Drinking Coffee Reduced Mortality in Treated HIV-Hepatitis C Co-Infected Patients

MedicalResearch.com Interview with:

Coffee Wikipedia image

Coffee
Wikipedia image

Patrizia Carrieri PhD
INSERM U912 – ORS PACA
IHU – Faculté de Médecine
Marseille, France

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study is based on the longitudinal data of the French  ANRS HEPAVIH cohort of patients with HIV and Hepatitis C co-infection. This cohort was set up thanks to a collaboration between INSERM (National Institute of health and medical research) UMR912 in Marseille, the ISPED (public health and epidemiology institute) in Bordeaux and several hospital/university sites. Our INSERM team in Marseille is specialized in the study of the impact of behaviors on HIV and HCV outcomes, including mortality.

We could think that HCV cure was enough to reduce mortality in HIV-HCV patients as the mortality risk was 80% lower in those who were cured of (i.e. who “cleared”) Hepatitis C thanks to treatment.

However, our study showed that, even after HCV cure, sociobehavioral factors still matter: drinking at least 3 cups of coffee a day was associated with a 50% reduction in mortality risk as well as not smoking which was also associated with a reduced mortality risk. This association between elevated coffee intake and reduced mortality risk is probably due to the properties of polyphenols contained in coffee which can protect the liver and also reduce inflammation.

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Hepatitis C Can Be Safely Treated By Primary Care Providers

MedicalResearch.com Interview with:

Sarah Kattakuzhy, MD Clinical and Administrative Director, DC PFAP Hepatitis Clinical Research Program Assistant Professor, Institute of Human Virology Division of Infectious Diseases University of Maryland 

Sarah Kattakuzhy, MD
Clinical and Administrative Director, DC PFAP Hepatitis Clinical Research Program
Assistant Professor, Institute of Human Virology
Division of Infectious Diseases
University of Maryland  

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The recent introduction of highly effective, well-tolerated direct-acting antiviral (DAA) therapy for hepatitis C virus infection has raised the possibility of rapid treatment expansion and widespread cure. However, the current specialist workforce is insufficient to meet the treatment demands of the 2.7 million Americans living with HCV infection. Several studies of partial task shifting—shared treatment between specialists and primary care providers—have demonstrated success in improving access to HCV care. Yet, information on the success of nonspecialists practicing independent of specialist supervision is limited.

The primary objective of ASCEND was to evaluate the efficacy of Hepatitis C treatment managed independently by 3 community-based provider types—nurse practitioners (NPs), PCPs, and specialists—after a succinct, guideline-driven educational intervention, set within a real-world, urban population.

In this investigation, 516 out of 600 patients achieved SVR, a response rate of 86% (95% CI, 83.0% to 88.7%), with no major safety signals. Rates of SVR were consistent across the 3 provider types—NPs: 89.3% (CI, 83.3% to 93.8%); PCPs: 86.9% (CI, 80.6% to 91.7%); and specialists: 83.8% (CI, 79.0% to 87.8%). Patient loss to follow-up was the major cause of non-SVR.

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High Hepatitis C Cure Rate Using Elbasvir plus Grazoprevir In Chronic Kidney Disease

MedicalResearch.com Interview with:

Annette Bruchfeld MD, PhD Senior Consultant Associate Professor Karolinska Institute Dept of Renal Medicine, M99 Karolinska University Hospital Huddinge Stockholm, Sweden

Dr. Bruchfeld

Annette Bruchfeld MD, PhD Senior Consultant
Associate Professor
Karolinska Institute
Dept of Renal Medicine, M99
Karolinska University Hospital Huddinge
Stockholm, Sweden

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In patients with stage 4–5 chronic kidney disease(CKD), hepatitis C virus (HCV) infection can accelerate the decline in kidney function, impair health-related quality of life (HRQOL), and decrease survival chances of both patients and grafts in transplantation recipients.

In this study additional data from patients with stage 4–5 chronic kidney disease undergoing treatment for HCV infection in the C-SURFER study, including HRQOL and resistance analyses was presented not previously reported for this patient population with gwnotype 1 infection.

The final virological analysis of this study indicated a high cure rate with sustained virological response at 12 weeks after the end of treatment (SVR12) in more than 98% of all treated patients. Even in patients with resistance-associated substitutions (RASs) the SVR was high in 11 (84·6%) of 13 patients genotype 1a infection.

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Single Tablet Triple Therapy Effective For Refractory Hepatitis C

MedicalResearch.com Interview with:
Dr Marc Bourlière

Professeur Associé CHP (Associate Professor PHC)
Chef de service (Head of Department)
Hôpital Saint Joseph
Hépato-Gastroentérologie

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The majority of HCV patients can be cured with combinations of direct-acting antivirals (DAAs); however, there is still 5 to 10% of patients who relapse after treatment with DAAs for whom there are currently no approved therapeutic options available.

In these two international phase 3 studies, we have demonstrated that a single tablet triple regimen combining sofosbuvir, velpastasvir and voxilaprevir (a pangenotypic protease inhibitor) for 12 weeks cured 96% of the patients who had relapsed following prior treatment with DAA regimens including NS5A inhibitors and 98% of the patients who had relapsed following prior treatment with DAA regimens without an NS5A inhibitor. These two studies demonstrate that a pangenotypic retreatment option for this patient population could be soon available.

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Genetic Marker Can Determine Cirrhosis Patients Who Do Not Benefit From Hepatitis C Cure

MedicalResearch.com Interview with:

Dr. Winston Dunn, MD Assistant Professor The University of Kansas Medical Center

Dr. Dunn

Dr. Winston Dunn, MD
Assistant Professor
The University of Kansas Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: It is widely believed that everyone with HCV can be cured with the medications now a day. But sadly, about 5% of the patients already have very bad damage done to the liver. We call this decompensated cirrhosis. Our medication is still very effective in curing the virus, but in decompensated cirrhosis, curing the virus is not always enough.

Only about half to two-thirds of patients with decompensated cirrhosis clinically gets better, but the remaining struggles along or even gets worse after the cure. That is the problem. So, our research was to understand why that was.

We used genetic factor to predict which patient would get better and which patient would not. We found that a gene previous found to be predictive of fatty liver and fibrosis is also predictive of recovery in this setting.

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Hepatitis C Can Be Successfully Treated in Homeless Population

MedicalResearch.com Interview with:
Joshua Barocas, MD
Clinical and Research Fellow
Division of Infectious Diseases
Massachusetts General Hospital and Brigham and Women’s Hospital 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Boston Health Care for the Homeless Program began treating HCV-infected individuals with the new oral medications.

Based on clinical experience and previous experience with medication adherence in the setting of HIV, there were no clinical reasons that homeless persons should be excluded.

As a result, we began to track the experience of treated individuals including cure, side effects, and adherence.

We found that in the initial group of treated individuals, 62 of 64 persons achieved SVR. There were minimal side effects and adherence was excellent

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Most Baby Boomers Still Not Receiving Recommended Hepatitis C Testing

MedicalResearch.com Interview with:

Stacey Fedewa, MPH Strategic Director, Screening and Risk Factor Surveillance Surveillance and Health Services Research program American Cancer Society

Dr. Fedewa

Stacey Fedewa, Ph.D.
Strategic Director, Risk Factors & Screening Surveillance
American Cancer Society
Atlanta GA 30303-1002

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: About 3.5 million people in the US are chronically infected with Hepatitis C, the majority are unaware of their infection despite the availability of treatments that may reduce the risk of HCV-related diseases such as liver cancer. About 80% of those with the infection are baby-boomers (people born between 1945-1965). To help reduce growing burden of these HCV-associated diseases, the U.S. Preventive Services Task Force (USPSTF) recommended one-time HCV testing for baby-boomers in 2013.

We examined nationwide data between 2013-2015 to see if HCV testing in baby-boomers has increased since the USPSTF recommendation.  We found that only about 14% of baby-boomers had ever been tested in 2015, which represented a very small increase from 2013 where testing prevalence was about 12%. In 2015, we estimated that there were about 76.2 million baby boomers and only 10.5 reported ever receiving HCV testing.

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Incidence, Risk factors and Prevention of Hepatitis C Reinfection

MedicalResearch.com Interview with:
Naveed Zafar Janjua, MBBS, MSc, DrPH
Senior Scientist, Clinical Prevention Services
BC Centre for Disease Control
Clinical Associate Professor, School of Population and Public Health
University of British Columbia

MedicalResearch.com: What is the background for this study?

Response: Hepatitis C is a viral infection that affects the liver. About quarter of people infected with hepatitis C clear their infection spontaneously rest develop chronic infection. Left untreated, hepatitis C could results in scarring of liver (liver cirrhosis), liver cancer or death. New anti-viral drugs are highly effective in curing hepatitis C, about than 95 per cent of those treated can be cured. However, people who engage in high risk activities such as people who inject drugs (PWID) remain at risk of reinfection. As the cost of treatment is very high, re-infection is a concern among physicians and policy makers in Canada and around the world.

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Single-Step Testing Can Improve Access To Hepatitis C Testing

MedicalResearch.com Interview with:

J. Morgan Freiman, MD Infectious disease research fellow Boston Medical Center

Dr. Morgan Freiman

J. Morgan Freiman, MD
Infectious disease research fellow
Boston Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Freiman:  There are 130-150 million persons infected with chronic HCV with 75% of all cases occurring in low- and middle- income countries (LMICs). Diagnosis is a 2-step process that starts with screening for exposure with an assay that detects antibodies to HCV (anti-HCV), followed by nucleic acid testing (NAT) for persons with reactive anti-HCV to measure HCV ribonucleic acid (RNA) and confirm active viremia.

In LMICs diagnostic capacity is low, and fewer than 1% of patients are aware of their infection. Additionally, a significant proportion of patients who test positive for anti-HCV are lost to follow-up before nucleic acid testing. The 2-step diagnostic process is thus a major bottleneck to the HCV cascade of care. Testing for hepatitis C virus core antigen (HCVcAg) is a potential replacement for NAT.

Our systematic review evaluated the accuracy of diagnosis of active HCV infection among adults and children for 5 commercially available HCVcAg tests compared with NAT. We found that HCVcAg assays with signal amplification have high sensitivity, high specificity, and have the potential to replace NAT in settings with high HCV prevalence.

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Caffeine May Slow Progression of Liver Fibrosis in Chronic Hepatitis C

MedicalResearch.com Interview with:

Sikarin Upala MD, MS, LLB Internal Medicine, Bassett Medical Center and Columbia University College of Physicians and Surgeons, Cooperstown, New York Preventive and Social Medicine Mahidol University, Bangkok, Thailand

Dr. Sikarin Upala

Sikarin Upala MD, MS, LLB
Internal Medicine, Bassett Medical Center and Columbia University College of Physicians and Surgeons, Cooperstown, New York
Preventive and Social Medicine
Mahidol University, Bangkok, Thailand

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Upala: Chronic hepatitis C virus infection is the most common cause of chronic liver disease and cirrhosis as well as the most common cause of liver transplantation in the United States. As caffeine has been found to be related to decreased liver enzymes, chronic liver disease,cirrhosis, and risk of hepatocellular carcinoma in several liver disease pathologies. There is inconclusive findings on the effect of caffeine on hepatitis C infected patients. Thus, we conducted a systematic review and meta-analysis to summarize the effect of caffeine consumption in patients with chronic hepatitis C.

We found that caffeine consumers have a 61% reduced risk of developing advanced hepatic fibrosis, which is one of the consequence of chronic hepatitis C. Our meta-analysis result is in the same way with other studies who found that coffee consumption could prevent the development of hepatic fibrosis in patients with liver disease. However, we cannot conclude about the effect of caffeine on HCV viral load as there is not enough information.

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Hepatitis C Raises Risk of HPV Head and Neck Cancers

MedicalResearch.com Interview with:

Harrys A. Torres, MD, FACP, FIDSA Associate Professor Director of Hepatitis C Clinic Department of Infectious Diseases, Infection Control and Employee Health The University of Texas MD Anderson Cancer Center Houston TX 77030

Dr. Harrys Torres

Harrys A. Torres, MD, FACP, FIDSA
Associate Professor
Director of Hepatitis C Clinic
Department of Infectious Diseases, Infection Control and Employee Health
The University of Texas MD Anderson Cancer Center
Houston TX 77030

Medical Research: What is the background for this study? What are the main findings?

Dr. Torres: Hepatitis C virus (HCV) is an oncogenic virus and is associated with an increased risk of liver cancer and certain types of non-Hodgkin lymphomas. In 2009, at MD Anderson Cancer Center, we set up the first clinic in the United States, and probably in the world, specifically devoted to managing HCV infection in cancer patients. In the clinic, we expected to see a number of patients with liver cancers and non-Hodgkin’s lymphoma, as these have documented associations with HCV. Unexpectedly, we saw a high number of HCV-infected patients with head and neck cancers, and wondered whether there was an undiscovered association between having the infection and head and neck cancers. To explore this, we conducted a case-control study using 409 head and neck cancer subjects (164 oropharyngeal, 245 non-oropharyngeal [oral cavity, nasopharynx, larynx] cancers) and 694 control subjects with other smoking-associated cancers (378 lung, 168 esophagus, and 148 urinary bladder cancers), and compared the prevalence of HCV infection in the two groups. We observed a high prevalence of HCV infection in oropharyngeal (14%) and non-oropharyngeal (20%) cancer patients when compared to control subjects (6.5%). After adjusting for confounders such as smoking, alcohol intake, and socioeconomic status, HCV-infected individuals were 2.04 times more likely to have oropharyngeal cancers and 2.85 times more likely to have non-oropharyngeal cancers. Of note, HCV was associated only with patients with oropharyngeal cancers that tested positive for human papilloma virus, which is one of the main virus linked with increased risk of oropharyngeal cancers.

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All Baby Boomers Should Be Screened At Least Once For Hepatitis C

Dr Waridibo Allison MD PhD Department of Medicine, Division of Infectious Diseases and Immunology New York Langone University School of Medicine New York, NY 10016MedicalResearch.com Interview with:
Dr Waridibo Allison MD PhD
Department of Medicine, Division of Infectious Diseases and Immunology
New York Langone University School of Medicine
New York, NY 10016

Medical Research: What is the background for this study? What are the main findings?

Dr. Allison: It was found that among 383 baby boomers presenting to a large urban emergency department in New York City the prevalence of HCV antibody reactivity was 7.3%. Only four patients were successfully linked to care and only one patient was started on HCV treatment. The study highlights the possibility that there may be problems in linking patients to care from the ED compared to other clinical settings such as primary care and inpatient settings. It was concluded that only with strategies to improve linkage to care could a screening program for baby boomers be recommended in the ED where the study was carried out.

The study additionally had a qualitative component and, via structured interviews, evaluated knowledge about HCV infection amongst baby boomers presenting to the ED. Overall knowledge was good but some misconceptions about transmission persisted and many patients mistakenly believed that there is a vaccine for hepatitis C.

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Screening and Treating Hepatitis C In Prisons Cost Effective For Wider Community

Dr. Tianhua He MD Beijing China, 100005

Dr. Tianhua He

MedicalResearch.com Interview with:
Dr. Tianhua He MD
Beijing China, 100005

Medical Research: What is the background for this study? What are the main findings?

Response: The prevalence of Hepatitis C (HCV) infection is high (17%) in US prisons. And about 30% of all HCV-infected persons in US spend part of the year in correctional facilities.

However, most state prisons offer no routine screening for Hepatitis C. Undiagnosed and untreated inmates, after releasing, will contribute to the spread of the disease in society. HCV infection is now the leading cause of liver cancer, and the most common indication for liver transplant. With the recently launched highlyy effective antiviral drugs, previous studies have shown that treating infected prisoners was cost-effective. However, no studies yet have evaluated the effect of interventions including screening and treatment among prisoners on prevention of Hepatitis C transmission and reduction of disease burden, neither the cost effectiveness of such interventions.

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New HCV Treatment Improves Hepatitis C Cirrhosis

Dr. Michael P. Curry, MD Medical Director for Liver Transplantation Harvard Medical Faculty Physicians Beth Israel Deaconess Medical Center

Dr. Curry

MedicalResearch.com Interview with:
Dr. Michael P. Curry, MD
Medical Director for Liver Transplantation
Harvard Medical Faculty Physicians
Beth Israel Deaconess Medical Center

Medical Research: What is the background for this study? What are the main findings

Dr. Curry: As the population that is infected with the hepatitis C virus (HCV) ages, the number of patients with decompensated cirrhosis is expected to increase. For many years, the only treatment option for these patients was liver transplantation. Recently, however, clinical trials of newly approved direct-acting antiviral agents (DAAs) have shown that it is possible to treat HCV infection safely and effectively in patients with decompensated cirrhosis. We conducted this Phase 3, open-label trial to assess the efficacy and safety of a fixed dose combination of sofosbuvir/velpatasvir with or without ribavirin for 12 weeks or sofosbuvir/velpatasvir for 24 weeks in patients infected with hepatitis C virus genotypes 1 through 6 and with decompensated cirrhosis. We found that treatment with sofosbuvir/velpatasvir resulted in high rates of sustained virologic response (SVR) and early improvements in hepatic function in this patient population. SVR rates were 83 percent  in patients who received sofosbuvir/velpatasvir for 12 weeks, 94 percent among those who received sofosbuvir/velpatasvir plus ribavirin, and 86 percent among those who received sofosbuvir/velpatasvir for 24 weeks.

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Combination Medication Effective For Hepatitis C Recurrence After Liver Transplantation

MedicalResearch.com Interview with:
Dr. Audrey Coilly MD
Fellow at the Centre Hepato-Biliaire
Paul Brousse Hospital
Villejuif, France

Medical Research: What is the background for this study? What are the main findings?

Dr.
Coilly: Hepatitis C (HCV) recurrence used to be a major issue during two decades for patients transplanted with an active HCV infection at the time of transplantation impacting both patient and graft survival. The combination of sofosbuvir and daclatasvir has not been studied after liver transplantation. The main findings are a high efficacy profile with an overall SVR12 rate of 95%. The safety profile is also good​. The most frequent adverse event is anemia, particularly when ribavirin is still used.

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Cancer Risk Elevated In Patients With Hepatitis C

Lisa M. Nyberg, MD, MPH Transplant Hepatologist Director, Hepatology Research Kaiser Permanente, Garfield Specialty Center San Diego, CA  92111MedicalResearch.com Interview with:
Lisa M. Nyberg, MD, MPH
Transplant Hepatologist
Director, Hepatology Research
Kaiser Permanente, Garfield Specialty Center
San Diego, CA  92111

Medical Research: What is the background for this study? What are the main findings?

Dr. Nyberg: The overall cancer rates were higher in patients with Hepatitis C (HCV) vs those without HCV. Of note, though, the HCV cohort had higher rates of alcohol abuse, tobacco use, cirrhosis and diabetes mellitus (DM). However, even after stratification for the variables alcohol abuse, tobacco use, body mass index (BMI) and DM; the increased cancer rates remained significant for total cancer sites, liver cancer and NHL.

Note that this study does not establish a cause and effect relationship between Hepatitis C and cancer. A strength of this study is that it is an evaluation of a large patient population (n=35,712 with HCV and 5,297,191 without HCV). Limitations of the study are those inherent in epidemiological studies using large databases. For example, confounders may not be accurately recorded in automated databases (smoking and alcohol abuse may be under-recorded).

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Single Pill Combination Therapy For Some Hepatitis C Subtypes

Stefan Zeuzem, MDProfessor of Medicine Chief Department of Medicine Goethe University Hospital FrankfurtMedicalResearch.com Interview with:
Stefan Zeuzem, MD
Professor of Medicine
Chief Department of Medicine
Goethe University Hospital
Frankfurt

Medical Research: What is the background for this study? What are the main findings?

Dr. Zeuzem: Interferon- and ribavirin-free regimens are needed to treat HCV infection. The objective of the study was to evaluate the safety and efficacy of grazoprevir (NS3/4A-protease-inhibitor) and elbasvir (NS5A-inhibitor) in previously untreated patients with chronic hepatitis C (without and with liver cirrhosis). Among 421 participants, 194 (46%) were women, 157 (37%) were non-white, 382 (91%) had genotype-1 infection, and 92 (22%) had cirrhosis. Of 316 patients receiving immediate treatment, 299/316 achieved SVR12 (undetectable HCV 12 weeks after treatment), including 144/157  with genotype-1a, 129/131  with genotype-1b, 18/18  with genotype-4, 8/10 with genotype-6, 68/70 with cirrhosis, and 231/246 without cirrhosis. Virologic failure occurred in 13 patients including 1 breakthrough and 12 relapses, and was associated with baseline NS5A-polymorphisms and emergent NS3- and/or NS5A-variants. Serious adverse events occurred in 9 (2.8%) and 3 (2.9%) patients in the active and placebo arms, respectively; none were considered drug-related.
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Antihistamine May Be Useful In Fight Against Hepatitis C

MedicalResearch.com Interview with: Dr. Jake Liang MD Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MDMedicalResearch.com Interview with:
Dr. Jake Liang MD
Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD

Medical Research: What is the background for this study? What are the main findings?

Dr. Liang: Currently existing drugs against HCV, like Sovaldi, are expensive, have some side effects and are associated with drug resistance. They are not reaching the populations that are most in need of treatment. We discovered that certain over-the-counter medications used to treat allergies can block HCV infection in the laboratory and animal model. We still need to test their benefit in treating people with HCV. The drug blocks the step of HCV getting into the cells and is different from the current HCV drugs, which block the step of viral replication.

Medical Research: What should clinicians and patients take away from your report?

Dr. Liang: We don’t know whether this drug works in people with hepatitis C. It still needs to be tested in human trial.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Liang: Since CCZ has been used widely and have a good safety profile in people, it is reasonable to consider a trial in people. However we would have to use the currently accepted dosing for any clinical trial, because chlorcyclizine at high dose may have significant side effect, such as drowsiness. It is possible that chlorcyclizine in current dosing may not be active against HCV in people. To further optimize this drug for testing in people, we may have to modify the drug to make it more active, minimize its antihistamine effect, and improve its pharmacological properties. This effort will require additional pharmacological research and development.

Citation

Repurposing of the antihistamine chlorcyclizine and related compounds for treatment of hepatitis C virus infection
Shanshan He1, et al

Sci Transl Med 8 April 2015:
Vol. 7, Issue 282, p. 282ra49
Sci. Transl. Med. DOI: 10.1126/scitranslmed.3010286

MedicalResearch.com Interview with: Dr. Jake Liang MD (2015). Antihistamine May Be Useful In Fight Against Hepatitis C 

Costs To Treat Inmates With Hepatitis C Potentially Staggering

Brian Montague, DO MS MPH Assistant Professor of Medicine and of Health Services, Policy and Practice Division of Infectious Diseases Brown University / The Miriam HospitalMedicalResearch.com Interview with:
Brian Montague, DO MS MPH
Assistant Professor of Medicine and of Health Services, Policy and Practice
Division of Infectious Diseases
Brown University / The Miriam Hospital

Medical Research: What is the background for this study?

Dr. Montague: Hepatitis C is in an important public health problem affecting 4-5 million persons in the US alone.  Given the risk of infection associated with drug use, the prevalence of hepatitis C in corrections has been significantly higher than in the general population.

Prior to 2013, the available treatment options were both expensive and of significant toxicity and limited efficacy.  Uptake to these therapies were low.  Starting in 2013, new therapeutics options offering shorter course treatments and efficacies greater than 90% became available.  These therapies offer new possibilities to increase uptake to treatment, however the cost of the therapies has made rapid scale up of treatment impossible.  Given the risk of serious harms to patients with advanced liver disease if not treated, insurance has begun to approve these new therapies for patients with more advanced disease.

Departments of corrections are obliged to provide the same standard of care to persons in corrections as they would receive in the community.  Unlike Medicaid and community insurance providers, correctional systems worker under a fixed budget. Large increases in expenditures for treatment of hepatitis C without establishing mechanisms to offset these costs risks compromising other essential programs and functions in the correctional health system.

Medical Research: What are the main findings?

Dr. Montague: In a cross-sectional analysis we estimated the burden of hepatitis C within the department of corrections.  At the time of the study, an estimated 836 persons have chronic hepatitis C.  Among these an estimated 119 have advanced liver disease, stage 3 or 4 fibrosis, and would meet criteria for treatment under most insurance programs.  Even a conservative approach of restricting treatment in corrections to those with stage 3 or 4 fibrosis would incur costs of over $15 million, which is greater than 6 times the current correctional health budget for pharmaceuticals and 76% of the overall correctional health budget.

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New Oral Hepatitis C Virus Treatment Works But Will Cost Billions

Jagpreet Chhatwal Ph.D. Assistant Professor, Department of Health Services Research Division of Cancer Prevention and Population Sciences The University of Texas MD Anderson Center Houston, TXMedicalResearch.com Interview with:
Jagpreet Chhatwal Ph.D
.
Assistant Professor, Department of Health Services Research
Division of Cancer Prevention and Population Sciences
The University of Texas MD Anderson Center
Houston, TX

Medical Research: What is the background for this study? What are the main findings?

Dr. Chhatwal: More than two million people in the U.S. are infected with Hepatitis C (HCV), a virus found in the liver. In 2012, the Centers for Disease Control and Prevention and the U.S. Preventive Services Task Force both recommended a one-time hepatitis C screening for baby boomers – people born between the years 1946 and 1964. Last year, the Food and Drug Administration approved the medications sofosbuvir and ledipasvir for Hepatitis C treatment. The newly approved oral regimen comes at a staggering price to payers – as much as $1,125 per day. As a result, several payers have questioned if the price is justified.

The study results show that using new therapies is cost-effective in the majority of patients. However, the budget required to treat all eligible patients would be $136 billion over the next five years. Compared with the old drugs, new therapies would cost an additional $65 billion, whereas the cost offsets would be only $16 billion.

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Oral Medication For Hepatitis C- HIV Combined Infection

Shyamasundaran Kottilil MBBS, PhD University of MarylandMedicalResearch.com Interview with:
Shyamasundaran Kottilil MBBS, PhD
Division of Infectious Diseases, Institute of Human Virology, University of Maryland, Baltimore
Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

Medical Research: What is the background for this study? What are the main findings?

Dr. Kottilil:  Due to shared routes of transmission, almost half of all HIV-infected patients also have HCV infection. Traditionally, interferon based therapies have resulted in lower cure rates of HCV in HIV-infected subjects. Treatment for HCV is rapidly changing from an injection (interferon) based therapy to oral well tolerated pill based therapy for a shorter duration.Our intention was to test whether a treatment regimen without the use of interferon and ribavirin can be effective in HIV/HCV infected patients.

Our study demonstrated that HIV/HCV connected patients without cirrhosis can be effectively treated with ledipasvir and sofosbuvir in 12 weeks. Overall 98% of patients were cured.

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One Case Of Hepatitis C Transmitted From Shared Kidney Perfusion Machine

Gwen Borlaug, CIC, MPH Coordinator, HAI Prevention Program Wisconsin Division of Public Health Madison, WI 53702MedicalResearch.com Interview with:
Gwen Borlaug, CIC, MPH

Coordinator, HAI Prevention Program
Wisconsin Division of Public Health
Madison, WI 53702

MedicalResearch: What is the background for this study? What are the main findings?

Response: Healthcare-associated transmission of blood borne pathogens such as hepatitis C and B viruses is previously documented.

A single incident of HCV transmission likely occurred in an operating room where two kidneys were attached to the same perfusion machine at the same time, the two kidneys and the perfusion machine were shared between two operating rooms when patients were present in each operating room, and the two kidneys housed in the same perfusion machine were ultimately transplanted into two different recipients.

No additional healthcare-associated cases of hepatitis C virus transmission were identified among patients receiving hospital care at the same time and in the same locations as these transplant patients.

MedicalResearch: What should clinicians and patients take away from your report?

Response: Observing basic infection control practices is paramount to preventing transmission of blood borne pathogens in the healthcare setting.  Healthcare personnel should ensure strict adherence to protocols for cleaning and disinfecting used medical equipment and for safe injection practices.

 Citation:

Transmission of Hepatitis C Virus Associated with Surgical Procedures — New Jersey 2010 and Wisconsin 2011

 MMWR Weekly February 27, 2015 / 64(07);165-17

MedicalResearch.com Interview with: Gwen Borlaug, CIC, MPH (2015). One Case Of Hepatitis C Transmitted From Shared Kidney Perfusion Machine 

PHOTON-2 Study Addresses Combination Hepatitis C Pill For HIV+ Patients

MedicalResearch.com Interview with: Prof Jean-Michel Molina Maladies Infectieuses et Tropicales, Hôpital Saint-Louis, Paris France MedicalResearch.com Interview with:
Prof Jean-Michel Molina
Maladies Infectieuses et Tropicales, Hôpital
Saint-Louis, Paris France

Medical Research: What is the background for this study? What are the main findings?

Prof. Molina: Treatment of co-infected patients is complicated by drug drug interactions with HIV drugs, and the news DAAs are not very potent on HCV G2 and 3 infections.

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Liver Fibrosis Starts Early After Hepatitis C Infection

Adeel A. Butt, MD, MS, FACP, FIDSA Adjunct Associate Professor of Medicine and Clinical and Translational Science University of Pittsburgh School of MedicineMedicalResearch.com Interview with:
Adeel A. Butt, MD, MS, FACP, FIDSA
Adjunct Associate Professor of Medicine and Clinical and Translational Science
University of Pittsburgh School of Medicine

 

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Butt: Studying clinical consequences of hepatitis C virus (HCV) infection is often limited by the lack of knowledge of actual time of infection. We used the Electronically Retrieved Cohort of HCV-Infected Veterans (ERCHIVES), a well-established national cohort of HCV infected veterans and corresponding HCV-uninfected controls, to identify patients with a known time frame for HCV infection. Our primary aim was to determine the rate of liver fibrosis progression among HCV-infected persons over time, with and to determine factors associated with development of cirrhosis and hepatic decompensation among these persons.

Among 1840 persons who were HCV+ and 1840 HCV− controls, we found that fibrosis progression started early after HCV infection tapered off after 5 years. After 10 years of follow-up, 18.4% of HCV+ and 6.1% of HCV- persons developed liver cirrhosis. Nine years after diagnosis of cirrhosis, only 1.8% of HCV+ and 0.3% of HCV- persons had developed hepatic decompensation.

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Hepatitis C: Progression to Liver Fibrosis Starts Early

Adeel A. Butt, MD, MS, FACP, FIDSA Vice Chair for Faculty Affairs Department of Medicine Hamad Medical Corporation, Doha, Qatar Adjunct Associate Professor of Medicine and Clinical and Translational Science University of Pittsburgh School of MedicineMedicalResearch.com Interview with:
Adeel A. Butt, MD, MS, FACP, FIDSA Vice Chair for Faculty Affairs
Department of Medicine Hamad Medical Corporation, Doha, Qatar
Adjunct Associate Professor of Medicine and Clinical and Translational Science
University of Pittsburgh School of Medicine

Medical Research: What is the background for this study? What are the main findings?

Dr. Butt: Precise rate of progression of liver disease in Hepatitis C (HCV) infection is unknown because the precise time of infection with HCV is seldom known. Knowledge of liver disease progression is critical to determine the optimal time for treatment.

We found that progression of liver disease starts early after acquiring HCV infection. This is more rapid than was previously thought. About 18% of HCV infected persons develop cirrhosis within 10 years of acquiring HCV infection, which is 3-fold higher than demographically similar HCV uninfected persons.
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Eradicating Hepatitis C In Liver Transplant Patients With Less Toxic Combination Therapy

Surakit Pungpapong, M.D. Transplant Hepatologist Associate Professor of Medicine Mayo Clinic, Jacksonville, Fla.Medical Research.com Interview with:
Surakit Pungpapong, M.D.

Transplant Hepatologist
Associate Professor of Medicine
Mayo Clinic, Jacksonville, Fla.

 

Medical Research: What is the background for this study? What are the main findings?

Dr. Pungpapong: This study reports our multicenter experience from Mayo Clinic’s three sites using sofosbuvir and simeprevir with/without ribavirin for 12 weeks to treat hepatitis C genotype 1 recurrence after liver transplantation. We found that this all-oral interferon-free antiviral regimen was very well tolerated with minimal to mild side effects. It required minimal dose adjustment of immunosuppression and no episode of acute rejection occurred. Overall, sustained virologic response rate was very high, more than 90 percent.
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Hepatitis C: Pilot Study Investigates Re-treatment After Relapse

MedicalResearch.com Interview with:
Anita Kohli, MS, MD

Clinician Investigator, Clinical Monitoring Research Program (CMRP)
Leidos Biomedical Research, Inc. formerly SAIC-Frederick, Inc.
National Institutes of Health Bethesda, MD 20892

Medical Research: What is the background for this study? What are the main findings?

Dr. Kohli: We previously treated 60 patients with sofosbuvir and ribavirin for 24 weeks. Patients who relapsed after treatment were offered re-treatment with another regimen of directly acting antivirals alone. 13 patients who relapsed were treated with sofosbuvir and ledipasvir for 12 weeks. All patients achieved SVR12. This is the first report of re-treating patients who failed a regimen including sofosbuvir with another regimen incorporating this same antiviral.
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Hepatitis C Linked To Higher Risk of Coronary Artery Disease

MedicalResearch.com Interview with:
Naga Pothineni, MD
Division of Cardiology
University of Arkansas for Medical Science

MedicalResearch: What are the main findings of the study?

Dr. Pothineni: Hepatitis C is a blood borne infection that is very common worldwide. Most pateints who contract hepatitis C develop a chronic form on infection that progresses to liver damage and eventually hepatocellular cancer. Coronary heart disease is a worldwide problem as well. There has been interest in chronic infections being a mechanism of progression of atherosclerosis and coronary heart disease. We wanted to study the association of coronary heart disease events in patients with hepatitis C. We conducted a retrospective study of around 24,000 patients of which around 10,000 were hepatitis C positive. Our study showed that patients who have hepatitis C have a higher incidence of coronary heart disease events (myocardial infarction) when compared to patients who are negative for hepatitis C. In our analysis, we found that hepatitis C positivity is an independent risk factor for coronary events after adjusting for traditional cardiovascular risk factors like age, hypertension, smoking and diabetes.

Another interesting finding in our study was that patients with hepatitis C have lower levels of cholesterol compared to patients without hepatitis C. Low cholesterol levels in these patients do not seem to be protective against future coronary heart disease events.

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Hepatitis C Infection Could Be Rare in 20 Years

MedicalJagpreet Chhatwal, Ph.D. Assistant Professor Department of Health Services Research Houston, TX 77098Research.com Interview with
Jagpreet Chhatwal, Ph.D.
Assistant Professor
Department of Health Services Research
Houston, TX 77098


Medical Research: What are the main findings of the study?

Dr. Chhatwal: The recent updates in hepatitis C virus (HCV) screening policy and ongoing therapeutic advances can make hepatitis C a rare disease in the US by 2036. However, more aggressive screening strategies are needed to further reduce the burden of disease. For example, 1-time universal screening further identify 487,000 chronic hepatitis C virus cases in the next 10 years, and can make hepatitis C a rare disease in the next 12 years.
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Chronic Hepatitis C: Clinical Outcome Tool

Dr. Adriaan J van der Meer Department of Gastroenterology and Hepatology Erasmus MC, University Medical Center Rotterdam, The NetherlandsMedicalResearch.com Interview with:
Dr. Adriaan J van der Meer
Department of Gastroenterology and Hepatology
Erasmus MC, University Medical Center
Rotterdam, The Netherlands


MedicalResearch: What are the main findings of the study?

Dr. J van der Meer: The main finding of our study is that the prognosis of patients with compensated HCV-induced advanced liver disease can be adequately assessed by risk scores which merely include objective variables that are readily available in daily practice. Our analyses resulted in two separate prognostic scores by which the individual patient’s risk of mortality or clinical disease progression (defined as occurence of Hepatitis C Cirrhosis (HCC), liver failure, liver transplantation or death) can be assessed.
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Hepatitis C: Triple DAA Plus Ribavirin Highly Effective for Genotype 1 Infections

Jordan Feld MD MPH Toronto Western Hospital Liver Center University Health Network Sandra Rotman Centre for Global HealthMedicalResearch.com Interview with:
Jordan Feld MD MPH
Toronto Western Hospital Liver Center
University Health Network
Sandra Rotman Centre for Global Health


MedicalResearch.com:  What are the main findings of the study?

Dr. Feld: The SAPPHIRE 1 study was an international, large (631 patients) Phase 3 study of 3 direct acting antivirals combined with ribavirin for 12 weeks for the treatment of patients with genotype 1 hepatitis C virus (HCV) infection without cirrhosis.  The antivirals used were ABT-450, which is a protease inhibitor that is boosted with ritonovir to allow for once daily dosing along with ombitasvir (formally ABT 267), a potent NS5A inhibitor and dasabuvir (formerly known as ABT 333), a non-nucleoside polymerase inhibitor.  The ABT-450, ritonovir and ombitasvir were all co-formulated into a single tablet and dasabuvir was taken twice daily, as was ribavirin. The results of the study showed that the treatment is highly effective with 96% of patients achieving a sustained virological response (SVR) at 12 weeks after completing treatment.  SVR is a cure of HCV infection.  Importantly, patients with genotypes 1a and 1b had similar results with a rate of SVR12 of 95% in genotype 1a and 98% in genotype 1b.  These results were clearly superior to a historical control treatment with telaprevir combined with peginterferon and ribavirin.  Baseline factors were not predictive of outcome, including factors associated with non-response to interferon such as the IL28B genotype, baseline HCV viral load and older age.
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Chronic Hepatitis C: RESTORE Study Results

Christophe Moreno, MD, PhD Directeur clinique, clinique d’Hépatologie Service de Gastroentérologie Hépatopancréatologie et Oncologie DigestiveMedicalResearch.com Interview with:
Christophe Moreno, MD, PhD
Directeur clinique, clinique d’Hépatologie
Service de Gastroentérologie
Hépatopancréatologie et Oncologie Digestive

MedicalResearch.com: What are the main findings of the study?

Dr. Moreno: The RESTORE study is an open label, phase 3 study, evaluating Simeprevir in combination with PegIFN and ribavirin in genotype 4 Chronic Hepatitis C patients, either naïve or treatment experienced. Results of this study demonstrated high efficacy of this combination, with an overall SVR rate of 65.4%. Efficacy is particularly high in treatment naïve and prior relapsers patients, with SVR rate of 82.9% and 86.4%, respectively.

Moreover, treatment naïve patients and prior relapsers were eligible to a shorter treatment duration of 24 weeks if they met response-guided therapy (RGT) criteria (defined by an HCV RNA below 25 at week 4 and undetectable at week 12). 89.5% met RGT criteria. Of those, 94.1% achieved a SVR. Continue reading

Chronic Hepatitis C: Combination Pill Achieves High Cure Rates

Kris V. Kowdley, MD Director of Research & Director of the Liver Center of Excellence Digestive Disease Institute Virginia Mason Medical Center Seattle, WA 98111MedicalResearch.com Interview with:
Kris V. Kowdley, MD
Director of Research & Director of the Liver Center of Excellence
Digestive Disease Institute
Virginia Mason Medical Center
Seattle, WA 98111

MedicalResearch.com: What are the main findings of the study?

Dr. Kowdley:  A fixed-dose combination of ledipasvir and sofosbuvir in chronic Hepatitis C (HCV) genotype 1 patients without cirrhosis for 8 weeks without ribavirin was equally effective as the same combination with ribavirin added and also a 12 week combination of ledipasvir-sofosbuvir (without ribavirin).
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Hepatitis C: About 1% US Population Infected

Scott D. Holmberg, MD, MPH Chief, Epidemiology and Surveillance Branch Division of Viral Hepatitis.MedicalResearch.com Interview with:
Scott D. Holmberg, MD, MPH
Chief, Epidemiology and Surveillance Branch
Division of Viral Hepatitis.


MedicalResearch.com: What are the main findings of the study?

Dr. Holmberg: Based on interview and testing of over 30, 000 National Health and Nutrition and Examination Survey (NHANES) participants from 2003 to 2010, 273 US residents or about 1%, are chronically (actively) infected with hepatitis C virus (HCV).  This translates to about 2.7 million chronic HCV-infected persons in the non-institutionalized population.
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Hepatitis C: Factors Associated with Spontaneous Clearance

Dr. Jason Grebely PhD The Kirby Institute University of South Wales, AustraliaMedicalResearch.com Interview with:
Dr. Jason Grebely PhD
The Kirby Institute
University of South Wales, Australia

MedicalResearch.com: What are the main findings of the study?

Dr. Grebely: Although 20%-40% of persons with acute hepatitis C virus (HCV) infection demonstrate spontaneous clearance, the time course and factors associated with clearance remain poorly understood. This study investigated the time to spontaneous clearance and predictors among participants with acute HCV. Female sex, favorable IL28B genotype, and HCV genotype 1 were identified to be independent predictors of spontaneous clearance. This study provides important insights into factors affecting HCV viral control and offers guidance in clinical decision-making for the treatment of acute HCV infection.
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Hepatitis C: Does Chemotherapy Cause Viral Relapse?

Harrys A. Torres, MD, FACP Assistant Professor Director of Hepatitis C Clinic Department of Infectious Diseases, Infection Control and Employee Health The University of Texas MD Anderson Cancer CenterMedicalResearch.com Interview with:
Harrys A. Torres, MD, FACP
Assistant Professor, Director of Hepatitis C Clinic
Department of Infectious Diseases, Infection Control and Employee Health
The University of Texas MD Anderson Cancer Center

MedicalResearch.com: What are the main findings of the study?

Dr. Torres: The main findings of the study were that patients with hepatitis C virus (HCV) infection who were successfully treated with antivirals and attained sustained virologic response (SVR) did not have a relapse of HCV infection after receiving immunosuppressive chemotherapy for cancer. Patients in the study received different chemotherapeutic agents, including rituximab and systemic corticosteroids. Durability of SVR was maintained up to 14 years after chemotherapy in cancer patients.
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Hepatitis C: Sofosbuvir/Ledipasvir Combination Treatment

Prof Eric Lawitz MD Vice President of Scientific and Research Development at The Texas Liver Institute Clinical professor of Medicine San Antonio University of Texas Health Science Center.MedicalResearch.com Interview with:
Prof Eric Lawitz MD
Vice President of Scientific and Research Development at The Texas Liver Institute
Clinical professor of Medicine
San Antonio University of Texas Health Science Center.

MedicalResearch.com: What are the main findings of the study?

Dr. Lawitz: Currently available treatments for HCV involve weekly injections of pegylated interferon and daily doses of oral antivirals that must be taken for up to a year.  These regimens are not only burdensome for patients, but are not always effective and can cause serious and debilitating side effects, including anemia. So there is a significant need for new tablet-based treatment regimens for HCV that eliminate interferon and ribavirin, are more effective, better tolerated and easier for patients to take.
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