaminophen, aspirin and non-steroidal anti-inflammatory drugs (NSAIDs). Also a look at risky drinking and drug misuse among baby boomers in the UK and Australia. As for exercise, NPR talks about the dangers of prolonged sitting and risk of a host of diseases, yep, among baby boomers. Last but not least, getting tested for the hepatitis C virus.

Immunization Action Coalition
Vaccinations for adults with hepatitis C infection
One-page sheet describes vaccinations that HCV-positive adults need

Click On Image To Enlarge

Source Link - http://www.immunize.org/catg.d/p4042.pdf

Get Your Flu Shot
People 65 years and older, living with chronic liver disease, cirrhosis and liver transplant recipients are particularly at risk from the flu and are more susceptible to flu-related complications.

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

More information is available on the CDC website: Frequently Asked Flu Questions 2017-2018 Influenza Season

During The Flu Season Protect Your Liver
When the flu season hits home the first thing we do is run out to purchase an over-the-counter medication to help relieve cold and flu symptoms. According to the FDA, more than 600 medications used to help relieve pain and reduce fever, including prescription and over-the-counter (OTC) medications contain the active ingredient acetaminophen. When checking the label for "acetaminophen" it may not be spelled out in full on the container's prescription label. Abbreviations such as APAP, Acetaminoph, Acetaminop, Acetamin, or Acetam may be used instead.

To lower your risk of liver damage, the FDA suggests the following:
  • Follow dosing directions and never take more than directed; even a small increase in the recommended dose can cause liver damage.
  • Don't take acetaminophen for more days than directed.
  • Don't take more than one medicine that contains acetaminophen at a time. To determine if a medicine contains acetaminophen, read the "Drug Facts" label under "Active Ingredients". It will either say "acetaminophen" or "APAP." (APAP is an acronym for the chemical name, N-acetyl-paraaminophenol.)
  • Talk to your doctor before you take acetaminophen if you drink three or more alcoholic beverages every day, have liver disease, or take warfarin, a blood thinner. Together warfarin and acetaminophen may raise your risk of bleeding.
For a complete list of drug brand names containing acetaminophen, click here.

Tylenol & Viral Hepatitis
Hepatitis C Online is a great site with educational tools to learn more about diagnosis, treatment and HCV management. The following document addresses acetaminophen, aspirin and non-steroidal antiinflammatory drugs (NSAIDs) for people with or without cirrhosis.

Acetaminophen (Tylenol) is a known hepatotoxin that can cause clinically important hepatotoxicity, either through an acute overdose or when taken on a regular basis (even at lower doses): in one large study that examined causes of acute liver failure, patients taking a dose less than 4 grams per day accounted for 7% of the total cases and in some were taking doses as low as 1 gram per day. Among healthy volunteers taking 4 grams per day for 14 days, more than 30% developed alanine aminotransferase (ALT) values in excess of 3 times the upper limit of normal. Concurrent alcohol use greatly increases the chance of acute or chronic acetaminophen-induced hepatotoxicity. Studies have also shown an increased risk of acute liver injury in patients with chronic hepatitis C following acetaminophen overdose, but none have examined the safety of long term, low dosages of acetaminophen in patients with chronic hepatitis C. Guidelines for the safe use of acetaminophen in HCV-infected persons do not exist. Considering many patients with chronic hepatitis C have limited pain treatment options, most experts believe low dosages of acetaminophen (up to two grams per day) can safely be used in most patients with chronic hepatitis C infection without cirrhosis; those with cirrhosis should limit their intake of acetaminophen to one gram per day. Patients drinking excess alcohol should avoid taking acetaminophen altogether. Clinicians should remind patients that many narcotic combination pills and over-the-counter cold and flu medications may contain acetaminophen. Patients taking acetaminophen should have laboratory monitoring for hepatotoxicity every 3 to 6 months.

Aspirin and Nonsteroidal Anti-inflammatory Medications:
A few different types of NSAIDs are available over the counter:
- Aspirin (Bayer, Bufferin, Excedrin) Each caplet of Excedrin Extra Strength Pain Reliever contains 250 milligrams (mg) of acetaminophen, 250 mg of aspirin, and 65 mg of caffeine
- Ibuprofen (Advil, Motrin IB)
- Naproxen (Aleve)

Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) are generally safe for patients with hepatitis C when taken at standard doses.  The one exception is in patients who have cirrhosis: NSAIDS and aspirin are best avoided in patients with cirrhosis, especially those with decompensated cirrhosis. In patients with decompensated cirrhosis, the use of NSAIDS and aspirin may further increase the inherent risk these patients have for developing nephrotoxicity and gastrointestinal bleeding. Patients with chronic hepatitis C who do not have cirrhosis may take aspirin or NSAIDs at low or standard recommended dosages, with food and water.  Those with cirrhosis who have short-term, minor pain should, in general, avoid taking aspirin or NSAIDs, but can take acetaminophen in this setting as long as the dose does not exceed one gram per day.  In the unfortunate situation involving a patient with cirrhosis who has joint or musculoskeletal pain unresponsive to acetaminophen, NSAIDs can be used for a very brief period of time if given at the lowest daily dose possible.
Download PDF, here.

Of Interest

Harvard Heart Letter
Daily aspirin users 75 or older: Consider taking a stomach-protecting drug
Research we're watching

Roughly half of Americans ages 75 or older take a daily, low-dose aspirin to prevent a heart attack or stroke. New research suggests these people might benefit from taking a stomach-protecting drug to prevent a higher-than-expected risk of gastro-intestinal (GI) bleeding.

The study, published online June 13, 2017, by The Lancet, involved nearly 3,200 people who were prescribed aspirin because of a previous heart attack or stroke. Researchers followed them for up to 10 years to see how many were hospitalized for bleeding — a well-known side effect of aspirin use. Upper GI bleeding usually results from a stomach ulcer, which can cause anemia, heartburn, and abdominal pain.

The risk of serious GI bleeding was much higher among people ages 75 or older compared with people ages 65 or younger. But bleeding events were much less common in people taking prescription heartburn drugs called proton-pump inhibitors, such as omeprazole (Prilosec) and esomeprazole (Nexium). These drugs can reduce GI bleeding by as much as 90%, according to the study authors.

Recommended Reading
HCV Advocate's fact sheet contains information about acetaminophen for people with chronic hepatitis B or C. In this article; It’s Flu Season: When You Have Hepatitis B, Too Much Tylenol Can Damage Your Liver, Christine Kukka explains the dangers of Tylenol for people living with hepatitis B. Or check out this article from Pharmacy Times about general risks associated with over-the-counter pain medications.

Baby Boomers Alcohol & Drug Misuse
A rise in alcohol and drug misuse among the over 50s (commonly known as “baby boomers”) is causing concern, warn experts.
Researchers at South London and Maudsley NHS Foundation Trust and Flinders University in Australia, say the number of people aged over 50 experiencing problems from substance misuse is growing rapidly, with the numbers receiving treatment expected to treble in the United States and double in Europe by 2020.

Commenting on the research, which appeared in the British Medical Journal (BMJ), Vanessa Hebditch, the British Liver Trust Director of Communications and Policy said,

“Urgent action is needed to tackle drink and drug misuse among baby boomers – this research adds to the growing body of data in the UK suggesting that alcohol and other substance misuse is increasing among those in their mid-50s and older.

The over 50s have seen a time when filling up your supermarket trolley with wine and drinking at home has become normalised so that is part of our culture and this all too easily becomes habit forming. Alcohol has become increasingly acceptable and affordable.

The British Liver Trust advises that one easy step that people can take is to make sure that they have two –three consecutive days off every week from drinking – this not only reduces overall units but stops dependency.

However, if we are to turn around the massive increases in liver disease that we are seeing as a result of drinking too much we also need Government measures which tackle the affordability, availability and promotion of alcohol.”

The research found that in both the UK and Australia, risky drinking is declining, except among people aged 50 years and older, they explain. There is also a strong upward trend for episodic heavy drinking in this age group.

With alcohol being the most common substance of misuse among older people, under-detection of alcohol problems is of immediate concern – and may increase further as baby boomers get older because of their more liberal views towards, and higher use of, alcohol, they write.

A lack of sound alcohol screening to detect risky drinking may result in a greater need for treatment, longer duration of treatment, heavier use of ambulance services, and higher rates of hospital admission.

Research suggests that treatment programmes adapted for older people with substance misuse were associated with better outcomes than those aimed at all age groups.

However, the authors point out that clinicians will need improved knowledge and skills in assessing and treating older people at risk of substance misuse.

“There remains an urgent need for better drug treatments for older people with substance misuse, more widespread training, and above all a stronger evidence base for both prevention and treatment,” they write.

“The clinical complexity of older adults with substance misuse demands new solutions to a rapidly growing problem. So far, there has been little sign of a coordinated international approach to integrated care,” they conclude.

Read the full article here

Baby Boomers - Walk A Little Each Day
Get Off The Couch Baby Boomers, Or You May Not Be Able To Later
In a study of sitting and walking ability that surveyed people ages 50 to 71 across 8 to 10 years, those who tended to sit the most and move the least had more than three times the risk of difficulty walking by the end of the study, when compared to their more active counterparts.

Some ended up unable to walk at all. The study appears in the current issue of The Journals of Gerontology: Medical Sciences
Continue reading the article, or listen to the audio posted today over at NPR....

HCV & Baby Boomers
USA Today
Most boomers infected with liver-damaging hepatitis C virus do not know it
Boomers grew up and became young adults before the virus was identified in 1989. So it is likely many were infected through medical procedures and transfusions before improved infection control techniques and blood screening nearly eliminated those risks, CDC says. 
Continue reading...

Most of the 3.5 million Americans living with hepatitis C are baby boomers born from 1945 to 1965. Baby boomers are five times more likely to be infected with hepatitis C than other age groups. 
CDC officials recommend Hepatitis C testing for the following groups of people:

1- People born from 1945 through 1965. 
2- Current or former injection drug users, including those who injected only once many years ago.
3- Recipients of clotting factor concentrates made before 1987, when more advanced methods for manufacturing those products were developed.
4- Recipients of blood transfusions or solid organ transplants before July 1992, when better testing of blood donors became available.
5- Chronic hemodialysis patients.
6- Persons with known exposures to HCV, such as
health care workers after needlesticks involving HCV-positive blood
recipients of blood or organs from a donor who tested HCV-positive

7- Persons with HIV infection.
8- Children born to HCV-positive mothers.
Learn More Here.....

New Hepatitis C Infections Nearly Tripled over Five Years
The rising number of hepatitis C infections are primarily a result of increasing injection drug use associated with America’s growing opioid epidemic, according to the federal Centers for Disease Control and Prevention. Over five years, the number of new infections has nearly tripled, reaching a 15-year high. The highest number of new infections are among 20- to 29-year-olds.

Until next time.

Sunday, September 3, 2017

Hepatitis C patients in the US and China, and factors influencing disease stage

The higher prevalence of truncal obesity and diabetes in American than Chinese patients with chronic hepatitis C might contribute to more rapid progression to advanced liver disease
Rao, E. Wu, S. Fu, M. Yang, B. Feng, A. Lin, R. Fei, R. J. Fontana, A. S. Lok, L. Wei First

Published: 22 August 2017
Full publication history DOI: 10.1111/apt.14273

In summary, our study found a higher per cent of US patients with chronic HCV infection had cirrhosis or HCC compared to Chinese patients even among patients with similar estimated duration of infection. We believe that a higher prevalence of concomitant fatty liver in the US patients may be a major contributor to this observed difference. Our findings if confirmed highlight that management of glycometabolic abnormalities should go hand in hand with anti-viral treatment for patients with chronic hepatitis C and concomitant obesity or diabetes.

View full text journal article online

Chronic hepatitis C virus (HCV) infection is the leading cause of cirrhosis and hepatocellular carcinoma (HCC) in the United States (US) and an emerging cause in China.

To compare the clinical characteristics of hepatitis C patients in the US and China, and factors influencing disease stage.

Prospective study of 2 cohorts of HCV patients recruited at 1 site in the US and 3 sites in China. Standardised questionnaire on risk factors and medical history were used and diagnosis of cirrhosis and HCC was based on pre-defined criteria.

One thousand nine hundred and fifty seven patients (1000 US and 957 China) were enrolled. US patients were more likely to be men (61.4% vs 48.5%), older (median age 57 vs 53 years), obese (38.4% vs 16.8%) and diabetic (21.8% vs 10.8%). A significantly higher per cent of US patients had cirrhosis (38.2% vs 16.0%) and HCC (14.1% vs 2.7%). Investigator estimated time at infection in US was 10 years earlier than in Chinese patients but US patients were more likely to have advanced disease even after stratifying for duration of infection. Study site in the US, older age, truncal obesity, diabetes and prior HCV treatment were significant predictors of advanced disease on multivariate analysis.

HCV patients in the US had more advanced liver disease than those in China. We speculate that underlying fatty liver disease may be a major contributor to this difference, and management of glycometabolic abnormalities should occur in parallel with anti-viral therapy to achieve optimal outcomes.

Saturday, September 2, 2017

Updates - Cochrane Rebuttal, Impact Of HCV Therapy On Fibrosis & OTC Pain Medications

September Newsletters & Blog Updates From Around The Web
Here is another look at must-read articles you might've missed over the last week.

Cochrane Rebuttal
As you may recall in July, a Cochrane Collaboration systematic review concluded achieving SVR (cure) for patients using hepatitis C direct-acting antivirals (DAAs) doesn't correlate with any long term benefits, a highly debated topic, check out each rebuttal, "here."

On Twitter
Sep 21, 2017
Tweeted by  Henry E. Chang: Recently, authors of Cochrane DAA review "changed" their conclusions but remain amazingly tone-deaf to what HCV community & experts are saying.

Click on image to enlarge

From the AGA Reading Room over at MedPage today, in this article: SVR Good Indicator of Hep C Treatment Benefit - just published; Experts blast Cochrane review suggesting inadequate evidence for effectiveness of direct-acting antivirals, read it here.

Recommended Reading
Treatment with DAAs reduces the risk of mortality in the first 18 months after the completion of treatment
Michael Carter
Published:10 August 2017
The study – published in Clinical Infectious Diseases – matched people who received therapy with all-DAA regimens with untreated controls. Mortality rates in the first 18 months after therapy were significantly lower among people who received DAAs. After controlling for other factors, treatment with DAAs was associated with a 57% reduction in the risk of death.

A recent Cochrane Collaboration systematic review concluded that, due to the lack of long-term follow-up studies, there was no evidence that DAAs prolonged life or reduced liver-related ill-health in people who achieved SVR to DAA treatment. The Cochrane review has been strongly criticised by European and United States associations of liver experts for ignoring the short-term nature of the studies of DAAS designed for registration and for ignoring previous evidence from the treatment of hepatitis C, which showed that achieving SVR to interferon-based treatment was associated with a reduction in the risk of death and liver disease......
Continue reading.....

In The Journals

Impact Of HCV Therapy On Fibrosis
In a prospective cohort study evidence suggest SVR (cure) using direct-acting antivirals (DAAs) is associated with regression of liver fibrosis, according to a study published in European Journal of Gastroenterology & Hepatology/Aug 29 2017; "Regression of liver fibrosis over a 24-wk period after completing direct-acting antiviral therapy in patients with HCV receiving care within the national hepatitis C elimination program in Georgia."

Achieving SVR using direct-acting antivirals (DAAs) is associated with regression in liver stiffness (LS), which could explain the clinical benefits associated with SVR. Our study also showed that irrespective of achieving SVR, liver damage will persist in a significant proportion of patients who had advanced fibrosis and cirrhosis at the time of HCV treatment initiation. Thus, early identification and treatment of patients with HCV infection can significantly prevent residual liver damage leading to the development of eventual hepatic complications.
LINK - Full text article
*PDF provided by Henry E. Chang via Twitter.

New Online

New England Journal Of Medicine
A Tale of Two Epidemics — HCV Treatment among Native Americans and Veterans
Brigg Reilley, M.P.H., and Jessica Leston, M.P.H.
PDF Download
Audio Interview
In light of ongoing debates about health care budgets and rising drug prices, a current public health crisis can provide useful insights. For patients who get their health care through two separate federal agencies, the hepatitis C virus (HCV) epidemic is unfolding in vastly different ways. In recent years, the Department of Veterans Affairs (VA) health care system has mounted a response to HCV that should be the envy of any health system, public or private. On the other hand, the Indian Health Service (IHS), an agency that serves American Indians and Alaska Natives, is struggling to meet the needs of its patients with HCV.
Continue reading....

New At Hepatitis C Online
Vosevi and Mavyret
Information on Gilead's newly FDA approved Vosevi and AbbVie's Mavyret is now available.

Australian recommendations for management of HCV have recently been updated.

Liver Health

Pharmacy Times
OTC Pain Medications: The Pros and Cons
AUGUST 30, 2017
Kathleen Kenny, PharmD, RPH
Two types of OTC pain medications are available. The first is acetaminophen (N-acetyl-p-aminophenol, or APAP), and the second is nonsteroidal anti-inflammatory drugs (NSAIDs), which include ibuprofen, naproxen, and aspirin.

Acetaminophen works by inhibiting the synthesis of prostaglandins, which help transmit pain signals and induce fever, thereby easing pain and lowering fever. Acetaminophen will not, however, reduce swelling and inflammation.5 Acetaminophen may be a good choice to treat headaches, arthritis pain, and fever.5 Certain patients should not take APAP, including those with liver disease, individuals taking blood thinners, people drinking three or more alcoholic beverages daily, and those with an allergy to APAP.6
Continue reading......

HCV Advocate
Acetaminophen and Your Liver
What does all this mean for people with chronic hepatitis B or C?
Doctors often recommend acetaminophen to relieve symptoms such as body aches and fever, which are common side effects of interferon therapy. For most people, acetaminophen is safe and effective. According to the FDA’s Dr. John Senior, “It’s very clear the average dose for the average person is very safe. But we are not all average people.” For many individuals, acetaminophen is still a good choice, especially considering that other over-the-counter pain relievers can cause problems of their own (such as stomach bleeding with aspirin and nonsteroidal anti-inflammatory drugs). Many HCV providers now recommend that their patients with HCV or other forms of liver disease take a somewhat lower dose than is generally recommended for people with healthy livers.
Continue reading.....

Of Interest
Harvard Heart Letter
Daily aspirin users 75 or older: Consider taking a stomach-protecting drug
Research we're watching

Roughly half of Americans ages 75 or older take a daily, low-dose aspirin to prevent a heart attack or stroke. New research suggests these people might benefit from taking a stomach-protecting drug to prevent a higher-than-expected risk of gastro-intestinal (GI) bleeding.

The study, published online June 13, 2017, by The Lancet, involved nearly 3,200 people who were prescribed aspirin because of a previous heart attack or stroke. Researchers followed them for up to 10 years to see how many were hospitalized for bleeding — a well-known side effect of aspirin use. Upper GI bleeding usually results from a stomach ulcer, which can cause anemia, heartburn, and abdominal pain.

The risk of serious GI bleeding was much higher among people ages 75 or older compared with people ages 65 or younger. But bleeding events were much less common in people taking prescription heartburn drugs called proton-pump inhibitors, such as omeprazole (Prilosec) and esomeprazole (Nexium). These drugs can reduce GI bleeding by as much as 90%, according to the study authors.

Blog Updates

HEP - Blog Updates
Hep is an award-winning print and online brand for people living with and affected by viral hepatitis. Offering unparalleled editorial excellence since 2010, Hep and Hep Magazine are the go-to source for educational and social support for people living with hepatitis.

Hepatitis C and Cirrhosis; Stages of Liver Damage
August 30, 2017 • By Connie M. Welch
Battle scars from hepatitis C. At times they can leave scars after going through a long journey with hepatitis C. No doubt each Hepatitis C patient transforms into a warrior on many fronts. Having hepatitis C is one of the leading causes for cirrhosis, cancer and liver transplants.

Sharing My Deepest Secrets
September 1, 2017 • By Carleen McGuffey
Like most people with Hepatitis-C I didn’t learn my status until decades after I had contracted the virus. By the time I was diagnosed I had changed my life so thoroughly that during the very few times I would even think about my wild years it would literally feel like I was considering a whole other person.

On Overdose Awareness Day, Let’s Choose Treatment Over Punishment
August 29, 2017 • By NVHR
People like Andrea Roberts, a 35-year-old mother of two children. Ms. Roberts had been incarcerated for about 6 weeks at LaPorte County Jail in Indiana, unable to afford bail, and had 2 weeks remaining until her release. Then, on July 15, 2017, a jail supervisor discovered her “unresponsive” in her cell. Within 30 minutes, after CPR was attempted, Ms. Roberts was pronounced dead.

To view a list of all bloggers please click here.

Médecins Sans Frontières/ Doctors Without Borders (MSF)
Médecins Sans Frontières(MSF) is an international, independent, medical humanitarian organisation. We offer assistance to people based on need, irrespective of race, religion, gender or political affiliation. Our actions are guided by medical ethics and the principles of neutrality and impartiality.

My name is Theresa Chan. I’m a family doctor and hospitalist from the United States. Working with MSF in the field has been a long-held dream. For most of 2017, I’ll be in Phnom Penh, Cambodia, where I’ll be working with a multi-national MSF staff to bring cutting-edge hepatitis C treatment to the people of Cambodia.

Fighting Hepatitis in Cambodia: Yellow as a Duck

'“This is the doctor,” said the son, pointing to me. The man in the bed made a weak attempt to greet me with his palms pressed together in the traditional Cambodian manner. “Hello,” I said, “may I listen to you?” He said yes. I listened to his faint breaths. He dozed off despite my prodding, the lids drawing like curtains over his yellow eyes.'

Cambodia: A Lot Happens On Our Days Off

Theresa is in Cambodia, where she's working at the Doctors without Borders / MSF hepatitis C clinic. She blogs about her tiniest patient so far, and why doctors are never entirely off duty...

At HepatitisC.net we empower patients and caregivers to take control of Hepatitis C by providing a platform to learn, educate, and connect with peers and healthcare professionals

Pain: The Invisible Symptom
September 1, 2017
Pain is one of the lesser known symptoms many living with hepatitis C or who have undergone treatment experience. Pain can range from muscles aches and joint pain to neuropathy.

Truth and Lies about Hepatitis C
By Karen Hoyt - September 1, 2017
There can be a lot of confusion when you are first diagnosed with the Hepatitis C Virus. It takes time to figure out what is the truth and what is a lie..

Tips for Choosing a Health Care Provider with Hep C
By Karen Hoyt
Do you have faith in your medical provider? Does it seem like they have your best interest at heart, or are you just a number to them? There are few relationships as...

View all blog updates, here.

Hepatitis B Foundation
The Hepatitis B Foundation is a national nonprofit organization dedicated to finding a cure for hepatitis B and helping to improve the lives of those affected worldwide through research, education and patient advocacy. Our monthly electronic newsletter, provides research updates, healthy liver tips, information on public health initiatives, and other HBF news.

Diagnosed with Hepatitis B? Preventing Transmission to Others Learning the HBV Basics, Transmission Part II
Part I discussed how hepatitis B is transmitted and may have helped you determine how you were infected with HBV.   In Part II we will discuss the people closest to you who may be susceptible to your infection.
Continue reading....

View all updates, here.

Creating a World Free of Hepatitis C
Welcome to my website and blog. My name is Lucinda Porter and I am a nurse committed to raising awareness about hepatitis C. I believe that we can create a world free of hepatitis C. We do this together, one step at a time.

New Healthcare Provider? Questions to Ask
Are you going to see a new healthcare provider? If so, you may have questions for her or him.

Acts More Powerful Than Hurricane Harvey
Recently, Hurricane Harvey flooded, buffeted, and devastated southeastern Texas and nearby coastal areas. Then Harvey moved eastward to cause more damage. The toll is enormous and continues to grow as those communities cope with Harvey’s wreckage. Many have donated money and time in response to these needs. However, there is more that you can do—be a blood, tissue and organ donor.

Just For Fun

MD Whistleblower
Michael Kirsch, M.D.
I am a full time practicing physician and writer. I write about the joys and challenges of medical practice including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When I'm not writing, I'm performing colonoscopies

Yikes! There's Food Stuck in My Throat! The Steakhouse Syndrome Explained
While I typically offer readers thoughts and commentary on the medical universe, or musings on politics, I am serving up some lighter fare today. Hopefully, unlike the patient highlighted below, you will be able to chew on, swallow and digest this post. If this blog had a category entitled, A Day in the Life of a Gastroenterologist, this piece would reside there.

View additional blog updates, here.

September Newsletters 
Whether you're looking for research, or easy-to-read articles on liver health, these newsletters reflect the most recent updates about viral hepatitis.

HCV Advocate
The HCV Advocate newsletter is a valuable resource designed to provide the hepatitis C community with monthly updates on events, clinical research, and education.

September Issue 
AbbVie’s Mavyret Approved.
Healthwise: Hepatitis C Is Threatening Our Youth
Under The Umbrella: Education in the HCV Treatment
Drug Pipeline


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Homepage - HCV Medications Blog
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Homepage - HBV Advocate

Weekly Bull
HepCBC is a non-profit organization run by and for people infected and affected by hepatitis C. Our mission is to provide education, prevention and support to those living with HCV.

Latest Issue: Weekly Bull

The New York City Hepatitis C Task Force
The New York City Hepatitis C Task Force is a city-wide network of service providers and advocates concerned with hepatitis C and related issues. The groups come together to learn, share information and resources, network, and identify hepatitis C related needs in the community. Committees form to work on projects in order to meet needs identified by the community.

September Hep Free NYC Newsletter

HCV Action - UK
HCV Action brings together hepatitis C health professionals from across the patient pathway with the pharmaceutical industry and patient representatives to share expertise and good practice.

Public Health England has published its ninth annual Hepatitis C in the UK report, providing an update on the number of new hepatitis C infections and efforts to reduce mortality from HCV.

British Liver Trust
The British Liver Trust is the leading UK liver disease charity for adults – we provide information and support; increase awareness of how liver disease can be prevented and promote early diagnosis; fund and champion research and campaign for better services.

September Newsletter

News Updates
New research into end of life care for people with liver disease
Research published today has highlighted limitations in the care provided to people with advanced liver disease who are in the last year of life.

New study finds 86% of public support mandatory labelling on alcohol
As part of the Alcohol Health Alliance (AHA), the British Liver Trust has been …

Concerns over rise of substance misuse in “baby boomers”
A rise in alcohol and drug misuse among the over 50s (commonly known as “baby boomers”) is causing concern, warn experts. Researchers at South London …

The Hepatitis Foundation of New Zealand
The Hepatitis Foundation is a not-for-profit organisation which provides care for people living with hepatitis B. The Foundation provides a long-term follow-up programme for people living with chronic hepatitis B. This Programme provided Hepatitis B patients with ongoing monitoring and follow-up to help improve health outcomes.

Hepatitis symptom series: Depression and anxiety

Hep C Stories
James Story
I was diagnosed with hepatitis C in 2004. I had gone to my doctor because I was feeling a bit run down and he took some blood and put me on a vitamin supplement. At the time, I was working part time, studying full time and doing volunteer work. Being so busy, I had forgotten all about the blood test until I was contacted by the health department to inform me that I had been diagnosed hepatitis C positive and to get in touch with my doctor.

GI & Hepatology News
Over 17,000 gastroenterologists and hepatologists rely on GI & Hepatology News every month to cover the world of medicine with breaking news, on-site medical meeting coverage, and expert perspectives both in print and online. The official newspaper of the AGA Institute was launched in partnership with IMNG in January 2007.

View all newsletters, here.

Healthy You

In a study of sitting and walking ability that surveyed people ages 50 to 71 across 8 to 10 years, those who tended to sit the most and move the least had more than three times the risk of difficulty walking by the end of the study, when compared to their more active counterparts.

Some ended up unable to walk at all. The study appears in the current issue of The Journals of Gerontology: Medical Sciences.

Article here, listen below or here

Check back for updates, enjoy the rest of your weekend!

Friday, September 1, 2017

Thank You Hepatitis Foundation International For 23 Years

Imagine some twenty years ago being diagnosed with hepatitis C, a virus patients knew little about, in addition a disease lacking safe and effective treatments.

In 1994 an estimated 2.7 million persons in the United States were thought to be chronically infected with HCV, an estimate that might be disputed today. We had millions of people with scarce information about one serious disease, not until HCV advocacy began to emerge and premier websites were launched, did vulnerable patients get the help they needed to make difficult medical decisions.

The Best Of The Best Continue On
Today those early websites continue to do what they do best, in 1995 National AIDS Treatment Advocacy Project (NATAP) was educating us about HIV and Hepatitis, HepCBC in 1996 was for patients by patients, HCV Advocate opened its doors in 1997 with articles we could understand, both HIVandHepatitis and Caring Ambassadors Program (Hepc Challenge) were up and running by 1999.

Hepatitis Foundation International (HFI)
The site that started it all in 1994 recently closed this past July, after 23 years of educating the world about viral hepatitis, Hepatitis Foundation International (HFI) bids farewell to all the people they served so well. 

I remember visiting HFI on a daily basis, reading about disease progression, genotypes, treatment, and when it was time for that liver biopsy no one wanted, I read an article that left me feeling confident, turning my fear into determination. I'm not sure if that particular article was written by our admired and much loved Liver Lady (Thelma King Thiel), but many articles during that time were. From Thelma King Thiel, former CEO of the American Liver Foundation, established the Hepatitis Foundation, bringing early awareness about viral hepatitis to the public. The foundation gave us patient friendly articles about liver health, along with basic information about viral hepatitis, liver function, but more importantly - it gave us hope. 

Thank you to all the good people involved with the Hepatitis Foundation, each newsletter, DVD and article found on HFI's website was invaluable. The foundation made a real difference in the lives of countless people, and changed the course of viral hepatitis.

Press Release From HFI:








Regression of liver fibrosis over a 24-wk period after completing direct-acting antiviral therapy in patients with HCV receiving care within the national hepatitis C elimination program in Georgia

Recommended Reading
September 8, 2017
In summary, our study found that successful treatment of chronic HCV with DAA therapy is associated with improvement in liver stiffness, assessed by VCTE measured serially over the first 12 months after treatment. Continued improvement in VCTE scores between EOT and12 months post-treatment suggests possible early regression of fibrosis in addition to resolution of inflammation that occurs soon after starting HCV therapy. Longer-term data are needed to determine whether improvement in liver stiffness continues beyond 1 year, and larger studies are needed to elucidate factors associated with rapidity and magnitude of improvement.

Regression of liver fibrosis over a 24-week period after completing direct-acting antiviral therapy in patients with chronic hepatitis C receiving care within the national hepatitis C elimination program in Georgia: results of hepatology clinic HEPA experience.
Dolmazashvili E, et al. Eur J Gastroenterol Hepatol. 2017.

Eur J Gastroenterol Hepatol. 2017 Aug 29. doi: 10.1097/MEG.0000000000000964.
[Epub ahead of print]

PDF provided by Henry E. Chang via Twitter.

OBJECTIVE: We assessed the impact of direct-acting antiviral (DAA) therapy on liver fibrosis regression measured by transient elastography (TE) in patients with chronic hepatitis C virus (HCV) infection.

PATIENTS AND METHODS: A prospective cohort study was carried out in HCV monoinfected patients with advanced liver fibrosis or cirrhosis receiving interferon (IFN)-containing or IFN-free DAA therapy. Liver stiffness (LS) score more than 14.5 kPa indicated LS-defined cirrhosis. The primary outcome was improvement in liver stiffness measurement (LSM) at week 24 after treatment measured as (a) decrease in the median LS compared with baseline and (b) at least a 20% decrease in LSM compared with baseline. A multivariate logistic regression model was utilized to identify the factors associated with at least a 20% improvement in LSM.

RESULTS: Of a total of 304 patients, 172 (56.6%) had LS-defined cirrhosis before treatment. LSM decreased from the baseline median value of 16.9 (interquartile range: 11.8-27.7) kPa to a post-treatment week 24 score of 11.9 (interquartile range: 8.2-20.9) kPa (P<0.0001). Of a total of 304 patients, 198 (65.1%) achieved at least a 20% reduction in LS. In multivariate logistic regression analysis, sustained virological response (SVR) was associated significantly with this reduction (P<0.0001). The addition of IFN to the treatment regimen had no impact on the decrease in LSM. Despite decreasing baseline LSM, more than half of the LS-defined cirrhotic patients remained cirrhotic at week 24 after treatment.

CONCLUSION: In patients with advanced fibrosis, pretreatment LS significantly reduced during DAA therapy. SVR was the only independent factor associated with the regression in LSM. However, irrespective of achieving SVR, liver damage still persisted in a substantial proportion of patients. Thus, early treatment of HCV-infected patients can significantly prevent residual liver damage.