Hepatitis C virus (HCV) transmission from mothers to babies could largely be prevented if Canada recommended universal screening for HCV in pregnancy, argues a commentary in CMAJ (Canadian Medical Association Journal).
“We encourage all care providers to consider the reproductive implications of HCV, to consider HCV screening in pregnancy and referral for treatment of HCV,” write Drs. Chelsea Elwood, Department of Obstetrics and Gynaecology, University of British Columbia, and Laura Sauve, BC Children’s Hospital, University of British Columbia, Vancouver, BC. “The time has come to move toward universal HCV screening in women who are pregnant, with initial prenatal investigations that are then repeated based on risk factors in the third trimester.”
Almost half of women infected with HCV are unaware of their infection, and current treatment with direct-acting antiviral regimens is quite effective.
Although not currently licensed for patients undergoing dialysis for severe renal impairment, researchers found that treatment with Epclusa for hepatitis C was safe and effective in patients with end-stage renal disease.
“Chronic HCV infection has a significant negative impact on morbidity and mortality in patients undergoing dialysis,” Sergio M. Borgia, MD, FRCPC, from Brampton Civic Hospital in Ontario, Canada, and colleagues wrote. “HCV-infected patients with [chronic kidney disease (CKD)] have an accelerated rate of loss of kidney function, risk of progression to end-stage renal disease (ESRD), and increased risk of all-cause mortality when undergoing dialysis.”
Borgia and colleagues enrolled 59 patients with HCV and ESRD to undergo 12 weeks of treatment with Epclusa (sofosbuvir/velpatasvir, Gilead Sciences). Most were treatment-naive (78%), 92% were undergoing hemodialysis for a mean duration of 7 years (range, 0-40 years), and 8% were undergoing peritoneal dialysis.
Continued efforts are needed to aggressively screen, diagnose, and treat hepatocellular carcinoma (HCC) because patients with chronic hepatitis C and HCC may be less likely to achieve cure status than those without HCC, according to a systematic review and meta-analysis published in the Journal of Hepatology.1
Studies have demonstrated that antiviral therapy in patients with hepatitis B-related HCC can significantly reduce overall long-term mortality, even in patients with very advanced HCC or decompensated cirrhosis.2-5 Questions remain, however, about the effect of HCC on response to interferon-free direct-acting antiviral (DAA) therapy for patients with chronic hepatitis C compared with those without HCC.1 Therefore, researchers investigated the effect of DAA therapy on sustained virologic response (SVR) among 3341 patients with chronic hepatitis C and HCC and 35,701 patients with chronic hepatitis C but without HCC from 49 studies conducted in 15 countries. Overall, they found that SVR rates were lower in patients having chronic hepatitis C with HCC compared with patients diagnosed with chronic hepatitis C without HCC (89.6% vs 93.3%, P=.0012), which indicated a 4.8% SVR reduction. However, the largest SVR reduction (18.8%) occurred in patients with active/residual HCC compared with inactive/ablated HCC. Patients with HCC who had a prior liver transplant also had a higher SVR compared with patients with HCC who had not had a liver transplant (P <.001).
Adults in the US who have an hepatitis B (HBV) or hepatitis C (HCV) infection are often completely unaware, according to a new study.
An analysis of nearly 15,000 adult participants, including serologic data, showed that up to 1 half of virus-infected persons have never received a diagnosis from their physician. Investigators, led by Norah Terrault, MD, Chief of Gastroenterology & Hepatology at the USC Keck School of Medicine, noted the findings evidence the real-practice effects of a largely asymptomatic disease such as viral hepatitis.
“It can be sort of silent,” Terrault told MD Magazine®. “You can’t wait for patients to either present with symptoms or have a lab test come back abnormal. You have to screen based on risk profiles and/or age and/or just screening.”
Note: This is one of the clinical studies that I was proud to participate on the Patient Advisory Board. – Alan
In real-world clinical practice, heterogeneous patient experiences occur during and after direct acting antiviral (DAA) therapy, and symptom improvement is often more pronounced in younger patients, according to a multicenter observational study published in the Journal of Hepatology.1
Patients with hepatitis C virus (HCV) infection often report various symptoms such as neuropsychiatric, somatic, and gastrointestinal symptoms that they attribute to the virus infection.2-4 Studies have demonstrated that health-related quality of life and other patient-reported outcomes improve during DAA therapy,5-7 but a comprehensive analysis of changes in symptoms and functioning during and after DAA therapy for chronic HCV has not been conducted for patients treated in real-world clinical settings. Therefore, researchers in the United States evaluated patient-reported outcomes in a diverse cohort of 1564 patients with HCV treated with commonly-prescribed DAAs (63% were prescribed sofosbuvir/ledipasvir; 21%, sofosbuvir/velpatasvir; 11%, grazoprevir/elbasvir; and 5%, paritaprevir/ombitasvir/ritonavir+dasabuvir).1 Overall, they found that these patients did not experience significant changes in baseline symptoms during treatment. However, they observed a full range of experiences, with some patients experiencing substantial symptom improvement, others experiencing less improvement, and some even experiencing a worsening of symptoms. Of these patients, 1346 were cured of HCV and experienced improvements in fatigue, sleep disturbance, and functional well-being and trends for improvement in pain and depression. However, 64 patients were not cured and experienced minimal improvement.
Nearly one-third of patients coinfected with human immunodeficiency virus (HIV) and hepatitis C virus(HCV) are affected by hepatic steatosis (HS), according to study results published in AIDS Patient Care and STDs.1
Because of shared routes of transmission, HIV/HCV coinfection is common and is associated with more rapid progression toward severe liver disease compared with patients who are infected with HCV alone.2,3 In addition, HS appears to be more prevalent in patients coinfected with HIV/HCV than patients monoinfected with HCV.4 Thus, HIV-induced metabolic abnormalities and antiretroviral therapy (ART), genetic factors, as well as HCV coinfection may all cause HS.1 However, recent studies suggest a protective effect of HCV infection on HS as well as faster progression of HS and liver fibrosis in HIV-infected patients who are not coinfected with HCV.5,6 These discrepant data caused researchers to evaluate HS prior and after HCV eradication in an HIV/HCV-coinfected cohort of 247 patients at the Medical University of Vienna between January 2014 and June 2017. They found that HS was prevalent in 31% of patients, and that independent risk factors for HS were body mass index, year exposed to HIV, patatin like phospholipase domain containing 3 gene alleles, and protease inhibitor (PI) intake. They also observed a significant increase in controlled attenuation parameter (CAP) after HCV eradication, while patients on PI-containing ART experienced a significant decrease in CAP.
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: A report from the Institute for Safe Medication Practices based on FDA data and observations from a Kaiser Permanente physician leader raised questions about whether direct acting antiviral medications for the treatment of Hepatitis C posed any significant safety risks for patients. Since the decision to take medications requires making tradeoffs between benefits (which had been clearly established in clinical trials) and risks (which are often harder to ascertain until drugs are in widespread use in the real world) we decided this was an important question to pursue. We found no evidence of increased risks of significant side effects associated with taking these drugs. In this cohort study of 33,808 patients in three large health systems we found lower adjusted odds of experiencing the following adverse events: death, multiple organ failure, hepatic decompensation, acute-on-chronic liver event, and arrhythmia.
MedicalResearch.com: What should readers take away from your report?
Scientists from Trinity College Dublin have discovered how the highly infectious and sometimes deadly Hepatitis C virus (HCV) “ghosts” our immune system and remains undiagnosed in many people. They report their findings today [Wednesday June 5th] in the international FASEB journal.
HCV’s main route of transmission is via infected blood but over the past 40 years it has accidentally been given to many patients across the world via infected blood products. The virus replicates particularly well in the liver, and the damage it causes makes it a leading cause of liver disease worldwide.
Even though HCV can be deadly, initial infection is rarely accompanied by any obvious clinical symptoms for reasons that have – until now – remained unknown. As a result, it often goes undiagnosed for the first 6-12 months following infection.