RECOMMENDATIONSEMA Expands Review of New HCV DrugsNew Hep C Treatments Cause Adverse Effects in the ElderlyNew Treatments Not Enough to Eliminate Hepatitis CMy AlertsClick the topic below to receive emails when new articles are available.Add “Hepatitis C Virus (HCV)”RELATED DRUGS & DISEASESHepatitis CChronic Hepatitis C PathologyPediatric Hepatitis CIn this cohort, 237 patients were infected with hepatitis C genotype 1, 191 had received previous antiviral treatment, and 59 had been successfully treated for hepatocellular carcinoma.Contrast-enhanced ultrasonography and CT scans or MRIs were performed at baseline to exclude active hepatocellular carcinoma, and then again 12 and 24 weeks after treatment.During the follow-up period, 26 of the 344 patients (7.6%) were diagnosed with hepatocellular carcinoma. This included 17 of the 59 patients previously treated for hepatocellular carcinoma, and nine of the 285 patients (3.2%) with no history of carcinoma.There was no association between recurrence and hepatitis C genotype, direct-acting antiviral regimen, or treatment response for patients who did not develop hepatocellular carcinoma or for those who did. The sustained viral response rate at 12 weeks was 89% in the two groups.For patients with a history of hepatocellular carcinoma, those who developed a recurrence were significantly younger than those who did not (56 vs 73 years), were more frequently treatment-experienced (88.2% vs 61.9%), and had more advanced liver fibrosis at baseline.More patients who developed hepatocellular carcinoma during the follow-up period, regardless of history, had advanced cirrhosis than those who did not, indicated by a Child-Pugh class B score (26.9% vs 10.1%; P =.02). They also had more liver stiffness, indicated by a measure above 21.3 Kpa (61.5% vs 31.8%; P = .005), and fewer platelets at baseline (102.3 vs 124.4 × 1000/mm³; P = .02).Second StudyIn the Spanish study, all 58 hepatitis C patients had a history of hepatocellular carcinoma (with complete radiologic response), and all but three were cirrhotic at the start of direct-acting antiviral therapy. After a median follow-up of 5.7 months, the rate of tumor recurrence was 27.6%, with a median time to recurrence of 3.5 months. The sustained viral response rate at 12 weeks was 97.5%.In their publication, the Spanish authors note that these findings “raise a concern about the benefits” of direct-acting antiviral therapy in the subgroup of hepatitis C patients with a history of hepatocellular carcinoma. Although the therapies “offer a major hope for current and future patients, we may face a drawback that may change these predictions in specific groups of patients,” they point out.Dr Brillanti said he is less concerned. “Clones of the hepatocellular carcinoma were present before the therapy,” he pointed out, suggesting that direct-acting antivirals simply accelerated their inevitable progression. Either way, he said, an increased risk for hepatocellular carcinoma should not deter clinicians or patients from pursuing treatment with direct-acting antivirals when it is needed.”This is a different cancer than elsewhere in oncology — it is a cancer within an advanced chronic disease — so the prognosis, the life expectancy, is related not only to the liver cancer but also to the liver disease and liver function,” he explained. “If you don’t treat these patients and ameliorate their liver function, and if hepatocellular carcinoma occurs, you have no chance of curing them. But if you ameliorate liver function and they develop hepatocellular carcinoma, you can cure it better because their improved liver function will allow an ablation.”This finding is “quite striking and unexpected, but we have to be cautious,” said Laurent Castera, MD, PhD, from Hôpital Beaujon in Clichy, France, who is vice-secretary of the European Association for the Study of the Liver, and was not involved with the research.”It is potentially worrying, but these are retrospective studies, with possible referral bias, and no long-term follow-up,” he told Medscape Medical News.Dr Brillanti reports receiving research grants from Gilead Sciences and being on the advisory board for Janssen and Gilead Sciences. Dr Castera reports serving on the speaker’s bureau for Echosens.International Liver Congress (ILC) 2016: Abstract LBP506. Presented April 14, 2016.
People treated for hepatitis C have unexpectedly high rate of liver cancer recurrenceLiz HighleymanProduced in collaboration with hivandhepatitis.comPublished: 29 April 2016Hepatitis C patients with cirrhosis who were treated with direct-acting antivirals had about twice the expected likelihood of developing hepatocellular carcinoma (HCC), with the excess risk seen in people with a previous history of HCC, according to research presented at the recent 2016 International Liver Congress in Barcelona. These findings underline the importance of ongoing liver cancer monitoring even after successful hepatitis C treatment.The advent of interferon-free direct-acting antiviral (DAA) therapy has brought about a revolution in hepatitis C treatment, with more than 90% of patients achieving a cure. As with interferon-based therapy, sustained virological response (SVR) to DAA treatment – or permanent clearance of hepatitis C virus (HCV) – is expected to slow liver disease progression and reduce the chances of adverse outcomes such as liver cancer or decompensation, but some risk remains even after the virus is eradicated. Most HCC occurs in people who have developed cirrhosis or scarring of the liver, which can result from chronic viral hepatitis, heavy alcohol use or other causes.Federica Buonfiglioli and Stefano Brillanti of the University of Bologna and colleagues analysed a cohort of hepatitis C patients with cirrhosis treated with DAAs at a referral centre in Italy between March and November 2015.The study included 344 HIV-negative participants with hepatitis C-related cirrhosis. A majority (60%) were men and the median age was 63 years. The most common HCV genotype was 1 (69%) and 55% had experienced previous treatment failure using pegylated interferon and ribavirin.Participants had Child-Pugh class A or B cirrhosis. Child-Pugh scores are used to assess liver disease prognosis; class A indicates well-preserved liver function, class B indicates significant functional impairment and class C indicates decompensation.Participants were treated with interferon-free DAA regimens including:Sofosbuvir (Sovaldi) + simeprevir (Olysio): 34%Ombitasvir/paritaprevir/ritonavir/dasabuvir (Viekirax/Exviera): 22%Sofosbuvir + ribavirin: 17%Sofosbuvir + daclatasvir (Daklinza): 16%Sofosbuvir/ledipasvir (Harvoni): 10%At the start of the study participants did not have active liver cancer. However, 17% had a history of prior HCC treated with chemoembolisation or radiation and had magnetic resonance imaging (MRI) or computed tomography (CT) scans showing no evidence of active tumours. Occurrence of HCC during the 24-week post-treatment follow-up period was assessed by ultrasonography and confirmed with MRI or CT scans.At 12 weeks post-treatment, 89% of patients achieved SVR12, which is considered a cure.Overall, active HCC was detected in 26 patients (7.6%) between the end of treatment and 24 weeks of follow-up, 22 of whom had achieved SVR. Most (81%) had only a single detectable HCC nodule, but five people had multiple nodules.Liver cancer developed in 17 (29%) of the 59 patients with a history of previous HCC. However, among participants with no prior history of HCC, just nine patients or 3.2% developed new HCC – not much higher than the expected rate.Among the patients with HCC the median age was 58 years – younger than the study population as a whole – and more than twice as many were men. People with Child-Pugh class B were significantly more likely to develop HCC (although the numerical majority of those who developed HCC were class A). HCC was also associated with greater liver stiffness according to FibroScan and lower platelet counts. However, there was no difference in HCC occurrence or recurrence according to HCV genotype or specific DAA regimen.At the time HCC was detected only two patients (8%) had elevated levels of alpha-fetoprotein (AFP), a biomarker often measured to monitor for HCC.”In this large retrospective cohort study on cirrhotic patients treated with DAAs, we observed a high rate of HCC recurrence and a standard rate of HCC [first time] occurrence in a relatively short follow-up observation,” the researchers concluded. “Development of HCC was rarely associated with increase in AFP levels.””In cirrhotic patients treated with DAAs, development of HCC represents a significant clinical problem, despite a high rate of SVR,” the researchers concluded. “This seems particularly true [of] those patients with a history of previous HCC, in whom a surprisingly high rate of HCC recurrence was observed, over a relatively short period of time.””We believe our findings justify close monitoring for all cirrhotic patients on such treatments,” Dr Buonfiglioli said in an EASL press release.EASL secretary general Prof Laurent Castera noted that a higher than expected rate of HCC recurrence was also seen in a recent Spanish study published online in the current edition of Journal of Hepatology.That study, by Dr Jordi Bruix of Hospital
AND THEY WONDER WHY I AM HESITANT.
BARCELONA, Spain — In a surprising number of patients with hepatitis C and cirrhosis, hepatocellular carcinoma develops within weeks of starting treatment with direct-acting antivirals, new research suggests.”I do not think that direct-acting antivirals are directly responsible,” said lead investigator Stefano Brillanti, MD, from the University of Bologna, Italy.”The hypothesis is that immune surveillance may be reduced too rapidly,” he told Medscape Medical News. “You have an immediate drop in viremia, but also attenuation of inflammation. I think inflammation is a bad thing in terms of hepatitis progression, but it may be a good thing in terms of controlling cancer.”
Welcome to the HCV AdvocateAUGUST 28, 2015 BY ALAN FRANCISCUSWelcome to the HCV Advocate website.Welcome! If you are new to our Website or the latest design I hope that your experience will be a productive one. The purpose of this introduction is to acquaint you with some of the features of the website.If you are looking for specific information, you may want to start at the Google search engine located at the right of the page (bottom of the page on mobile and tablets).The top bar has a list of the pages:Home: This will always take you back here, to our Home page. Under this tab, we have information About Us, a Site Map, and a form you can use to Contact Us.Newly Diagnosed: Information and a printable brochure to help newly diagnosed patientsTreatment Issues: Treatment-related information: fact sheets about approved medications, side effects, and moreFact Sheets: This lists all of our fact sheets including our Easy C Facts, HCSP Fact Sheets, FAQ, Guides, Coinfection Facts, Chinese Easy C’s, and TattoosResources: Disability Benefits, Glossaries (Medical & Herbal), Helpful links including support groupsEspanol: Fact Sheets in SpanishHBV: A web page dedicated to hepatitis BNewsletter: All of our newsletters back to 2013I hope this information is helpful. If you have any questions or concerns, click here to contact us.Alan
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Gilead Sciences’ Harvoni (ledipasvir/sofosbuvir) is safe and effective in treating hepatitis C virus (HCV) among individuals age 65 and up, Reuters Health reports. Publishing their findings in the journal Hepatology, researchers analyzed data on 2,293 people with hep C enrolled in four Phase III trials of Harvoni. Twelve percent (264) of the participants were age 65 or older. Among this group, 24 were age 75 or older. Ninety-seven percent (1,965 of 2,029) of those under age 65 achieved a sustained virologic response 12 weeks after completing therapy (SVR12, considered a cure), as did 98 percent (258 of 264) of those age 65 and up. The most common adverse health issues in both the older and younger age groups, experienced by at least 10 percent of participants, were headache and fatigue. The rates of individuals stopping treatment because of apparent side effects was similar in the two age groups. Forty-five percent (1,042) of the participants were also treated with ribavirin, which increased the number of adverse health issues, treatment-related adverse health issues, and such health problems that led to a modification or termination of treatment. These effects were pronounced among elderly individuals. Ribavirin did not increase the cure rate among the participants.
In Australia it is estimated that more than 230,000 patients were living with chronic hepatitis C in 2012 yet less than 2% were receiving treatment.For many patients disclosing that they have hepatitis C it is not easy and so they may not have told you, or their family or friendsThere may be a number of your customers who have chronic hepatitis C infection, but you won’t necessarily know who they are.
While there isn’t a specific diet to benefit everyone with hepatitis C, a healthy diet full of fruits and vegetables is certainly a healthy option for everyone. Those with hepatitis C are at an increased risk for fatty liver disease and type 2 diabetes, suggesting that some alterations to diet may be beneficial. Here is a breakdown of the best foods to incorporate into your hepatitis C nutrition plan as well as some tips for foods to avoid.