—Lucinda K. Porter, RN
Source: Annals of Internal Medicine March 4, 2014; Volume 160, Number 5
from 30,074 participants in the National Health and Nutrition
Examination Survey (NHANES) between 2003 and 2010. The researchers
estimate that approximately 2.7 million persons* in the U.S. have
chronic hepatitis C virus (HCV) infection. Less than half of those with
HCV have been tested, which means they lack vital information that
accompanies an HCV diagnosis. Those with HCV are frequently poor and
less educated, and many do not receive medical care. Baby Boomers,
those born between 1945 and 1965, are six times more likely to have HCV
than the general population.
these are conservative estimates, because the NHANES did not survey
anyone who is homeless, incarcerated, or in the military.
The Bottom Line:
At first glance, it appears that the number of chronic HCV cases is
the U.S. is shrinking, but the analysis suggests this decrease is
because more people are dying from HCV-related conditions. To avoid
needless death, the researchers urge implementation of the Centers for
Disease Control and Prevention (CDC) recommendation to screen all Baby
Boomers for HCV.
In June 2013, the U.S. Preventive Services Task Force (USPSTF) echoed
the CDC’s advice by issuing recommendations to screen adults born
between 1945 and 1965 for hepatitis C. These recommendations have not
yet gone into effect, despite the fact that the CDC has been urging
this for nearly two years. In the light of this inaction, we can make a
difference—urge every Baby Boomer you know to get tested for HCV.
Progression in Human Immunodeficiency Virus/Hepatitis C Virus
Coinfected Adults: Prospective Analysis of 435 Liver Biopsy Pairs –
Monica A. Konerma, et al.
Source: Hepatology March 2014; Volume 59, Issue 3, pages 767–775
(HIV) and HCV coinfection (HIV/HCV) is associated with progressive
liver disease. The purpose of this research was to examine the
incidence of HIV/HCV coinfection and identify risk factors for fibrosis
progression. This prospective study enrolled 282 coinfected subjects,
and performed 435 liver biopsies.
The Bottom Line:
HIV/HCV coinfected patients have an increased risk of rapid liver
fibrosis progression. Researchers recommend close monitoring of patients
with persistent elevations in liver enzyme levels (ALT/AST) as these
may indicate an increased likelihood of disease progression.
presented at the March 2014 Conference on Retroviruses and
Opportunistic Infections (CROI) revealed that those with HIV/HCV
coinfection had significantly shorter 5-year survival rates after liver
transplant than people infected only with HCV. This underscores the
need for close monitoring of patients along with HCV treatment,
especially since treatment has increased success rates in those
coinfected with HCV/HCV.
Article: Active At Night, Sleepy All Day – Sleep Disturbances in Patients with Hepatitis C Virus Infection – Meike Heeren, et al.
Source: Journal of Hepatology December 4, 2013; Epub ahead of print
patients with mild liver disease (no cirrhosis) report chronic fatigue,
daytime sleepiness and poor sleep quality. This German study examined
sleep patterns of 20 women with mild liver fibrosis who contracted HCV
from immunoglobulin in 1978/79. Those included in the study did not
have any other obvious causes of sleep disturbances, such as
neuropsychiatric conditions, shift work, medications, etc. When
compared to healthy controls, the patients had higher scores for
depression, fatigue and sleep disturbances and lower quality of life
scores. Fatigue and quality of life scores correlated with poor sleep
quality and daytime sleepiness.
The Bottom Line: Chronic
fatigue is associated with poor quality sleep and increased nocturnal
activity suggesting an alteration of sleep in HCV-infected patients.
I believe that sleep disturbances are associated with HCV because I’ve
been listening to patients talk about this for decades. It is something
I have experienced, and my sleep quality is significantly improved
since HCV treatment. However, I have a problem with this study. First,
the study is small with only 20 subjects. Second, eight patients
were HCV PCR negative, seven spontaneously and one after therapy. This
means that 40% of the patients technically did not have HCV. Third,
five patients are current smokers and 9 patients reported light to
moderate alcohol consumption, and although the control group had a
similar composition, alcohol and smoking can affect sleep. In a study
using only 20 participants, I would hope for fewer variables.
Source: Presentation at the 2014 Conference on Retroviruses and Opportunistic Infections, March 3-6, 2014, Boston; Abstract #685
with increased coronary artery disease. Increased lipid levels
(cholesterol and triglycerides) are also associated with greater risk of
heart attack or myocardial infarction (MI). Lipid levels drop with
worsening liver disease, so this study investigated the role of lipids
on heart attack risk in HCV-positive veterans. More than 35,000 HCV
antibody-positive men were compared to a similar group of 45,299
The Bottom Line:
Higher lipid levels increase heart attack risk in HCV RNA-positive
male veterans by 22% to 64%, but not in HCV antibody-positive veterans
without detectable HCV RNA. The researchers propose managing lipid
levels and eliminating HCV as potential strategies for lowering risk of
coronary artery disease in HCV-infected persons.
Editorial Comment: Thank goodness easier, more effective treatments are within sight.