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Hepatitis C

Attitudes of Health Professionals toward Caring for People with Hepatitis C

With an estimated 170 million people worldwide infected with hepatitis C, those with chronic disease are expected to experience significant morbidity and mortality. As a result, many health professionals likely will care for these patients at some point in their medical careers. Despite this situation, there are scant data on the attitudes of health professionals toward caring for individuals living with hepatitis C. To help fill this gap, researchers at the University of Melbourne in Australia conducted a cross-sectional survey to explore the inter-relationship among health prpfessionals' hepatitis C knowledge and attitudes towards treating people with hepatitis C and their self-reported clinical behavior.

Antiviral Activity of Interferon beta-1a with or without Ribavirin in Asian Patients with Chronic Hepatitis C

Treatment with pegylated interferon alpha-2a (Pegasys) or pegylated interferon alpha -2b (PegIntron) plus ribavirin is the current standard of care for treatment of chronic hepatitis C virus (HCV) infection. This regimen produces a sustained virological response (SVR) in approximately 50%-60% of patients.

CROI 2007: Does Pre-existing HIV Infection Lead to Accelerated Liver Fibrosis in People with Acute Hepatitis C?

Multiple outbreaks of acute hepatitis C virus (HCV) infection have recently been reported in cities in the UK and Europe among HIV positive men who have sex with men (MSM). These outbreaks are notable because these patients were already infected with HIV when they acquired HCV. More typically, individuals with both HIV and HCV infection acquired HCV first, since it is easier to transmit (e.g., through shared use of injection drug equipment).

Although much is known about the course of liver disease in HCV-infected patients who later acquire HIV, little is known about the course of liver damage in HIV-infected patients who later acquire HCV.

Researchers at Mount Sinai School of Medicine in New York City conducted a prospective study of HIV-infected MSM with acute HCV infection, including examination of liver histology. At the 14th Conference on Retroviruses and Opportunistic Infections last month in Los Angeles, they reported data from the first 5 consecutively-enrolled patients.

The patients underwent serological testing for hepatitis A virus (HAV) antibodies; hepatitis B virus (HBV) antigens, antibodies, and HBV DNA; and HCV antibodies, HCV RNA, and HCV genotype. They also received liver biopsies within 4 months of the first-noted ALT elevation.

Acute hepatitis C was defined as the first 6 months of HCV infection. Because no single test result provides a definitive diagnosis of acute HCV infection, the researchers considered 3 factors in combination:

  • Recent seroconversion to HCV antibody positive status;
  • Marked elevations in serum ALT level;
  • Wide fluctuations in HCV viral load.

The latter 2 factors are considered hallmarks of acute HCV infection and are uncommon during chronic infection.

All patients were MSM in their 40s who had:

  • Recent seroconversion to anti-HCV antibody positive status; in 3 cases, this occurred within a year after a previous negative test, defining a narrow time window in which the new HCV infection could have occurred;
  • Rapid changes in ALT levels, with elevations greater than 10 times the upper limit of normal (ULN), consistent with acute hepatitis;
  • Wide HCV viral load fluctuations, in 4 cases exceeding 1.5 log10 IU/mL.

Results

  • Liver biopsies showed moderate portal fibrosis (stage 2 of 4; Scheuer system) in 3 of 4 patients, as well as acute HCV.
  • 1 patient had central hyalin sclerosis.
  • All patients denied heavy alcohol use and 1 had never received HAART.
  • No cause of chronic liver disease common to all patients could be identified to explain the degree of fibrosis.
  • All had negative evaluations for active HAV or HBV infection.
  • No evidence for other etiologies of new hepatitis was found.
  • All patients had recent histories of unprotected receptive anal intercourse, some with many partners.
  • 3 acknowledged a single recent episode of injection drug use, but without clear recollection of sharing injection equipment.
  • 1 shared paraphernalia for snorting drugs.
  • All denied any other known risk factors for HCV infection.

The researchers concluded that 4 of 5 HIV-infected MSM had moderately advanced portal fibrosis during the acute phase of HCV infection. No other etiologies were found to explain the presence of moderate liver fibrosis in this population, suggesting that pre-existing HIV infection results in accelerated fibrosis progression in patients with acute hepatitis C.

The investigators noted that, “These cases suggest that HIV-infected patients presenting with acute HCV infection may already have significant liver disease, and that liver biopsy should be considered in theses patients.”

They added that further research is needed to define the prevalence and understand the pathogenesis of rapid liver fibrosis in this population.

3/16/07

Reference

D Fierer, A Uriel, D Carriero, and others. Portal Fibrosis During Acute HCV Infection of HIV-infected Men. 14th Conference on Retroviruses and Opportunistic Infections. Los Angeles, February 25-28, 2007. Abstract 889 (poster).

Asian Patients Appear to Respond Better than Whites to Pegylated Interferon Plus Ribavirin for Hepatitis C

As reported in the July 19, 2007 advance online edition of the American Journal of Gastroenterology, researchers with the Canadian Pegasys Expanded Access Group conducted a study to determine whether Asian race/ethnicity is an independent predictor of response to antiviral therapy in patients with hepatitis C.

CROI 2007: HCV May Be Sexually Transmitted in HIV Negative as Well as HIV Positive Men

In recent years, outbreaks of apparently sexually transmitted hepatitis C virus (HCV) infection have been reported in London and Brighton in the UK and in a few European cities. In almost all cases, these acute HCV infections have occurred in HIV positive gay and bisexual men.

Anadys to Halt Development of Investigational Hepatitis C Drug ANA975

Anadys Pharmaceuticals announced last week that it will discontinue development of its investigational anti-HCV drug candidate, ANA975, a toll-like receptor 7 agonist.Anadys was developing the agent in collaboration with Novartis. The decision comes in the wake of disappointing data from toxicology studies in animals. Toll-like receptor agents can cause excessive immune stimulation, leading to a range of side effects.

Low-density Lipoprotein Receptor Plays a Role in HCV Infection of Liver Cells

Past research has suggested that the low-density lipoprotein (LDL) cholesterol receptor plays a role in hepatitis C virus (HCV) infection, but the process is not well understood. As reported in the March 2007 Journal of Hepatology, in a laboratory study French researchers assessed expression and activity of the LDL receptor in the absence or presence of squalestatin (which up-regulates LDL receptor expression) or 25-hydroxycholesterol (which down-regulates LDL receptor expression).

Atorvastatin Does Not Inhibit HCV Replication at Normal Doses

In July 2006, researchers reported data from a laboratory study showing that HMG-CoA reductase inhibitors -- better known as statins -- suppressed replication in an HCV "replicon" system. Statins are widely used to manage elevated blood cholesterol. According to a study published in the April 2007 issue of Hepatology, however, statins may not be active against HCV in patients at the doses typically used.

More Evidence that Hepatitis C Virus Infection is Associated with Insulin Resistance

Research to date has produced conflicting data about the relationship between hepatitis C virus (HCV) infection and insulin resistance.