—Lucinda K. Porter, RN
Article: The Relationship of Hepatitis C Virus Infection with Diabetes in the United States Population – Constance E. Ruhl, et al.
Source: Hepatology Pre-published accepted manuscript posted Feb 5, 2014 doi: 10.1002/hep.27047
Since the discovery of the
hepatitis C virus (HCV) in 1989, risk of type 2 diabetes has been
linked to HCV infection. HCV and diabetes are common conditions in the
U.S., and researchers studied the relationship between the two, using
recent data from the U.S. National Health and Nutrition Examination
Survey from 15,128 adults.
The Bottom Line:
HCV was not associated with diabetes or insulin resistance. Since
elevated liver enzymes are linked to type 2 diabetes, these researchers
suggest this as a possible explanation for previously reported
connections between diabetes and HCV.
It is disconcerting to learn that a closely held piece of knowledge is
not true. Medical professionals are human, and thus just as likely to
find change difficult. It may take more research and time before this
long-held “fact” is laid to rest.
Fibrosis Progression at Autopsy in Injecting Drug Users Infected by
Hepatitis C: A Longitudinal Long-Term Cohort Study – Knut Boe Kielland,
Source: Journal of Hepatology February 2014; Volume 60, Issue 2, Pages 260-266
The purpose of this Norwegian
study was to evaluate liver fibrosis levels of deceased HCV+ injection
drug users (IDUs). Using stored blood samples from IDUs who were
treated for chemical dependency from 1970–1984, 220 deceased subjects
were identified. Liver tissue was available from the autopsies of 102
subjects, of which 61 were HCV RNA+. Researchers used a 0 to 4-fibrosis
scale, with 4 being cirrhosis.
16.4% of HCV RNA+ subjects had
stage 3 fibrosis or cirrhosis compared to 2.4% of subjects who were
positive for HCV-antibody but negative for HCV RNA. Of 18 HCV RNA+
subjects autopsied less than 15years after HCV exposure, none had
fibrosis stage 3 or 4. Those exposed to HCV more than 25 years had a
35% risk of stage 3–4. The main cause of death was drug-related; death
from liver disease occurred in less than 5%.
The Bottom Line: One in three Norwegian IDUs with chronic HCV developed stage 3 fibrosis or cirrhosis 25years or more after exposure.
Editorial Comment: Although
I am grateful for the information gained by this study, participants
did not give direct consent. I wonder if consent would have been more
rigorously obtained if the subjects were not IDUs.
Eltrombopag Increases Platelet Numbers in Thrombocytopenic Patients
with HCV Infection and Cirrhosis, Allowing for Effective Antiviral
Therapy – Nezam H. Afdahl, et al.
Source: Gastroenterology February 2014;146:442–452
Low platelets (thrombocytopenia)
are a common occurrence in HCV patients who have advanced fibrosis or
cirrhosis. Since pegylated interferon-alfa (PEG) causes platelets to
drop, PEG and ribavirin (RBV) therapy may be limited, delayed, or not
initiated. Eltrombopag is a drug used to stimulate platelet growth, and
this phase 3 study compared eltrombopag to placebo in its effect on
sustained virologic response (SVR) 24 weeks after completion of PEG/RBV
The Bottom Line: Eltrombopag increased platelet count in thrombocytopenic HCV patients and significantly increased SVR rates.
Aviva Leber and Jordan J. Feld of the University of Toronto wrote an
editorial questioning this study’s findings, highlighting the risks of
eltrombopag (thromboembolic events, such as stroke). Leber and Feld
advise that eltrombopag be used only when the benefits outweigh the
risks, and to start the drug at the lowest dose.
Interventions Using Electronic Medical Records Improves Follow Up of
Infants Born to Hepatitis C Virus Infected Mothers – Nazha Abughali, et
Source: Pediatric Infectious Disease Journal Pre-published accepted manuscript Jan 7, 2014 doi: 10.1097/INF.0000000000000129
This two-part study examined
medical records of all infants born to mothers with HCV from 1993—2005.
Despite recommendations from the American Academy of Pediatrics to
test all HCV-exposed infants at 18 months or older for HCV antibody,
the majority were not tested. The second part of the study examined the
medical records of infants born to mothers with HCV after the
implementation of electronic medical records from 2006—2011. Of the
67,112 infants born during the study period at this Cleveland, Ohio
hospital, 280 had maternal HCV infection.
The Bottom Line:
The use of electronic medical records resulted in a significant
improvement of appropriate HCV testing among HCV exposed infants from
8% to 50%.
Editorial Comment: It is interesting that such a simple use of technology can yield such significant results.
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