Source: Curr Opin Pediatr. 2015 Jul 18. [Epub ahead of print]
The main focus of the abstract was when to initiate
treatment and when it is safe to wait for approval of the new highly
effective direct-acting antiviral therapies to treat hepatitis C (HCV).
standard of care to treat children with hepatitis C. There are
pediatric clinical trials of sofosbuvir/ledipasvir, ribavirin, and
Vieikira Pak, with and without ribavirin. Approval of these drugs is
expected in the near future.
- Wait: Children generally have a slow disease
progression so in most cases it is safe to wait for the interferon- and
ribavirin-free medications to be approved.
- Treat: In the case of children who do have
serious disease progression treatment now is warranted. Genotype
information should be factored into the treatment decision process since
genotype 2 and 3 cure rates are higher and treatment durations are
shorter with pegylated interferon and ribavirin combination therapy.
All children with HCV should be monitored on a regular
basis. Any treatment decisions for children should be evaluated on a
The general consensus is to wait (if possible) until the
interferon- and ribavirin- free therapies are available. However, there
is a small percentage of children with HCV who progress on to serious
liver disease very quickly—this is why it is so important to identify
and monitor children on a regular basis.
are approved to treat children with HCV. Will insurance companies be
as restrictive as they are with adults? Hopefully not! But if they
are it just might be enough to raise the level of public ire to demand
that they cover the medications for everyone. It might also be enough
that the public finally demand that the prices come down so that
everyone affected by hepatitis C can afford the medications.
of Cirrhosis in Hepatitis C Patients in the Chronic Hepatitis Cohort
Study (CHeCS): A Retrospective and Prospective Observational Study—S C
Gordon et. al
Source: Am J Gastroenterol. 2015 Jul 28. doi: 10.1038/ajg.2015.203. [Epub ahead of print]
In the Chronic Hepatitis Cohort Study (CHeCS) there were 9,783
patients, 2,788 (28.5%) were cirrhotic by at least one method. Biopsy
identified cirrhosis in only 661 (7%). Other parameters, such as the
International Classification of Disease, Ninth Revision, Clinical
Modification (ICD-9-CM) were not assigned to the biopsy proven
The authors noted that the since the ICD-9 codes may not be
the best codes to indicate the prevalence of cirrhosis and that there
may be a ‘fourfold’ higher prevalence of cirrhosis in studies
This is an important study. We need to understand the true
prevalence of cirrhosis in this country. It will help to push for
better funding and making sure that people are treated sooner rather
than waiting until people become sick.
Associated with Subclinical Coronary Atherosclerosis in the Multicenter
AIDS Cohort Study (MACS): a Cross-Sectional Study—RA McKibben
Source: J Infect Dis. 2015 Jul 27. pii: jiv396. [Epub ahead of print]
Eighty-seven men with chronic hepatitis C were evaluated for the risk of cardiovascular disease (CVD).
non-contrast coronary CT and CT angiography and evaluated the
associations of CHC with measures of plaque (substances that lead to
hardening of the veins/arteries), prevalence, extent, and stenosis
(narrowing of the veins). It was found that all types of plaques were
significantly higher in men with chronic hepatitis C.
This is not the first study that has shown that there are
cardiovascular problems associated with hepatitis C. But it is
important to remember that this is a small study. It also needs to be
replicated in a larger patient population and in women with HCV.
As we come to understand more and more about hepatitis C it becomes
clear how much damage hepatitis C causes to many organs outside of the
liver. Everyone with hepatitis C needs to be monitored on a regular
basis. In this case men and women need to be monitored for
cardiovascular disease. This is another reason why people with
hepatitis C should be treated before these types of health issues are
allowed to begin.