Monthly Archives: August 2010

Dental Issues and Treatment

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There is very little literature or information about the need for dental care prior to starting therapy. A new study of 750 HCV patients (296 women) with a mean age of 57.2 years found that six patients could not start therapy because of dental disease.

Comment: In addition to having a dental exam and treatment if needed prior to HCV therapy every effort should be made to brush and floss during daily while on treatment and to drink plenty of fluids. Interferon is well known to cause dry mouth and could lead to dental decay and gum problems.

Source: Author: Yumiko NagaoMichio Sata
Credits/Source: Virology Journal 2010, 7:192

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Is There Improvement in Liver Health without SVR?

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Is there Improvement in liver health with treatment of hepatitis C even in the absence of SVR?

A retrospective study out of the Scripps Clinic is providing insight into whether a partial response to HCV treatment improves the overall health of the liver.

The authors analyzed records (retrospective study) of 1571 HCV positive patients who were treated with interferon or interferon plus ribavirin therapy. Of these 80% were treated with pegylated interferon monotherapy or pegylated interferon plus ribavirin combination therapy. The records were obtained from eight phase 2 to phase 4 studies. The majority of the patients were white, male, with HCV genotype 1 or 4, and viral load levels greater than 800,000 IU/mL at start of treatment. The METAVIR activity/staging model was used (stages 0 though 4; 0 equals no activity and up to 4 equal cirrhosis). Paired biopsy information (before and after treatment) was available for the 1571 patients.

The authors found that there was a “positive correlation between the degree of virologic response and improvements in METAVIR activity and fibrosis, and inverse correlation with worsening activity and fibrosis.” As the authors expected it was found that an improvement in liver health was related to a faster decrease in HCV RNA or viral load and a longer suppression of the viral load.

The authors concluded that “In patients with chronic hepatitis C who are treated with interferon-based therapies, histologic benefits may be observed even in the absence of an SVR.”

Comments: Improvement in liver health is one of the main reasons people seek treatment. Although this is a retrospective analysis it is welcome news since there may be improvement in liver health even without achieving an SVR. In addition, people who are treated many times do not have access to a liver biopsy after treatment to assess whether or not treatment improved the health of their liver. While this doesn’t conclusively prove that everyone treated has improvement in liver health it does suggest this and helps us to better understand that treatment has benefits regardless of SVR.

The HALT-C trial results did not show improvements in liver health, but many in the science and advocacy community believe that the trial design was at fault because the study medicine included only low dose pegylated interferon WITHOUT ribavirin. AF

Source:
Histologic outcomes in hepatitis C-infected patients with varying degrees of virologic response to interferon-based treatments.
Pockros PJ, Hamzeh FM, Martin P, Lentz E, Zhou X, Govindarajan S, Lok AS.
Scripps Clinic, La Jolla, CA.
Hepatology 2010

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FDA Warning on Miracle Mineral Solution

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The FDA issued a consumer warning to immediately discontinue the use of a substance that claims to treat a wide variety of diseases including cancer, HIV and hepatitis. The warning was issued because of reports of serious side effects from people who took Miracle Mineral Solution (also sold under the name Miracle Mineral Supplement). The side effects included nausea, vomiting, diarrhea, and life-threatening low blood pressure due to dehydration.

Miracle Mineral Solution is a 28% solution of sodium chloride mixed in distilled water. The solution produces a potent form of bleach called chlorine dioxide that is an industrial grade bleach.

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Sexual Transmission of hepatitis C

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Meta-Analysis of Sexual Transmission of Hepatitis C
Alan Franciscus
Editor-in-Chief, HCV Advocate

Sexual transmission of hepatitis C is always a controversial topic. A new report was released that analyzed 80 studies to determine the transmission of hepatitis C through sexual contact. The authors came to the conclusion that the weight of evidence supports that there is no increased risk of hepatitis C sexual transmission among heterosexual couples in a ‘regular relationship.’ The risk of hepatitis C sexual transmission, however, increases among persons with multiple sexual partners, but this association may be ‘confounded’ by the increased likelihood of injection drug use with the increased number of sexual partners. The authors found an increased risk for women coinfected with HIV or other sexually transmitted infections and particularly for HIV-infected gay men who are having sex with other HIV-infected gay men when compared with gay men who were not infected with HIV. The increased risk of sexual transmission was associated with sexual practices that lead to “mucosal trauma (multiple sexual partners, fisting, use of sex toys) and the presence of genital ulcerative disease.” The authors concluded that “health care providers need to pay special attention to sexual transmission of HCV among HIV-infected individuals.”

This analysis of 80 studies of sexual transmission of hepatitis C adds to the body of knowledge that confirms that the risk of sexual transmission of hepatitis C among people in a stable long-term monogamous relationship is very low, some studies even finding it to be completely absent. Safer sex, however, should be encouraged in situations when blood is present, and for people who engage in high risk sexual practices. Increasing evidence , however, points to the fact that  HIV positive gay men are at increased risk for sexual transmission of hepatitis C and should be counseled on safer sex practices and tested for hepatitis C.

Reference:
Is sexual contact a major mode of hepatitis C virus transmission?
Tohme RA, Holmberg SD –Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA. Hepatology. 2010 Jun 16. [Epub ahead of print]

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