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The risk for hepatocellular carcinoma was low among patients with cirrhosis, with a 10-year incidence of 4% or lower, according to the results of a U.K. population-based cohort study.
While low overall, investigators found the incidence of HCC was highest among patients with cirrhosis due to chronic viral hepatitis compared with other etiologies.
“This very low incidence of HCC occurrence in people with cirrhosis caused by alcohol or of unknown origin suggests that surveillance for HCC among these groups is likely to benefit patients little,” Joe West, PhD, of the division of epidemiology and public health at the University of Nottingham in the U.K., said in a press release. “As surveillance incurs substantial cost, it is therefore unlikely to represent value for money for the NHS. There may well be other ways of spending this money that would benefit patients far more.”
Complications of advanced liver disease including cirrhosis and hepatic decompensation have risen over the past decade among people with chronic hepatitis C, according to study findings presented at the 2016 AASLD Liver Meeting in November. However, in recent years the increase has slowed, especially among those at highest risk – black people and people aged 60 and over.
Over years or decades, chronic hepatitis C virus (HCV) infection can lead to severe liver damage including cirrhosis (build-up of scar tissue), hepatocellular carcinoma (HCC, a type of liver cancer) and hepatic decompensation (when the liver can no longer perform its vital functions).
Successful hepatitis C treatment can slow or halt liver disease progression, but people who are treated too late, after they have already developed cirrhosis, remain at risk for HCC and end-stage liver disease.
Link to open access journal – AF
WEDNESDAY, Jan. 4, 2017 (HealthDay News) — For patients with hepatitis C virus (HCV) infection and biopsy-proven cirrhosis, sustained viral response (SVR) is associated with a reduction in critical events, both liver and non-liver related, according to research published in the January issue of Gastroenterology.
Pierre Nahon, M.D., Ph.D., from the Hôpital Jean Verdier in Bondy, France, and colleagues conducted a retrospective review using data from 1,323 patients in a prospective viral cirrhosis cohort. Patients had HCV infection and biopsy-proven cirrhosis, were Child-Pugh class A, and had no previous liver complications. Patients received anti-HCV treatment before or after inclusion and underwent ultrasound examination every six months, as well as endoscopic assessments.
The researchers found that 50.5 percent of the patients achieved SVR after a median follow-up of 58.2 months. SVR correlated with reduced incidence of hepatocellular carcinoma and hepatic decompensation (hazard ratios, 0.29 and 0.26, respectively). The risks of cardiovascular events and bacterial infections were also lower with SVRs (hazard ratios, 0.42 and 0.44, respectively). In patients with SVRs, but not patients with viremia, metabolic features correlated with higher risk of hepatocellular carcinoma. SVR correlated with a reduction in overall mortality (hazard ratio, 0.27) and death from liver-related and non-liver-related causes.
Every 30% increase of time taking a statin yielded a one-third lower risk of cirrhosis in HIV/hepatitis C (HCV)-coinfected male veterans who did not already have advanced liver disease. Diabetes and low high-density lipoprotein (HDL) cholesterol boosted cirrhosis risk in this 5985-veteran analysis.
HCV coinfection affects nearly 30% of the HIV population in parts of the United States and Europe and is associated with faster fibrosis progression, noted the Veterans Affairs (VA) researchers who conducted this study. Because statins have anti-inflammatory, immunomodulatory and antineoplastic traits, the VA team proposed that they might be useful adjunctive therapy to reduce liver disease progression in HIV/HCV-coinfected people.
The analysis included veterans in the VA HIV and HCV Clinical Case Registries between January 1999 and December 2010. The investigators defined cirrhosis by ICD-9 code or by aspartate aminotransferase to platelet ratio index (APRI) >2. They measured statin use as percent of time with an active prescription, and they time-updated that measure through follow-up. After stratifying participants by alanine aminotransferase (ALT) above or below 40 IU/L, the VA team used Cox proportional hazards regression to calculate the impact of statin use and other variables to time to cirrhosis.
Article: Eradication of Hepatitis C Virus Infection in Patients With Cirrhosis Reduces Risk of Liver and Non-Liver Complications—Nahon et. al
Study Aims and Results: The authors evaluate if curing hepatitis C reduces illness and death. Information was collected from 35 centers located throughout France. The data included 1,323 hepatitis C patients with compensated cirrhosis—the cirrhotic patients did not have complications from cirrhosis. Compensated cirrhosis was confirmed by liver biopsy.
Editorial Note: Compensated cirrhosis is the first stage of cirrhosis. People with compensated may experience few or no symptoms. The medical goal of people infected with chronic hepatitis C who have progressed to compensated cirrhosis is to treat it, and cure it
The patients were treated with interferon-based therapy and direct-acting antiviral therapies.
Conclusion: After a mean follow-up period of 58 months, 50.5% (668 patients) were cured. Being cured of hepatitis C was associated with decreased rate of liver cancer, and decreased progression to decompensated cirrhosis. Curing hepatitis C also lowered the risk of cardiovascular events (heart disease), and bacterial infections.
In the entire study, 175 patients or 13.5% died during the follow-up period—this means that there was an 88.6% 5-year survival. Ninety-one patients died of liver complications and 66 patients died of non-liver complications.
The study was able to confirm that being cured of chronic hepatitis C improved liver related health and importantly non-liver related health issues such as cardiovascular deaths.
Editorial Comments: This is a fairly large and encouraging study. Most people who were cured of hepatitis C had positive long-term outcomes. There is a need for more and larger studies with only direct-acting antiviral medications to fully understand the long-term benefits of curing people with hepatitis C.
Anecdotally, I hear from many people that they feel so much better physically, emotionally and spiritually after being cured that it feels like a second lease on life.
Article: Proton pump inhibitors as a risk factor for hepatic encephalopathy and spontaneous bacterial peritonitis in patients with cirrhosis with ascites by Alan Franciscus
Source: Source: Hepatology 2016;64:1265-1272
Editorial Comments: Proton pump inhibitors (PPIs) increase the risk for spontaneous bacterial peritonitis and hepatic encephalopathy. The authors suggest that these agents could promote an increase bacterial infections. Patients who have cirrhosis should talk with their medical provider to assess their risk of taking these medications.
Spontaneous bacterial peritonitis is an infection in the ascites fluid often caused by severe or advanced liver or kidney disease. Encephalopathy is caused when toxins build up in the brain and are also caused by advanced liver disease. These conditions can be life-threatening, but can also be medically managed if caught in time.
Examples of Proton Pump Inhibitors:
- omeprazole (Prilosec, Prilosec OTC)
- aspirin and omeprazole (Yosprala)
- lansoprazole (Prevacid, Prevacid IV, Prevacid 24-Hour)
- dexlansoprazole (Dexilent, Dexilent Solutab)
- rabeprazole (Aciphex, Aciphex Sprinkle)
- pantoprazole (Protonix)
- esomeprazole (Nexium, Nexium IV, Nexium 24 HR)
- esomeprazole magnesium/naproxen (Vimovo)
- omeprazole/sodium bicarbonate (Zegerid, Zegerid OTC)
Abstract: Proton pump inhibitors (PPIs) may be a risk factor for hepatic encephalopathy (HE) in patients with cirrhosis, possibly through translocation of gut bacteria, which can also lead to spontaneous bacterial peritonitis (SBP).
We examined the associations between PPIs and development of HE or SBP in patients with cirrhosis with ascites. We used data from three 1-year trials of satavaptan for ascites control. We used Cox regression to compare HE and SBP rates between users and nonusers of PPIs.
At inclusion, 39% of the 865 patients with cirrhosis with ascites used PPIs, 52% used them at some point during the follow-up, and the proportion of current users was always in the 30%-39% range. There were 189 first-time HE episodes during the follow-up, and the cumulative 1-year risk was 31% for those who used PPIs at baseline versus 25% for those who did not. The confounder-adjusted hazard ratio (HR) of HE for current PPI use versus current nonuse was 1.36 (95% confidence interval [CI], 1.01-1.84). The HR for overt HE was higher (adjusted HR = 1.88; 95% CI, 1.21-1.91). During the follow-up, 86 patients developed SBP. The adjusted HR of SBP for current PPI users versus nonusers was 1.72 (95% CI, 1.10-2.69).
Conclusion: PPIs were used by 52% of this international cirrhosis cohort during a 1-year period and was a risk factor for developing HE and SBP. These findings are consistent with the hypothesis that PPIs may increase translocation of gut bacteria. (Hepatology 2016;64:1265-1272)