Article: Treatment of hepatitis C virus–associated mixed cryoglobulinemia with direct-acting antiviral agents—M E Sise et al.
Source: Hepatology, 63: 408–417. doi:10.1002/hep.28297
Study Aims and Results: HCV-related cryoglobulinemia is a disease that can cause severe consequences. Cryoglobulinemia produces cryoglobulin proteins that circulate in the blood that causes damage to various organs such as the skin and kidneys.
There has been a lack of information about the safety and effectiveness of treatment with direct-acting antiviral medications to treat cryoglobulinemia. The study compiled data from previous studies of twelve patients treated between December 2013 and September 2014 with simeprevir plus sofosbuvir or sofosbuvir plus ribavirin. Kidney biopsies or kidney function tests established cryoglobulinemia involvement in 7 patients. Fifty percent of the patients had cirrhosis. Four patients were also receiving rituximab (a drug used to treat non-Hodgkin’s lymphoma, rheumatoid arthritis, and cryoglobulinemia-related complications) while receiving direct acting antiviral therapy.
Conclusions: The overall hepatitis C cure rate was 83%. Eighty-nine percent of the patients who were cured of hepatitis C had a decrease in cryoglobulin levels. Four of the nine patients who had their cryoglobulin levels available for measurement had complete disappearance. Kidney function also improved after being cured. The treatment was generally well tolerated – there were only 17% with serious side effects.
Editorial Comment: This is good news for people with cryoglobulinemia. It is a disease with serious and potentially life-threatening consequences. The previous therapies that included pegylated interferon and ribavirin had many more serious side effects. If there was kidney involvement, ribavirin was often limited or dose reduced. Now that we have interferon- and ribavirin-free therapies we should be treating everyone with hepatitis C and cryoglobulinemia. Check out the article about cryoglobulinemia in this issue of the HCV Advocate. Also, follow this link to our new Extrahepatic Manifestation Glossary.
Article: Increasing Prevalence of Cirrhosis among US Adults Aware or Unaware of their Chronic Hepatitis C Virus Infection—P Udompap et al.
Source: J Hepatol. 2016 Jan 22. pii: S0168-8278(16)00014-3. doi: 10.1016/j.jhep.2016.01.009. [Epub ahead of print]
Study Aim and Results :The aim of the study was to estimate the prevalence of cirrhosis in the United States in people who had already been diagnosed with hepatitis C and people who had not yet been diagnosed with hepatitis C. The authors used the National Health and Nutrition Examination Survey (NHANES) database. They tested people who were over 20 years old for HCV antibodies and follow-up HCV RNA (viral load) and determined the degree of fibrosis/cirrhosis. They also re-evaluated HCV positive people who had already been evaluated for cirrhosis.
Of the 52,644 NHANES people identified, 49,429 were tested for HCV, of whom 725 met the inclusion criteria of HCV RNA /viral load positive and had a fibrosis/cirrhosis measurement.
Conclusions: The percentage increase of cirrhosis and the number increase of Americans with cirrhosis:
- 6.6% in Era 1 (1988 – 1994) – 170,000 Americans
- 7.6% in Era 2 (1999 – 2006) – 190,000 Americans
- 17% in Era 3 (2007-2012) – 370, 000 Americans
The increase in cirrhosis was due to increased age, diabetes, and obesity. The increase in the cases of cirrhosis was similar in the people who were already diagnosed and those newly diagnosed.
Editorial Comment: This study is alarming because the rise in the cases of cirrhosis is similar in the diagnosed and the newly diagnosed. Diagnosis and treatment of hepatitis C, diabetes and obesity could help curb the future prevalence of HCV-related cirrhosis, but time is rapidly running out.
Article: Vertically acquired hepatitis C virus infection: Correlates of transmission and disease progression—P. A. Tovo et al.
Source: World J Gastroenterol. 2016 Jan 28;22(4):1382-92. doi: 10.3748/wjg.v22.i4.1382.
Study Aim and Results: This paper summarized the transmission of hepatitis C from mother-to-child. Information was collected from various research papers worldwide.
Conclusions: The global prevalence of hepatitis C virus in children is 0.05%-0.4% in developed countries. The prevalence is 2%-5% in countries that inadequately test blood products, or where unsterile medical injections remain important routes of infection. After the screening of blood donors, mother-to-child transmission (MTCT) of HCV has become the leading cause of pediatric infection, at a rate of 5%.
Coinfection with HIV and HCV increases the risk of mother-to-child transmission. The study authors point out that currently there is no approved interferon- or ribavirin-free—direct acting antiviral—medication to treat children infected with hepatitis C. In regards to mode of delivery—natural birth or caesarean—there isn’t an increased or decreased risk of mother-to-child transmission.
The rate of spontaneous or natural clearance of the hepatitis C virus from the baby is about 25%, but interestingly it can occur for a child up to 6 years of age. The factors associated with natural clearance of HCV are IL28B (a type of HCV gene) and genotype 3.
Children typically have mild to moderate HCV disease progression, and a child’s growth is similar to that of non-HCV infected children. It was also pointed out there are exceptions—some children do have accelerated HCV disease progression. Importantly, children typically have few extrahepatic manifestations or autoimmune diseases.
Editorial Comment: It must be heart wrenching to have a child infected with hepatitis C. In most instances treatment with pegylated interferon and ribavirin is not recommended unless a child has advanced HCV disease progression. There are on-going clinical trials with direct-acting antiviral medications that should be completed in 2016. Approval of direct acting antiviral medication to treat children with hepatitis C will bring some much-needed effective treatment and much-needed relief to their parents.
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