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).
- 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 case-by-case basis.
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.
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 cirrhosis results.
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 previously reported.
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.
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).
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.