Hepatitis C Blog

AASLD 2018

Abstract: #1582 Chronic Hepatitis C and Autoimmune Hepatitis Overlap Syndrome: Fact or Fiction? – Juan Putra, et al. By Lucinda Porter, RN

In addition to having hepatitis C, some patients are also diagnosed with autoimmune hepatitis (AIH), leading to a diagnosis of overlap syndrome (HCV-AIH). Not only is this an uncommon diagnosis, it is controversial since both diseases share common features. This study evaluated biopsies from 2011 to 2018 of 5 patients with HCV-AIH who were treated with direct-acting antiviral agents (DAAs).

Conclusion: Even without immunosuppression, most patients showed improvement in liver tissue following DAA treatment. Researchers state that the results suggest that the autoimmune component is a secondary phenomenon of HCV. They recommended using the term “HCV with autoimmune features” instead of HCV-AIH to prevent overtreatment with immunosuppressants.

Editorial Comments: Although this is a very small study, it opens the door wider to examining the role of HCV on the immune system, particularly when autoimmune features appear to be present.

Pharmaceutical companies make obscene profits from life-saving drugs – we need to change the system to prioritise human life over profiteering, writes Lynn Ruane.

DR KIERAN HARKIN recently made me aware of a group he is a member of called Access to Medicines Ireland – their objective is to ensure that new medicines are developed for the benefit of public health, rather than private gain.

The current system permits the inventor of a new drug to charge whatever price they believe the market will bear.  Drugs used to treat hepatitis C are a good example of the problem created for society by this system.

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AASLD 2018

Title: Abstract: #203 Chronic Hepatitis C Infection Elicits a Poly-Functional T Cell Immune Response at the Maternal/Fetal Interface to Limit Vertical Transmission – Matthew A. Burchill, et al. By Lucinda Porter, RN

Approximately one to three percent of pregnant women in the US are infected with HCV. Despite this, the rate of vertical transmission between mother and fetus is quite low at four to eight percent. Researchers wanted to know why.

Conclusion: Looking at mother-child pairs with and without HCV, they found an aspect of fetal immunity by identifying HCV-specific T cells at the maternal/fetal interface. Further, the T cell responses at the maternal/fetal interface are highly active in patients with active HCV infection. Researchers speculated as to whether in the future this understanding can lead to reduced transmission rates of not only HCV, but also of hepatitis B.

Editorial Comments: This is very exciting. Few things break my heart more than hearing about women who learn that their child has hepatitis C because of vertical transmission.

AASLD 2018

Title: #202 HCV-RNA Is Readily Detectable in Nasal and Rectal Fluids of Patients with High Viremia – David Chromy, et al.  By Lucinda Porter, RN

The purpose of this research was to better understand the mechanisms of HCV transmission among men who have sex with men (MSM). This prospective study enrolled 34 subjects with acute or chronic HCV infection. Researchers analyzed HCV RNA (viral load) obtained from rectal and nasal swabs from all participants. Fecal occult blood tests were performed to rule out rectal bleeding. Participants completed questionnaires to assess risk behavior related to recreational drug use and sexual practices.

Here are the results: The mean age of participants was 43 years; all but one were HIV-positive; 82% were male of whom 64% were MSM. Acute HCV was observed in 32% (11/34) with all subjects being HIV+MSM. Twenty-three (68%) patients had at least one positive swab sample (56% nasal and 52% rectal), whereas blood contamination was never detected. Individuals with positive swab samples had significantly higher HCV-RNA levels vs. those with negative swab samples.

Conclusion: Despite the absence of blood, HCV-RNA is readily detectable in rectal and nasal fluids in patients with acute and/or chronic hepatitis C. This suggests that unprotected anal intercourse and sharing of drugs via nasal route may be high-risk practices for HCV transmission, especially in patients with high HCV viral levels.

Editorial Comments:  First, this is a small study. Second, we need more studies like this. Third, this research has the potential to shed light on transmission routes for which we need more information.