The proportion of pregnant women with hepatitis C virus infection who receive Medicaid in Wisconsin has risen dramatically, suggesting an increased risk for mother-to-infant transmission, according to an MMWR.
As HCV infection among women of child-bearing age increases both in the Midwest state and nationally, clinicians must step up diagnostics and surveillance, researchers wrote in the report.
“Enhanced identification through HCV screening during pregnancy and public health follow-up to monitor infants at risk for vertical transmission are needed,” Theresa Watts, MPH, of the University of Wisconsin School of Nursing, and colleagues said.
The most common type of glomerulonephritis (a type of kidney disease) found in people with hepatitis C (HCV) is cryoglobulinemic membranoproliferative glomerulonephritis (MPGN). Other less common forms of these types of kidney diseases include non-cryoglobulinemic MPGN, membranous glomerulonephritis, MPGN type III, and mesangial proliferative glomerulonephritis. This article will concentrate on MPGN.
MPGN is a type of kidney disease caused by complexes (such as HCV antibodies, the hepatitis C virus, rheumatoid factor) deposited in the membranes (glomeruli) of the kidneys. The prevalence of MPGN in the hepatitis C population is difficult to gauge because of the limited number of studies conducted.
Despite the fact that HCV-related MPGN is relatively uncommon in the hepatitis C population, MPGN is considered a significant problem because of a large number of people infected with hepatitis C and the potential for severe and life-threatening complications.
MPGN is usually diagnosed using various laboratory tests such as HCV antibody positive, HCV viral load, elevated liver enzymes, positive rheumatoid factor, circulating cryoglobulins and confirmed by kidney biopsy.
MPGN is a complicated disease to diagnose because there are few symptoms during the early stages of MPGN. The actual diagnosis of most cases occurs mostly in people who are in their 50’s and 60’s. It also happens somewhat more commonly in women than in men. Symptoms can include elevated liver enzymes, hypertension (high blood pressure), joint pain and neuropathy.
The disease progression of MPGN occurs over an extended period of time and is highly variable from one person to another. A small percentage of people with MPGN will develop severe kidney disease (end-stage renal disease) that will require dialysis. Treatment of HCV-related MPGN usually consists of treatment of the underlying cause – hepatitis C. HCV treatment has had limited success, but it has been shown to improve the condition of the kidneys and reduce the incidence of acute flare-ups in some people. Remission of HCV-related MPGN only occurs in a minority of people treated. One of the most important strategies for managing MPGN is to control blood pressure, which will help to prevent further damage to the kidneys. Other treatment options included the use of corticosteroids, antiplatelet therapy, Cyclophosphamide (immunosuppressive drug and chemotherapy) calcineurin inhibitors, and Rituximab.
Hepatitis C-related cryoglobulinemic membranoproliferative glomerulonephritis is a rare disease that can be improved if caught early. Diagnosis of hepatitis C soon after infection along with early treatment and cure will prevent this extrahepatic manifestation and other EHs. Curing hepatitis C in someone with membranoproliferative glomerulonephritis will help to improve it but will not cure it.
To learn about cryoglobulinemia, click here
To read about other extrahepatic manifestations, click hereShare This Page
A companion piece to Hepatitis C and Children, this fact sheet give practical advice for people who have to give the difficult information to children. To view the entire fact sheet, click here
Note: To find out more information contact Tina Broder, or register with the link in the blog:
Tina Broder, MSW, MPH
National Viral Hepatitis Roundtable
Tina Broder, MSW, MPH
National Viral Hepatitis Roundtable
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Hepatitis C incidence is increasing among gay and bisexual men living with HIV in San Diego, according to the largest analysis of its kind done in the United States. Study results were presented this week at the 2017 AASLD Liver Meeting in Washington, DC.
Not surprisingly, the small number of men who reported injecting drug use had a higher likelihood of being newly infected with hepatitis C virus (HCV), but so did the much larger proportion who reported non-injection methamphetamine use.
Starting in the early 2000s researchers in the UK and elsewhere in Europe began to report clusters of apparently sexually transmitted acute HCV infection among HIV-positive men who have sex with men (MSM). Similar outbreaks have since been seen in Australia and the US.
Extrahepatic Manifestations of Hepatitis C—Raynaud’s Phenomenon
Foreword: In someone infected with hepatitis C, Raynaud’s phenomenon is caused by HCV-related cryoglobulinemia. The prevalence of Raynaud’s phenomenon in the hepatitis C population is unknown, but it is believed to be an uncommon condition. In people with HCV-related cryoglobulinemia, however, one study found that 30% of people also had Raynaud’s phenomenon.
Symptoms: Raynaud’s is a painful condition that affects the blood vessels in the fingers, toes, ears, and nose. When Raynaud’s phenomenon affects the fingers is it easy to diagnose because the end of the fingers turns white. Raynaud’s is diagnosed by lab tests (for autoimmune diseases), and by physical exam.
Raynaud’s affects more women than men – about 75% of all cases are diagnosed in women who are between 15 and 40 years old. Between 5 to 10% of the U.S. population have Raynaud’s Phenomenon.
There are two types of Raynaud’s – primary and secondary. Primary is the milder form of Raynaud’s that has no underlying disease or associated medical condition. The secondary form of Raynaud’s is less common than the primary one, but it is considered a more severe condition that is caused by another disease or condition.
Causes: The exact cause of Raynaud’s is unknown, but it is considered an autoimmune disease and has been linked to cryoglobulinemia, hypothyroidism, scleroderma, lupus, Sjögren’s syndrome as well as occupational exposure to toxins, environmental factors (exposure to cold temperature) and certain medications, and can be triggered by emotional stress.
Below are some strategies for managing Raynaud’s:
Treatment: Medical treatment of Raynaud’s may include calcium-blockers, various topical skin ointments, and vasodilators including high-blood pressure drugs, erectile dysfunction medication sildenafil, the antidepressant fluoxetine, and the hormone prostaglandins.
Another treatment of Raynaud’s phenomenon caused by hepatitis C-related cryoglobulinemia is treating the underlying cause-hepatitis C. To read the blog article on cryoglobulinemia, click hereShare This Page
Gilead Sciences Inc.’s U.S. patents on the blockbuster $84,000 hepatitis C treatment Sovaldi were challenged by a consumer group that’s battled the drugmaker around the world over the pricing.
The Initiative for Medicines, Access & Knowledge, a nonprofit focused on how patents affect access to medicine, said that it’s filed petitions with the U.S. Patent Trial and Appeal Board seeking to challenge intellectual-property rights that would keep generic versions of Sovaldi from entering the market.