Abstract: #1588 Hepatitis C Infection in Pregnant American Indian and Alaska Native Women; 2011-2015 – Leisha Nolen, et al., By Lucinda Porter, RN
Recent data show an increasing number of younger HCV-infected individuals, presumably due to the opioid epidemic. Because HCV can be transmitted vertically during pregnancy, this study assessed the HCV infection rate in pregnant American Indian and Alaska Native (AI/AN) women from 2011 through 2015.
They found that between 2013 and 2015, more than 12% of non-Native women and nearly 17% of AI/AN women of reproductive age self-reported ever having been tested for HCV. The percentage of pregnant women who were known to have HCV infection increased between 2011 and 2015 in both the AI/AN population (0.57% to 1.19%) and the non-Native population (0.21% to 0.36%,).
Conclusion: This study found a significant increase in the proportion of pregnant AI/AN and non-Native women with known HCV infection between 2011 and 2015. Only a small percentage of women reported having ever been screened, raising the possibility that the true prevalence of infection is higher. The majority of women with HCV did not have medically documented history of injection drug use. The researchers state that the data suggest reassessing risk-based HCV testing and prevention programs in high-risk pregnant AI/AN women.
Editorial Comments: Universal HCV testing of all pregnant women is an economic and logical alternative to risk-based HCV testing. The cost-effectiveness of this strategy was reported in another presentation: #87 Hepatitis C Virus Risk-Based Vs. Universal Screening Among Pregnant Women: Implementation and Cost-Effectiveness Analysis – Michelle Rose, et al.
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.
SAN DIEGO (CNS) – A newly formed steering committee is working to drastically reduce the number of hepatitis C cases in San Diego County, it was announced Monday.
The county’s Health and Human Services Agency and the American Liver Foundation-Pacific Coast Division oversee the Eliminate Hepatitis C San Diego County Initiative steering committee, which also includes members of the public and private medical communities. The aim is to reduce new hepatitis C infections in the county by 80 percent and deaths by 65 percent by 2030.
“By joining forces and strengthening our local efforts, we expect to eliminate this curable disease as a public health threat and improve longevity and quality of life for people living with hepatitis C,” said Dr. Wilma Wooten, the county’s public health officer.
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.
Title: Abstract: #490 1-Hour Recovery Time in Subjects Undergoing Percutaneous Liver Biopsy: A Quality Improvement and Patient Safety Project – Amilcar L. Morales-Cardona, et al. By Lucinda Porter, RN
Liver biopsy is an important diagnostic tool used to evaluate the condition of the liver. There are no universal guidelines on recovery times following percutaneous biopsy. Using a consistent liver biopsy protocol and follow-up procedure, these researchers evaluated recovery times after 456 liver biopsies were performed.
Less than 8% of subjects reported a pain level above 5 on a 0-10 scale; 13% required post-procedure pain medications. There were three serious complications: two cases of hemorrhage and one pneumothorax. There were no deaths. All complications were detected during the 1-hour recovery time. Nearly 80% of subjects were discharged in less than 90 minutes post-procedure, and 50% of subjects were discharged 1-hour post intervention. Overall complication rate after 24 hours was less than 1%. There were no mortalities.
Conclusion: Following a liver biopsy, a 1-hour recovery time appears to be adequate to identify major complications and shorten post procedure stay.
Editorial Comments: I’ve had 5 liver biopsies, all requiring a 6-hour stay following the very brief procedure. One-hour biopsies seems like a vast improvement.
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.
Advocates Scandalized That Gilead’s Hepatitis C Profit Have Raked in US$25.8 Billion, Which Could Have Treated Everyone While Still Earning Us$16 Billion in Profits – From Treatment Action Group
People living with hepatitis C, access to medicines activists, and the medical community around the world “mark” the fifth birthday of the first all-oral, one dose per day cure sofosbuvir (Sovaldi®), launched by Gilead Sciences. A global hepatitis C coalition has released a fact sheet revealing treatment barriers that resulted in only 1.85 million of the 71 million people worldwide who need treatment, receiving Gilead’s sofosbuvir-based drugs, largely due to pricing, patents and registration delays.
Since 2013, Gilead reaped US$58.6 billion in hepatitis C product sales, of which 25.8 billion are estimated profit1, with a fraction of these earnings invested in research and development. Instead, in 2017 alone, Gilead spent US$14.8 billion rewarding shareholders. This amount is more than sufficient to treat everyone with chronic hepatitis C with generic versions.
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.